AMA #9：卡痛叶的风险、红外线桑拿是否有效及写日记的好处

欢迎收听休伯曼实验室播客，我们将探讨科学及基于科学的日常生活工具。

Welcome to the Huberman Lab Podcast where we discuss science and science based tools for everyday life.

我是安德鲁·休伯曼，斯坦福大学医学院神经生物学和眼科学教授。

I'm Andrew Huberman and I'm a professor of neurobiology and ophthalmology at Stanford School of Medicine.

今天是一期问答环节，即AMA。

Today is an Ask Me Anything episode or AMA.

这是我们的高级订阅者频道的一部分。

This is part of our premium subscriber channel.

我们开设高级订阅者频道，是为了支持普通的休伯曼实验室播客，该播客每周一发布，免费向所有人在所有主流平台提供，包括YouTube、Apple、Spotify等。

Our premium subscriber channel was started in order to provide support for the standard Huberman Lab Podcast, which comes out every Monday and is available at zero cost to everybody on all standard feeds, YouTube, Apple, Spotify, and elsewhere.

我们开设高级频道，也是为了支持斯坦福大学及其他机构正在进行的令人兴奋的研究。

We also started the premium channel as a way to generate support for exciting research being done at Stanford and elsewhere.

针对人类开展的研究，旨在促成重要发现，从而促进心理健康、身体健康和表现提升。

Research on human beings that leads to important discoveries that assist mental health, physical health, and performance.

我也很高兴地通知大家，对于休伯曼实验室高级频道为研究项目筹集的每一美元，Tiny基金会都同意等额匹配。

I'm also pleased to inform you that for every dollar the Huberman Lab premium channel generates for research studies, the Tiny Foundation has agreed to match that amount.

因此，我们现在能够将用于心理健康、身体健康和人类表现研究的总资金翻倍。

So So now we are able to double the total amount of funding given to studies of mental health, physical health, and human performance.

如果您想订阅Huberman Lab播客高级频道，请访问hubermanlab.com/premium。

If you'd like to subscribe to the Huberman Lab Podcast Premium channel, please go to hubermanlab.com/premium.

订阅费用为每月10美元，或者您可以一次性支付100美元，获得整年的12个月订阅。

It is $10 a month to subscribe, or you can pay $100 all at once to get an entire twelve month subscription for a year.

我们还提供一次性付费的终身订阅模式。

We also have a lifetime subscription model that is a one time payment.

您可以在hubermanlab.com/premium找到这一选项。

And again, you can find that option at hubermanlab.com/premium.

对于已经订阅高级频道的朋友们，请前往hubermanlab.com/premium下载高级订阅源。

For those of you that are already subscribers to the Premium channel, please go to hubermanlab.com/premium and download the Premium subscription feed.

对于尚未订阅Huberman Lab播客高级频道的朋友们，您仍然可以收听今天节目的前二十分钟，以判断是否值得成为高级订阅用户。

And for those of you that are not Huberman Lab Podcast Premium subscribers, you can still hear the first twenty minutes of today's episode and determine whether or not becoming a premium subscriber is for you.

那么，不多说了，我们开始回答你们的问题。

So without further ado, let's get to answering your questions.

第一个问题是关于 kratom 的，问题是：服用 kratom 的短期和长期影响是什么？

The first question is about kratom, and the question is, what are the short and long term effects of taking kratom?

对于那些还没听说过 kratom 的人，kratom 是一种源自印度尼西亚天然生长的树木的物质。

For those of you that haven't heard of kratom, kratom is a substance that comes from a tree that grows naturally in Indonesia.

这种树被称为 Mitragyna speciosa，人们已知它至少有几百年的历史了——确切时间尚不明确——但至少几百年来，人们发现咀嚼这种树的叶子会产生轻微的兴奋作用。

The tree itself is called Mitragina speciosa, and it's been known for hundreds of years or more, we don't really know how long, but at least for a couple of hundred years, that when people chew the leaves of this tree, they experience a mild stimulant effect.

此外，还有一种提取工艺，可以将叶子加工成高浓度的 kratom，如今通常被制成各种补充剂，最常见的是胶囊形式，有时也以原始粉末形式出售。

And there's also a process of extraction whereby you can take the leaves and get high concentrations of kratom that nowadays is packaged into various supplements, most often consumed in capsule form, although sometimes it's sold in raw powder form.

关于 kratom，这里有一个关键点需要理解。

Here's the key thing to understand about kratom.

确实，在低剂量时，kratom 会产生轻微的兴奋作用。

Indeed, at low dosages, kratom has a mild stimulant effect.

然而，在高剂量时，它会产生所谓的镇痛作用，即止痛效果，并具有镇静作用，而 kratom 本身在体内会像阿片类物质一样发挥作用。

However, at higher dosages, it has what's called an analgesic effect, that is a painkilling effect, and it acts as a sedative, and kratom itself acts as an opioid in the body.

这正是如今 kratom 成为极具争议话题的原因，尤其是因为大多数人听说过所谓的阿片类药物危机。

This is what's making kratom a very controversial topic these days, in particular, because most people have heard of the so called opioid crisis.

阿片类药物危机这一术语主要是为了描述在美国发生的问题，尽管这些问题无疑超出了美国的国界，但阿片类药物危机本质上是指阿片类药物的过度使用和广泛成瘾。

The opioid crisis has been a term coined to largely center around issues that have taken place in The United States, although these issues definitely extend beyond the borders of The United States, but the opioid crisis is essentially the overconsumption and widespread addiction to opioids.

