How to Avoid Accidental Death | Dr. Peter Attia & Dr. Andrew Huberman
00:00:00.000 | If you talk about true accidental deaths, automotive, uh, and falls and overdoses are
00:00:11.180 | the, are the three.
00:00:12.700 | That's basically what it comes down to.
00:00:14.160 | So you know, in our death bar analysis, we kind of list all this stuff out.
00:00:18.120 | In fact, I think that's actually one of the figures in the book is I have the accidental
00:00:21.360 | death, uh, figure that we've put together where we've adjusted by population and you'll
00:00:28.420 | see a couple of things.
00:00:29.420 | If you look at it in absolute terms, it's basically a pretty constant.
00:00:34.880 | So regardless of what decade of life you're in, once you're above, you know, 20 accidental
00:00:40.360 | deaths are a pretty sizable number of, of deaths.
00:00:43.780 | Now car accidents seem to be pretty constant throughout life, little more common if you're
00:00:49.480 | under 60 than over 60, but they never go away.
00:00:53.240 | I was told that, um, in teenage and boys and, and, uh, boys in their, in their early twenties,
00:00:59.780 | alcohol induced, uh, automotive fatalities would place them at, at this astronomic risk.
00:01:06.060 | Is that just not true?
00:01:07.580 | It's not true anymore compared to overdoses.
00:01:09.900 | Is that because young people now, um, aren't getting their driver's licenses.
00:01:13.220 | I've also heard that.
00:01:14.220 | Yeah.
00:01:15.220 | Well, I think it's also because we're seeing such an uptick in the deaths that come from
00:01:18.500 | fentanyl.
00:01:19.500 | Got it.
00:01:21.020 | So fentanyl related deaths have basically squashed all other deaths below 65 on the
00:01:26.680 | accidental front.
00:01:27.680 | Really?
00:01:28.680 | Oh, it, it, it's not even close.
00:01:31.600 | Because of the number of different substances that fentanyl is being woven into.
00:01:34.960 | It's winding its way into everything, right?
00:01:37.400 | So all counterfeit drugs, all illicit drugs, and look, most of the time you're not getting
00:01:41.720 | a lethal dose.
00:01:42.720 | So it's, you know, it's, it's, but, but you're getting lethal doses so often now that, um,
00:01:49.320 | well, you know, I did a little analysis actually the other day when I looked at how are deaths
00:01:55.960 | of despair increasing over the last five years.
00:01:59.640 | So what did I define as a death of despair?
00:02:02.360 | Suicide, alcohol related death, or overdose.
00:02:06.960 | Accidental overdose.
00:02:07.960 | So we differentiate that from suicide where suicide is obviously deliberate and accidental
00:02:12.440 | is not.
00:02:13.440 | So if you just look at those three things, so accidental overdoses, suicides, and alcohol
00:02:18.280 | use, or alcohol related death, um, not including driving, by the way, this is like cirrhosis
00:02:25.920 | of the liver that comes from, that number is going up at almost 20% per year since 2019.
00:02:34.520 | So the, I couldn't get 2022 numbers yet.
00:02:37.320 | So at the time of, the time I did this analysis, which was last week, um, the 2021 numbers
00:02:46.160 | was about 210,000 Americans.
00:02:48.960 | Goodness.
00:02:50.160 | Up from 180,000 in 2020 up from like 150,000 in 2019.
00:03:00.500 | So is this, um.
00:03:02.320 | And that is driven almost entirely by fentanyl use.
00:03:06.080 | What other sorts of drugs are people buying?
00:03:07.080 | No, so the majority of people are dying from fentanyl poisoning.
00:03:11.780 | And I had a guy on my podcast recently named Anthony Hippolito and if anybody's interested
00:03:15.160 | in this topic, they really need to go listen to that.
00:03:17.280 | So Anthony.
00:03:18.280 | I watched the YouTube version of this and your podcasts are excellent.
00:03:21.000 | So if you're interested in this, and I think everyone should be interested in this.
