When the U.S. Surgeon General issued an advisory last year calling loneliness a public health crisis ― one that increases the risk of conditions like heart disease and dementia — many people took note. Anna Bonavita took action.

The Loneliness Cure

The time was finally ripe for her experiment, the Edina woman realized.

Bonavita is well acquainted with loneliness. She got her first taste of it when she moved to Minnesota in the 1990s. She knew no one, and at her job, everyone else seemed to be too busy with their own friends and extended families to offer an invite. For years, it felt like the National Public Radio hosts she listened to were her only friends.

Eventually, she made friends — real ones — by connecting with a fellow newcomer who widened her circle. But the loneliness returned years later, when her husband became terminally ill and they moved to his Italian hometown to spend his last few months.

Far away from her support network and often alone, she began spending time at a local cafeteria that had a large communal table. The other regulars at the table ended up becoming the friends she needed in such a difficult time. Even after returning to Minnesota, she often thought about how the friendship she found at a communal table helped her and wondered if it could help people here feel less alone.

How to tell if you're lonely
This series of questions, called the UCLA Loneliness Scale, is what doctors and researchers use to measure people's feelings of loneliness.

So, this winter she started a communal table in Minneapolis by extending an open invitation in the Southwest Connector newspaper and via a Facebook group for Thursday nights at Gigi's Cafe to anyone who wanted to gather. Just a month in, she's drawing a small crowd of former strangers who are getting to know each other.

It's in the same spirit that the Star Tribune is introducing a month-long series, The Loneliness Cure. We'll focus on why loneliness is so bad for our health, why it's so pervasive today and why Minnesotans may be especially prone to it. We'll also look at the antidote — social connection, in its many forms — and how to foster it.

With weekly reader challenges that spark connections, our hope is that all of us will feel a little less lonely by month's end. And that's no minor achievement, as Bonavita knows well.

"The miracle of getting together — it's not a small miracle nowadays," Bonavita said. "I mean, to get up from the couch, to overcome the embrace of the internet or Netflix, to get out in the cold and dark night in search of elusive human connection."

Anna Bonavita, right, gathers a group at a communal table at Gigi’s Cafe in  Minneapolis on Jan. 18.
Anna Bonavita, right, gathers a group at a communal table at Gigi’s Cafe in Minneapolis on Jan. 18.

Richard Tsong-Taatariii, Star Tribune

Loneliness' big impact

Loneliness is a powerful feeling. It makes sense that it would impact our mental health. But why does it also impact our physical health to such a serious degree?

Research shows that loneliness triggers a physiological stress response. The body releases cortisol, a hormone that, in the short term, can cause shortness of breath or a fast heart rate, explained Dr. Patrick Bigaouette, a psychiatrist at Mayo Clinic Health System.

Over time, this response impacts the body's systems, including our cardiovascular and immune systems, in damaging ways.

"Lacking connection can increase the risk of premature death comparable to smoking 15 cigarettes daily," said Bigaouette. "Which is just astounding to me."

In his bestselling 2020 book "Together: The Healing Power of Human Connection in a Sometimes Lonely World," Surgeon General Vivek Murthy writes that the surge in stress hormones in response to loneliness had a meaningful purpose for early humans. Being alone was dangerous — it demanded a reaction, just like hunger or thirst.

"Over millennia, this hypervigilance in response to isolation became embedded in our nervous system to produce the anxiety we associate with loneliness," Murthy writes. "When we feel lonely, our bodies react as if we were lost on the tundra surrounded by wild animals and members of alien tribes."

But if the feeling persists, as it so often does now, this repeated stress response can lead to anxiety, depression, trouble sleeping, heart disease and dementia.

Loneliness vs. being alone

In his advisory last May, Murthy called loneliness an "epidemic." He cited surveys showing that about one in two U.S. adults reported experiencing it, even before the pandemic isolated so many of us.

Changes in technology, demographics like family size and marriage rates as well as community involvement have all eroded social connection.

Every year since 2003, the U.S. Census Bureau has collected data on how Americans spend their time. Time spent alone rose annually, then started to trend sharply upwards in 2018. By 2020, U.S. adults were spending 24 more hours a month alone than they had 17 years earlier.

Spending time alone and experiencing loneliness aren't necessarily the same thing, however. As any introvert can attest, there are positives to having time to yourself — productivity, for example, or focus or mindfulness. And it's certainly very possible to feel lonely in a crowded room.

Loneliness has to do with a person's perception, said Bigaouette.

"There are people that are introverts, there are people that are homebodies that really like to be alone. That's fine, and that doesn't cause them any distress. And they go about their lives completely fine. But loneliness is that feeling of separation where it's driving distress," he said. "The American Psychological Association, they define loneliness as a perceived state of being alone that causes discomfort or uneasiness. And I think that is a big differentiator."

Making connections

The tricky thing about loneliness, according to experts like the late Dr. John Cacioppo, author of "Loneliness: Human Nature and the Need for Social Connections," is that it's not a problem you can solve entirely on your own.

