为什么你总是感到身体疲惫

所以如果你想想疲劳的感觉是什么，疲劳的感觉是各种心理和生理信号的混合体。

So if you think about what is the feeling of tiredness, the feeling of tiredness is an amalgamation of all kinds of mental and physiologic signals.

所以当我们谈论疲劳时，我们必须记住它有多个维度。

So when we're talking about tiredness, we have to remember that there are different dimensions of it.

对吧？

Right?

所以疲劳可以在精神上感受到。

So tiredness can be felt sort of mentally.

对吧？

Right?

比如，你一想到要做某件事就会感到疲惫。

So, like, you can sort of feel fatigued at the thought of doing something.

比如，如果我想写一本书，或者想搬家，比如说，那是个很好的例子。

Like, if I wanna, like, write a book or if I wanna, you know, move, for example, that's, like, a really good one.

就像，哦，天哪。

It's like, oh, man.

我得搬家。

I gotta move.

如果你仔细想想，搬家的念头其实并不会消耗太多能量。

And if you really think about it, like, the thought of moving is not doesn't actually cost a whole lot of energy.

又不是真的在搬家。

It's not like you're actually moving.

就是那个念头本身让你觉得累。

It's the very thought of it that makes you feel fatigued.

但我们知道，疲劳不只是心理作用。

But we do know that tiredness is not just in your head.

对吧？

Right?

我们知道，疲劳和很多生理因素有关。

We know that there's a lot of physiology that has to do with tiredness.

我们知道，疲劳是能量水平的一种衡量。

We know that tiredness is a measure of energy levels.

比如说，如果我二十四小时没睡觉，我会感到非常非常非常累。

So for example, if I haven't slept in twenty four hours, I'm going to feel really, really, really tired.

这跟我需要完成什么任务或者别的事情没关系。

And that has nothing to do with whatever tasks I need to complete or things like that.

如果我吃了一顿特别特别丰盛的饭，之后我会感到特别累。

If I eat a really, really heavy meal, I'm going to feel really tired afterward.

这其实是生理上的反应。

And that's actually physiologic in nature.

所以现在我们要从另一个角度来看待疲劳，也就是生理角度。

So now what we're gonna do is look at tiredness from a different angle, which is sort of the physiologic angle.

这通常是人们在谈论疲劳时会想到的，他们会想，我的能量水平出了问题，我该怎么办？

And this is oftentimes what people kind of think about when they're think when they're talking about tiredness, they kind of think about, okay, there's something wrong with my energy levels, and what should I do about it?

所以今天我想和大家分享的是，我是如何从生理角度来思考和整理对疲劳的看法的。

And so what I'd love to do today is share with you all kind of like how I think about or organize looking at tiredness, like kind of within you from a physiologic angle.

对吧？

Right?

那么，我们怎么从生理角度来理解疲劳呢？

So how can we understand the physiology of tiredness?

先简单说几点，或者说是几个视角。

So a couple of quick disclaimers or perspectives.

首先，很多人会分享或讨论关于疲劳的基础科学研究。

So the first is that a lot of people will share or talk about basic science research as it relates to tiredness.

对吧？

Right?

比如，有人会说，你可以看看某项研究，比如从饮食中去除精制糖，看看它如何提升能量水平。

So people will say things like you can look at, like, let's say, a study that looks at eliminating, let's say, refined sugar from your diet and how that boosts energy levels.

你还可以看一些研究，把维生素D和能量水平联系起来。

You can look at studies that correlate things like vitamin d with energy.

有各种各样的基础科学研究，说这些东西让人更累。

There are all kinds of basic science studies out there that will say this stuff makes people more tired.

那些东西让人不那么累。

This stuff makes people less tired.

这些主要是在实验室里做的研究。

These are primarily studies that are done in a laboratory.

所以这些研究中的任何一个，棘手的地方在于，它可能不适用于每一个具体的人。

So the tricky thing for any one of those studies, it may not apply to an individual perp person.

对吧？

Right?

所以，对于那些研究表明，比如说，从饮食中去除精制糖能改善疲劳，但这并不能让试验中每个人的疲劳感百分之百完全消失。

So for all those studies that show that, let's say, eliminating refined sugar from your diet improves tiredness, it doesn't make tiredness completely go away a 100% in everyone in the trial.

对吧？

Right?

有些人实际上从戒糖中得不到任何好处，其他人能得到一些好处，有些人则能得到很多好处。

Some people actually get no benefit from eliminating sugar, other people get some benefit from eliminating sugar, some people get a lot of benefit from it.

然后我们在科学上所做的就是把这些结果平均起来，然后得出一个结论。

And so then what we do in science is we average all those things together, and then we kind of come up with a conclusion.

所以总的来说，作为临床医生，我发现几乎更有效的方法是，当你面对真实的人时，有很多不同的解决方案，要弄清楚从哪里开始。

So generally speaking, what I found works almost better as a clinician is when you're working with real human beings, there are a bunch of different solutions, trying to figure out where do I start.

我该戒掉麸质吗？

Should I eliminate gluten?

我该戒掉乳制品吗？

Should I eliminate dairy?

