Fatty Liver

The liver is our largest internal organ and our body's workhorse. It participates in multiple important tasks: converting food into energy, processing fat from blood, clearing harmful toxins, and making proteins that help our blood clot. However, this hard-working organ is susceptible to a dangerous and often hard-to-diagnose condition called nonalcoholic fatty liver disease, or NAFLD.

NAFLD is the presence of fat in more than 5% of liver cells. It is the most common liver disease and affects up to 25% of American adults, 60% of whom are men.

The disease raises the risk of heart disease and left untreated, NAFLD also can lead to an inflamed liver, a condition called nonalcoholic steatohepatitis (NASH). Distinguishing between NALFD and NASH is essential. 40% of people with NAFLD develop NASH. NASH can lead to scarring of the liver; severe scarring, called cirrhosis, increases the risk of liver cancer. NASH and alcoholic liver disease (ALD) have overtaken hepatitis C as the most common causes of advanced liver disease among people awaiting liver transplants in the USA.

CAUSES

With the explosion of the obesity epidemic, the prevalence of NAFLD is rising exponentially. The liver is the first organ to metabolize the foods we eat. Eating a lot of high-sugar, high saturated-fat foods can lead to fatty liver disease. Although drinking too much alcohol can cause fat buildup in the liver, NAFLD affects people who consume little or no alcohol. Instead, the main offender is

• excess weight — causing extra fat to get stored in the liver

• abnormal cholesterol (abnormally high LDL cholesterol levels, low HDL levels, or both)

• high blood pressure

• diabetes.

• consumption of highly processed food

• high carbohydrate (simple sugars, high fructose corn syrup) intake

• high saturated fat and trans fat intake

• high animal protein (red meat) intake

• low fiber intake

• sedentary lifestyle

• some medications

• genetic / inherited: some people with fatty livers have none of the above risk factors, which suggests that genes can play an important role.

 DETECTION

NAFLD is difficult to detect as it usually silent without any symptoms. However, NAFLD is sometimes associated with fatigue, weakness, loss of appetite, nausea, weight loss, and abdominal pain. NAFLD is suspected when a blood test reveals elevated liver enzymes. Usually, diagnosis becomes clear after ruling out other causes, such as viral or drug-induced hepatitis. However, a definite diagnosis requires a liver biopsy — an outpatient procedure in which a needle is inserted into the right side of the abdomen to extract a small piece of liver tissue.

 TREATMENT

Although currently, no drug treatment is available, it's possible to stop further liver damage and even reverse NAFLD's effects if addressed early enough. Treating underlying conditions - abnormal cholesterol, diabetes mellitus, obesity, is the most effective way of reducing or preventing further fatty buildup in the liver. The best way to do that is by weight loss and proper exercise and meal planning.

Sugar (carbohydrates) can be a sweet poison for the liver. A study published online Oct. 17, 2017, by Clinical Science found that when healthy men with a low level of liver fat consumed at least 650 calories from sugar daily for 12 weeks, not only increased their liver

Fat but also showed changes in their fat metabolism associated with a higher risk of cardiovascular disease and stroke. The most significant risk for people with a fatty liver is still cardiovascular disease. 

PREVENTION

NAFLD is preventable. A recent study found that cardiovascular exercise lowers elevated liver enzyme levels in people with NAFLD. While any cardio activity helps, the researchers cited 90 minutes of brisk walking, or 30-45 minute cycling sessions three times a week, as beneficial.

The dietary recommendations for NAFLD are similar to weight loss and maintenance. For example, follow a plant-based diet like the Mediterranean or DASH diets, and refrain from alcohol — or at least limit your daily intake to 20 to 30 grams (about an average glass of beer or a small glass of wine).

Limit added sugar to no more than 6 (24g) teaspoons for women and 9(36g) teaspoons for men each day. Limit foods with any added sugars, which go by many names, including high-fructose corn syrup, sucrose, honey, turbinado sugar, dextrose, evaporated cane juice, and concentrated fruit juice. High fructose corn syrup is found in juice, soda, sports drinks, sweet tea, breakfast cereal, yogurt, salad dressing, nutrition bars, bread, protein bars, ketchup, jams, jellies, syrups.

