#096 如何通过高强度间歇训练、按昼夜节律进食和睡眠改善代谢健康

你即将听到的这一集，是我在2024年5月于佛罗里达州棕榈滩举行的美国抗衰老医学学会会议上所做的一场演讲，我在其中分享了我优化代谢健康的三大策略。

The episode you're about to listen to is a presentation I gave at the American Academy of Anti Aging Medicine Conference in Palm Beach, Florida, last May 2024, where I discussed my top three strategies for optimizing metabolic health.

第一，高强度间歇训练，也就是HIIT。

Number one, high intensity interval training or HIIT.

第二，根据昼夜节律安排进食时间。

Number two, circadian timed eating.

第三，优化优质睡眠。

And number three, optimizing good sleep.

我还会讨论如何实施这些策略，以及它们对代谢健康的强大影响。

So I'd also discuss how to implement these and the powerful effects they have on metabolic health.

在演讲中，我讲解了为什么高强度间歇训练在改善代谢健康方面优于中等强度运动，高强度训练产生的乳酸积累如何有益于血糖平衡，以及改善身体成分的最佳高强度间歇训练条件。

In the presentation, I cover why high intensity interval training outshines moderate intensity exercise for improving metabolic health, how lactate accumulation from higher training intensity benefits glucose homeostasis, The optimal high intensity interval training conditions for improving body composition.

剧烈运动如何通过一种叫做线粒体自噬的过程促进线粒体修复。

How vigorous exercise boosts mitochondrial repair through a process called mitophagy.

基于证据的HIIT方案，比如TABATA、温盖特一分钟全力训练加一分钟休息，以及挪威的4×4训练法。

Evidence based HIIT protocols like TABATA, Wingate one minute on, one minute off, and the Norwegian four by four.

为什么仅仅做10次深蹲，在改善血糖稳态方面比散步45分钟更有效。

How just 10 reps of doing squats are more powerful at improving glucose homeostasis than a forty five minute walk.

如何通过运动零食来改善餐后血糖调节。

How to improve postprandial glucose regulation with exercise snacks.

为什么你应该在睡前3小时停止进食，为什么高正常血糖水平可能加速海马体萎缩，即使是轻度睡眠限制也会产生类似2型糖尿病的代谢特征，为什么仅仅多睡1小时可能有助于减肥，如何降低每晚睡眠不足7小时带来的死亡风险增加，以及更多内容。

Why you should stop eating three hours before bed, why high normal glucose levels might accelerate atrophy in the hippocampus, how even mild sleep restriction creates a metabolic profile similar to type two diabetes, why just one hour of extra sleep might help you lose weight, how to ameliorate the increased mortality risk associated with sleeping less than seven hours a night, and much more.

在你听这个演讲时，有一个我没有涵盖但认为对长寿有巨大益处的生活方式策略是补充Omega-3。

As you listen to this presentation, one of the lifestyle strategies that I don't cover but still think has an outsized benefit for our longevity is omega-three supplementation.

Omega-3脂肪酸不仅对神经发育和认知功能至关重要，还能降低心血管死亡率、抑制慢性炎症，并普遍支持健康老龄化。

Omega-three fatty acids are essential not only for neurodevelopment and cognitive function, but also for reducing cardiovascular mortality, dampening chronic inflammation, and generally supporting healthy aging.

然而，全球超过90%的人口没有达到推荐的Omega-3摄入量。

Yet more than ninety percent of the global population does not meet the recommended intake levels for omega-3s.

对大多数人来说，简单的解决方案是服用补充剂。

The easy solution for most people is to take a supplement.

然而，选择高质量的补充剂可能是一项艰巨的任务。

However, choosing a quality supplement can be a daunting task.

所以我们准备了一份13页的关于欧米伽-3补充剂的全面指南，涵盖了如何选择高质量的欧米伽-3补充剂，包括纯度、新鲜度、不同形式欧米伽-3的生物利用度，以及能将欧米伽-3指数提升到与延长五年寿命相关的水平的剂量策略。

That's why we've prepared a 13 page comprehensive guide on omega-three supplementation that covers how to choose a quality omega-three supplement, including factors like purity, freshness, the bioavailability of the different forms of omega-three, and dosing strategies that can elevate the omega-three index to a level that's linked to a five year increase in life expectancy.

我们还提供了一些在第三方消费者测试中表现良好的欧米伽-3补充剂品牌，这些品牌是根据氧化程度和浓度等关键因素进行评估的。

We also provide a selection of a handful of omega-three supplement brands that have scored positively on third party consumer tests, which were evaluated based on key factors like oxidation and concentration.

你可以在fmfomega3guide.com免费下载这份指南。

You can download this free guide at fmfomega3guide.com.

再说一遍，网址是fmfomega3guide.com。

One more time, that's fmfomega3guide.com.

那么，希望你们喜欢这次演讲。

On that note, I hope you enjoy this presentation.

很高兴来到这里。

So glad to be here.

我要感谢A4M的组织者邀请我来演讲。

I wanna thank the organizers at a four m for inviting me to speak.

去年十二月我在长寿节上做过演讲。

I spoke at longevity fest last December.

那真是太棒了。

It was amazing.

所以今天能在这里和大家聊代谢健康，我特别兴奋。

So I'm super pumped to be here today talking all about metabolic health.

我们会重点讨论我认为对代谢健康影响很大的三个主要生活方式因素。

And we're really gonna we're gonna focus on what I think are three major lifestyle factors that can play a pretty big role in metabolic health.

我们要聊的是——抱歉，这个是不是没反应？

So we're going to be talking about sorry, is this not working?

好，我们会聊高强度间歇训练，这是一种非常省时间的锻炼方式，能提高心率，改善胰岛素敏感性、血糖稳态、葡萄糖转运和线粒体功能。我们还会聊一下可以巧妙安排时间的“运动零食”，这对血糖稳态有很重要的作用。

All right, we'll be talking about high intensity interval training, which is a very time efficient way to, get your heart rate up to improve insulin sensitivity, glucose homeostasis, glucose transport, mitochondrial function, and we're going to talk a little bit about exercise snacks that can be strategically timed and how that can play a profound role in glucose homeostasis.

我们会聊根据生物钟安排进食，比如为什么避免深夜进食很重要，褪黑素对胰岛素的影响，限时进食，以及生物钟紊乱的问题。然后我们会进入睡眠话题，聊睡眠不足对代谢健康的深远影响，以及一些可以改善代谢健康的行为调整。

We're going to talk about circadian timed eating, so why it's important to avoid late night eating, what the effects of melatonin are on insulin, time restricted eating, and circadian misalignment, then we're going to jump into sleep and the profound metabolic effects of sleep restriction on metabolic health, as well as some behavioral changes that can be implemented to improve metabolic health.

那我们先从高强度间歇训练开始。

So let's start with high intensity interval training.

就像我提到的，这是一种非常省时间的提高心率和锻炼的方式，它包含非常短时间的高强度运动。

So as I mentioned, this is a very time efficient way to get your heart rate up and exercise, so it involves very short bouts of intense exercise.

首先，我们要说的是心率至少要达到最大心率的75%，然后跟着是恢复期。

One, we're talking about heart rate up at at least 75% max heart rate, followed by periods of recovery.

我们会讨论很多不同的训练方案，但已经有很多研究表明，高强度间歇训练可以改善血糖稳态、提高胰岛素敏感性，还能减少脂肪、改善身体成分，并增强线粒体功能。

There's a lot of different protocols we're going to discuss, but there have been lots of studies talking and showing that high intensity interval training can improve glucose homeostasis, insulin sensitivity, it also decreases fat mass, improves body composition, and enhances mitochondrial function.

一项包含50个随机对照试验的荟萃分析，比较了高强度间歇训练和中等强度持续运动。

So a meta analysis of 50 different randomized controlled trials compared high intensity interval training to moderate intensity continuous exercise.

中等强度持续运动就是强度较低的运动，那种你能边运动边聊天，但可能还有点喘的程度，有时也叫二区训练，这种运动持续时间更长。

So this would be exercise that's at a lower intensity, the kind of intensity where you can have a conversation, but you're maybe still breathy, sometimes called zone two, and this is a longer duration type of exercise.

在降低胰岛素抵抗方面，高强度间歇训练比中等强度持续运动效果更好。

So high intensity interval training outperforms moderate intensity continuous exercise at decreasing insulin resistance.

它还能改善糖化血红蛋白水平，这是反映长期血糖升高的生物标志物。

It also improves HbA1c levels, so the long term biomarker for elevated blood glucose levels.

它还能让体重下降，并且显著降低空腹血糖水平。

It leads to a decrease in body weight, and also significantly lowers fasting blood glucose levels.

再说一遍，这是50个随机对照试验的结果。

Again, this is 50 different randomized controlled trials.

还有另一项对许多随机对照试验的系统回顾也发现，高强度间歇训练在改善心肺功能、舒张压和收缩压、高密度脂蛋白、甘油三酯和空腹血糖、降低氧化应激、改善脂联素和胰岛素敏感性以及β细胞产生胰岛素的功能方面，都优于中等强度持续运动。

And another systematic review of many different randomized controlled trials has found that again, high intensity interval training outperforms moderate intensity continuous exercise at improving cardiorespiratory fitness, improving diastolic and systolic blood pressure, improving HDL, triglycerides, and fasting glucose, lowering oxidative stress, improving adiponectin and insulin sensitivity, as well as beta cell function to produce insulin.