我该戒掉鸡蛋吗？

Should I eliminate eggs?

我该试试生酮饮食吗？

Should I do keto?

我该试试间歇性禁食吗？

Should I do intermittent fasting?

我该每天早上五点起床吗？

Should I wake up every morning at 5AM?

我去游泳？

I go swimming?

我该做力量训练吗？

Should I do resistance training?

我应该做瑜伽吗？

Should I do yoga?

我应该打太极吗？

Should I do tai chi?

我应该练气功吗？

Should I do qigong?

我应该喝这种特别的咖啡吗？

Should I drink this special kind of coffee?

我应该把这种补充剂加入我的饮食吗？

Should I add this supplement to my diet?

有成千上万种不同的东西，而所有问题的答案都是肯定的。

There are a thousand different things, and the answer to all of them is yes.

你会找到一些人，他们会谈论某篇论文，然后对所有那些事情都说好。

You'll find someone out there who will talk about a paper who will say yes to all of those things.

但实际上作为一个人，如果你总是感到疲惫，你会怎么做呢？

But practically as a human being, like, what do you do if you are tired all the time?

所以今天我想和大家分享的是一种应对疲劳的方法，它涵盖了所有这些方面。

So what I'd love to share with you all today is an approach to tiredness that incorporates all of that stuff.

说到疲劳，我会把它分成两类。

When I think about tiredness, I think about two buckets.

这是我在多年精神科医生工作中总结出来的。

And this is what I've learned, like, working for years as a psychiatrist.

一类是昼夜节律类，另一类是代谢类。

There's the circadian bucket, and there's the metabolic bucket.

你可能会问，昼夜节律是什么意思？

And you may say, okay, like, what do you mean by circadian?

我们的身体在一天中会经历各种周期。

So our body goes through various cycles throughout the day.

晚上我们会更累，有些人早上觉得累，起床困难，还有的人睡眠有问题。

We feel more tired at night, some people feel tired in the morning, people have trouble getting out of bed, people have difficulty with sleep.

所以很多疲劳其实和代谢、能量无关，而是和睡眠周期这类东西有关。

So there's a lot of tiredness that has nothing to do with, like, metabolism, has nothing to do with energy, but has to do with cycles in sleep and things like that.

我说的能量，是指ATP的生成。

By energy, I mean, like, you know, ATP generation.

我不是指那种主观上的能量感觉。

I don't mean, like, the subjective feeling of energy.

有很多东西会让你主观上感到疲惫，这和昼夜节律有关。

There's a lot of stuff that will subjectively make you feel tired and is kind of related to the circadian stuff.

所以这里我考虑的是睡眠、日常周期，比如下午犯困、早上起床困难这些。

So this is where I think about things like sleep, daily cycles, you know, like afternoon crashes, difficulty waking up in the morning.

这就是昼夜节律这个类别。

So this is the circadian bucket.

我们会讨论所有这些内容。

So we're gonna talk about all that stuff.

在代谢这个类别里，我们有不同的东西。

In the metabolic bucket, we've got different stuff.

明白吗？

Okay?

所以，咱们先别管睡眠那些事。

So, like, let's not worry about the sleep and stuff.

但疲劳和精力水平的另一个重要方面，就是你吃进身体里的东西，以及你身体对它的反应。

But the other big dimension of tiredness and energy levels is what you put into your body and how your body responds to that.

这包括像体内平衡、血糖、营养，比如营养缺乏，但代谢方面还有其他问题，比如炎症。

So this is stuff like, let's say, homeostatic balance and, like, blood sugar, nutrition, things like nutrient deficiencies, but there's other stuff going on with metabolism as well, like inflammation.

所以，这就是关于该吃什么、什么时候吃，以及吃进去的食物对身体有什么影响。

And so this is where all the stuff of, like, what should I eat, when should I eat it, and what effect does the food that I put into my body have.

这就是代谢方面的问题。

That's the metabolic stuff.

这和昼夜节律方面的问题完全不同。

That's completely different from, like, the circadian stuff.

作为临床医生，当有人来我办公室说‘我累了’时，这里面还有心理或精神方面的因素。

And so as a clinician, when someone comes in into my office and says, I'm tired, there's also a psychological component or spiritual component.

你可能会问，心理方面是什么意思？

You may say, like, what do you mean there's a psychological component?

心理层面的意思是，有些任务就是会让你觉得累。

Like, psychological component in terms of there's some tasks that just make you feel tired.

就是那种感觉。

It's up here.

你就是不想去做。

You just don't wanna do it.

还有精神层面，有些人来我办公室说，我很累。

And spiritually, like, some people come into my office and they say, I'm tired.

他们真正的意思是，我对生活没有热情了。

And what they really mean is, like, I have no zest for life.

一切都像在完成任务。

Everything just feels like a chore.

然后如果他们试图调整睡眠时间，那其实不是问题所在。

And then what happens is if they try to, you know, fix their sleep schedule, like, that's not the problem.

问题在于，他们白天没有什么值得期待的事情。

The problem is that, like, they've got nothing to look forward to during the day.

他们想吃多少补品就吃多少，但那样解决不了问题，因为这不是代谢问题。

They can take as many supplements as they want to, but that's not gonna fix it because it's not a metabolic problem.