Limit intake of fats. Avoid trans fats ( commercially baked goods such as cookies and cakes), fried foods ( doughnuts, French fries).

Emphasize monounsaturated fats ( olive, peanut, and canola oil) and polyunsaturated fats (found in corn, soybean, and safflower oil), and emphasize omega-3 fatty acids( in walnuts, salmon, and flaxseed oil).

Consume low-glycemic foods ( most fruits, vegetables, and whole grains) and limit high-glycemic foods ( white bread, white rice, potatoes).

Treatment

• Weight loss: for patients with overweight and obesity, the more weight they lose, the better it is. However, even losing a little can have an impact. JAMA Internal Medicine recently published a study demonstrating that people who lost just 3% to 6% of their body weight reduced their liver fat levels by 35% to 40%. Another Hepatology study confirmed that losing 7% to 10% of total body weight can lead to NASH remission. Weight loss of roughly 5% of your body weight might be enough to improve abnormal liver tests and decrease the fat in the liver. Losing between 7% and 10% of body weight seems to reduce the amount of inflammation and injury to liver cells, and it may even reverse some of the damage of fibrosis. Target a gradual weight loss of 1 to 2 pounds per week, as very rapid weight and fibrosis. Avoid excessively rapid weight loss.

• Manage blood lipids ( triglycerides, etc.) if they are elevated. Statins appear to be safe and might also reduce cardiovascular events in patients with fatty liver.

• Unfortunately, there are no FDA-approved medications for fatty liver disease. So far, the two best drug options affirmed by the American Association for the Study of Liver Diseases for biopsy-proven NASH are vitamin E (an antioxidant) and pioglitazone (used to treat diabetes). However, not everyone will benefit from these treatments, and there has been some concern about safety and side effects.

• Drink coffee: It is second only to water as the world’s most popular beverage and has been consumed for many centuries. Few studies indicate that patients with NAFLD who drank (black) coffee (about two cups every day) had a decreased risk of fibrosis. However, one should also take into consideration the downsides of regular caffeine intake.

• Drinking coffee is just one way to keep your liver healthy. It’s also important to get vaccinated against hepatitis A and hepatitis B viruses, which both damage the liver.

BOTTOMLINE

To keep your liver healthy, you should

1. Eat an appropriate diet.

2. Exercise

3. Get to and maintain a healthy weight.

4. Limit alcohol.

5. Get vaccinated to protect against liver viruses hepatitis A and B.

6. Control other health conditions that might also affect your liver, and check with your doctor if you might have other underlying, treatable diseases contributing to your fatty liver.

Published 7/25/2020

Updates 2/28/2021; 11/15/2021

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About Us

Dr. Amar Singh, MD, and Dr. Poonam Singh, MD, are board-certified by the American Board of Internal Medicine and American Board of Obesity Medicine. They specialize in preventing, treating, and reversing chronic diseases using an evidence-based holistic approach. They are specifically interested in weight management, hormone re-balancing, and longevity. The American College of Physicians has recognized them as Fellows, FACP, for their excellence and contributions to medicine and the broader community. They enjoy teaching, volunteering, and advocating for their patients. Their mission is to share simple, effective, and proven strategies that lead to meaningful, sustainable, and long-lasting well-being.

Coffee Ways

Coffee is the second most popular beverage (first is water) on the planet. The world drinks approximately 2.25 billion cups of coffee every day.

WHAT IS IN IT

Coffee is a complex mixture of proteins, carbohydrates, lipids. Coffee is full of compounds that are good for health, such as:

• magnesium, potassium, and niacin

• caffeine, which in small amounts can reduce fatigue and improve alertness and concentration

• potent compounds such as chlorogenic acid and polyphenols, which have antioxidant properties that help prevent cell damage.

BENEFITS

Coffee has multiple health benefits. The most significant health benefits are associated with drinking three to four cups of coffee per day.