There is a clear cure, however: "When you feel hungry, you eat. When you feel a sharp pain in your lower extremity, you move your toe off the tack. But when the unpleasant state is loneliness, the best way to get relief is to form a connection with someone else," Cacioppo wrote.

A pioneer in the field of social neuroscience, Cacioppo's research led to much of what is currently understood about loneliness' impact. After he died in 2018, his wife and fellow researcher Stephanie Cacioppo told the New York Times, "As John would say, and I agreed with him: 'If you think about what our species would be like without loneliness, it would not be nearly as endearing a species. Loneliness, which compels us to bond with others, gives us what we call Humanity.' "

Social connection can take many forms – from feeling understood when talking with a close friend to chit-chatting with your mail carrier or meeting up for a book club discussion each month. Just as loneliness triggers a stress response, connection with another person causes us to release "happy" hormones that are good for our health and wellbeing.

In fact, social connection is so key to our health and wellbeing, that it's one of the factors longevity expert Dan Buettner identified in the "Blue Zones," places around the world where people live the longest, happiest lives.

In Okinawa, Japan, a Blue Zone, there's a tradition of forming children into groups of five, called a "moai," a sort of second family that stays together their entire lives. These groups play together as kids, support each other financially when needed and gather for tea and conversation in their old age.

“When you feel hungry, you eat. When you feel a sharp pain in your lower extremity, you move your toe off the tack. But when the unpleasant state is loneliness, the best way to get relief is to form a connection with someone else.”
John Cacioppo, author of Loneliness: Human Nature and the Need for Social Connections

When Buettner wanted to put his research to the test here in the U.S., several different cities "auditioned" to host a pilot project in 2009. He chose Albert Lea, Minn. Within months, the city managed to make enough healthy changes to add a projected 2.9 years to the lifespans of its residents.

In the years since, Buettner's Blue Zone Project has reshaped dozens of communities across North America. One thing they all have in common? They set up "walking moais," small groups that commit to going for a walk together every week for ten weeks to stroll and socialize. It's not just the movement that's a boost to their health; the social support these groups offer makes participants feel more connected.

Talking about it

Because loneliness often carries a stigma, many people don't talk about it — whether it's to share their own feelings or ask someone else if they are feeling lonely and would like to connect more often.

"There are different levels of loneliness. What's really important to pay attention to is the duration," said Carrie Henning-Smith, deputy director of the University of Minnesota's Rural Health Research Center. "It's very normal to feel lonely for brief periods of time, even if you're around other people, but may not be finding meaningful connection. But if loneliness goes on for an extended period of time it can become more worrisome."

It's likely that you have people in your life who are impacted right now, said Henning-Smith said.

"It's okay to ask about it directly, and it may be helpful to share your own experiences with loneliness to help reduce some of the stigma of talking about it," she said. "And, whether you know for sure that someone is feeling lonely or not, there's no harm in reaching out to connect. That can benefit you, too."

There are many factors that put people at a higher risk for loneliness — and it often occurs at times of change, impacting young adults, seniors and people living alone. People with lower incomes and those with a disability or chronic health conditions are also at higher risk of being lonely, Henning-Smith said.

Some of the highest rates of loneliness, according to national surveys, are found in young people, and social media can sometimes make those feelings worse, she added.

Minnesota doesn't have higher rates of loneliness than other states, Henning-Smith said. Still, specific hurdles to social connection do exist here.

"In particular, winter weather can make it more difficult for people to get out and socialize with one another, especially if someone is worried about driving in the snow or falling on ice," she said.

And people who move to Minnesota from another state or country often say it is difficult to form new connections with locals — a phenomenon reporter Zoë Jackson explored in the Star Tribune's reader-driven community reporting project, Curious Minnesota, after a reader asked "Why is it that Minnesotans will 'give you directions to anywhere but their home'?"

Nearly 70% of Minnesotans born here end up staying in the state, often maintaining their long-term friendships and family ties. Those deep roots could be a reason that newcomers find it difficult to break through, Grace Vieth, who researches adult friendship at the University of Minnesota's Social Interaction Lab, told Jackson.

David Wolf danced with Connie Cohen at Gigi’s Café, where Bonavita hosts her own Minneapolis loneliness experiment to help people connect.
David Wolf danced with Connie Cohen at Gigi’s Café, where Bonavita hosts her own Minneapolis loneliness experiment to help people connect.

Richard Tsong-Taatariii, Star Tribune

Henning-Smith's research has shown that Minnesota's rural residents tend to be connected to more family and friends than those in urban areas but still sometimes have higher rates of loneliness, she said. That's likely because they often have more barriers to connecting — greater distances and fewer transportation options and resources.

For Bonavita, who started the communal table night in Minneapolis, attention from the surgeon general and others about the topic has made her feel less alone in her work to push against loneliness.

It also gave her the bravery to follow through with her idea.

Not everyone is up for leading these kinds of social happenings, of course, or starting a "walking moai" of their own. But making a baby step toward building social connections can have a meaningful impact, Bigaouette and other experts say.

"Try saying, 'I'm going to commit to meeting my friend for coffee for 15 minutes once a week,'" Bigaouette said. "It's those small, tangible steps that don't feel so overwhelming."