所以这种方法几乎是从鉴别诊断的角度来看的。

So this approach is almost like from a differential diagnosis standpoint.

感到疲劳的鉴别诊断是什么？

What's the differential diagnosis of feeling tired?

所以可能是生理上的、心理上的，或者精神上的。

So it can be physiological, psychological, or spiritual.

然后在生理方面，有昼夜节律分支和代谢分支。

And then in the physiology of it, there's the circadian branch and the metabolic branch.

那我们来谈谈昼夜节律分支。

So let's talk about the circadian branch.

我们先从简单的事情说起，那就是病理。

Let's start with simple stuff, and that is the pathology.

有各种各样的事情会扰乱你的睡眠。

There are all kinds of things that can mess with your sleep.

所以，排在第一位的是睡眠呼吸暂停。

So at the top of the list is sleep apnea.

睡眠呼吸暂停这种病，大概影响全球百分之五到八的人，比例高得惊人，它会导致睡眠期间呼吸暂停。

So sleep apnea is a condition that probably affects somewhere around five to eight percent of people in the world, shockingly high, results in periods of cessation of breathing during sleep.

基本上，你就是在睡梦中溺水或窒息。

So, essentially, what you do is drown or choke in the middle of your sleep.

当你溺水或窒息时，你吸不进氧气。

As you drown or choke, you don't get oxygen in.

然后，你就在生理上开始溺水。

Then what happens is you start to drown physiologically.

这是最贴切的形容。

That's the best word.

对吧？

Right?

所以，你得不到氧气。

So you're not getting oxygen.

所以有六十秒的时间，你会完全没有氧气。

So for sixty seconds, you're gonna have, like, no oxygen.

然后这会触发一种生存反应。

And then what it does is triggers a survival response.

肾上腺素飙升，你重新调整呼吸机制，然后又开始呼吸。

Rush of adrenaline, you kind of reset your breathing apparatus, and you start breathing again.

但问题是，这种肾上腺素飙升和生理反应会让你早上醒来时感到筋疲力尽。

But the problem is that the the rush of adrenaline and physiologic response is gonna make you feel exhausted when you wake up in the morning.

对吧？

Right?

因为想想看发生了什么。

Because think about what's happening.

比如说，想象你被扔下船，在水下待了六十秒才浮上来，没有呼吸，想象一下那之后你会多累。

Like, imagine, like, if you were to get thrown overboard and were underwater for sixty seconds before you came up without a breath, imagine how exhausted you would feel after that.

有些人一晚上会有二十次、三十次、五十次、六十次、一百次甚至一百二十次呼吸暂停发作。

People will have twenty, thirty, fifty, sixty, 100, 120 apneic episodes per night.

所以从生理上讲，你醒来的时候，身体会非常疲惫。

And so physiologically, when you wake up, your body is ragged.

这就是睡眠呼吸暂停。

That's sleep apnea.

还有其他一些我们稍后会谈到的问题。

There are other things that we'll kind of talk about.

你可能会有其他诊断，但昼夜节律紊乱就是另一个例子。

There are other diagnoses that you can have, but circadian rhythm disorders are other examples.

你也可能会有发作性睡病之类的情况，但我们不打算讨论这个。

You can also have stuff like narcolepsy and stuff like that, but we're not going to talk about that.

所以昼夜节律紊乱，我觉得另一个非常非常常见的问题，实际上相当普遍。

So circadian rhythm disorders, I think the other really, really big one that I think is actually quite common.

那么这些是什么意思呢？如果我们考虑一个普通的一天。

And so what this what these kind of mean is if we think about a regular day.

对吧？

Right?

比如说，有午夜、早上6点、中午、下午6点，然后又到午夜。

So let's say there's midnight, there's 6AM, there's noon, 6PM, and then midnight.

如果我们考虑一下活动水平随时间的变化，对吧，大多数人的活动水平大概是这样的。

If we think about the activity level over time, right, so most human beings, their activity level is kind of like this.

对吧？

Right?

你大概6点起床，9点去上班，工作到下午6点，然后慢慢放松，午夜时入睡。

So you wake up at maybe six, you go to work by nine, kind of work until 6PM, you kind of wind down, and you're asleep by midnight.

问题是，有些人的昼夜节律实际上更像是这样的。

Now the problem is that some people, their circadian rhythm is actually more like this.

这意味着，当其他人都在工作的时候，他们却非常疲惫。

And so what that means is that they're very exhausted when the rest of the world is working.

他们就是那种，别人都下班回家了，我才刚刚开始。

They're just when everyone else goes home for the day, I'm just getting started.

而且凌晨12点到4点其实是我效率最高的时候。

And between twelve and 4AM is actually my maximum productivity.

所以如果你的生物钟，也就是昼夜节律，和世界的其他部分不同步，而你强迫自己和别人一样在早上六点起床，这就是你的人生体验。

And so if your body's clock, which is what a circadian rhythm is, is off center from the rest of the world and you force yourself to wake up at 6AM like everyone else, this is your experience of life.

对吧？

Right?