00:03:24.000 | If you have a child or know somebody who has a child, you just got to get this podcast
00:03:28.560 | into their hands because it's the most important public service announcement I'll probably
00:03:32.360 | ever do in terms of saving more lives potentially, um, where the majority of this is making its
00:03:39.280 | way into the, into the accidental poisonings is through illicit counterfeit pills.
00:03:45.800 | So it's when kids are out there buying, you know, oxy, they want oxy.
00:03:50.280 | Well, they can't, they can't get real oxy, right?
00:03:52.520 | Because they're not going to go to a doctor and get real oxy.
00:03:54.360 | So they're going to buy it through, you know, Snapchat, right?
00:03:57.680 | They're going to buy it through some drug dealer that they're finding on social media.
00:04:00.720 | Um, they're buying sleeping pills.
00:04:03.320 | They're buying all sorts of counterfeit stuff like Adderall.
00:04:07.320 | Many of these things are being laced with fentanyl.
00:04:10.160 | Adderall.
00:04:11.160 | Absolutely.
00:04:12.160 | Wow.
00:04:13.160 | I assumed the fentanyl.
00:04:14.160 | And again, the reasons are it's insanely cheap to use synthetic fentanyl.
00:04:18.900 | And secondly, and again, but the effects of fentanyl are nothing like the effects of Adderall.
00:04:23.240 | So cocaine, um, doesn't make sense for that reason.
00:04:25.720 | Cocaine doesn't make sense either.
00:04:26.840 | Yep.
00:04:27.840 | And yet it's still showing up in cocaine.
00:04:29.080 | Again, I don't think that's the dominant place it's showing up.
00:04:32.120 | I would, I would guess that the dominant place it's showing up is in counterfeit opioids.
00:04:39.260 | So any opioid, barbiturate, any sedative, depressant.
00:04:41.960 | Let me tell you what I'm telling my daughter, right?
00:04:44.620 | Because this is to me, it's a frontline problem.
00:04:46.120 | I have a 14 year old daughter.
00:04:47.640 | I'm like, listen, I don't care which friend of yours it is.
00:04:50.480 | I don't care how much she's amazing.
00:04:52.720 | If she tells you to try this sleeping pill because she took it the night before and it
00:04:57.080 | was really helpful or this will help you study better or this will help you do anything.
00:05:01.240 | I'm like, just come to us.
00:05:03.160 | We've got a better pill for you, right?
00:05:05.080 | Like in other words, you can't trust anything because you don't know where she got it.
00:05:09.800 | She has the best of intentions I'm sure when she's given it to you.
00:05:12.120 | And by the way, she probably took it the night before and was just fine.
00:05:15.000 | But the people who are making these pills are not exactly up to GMP standards.
00:05:20.720 | So you know, you just have no idea which pill is getting what dose of fentanyl.
00:05:26.500 | One thing that Anthony Hippolito told me that I simply couldn't believe I had to ask him
00:05:29.280 | six times was that some of these pills have like one milligram of fentanyl in them.
00:05:36.520 | Now, I made the point on the podcast that a hundred milligrams of fentanyl for most
00:05:41.780 | people is a hit.
00:05:43.540 | Like they've like, I've had fentanyl before I've been in the hospital and I've had fentanyl.
00:05:47.400 | A hundred milligrams is like, wow, that is such a trip.
00:05:52.560 | Why are people dying from one milligram intake?
00:05:55.140 | Respiratory inhibition.
00:05:56.140 | You can't breathe.
00:05:57.300 | That shuts the brainstem off.
00:05:58.640 | Well, I don't think we can highlight this enough.
00:06:01.760 | You know, adults are dying.
00:06:02.760 | Kids are dying.
00:06:03.760 | I met someone earlier this week who told me her 35 year old son died of an accidental
00:06:07.660 | fentanyl overdose and he wasn't, at least by her description, a drug addict or anything
00:06:12.760 | of that sort.
00:06:13.760 | Yeah, this is, this is, we're talking about a different game now, right?
00:06:16.060 | So it's like, these are kids that have anxiety.
00:06:18.360 | These are kids that are, you know, are sort of addressing another issue with these, with
00:06:24.280 | these pills.
00:06:25.280 | And I think this, this whole concept of deaths of despair is, is, is a really important one.