它能增加PGC1α，这是线粒体生物合成的标志物，我们稍后会讨论这个。

It increases PGC1 alpha, which is a biomarker for mitochondrial biogenesis, which we'll be discussing in a little bit.

它还能改善心脏功能，这些效果都比中等强度持续运动要好。

And it also improves cardiac function, and this is all better than moderate intensity continuous exercise.

所以这真的为人们提供了一个省时高效的方式来改善代谢健康。

So it really provides a opportunity for people to have a time efficient way of improving metabolic health.

部分原因是，当你的心率升高，当你付出努力时，你给线粒体和肌肉施加了很大的压力，而线粒体无法快速产生足够的能量来满足需求。

And part of that is because when you get your heart rate up high, when you are putting in the effort, you are you're putting a strong stress on your mitochondria and your muscle, and your mitochondria are unable to produce energy quick enough to keep up with the demand.

所以你的肌肉细胞会转向通过糖酵解利用葡萄糖作为能量来源，这最终会产生乳酸，以前人们认为乳酸是代谢的副产品。

And so your muscle cells shift to using glucose as a source of energy through glycolysis, and that ends up producing lactate, which was thought to be a byproduct, a metabolic byproduct.

嗯，几十年前，博士。

Well, decades, a couple of decades ago, Doctor.

加州大学伯克利分校的乔治·布鲁克斯是率先发现运动产生的乳酸绝非副产品的先驱之一。

George Brooks at the University of California in Berkeley, was one of the pioneers to find that lactate generated from exercise is anything but a byproduct.

静息状态下的乳酸水平低于一毫摩尔，当你加大运动强度时，乳酸水平可以升到十五到十七毫摩尔，这些乳酸进入血液循环，被其他器官利用。

So steady state lactate levels are less than one millimolar, when crank up the intensity of exercise, you can go anywhere up to fifteen, seventeen millimolar, and that lactate gets in circulation and it's consumed by other organs.

它会进入大脑、心脏，回到肌肉，去肾脏，去肝脏，作为一种非常可用的能量来源。

It goes into the brain, it goes into the heart, it goes back into the muscle, it goes to the kidneys, it goes to the liver, and it's serving a very utilizable source of energy.

所以乳酸可以被利用，你知道，转化为乙酰辅酶A，然后被线粒体用作能量。

So lactate can be used, you know, and converted into acetyl CoA and used by energy by the mitochondria.

但它最重要的作用之一可能是作为信号分子。

But probably one of its most important roles is as a signaling molecule.

这是你的肌肉与其他器官和组织沟通联系的一种方式。

It's a way for your muscle to connect to communicate with other organs and other tissues.

它的一个信号作用是在肌肉内部，它增加了葡萄糖转运蛋白向肌肉细胞表面的转运，即GLUT4转运蛋白。

And one of its signaling roles is back in the muscle, it's increasing the translocation of glucose for transporters to the cell surface of the muscle, GLUT-four transporters.

所以乳酸回到肌肉，基本上是在告诉肌肉：嘿，我们这里消耗大量葡萄糖来获取能量，所以我们需要更多的葡萄糖进来，而它通过增加肌肉中的GLUT4转运蛋白来实现这一点。

And so lactate gets back into the muscle, it's basically telling the muscle, hey, we're using a lot of glucose here for energy, so we need to bring more glucose in, and the way it does it is by increasing GLUT-four transporters at the muscle.

我提到过，在剧烈运动期间乳酸水平会升高，但这是非常短暂的。

And I mentioned lactate levels go up during this intense exercise, that's very transient.

所以大约二十分钟后，当运动停止时，你的乳酸水平会回到基线，因为包括肌肉在内的所有这些其他器官都在快速消耗它。

So after about twenty minutes, when exercise stops, your lactate levels go back to baseline because all these other organs, including the muscle are consuming it so quickly.

然而，葡萄糖转运蛋白的增加会保持升高长达48小时，其中前24小时效果最为显著。

However, the increase in glucose for transporters stays, you know, elevated for up to 48 with the first twenty four hours being the most robust.

所以你会从乳酸向肌肉发出的信号中获得长期效果，以增加GLUT4转运蛋白。

So you're getting a long term effect from that signaling from lactate back to the muscle to increase GLUT-four transporters.

这就是为什么高强度间歇训练在改善葡萄糖稳态方面如此有效和强大。

And that is why high intensity interval training is so potent and powerful at improving glucose homeostasis.

还有一项对36项随机对照试验的荟萃分析，研究了高强度间歇训练改善身体成分的最佳条件。

So there was an another meta analysis of 36 randomized controlled trials that were looking at optimal conditions of high intensity interval training for improving body composition.

研究发现，高强度间歇训练（HIIT）的最佳持续时间是八周，以改善身体成分。

And so it's been identified that the duration of of of the HIIT workout, high intensity interval training workout, eight weeks is optimal for for improving body composition.

频率是每周至少三次，间隔是六十秒或更短的剧烈运动，然后大约九十秒的恢复。

The frequency is at least three sessions a week, and the intervals are sixty seconds of sixty seconds or less of the robust intense, you know, interval, followed by about ninety seconds of recovery.

这会导致脂肪量的减少。

And this leads to improvements in reducing fat mass.

在这方面，骑自行车和跑步效果最好。

Cycling and running was the best at doing that.

还有改善体脂率，也就是减少体脂，跑步效果最好；而增加去脂体重，包括肌肉，实际上骑自行车效果最好。

Also improving percent body fat, so body fat reduction, and that was the best with running, and then increasing fat free mass, which includes muscle, and the best at that was actually cycling.

这些就是高强度间歇训练在改善身体成分方面的一些最佳条件。

So these are some of the optimal conditions for improving body composition with respect to high intensity interval training protocols.

接下来我们要讨论高强度间歇训练如何调节线粒体功能，但在此之前，我觉得有必要认识到，代谢综合征、胰岛素抵抗、肥胖和二型糖尿病患者，其线粒体功能已经出现相当严重的失调。

We're going to talk about how high intensity interval training can regulate mitochondrial function, but before we talk about that, I think it's important to recognize that people with metabolic syndrome, insulin resistance, obesity, and type two diabetes have been identified to have pretty profound dysregulated mitochondria.

多项研究发现，二型糖尿病和肥胖患者骨骼肌中的线粒体，其呼吸能力比没有二型糖尿病或偏瘦人群的骨骼肌细胞低约40%。

So the mitochondria and skeletal muscle from people with type two diabetes and obesity have been found in multiple studies to respire about 40% less than skeletal muscle cells from people that do not have type two diabetes or people that are lean.

所以他们的线粒体功能失调，后续研究还发现了线粒体结构上的缺陷。

So their mitochondria are dysfunctional, and subsequent studies have also identified structural defects in the mitochondria.

二型糖尿病患者的线粒体是碎片化的。

So mitochondria from people with type two diabetes are fragmented.

正常情况下，线粒体形成一个非常紧密的网络，看起来像意大利细面，那是一个很漂亮的线粒体网络，能够高效地进行呼吸和发挥功能。

So mitochondria are typically, they form a very connected network that sort of look like vermicelli spaghetti, and that's a really beautiful network of mitochondria that, you know, are able to undergo respiration and do their functions, quite robustly.

当线粒体变得非常碎片化时，它们就功能失调了，它们无法很好地利用甚至产生能量，而且它们基本上正在走向死亡，并导致细胞死亡。

When mitochondria become really fragmented, they are dysfunctional, they can't, you know, utilize or even produce energy very well, and they're on their way to basically dying and causing cells to die.

所以线粒体的结构和功能之间有着非常紧密的联系。

So there's a very intricate connection between structure of mitochondria and the function of mitochondria.

这一点很重要，因为剧烈运动、高强度运动已被证明能增加线粒体的修复过程，即线粒体自噬。

And that's important because vigorous exercise, high intensity exercise has been shown to increase this repair process in mitochondria known as mitophagy.

所以当运动强度足够大时，它会激活营养感应蛋白AMP激酶，也就是AMPK，这会让线粒体发出需要自我修复的信号。

So when exercise is intense enough, it increases the nutrient sensing protein AMP kinase, AMPK, it activates it, and this causes the mitochondria to send the signal that they need to repair themselves.

线粒体可能有点功能失调，也可能严重功能失调。

And so mitochondria can be sort of dysfunctional or they can be really dysfunctional.

线粒体自噬可以清除整个功能失调的线粒体，将其回收利用，也可以清除功能失调线粒体的部分片段。

So mitophagy can clear away an entire dysfunctional mitochondria to be used and recycled, or it can clear away pieces of a dysfunctional mitochondria.