所以，我希望你们想一想，我们用微积分来计算曲线下的面积。

So, like, I want you all to think about let's use calculus and calculate area under the curve.

对于一个昼夜节律不同的人来说，这是他们一天中拥有的总能量。

For someone with a circadian, this is the total amount of energy that they have during the day.

而相对于一个正常人，这是他们一天中拥有的总能量。

Compared to a normal person, this is the total amount of energy that they have during the day.

所以你看那些所谓的“正常人”，你会觉得，哇。

And so you look at, quote, unquote, normal people, and you're like, wow.

他们能做那么多事情。

They're able to do so much.

再看看你自己，你会觉得，我一直都很累。

And you look at yourself, and you're like, I'm exhausted all the time.

我什么都干不了。

I can't do shit.

那是因为你有昼夜节律紊乱。

And that's because you've got a circadian rhythm disorder.

其实你能做同样多的事情。

And you you can actually do the same amount.

只是你相对于社会来说，有点时差。

It's just you're you're jet lagged compared to society.

所以这就是昼夜节律紊乱。

So this is a circadian rhythm disorder.

还有很多有趣的研究。

There's also all kinds of really interesting research.

比如，青少年的昼夜节律会推迟。

For example, the circadian rhythm of teenagers shifts later.

有数据显示，如果学校九点甚至十点上课，而不是八点，青少年会表现得好很多，因为他们的昼夜节律变了。

So there's data that shows that if you start school at 9AM or even 10AM, instead of, let's say, like 8AM, that teenagers will do a lot better because their circadian rhythm changes.

为什么他们的昼夜节律会改变？

Why does their circadian rhythm change?

因为他们正在经历青春期和生长突增期。

Because they're going through puberty and growth spurts.

我们的身体在睡觉时实际上在生长。

And our body physically grows while we're asleep.

我不知道你们有没有注意到，青少年时期我们的身体确实在大量生长。

And I don't know if you all have noticed this, but our body does a lot of growing when we're teenagers.

对吧？

Right?

所以甚至有数据显示，那些上课时间很早的学校，那些孩子在很多方面表现更差。

So there's even data that shows that schools that start super early for teenagers, those kids do worse in all kinds of different ways.

明白吗？

Okay?

所以确实存在昼夜节律紊乱的情况。

So there can be circadian rhythm disorders.

昼夜节律问题的一部分原因就是这样。

Part of the problem with circadian rhythm stuff okay.

那我们接下来聊聊解决方案。

So let's talk about solutions for a second.

一个是，如果你有睡眠呼吸暂停，解决办法其实是医疗护理。

One is if you've got sleep apnea, the solution is actually medical care.

对吧？

Right?

有一种叫CPAP的东西，就是持续气道正压通气。

So there are these things called CPAPs, continuous positive airway pressure.

它们是不同的医疗设备，你可以在夜间使用，防止你发生呼吸暂停。

They're different, like, medical devices that you can use that will keep you from having apneic episodes overnight.

所以你需要为此接受医疗护理。

And so you just have to get medical care for that.

如果你担心，怎么知道自己有没有睡眠呼吸暂停呢？

If you're worried about, okay, how do I know if I have sleep apnea?

很遗憾，我没法在网上给你诊断。

I can't diagnose you all over the internet, unfortunately.

但睡眠呼吸暂停一个非常非常常见的迹象是，即使睡够了，早上醒来还是很累。

But a really, really common sign of sleep apnea is waking up in the morning despite sleeping enough.

所以如果你上床睡了八九个小时，但醒来却精疲力尽，感觉像没睡一样，需要睡十二三个小时，那你可能应该去看医生。

So if you went to bed and you got like eight or nine hours of sleep, but you wake up and you're exhausted, and it feels like you didn't get any sleep at all, you need twelve hours of sleep, thirteen hours of sleep, that you should probably talk to a doctor about that.

睡眠呼吸暂停另一个非常常见的迹象是打鼾。

Another really common sign of sleep apnea is snoring.

之所以会呼吸暂停，部分原因是我们有时软腭、会厌以及口咽部的某些组织会真的收紧，阻碍呼吸。

So what part of the reason that will become apneic is sometimes we have our soft palate and our, like, epiglottis and, like, some of the stuff in our oropharynx literally, like, clamps down and prevents us from breathing.

所以它会从口咽部这个区域堵住我们的气道。

So it'll, like, block our airways from this oropharynx area.

我们还知道，比如这里周围有很多脂肪，所以如果你脖子很粗或者肥胖，会增加睡眠呼吸暂停的风险。

And we also know that, for example, having a lot of mass around here, so if you've got a really thick neck or obesity, can increase the risk of sleep apnea.

所以，根据生理情况不同，减肥甚至也可以作为睡眠呼吸暂停的一种治疗方法。

So even weight loss can be a treatment for sleep apnea depending on what the physiology is.

所以，如果你经常打鼾，而且即使睡了一整晚，早上还是觉得很累，那么给大家提个醒，去跟医生聊聊这件事吧。

So if you snore a lot and if you feel very tired in the morning despite getting a full night's sleep, public service announcement, talk to your doctor about it.