00:06:30.200 | But back to your question, what do, what do accidental deaths primarily amount to for,
00:06:36.040 | for the aging population?
00:06:37.920 | Again, it is so clear that it is fall related.
00:06:42.320 | This is where, um, once you hit 60, 65, the, the risk of a fall that results either immediately
00:06:51.320 | in death, you know, you hit your head and die, going back to like cerebral hemorrhage,
00:06:56.280 | or it is the straw that basically leads you down the path to death within the next 12
00:07:02.120 | months, is astonishingly high.
00:07:04.720 | It's so high that it's sort of hard to wrap your head around.
00:07:07.880 | But if you're over 65 and you fall and break your femur or hip, so you either crack the
00:07:15.840 | femoral neck or the femur itself, your 12 month mortality, the probability you will
00:07:22.040 | be dead in 12 months after that break, if you're 65 or older, depending on the study,
00:07:27.080 | is about 15 to 30 percent.
00:07:29.760 | Wow.
00:07:30.760 | Wow.
00:07:31.760 | So in terms of offsetting the probability of falls, um, you talked a little bit about
00:07:36.280 | this, um, before, but I, uh, you and I have talked a little bit about this before, but
00:07:41.480 | maybe we could go a little bit deeper.
00:07:43.720 | Um, people's ability to jump and land seems to be highly correlated with one's ability
00:07:49.900 | to not fall or at least fall and control the fall in a way that, uh, leads to no or less
00:07:57.660 | severe injury.
00:07:58.660 | Yeah.
00:07:59.660 | So Andy Galpin talked about this on your podcast, he talked about it on my podcast.
00:08:04.680 | What is the hallmark of aging on the muscle?
00:08:08.200 | It is atrophy of the type two muscle fiber.
00:08:11.440 | That's the hallmark.
00:08:12.440 | Fast twitch.
00:08:13.440 | Fast twitch muscle fiber.
00:08:14.440 | So if you want to understand what looks different in 50 year old Peter versus 18 year old Peter,
00:08:19.760 | it's not my type one fibers, it's my type two fibers.
00:08:22.640 | It's my fast twitch fibers.
00:08:23.640 | It's my explosive fibers.
00:08:24.640 | I mean, when I was 18 years old, I could vertical jump over 30 inches.
00:08:28.640 | Today, I'm lucky if I can vertical jump 24 inches and you know, and when I'm 60, boy,
00:08:36.200 | it's like my goal is to be able to vertical jump 60, uh, 20 inches when I'm 60 and I don't
00:08:40.240 | know if I'm gonna be able to do it.
00:08:41.240 | I've seen some videos of some, uh, 80 year old sprinters that are pretty impressive and
00:08:45.680 | certainly 80 year old gymnasts that are impressive.
00:08:48.480 | I've not seen very many videos of 80 year olds, um, dunking basketballs, for instance.
00:08:54.920 | Yeah.
00:08:55.920 | Who are not more, who are not, uh, taller than six feet, five inches.
00:09:00.120 | Yeah.
00:09:01.120 | Um, so, so when we lose, you know, our, so, so again, if you just think about size, strength,
00:09:08.600 | speed, we lose speed first.
00:09:11.440 | We lose speed, then strength, and the last thing you lose is size.
00:09:15.320 | So again, size is agnostic to fiber, right?
00:09:19.000 | You could, you could have big type one fibers and still have lots of size.
00:09:22.320 | They're not gonna be that strong and they're certainly not gonna be fast.
00:09:25.640 | So what I mean, like we could go through, we could spend hours on this particular topic,
00:09:30.920 | but I think the most important thing that people need to understand is you cannot age
00:09:35.600 | well if you are not doing the type of training that is there to strengthen and delay or minimize
00:09:42.960 | the hypertrophy of your type two fibers.
00:09:45.160 | So everything matters, right?
00:09:46.640 | You have to be doing your zone two.
00:09:48.480 | You have to be doing, you know, all of these other things, but some component of your training
00:09:53.480 | needs to be stressing the type two fibers.
00:09:55.720 | You have to be doing strength training that taxes those fibers.
00:09:59.600 | You have to be doing reactivity training.
00:10:01.920 | You have to be doing explosive training.
