If you talk about true accidental deaths, automotive, uh, and falls and overdoses are the, are the three. That's basically what it comes down to. So you know, in our death bar analysis, we kind of list all this stuff out. In fact, I think that's actually one of the figures in the book is I have the accidental death, uh, figure that we've put together where we've adjusted by population and you'll see a couple of things.

If you look at it in absolute terms, it's basically a pretty constant. So regardless of what decade of life you're in, once you're above, you know, 20 accidental deaths are a pretty sizable number of, of deaths. Now car accidents seem to be pretty constant throughout life, little more common if you're under 60 than over 60, but they never go away.

I was told that, um, in teenage and boys and, and, uh, boys in their, in their early twenties, alcohol induced, uh, automotive fatalities would place them at, at this astronomic risk. Is that just not true? It's not true anymore compared to overdoses. Is that because young people now, um, aren't getting their driver's licenses.

I've also heard that. Yeah. Well, I think it's also because we're seeing such an uptick in the deaths that come from fentanyl. Got it. So fentanyl related deaths have basically squashed all other deaths below 65 on the accidental front. Really? Oh, it, it, it's not even close. Because of the number of different substances that fentanyl is being woven into.

It's winding its way into everything, right? So all counterfeit drugs, all illicit drugs, and look, most of the time you're not getting a lethal dose. So it's, you know, it's, it's, but, but you're getting lethal doses so often now that, um, well, you know, I did a little analysis actually the other day when I looked at how are deaths of despair increasing over the last five years.

So what did I define as a death of despair? Suicide, alcohol related death, or overdose. Accidental overdose. So we differentiate that from suicide where suicide is obviously deliberate and accidental is not. So if you just look at those three things, so accidental overdoses, suicides, and alcohol use, or alcohol related death, um, not including driving, by the way, this is like cirrhosis of the liver that comes from, that number is going up at almost 20% per year since 2019.

So the, I couldn't get 2022 numbers yet. So at the time of, the time I did this analysis, which was last week, um, the 2021 numbers was about 210,000 Americans. Goodness. Up from 180,000 in 2020 up from like 150,000 in 2019. So is this, um. And that is driven almost entirely by fentanyl use.

What other sorts of drugs are people buying? No, so the majority of people are dying from fentanyl poisoning. And I had a guy on my podcast recently named Anthony Hippolito and if anybody's interested in this topic, they really need to go listen to that. So Anthony. I watched the YouTube version of this and your podcasts are excellent.

So if you're interested in this, and I think everyone should be interested in this. If you have a child or know somebody who has a child, you just got to get this podcast into their hands because it's the most important public service announcement I'll probably ever do in terms of saving more lives potentially, um, where the majority of this is making its way into the, into the accidental poisonings is through illicit counterfeit pills.

So it's when kids are out there buying, you know, oxy, they want oxy. Well, they can't, they can't get real oxy, right? Because they're not going to go to a doctor and get real oxy. So they're going to buy it through, you know, Snapchat, right? They're going to buy it through some drug dealer that they're finding on social media.

Um, they're buying sleeping pills. They're buying all sorts of counterfeit stuff like Adderall. Many of these things are being laced with fentanyl. Adderall. Absolutely. Wow. I assumed the fentanyl. And again, the reasons are it's insanely cheap to use synthetic fentanyl. And secondly, and again, but the effects of fentanyl are nothing like the effects of Adderall.

So cocaine, um, doesn't make sense for that reason. Cocaine doesn't make sense either. Yep. And yet it's still showing up in cocaine. Again, I don't think that's the dominant place it's showing up. I would, I would guess that the dominant place it's showing up is in counterfeit opioids. So any opioid, barbiturate, any sedative, depressant.

Let me tell you what I'm telling my daughter, right? Because this is to me, it's a frontline problem. I have a 14 year old daughter. I'm like, listen, I don't care which friend of yours it is. I don't care how much she's amazing. If she tells you to try this sleeping pill because she took it the night before and it was really helpful or this will help you study better or this will help you do anything.

I'm like, just come to us. We've got a better pill for you, right? Like in other words, you can't trust anything because you don't know where she got it. She has the best of intentions I'm sure when she's given it to you. And by the way, she probably took it the night before and was just fine.

But the people who are making these pills are not exactly up to GMP standards. So you know, you just have no idea which pill is getting what dose of fentanyl. One thing that Anthony Hippolito told me that I simply couldn't believe I had to ask him six times was that some of these pills have like one milligram of fentanyl in them.

Now, I made the point on the podcast that a hundred milligrams of fentanyl for most people is a hit. Like they've like, I've had fentanyl before I've been in the hospital and I've had fentanyl. A hundred milligrams is like, wow, that is such a trip. Why are people dying from one milligram intake?

Respiratory inhibition. You can't breathe. That shuts the brainstem off. Well, I don't think we can highlight this enough. You know, adults are dying. Kids are dying. I met someone earlier this week who told me her 35 year old son died of an accidental fentanyl overdose and he wasn't, at least by her description, a drug addict or anything of that sort.

Yeah, this is, this is, we're talking about a different game now, right? So it's like, these are kids that have anxiety. These are kids that are, you know, are sort of addressing another issue with these, with these pills. And I think this, this whole concept of deaths of despair is, is, is a really important one.