所以当你进行急性运动时，如果你的线粒体有功能失调的，线粒体自噬通路就会被激活，线粒体会分裂，受损的部分会通过溶酶体被回收，长期来看，经过规律的高强度运动，你会拥有更多健康、功能正常的线粒体，因为你只是清除了受损的部分。

So when that when you're doing that acute exercise, your mitochondria, if you have a dysfunctional one, the the mitophagy pathway gets activated and the mitochondria fizzes off, it kind of goes to this mitochondrial fission process, and that damaged part of the mitochondria then goes and is recycled through the lysosome, and then what you have is a long term effect of after doing, you know, routine high intensity exercise, you then have more healthy functional mitochondria because you're just getting rid of the damaged part of the mitochondria.

如果线粒体功能失调得足够严重，你就会清除整个线粒体。

If the mitochondria is dysfunctional enough, you're going to get rid of the whole mitochondria.

顺便说一下，AMP激酶通路，很多人可能在想，哦，那是个营养感应通路，在禁食期间会被激活。

And by the way, the AMP kinase pathway, many of are probably thinking, oh well that's act that's a nutrient sensing pathway, it's activated during periods of fasting.

确实是这样。

And that is true.

AMP激酶在禁食期间会被激活，而禁食是诱导自噬和线粒体自噬的强力信号。

AMP kinase is activated during periods of fasting, and fasting is a powerful signal for inducing autophagy and mitophagy.

不过，在这项特定的研究中，那些做了三十分钟高强度剧烈运动的人，不管他们是否禁食了十六个小时，线粒体自噬都没有差异。

However, in this particular study, people that did this high intensity vigorous exercise for thirty minutes, it did not matter if they had fasted for sixteen hours or not, there was no difference in the mitophagy.

换句话说，运动本身就是一个非常强烈的激活线粒体自噬的信号，以至于即使他们没有禁食十六个小时也没关系，因为运动太强了。

So in other words, the exercise itself was such a strong signal for activating mitophagy that it didn't matter if they had not fasted for sixteen hours, because it was so powerful.

除了修复过程，高强度间歇训练是最能促进线粒体生物发生的运动方式之一，也就是新线粒体的生长，增加线粒体体积，所以你有双重效果：一方面修复线粒体，清除不健康的部分，另一方面促进新线粒体的生长。

On top of the repair process, high intensity interval training is one of the most robust exercise modalities that can increase mitochondrial biogenesis, so the growth of new mitochondria increasing mitochondrial volume, so you're having this double whammy effect where you're getting repairing of the mitochondria, getting rid of the unhealthy parts, and then you're increasing the growth of new mitochondria.

高强度间歇训练之所以比中等强度持续运动更能促进线粒体生物发生，原因之一就是剧烈运动产生的乳酸是一种信号分子，能激活一种在骨骼肌中调节线粒体生物发生的蛋白质，也就是PGC1α。

So one of the reasons high intensity interval training is very good at increasing mitochondrial biogenesis compared to let's say moderate continuous exercise is because lactate that's generated from that vigorous exercise is a signaling molecule to activate the protein that very much regulates mitochondrial biogenesis and skeletal muscle, PGC1 alpha.

所以再说一遍，乳酸在扮演信号角色，它由肌肉产生，又被肌肉吸收，然后与肌肉沟通，它说，嘿，我们无法快速产生足够的能量，因为运动太剧烈了，我们需要更多的线粒体来做到这一点。

So again lactate is playing that signaling role, it's generated by the muscle, it's taken back up by the muscle, and then it's communicating with the muscle, it's saying, hey we can't make energy fast enough because this exercise is so intense, we need more mitochondria to be able to do that.

所以这是对高强度运动的一种适应，这种适应就是产生更多的线粒体，这显然不仅对二型糖尿病、代谢综合征、肥胖症患者非常有益，对所有人也都是如此。

So it's an adaptation to the vigorous intensity exercise, and that adaptation is making more mitochondria, which is obviously very beneficial for not only people with type two diabetes, metabolic syndrome, obesity, but also everybody.

线粒体生物发生能提高线粒体的能量效率，同时还与其他好处相关，比如减少肌肉萎缩和改善运动耐力。

So mitochondrial biogenesis improves energy efficiency in mitochondria, and also is associated with other benefits like decreased atrophy and improved exercise endurance as well.

所以增加线粒体生物发生有一大堆好处。

So there's a whole host of benefits with increasing mitochondrial biogenesis.

在这些系统分析和荟萃分析中使用的许多高强度间歇训练方案，都是基于证据的HIIT方案。

So a lot of the high intensity interval training protocols that were used in these systematic analysis and these meta analyses were, evidence based HIIT protocols.

Tabata就是其中之一，它是20秒运动、10秒休息的间隔，20秒内以你能达到的最高强度全力冲刺，然后休息10秒，这样重复8次，总共4分钟的训练。

So Tabata is one that's used, that's a twenty second on, ten second off interval, twenty seconds at the highest intensity you can do, you're going all out, and then you're resting for ten seconds, and that's repeated eight times for a total of a four minute workout.

在某些情况下，Tabata方案会重复两次。

In some cases, the Tabata protocol was repeated twice.

Wingate，也就是冲刺间歇训练，是另一种非常常用的方案，就是30秒全力冲刺，然后进行4分钟低强度的主动恢复，这样重复4到6次，大约20分钟左右的训练。

The Wingate, hot hit protocols, another very commonly used one, and that is a thirty second all out sprint, followed by four minutes of active recovery where you're low intensity, and then you do that four to six times, that's about a twenty minute or so workout.

还有传统方案，就是1分钟运动、1分钟休息，以你能达到的最大强度运动1分钟，然后有1分钟非常轻松的主动恢复，这样重复10次，总共20分钟的训练，这很辛苦，但对改善各种代谢指标非常非常有效。

And then there's the conventional workout, it's the one minute on, one minute off, so you're going as intense as you can for one minute, and then you have one minute of very light active recovery, and then you repeat that 10 times, that's a twenty minute workout, it is hard, but it's very, very effective at improving a variety of metabolic parameters.

还有一种临床训练，也叫挪威4x4，我喜欢这么叫它，因为挪威滑雪队经常用这种HIIT训练法。就是四分钟高强度间歇，你尽全力做四分钟，然后轻松恢复三分钟，非常轻松地让心率降下来，这样重复四次，总共大约二十五分钟。

And then there's the clinical workout also known as the Norwegian 4x4, which I like to call it because the Norwegian ski team often uses this HIIT protocol for their training, it's a four minute interval where you're going as intense as you can for four minutes, and then you have light recovery for three minutes, so you're going very, very light getting your heart rate down, and that's repeated four times, so it's about a twenty five minute workout.

那我们再聊聊运动零食，这也是一种高强度间歇训练。

So let's just talk a little bit about exercise snacks, which is a type of high intensity interval training workout.

它就是在高强度下做点什么，你知道的，让心率达到高强度水平，持续一到两分钟。

It involves doing something at vigorous intensity, you know, a vigorous intensity heart rate for one to two minutes.

之所以叫运动零食，是因为你可以在一天中随时做。

And they're often called exercise snacks because you can just do them whenever throughout the day.

我觉得这特别有意义，因为我几周前刚看到一项研究，说每四十五分钟做十个自重深蹲，对改善血糖稳态的效果比走三十分钟还明显。

And I think this is a very relevant because I just came across a study a couple of weeks ago that showed 10 body weight squats, okay 10 for every forty five minutes was more powerful at improving glucose homeostasis than a thirty minute walk.

所以我觉得这很能说明问题，因为站起来做十个自重深蹲有多容易，对吧，每四十五分钟一次。

So I feel like that is, it's just it kind of puts it in context, because how easy is it to get up and do 10 body weight squats, right, every 45.

没有比这更简单的了。

I mean it doesn't get easier than that.

而且，还有理由把这些运动零食安排在特定时间，比如饭前三十分钟到一个小时，或者饭后三十分钟到一个小时。

And there's also a reason to strategically time these exercise snacks either thirty minutes to an hour before a meal, or thirty minutes to an hour after a meal.

所以，关于这些运动零食的时机，在几项针对二型糖尿病或胰岛素抵抗患者的研究中已经证明，确实能改善他们餐后的血糖调节。

So the timing of these exercise snacks has been shown in several studies in people with type two diabetes or insulin resistance to really improve their glucose regulation after a meal.

也就是说，他们餐后的血糖调节和葡萄糖处理能力都得到了改善。

So their postprandial glucose regulation and their glucose disposal was improved.

再说一次，因为进行高强度运动时会产生乳酸，这会增加肌肉中的GLUT4转运体，然后促使葡萄糖进入肌肉，这样就减轻了胰腺产生胰岛素的负担，从而改善了血糖稳态。

Again, because getting that high intensity exercise when you're generating some lactate, it's increasing GLUT-four transporters of the muscle, and that is then you know causing glucose to come into the muscle, it's low in the burden of your pancreas to have to produce insulin, and it's improving glucose homeostasis.

所以，在餐前或餐后做点运动零食，是改善餐后血糖调节和血糖稳态的简单方法。

So exercise snacks around meals, is an easy way to improve postprandial glucose regulation and glucose homeostasis.

这对二型糖尿病患者显然非常重要，但我觉得对每个人来说也都很重要。

It's obviously very relevant for people with type two diabetes, but also I think for everyone.