00:10:04.600 | And ideally, some training that involves jumping and landing.
00:10:07.720 | Well, jumping is a very big part of it.
00:10:09.520 | And landing is a very big part of another one of what I kind of think of as my four
00:10:13.240 | pillars of strength training.
00:10:15.360 | So one of the pillars of strength training is eccentric strength, which is breaks.
00:10:21.200 | So you know, you're gonna hurt yourself 10 times more likely, I'm making that number
00:10:28.240 | up by the way.
00:10:29.240 | I don't know if it's 10 times.
00:10:31.240 | Experientially it seems to be.
00:10:32.240 | You are 10 times more likely to hurt yourself stepping off something than stepping onto
00:10:37.360 | something, right?
00:10:38.640 | Stepping down versus stepping up.
00:10:42.040 | Because when you step up onto something, you are concentrically controlling the muscle.
00:10:47.520 | When you step down, you have to apply the breaks.
00:10:51.240 | And that's where most people falter.
00:10:53.440 | Much harder to walk downhill than uphill.
00:10:55.600 | Uphill is taxing your cardiovascular system.
00:10:58.080 | But if you slow down enough, you're fine.
00:11:00.320 | But a lot of people don't have the ability to slow themselves down when they're walking
00:11:03.280 | downhill.
00:11:04.280 | And so when an older person steps off a curb and can't fully stop themselves, and that
00:11:10.000 | results in a fall.
00:11:11.680 | So you know, I like doing things like a broad jump.
00:11:14.960 | Broad jump's a fun little test set I like to do every once in a while.
00:11:18.200 | I always want to make sure I can broad jump six feet.
00:11:20.360 | That's kind of my arbitrary number that I've chosen.
00:11:22.880 | And the reason is, on the takeoff, that's a very explosive movement.
00:11:27.200 | But the landing is just as important.
00:11:28.920 | If I can't stick that landing, it means I don't have the breaks.
00:11:32.600 | So those are kind of some of the tests I want to be able to do to make sure that I'm utilizing
00:11:37.440 | that system.
00:11:38.440 | Because I do think, you know, look, I've watched my mom.
00:11:42.000 | My mom fell, gosh, probably been about four months ago, just fell in a typical way that
00:11:48.280 | people fall.
00:11:49.280 | By the way, it could have happened to anybody.
00:11:50.800 | It's not like, you know, my mom walks around and moves around just fine.
00:11:54.160 | And this particular day, she just tripped on a uneven stone and fell and landed and
00:12:01.240 | broke her hand.
00:12:02.240 | And she's really lucky she didn't break her hip.
00:12:04.160 | And I told her that because my mom was, you know, probably in her mid-70s.
00:12:06.400 | And I said, look, you know, if that was your femur, I'd give you a 30% chance of dying
00:12:12.640 | in the next year.
00:12:13.640 | I mean, it's just an un... those are such difficult to recover from injuries.
00:12:18.040 | Because first of all, you're dealing with the immobility of, you know, the hospitalization
00:12:23.720 | and immobility that follows that.
00:12:25.400 | And the amount of muscle loss that occurs could easily be, you know, four or five pounds
00:12:32.920 | of lean tissue lost, that for most people that age, becomes almost impossible to get
00:12:37.280 | back.
00:12:38.280 | And that says nothing about sort of the acute causes of death, like a fat embolism that
00:12:42.200 | results from a broken femur, a blood clot from laying in bed.
00:12:45.080 | Those things are also catastrophic.
00:12:47.260 | But what happens is a lot of these patients just never get back to the same level of mobility.
00:12:52.600 | And you know, now I think in many ways, we're kind of pivoting from what kills you to what
00:12:56.960 | ruins your quality of life.
00:12:59.440 | And we've spent so much time talking about what kills you, but I think you might as well
00:13:05.440 | be dead in some ways if you can't do the things you want to do.
00:13:09.080 | And if playing with your grandkids or gardening or playing golf or going for a walk with your
00:13:14.480 | spouse or think of any of the things that we all do today and take for granted, if you
00:13:18.720 | can't do those things, I don't know, you sort of lose the reason to be around.
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