There is limited but emerging evidence that coffee lowers the risk of several cancers, including 

• Colorectal

• Liver

• Kidney

• Ovary

• Pancreas

• Esophagus

• Uterus

• Throat

Coffee (regular, not decaff) protects the liver and decreases

• Liver inflammation

• Liver stiffness and scarring

• Liver cancer

  Drink at least three cups every day to help prevent liver problems and if you have hepatitis or fatty liver disease, even more — as many as four, five, or even six cups a day — might be helpful, if you can tolerate it. However, coffee isn’t a miracle worker. It won’t completely reverse the liver disease or undo the damage caused by excessive alcohol use. But it can be one delicious and satisfying step toward a happier liver.

The most significant benefit is evident in diabetes and obesity, associated with an intake of one to five cups of coffee per day. It usually doesn’t matter much if the coffee has caffeine or not. Coffee delays the absorption of sugar, helps cells draw sugar from the blood into cells, and lowers the risk of

• Gestational Diabetes (Diabetes during pregnancy)

• Metabolic Syndrome

• Type 2 Diabetes

Coffee increases metabolic rate, and helps blood vessels contract and relax. It may account for coffee’s association with 

• lower blood pressure

• the slower pace of weight gain with age

• reduced risk of dying from cardiovascular disease or neurological diseases.

Coffee protects the brain. Moderate coffee intake (1-5cups/d) may reduce the risk of

• Parkinson’s Disease

• Alzheimer’s disease 

 Coffee can help increase longevity. Moderate intake reduces all-cause mortality.

CAUTIONS

• One 8 oz cup of drip/filter coffee contains 95 grams of caffeine. In some people, more than 300 milligrams of caffeine per day may lead to insomnia, nervousness, palpitations, and jitters. Caffeine consumed after noontime is especially likely to interfere with sleep. Too much caffeine may also raise blood pressure. The adverse effects of caffeine go away when you stop consuming it.

• If you have an irregular heart rate or other heart problems, excessive coffee might be dangerous.

• Coffee might also cause problems if you have lung cancer. In such cases, steer clear until you talk to your doctor for advice.

• Moderate your coffee intake. Although there is no proof that drinking six or more cups of coffee is dangerous, the risk of side effects is lower with moderation.

• Don’t drink beverages at very high temperatures (i.e., over 149° F). In addition to the potential risk of esophageal cancer, there is a risk of burning yourself.

• The most significant risks of coffee come from what is added to it: cream, sugar, or sugary syrup. These add saturated fat and empty calories to the diet, increasing blood sugar and weight. So be careful about what you put into your cup.

• The connection between caffeine consumption and migraine headaches remains uncertain. Until we know more, it seems wise to listen to your body: if you notice more headaches when you drink more coffee (or other caffeinated beverages), cut back. Fortunately, this latest research did not conclude that people with migraines should swear off coffee entirely.

 BOTTOMLINE

If you are already a coffee drinker, it should be reassuring that after decades of research, several health benefits have been found in coffee. If coffee isn’t already part of your daily routine, don’t worry about starting a love affair with it. There are plenty of other ways to stay healthy and trendy without becoming a java aficionado — or even a plain old coffee drinker.

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Posted: 7/11/2020

Updated: 11/15/2021

About Us

Dr. Amar Singh, MD, and Dr. Poonam Singh, MD, are board-certified by the American Board of Internal Medicine and American Board of Obesity Medicine. They specialize in preventing, treating, and reversing chronic diseases using an evidence-based holistic approach. They are specifically interested in weight management, hormone rebalancing, and longevity. The American College of Physicians has recognized them as Fellows, FACP,  for their excellence and contributions made to both medicine and the broader community. They enjoy teaching, volunteering, and advocating for their patients

Top Twelve Reasons Why Water Matters

“Water, water, everywhere, nor any drop to drink.” Unlike Samuel Taylor Coleridge’s Ancient Mariner, who was surrounded by undrinkable salt water, most Americans have an unlimited supply of clean water to quench their thirst. Yet, many still prefer sodas, coffee, juices, and tea over water. Convincing many people otherwise is challenging. 

Why should you drink water?

To stay alive, in short. Leonardo da Vinci described water as the living force of nature. Most of the human body is water. Babies have the most water, being born at about 78%, which drops to about 65% in one year. Adult men’s body has about 60% water. However, fat tissue does not have as much water as lean tissue. In adult women, fat makes up more of the body than men, so they have about 55% of their bodies made of water. The brain and heart are composed of 73% water, and the lungs are about 83% water. The skin contains 64% water, muscles and kidneys are 79%, and even the bones are watery, 31%. 