运动零食还与全因死亡率的降低有关。

Exercise snacks has also been associated with a decrease in all cause mortality.

有一些基于英国生物银行数据的大型研究，参与者佩戴加速度计，这些研究属于剧烈间歇性生活方式活动研究，简称VILPA。

So there have been very large studies, out of The UK biobank data where people are wearing accelerometers, and, they're part of the vigorous intensity, sorry vigorous intermittent lifestyle activity studies that have been done, VILPA they're called.

这些研究发现，那些进行一到两分钟剧烈运动的人，比如不坐扶梯而是跑着上楼梯，或者走楼梯上去，这样的活动。

And what those studies have identified is that people that do one to two minutes of vigorous intensity exercise, and these are things like just sprinting up the stairs rather than taking the escalator or walking up the stairs.

他们每天做三次，每次一到两分钟的高强度爆发运动。

And they do this, there's like a one to two minute high intensity burst, and they do this three times a day.

这与心血管疾病死亡率降低百分之五十相关，降低百分之五十。

That's associated with a fifty percent reduction in cardiovascular related mortality, fifty percent reduction.

这也与癌症相关死亡率和全因死亡率降低百分之四十相关。

It's also associated with a forty percent reduction in cancer related mortality and all cause mortality.

所以癌症、心血管疾病，这些都是与代谢紊乱相关的疾病。

So cancer, cardiovascular disease, these are all diseases that are associated with metabolic dysregulation.

所以，我认为实施运动零食是获得一点锻炼、提高心率、产生乳酸、增加葡萄糖转运蛋白的最简单方法之一，同时也能改善心情，打破久坐时间。

So implementing exercise snacks, I think is one of the easiest ways to get, you know, get a little bit of exercise, get your heart rate up, get that lactate generated, increase your glucose transporters, but also just improve your mood to break up your sedentary time, you know.

在办公桌前坐几个小时就是久坐，而久坐是某些疾病（如癌症）的独立风险因素。

So being sitting at your desk for a couple of hours is sedentary, and being sedentary is an independent risk factor for certain diseases like cancer.

我们都已经坐在这里至少一个小时了。

So I mean we've all been sitting here for what an hour at least.

我建议我们站起来，做一分钟的自重深蹲。

I say we get up and we do a minute of body weight squats.

自重深蹲。

Body weight squats.

好的。

All right.

准备好了吗？

Ready?

好。

Okay.

我来开个计时器。

I'm gonna get this timer going.

我们要做整整一分钟。

We're gonna do a whole minute.

我帮你省了高抬腿。

I'm saving you the high knees.

好，开始吧。

All right here we go.

那我们就来做自重深蹲。

So we're gonna do body weight squats.

我们要把心率提上去，做一分钟。

We're gonna try to get the heart rate up and we're gonna do it for one minute.

如果可以的话，尽量蹲低一点。

Try to go low if you can.

你会感觉到大腿前侧有灼烧感。

You wanna feel the burn in your quads.

我往旁边挪一下。

I'll go sideways there.

继续。

Keep going.

我们连三十秒都还没到呢。

We're not even at thirty seconds yet.

好。

Okay.

我们已经做了一半了。

We're halfway.

你们的心率上来了吗？

Are you guys getting your heart rate up?

你们有感觉吗？

Are you feeling it?

还剩十五秒。

Fifteen seconds left.

五、四、三、二。

Five, four, three, two.

好了。

Alright.

有点喘，但感觉不错，促进了大脑的血液循环，但更重要的是，GLUT-4转运蛋白。

So a little out of breath, feeling good, increase the blood flow to the brain, but more importantly, GLUT-four transporters.

好的。

Okay.

那我们换个话题，来聊聊昼夜节律和进餐时间的关系。

So we're gonna shift gears, and we're gonna talk a little bit about circadian meal timing.

好。

Alright.

行。

Okay.

大家都知道昼夜节律吧，我们都是昼行性动物，白天更活跃，晚上就不那么活跃了，对吧？

So as everybody here knows about circadian rhythm, we're all diurnal creatures here, more active during the day, less active in the evening, right?

我们的新陈代谢也是跟着昼夜节律走的。

Our metabolism is also on a circadian rhythm.

早上我们对胰岛素更敏感，到了晚上，敏感度就降低了。

We are more insulin sensitive earlier in the day, and later in the evening, less insulin sensitive.

关于这一点，我想讲一个研究，我觉得它在说明一天中胰岛素敏感性和血糖调节方面挺有说服力的。

Part of that, so let me talk about a study that I think is pretty telling in terms of insulin sensitivity and glucose regulation throughout the day.

研究人员让参与者在早上、下午或晚上吃完全相同的餐食，就是宏量营养素组成一样，热量一样，所有东西都一样。

So participants were given the same exact meals in the morning, in the afternoon, or in the evening, okay, so same macronutrient composition, same caloric content, everything the same.

参与者在早上吃第一餐时，胰岛素敏感性比晚上那一餐要高得多。

And participants were much more insulin sensitive in their first meal given in the morning compared to their evening meal.

我觉得这有一部分跟我们的昼夜节律有关，而且随着一天时间变晚，褪黑素也会起作用。

And I think part of this has to do with our circadian rhythm, and as we get later in the day, melatonin.

大概在2000年代初，也就是2009年左右，遗传学领域开始涌现出很多研究，发现褪黑素受体1B的某种变异是发展成2型糖尿病和胰岛素调节紊乱的一个相当高的风险因素。

So back in like the early 2000s, about 2009, a lot of studies started coming out in the genetics world where the variation, a certain variation in the melatonin receptor 1B was identified to be a pretty high risk factor for developing type two diabetes, and for having basically insulin dysregulation.

也就是说，这些人不能正常分泌胰岛素。

So people were not producing insulin correctly.

当时这让科学家们非常困惑，因为褪黑素一直被认为只是松果体分泌的一种调节睡眠的激素。

And it was very perplexing to scientists at the time because melatonin was thought to be just this hormone that is produced by the pineal gland that is regulating our sleep.

它让大脑安静下来，告诉我们该困了，让我们感到疲倦。

It's quieting down our brain, telling us it's time to get sleepy, right, it's making us tired.

但随着更多研究深入调查，结果发现我们的胰腺，特别是胰岛β细胞上，也有褪黑素受体。

Well it turns out after more studies started to investigate this, that we have melatonin receptors on our pancreas, on our pancreatic beta islet cells.

而褪黑素受体，特别是1B型受体，对褪黑素很敏感。

And the melatonin receptors, the 1b receptors are sensitive to melatonin.

有这种基因变异的人，受体特别敏感，一点点褪黑素就能把它激活。

People with that gene variation had a hypersensitive receptor where little bits of melatonin were enough to really kind of activate it.

所以事实证明，褪黑素在晚上也会让胰腺安静下来，告诉胰腺，我们不需要分泌那么多胰岛素，现在是晚上，我们不会吃东西。

And so it turns out melatonin is also quieting down our pancreas at night and telling our pancreas, we don't have to produce so much insulin, it's nighttime, we're not going to be eating.

所以褪黑素不仅对大脑有影响，对我们其他对代谢很重要的器官也有全身性的影响。

And so there's a systemic effect of melatonin, not only on our brain, but also on our other organs in that are, you know, important for metabolism.

我觉得这真的是一个很好的理由，让你考虑什么时候吃最后一餐，以及为什么深夜进食是有害的。

And I think this is a really good reason to think about when you're going to have your last meal, and why it is detrimental to engage in late night eating.

我们的身体通常会在自然入睡前大约三个小时开始分泌褪黑素。

So our bodies naturally produce melatonin about three or so hours before our natural bedtime.

所以一个很好的经验法则是，确保你在那个时间之前已经吃完最后一餐，完成进食。

So it's a good rule of thumb to make sure that you have finished your last meal, you finished eating before that time.

也就是说，在自然入睡前三个小时之前，确保你已经吃完东西，这真的是一个很好的经验法则。

So, know, before three hours before your natural bedtime, It's really just a good rule of thumb to kind of make sure you're done eating that.

早上醒来的时候，大约第一个小时内，你仍然会分泌一些褪黑素。

When you wake up in the morning, you're also still producing some melatonin for about the first hour.

不过，明亮的光线可以抑制褪黑素，加速它的清除，但我觉得醒来后最好等大约一个小时再吃第一顿饭。

Now, bright light exposure can inhibit that, so it can hasten the clearance of the melatonin, but also I think it's a good idea to wait about an hour after you first wake up before you start taking in your meal.

明亮的光线暴露我们稍后会讲，它对调节昼夜节律非常重要，这对睡眠也很关键，但总的来说，我觉得让吃饭时间和昼夜节律保持一致很有道理。想想褪黑素的作用，它让大脑和胰腺都安静下来，你就明白为什么深夜吃东西不好了。

So bright light exposure we'll talk about also it's very important for regulating our circadian rhythm and that's important for, know, sleep, but generally speaking, I think just aligning your meals with your circadian rhythm, it makes sense when you think about the role of melatonin, you know, in quieting down our brain and also our pancreas, it makes a lot of sense why you don't want to be eating late at night.