阿片类药物包括吗啡、羟考酮（也称为奥施康定），以及其他类似化合物，它们的共同作用是镇痛和镇静，对某些人而言，尤其是在低至中等剂量下，还会引发欣快感。

Opioids include things like morphine, oxycodone, also called OxyContin, and there are other opioids similar to those compounds, all of which have the general effect of being painkillers and sedatives, and in some people, again, some people eliciting a sense of euphoria, in particular at low to moderate dosages.

然而，人们很快会对这些药物产生耐受性，必须服用越来越多的剂量才能获得最初较低剂量时的效果，它们不仅极易形成习惯，而且极具成瘾性。

However, people quickly develop a tolerance to those drugs and need to consume more and more of them in order to get the effect that they initially got from a lower dosage, and they are not just highly habit forming, they are highly addictive.

我们可以通过简单区分来理解习惯性与成瘾性：成瘾意味着人们即使面对负面后果，仍会继续使用某种物质或从事某种行为。

And we can distinguish between habit forming and addictive by simply saying that addictive means people will continue to take something or do something despite negative consequences.

关于成瘾，还有其他相关的定义。

There are other relevant definitions of addiction as well.

我更广泛地将成瘾定义为：让你感到快乐的事物逐渐变少的过程。

I define addiction more broadly as the progressive narrowing of the things that give you pleasure.

当人们对阿片类药物上瘾时，情况确实非常糟糕。

And indeed, when people get addicted to opioids, it is a very bad picture.

它常常严重损害人们生活的诸多方面。

It often hampers many, many areas of their lives and seriously so.

因此，阿片类药物危机指的是阿片类药物的过度处方。

So the opioid crisis refers to the overprescription of opioid drugs.

这通常被理解为它的含义，但它也包括通过灰色市场、黑色市场等途径获取阿片类药物，如吗啡、羟考酮等。

That's sort of what it's generally taken to mean, but it also includes accessing opioids such as morphine, oxy codone, etcetera, through gray market sources, through black market sources, and on and on.

当然，药物的获取只是其中一部分。

And of course, the acquisition of the drugs is just one piece.

还包括这些药物的过度使用，以及众所周知的、极具破坏性的药物成瘾问题。

It's also the overconsumption of those drugs, and of course, the addiction to those drugs, which has proved to be so pernicious.

那么，这与 kratom 有什么关系呢？

So what does this have to do with kratom?

Kratom 也是一种阿片类物质，我们会讨论它与我刚才提到的药物在阿片特性上的差异，因为它与吗啡和氢可酮不同，但也具有一些相似的特性。

Kratom is also an opioid, and we'll talk about how it differs in its opioid properties from the drugs I just talked about, because it is different from morphine and hydrocodone, but it also has some similar properties as well.

但 kratom 的情况是，相当多的人通过使用 kratom 成功戒除了吗啡和氢可酮等阿片类药物，这被用作支持 kratom 继续在市场上销售并保持合法的理由。

But the deal with kratom is that a good number of people out there have managed to wean themselves off opioids such as morphine and hydrocodone through the use of kratom, and that has been used as justification for keeping kratom on the market and keeping it legal.

然而，这是一个非常重要的转折：kratom 本身也被证明不仅具有成瘾性，而且具有高度成瘾性，尤其是在摄入量超过低剂量（仅产生轻微兴奋和轻微欣快感）时。

However, and this is a very important however, kratom itself has also proved to be not only habit forming, but addictive, especially when taken at dosages that exceed that lower dose that just generally creates a bit of stimulant, a little bit of euphoric effect.

当人们开始服用更高剂量的 kratom 时，很明显它会变得极具成瘾性，而且很难戒断，以至于许多人会经历所谓的 kratom 戒断反应。

When people start taking higher dosages of Kratom, it is very clear that it does become addictive and itself is very hard to come off of, so much so that people experience so called kratom withdrawal.

我之所以提到很多人用 kratom 来戒除更强效的处方阿片类药物，是因为当我在社交媒体上征集关于 kratom 的问题时，得到的回应非常两极分化。

Now, the reason I mentioned that kratom has been used by a good number of people to wean themselves off of the more potent forms of prescription opioids, is that when I solicited for questions about kratom on social media, it was a very binary response.

事实上，有一派观点非常激烈，他们说：kratom 太糟糕了，我用过这东西，结果上瘾了，戒掉它极其困难。

In fact, there was one camp, a very rabid camp that said, Kratom is terrible, I took this stuff, I got addicted, it was extremely hard to come off of.

还有其他评论提到：我知道有人因为 kratom 真的不得不去康复中心，还因为 kratom 发展出其他多种成瘾问题。总体而言，有很多人分享了他们或他们认识的人与 kratom 的负面经历，意思是他们最初觉得 kratom 效果不错，于是持续使用，最终导致自己或他人上瘾。

There were additional comments in there such as, I know somebody who literally had to go to rehab because of Kratom, who developed a bunch of other addictions because of Kratom, essentially many, many responses of people who had only bad experiences with kratom, meaning they liked it enough at first that they continued to take it and it became addictive for them or somebody that they know.

然而，还有另一派同样声音响亮，他们坚持认为：如果严格控制在低剂量使用，kratom 本身可以成为帮助戒除其他阿片类药物的有用工具。

However, there was another camp that was equally vocal, which kept saying, no, if one really adheres to the lower dosages of kratom, kratom itself can be a useful tool for getting off other opioids.