Water keeps every system in the body functioning correctly. Top twelve reasons our body needs water for are for:

1. carrying nutrients and oxygen to your cells

2. flushing bacteria from your bladder

3. regulating respiration

4. regulating sweating

5. regulating internal body temperature

6. aiding digestion

7. preventing constipation

8. normalizing blood pressure

9. stabilizing the heartbeat

10. cushioning joints

11. protecting organs and tissues

12. maintaining electrolyte (sodium) balance.

Therefore, staying hydrated is essential for life. If you don't drink enough water each day, you risk becoming dehydrated. Warning signs of dehydration include weakness, low blood pressure, dizziness, confusion, or urine that's dark in color.

How much?

Each day we must consume a certain amount of water to survive, which varies according to age, gender, geographical location, work and recreational habits, exercise routine, underlying health conditions, etc. Generally, an adult male needs about 3 liters (3.2 quarts) per day, while an adult female needs about 2.2 liters (2.3 quarts) per day. 

Like everything else, one size never fits all.  For those individuals who are having no problems with hydration, there is no reason to change their habits. Most healthy people are generally good at following the signals that their body sends as to when to drink, and their kidneys and other organs perform just fine.

However, individuals who are having problems with hydration — for example, those experiencing symptoms of dehydration, which include dark-colored urine, low blood pressure, weakness, dizziness, or confusion — may need to drink more. A straightforward recommendation for those who become easily dehydrated is to drink enough such that you have to urinate at least every two hours. If you don't need to pee in two hours, you may not be drinking enough. Individuals with memory impairment may forget to drink liquids or eat meals. Individuals with cognitive impairment may also fail to make the necessary adjustments and drink more fluids when they are exercising or out on a hot day. Sometimes people will also deliberately drink less so that they will not need to find bathrooms when they are out of the house. Family members can help by scouting out the bathrooms before they go on an outing and also encouraging their loved ones to use the toilet every hour, whether they feel like they need to urinate or not (timed voiding).

People with advanced liver disease, heart failure, kidney failure, uncontrolled thyroid disease, or taking certain types of medications (anti-inflammatory, opiate, certain mental health medications) should consult their health care providers to ensure they are taking a proper volume of water.  For those who sweat a lot, due to exercise or work, they should also individualize their water consumption. The usual recommendation for healthy people is to drink two to three cups of water per hour, or more if you're sweating heavily.

How to avoid dehydration?

Water is the best choice. However, if one is sweating fluids out, it needs to be replenished by water with electrolytes. It's not just water that keeps you hydrated. All beverages containing water contribute toward your daily needs. Yes, caffeinated drinks can add to your daily fluid requirement. Caffeine is indeed a mild diuretic, which means that it causes your kidneys to flush extra sodium and water from the body through urine. If you’re frequently urinating, it’s logical to think you could become dehydrated. Despite that, when you drink a cup of coffee, or you drink a glass of iced tea, you are necessarily taking in a volume of fluid along with caffeine. You won’t lose more fluid through urine than you take in by drinking a caffeinated beverage. Your body can absorb as much fluid as it needs and expel the rest. For that reason, your morning pick-me-up helps hydrate you, not the opposite. Coffee and tea count toward your daily eight-or-so cups of water per day. We should still remind ourselves that water is still the best option.

When you want to quench your thirst, you probably don’t reach for a steaming cup of coffee or tea. But despite what you’ve heard, coffee and caffeinated tea are not as dehydrating. And know that you also get fluids from water-rich foods, such as salads, fruit, and applesauce.

To ward off dehydration, drink fluids gradually throughout the day. Have a drink at each meal, as well as socially, or with medicine.

 Why is water a better choice?

 Water is not only essential for health, but it also helps promote weight loss. A recent study in the Journal of Human Nutrition and Dietetics provides even more evidence that we should choose water over other drinks if we want to control our weight. The researchers found that increasing plain water consumption by one to three cups a day could decrease calorie intake by 68 to 205 calories a day. That could add up to a lot fewer calories over time — and result in significant weight loss. Drinking water before meals and substituting water for sweetened beverages can cut down on calorie intake and improve weight control. 

