Thus far, we have covered four out of the Six Pillars of Lifestyle Medicine in our series, and in this article, we address healthy relationships. We discussed the stress management pillar with Adam Courchaine, PA-C, MPAS of NuMed Direct Primary Care and invited him back to discuss healthy relationships since there is such a strong correlation between the two pillars. Healthy relationships are so important in achieving positive health outcomes because as human beings we are “wired to be more of a tribe,” says Adam. In fact, having healthy relationships extends your life.


Love is therapeutic, quite literally! There is a physiological effect that good relationships produce as it activates the parasympathetic nervous system, which helps you to relax after any stress response (bringing the heart rate down, lowering blood pressure and breathing easier) as well as induce digestion and manage the body’s sexual function. The brain also releases “feel good” hormones including dopamine when you get rewarded. Endorphins, the body’s natural pain and stress reliever get released from physical touch in addition to exercise. With a lot of stress, fear, negativity, and uncertainty in the world, healthy relationships foster safety, community and “help you connect to the present.”


Relationships have a profound impact on health, even more than physical health indicators. The longest study on human quality of life and happiness is The Grant Study, which began in 1938 with 268 Harvard students including John F. Kennedy, and now has only 19 men still alive. The study produced unequivocal proof that the quality and satisfaction of close relationships were more closely tied to happiness and longevity than money, notoriety, genes, or IQ. “Several studies found that people’s level of satisfaction with their relationships at age 50 was a better predictor of physical health than their cholesterol levels were.” 


“The surprising finding is that our relationships and how happy we are in our relationships has a powerful influence on our health,” states Robert Waldinger, director of The Grant Study, psychiatrist at Massachusetts General Hospital and professor of psychiatry at Harvard Medical School.


When it comes to relationships, however, quality is more essential than quantity. We need human contact and connection, but that connection has a more positive impact when it is genuine and promotes a deep shared bond rather than a superficial connection based on momentary pleasures.


Relationships at Work 

Since so much of our time is spent at work, I asked Adam Courchaine, PA-C, MPAS about his thoughts on the impact of the quality of work relationships. Adam described some of his patients who live in fear, not knowing if each day at work may be their last, which is a recipe for disaster when it comes to health because of the chronic stress. A negative work environment keeps people fearful and it doesn’t activate one’s potential. This along with disconnected employees who compete against each other instead of nurturing a collaborative team can easily create a toxic work environment.


If people at work are undermining you, talking about you, taking credit for your work, and/or devaluing you, it will have detrimental effects on your performance, how you feel about yourself, your work and ultimately your health. However, if people at work are encouraging and supporting you with leadership that advocates an environment of safety, that will push you to do your best and feel good about yourself and your work.



In good work environments, people are encouraged to question things and to think constructively to achieve the best outcome. In poor work environments, people are expected to “fall in line” and are fearful to bring in ideas or suggestions, says Adam. There is a general idea that value at work is mainly associated with compensation, although treating people poorly at work and excusing or justifying this behavior due to high compensation is a recipe for disloyalty, resentment, mediocre performance and ultimately high turnover. Value at work goes way beyond compensation thus healthy relationships, which include seeing a person’s talents and contributions and challenging them to perform their best is paramount.


Personal Relationships

Paying attention to the quality of your personal relationships is a crucial component of health. Unfortunately, in our modern, global society there is not much focus or education dedicated to understanding and improving personal relationships. Therefore, people are left to model after what could be dysfunctional, poor and/or simply unhealthy examples of how to relate to others from their family of origin or other close relationships imprinted from childhood.


“We tolerate sometimes horrible behavior from people that are supposed to have your back and that’s why in-family abuse is so detrimental…it’s that fundamental destruction of a relationship.” - Adam Courchaine, PA-C, MPAS 


I asked Adam if people and relationships can be a major source of stress and he said, “100%, yes.” He described patients having abnormal connections with family members who they are “supposed to love, but don’t like” usually due to poor treatment or abuse. While healthy relationships activate the parasympathetic nervous system, unhealthy and toxic relationships constantly activate the body’s stress response - the sympathetic nervous system. Dr. Janice Kiecolt-Glaser has done several studies showing how hostile marital conflicts can result in immune changes and depression. 