而说到昼夜节律紊乱，情况就稍微复杂一些了。

And in the case of circadian rhythm disorders, things are a little bit more complicated.

我觉得现在社会里昼夜节律紊乱的人越来越多，部分原因是我们不再像以前那样受太阳和月亮的约束了。

So part of the reason that I think we have circadian rhythm disorders increasing in our society is because we aren't quite as bound to the sun and the moon as we used to be.

这倒不是说我们是德鲁伊或者不再是德鲁伊了。

This doesn't mean like we're druids or we're no longer druids.

而是说，实际上，你知道，这就是蓝光这些东西起作用的地方。

This means that, like, literally, we have you know, this is where all the blue light kind of stuff comes in.

蓝光会抑制褪黑素的分泌。

So blue light suppresses melatonin production.

其实，这是来自松果体的正确信号。

Actually, it's this is the right symbol from the pineal gland.

褪黑素能帮助我们入睡，并保持我们的生物钟规律，所以人们会用褪黑素来调整时差。

And then melatonin helps us sleep and keeps us on schedule, which is why people will use melatonin to adjust for jet lag.

所以我们现在的做法是，吃褪黑素来帮助自己建立良好的睡眠规律。

So what we've got is, we'll take melatonin to help us get on a good sleep schedule.

但我们却在用蓝光和科技，这实际上和吃褪黑素片的效果正好相反。

But here we are using blue light and technology that actually does the opposite of taking a melatonin tablet.

它会抑制褪黑素的分泌。

It shuts off melatonin production.

所以像这些东西，互联网的普及，你可能会问，你这话是什么意思？

And so this kind of stuff, the availability of the Internet, you may say, well, what do you mean by that?

意思是，在午夜时分，你们想象一下一万年前，如果你是人类，在午夜到凌晨四点之间你能做什么？

It means that at midnight you know, I want you all to imagine ten thousand years ago, what could you do if you were a human between the hours of midnight and 4AM?

你能做什么？

What can you do?

你什么都做不了。

You can't do anything.

没什么可做的。

There's nothing to do.

大家都睡了。

Everyone's asleep.

但现在我们有各种各样的事情可以做。

But now we have all kinds of stuff to do.

东西随时都有。

Stuff is available all the time.

有24小时营业的餐馆。

They're twenty four hour eateries.

我们可以让食物送到家门口。

We can get food brought to our doorstep.

凌晨三点还有一群不睡觉的菜鸟在排队等着玩你想玩的游戏。

There can be some degenerate noobs that are queuing at 3AM for whatever game you wanna play.

所以有各种乱七八糟的事情可以做，这些都会干扰你的生物钟。

And so there's all kinds of crap that you can do, and that all interferes with your your circadian rhythm.

这会让你的生物钟变得乱七八糟，你可能会成为一个彻底的夜猫子。

It allows you to get circadian rhythm adjusted like you can become an absolute degenerate when it comes to your circadian rhythm.

但事实证明，除了这些之外，还有几件关于昼夜节律的事情是大家没意识到的。

But it turns out that aside from these kinds of things, there are a couple of other things which people don't realize about circadian rhythm.

所以我们就来聊聊这个。

So we're going to talk about that.

首先，你的昼夜节律是一个自然的周期，一天中有特定的时间段你特别擅长做某些事情。

The first is that your circadian rhythm is a natural cycle and that there are particular times of the day where you're good at particular things.

所以这其实不是昼夜节律的真实样子。

So this isn't actually what the circadian rhythm looks like.

真正的昼夜节律看起来不是这样的，而更像是这样的。

What the actual circadian rhythm looks like, it's not like this, but probably like this.

这大概是从九点到十点。

So this maybe is like nine nine to 10AM.

这大概是中午，从中午到三点。

This is noon ish, noon to three.

这大概是四点到七点，有时候是九点到十一点。

This is like four to seven, and sometimes this is like nine to eleven.

所以如果你真的看我们的活动，顺便说一句，这应该是平的。

So if you actually look at our activity, and this should be flat, by the way.

但如果你真的看我们的活动，我们实际上有，像，活动的波动，这在哺乳动物界是保守的。

But if you actually look at our activity, we actually have, like, fluctuations in our activity, and this is conserved throughout the mammalian kingdom.

所以如果你看，像，午睡或下午小睡的想法，即使在欧洲的一些国家，像，事情会在下午2点左右关闭，然后他们会在下午晚些时候再开门。

So if you look at, like, the idea of a siesta or a nap in the afternoon, like, even in some countries in Europe, like, things will shut down around, like, 2PM, and they'll, like, open up again in the afternoon late afternoon.

所以如果你看大多数哺乳动物，像，看猴子，猴子在早上5点甚至更早醒来，然后它们在十点左右放松，然后在一天中最热的时候安静下来。

So if you look at most mammals, like, look at monkeys, monkeys are awake at, like, you know, 5AM or even earlier, and then they kinda chill out around ten, and then they're, like, quiet during the hottest part of the day.

然后在黄昏时分，它们又变得活跃起来。

And then around dusk, they become active again.

瞪羚和黑斑羚也是如此。

Same is true of, like, gazelle and impala.