So next time you’re thirsty, instead of ignoring your kitchen sink at home or the water cooler at work, take a moment to savor the one drink that’s free, refreshing, and good for us: plain old water. 

Have a happy 4th and stay hydrated!

References:

https://bionumbers.hms.harvard.edu/files/625.full.pd

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About Us

Dr. Amar Singh, MD, and Dr. Poonam Singh, MD, are board-certified by the American Board of Internal Medicine and American Board of Obesity Medicine. They specialize in preventing, treating, and reversing chronic diseases using an evidence-based holistic approach. They are specifically interested in weight management, hormone rebalancing, and longevity. The American College of Physicians has recognized them as Fellows, FACP,  for their excellence and contributions made to both medicine and the broader community. They enjoy teaching, volunteering, and advocating for their patients

How Fit Are You?

How fit are you? Fitness is not always best measured by parameters like your weight, your ability to run a 5K, or whether you can do ten push-ups. Instead, one test of fitness is how well you can stand from a seated position.

Let’s try it:

Rise from the floor without using your hands

Keep in mind that this test is not for everyone. For instance, someone with a sore knee, arthritis, poor balance, or another kind of limitation would have difficulty doing the test with little or no assistance.

Sit on the floor with your legs crossed or straight out. Now stand up again. For safety, do this with someone next to you.)

How did you do? Did you need to use your hands or knees? Could you not get up at all?

Now, do the test again. Only this time, grade your effort. Beginning with a score of 10, subtract one point if you do any of the following for support when you both sit and stand:

Use your hand

Use your knee

Use your forearm

Use one hand on the knee or thigh

Use the side of your leg

Lose your balance at any time.

For example, if you sat with no problem, but had to use either a hand or a knee to get up, take off one point. If you had to use both your hands and knees, deduct four points (two points each).

If you can sit and stand with no assistance, you scored a perfect 10. If you could not get up at all, your score is zero. Ideally, you want a score of eight or higher. 

What does the no-hands test tell us about fitness?

It can reveal much about your current strength, flexibility, and overall wellness. Performing the sit-and-rise test [SRT] requires leg and core strength, balance and coordination, and flexibility. But if you struggle, that does not necessarily mean you are out of shape. It is an opportunity to focus on areas of your physical health you should address. Even if you currently do reasonably well on the test, practicing can find weak spots before they become worse.

Three exercises that can specifically help improve your score — and ultimately, your fitness. Add them to your regular workout routine. If you are just starting, perform them twice a week and build from there.

• Lunges.: help with both leg strength and balance. Stand with your feet shoulder-width apart. While keeping your abdomen tight and your back in an upright position, step forward with one leg until your knee aligns over the front of your foot. The trailing knee should drop toward the floor. Hold for a few seconds and return both legs to the starting position. Repeat with the opposite leg. Do five to 10 repetitions with each leg to make a set. Do two to three sets.

  Modification: Stand next to a wall for hand support if needed. For an extra challenge, hold small hand weights during the movements.

• Hamstring stretch. Tight hamstrings are a significant contributor to poor flexibility among older adults. Lie on your back and place a strap, belt, or towel around one foot. Holding the strap, gently pull the leg back until you feel a stretch in the back of the leg. Hold the stretch for 30 seconds and then release. Switch to the other leg and repeat.

• Plank: helps strengthen a weak core. Lie face down with your forearms resting on the floor. Raise your body, so it forms a straight line from your head and neck to your feet. Tighten your abs and try to hold this position for 10 seconds. Rest and then repeat. Do two to three planks in total. Work up to holding each plank for 30 seconds or longer.

  Modification: To make the exercise easier, do it while leaning against a counter or table at a 45-degree angle. You can also hold the plank from a full push-up position.