甚至还有几位真正的医疗专业人士——也就是医生——参与了讨论，我认识他们，他们的声誉非常好，他们试图调和这两派观点，表示：确实，如果能完全避免使用 kratom，那你最好别用。

And there were even a few bonafide medical professionals, medical doctors that is, and I happen to know them and their reputations is quite good, who chimed in and sort of reconciled the two camps by saying, indeed, if one can avoid taking kratom at all, you should.

没有理由认为 kratom 对你有好处而去服用它。

There is no reason to take this thing thinking that it's quote unquote good for you.

明智的做法是避免使用它，因为如果你服用的剂量足以让你的大脑和身体进入愉悦、镇痛这类典型的阿片类效应状态，那么它极有可能对你产生依赖或成瘾。

You would be wise to avoid taking it because there is a high probability if you take it at a given dosage or at a dosage that is going to get your brain and body into a state of euphoria, analgesia, and that sort of classic opioid effect, that it's going to become habit forming or addicting for you.

尽管如此，这些医疗专业人士也承认，他们认识的相当一部分人成功地借助 kratom 摆脱了更强烈的阿片类药物，比如吗啡、羟考酮等。

That said, these same medical professionals acknowledged that a fair number of people that they knew managed to get off of the more potent forms of opioids, such as morphine, oxycodone, and so forth using kratom.

他们表示，如果要在对吗啡和氢可酮上瘾，以及对 kratom 上瘾但能借此逐步摆脱更强效药物之间做选择，只要能承诺逐步减少 kratom 的用量并最终彻底停用，他们会对 kratom 持更积极的看法。

And they said, well, if it's a choice between being addicted to morphine and hydrocodone versus taking kratom and addicted to those substances, and kratom somehow allowed them to taper off of those substances, that they would look more favorably upon kratom if and only if they would also commit to progressively lowering their dose of kratom and eventually coming off of kratom.

因此，从这一切中得出的总体结论是：如果你能避免使用 kratom，也就是说，如果你还没用过，就别用。

So the general takeaway from all of that is if you can avoid taking Kratom, meaning if you haven't taken it already, don't.

这让我想起一个非常重要的观点，来自《休伯曼实验室播客》的一位嘉宾，罗伯特·穆拉伦卡医生。

And that reminds me of a very important point, which a guest on the Huberman Lab Podcast, Doctor.

罗伯特·穆拉伦卡是医学博士和哲学博士，也是我在斯坦福大学医学院的同事，他是成瘾机制、多巴胺和药物强化作用等领域的世界级专家。

Robert Muralenka, who's a MD and PhD, he's my colleague at Stanford School of Medicine, he's a world expert on the mechanisms underlying addiction and dopamine and drug reinforcement among many other things.

他在播客中所说的话完全正确：你从未使用过的物质，是不可能让你上瘾的。

What he said on the podcast is absolutely true, which is that it is impossible to get addicted to a substance that you've never consumed.

这听起来可能显而易见，但再仔细想想：你从未使用过的物质，是不可能让你上瘾的。

That might seem obvious, but think about that one again, it is impossible to get addicted to a substance that you've never consumed.

因此，我认为最稳妥的说法是：如果你还没尝试过 kratom，最好避免使用，因为你有染上瘾的风险。

So I think the safest statement to make is if you have not tried kratom, you would be wise to avoid it because you stand a chance to become addicted to it.

但如果你已经对其他类型的阿片类药物上瘾，你绝对应该与医生讨论如何戒除这些药物，因为有证据表明，一些人确实使用了 kratom 成功地戒掉了我之前提到的更强效的阿片类药物，比如吗啡和氢可酮，以及其他几种药物。

If however you are somebody that's addicted to other forms of opioids, you absolutely should talk to your physician about that and how to get off of those opioids, but there is evidence that some people have used kratom to successfully wean themselves off the more potent forms of opioids that I talked about, namely morphine and hydrocodone, as well as a few others.

如果你已经使用 kratom，那么你必须非常谨慎地控制剂量，同时也要意识到，不同人对阿片类药物的反应差异极大。

Now, if you're somebody who already takes kratom, you need to be very thoughtful about the dosage that you take, and you also need to be thoughtful about the fact that people differ dramatically in their response to opioids.

这一点极其重要，但人们却很少谈论它。

This is oh so important and people do not talk about this enough.

我们常听到这样的说法，比如，如果人们每天摄入一到五克，甚至一到六克 kratom，就属于不太容易上瘾的剂量范围。

We hear for instance that, oh, you know, if people are taking anywhere from one to five grams, maybe one to six grams of kratom per day, that's keeping it in the dosage range for which people don't generally tend to get addicted.

你会听到类似这样的话。

You'll hear things like that.

顺便说一下，当我提到每天一到五克或一到六克时，我指的并不是 kratom 中所含的单一化合物。

And by the way, when I say one to five or one to six grams per day, I'm not talking about the individual compounds that are present in kratom.

kratom 中含有几种不同的植物生物碱，我稍后会提到，它们对阿片系统有不同的作用。

There are a couple of different plant alkaloids I'll talk about in a moment that are present in kratom and these have different effects on the opioid system.

如今，一些销售 kratom 的公司——顺便说一句，kratom 是作为膳食补充剂在柜台销售的，至少目前在美国购买不需要处方。

So nowadays, some of the companies that sell kratom, and by the way, this is sold over the counter as a supplement, it does not require a prescription to purchase, at least at this point in time in The United States.