所以人类可能也是这样。

So humans are probably the same way.

甚至有一些证据表明，例如，在凌晨4点到6点之间的认知活动非常非常高效。

There's even some evidence that, for example, cognitive activity between the hours of four and 6AM is very, very, like, productive.

如果你看看世界各地的宗教传统，他们都会在凌晨五点起床祈祷或冥想。

So if you look at religious traditions across the world, they all wake up and pray or meditate at, like, 5AM.

那为什么所有宗教传统都这么做呢？

And why do all the religious traditions do that?

事实证明，这很可能跟昼夜节律有关。

Turns out that there's probably a circadian rhythm.

我们的心灵在那个时间段似乎更平静。

There's, like, something about our mind is more at peace at that time.

另一个有趣的事情是，我会和一些自认为是夜猫子的人合作，然后我会问他们，你是什么意思？

And the other really interesting thing is I'll I'll I'll work with some people who think they're night owls, and then I'll ask them, what do you mean?

帮我理解一下，你说你是夜猫子具体是什么意思？嗯，我有时候大概午夜开始工作，然后到凌晨四点，有时我会做最有创意的活儿。

Like like so help me understand the details of what do you mean by your night Well, I get started kinda sometimes around midnight, and then at 4AM, sometimes I'll, like, do my best creative work.

我会写音乐。

I'll write music.

你知道，我会写散文、诗歌，灵感涌现。

You know, like, I'll I'll write prose, poetry, inspiration.

灵感大概在凌晨三四点来，这其实和我们的昼夜节律是一致的。

Like, it comes at, like, three in the morning, four in the morning, which is actually consistent with our circadian rhythm.

所以，他们不是夜猫子，而是早起的人，非常非常早起的人，清晨型的人，这和大多数哺乳动物的习性是一致的。

So it's not that they're night owls, it's that they're, like, morning people, like, really, really morning people, early morning people, which is consistent with most of the mammalian kingdom.

关于昼夜节律，还有一个很多人忽略的点，就是我们有所谓的睡眠周期。

Another consideration for circadian rhythm, which a lot of people forget, is that we have these things called sleep cycles.

睡眠分为一到四期，之后是快速眼动睡眠。

So if you look at sleep, it's stage one to four sleep, and then we have REM sleep after that.

但人们不了解的是睡眠结构，基本上你会经历这五个阶段。

But what people don't understand about sleep architecture and so you basically go through these five stages.

对吧？

Okay?

问题是，不同的睡眠阶段对我们有不同的作用。

The problem is that different stages of sleep do different things for us.

比如在夜晚的开始，假设这是一期睡眠，这是二期睡眠，这是三期睡眠，这是四期睡眠，这是快速眼动睡眠。

So at the beginning of the night, let's say this is stage one sleep, this is stage two sleep, this is stage three sleep, this is stage four sleep, this is REM sleep.

到了夜晚快结束的时候，第一阶段睡眠很短，第二阶段很短，第三阶段很短，第四阶段稍微短一点，而快速眼动睡眠其实非常长。

And at the end of the night, stage one is short, stage two is short, stage three is short, stage four, let's say, a little bit shorter, and REM sleep is actually really long.

所以你睡得越久，你的大脑就越会改变它在各个阶段所花的时间。

So the more the longer you sleep, the more your brain changes what stages it spends its time in.

你实际上会经历一个睡眠周期，经历这五个阶段，然后再重复一遍。

So you'll actually go through a sleep cycle where you'll go through all five of these, and then you go through them again.

然后你又回到第一阶段睡眠。

Then you go back to stage one sleep.

有一点人们没有意识到的是，如果你在睡眠周期中间醒来，你会感到非常昏沉。

Now one thing that people don't realize is that if you wake up in the middle of a sleep cycle, you will feel really groggy.

我不知道你们有没有遇到过这种情况，但你们可能会觉得有点奇怪。

And I don't know if this has ever happened to y'all, but you may find that it's kinda weird.

但是，比如我睡八个小时，醒来时会觉得累。

But, like, if I sleep eight hours, I will feel tired when I wake up.

如果我睡八点半到九个小时，我会感觉非常好。

If I sleep eight and a half to nine, I'll feel really good.

或者我睡四个小时或六个小时，我会感觉很好。

Or if I sleep four hours or six hours, I'll feel really good.

我睡六个小时醒来比睡七到八个小时醒来更容易。

It's easier for me to wake up with six hours of sleep than it is for me to wake up with seven to eight hours of sleep.

你们有没有注意到这一点？

Have you all ever observed that?

就是，真的很奇怪。

Like, it's really weird.

我明明睡得更少，但醒来时却感觉更精神。

Like, I'm actually getting less sleep, but I feel more rested when I wake up.

这是因为你必须在睡眠周期的正确时间醒来，这样就不会感到昏昏沉沉。

And it's because you have to wake up during the right time of your sleep cycle, then you won't feel groggy.

但如果你在睡眠周期的中间醒来，那就麻烦了。

But if you wake up during, like, the middle of your sleep cycle, it's gonna be a mess.