Research evidence indicates that musculoskeletal fitness (as assessed by SRT) is linked to cardiorespiratory fitness and longevity. Researchers have been investigating ways to evaluate physical fitness, quality of life, and life expectancy in a more straightforward approach. In the late 1990’s Claudio Gil Soares de Araûjo, a professor at Gama Filho University in Rio de Janeiro, developed the SRT to help evaluate physical fitness simply and directly. Professor Araûjo published a study in 2012 that showed a clear correlation between the SRT score and how long people will live. He studied people 51-80 years old. The results may be surprising. People scoring in the lowest range (scores 0 - 3) had a 5 ~ 6 times higher chance of dying in the period of the study than those scoring in the highest range (scores 8 - 10). 40% of those in the lowest range (red line) had died within 11 years of the study, while only 6% of those in the highest range (black line) passed away. These mortalities were from all causes.

Aerobic fitness is unequivocally related to survival. This study reveals that maintaining high levels of body flexibility, muscle strength, power-to-body weight ratio, and coordination are not only useful for performing daily activities but have a favorable influence on life expectancy. The ability to achieve a high SRT score could reflect the capacity to complete a wide range of activities of daily living, such as bending over to pick up a newspaper or a pair of glasses lying under the bed or table. Moreover, a high SRT score likely indicates a reduced risk of falls. The SRT can be considered a simple screening procedure in which a low score primarily reflects the degree of impairment in the components of musculoskeletal fitness – mainly those indicating a reduction in muscle strength and joint flexibility. SRT is a good measure of leg and core strength, as well as balance. Older adults who have such muscular strength and flexibility are less likely to fall. And falls are the leading cause of unintentional-injury-related deaths for people ages 65 and older, according to the Centers for Disease Control and Prevention.

SRT serves as one method of screening an individual’s loss of muscle in the aging process, known as sarcopenia. That decline leads to other mobility problems, which decreases the quality of life. Frailty, strength, muscle mass, physical performance — those things are all correlated to mortality. A word of caution: correlation doesn’t mean causation. If somebody had a terrible knee and there’s no way they could do the test, just because that person has a terrible knee doesn’t mean they’re going to die soon. The ability to get off the floor is a useful screening tool, but it can be difficult for anyone. If you have a thicker midsection, getting off the floor might be challenging. But unless body composition is a sign of other health problems, such as obesity, you’re probably not going to die of it.

A high score is a sign that now, you’re in pretty good physical condition in terms of muscle strength. One shouldn’t forget the genetic component. Some people are just healthier physiologically and more coordinated than others. If you’re sitting on the floor worried because you can’t get up, the good news is that barring complications such as arthritis or inner ear problems, you can work on it, and you’ll likely improve over time. 

Physicians have many other screening tools to measure health and longevity. A study published in the February 2019 Journal of the American Medical Association Network Open, measured the health data and push-up capacity of 1,104 middle-aged, active male firefighters for ten years. The men who could complete 40 push-ups during the ten years had a 96 percent lower risk of cardiovascular disease than those who could do fewer than ten push-ups.

Walking speed can also provide insight to life span. One 2011 study published in the Journal of the American Medical Association concluded that people ages 65 and older who could walk one meter per second or faster lived longer than those who couldn’t. Another study published in the British Journal of Sports Medicine concluded that walking at a faster than average pace reduced the risk of death from cardiovascular disease by 53 percent for all people 60 and older. If you can walk at your natural pace at two miles per hour or faster, you’re a lot less likely to die in the next ten years. Walking speed is highly correlated to mortality.

Occasionally a hand dynamometer to assess grip strength can help one determine the risk of death. One study showed that each 11-pound decrease in grip strength leads to a 16 percent higher risk of dying from any cause, including heart disease, stroke, and heart attack. How hard you can squeeze the dynamometer is another marker of frailty. The most definite impact on grip strength has to do with how fit you were in young adult and middle adult life. 

TAKEAWAYS

Get moving.

The U.S. Department of Health and Human Services recently released new guidelines for physical activity, suggesting that adults 65 and older break their 150 to 300 minutes of exercise each week into short bouts of activities that focus on balance, aerobic exercise, and muscle strengthening.

The key is to find forms of exercise you enjoy — or find purpose in doing what you may not like to do. If I tell a patient to exercise because it’s going to improve cardiovascular health, it may not motivate them as much. What motivates them is the ability to go to a grandchild’s kindergarten graduation. Think, what do you care about? What do you want to be able to do?