这些产品中有些含有较高浓度的某种或另一种生物碱，因此你无法将一克某个品牌的 kratom 与一克另一个品牌的 kratom 直接比较，因为它们所含的不同生物碱浓度差异极大，而这些生物碱对你的大脑和身体生理机制，尤其是对所谓的内源性阿片系统的影响也截然不同，明白吗？

Some of these products will have a higher concentration of one or the other alkaloids within them, such that you can't really compare one gram of one brand of kratom to one gram of another brand of kratom because they can have wildly different levels of these different alkaloids and these different alkaloids have wildly different impact on different aspects of your brain and body biology, in particular, how much they tend to impact the so called endogenous opioid system, okay?

所以当我们讨论剂量时，必须时刻牢记这一点，同时也要意识到，确实存在一小部分人群。

So when we talk about dosages, we have to keep this in the back of our mind and we have to keep in the back of our mind that there does seem to be a subgroup of people.

我们不知道这一小部分人群具体有多大，但可以确定的是，并非所有人都如此，大约有百分之十到四十的人对阿片类物质反应特别强烈。

We don't know how big this subgroup of people is, but we know it's not everyone, but it's somewhere between ten and forty percent of people seem to respond to opioids in a particularly potent way.

他们非常喜欢这些物质。

They really like them.

而毫不意外的是，不属于这一群体的人通常并不喜欢阿片类药物。

And perhaps not surprisingly, people outside of that category don't tend to like opioids.

我可以明确地说，我自己就是那种人——当术后被开具维柯丁或其他任何阿片类止痛药时，我非常讨厌服用这些药物。

I can certainly say that I am somebody who, when I've been prescribed things like Vicodin or any other opioid post surgery for pain, I hate taking those drugs.

我真的很讨厌。

I absolutely hate it.

我宁愿忍受疼痛。

I'd rather deal with the pain.

它们让我恶心。

They make me nauseous.

它们让我感觉很糟糕。

They make me feel terrible.

话虽如此，我知道有些人非常喜欢阿片类药物。

That said, I know people who love opioids.

这对他们体内的化学机制来说就像是天然契合，因为这类药物往往能引发更强的欣快感。

It's like a natural fit for their chemistry in the sense that it tends to evoke more euphoria.

他们立刻就喜欢上了那种感觉。

They just immediately like the feeling.

你们中有些人可能还记得我关于酒精的《休伯曼实验室播客》那一期，当时我也提到，大约有8%到10%的人在饮酒后会产生比其他人更强的多巴胺反应，而这一特定人群极易发展为酒精使用障碍，有时被称为酒精成瘾，因为他们饮酒的方式以及饮酒带来的快感是其他人根本无法体验的。

Some of you may remember the episode of the Huberman Lab Podcast that I did about alcohol, and there too, I discussed the fact that about eight to ten percent of people who consume alcohol get an increased dopamine response to alcohol that's not observed in other people, and that particular subgroup of people is very, very at risk for developing alcohol use disorder, sometimes called alcoholism, because they can drink in a way and they experience a high from drinking in a way that other people simply do not experience.

而对于其他人来说，如果饮酒过量，他们只是会喝醉。

Now, everybody else, if they consume too much alcohol, they get drunk.

所以，问题不在于醉酒本身，而在于这些人对酒精产生的多巴胺及其他化学物质的反应强度，是其他人根本无法达到的。

So it's not about the drunk effect, it's about the dopamine and other sorts of chemicals that are released in those people in response to alcohol that other people just don't seem to experience at the same level of potency.

所以，对于像 kratom 和其他阿片类药物这样的物质，存在一类人，而且这类人的比例要大得多，大约在百分之十到四十之间，我们还不知道确切数字，因为相关研究尚未完成，目前这类研究还太少，不幸的是，当这些人服用阿片类药物时，他们会非常喜欢这种感觉，而这些人尤其容易发展出阿片类药物成瘾，因此，那些尚未接触过 kratom 的人，或者已经使用 kratom 的人，绝对不应该碰它。

So again, with things like kratom and the other opioids, there's a category of people and it's a much larger category of people, again, ten to forty percent, we don't know exactly how many because the studies are not really completed and there aren't enough of those studies yet, unfortunately, but when those people take an opioid, wow, oh wow, do they like it, and those people in particular are very much at risk for developing an addiction to opioids, and so those people especially should never ever go near kratom if they haven't, or if they are already taking kratom.

这些人总是不断加大剂量。

These are the people that are constantly ratcheting up their dose.

这些人会告诉你：不，我没有上瘾，但如果你说：好吧，那我们做个实验，你一周不使用 kratom 试试。

These are the people that tell you, no, I'm not addicted, but if you were to say, hey, all right, well then let's do an experiment where you don't take kratom for a week.

这些人一听到这个建议就会立刻感到焦虑。

Those are going to be the people that are suddenly going to get anxious about the mere idea of that.

我在关于大麻的那期节目中也提到过这一点。

I've also talked about this in reference to cannabis when I did an episode about cannabis.

在那期节目中，我并没有对大麻的好坏做出一刀切的结论。

Again, I'm not putting a blanket statement out there about cannabis as being good or bad on that episode.

我提到过，大麻确实有多种治疗用途，但也有很多人依赖大麻来控制焦虑，以及调节大脑和身体的化学状态，因此，如果你问他们：你对大麻上瘾吗？

I talked about the fact that cannabis does indeed have various therapeutic uses, but that there are a good number of people who rely on cannabis for anxiety control and other ways of modulating their brain chemistry and bodily chemistry such that if you were to say, Hey, are you addicted to cannabis?

他们会说：不，我不非得吸大麻不可。

They'd say, No, I don't have to smoke cannabis.

我不必吃我的大麻食品。

I don't have to take my edibles.