顺便提一下，血糖水平在正常范围内但偏高，也就是高正常血糖，在英国生物库的数据中与海马体萎缩发生率更高有关，海马体是大脑中负责学习和记忆的部分。

So just as a, you know, I think an aside here, having glucose levels in the normal range, but on the high normal range, so high normal glucose was associated in UK Biobank data with higher incidence of atrophy in the hippocampus, so the part of the brain involved in learning and memory.

所以，那些血糖处于正常范围偏高的人，海马体萎缩程度比正常偏低的人更严重。

So people that just had higher than, they were on the high end of normal, had more atrophy in their hippocampus than people on the low end of normal.

这还是在没有临床二型糖尿病的情况下，这真的凸显了每个人关注代谢健康的重要性，即使你没有二型糖尿病，甚至没有糖尿病前期，你也希望血糖调节尽可能处于最佳状态。

So this is in the absence of any clinical type two diabetes, really sort of highlighting the importance of everyone considering their metabolic health, even if you don't have type two diabetes, even if you're not, you know, pre diabetic, you just, you wanna make sure that glucose regulation is, you know, the best it can be.

昼夜节律失调。

Circadian misalignment.

现在，很多人可能像我一样来自西海岸或者欧洲，你们的昼夜节律可能不同步。

Now, so many of you may have come from like me, the West Coast or perhaps Europe, and you're out of sync with your circadian rhythm.

昼夜节律失调指的是你的内在生物钟因为行为模式而与外部环境不同步。

So circadian misalignment refers to when your natural internal clock is out of sync based on a behavioral pattern.

这在时差反应中非常常见。

So this is very common with jet lag.

在夜班工作者中也很常见，他们晚上和夜间工作、进食。

It's very common in shift workers who are up in the night, in the evening, working and eating.

在睡眠习惯不规律的人群中也很常见。

It's also very common in people with erratic sleep behaviors.

有研究做过这样的实验，参与者被故意打乱昼夜节律，也就是让他们的睡眠和进食时间大约偏移12个小时。

So there's been studies done where people, participants are, they're circadian misaligned, so they're out of sync, so they're basically their sleep and meals are shifted by about 12 hours.

当这种情况发生时，人们的血糖大约升高6%，胰岛素分泌增加22%，瘦素水平下降，而瘦素是让人产生饱腹感的激素。

And when that happens, people have about a 6% increase in their glucose, they make 22% more insulin, they have decreased leptin levels, so that's the hormone involved in being satiated.

他们的餐后血糖水平甚至达到了糖尿病前期的范围，仅仅是因为把昼夜节律时钟偏移了12个小时。

And their postprandial glucose levels are in the pre diabetic range, only by shifting their circadian, you know, clock by 12.

所以昼夜节律紊乱的影响是非常大的。

So it has a profound effect being circadian misaligned.

运动可以帮助改善这种情况，尤其是高强度间歇训练，限时进食也有帮助。

Exercise can help with that, especially high intensity interval training, but also time restricted eating.

所以限时进食指的是在有限的时间窗口内吃完所有食物，而不是整天随意吃。

So time restricted eating refers to eating all your food in a restricted window of time, instead of just eating ad libdom, right, throughout the day.

通常限时进食的进食窗口在六到十小时之间，其余时间则是禁食。

And typically time restricted eating is anywhere between six to ten hours of an eating window, and the rest is fasting.

有很多研究是由博士做的。

There's been a lot of work done by Doctor.

萨钦·潘达关于轮班工人限时进食的研究。

Sachin Panda on time restricted eating in shift workers.

他对消防员做了一些研究，表明那些整夜不睡的消防员，如果在限时进食窗口内进食，比如八小时或十小时，他们的代谢指标会得到改善。

He's done some work on firefighters showing, you know, these firefighters that are up all night, if they eat their food in a time restricted eating window, you know, eight eight hours, ten hours, that it improves their metabolic biomarkers.

所以有很多关于限时进食及其改善代谢健康的荟萃分析。

So there's been a lot of meta analyses done on time restricted eating and how it improves metabolic health.

不过，限时进食并不意味着你必须减少卡路里摄入，但我们稍后会谈到，那些自然进行限时进食的人往往会减少卡路里摄入，因为他们会跳过零食、甜点或一餐。

Now, restricted eating does not mean you have to reduce your calorie intake, but we're going talk about in a minute people that are naturally doing time restricted eating tend to do that because they're skipping snacks, so they're skipping their dessert, or they're skipping a meal.

所以，当人们确实在限时进食的同时减少了卡路里摄入，他们最终会减重并减脂。

So, when people do end up reducing their calorie intake along with time restricted eating, they end up losing weight and losing, fat.

但如果不考虑卡路里，也就是说，如果他们不改变热量摄入，但坚持限时进食，这能改善血糖调节和胰岛素敏感性，还能降低血压，所以仅仅通过限时进食，很多代谢指标都能得到改善。

But independent of calories, so if they do not change their caloric intake, but they are practicing time restricted eating, it can improve glucose regulation, insulin sensitivity, it can lower blood pressure, and so there's a lot of metabolic parameters that are improved with just the time restricted eating.

现在，正如我提到的，那些实践限时进食的人，有很多研究甚至只看了十小时的进食窗口，这其实并不算太严格。

Now, as I mentioned, people that do practice time restricted eating, so there's been there's been multiple studies looking at even just a ten hour window, which isn't even that restricted.

那些采用十小时限时进食窗口的人，不是对照试验，就是直接告诉他们这么做，他们平均每天会减少大约200卡路里的摄入。

People that are doing a ten hour time restricted eating window, not a controlled trial, but just like you tell them to do it, they end up reducing on average about 200 calories a day.

这通常是因为人们会跳过零食或某一餐。

Again, because typically people are skipping snacks or meals.

所以这确实会导致体重下降，减少腰围和体脂率，同时也能减少内脏脂肪，也就是包裹在器官周围的深层脂肪，它会分泌促炎细胞因子和激素，这些在2型糖尿病和代谢综合征中起作用，而且，越来越多的证据表明，内脏脂肪也与癌症有关。

And so that does lead to weight loss, and it reduces waist size, body fat percentage, and also reduces visceral fat, which is the deep fat that surrounds your organs that's secreting pro inflammatory cytokines and hormones that play a role in type two diabetes metabolic syndrome, but also, you know, emerging evidence indicates visceral fat plays a role in cancer as well.

限时进食还能降低血压，改善血脂谱，并改善糖化血红蛋白（HbA1c）这一血糖指标。

Time restricted eating also lowers blood pressure and improves lipid profiles and improves the HbA1c glucose biomarker.

早期限时进食，通常是指人们在下午4点左右结束最后一餐。

Early time restricted eating, so this is typically people that end their last meal at about 4PM.

通常早期限时进食大约是六小时的进食窗口，也就是说进食时间更短。

Usually early time restricted eating is about a six hour window, so it's a shorter eating window.

进行早期限时进食的人，即使不减少热量摄入，也能显著改善多种代谢指标。

People that do early time restricted eating without reducing their calorie intake dramatically improve a variety of metabolic parameters.

胰岛素水平得到改善，胰岛素敏感性提高，β细胞对葡萄糖的反应也更灵敏。

Insulin levels are improved, insulin sensitivities improved, beta cells are more responsive to glucose.

血压的改善效果非常显著，甚至与一些降压药物的效果相当。

The improvements in blood pressure were so profound that they were equivalent to some antihypertensive treatments.

这是那项研究的一个重要发现，而且氧化应激水平也有所改善，这就是早期限时进食的效果。

So that was a big finding of that study, and then ex oxidative stress levels were also improved, and this is early time restricted eating.

有一项荟萃分析，涵盖了大约12项随机对照试验，专门研究早期限时进食。

There's been a meta analysis of about 12 randomized controlled trials looking at early time restricted eating.

同样，定义为大约下午4点结束最后一餐，然后与晚期限时进食进行比较。

Again, was defined at stopping your last meal at about 4PM, and then comparing it to later time restricted eating.

也就是说，那些不是在4点结束进食，而是稍晚一些的人，所有进食窗口都在4到10小时之间。

So people that were, you know, stopping their meals not at four, but a little bit later, and all the eating windows were either six, four, sorry, four to ten hours.

早期限时进食对血糖调节的影响更为显著，主要是因为我们在早些时候胰岛素敏感性更高，晚些时候则更低，而且一旦褪黑素开始分泌，情况就会变得更糟。

And early time restricted eating does have more profound effects on glucose regulation, largely because again, we're more insulin sensitive earlier, less insulin sensitive later, and once the melatonin starts to kick in, again, just it gets much worse.

所以，早期限时进食比晚期限时进食更能改善空腹血糖水平和胰岛素抵抗，而且对血压调节的影响也更显著，也就是能降低血压。

So early time restricted eating can improve fasting blood glucose levels and insulin resistance more than later time restricted eating, but it also has a more profound effect on the blood pressure regulation, so lowering blood pressure.