But back to your question, what do, what do accidental deaths primarily amount to for, for the aging population? Again, it is so clear that it is fall related. This is where, um, once you hit 60, 65, the, the risk of a fall that results either immediately in death, you know, you hit your head and die, going back to like cerebral hemorrhage, or it is the straw that basically leads you down the path to death within the next 12 months, is astonishingly high.

It's so high that it's sort of hard to wrap your head around. But if you're over 65 and you fall and break your femur or hip, so you either crack the femoral neck or the femur itself, your 12 month mortality, the probability you will be dead in 12 months after that break, if you're 65 or older, depending on the study, is about 15 to 30 percent.

Wow. Wow. So in terms of offsetting the probability of falls, um, you talked a little bit about this, um, before, but I, uh, you and I have talked a little bit about this before, but maybe we could go a little bit deeper. Um, people's ability to jump and land seems to be highly correlated with one's ability to not fall or at least fall and control the fall in a way that, uh, leads to no or less severe injury.

Yeah. So Andy Galpin talked about this on your podcast, he talked about it on my podcast. What is the hallmark of aging on the muscle? It is atrophy of the type two muscle fiber. That's the hallmark. Fast twitch. Fast twitch muscle fiber. So if you want to understand what looks different in 50 year old Peter versus 18 year old Peter, it's not my type one fibers, it's my type two fibers.

It's my fast twitch fibers. It's my explosive fibers. I mean, when I was 18 years old, I could vertical jump over 30 inches. Today, I'm lucky if I can vertical jump 24 inches and you know, and when I'm 60, boy, it's like my goal is to be able to vertical jump 60, uh, 20 inches when I'm 60 and I don't know if I'm gonna be able to do it.

I've seen some videos of some, uh, 80 year old sprinters that are pretty impressive and certainly 80 year old gymnasts that are impressive. I've not seen very many videos of 80 year olds, um, dunking basketballs, for instance. Yeah. Who are not more, who are not, uh, taller than six feet, five inches.

Yeah. Um, so, so when we lose, you know, our, so, so again, if you just think about size, strength, speed, we lose speed first. We lose speed, then strength, and the last thing you lose is size. So again, size is agnostic to fiber, right? You could, you could have big type one fibers and still have lots of size.

They're not gonna be that strong and they're certainly not gonna be fast. So what I mean, like we could go through, we could spend hours on this particular topic, but I think the most important thing that people need to understand is you cannot age well if you are not doing the type of training that is there to strengthen and delay or minimize the hypertrophy of your type two fibers.

So everything matters, right? You have to be doing your zone two. You have to be doing, you know, all of these other things, but some component of your training needs to be stressing the type two fibers. You have to be doing strength training that taxes those fibers. You have to be doing reactivity training.

You have to be doing explosive training. And ideally, some training that involves jumping and landing. Well, jumping is a very big part of it. And landing is a very big part of another one of what I kind of think of as my four pillars of strength training. So one of the pillars of strength training is eccentric strength, which is breaks.

So you know, you're gonna hurt yourself 10 times more likely, I'm making that number up by the way. I don't know if it's 10 times. Experientially it seems to be. You are 10 times more likely to hurt yourself stepping off something than stepping onto something, right? Stepping down versus stepping up.

Because when you step up onto something, you are concentrically controlling the muscle. When you step down, you have to apply the breaks. And that's where most people falter. Much harder to walk downhill than uphill. Uphill is taxing your cardiovascular system. But if you slow down enough, you're fine. But a lot of people don't have the ability to slow themselves down when they're walking downhill.

And so when an older person steps off a curb and can't fully stop themselves, and that results in a fall. So you know, I like doing things like a broad jump. Broad jump's a fun little test set I like to do every once in a while. I always want to make sure I can broad jump six feet.

That's kind of my arbitrary number that I've chosen. And the reason is, on the takeoff, that's a very explosive movement. But the landing is just as important. If I can't stick that landing, it means I don't have the breaks. So those are kind of some of the tests I want to be able to do to make sure that I'm utilizing that system.

Because I do think, you know, look, I've watched my mom. My mom fell, gosh, probably been about four months ago, just fell in a typical way that people fall. By the way, it could have happened to anybody. It's not like, you know, my mom walks around and moves around just fine.

And this particular day, she just tripped on a uneven stone and fell and landed and broke her hand. And she's really lucky she didn't break her hip. And I told her that because my mom was, you know, probably in her mid-70s. And I said, look, you know, if that was your femur, I'd give you a 30% chance of dying in the next year.

I mean, it's just an un... those are such difficult to recover from injuries. Because first of all, you're dealing with the immobility of, you know, the hospitalization and immobility that follows that. And the amount of muscle loss that occurs could easily be, you know, four or five pounds of lean tissue lost, that for most people that age, becomes almost impossible to get back.

And that says nothing about sort of the acute causes of death, like a fat embolism that results from a broken femur, a blood clot from laying in bed. Those things are also catastrophic. But what happens is a lot of these patients just never get back to the same level of mobility.

And you know, now I think in many ways, we're kind of pivoting from what kills you to what ruins your quality of life. And we've spent so much time talking about what kills you, but I think you might as well be dead in some ways if you can't do the things you want to do.

And if playing with your grandkids or gardening or playing golf or going for a walk with your spouse or think of any of the things that we all do today and take for granted, if you can't do those things, I don't know, you sort of lose the reason to be around.