但如果你稍微施压，说好吧，我们来做个实验，让你十天内完全不以任何形式摄入大麻。

But if you were to push them a little bit and say, All right, well then, you know, let's do an experiment where you don't consume any cannabis in any form for ten days.

他们根本不喜欢这个实验的想法，以至于如果真的进行这个实验，他们会经历许多与成瘾相关的戒断症状。

They don't like the idea of that experiment at all, so much so that were they to run that experiment, they would experience a lot of the withdrawal symptoms associated with addiction.

因此，我不能负责任地说 kratom 对所有人都安全，因为它根本不是。

So I can't in good faith say that kratom is safe for everybody because it is simply not.

那么，它比其他阿片类药物更安全吗？

Now, is it safer than the other opioids?

如果是，为什么？

And if so, why?

要回答这个问题，让我们简要看一下 kratom 的药理学及其在体内的神经化学作用机制。

Well, in order to address that, let's take a short glance at the pharmacology of kratom and how it works in terms of its neurochemistry in the body.

我会尽量简短，因为未来我会专门做一期关于阿片类药物的长篇内容，届时会把 kratom 也纳入讨论。

And I'm going to keep this pretty brief because in the future, I'm going to do an extended episode all about opioids and I will include kratom in that conversation.

但让我们先退一步，谈谈什么是阿片类药物。阿片类药物是能够激活所谓内源性阿片系统的化合物。

But just to back up a little bit and discuss what opioids are, opioids are compounds that can activate the so called endogenous opioid system.

我们每个人的大脑和身体都具备释放自身阿片类物质的能力。

All of us have within our brain and body the capacity to release our own opioids.

没错，你的体内就有阿片类物质，它们由神经元释放，并与所谓的阿片受体结合。

That's right, you have opioids within your body, they are released from neurons and they bind to so called opioid receptors.

也许你们中有些人听说过所谓的‘跑者高潮’。

Perhaps some of you have heard of the so called runner's high.

跑者高潮在大多数情况下是一种较为温和的欣快状态，但这种状态是由长时间的体力活动引发的，也就是所谓的‘跑者高潮’。

The runner's high is it's a fairly mild euphoric state in most cases, but it's a euphoric state induced by long duration effort, AKA the runner's high.

‘跑者高潮’这个说法是用来解释当我们进行长时间、重复性的体力活动时，身体会开始释放这些内源性阿片类物质，它们与受体结合，引发镇痛、缓解疼痛，产生轻微的欣快感，并改变我们对外界的感知，让事物看起来更美丽、更闪亮，给一切增添一丝光泽。

The runner's high is just a phrase used to explain that when we engage in long duration, repetitive action effort, the body starts releasing these endogenous opioids, they bind to receptors and they trigger things like analgesia, relief from pain, they trigger mild euphoria, they tend to change our perception of the outside world, make things look more beautiful, shiny, they give things a little bit of a sheen.

我刚才描述的，就是人们服用吗啡时所体验到的轻微版本。

What I just described is a mild version of what people experience when they take something like morphine.

当人们服用吗啡时，会产生更强的镇静作用、更强烈的欣快感，以及更明显的梦幻般的效果，而这同样取决于剂量。

When people take morphine, there's a more of a sedative effect, there's more of a euphoric effect, and there's more of a dreamlike effect, and again, it will depend on dosage.

kratom、吗啡和氢可酮都具有类似内源性阿片类物质的特性，但效力要强得多。

Kratom and morphine and hydrocodone all have the property of acting like the endogenous opioids, but at much higher potency.

当它们进入你的体内时，会穿过血脑屏障，进入大脑并与多种不同的阿片受体结合。

When you bring them into your system, they cross the blood brain barrier, so they go into the brain and they bind to a number of different opioid receptors.

有μ阿片受体，顺便说一下，这些名称都遵循希腊字母的命名方式。

There's the mu opioid receptor, by the way, these names all follow Greek alphabet letters.

所以有μ阿片受体、κ阿片受体，还有其他几种不同的受体。

So the mu opioid receptor, the kappa opioid receptor, there are a bunch of different ones.

kratom 主要与μ阿片受体结合，也部分与κ阿片受体结合。

Kratom binds preferentially to the mu opioid receptor and somewhat to the kappa opioid receptor.

现在存在一个很大的误解。

There's a big misconception out there.

很多人，尤其是kratom的支持者会说：不，吗啡和氢可酮结合的是μ阿片受体，而kratom结合的是κ阿片受体，所以它是完全不同的物质，非常非常不同——这是错误的，完全不对。

A lot of people, especially people who are proponents of kratom will say no, morphine and hydrocodone bind the mu opioid receptor, whereas kratom binds the kappa opioid receptor, so it's a different compound, very, very different, not true, not true.

kratom、吗啡和氢可酮都会与μ阿片受体结合，这正是它们产生类似阿片类作用的主要原因，尤其是当你摄入的剂量达到一定程度，开始出现轻度镇静、镇痛和止痛效果时。请记住，很多人服用kratom就是为了获得止痛效果。

Kratom, morphine, and hydrocodone all bind to the mu opioid receptor, and that's what's largely responsible for its opioid like effects, especially when you get the dosage up to a level where you start getting the mild sedation, the analgesia, the pain relief, and keep in mind, a lot of people are taking kratom because they want pain relief.

当mu阿片受体系统被激活时，它会间接激活大脑中与多巴胺和血清素相关的大量强化回路。

And when that mu opioid receptor system is activated, it indirectly activates a lot of the reinforcement circuitry in the brain that relates to dopamine and serotonin.

这是我们将来会更深入探讨的另一个领域，但这里存在很多争议。

This is another area that we'll go into in more depth in the future, but there's been a lot of controversy.