晚期限时进食可以维持血压，但不像早期限时进食那样能改善血压。而且，早期和晚期限时进食都能改善血脂水平，以及空腹血糖和胰岛素抵抗，只是早期限时进食的效果更明显一些。

Late time restricted eating can sort of maintain blood pressure, but it doesn't improve it like the early time restricted eating, and both early and late improve lipid profiles, as well as fasting glucose and insulin resistance, just early does it a little bit more robustly.

所以，我认为有很强的证据表明，如果你昼夜节律紊乱，比如倒时差，或者你是轮班工人，或者只是想尽可能优化血糖稳态的人，当然，有代谢功能障碍的人，可能会从限时进食中受益，同时结合高强度间歇训练和每45分钟做10个自重深蹲。

So I think there's pretty strong evidence that if you are circadian misaligned, jet lag for example, if you're a shift worker, or just people that are you know wanting to sort of try to optimize their glucose homeostasis as much as possible, certainly people with you know metabolic dysfunction may benefit from time restricted eating along with the high intensity interval training and the 10 body weight squats every 45.

好，那我们来谈谈今天早上我想讨论的最后一个话题，那就是睡眠不好。我想我们大多数人都知道，当晚上没睡好时，我们会感觉认知能力不在状态，情绪受影响，感觉无精打采，没有那么多精力。

Okay, so let's talk about the last topic I want to discuss this morning, and it has to do with poor sleep and how most of us, I think, are aware when we don't get a good night's sleep, we don't feel cognitively on game, our mood is affected, we feel lethargic that we don't have as much energy.

但我不确定大多数人是否意识到，即使是轻微的睡眠限制，对我们的代谢健康和血糖调节也有深远的影响。

But I'm not sure that most people realize the profound effect that even mild sleep restriction has on our metabolic health and glucose regulation.

这一点非常重要，因为在美国，大约有三分之一的人没有达到每晚7到9小时的睡眠建议。

And this is extremely relevant because about one third of people in The United States do not meet the recommendations, which is seven to nine hours of sleep per night for sleep.

而且，这对倒时差也非常相关。

And again, this is very relevant for jet lag.

我的意思是，睡眠不好在这里有很多相关性。

I mean, there's a lot of there's a lot of relevance here for poor sleep.

所以轻度睡眠限制，就是每晚少睡一到三个小时。

So mild sleep restriction, this is one to three fewer hours of sleep per night.

我的意思是，少一个小时不算多。

So I mean one is not a lot.

连续三个晚上这样，就会让空腹胰岛素水平升高，胰岛素浓度变高，空腹胰高血糖素水平也升高，同时胰岛素敏感性下降。

Doing that three nights in a row can increase fasting insulin levels, it can lead to higher insulin concentrations, elevated fasting glucagon levels, and also it decreases insulin sensitivity.

再说一遍，就是每晚少睡一个小时，连续三个晚上。

Again, is just getting one hour less of sleep a night for three nights.

想想看，我们有多少人在这次会议上可能也这么做过，对吧？

I mean, how many of us have probably even done that at this conference, right?

这很容易做到，也很常见，而且对代谢有显著影响。

I mean, it's very easy and very applicable, and it's having a profound effect on metabolism.

睡眠债就是睡眠限制的累积效应，对吧？

Sleep debt is yet the cumulative effect of sleep restriction, right?

也就是说，你连续多天睡眠不足。

So this is when you're having multiple days of the sleep restriction.

所以在这个案例中，是三天每晚少睡四个小时，抱歉，是三天每晚少睡四个小时。

So in this case, was four, sorry, three days of four hours less sleep per night.

这导致葡萄糖清除速度慢了40%，葡萄糖有效性下降了30%，这跟胰岛素无关，类似糖尿病的情况，而且胰岛素反应也降低了30%。

That led to 40% slower glucose clearance, 30% decrease in glucose effectiveness, so this is independent of insulin similar to diabetes, and 30% lower insulin response.

所以这真的表明早期糖尿病，而且这些人并不是不健康的人。

So this is really indicating early diabetes, and these aren't healthy people.

健康的人在连续三晚每晚少睡四个小时后，代谢受到了非常显著的影响。

There's healthy people after three nights of having four hours less sleep a night, very profound effect on metabolism.

关于纵向研究中睡眠时长与2型糖尿病风险的关系，已经有很多大型荟萃分析。

There's been large meta analyses done on longitudinal studies looking at type two diabetes risk and sleep duration.

研究发现，2型糖尿病风险最低的最佳睡眠时长是每晚七到九个小时。

And it's been identified that the optimal range of sleep for the lowest type two diabetes risk is seven to nine hours of sleep a night.

所以睡眠少于七小时或超过九小时，都与2型糖尿病风险增加有关。

So going below seven hours or above nine hours were both associated with increased risk for type two diabetes.

七小时这个临界点，每晚睡眠少于七小时，与空腹胰岛素升高、血糖水平升高、HOMA-IR升高、HbA1c升高以及内脏脂肪增加有关。

So the seven hour threshold getting less than seven hours of sleep a night was associated with increases in fasting insulin, increases in glucose levels, HOMO IR was elevated, higher HbA1c, and then also visceral fat was increased as well.

所以，再次强调，每晚睡眠不足七小时，很多人其实都习以为常了。

So again, getting less than seven hours of sleep a night, which a lot of people do routinely.

说到糖化血红蛋白升高，我觉得这点真的很重要。你们大多数人可能都知道，当血糖水平持续升高时，会产生晚期糖基化终末产物，也就是所谓的AGEs。这在2型糖尿病患者中绝对是个大问题，因为他们一直存在血糖调节紊乱和血糖水平升高的情况。

And speaking of the elevated HbA1c, I think this is really important, most of you probably realize this, but when you are constantly having elevations in blood glucose levels, this leads to advanced glycation end products or AGES as they're called, and it's certainly a huge problem in people with type two diabetes because they are constantly having glucose dysregulation and their elevated blood glucose levels.

但一般来说，当你的糖化血红蛋白偏高时，意味着葡萄糖通过美拉德反应与脂质和蛋白质结合，包括胶原蛋白。这些反应都发生在我们血管、动脉内部，还有心肌周围，也就是心脏周围。

But generally speaking, when you have the HbA1c high, you are talking about glucose reacting with lipids and proteins through the Maylard reaction, including collagen, And this is all inside of our blood vessels, our arteries, you know, our myocardium making, you know, surrounding our heart.

当这些晚期糖基化终末产物形成时，会使胶原蛋白变硬。糖化血红蛋白水平大约每120天更新一次，对吧？

When you have those advanced vacation end products forming, it stiffens that collagen, okay, call it HbA1c levels turn over after about what, one hundred and twenty days?

但胶原蛋白是永久存在的。

Your collagen is in there forever.

所以，当这些晚期糖基化终末产物形成时，如果它们存在于血管中，就会使血管变硬，从而导致高血压，在高血压中扮演重要角色。

So what happens is you have those advanced vacation end products, there's, if it's in your blood vessels, it stiffens the blood vessels and this leads to hypertension, plays a big role in hypertension.

当这种情况发生在动脉和心肌中时，会降低心血管的顺应性，并且确实会随着年龄增长导致心脏变硬。

When it's happening in the arteries and, you know, in myocardium, decreases cardiovascular compliance and it really plays a role in the stiffening of your heart with age.

因此，这些晚期糖基化终末产物会增加心血管疾病、心脏病发作和高血压的风险。

And so these advanced medication end products increase the risk of cardiovascular disease, heart attacks, and hypertension.

所以，血糖水平升高，以及随之而来的HbA1c这个生物标志物，它不仅仅是二型糖尿病的风险指标，还关系到心血管健康，而且随着年龄增长，这种累积效应会越来越明显。

So having these elevations in your blood glucose levels and you know, subsequently the HbA1c biomarker, which bio marks that, is so much more than just type two diabetes risk, it's cardiovascular health, and it's really a cumulative effect that plays a role as we age.

目前已经发现了多种机制，解释睡眠不足和轻度睡眠限制如何导致代谢功能紊乱。

There are a variety of mechanisms that have been identified for how short sleep and, you know, mild sleep restriction can cause dysfunctional metabolism.

我们会讲到脂肪细胞中胰岛素信号传导的减弱，β细胞对葡萄糖敏感性的降低，肌肉和肝脏对葡萄糖吸收的受损，以及饱腹感激素的变化。

So there's, we're going to talk about decreased insulin signaling in adipocytes, we're going to talk about lower beta cell sensitivity to glucose, we're going to talk about impaired glucose absorption in muscle and liver, and then changes in satiety hormones.

有一些研究专门针对睡眠限制进行了观察。

So there's been some studies looking at sleep restriction.

比如连续四天每晚只睡大约四个小时。

This is about four hours of sleep a night for four days.

这会导致脂肪细胞中的胰岛素信号传导下降30%。

It decreased insulin signaling and adipocytes by 30%.

要知道，脂肪细胞是除了肌肉之外，处理葡萄糖的主要场所之一，它们会把葡萄糖储存为脂肪以备能量。但胰岛素信号传导下降30%，这可不是针对不健康的人，而是说一个健康的人，仅仅经过四天的睡眠限制，就可能迅速变得像肥胖或二型糖尿病患者一样。

So I mean your adipocytes are one of the major sinks aside from muscle for glucose disposal, Storing as fat, you know, for energy, but a 30 reduction in cellular insulin signaling adipocytes is, I mean you're talking about these aren't healthy people, this is like a healthy person immediately becoming obese or immediately becoming type two diabetic after just four days, right, of sleep restriction.