It’s never too early or too late in life to start or increase physical activity — it’s beneficial and increases life expectancy no matter when you do it. Aim for 30 minutes of moderate exercise a day.

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About Us

Dr. Amar Singh, MD, and Dr. Poonam Singh, MD, are board-certified by the American Board of Internal Medicine and American Board of Obesity Medicine. They specialize in preventing, treating, and reversing chronic diseases using an evidence-based holistic approach. They are specifically interested in weight management, hormone rebalancing, and longevity. The American College of Physicians has recognized them as Fellows, FACP,  for their excellence and contributions made to both medicine and the broader community. They enjoy teaching, volunteering, and advocating for their patients

Father’s Day

Be it known wide and clear

That it’s a hard job to be a dad

While you walk, sleep and work

Know there was once a man

Who unknowingly thought about you

And who once when you took your first breath

Whispered your name and help up to his face

And gently kissed you on your cheek

At that moment he was the happiest he had ever been

It was only then he realized the prize he held

The Origen of his seed and face that was his

Neglect not what this old man means today

Reject not what he created in your absence

Forget not what today he remembers

As he gently puts you down and smiles

And says my child remember your father

He will always remember you!

About Us

Dr. Amar Singh, MD, and Dr. Poonam Singh, MD, are board-certified by the American Board of Internal Medicine and American Board of Obesity Medicine. They specialize in preventing, treating, and reversing chronic diseases using an evidence-based holistic approach. They are specifically interested in weight management, hormone rebalancing, and longevity. The American College of Physicians has recognized them as Fellows, FACP,  for their excellence and contributions made to both medicine and the broader community. They enjoy teaching, volunteering, and advocating for their patients

Does Social Media Make You Lonely?

It is like asking if eating food causes obesity?

The need to connect with others is a primal human instinct. The warm feeling of social connection is essential in maintaining our overall emotional and physical health. There is unequivocal evidence that people who have satisfying relationships are happier, have fewer health problems, and live longer. As virtual social platforms permeate our lives, they can potentially take over ‘human’ from connection. With over 2.6 billion monthly active users of Facebook as of the first quarter of 2020, the world's largest online social network, and over half of them log in daily, one in three people on this planet interacts with Facebook. It is staggering. Over 1 billion people use Instagram every month, making it the second most popular social network platform in the world. As of the first quarter of 2020, photo and video sharing app Snapchat had 229 million daily active users worldwide, up from 190 million in the corresponding quarter of 2019. Approximately 77 percent of all Americans have a social media profile of some kind.

Despite the ubiquity of social media platforms, there’s a remarkable lack of precise data about how they affect us personally: our behaviors, our social relationships, and our mental health. Some emerging data is questioning it. 

Does eating make you fat? The answer is yes, and no.

Just like that, one may ask if social media makes you lonely and depressed? The answer is yes, certainly, but not all the time, not in everyone, and not forever.

Researchers at the University of Pennsylvania found that there is, in fact, a causal link between the use of social media and adverse effects on well-being, primarily depression and loneliness. Their study was published in the Journal of Social and Clinical Psychology. One hundred forty-three undergraduate students, who used iPhones,  from the University of Pennsylvania participated. They were randomly assigned to two groups. The control group continued to use social media as usual. The study group limited their social media to 30 minutes per day — 10 minutes on three different platforms (Facebook, Instagram, and Snapchat). iPhone usage data monitored the time spent using each app per day. Each participant filled out questionnaires in several areas of well-being: social support, fear of missing out, loneliness, anxiety, depression, self-esteem, autonomy, and self-acceptance at the beginning and end of the study. 

The outcome was unequivocal. The group that used less social media had better mental health outcomes. Both loneliness and depressive symptoms declined, with the most benefit in those who reported higher levels of depression. At the end of the trial, it was clear that no matter where they started, those in the study group experienced less depression and loneliness as social media exposure was limited. Meanwhile, both groups saw a decline in levels of anxiety and fear of missing out, which the researchers postulate as potentially coming from users merely becoming more aware of their social media use by taking part in the trial. Overall, if you use less social media, you are less depressed and less lonely. However, this study is almost entirely observational or correlational nature, meaning they don’t establish whether or not one is causing the other. A common argument against the theory that social media makes individuals more depressed and lonely is simply that perhaps those who are more depressed and isolated are more inclined to use social media as a way of reaching out.