这也是为什么睡眠阶段的进展顺序非常重要，因为我们知道，比如，睡眠中的很多好东西都发生在快速眼动期。

This is also why and and the progression of sleep staging is actually really, really important because we know that, for example, a lot of the good stuff in sleep happens in REM.

直到今天，如果有人告诉你他们完全了解我们大脑和睡眠的奥秘，那他们其实并不懂，因为没人真正知道。

And to this day, if anyone tells you they know exactly what's going on in our brain and sleep, they don't know what they're talking about because no one really knows.

注意你的睡眠周期，认识到你可能不需要八小时。

Pay attention to your sleep cycles and recognize that you may not need eight.

八这个数字是怎么来的？

How did we get the number eight?

每晚八小时睡眠是医生推荐的。

Eight hours of sleep a night is what the doctors recommend.

他们做的是，找了一千人，然后问这些人，好。

What they did is they took a thousand people, and they took these thousand people, and they asked, okay.

这里谁健康？

Who here is healthy?

然后这四个人举了手。

And these four people raised their hands.

然后他们问这些人，你们晚上睡多久？

And then they asked them, how much do you sleep at night?

一个人说十小时，一个人说八小时，一个人说七小时，一个人说七点五小时。

One person said ten, one person said eight, one person said seven, one person said 7.5.

他们把所有这些数字平均了一下，然后决定，好吧，七点五小时就是你需要的健康睡眠时间。

They averaged all these numbers together and they decided, okay, 7.5 is the healthy amount of sleep that you need.

这真的很奇怪。

So this is really weird.

如果我们用这个系统来推荐衣服，每个人都会穿那种中到大的灰色罩衫。

If we use this system to make clothing recommendations, everyone would wear gray smocks that were, like, medium to large.

我们就会问，医生，我今天该穿什么？

We're like, okay, doctor, what should I wear today?

然后他们会说，让我问问十个人他们穿什么，平均一下他们的尺码、颜色和款式，那就是答案。

And they're like, well, let me ask 10 people what they're wearing, average their sizes, average their colors, average their cuts, and that's the answer.

这就是我们做医学的方式，也是我们做基础科学研究的方式。

This is how we do medicine, and this is how we do basic science research.

我们就是把一群人平均一下。

We just average a bunch of people together.

对吧？

Right?

那我们看每日卡路里摄入量，这个数字是怎么来的？

So when we look at daily caloric intake, how did we get that number?

也是用同样的方法得来的。

We got it the same way.

为什么是每天2000卡路里？

Why is it 2,000 calories a day?

其实就是问了健康的人他们吃多少。

Well, we just asked people who were healthy how much they ate.

现在有研究显示，轻度限制卡路里，比如每天1800卡路里，长期来看反而对健康更好。

And now you have papers that come out that show that mild calorie restriction, like 1,800 calories a day, actually leads to better health outcomes over the long term.

所以，那个通过平均一堆数据得来的数字，其实并不是最健康的。

So turns out that that number that we got by just averaging all the crap together turned out to actually not lead to the best health.

真是有意思。

Fascinating.

谁能想到，如果你只是问10个人什么对他们有效，然后把所有答案平均一下，那其实并不是对你真正有效的答案。

Who would have thought that if you just ask 10 people what works for them and average it all together, that that's not actually the right answer of what works for you.

对吧？

Okay?

所以要注意不要在睡眠周期中间醒来，并且记住，如果你从昼夜节律的角度感到疲劳，一个可能的原因就是整晚的睡眠进程不够。

So be aware of waking up in the middle of your sleep cycle and remember that one of the reasons that you may not be you could be tired from a circadian standpoint is if you're not getting enough sleep progression throughout the night.

所以我们不想只睡很少的快速眼动睡眠，但也不是说睡眠的前两个小时和后两个小时给我们不同的好处。

So we don't wanna just sleep, you know, with a low amount of REM sleep, but we can't it's not like it's the first two hours of sleep and the last two hours of sleep give us different benefits.

现在，一个很好的过渡到新陈代谢话题的方式是聊聊咖啡因。

Now a good way to transition to metabolism is by talking about caffeine.

那么咖啡因是做什么的呢？

So what does caffeine do?

咖啡因，最简单的描述方式就是它抑制大脑中的腺苷受体。

Caffeine, the simplest way to describe what caffeine does is it suppresses adenosine receptors in the brain.

我们有一种叫做ATP的东西，它是我们细胞中基本的能量单位。

So we have this thing called ATP, which is our basic unit of energy in our cells.

当你用完一个ATP时，就会产生腺苷这种副产品。

And when you use up an ATP, you end up with an adenosine byproduct.

所以，当腺苷和ATP水平很高时，意味着我们能量充足。

So this is like when we have very high levels of this adenosine ATP, this means that we have lots of energy.

而腺苷水平高，则意味着我们能量低。

And we have high levels of adenosine, this means that we've got low energy.

然后，我们体内有某种东西来测量这个。

And then what we have is we have something that measures this.

我们测量的是腺苷与ATP的比例。

So we're measuring our a t our adenosine to ATP.

这其实是我在简化说法。

It doesn't I'm oversimplifying.

咖啡因的作用就是阻断低能量信号。

And so what caffeine does is it blocks the signal of low energy.