所以这对代谢健康的影响是非常显著的。

So it's very profound in terms of metabolic health.

睡眠不足，即使是轻微的睡眠不足，也会促进肥胖体质。伊芙·范考特实验室做了很多这方面的研究，她特别关注饥饿激素和饱腹感激素。连续两天每晚少睡四小时，瘦素水平就会下降，人们就不会觉得吃饱了，因为瘦素调节饱腹感，而饥饿素水平会上升，这真是双重打击。

Sleep loss, so sleep, mild sleep loss even, it does promote an obesogenic profile, and so a lot of work has been done out of Eve VanCoucher's lab, and she's looked a lot at these these hunger hormones, satiety hormones, so after two days of four hours less sleep, leptin levels go down, so people are not feeling satiated by their food, because leptin regulates satiation, and their ghrelin levels increase, so it's a double whammy.

饥饿素是饥饿激素，它告诉你你饿了，所以他们持续感到饥饿。

Ghrelin is the hunger hormone, it tells you you're hungry, and so they're getting this continual hunger.

所以整体的饥饿感评分上升，食欲也上升了。

So global hunger ratings go up, global appetite goes, you know, up.

所以人们吃饭不觉得饱，整天都觉得饿。

So people are not satiated by their food and they're hungry throughout their day.

伊芙·范考特的研究还表明，人们会吃得更多，他们渴望加工食品、高度精制的糖、咸的食物、加工脂肪和高脂肪食物，他们摄入这些不健康的加工食品的量增加了多达45%，饥饿感评分也高出24%，所以他们比睡个好觉时吃得更多。

And again, Eve Van Koucher's work has shown that people eat more, so they're and they're and they're consuming foods and have cravings for processed foods, highly refined sugars, salty foods, you know, processed fats and fatty foods, so they're eating up to 45% more of those processed unhealthy foods, and their hunger ratings are 24% higher, so they're eating even more than they would if they were getting a good night's sleep.

所以我认为很明显，睡眠限制和睡眠不好确实会导致代谢功能紊乱。

So I think it's pretty clear that sleep restriction, poor sleep does cause dysfunctional metabolism.

那么问题是，你能通过改善睡眠来改善代谢健康吗？

And so the question is, can you fix your sleep and improve metabolic health?

所以有很多基于证据的方法可以改善睡眠，我们接下来会讨论几种。

So there are a variety, there's a couple of evidence based ways we're going to talk about improving sleep.

这两点都离不开良好的睡眠卫生习惯。

Both of them involve good sleep hygiene.

良好的睡眠卫生习惯确实是优质睡眠的基础。

So good sleep hygiene is really the foundation of good sleep.

这里面有很多因素，就像一份清单一样。

And there's a variety of factors that are like a checklist of it.

我没有把所有的都列出来，但其中几个关键点包括聪明地利用光线。

And I didn't include all of them, but some of the main ones here are using light smartly.

早上起床后，第一时间接触明亮的光线，至少三十分钟，这是重置你的昼夜节律，让你在正常时间感到困倦的最重要方法之一。

So bright light exposure, first thing in the morning, at least thirty minutes is one of the most important ways to reset your circadian rhythm so that you become sleepy at a normal time.

这对重置昼夜节律非常重要，而且在你刚醒来时，它还能帮助抑制褪黑素的分泌，对吧。

Very, very important for resetting circadian rhythm and also important for stopping melatonin production when you're first waking up, right.

另外，傍晚日落之后，要避免接触明亮的光线，尤其是蓝光，对吧。

Also, avoiding bright light blue light exposure in the evening after sunset, right.

蓝光会抑制我们眼睛里的褪黑素分泌——其实是通过眼睛，而不是在眼睛里——它会抑制黑视蛋白，而黑视蛋白参与信号传导，促进褪黑素的产生，让我们感到困倦。所以你要避免蓝光，可以通过使用调光器或者不同颜色的灯光，比如红色或橙色，也可以戴过滤蓝光的眼镜。但也要意识到，屏幕充满了明亮的光线和蓝光，所以调暗屏幕，或者晚上避免使用屏幕，也是个好主意。

Blue light is what is inhibiting melatonin production in our eyes, it's through our eyes actually not in our eyes, but it's inhibiting melanopsin which then is involved in you know the signaling of producing melatonin to make us sleepy, and so you want to avoid blue light either by having light dimmers or different color lights, maybe red or orange, also glasses you can wear to filter it out, but also really realize that screens are full of bright light, blue light as well, so you know turning down the screens, maybe avoiding screens at night is another good idea.

还要确保你的房间是暗的，因为有研究表明，即使有一点环境光进来也会干扰睡眠。

Also making sure your room is dark, because there's been studies showing that even a little bit of ambient light coming in disrupts sleep.

控制温度也很重要。

Managing temperature is important.

褪黑素除了让你犯困之外，还会降低你的核心体温，这也是昼夜节律的一部分，对良好睡眠很重要，所以你要确保不要在很热的房间里睡觉，有很多方法可以维持卧室温度。

So part of what melatonin is doing, besides making you sleepy, is it's lowering your core body temperature, and this is part of the circadian rhythm, it's important for good sleep, and so you want to make sure you're not sleeping in a really hot room, and there's many ways that you can obviously maintain your bedroom temperature.

优化进餐时间也很重要。

Optimizing meal timing is also important.

除了睡前三个小时避免进食对褪黑素分泌很重要之外，这也能改善你的睡眠。

So in addition to the importance of avoiding eating, you know, like three hours before your bedtime because of melatonin production, it also improves your sleep.

这实际上是博士的一些研究成果。

So this has actually been some work by Doctor.

萨克研究所的萨钦·潘达博士。

Sachin Panda at the Salk Institute as well.

他从自己进行的大型研究中发现，那些在睡前至少三个小时停止进食的人睡得更好，这部分也是因为你在睡觉时没有在消化，消化是一个消耗能量的过程，对吧。

He's identified from large studies that he's done that people that stop eating three hours, at least three hours before their bedtime sleep better, and that's also partially because you're not digesting, mean digesting is a lot of, it's an energy consuming process, right, that's happening while you sleep.

所以这也说得通，消化过程多少会干扰睡眠。

So it makes sense that it would also disrupt sleep somewhat.

规律运动也很重要，这些因素都是相互关联的，运动也是一个非常强大的时间调节器。

Regular exercise, so again this is all, these are all tied together, so the exercise is also a very powerful zeitgeber.

所以，日常规律的运动对于重置生物钟、帮助你进入正常的作息并按时入睡也非常关键。

So you know just routine exercise is also really important for resetting the circadian rhythm and helping you just get on that rhythm and go to bed at a normal time.

然后要注意咖啡因的摄入。

And then monitoring caffeine intake.

咖啡因会使生物钟推迟四十五分钟。

Caffeine shifts the circadian clock by forty five minutes.

如果你喝一杯咖啡，生物钟就会推迟四十五分钟，再喝一杯，又推迟四十五分钟，所以如果你喝四杯咖啡，尤其是下午喝的话，你入睡的时间就会推迟好几个小时。

So if you're drinking a cup of coffee, that's forty five minutes of a circadian shift, and then you have another cup of coffee, that's forty five minutes of a circadian shift, right, and so you're going to be going to bed hours later if you're drinking four cups of coffee, particularly if it's you know afternoon.

当然，每个人代谢咖啡因的速度差异很大，所以确实存在个体差异，但总体来说，咖啡因仍然会使生物钟推迟接近一个小时。

Obviously there's a lot of individual variation between the way we metabolize caffeine, so yeah there's some individual variation, but generally speaking it still shifts circadian rhythm by about close to an hour.

延长睡眠时间是经过验证的改善睡眠的方法之一，这实际上就是调整你的上床时间以增加睡眠时长，要么早点睡，要么晚点起，两者都可以。

So sleep extension is one of the evidence based ways that's been shown to improve sleep, and this involves really just adjusting your bed times to increase the sleep time, so either going to bed earlier or sleeping in, both of those.

这还涉及很多与睡眠专家的咨询，以及我们刚才讨论的睡眠卫生建议。

It also involves a lot of consultations with sleep experts, and then sleep hygiene recommendations like we just discussed.

有荟萃分析研究了睡眠不足人群的睡眠延长，这些人每晚睡眠少于七小时。当他们进行这种行为改变，参与睡眠延长时，每晚每多睡一小时，他们的胰岛素敏感性就会改善，无论体重如何。

And so there's been meta analyses looking at sleep extension in people that are short sleepers, so they're getting fewer than seven hours of sleep per night, and when they undergo this type of behavioral change, when they're engaged in sleep extension, they're for every hour additional that they're sleeping per night, they improve their insulin sensitivity regardless of their body weight.

他们的激素，瘦素和饥饿素，也会改善并恢复正常。

They improve and normalize their hormones, leptin and ghrelin.