There are serious negative health consequences that result from the chronic stress that unhealthy relationships produce. Societal programming leads us to believe that family is everything and if something isn’t right, there is a tendency towards self-blame and exerting maximum efforts to make an imbalanced or unhealthy relationship swing the other way when the problem is the other person who is toxic. Adam advises that at a certain point, it is just best to limit or cut ties and preserve yourself. This will also allow space for healthy close relationships that will extend your life and provide you stress relief. 

Married couple enjoying each other at beach


Loneliness Hurts

According to the 2021 U.S. Census Bureau data, 28% of American households represent single adults who live alone or 37 million people. This is a modern phenomenon that is counter to human nature and our ancestral origins. When people feel lonely or have unhealthy relationships, they can often gravitate towards overindulging in unhealthy foods, alcohol or other substances, leading to addictions and sometimes risky behaviors to feel better in the short term, which can lead to negative health outcomes in the long term. 


“Loneliness kills. It’s as powerful as smoking or alcoholism.” - Dr. Robert Waldinger, Harvard Medical School


Adam shared a story of a new patient in her early 70s who lives alone in an apartment and she loved talking with Adam because she doesn’t get to talk to people very much. By the end of the appointment, Adam’s patient looked at him and he said to her, “You want a hug, huh?” To which, she replied, “Yeah, you do that here?” Adam said, “Sure, I’m a human.” His patient admitted that she hasn’t had much contact with other people and couldn’t remember the last time she touched anyone, so she also hugged Adam’s wife, Dara who is a registered nurse at NuMed Direct Primary Care. Adam does not know this patient’s entire life story, however he saw clearly that she is “starving for human contact.”


The pain of not being seen, heard or valued is real and research by Dr. Naomi Eisenberger, a social psychologist at UCLA shows that social rejection “activates some of the same neural regions that are activated in response to physical pain.”


Achieving Healthy Relationships

Achieving healthy relationships starts with the self and taking good care of yourself, which includes balanced nutrition, sleep, exercise, stress management, so you show up in a positive way with others. Adam Courchaine advises people to try different things in order to find your tribe by participating in activities and entering environments that you enjoy and highly recommends the book, Tribe by Sebastian Junger. Through this process be patient in getting to know others, opening up to others and be mindful to reciprocate.


“If I want to have a good relationship with you, I probably have to have a good relationship with me first because if I don’t, you’re going to feel that something is missing.” - Adam Courchaine, PA-C, MPAS

And that missing element may be a lack of contribution, compassion, respect, kindness, effort, etc., but whatever it is, it will eventually cause the other person to not want to engage as much or at all. 

“Remember: despite how open, peaceful and loving you attempt to be, people can only meet you, as deeply as they’ve met themselves.” - Matt Khan


Finally, we explored the topic of how healthy relationships with children impact longevity and wellness. Adam sees spending time with children as a great way to get back in tune with our true nature, as kids have an honesty, openness and acceptance of others without all of the judgment and programming that adults have been conditioned with. Children only want to play and aren’t concerned with your appearance, background or social status.


A family having fun together

“When I see a kid being silly and laughing, I smile and I realize I’m being too adult-like, so for me, it’s a reminder to have more fun.” - Adam Courchaine, PA-C, MPAS

Children have an uncanny ability to consistently be in the moment and are not concerned about the past and the future like adults are. Therefore, a great way to enhance your relationships is to engage with kids and/or get in tune with your inner child by incorporating more playfulness to your routine with others.



The Grant Study - The Harvard Gazette 

Social and Affective Neuroscience Laboratory - UCLA