December 29, 2019

Mental health

Why is life expectancy in the US declining?

Midlife mortality and mental health.

Read Time 2 minutes

According to a new study in JAMA, life expectancy (LE) at birth stopped increasing since 2010 and actually decreased in the US for three consecutive years. To put this in perspective, the last time we saw three consecutive years of declining LE was 100 years ago, coinciding with the flu epidemic of 1918.

Perhaps surprisingly, increased mortality rates in midlife—defined rather broadly as 25-64 years old—are driving the stall, and eventual decline, in LE. Within this group, the largest increases in mortality rate occurred in the subset of people aged 25-34, and it was the increase in drug overdoses, suicides, and alcohol-related diseases that were identified as three key causes of death in this group. Between 1999 and 2017, midlife mortality from drug overdoses increased by nearly 400% (from 6.7 deaths/100,000 to 32.5), alcoholic liver disease increased by 40.6% (from 6.4 to 8.9), and suicide rates increased by 38.3% (from 13.4 to 18.6). This triad is referred to as “deaths of despair” by one research group.

While I certainly can’t do justice to the analysis provided in the 21-page review in a short email, I do believe it is difficult to ignore the relationship between mental and emotional health and declining quantity (and quality) of life. The review is somewhat surprising because many people think if we can just focus on reducing mortality from cancer, cardiovascular disease, and dementia, we’ll increase LE. There was certainly a day when I only focused on those causes of mortality.

I’ve had many guests on the podcast explore their struggles with mental and emotional health. (Click here to find podcasts and posts on the site related to this topic.) I highly suggest people listen to at least one of them, and I suspect that most will relate to the guest on some level. 

This recent study is a sober reminder that morbidity and mortality take many forms, and supports a point that we must be willing to accept: in today’s world, in the US at least, the deterioration of emotional health can often be more deleterious than the decline of physical health when it comes to longevity.

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  1. Peter, on the web site page of the interview you did with that researcher who has a new book on longevity and discusses sirtuins, I commented that when you said the reduced national life expectancy in the last few years was due to metabolic disease was not correct. I mention this now because I feel like you are making another mistake here by emphasizing the connection between the deaths of despair and mental and emotional health. There is a component for sure. But I think if you look into social determinants of health, that will yield more fruitful answers. Obviously this is not something you have focused on in your practice (that I know of at least). I say that not as a criticism but just acknowledging the reality. Let me add that the massive amount of work you have given us has no doubt benefited the less advantaged indirectly.

  2. I agree that morbidity and mortality take on many forms, yet I can’t help but think that a contributing factor to the increase in drug overdose, suicide, and alcohol-related disease in the 25-34 year old age group could be a life time of poor diet and lack of exercise (due to our dependence on computer devices and social media starting in youth). I wonder if there are any studies looking at lifestyle factors in this subset? Just thinking about the extreme difference of my childhood and others my age in the amount of physical activity we engaged in (quite literally all day outside of school), along with less processed food; compared to the amount of time kids and young adults are now “plugged in”, sedentary, and raised on subpar diets. I don’t mean to over-simplify, but I think we can all agree that diet and exercise plays a big part in mental health and addiction. There’s a plethora of information on the subject out there; here’s a decent article with several links to studies: https://www.health.harvard.edu/blog/nutritional-psychiatry-your-brain-on-food-201511168626
    It just seems that this age group is at the apex of a generation raised on bad food (often deceptively so with packaging duping the well intentioned), and social media.
    Thanks for all you do, Dr. Attia

  3. This perfectly aligns with Dr. Robert Lustig’s recent book, The Hacking of the American Mind. There is an epidemic of depression and addiction instigated by the pervasive and purposeful confusion between pleasure and happiness, between dopamine and serotonin, between fulfilling cravings and finding contentment. Pleasure does not equal happiness. He goes over some real, practical strategies for finding contentment in a world driven by pleasure-seeking. Pleasure-seeking drives capitalism forward, so it will always be a go-to for anyone trying to maximize profits; however, when in overdrive, it destroys contentment and instigates depression and addiction. Neurons can only handle so much dopamine before they downregulate in order to prevent cell death, requiring higher and higher doses for the same reward. Additionally, excessive dopamine suppresses serotonin production. We would all do well to read this book and apply his advice in whatever form we need to in our lives.

  4. Very close to Dr. Perlmutter observations and specially his bibliography on the subject, our Microbiota -well directed by a careful nutrition- focused specifically on neural support could be the key to a redundant ‘healthy’ mental health, preventing depression, dementia and naturally the need of addictions and suicides. Coming from a ‘weak mental health family’, for 40 years I have kept my suicide (KCl-morphine) in my night table, which constitutes ‘a mental insurance’. For 15 years y have lived on 30gr a day of resistant starches and plenty of saturated fat and protein (though ‘protein metabolism’ produces aggressive metabolites the ‘Citric Cycle’, which affect lymphatic system and demand many antioxidants (A system epi-genically degraded since Paleolitic). These has been the experience of hundreds of my patients, under this disciplined treatment, only one death at 97, after surviving ten years of a heavy fibromyalgia, (death of simple ∑organic decay). The key element is this ‘bread of life’ directed to a ‘deep-nutrition’; and naturally no human invented carbs of any kind. I am totally healthy now at 80 capable of running an holding my breath for more than a minute at 8000’ in Bogota, reconstructing organs (as the center of my right macula or prostate). We are much stronger than what we think. Medice (Frenchfries eaters) cura te ipsum.

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