有些人说，克他命不会激活多巴胺系统，因此不会成瘾，但这完全不对。

People saying, oh, know, kratom doesn't trigger the dopamine system, therefore it's not addictive, but that is simply not true.

它间接激活了包含多巴胺和血清素的强化回路，但其主要作用是作用于大脑多个区域中存在的mu阿片受体系统，尤其是脑干中的一个叫导水管周围灰质的结构，从而提供止痛效果。

It indirectly activates the reinforcement circuitry that includes both dopamine and serotonin, but its primary effect is to hit this mu opioid receptor system that exists in a bunch of places in the brain, but mainly in the brainstem and structure called the periaqueductal gray nucleus, which then provides pain relief.

它会引发多种认知上的变化。

It triggers a number of different shifts in cognition.

这正是产生轻微欣快感等原因的根源。

It's what creates that mild euphoria, etcetera, etcetera.

那么，我们如何能如此确信克他命的作用机制与氢可酮和吗啡如此相似，只是效力较低呢？

Now, how can we be so confident that kratom is acting so similarly to hydrocodone and to morphine, albeit with lower potency?

原因是，如果在人们服用克他命之前，先给他们服用一种阻断mu阿片受体的药物，他们就不会体验到服用克他命时的任何典型效果。

And the reason is if you give people a drug that blocks the mu opioid receptor prior to them taking kratom, they don't experience any of the classic effects of taking Kratom.

没有愉悦感，没有镇痛效果，没有镇静作用，即使在低剂量下，也没有轻微的兴奋作用。

No euphoria, no analgesia, no sedation, even at the low dosages, no mild stimulant effect.

所以我们必须把 kratom 视为一种阿片类药物，明白吗？

So we really have to look at Kratom as an opioid, okay?

这不过是诚实的真相。

That's just the honest truth.

如果你不喜欢这个观点，因为你喜欢 kratom，我并不是说你不该喜欢 kratom，我是说，你很可能喜欢 kratom，正是因为它是阿片类药物。

And if you're somebody who doesn't like this message because you like kratom, I'm not telling you that you don't like kratom, I'm telling you, you likely like kratom because it's an opioid.

所以，如果你上网去问一些关于 kratom 的问题，你还是会看到这两个阵营。

So again, if you go online and you start asking questions about kratom, again, you're going to see these two camps.

你会看到一方说 kratom 很糟糕，它会上瘾，一无是处。

You're going to see the kratom is terrible, it's addictive, it's everything bad camp.

而另一方也非常活跃，声称 kratom 帮助他们避开了更糟糕的东西。

And then you're going to see the other camp out there, very vocal as well, talking about how kratom helped them avoid other things that are worse.

而且，你知道，这种争论说实话，我觉得我们并不应该依赖它，对吧？

And, you know, this is an argument that frankly, I don't think we want to lean on, right?

认为物质A没有物质B那么糟糕，因此如果禁止物质A，人们就会转而使用物质B，这种说法说实话很薄弱，对吧？

The idea that substance A is not as bad as substance B and that making substance A unavailable is just going to send everyone running for substance B, you know, that's a weak argument, frankly, right?

我以前也听过这种关于大麻的论点，顺便说一句，我对大麻的看法相当平衡。

I heard this argument around cannabis, and by the way, I'm, I think, pretty balanced about cannabis.

如果你听过我关于大麻的那期节目，你会同意我认为大麻有其治疗用途。

If you listen to the episode I did on cannabis, I think you'll agree that I believe that cannabis has its therapeutic applications.

我也认为，尤其是有精神病倾向的年轻男性，不应该使用高浓度THC的大麻，因为数据显示，他们本来就容易患精神病，使用后风险会大大增加。

I also believe that young people, especially young males with a predisposition to psychosis should not be taking high concentration THC cannabis, because the data tell us us they are already at risk of psychosis and they are at a much greater risk of psychosis if they do.

所以，我认为我对大麻的看法相当平衡，但我经常听到这样的论点：大麻没有酒精那么糟，因此大麻就是好的。

So, I think I'm pretty balanced about the story on cannabis, but I often hear the argument, oh, cannabis isn't as bad as alcohol and therefore cannabis is good.

这根本不符合理性。

That's simply not rational.

我们真正应该讨论的是，无论是大麻、酒精、卡痛叶，还是任何其他物质，它们的潜在益处是什么？

What we should be saying is whether or it's cannabis or alcohol or kratom or any substance for that matter, what are the potential benefits?

它们的潜在风险又是什么？

What are the potential risks?

而且，这一点远远超出了本次AMA所能涵盖的范围，我们将在未来《休伯曼实验室播客》的完整长篇节目中深入探讨。

And again, this is far too much than we can go into in this AMA and we will go into in a future full length episode of the Huberman Lab Podcast.

但另一个需要牢记的关键点是，对 kratom 补充剂缺乏监管。

But the other thing to really keep in mind is the lack of regulation over kratom supplements.

正如许多朋友所知，我支持许多——并非所有——在特定情况下使用的补充剂。

Now, as many of you know, I am a fan of many, not all, but many supplements in certain conditions.

我总是强调：先调整行为，再优化营养，只有在必要时才考虑补充剂，但补充剂本身涵盖的范围很广。

I always say behaviors first, then nutrition, then if and only if it's needed, rely on supplementation, but supplementation is a big category.

但当我们讨论的是阿片类化合物类补充剂时，我会感到担忧，因为阿片类物质具有很高的滥用和成瘾风险，而 kratom 正属于这一类。

But when we're talking about supplements that are opioid compounds, I start to get nervous because of the high abuse potential and the high addiction potential of opioids, and kratom is included in that category.