The bigger question is why so. What can we learn from this? Well, it’s complicated. When you log on, you’re generally dealing with very curated content on the other side. Some researchers have found that this may generate social compassion, although you may not be fully aware of it.  However, even if individuals are aware of the curated nature of many online platforms, it is not uncommon to feel compelled to compare your life with others, as presented. There are various published articles on the relationship between Facebook and specific mental health outcomes. The more you use the platforms, the more social comparisons you tend to induce, and that potentially causes a decrease in happiness and an increase in loneliness. It is not uncommon to have these constant upward social comparisons hundreds of times each day, depending on how frequently you check your social media feeds.

FOMO, or fear of missing out, is strongly linked with the use of social media usage also. Although FOMO seems a bit frivolous, psychologists consider it to be real. FOMO may be an extension of broader issues of inclusion and social standing. Once our basic needs are met, like food, shelter, and water, the need for inclusion and social interaction ranks next to them. FOMO is this feeling that I could have been there, and I wasn’t. Maslow’s Hierarchy of Needs theory can explain this well. Social media interaction may provide a powerful cue that maybe one is not being included by people who are important in one’s life. 

Social media affects different demographics differently. Some populations, such as college students, are more vulnerable to loneliness. The stress of college can weigh heavily on students who lack a social network to help them battle negative thoughts. In a 2017 survey of nearly 48,000 college students, 64% said they had felt “very lonely” in the previous 12 months, while only 19% reported they never felt lonely, according to the American College Health Association. Students also reported feeling “overwhelming anxiety (62%) or “very sad” (69%), and that “things were hopeless” (53%). Nearly 12% seriously considered suicide. Let’s ask ourselves honestly why we are checking in on Facebook, Instagram, or Snapchat so often. Is this a substitute for something else you could be doing IRL (in real life)? Healthier alternatives might include visiting with friends, reading a book, taking a contemplative walk in nature, or participating in arts such as photography, writing, or music. Be aware of what’s driving you to snack on social media. There are wholesome options to satisfy those cravings. Not all social media are created equal. Choose a social media platform carefully. Stick to a social media outlet that helps develop authentic social connections and pulls you into a welcoming community. That is what social media was meant to do in the first place.

As a wise person once said, “Do everything in moderation, even moderation,” social media use is great in moderation. So, should we all just be using less social media? Maybe. We don’t have enough evidence to say that one should not use social media at all. However, there is enough evidence that controlling and limiting could be helpful for people who are already seeming to struggle with negative emotions and a sense of belonging. Social media is not going away, and I am not suggesting that it should. Social media has permanently woven itself into the fabric of our daily lives. They are just going to be part of how we interact with our world and people in it. 

TAKEAWAYS

It is ironic, but perhaps not surprising that reducing social media, which promised to help us connect with others, actually helps people feel less lonely and depressed. Setting limits and sticking to them can help minimize these effects. Limiting social media use to 30 minutes a day may lead to significant improvement in well-being. Just being mindful of screen time is beneficial. Increased self-monitoring leads to significant decreases in anxiety and fear of missing out. It may potentially allow you to focus more on the task at hand than worry about what everyone else is up to. 

When it comes to social media, less is more.

References:

No More FOMO: Limiting Social Media Decreases Loneliness and Depression   https://bit.ly/2ULFWVc

FOMO: Fear of missing out https://bit.ly/3e4DHUF

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About Us

Dr. Amar Singh, MD, and Dr. Poonam Singh, MD, are board-certified by the American Board of Internal Medicine and American Board of Obesity Medicine. They specialize in preventing, treating, and reversing chronic diseases using an evidence-based holistic approach. They are specifically interested in weight management, hormone rebalancing, and longevity. The American College of Physicians has recognized them as Fellows, FACP,  for their excellence and contributions made to both medicine and the broader community. They enjoy teaching, volunteering, and advocating for their patients