它实际上并不给我们提供能量。

It does not actually give us energy.

它只是让我们的身体对能量或缺乏能量变得麻木。

It just makes our body numb to energy or the lack of energy.

对吧？

Right?

所以这就像，如果我们服用抑制饥饿或口渴的药物，那和咖啡因的作用是类似的。

So it's like it's like the equivalent of, like, if we were taking met medication that suppressed our hunger or suppressed our thirst, that's analogous to what caffeine does.

所以它麻痹了身体检测疲劳的能力，这就是为什么我们感觉更有精力，但实际上并没有。

So it numbs our body's ability to detect fatigue, which is why we feel more energized, but we're not actually energized.

对吧？

Right?

它还有其他作用，比如抑制食欲等等，这变得非常有趣。

It also does other things like suppress appetite and things like that, which gets really interesting.

关于咖啡因的关键是，当我们使用咖啡因时，它会让我们感觉更有精力，但实际上并没有。

The key thing about caffeine is as we use caffeine, it's gonna make us feel more energy without actually having more energy.

咖啡因还有其他一些影响。

Now there are other effects of caffeine as well.

比如说，它会加快心率，让脉搏变快。

So, like, it increases heart rate, for example, so it increases our pulse.

所以我们会有点兴奋。

So we get kinda amped up.

喝咖啡可能会让人紧张不安。

You can sort of get the jitters with caffeine.

对吧？

Right?

所以它还会带来各种其他影响。

So it does, like, all kinds of other things.

但很多人会用咖啡因来对抗像睡眠呼吸暂停这类问题。

But this is where a lot of people will combat this kind of stuff, like sleep apnea, with things like caffeine.

所以当我有睡眠呼吸暂停的患者时，有时我会问他们，你早上会觉得累吗？

So when I have patients who have sleep apnea, sometimes I'll ask them, you feel tired in the morning?

他们会说，是的，当然。

They'll be like, yeah, absolutely.

然后我会问他们，好吧，你醒来后会做什么？

And then I'll ask them, okay, what do you do when you wake up?

一开始就是两杯咖啡。

Starts with two cups of coffee.

我就想，哇。

I'm like, wow.

好吧。

Okay.

所以现在这个人有两件事同时发生。

So now this person has two things going on.

他们不仅有睡眠呼吸暂停，而且现在他们把所有能量信号都阻断了。

Not only do they have sleep apnea, but now they're blocking all of their energy signals.

然后发生的是，他们实际上没有在需要休息的时候休息。

And then what happens is they don't actually take rest when they need to.

所以接着，他们就像汽车没油了还在跑，这又引发了其他各种问题。

So then, like, then they start running their car starts running on empty, which creates all these other problems.

所以一般来说，很多人都喜欢咖啡因。

So generally speaking, a lot of people like caffeine.

有一些证据表明，适量的咖啡因可能实际上更多与含咖啡因饮料中的其他成分有关。

There's some evidence that shows that a moderate amount of caffeine, which may have more to do actually with the other things in caffeinated beverages.

比如绿茶或咖啡，里面含有各种各样的酚类和其他物质，这些可能对健康有好处。

So if you look at things like green tea or coffee, there are all kinds of, like, phenols and, like, other things that probably have positive health benefits.

每天适量摄入咖啡因其实是可以的，甚至对健康有益。

That a moderate amount of caffeine intake per day actually can be fine or even healthy.

但你需要特别小心的是，如果你累了还喝咖啡因，尤其是喝很多的话，很可能咖啡因在抑制你身体感知疲劳的能力，这样你就无法好好照顾自己。

But what you've got to be really careful about is if you're tired and you're drinking caffeine, especially if you're drinking a lot of caffeine, chances are what's happening is that the caffeine is suppressing your body's ability to detect fatigue, and so you can't take care of it the way that you should.

举个例子，咖啡因也会抑制食欲，这也是为什么有些人做间歇性断食时喜欢喝咖啡因的原因之一。

So as an example, caffeine also suppresses appetite, one of the reasons why people like it if they're doing intermittent fasting.

如果我使用食欲抑制剂，并且处于热量不足的状态，那会导致我的能量崩溃。

If I'm using an appetite suppressant and I'm running on a caloric deficiency, that's gonna cause my energy to crash.

所以我们用咖啡因来减轻疲劳感，结果却因为各种其他原因让自己更累了。

So we use caffeine to feel less tired and we end up making ourselves more tired because of all kinds of other things.

那我们接着聊新陈代谢的下一部分，就是血糖平衡。

So let's move on to the next thing on metabolism, which is glucose balance.

记住，咖啡因是抑制食欲的。

So remember, it's an appetite suppressor.

对吧？

Right?

现在我们要理解一下血糖平衡是怎么回事。

So now here's what we got to understand about glucose balance.

我们有两种激素，胰岛素和胰高血糖素。

We've got two hormones, insulin and glucagon.

这两者之间基本上是一种平衡关系。

There's basically a balance between these two things.

胰岛素是一种合成代谢激素。

Insulin is an anabolic hormone.

合成代谢是什么意思呢？

What does anabolic mean?