关于 kratom，还有几点需要注意。

A couple of other keynotes about kratom.

虽然直接因 kratom 导致死亡的情况较为罕见，但确实发生过。

While death directly from kratom is fairly rare, it has happened.

羟考酮和吗啡会通过一种机制抑制呼吸——如果你是《休伯曼实验室播客》的听众，你应该了解，这就是所谓的‘生理性叹气’。

Now hydrocodone and morphine suppress respiration, actually suppress breathing by way of a mechanism that if you're a listener of the Huberman Lab Podcast, you know about, which is the so called physiological sigh.

你们很多人听过我提到过‘生理叹息’，这是一种你可以主动进行的动作：通过鼻子进行两次快速吸气，然后长时间呼气，以迅速降低压力水平。

Many of you heard me talk about physiological sigh as something that you do voluntarily, the double inhale through the nose and then a long exhale in order to rapidly reduce your level of stress.

据我们所知，这是有意识地降低压力水平的最快方法。

As far as we know, that's the fastest way to deliberately lower your level of stress.

但生理叹息是在20世纪30年代被发现的，它是一种在睡眠中无意识出现的自发呼吸模式，目的是重新扩张肺部、排出二氧化碳，并在下一次呼吸时将氧气重新带入体内。

But the physiological psi was discovered in the 1930s as a spontaneous pattern of breathing that occurs involuntarily in sleep in order to reinflate the lungs and offload carbon dioxide and bring oxygen back into the system subsequent breath.

当我采访加州大学洛杉矶分校的杰克·费尔德曼博士时，

When I interviewed Doctor.

他是现代神经科学对呼吸机制研究的先驱，他谈到了自己实验室中一些探索人们服用阿片类药物后死亡原因的研究。

Jack Feldman, who is a professor at University of California, Los Angeles, and really the pioneer of the modern neuroscience understanding of respiration, he talked about some studies in his laboratory that were exploring why people die when taking opioids.

这是与阿片类药物危机密切相关的一个重大问题。

This is a major issue associated with the opioid crisis.

他提到，阿片类药物会与脑干中产生生理叹息的特定受体结合。

And what he mentioned was that the opioids bind to particular receptors in the brainstem locations that generate physiological size.

因此，当阿片类药物作为药物使用时，会抑制生理叹息，尤其在睡眠中，而呼吸不足——即睡眠中停止呼吸——是服用阿片类药物后致死的主要原因之一。

So opioids when taken as drugs suppress physiological sighing and do so during sleep and lack of adequate respiration, meaning people stop breathing during sleep is one of the primary reasons why people die when they take opioids.

现在，卡痛在低至中等剂量下并不以抑制呼吸而闻名，但当与其他阿片类药物结合，尤其是与酒精结合时，它可能抑制呼吸。

Now, kratom is not known to suppress respiration when taken at low to moderate dosages, but when combined with any other opioids, and certainly when combined with alcohol, it can suppress respiration.

尽管关于这一点的数据还很有限，但有一些证据表明，卡痛导致的死亡是由呼吸系统受到抑制引起的。

And while the data on this are fairly scant, there is some evidence that kratom induced death is caused by suppression of the respiration system.

因此，再次强调，按照大多数商品包装上推荐的剂量服用卡痛而导致死亡的情况相当罕见，尽管确实发生过。

So again, death due to taking kratom at the dosages that are recommended on most commercial packaging is fairly rare, although it has happened.

目前尚不清楚这些死亡是否是因为与其他物质联用所致，这似乎很有可能，但我们不能忽视的是，许多人正在从这些非处方来源服用远高于推荐剂量的卡痛，而且剂量还在逐步增加，随着剂量升高，呼吸衰竭的风险确实也随之增加。

It's unclear if it happened because it was taken in combination with other compounds, that seems likely, but we can't forget that a lot of people are taking kratom at much higher dosages and in fact, progressively higher and higher dosages from these over the counter sources and with increased dosage, there is, yes, an increased risk of respiratory failure.

因此，所有这些都表明，卡痛绝非一种无害的物质。

So again, all of this points to the fact that kratom is simply not a benign substance.

所以，如果我们坦诚相待，卡痛的成瘾潜力是真实存在的。

So if we're going to be very honest, the addictive potential of kratom is real.

它对某些人来说比其他人更严重，但这种成瘾性是确实存在的。

It is exacerbated for some people compared to others, but it is real.

它与其他更强效阿片类药物的相似性，使其对一些试图戒除更强效阿片类药物的人具有吸引力，但我们的目标当然是彻底摆脱所有阿片类药物，而卡痛本身也可能成为一个陷阱。

Its very similarities to other more potent forms of opioids are what make it attractive for some people who are trying to come off those more potent form of opioids, but the goal of course is to completely come off all opioids and kratom itself can be a bit of a trap.

它可能是一种陷阱，因为一些从未使用过其他阿片类药物的人也可能对 kratom 产生依赖。

It can be a trap in the sense that people who have never taken other opioids can become addicted to kratom itself.

这一点非常明确，这种情况确实会发生。

That is absolutely clear that can happen.

已经有很多人出现了这种情况。

It has happened in a great number of people.

很明显，kratom 也可能成为一种陷阱。

It's also clear that kratom can potentially be a trap.