他们的食欲会下降，对，不会那么饿了。

They have reduced appetite, right, they're not getting so hungry.

他们的糖分摄入减少，热量摄入减少，体重也会下降。

Their sugar intake goes down, and their caloric reduction goes down, and they lose weight.

当然，所有这些，糖分摄入和热量减少，都受饱腹感激素的调节，而如果你增加睡眠，基本上就能打开那个开关，帮助它们恢复正常。

So all these things, of course, the sugar intake and reducing the calories is all regulated by the satiety hormones, which again, if you're increasing your sleep, you can basically flip that switch to kind of help regulate them back and normalize them back.

另一种有证据支持的改善睡眠的方法是针对失眠的认知行为疗法，即CBT-I，这可能是最常用、最知名、最有效的改善失眠的方法之一。

The other type of evidence based way of improving sleep is a certain type of cognitive behavioral therapy for insomnia, CBT-I, this is probably one of the most used well known and effective ways to improve insomnia.

它涉及多种因素，我不打算深入讲，但刺激控制是其中最主要的一个。

It involves a variety of factors, I'm not going to go in-depth on, but stimulus control is the main one.

也就是说，床只和睡觉联系在一起。

So that means the bed is only associated with sleep.

所以不要在床看电视，不要在床上刷手机，也不要在床上做任何和屏幕有关的事情。

So no watching TV in your bed, no scrolling on your phone, no doing anything screens on your bed.

床就是用来睡觉的。

Bed is for sleeping only.

这就是刺激控制。

So that's stimulus control.

它还包括睡眠限制，这听起来有点矛盾，但意思是，如果你躺在床上翻来覆去，一两个小时甚至三个小时都睡不着，那就应该起床，去另一个房间，比如客厅的沙发上，躺下来，做一些你学过的放松技巧，然后等到困了再回到床上。

It involves sleep restriction, which is a little ironic, paradoxical, but so that means if you're laying in your bed and you're tossing and turning and you're up for an hour or two or three, it means getting out of your bed and going into another room, dark room, like your living room couch, and laying there and you do some relaxation techniques that are you learn about, and then wait till you get sleepy and then go back into the bed.

所以再说一遍，床只用来睡觉。

So again, is for sleep only.

它还包括我们之前提到的各种睡眠卫生习惯、睡眠教育以及放松技巧。

It also involves implementing a variety of the sleep hygiene factors that we talked about, sleep education, and relaxation techniques.

对失眠症患者来说，CBT-I的荟萃分析也显示能改善代谢健康，包括改善糖化血红蛋白、降低血压，当然睡眠质量和失眠状况也会有所改善。

So meta analyses of CBT-I have also been shown to improve metabolic health in people with insomnia, including improved HbA1c, improved blood pressure, of course their sleep quality and insomnia factors and all those things improve as well.

所以很明显，那些睡眠不好、有失眠症、睡眠时间短的人，如果他们努力改善睡眠，他们的代谢健康也会得到改善。

So it's pretty clear that people that have poor sleep that are in have insomnia that are short sleepers, if they work on fixing their sleep, they improve their metabolic health.

但有些情况下，想睡得更久、睡懒觉、做这些事情确实很难，比如你刚当上父母，必须醒来，睡眠肯定会受影响，这完全没办法。

But there are situations where it is challenging to sleep longer, stay you know, to sleep in, to do all these things, because maybe you're a new parent right, and you have to wake up and your sleep will be compromised, there's absolutely nothing you can do because of it.

还有其他情况，对吧？

There's other things as well, right?

比如时差反应之类的。

I mean, jet lag, things like that.

所以还有另一种方法可以改善代谢健康，即使你睡眠不是最佳状态，这就回到了我们演讲开头提到的高强度间歇训练。

So there is another way to improve metabolic health, even when you're not sleeping optimal, and that takes us full circle back to the beginning of the talk with high intensity interval training.

高强度间歇训练已被证明是在睡眠受限时改善代谢健康的一种非常有效的方法。

So high intensity interval training has shown to be a very robust way to improve metabolic health when you are sleep restricted.

有研究表明，如果你在五天里做三次高强度间歇训练，同时睡眠受限，比如每晚少睡四个小时，你仍然可以改善昼夜节律、葡萄糖耐量、线粒体功能以及线粒体生物发生的生物标志物。

So there's been studies that have shown that high intensity interval training if you do three sessions over five days of also being sleep restricted, so sleeping four hours less a night, you can still improve your circadian rhythm, you can still improve your glucose tolerance, your mitochondrial function, and, biomarkers of mitochondrial function, mitochondrial biogenesis.

你知道，这很重要，因为再说一次，葡萄糖调节，如果你做高强度间歇训练，睡眠受限损害葡萄糖调节的部分原因是它让你的肌肉对葡萄糖不那么敏感。

And you know, mean this is important because again the glucose regulations, if you're doing that high intensity interval training, well part of the way that's that high intensity interval training, I mean part of the way that sleep restriction restriction impairs impairs glucose regulation is it makes your muscle less responsive to glucose.

那么高强度间歇训练到底在做什么呢？

And so what is high intensity interval training doing?

它做的正好相反，对吧？

It's doing the exact opposite, right?

它会增加GLUT4转运蛋白，把葡萄糖带进你的肌肉里。

It's increasing GLUT-four transporters and it's bringing the glucose into your muscles.

所以你真的在抵消睡眠不好对肌肉的一些负面影响。

So you're really countering some of that negative effect of poor sleep on your muscle.

即使在你预感到要睡眠不足之前做高强度间歇训练也行。

Even doing high intensity interval training before you know you're going to be sleep restricted.

我昨天就上了我的Peloton，在从加州起飞前拼命练了一把，因为我知道到佛罗里达要倒三小时的时差，肯定会少睡。在睡眠不足之前做高强度间歇训练，基本上还是能缓解睡眠不足引起的高血糖和急性胰岛素抵抗。

So I got on my Peloton yesterday, went hard right before I got on my flight from California, I knew I was going to lose some sleep because it's three hours ahead in Florida, and doing doing high intensity well trained before you're going to be sleep restricted still mostly rescues the high high blood glucose and acute insulin resistance that's caused by sleep restriction.

所以再次强调，这真的非常重要，因为我们手头有这些工具来帮助减轻慢性睡眠不足甚至急性睡眠不足的影响，两者都有。

So yet again, just really important with respect to the tools that we have at our disposal to help mitigate some of the effects of, you know, chronic sleep loss or even acute sleep loss, both.

很多这些方案还是我们之前讨论过的那些，比如Tabata、Wingate、传统的一分钟练一分钟歇，还有挪威的4x4高强度间歇训练方案。

A lot of those protocols again are the ones we've discussed, the Tabata, the Wingate conventional one minute on one minute off, and the Norwegian 4x4 HIIT protocol.

现在有很多HIIT训练方案可以选，或者你也可以做运动零食，就像我提到的，10个自重深蹲，这也能帮助改善血糖平衡。

A lot of a lot of HIIT protocols out there that people can do, or you just do your exercise snacks as well, I mean that also has been shown to increase glucose homeostasis as I mentioned, the 10 body weight squats.

在结束之前，我还想提一项研究。英国生物银行的数据里有很多信息，有研究发现，每晚睡眠少于7小时或超过9小时的人，全因死亡率更高。

And I do want to mention one last study before we end on time, and that is again, there's lots of data out there to be harvested from the The UK biobank data, and there's been studies that have identified people that sleep fewer than seven hours or greater than nine hours a night are have have a higher all cause mortality.

但如果这些人有运动习惯，达到了运动指南的要求，比如每周75分钟的高强度运动，或者每周150分钟的中等强度运动，

However, if those people are physically active and they're getting and they're meeting the guidelines for physical activity, seventy five minutes a week of intense vigorous exercise, or one hundred and fifty minutes a week of moderate intensity exercise.

他们的全因死亡率就不会更高，和睡眠好的人一样。

They do not have a higher all cause mortality, they have the same mortality risk as someone that's getting good sleep.

所以，运动真的能弥补很多问题，而且没有理由不做省时高效的HIIT训练。

Yet again, exercise can forgive a lot of sins and there's no reason to not do a time efficient type of high intensity interval training workout.

它省时又简单，运动零食也很方便，证据都摆在那里，我们只需要去做，把它变成生活习惯，就像每天早上刷牙一样，每天做HIIT。

It's you know time efficient, it's easy, exercise snacks, I mean there's there's all the evidence there, we just have to implement it, make it part of your hygiene, like you brush your teeth every morning, you do your HIIT.

总结一下，我认为我们有三个非常有效的工具来改善代谢健康。

So in conclusion, I think there's three really powerful tools we have to improve our metabolic health.

我讲了高强度运动、HIIT，把它变成个人卫生习惯，还有按照昼夜节律进食，一个简单的原则是睡前3小时停止进食，因为要考虑到褪黑素的分泌。

I talked about the vigorous intensity exercise, high intensity interval training, making it part of your your personal hygiene, also trying to eat your meals in accordance with your circadian rhythm, a good rule of thumb, stop eating three hours before bed because of that melatonin production.