请注意，我说的是‘可能’，因为如果有人试图戒掉其他更强效的阿片类药物，转而使用 kratom，然后逐渐增加 kratom 的剂量，使其体内对 kratom 的反应与之前从吗啡和氢可酮中获得的效果几乎无异，那么他们实际上只是换了一种形式的吗啡和氢可酮。

Notice I said potentially, because if people are trying to come off other more potent forms of opioids and then they use kratom to do that, and then they're ratcheting up their dosage of kratom such that they're now matching the endogenous response to kratom in a way that doesn't really distinguish from the effects that they were getting from morphine and hydrocodone, well, then they're just using a different form of morphine and hydrocodone.

我敢肯定，有些人在心里觉得这太荒谬了。

And I'm sure that some of you are out there saying that is ridiculous.

你们可能会说，kratom 的效果根本不能和氢可酮相提并论，但它的效力大约是氢可酮的六分之一，确实有人不断加大剂量，并更换不同种类的 kratom，专门挑选那些含有高浓度特定生物碱、能强烈作用于μ阿片受体的产品，这样一来，虽然他们没有获得纯粹的氢可酮效果，但已经非常接近了。

You cannot compare the effects of kratom to the effects of hydrocodone, but the potency is about one sixth of hydrocodone, and there are people out there who are just increasing and increasing both the dosage and modifying the type of kratom that they're taking so that they're getting the kratom that has a particular Lehigh concentration of one of the alkaloids that hits that mu opioid receptor hardest, and in doing so, sure, they're not getting the pure hydrocodone effect, but they're getting really close.

所以我的建议是：如果你从未接触过 kratom，就永远不要碰它。

So my advice would be, if you haven't touched kratom, don't touch it at all, ever.

如果你正在使用 kratom，你需要留意我们刚才讨论的内容。

If you are taking kratom, you need to take note of what we just discussed.

感谢您参与本期问答环节的开始部分。

Thank you for joining for the beginning of this Ask Me Anything episode.

要收听完整版节目，以及未来所有问答环节的音频，同时获取这些问答环节和 Huberman 实验室播客标准频道的文本稿，以及独家发布的高级工具，请访问 hubermanlab.com/premium。

To hear the full episode and to hear future episodes of these Ask Me Anything sessions plus to receive transcripts of them and transcripts of the Huberman Lab Podcast Standard Channel and premium tools not released anywhere else, please go to hubermanlab.com/premium.

只是为了提醒大家，我们推出 Huberman 实验室播客高级频道的原因主要有两点。

Just to remind you why we launched the Huberman Lab Podcast Premium channel, it's really twofold.

首先，是为了支持标准版 Huberman 实验室播客频道，该频道将继续每周一完整发布。

First of all, it's to raise support for the standard Huberman Lab Podcast channel, which of course will still be continued to be released every Monday in full length.

我们不会改变标准版 Huberman 实验室播客的格式或任何内容，同时为人类研究提供资金支持——不是动物模型，而是真正的人类研究，我相信我们都认同，人类才是我们最关心的物种。

We are not going to change the format or anything about the Standard Huberman Lab Podcast and to fund research, in particular research done on human beings, so not animal models, but on human beings, which I think we all agree is a species that we are most interested in.

我们将专门资助旨在开发心理健康、身体健康和表现提升相关新方法的研究。

And we are going to specifically fund research that is aimed toward developing further protocols for mental health, physical health, and performance.

这些方法将通过所有渠道发布，不仅限于高级频道，还包括 Huberman 实验室播客及其他媒体平台。

And those protocols will be distributed through all channels, not just the premium channel, but through all channels, Huberman Lab Podcasts and other media channels.

所以，这里的目的是为您提供深入解答您最关心的问题，并让您有机会支持那些能够提供这类答案的研究。

The So idea here is to give you information to your burning questions in-depth and allow you the opportunity to support the kind of research that provides those kinds of answers in the first place.

现在，高级频道的一个特别令人兴奋的特色是，Tiny基金会慷慨承诺对通过高级频道筹集的所有研究资金进行一比一匹配。

Now, an especially exciting feature of the premium channel is that the Tiny Foundation has generously offered to do a dollar for dollar match on all funds raised for research through the premium channel.

因此，这是他们扩大通过高级频道流入的资金、进一步支持心理健康、身体健康和表现相关科学研究与工具的一种绝佳方式。

So this is a terrific way that they're going to amplify whatever funds come in through the premium channel to further support research for science and science related tools for mental health, physical health, and performance.

如果您想注册Huberman Lab高级频道，每月费用为10美元，或者您可以一次性支付100美元购买全年服务。

If you'd like to sign up for the Huberton Lab premium channel, again, there's a cost of $10 per month, or you can pay $100 upfront for the entire year.

这将使您能够访问所有AMA内容。

That will give you access to all the AMAs.

您可以提出问题并获得针对您问题的回答，当然也会获得其他所有人所提问题的答案。

You can ask questions and get answers to your questions, and you'll of course get answers to all the questions that other people ask as well.

此外，您还将获得一些独家内容，例如AMA的文本稿，以及在其他地方找不到的Huberman Lab播客集锦的文本稿和方案。

There will also be some premium content such as transcripts of the AMAs and various transcripts and protocols of Huberman Lab Podcast episodes not found elsewhere.

而且，您的支持将直接用于心理健康、身体健康和表现相关的研究。

And again, you'll be supporting research for mental health, physical health, and performance.

您可以通过访问 hubermanlab.com/premium 来订阅高级频道。

You can sign up for the premium channel by going to hubermanlab.com/premium.

再次提醒，网址是 hubermanlab.com/premium。

Again, that's hubermanlab.com/premium.

一如既往，感谢您对科学的关注。

And as always, thank you for your interest in science.