必备知识：心理健康的饮食与营养 | 克里斯·帕尔默博士

欢迎收听《Huberman Lab 精华版》，在这里我们会回顾往期节目，为大家带来最有效、最实用的基于科学的心理健康、身体健康和表现提升工具。

Welcome to Huberman Lab Essentials, where we revisit past episodes for the most potent and actionable science based tools for mental health, physical health, and performance.

我是安德鲁·胡伯曼，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.

现在，让我们开始与医生的对话。

And now for my discussion with Doctor.

克里斯·帕尔默。

Chris Palmer.

克里斯，医生。

Chris, Doctor.

帕尔默，感谢你的到来。

Palmer, thank you for being here.

谢谢你，安德鲁，感谢你的邀请。

Thank you, Andrew, for having me.

我有很多问题想问你，我对这个话题非常兴奋，因为我觉得大多数人知道什么是精神疾病，或者他们对此有一些概念。

I have a lot of questions for you, and I'm really excited about this topic because I think most people know what mental illness is, or they have some idea what that is.

大多数人对营养是什么都有一些概念。

Most people have some idea what nutrition is.

但肯定很少有人知道这两者之间能有多紧密的联系。

Fewer people certainly know how closely those things can interact.

我想每个人都熟悉那种感觉，就是吃了某种食物，短期内会让人感觉很好。

I think everybody is familiar with the feeling of a food or the ingestion of a food making them feel good in the short term.

但我相信，很少有人真正理解或意识到，营养和我们的心理健康之间有着这种非常密切、甚至可能是因果性的联系，而且这种联系是长期累积的，也就是说，我昨天、前天、甚至十年前吃的东西，可能都在影响我现在大脑和身体的感受。

But I believe that very few people understand or are familiar with the fact that nutrition and our mental health interact in this very intimate, maybe even causal way, and that is something that occurs over long periods of time, meaning what I ate yesterday, the day before, maybe even ten years ago could be impacting the way that my brain and body are making me feel now.

所以，如果你愿意的话，我希望你能给我们讲讲一些历史，特别是你自己探索营养和心理健康之间关系的经历，然后我们可以深入探讨生酮饮食和其他饮食的一些具体细节，以及你和其他人基于真实患者和真实经历得出的那些真正令人惊叹的发现，那些饱受痛苦的人通过改变营养状况而得到缓解的经历。

So if you would, I'd love for you to just tell us about a little bit of the history, in particular your history, with exploring the relationship between nutrition and mental health, and then we can dive into some of the more particulars of ketogenic diets versus other diets, and some of the truly miraculous findings that you and others are coming up with based on real patients and real experiences of people who suffer and then find relief by altering their nutrition.

好的。

Sure.

这个故事其实要从我个人的经历说起。

This story really starts with my own personal story.

我不需要讲得太详细，但为了铺垫一下，我小时候确实有心理疾病。

I don't need to go into great detail, but to set the stage, when I was a kid, I definitely had mental illness.

一开始是强迫症，后来又有抑郁症、自杀倾向，各种问题都来了。

Started with OCD, I went on to have subsequent depression, suicidality, all sorts of things.

不知怎么的，我把自己调整好了，顺利读完了医学院，成绩还挺好，然后在哈佛做实习和住院医生。

Somehow or another, I pulled myself together and got through medical school, actually did quite well in medical school, and then was doing my internship and residency at Harvard.

就在那个时候，我被诊断出代谢综合征。

And at that point in time, I was diagnosed with metabolic syndrome.

我有高血压，血脂特别差，还有糖尿病前期。

So I had high blood pressure, horrible lipids, and pre diabetes.

按理说，我做的每件事都是对的。

And I was doing everything right, supposedly.

我吃低脂饮食，还规律运动。

I was on a low fat diet, and I was exercising regularly.

年复一年，医生一直跟我说要注意饮食和运动。

And year after year, my doctor kept telling me diet and exercise.

他让我做的每件事我都照做了。

I was doing everything he kept telling me to do.

情况越来越糟了。

Everything was getting worse.

我的血压一直往上升。

My blood pressure kept going higher.

后来有一次，他说，你得吃药了，治前期糖尿病的，降胆固醇的，还有降血压的。

And at some point, he said, You're gonna have to go on medication for your prediabetes, something for your cholesterol, and something for your blood pressure.

所以就是三颗药。

So three pills.

基本上，你完了。

Basically, you're screwed.

这是基因的问题。

It's your genes.

你只能硬着头皮吃药了。

You're just gonna have to bite the bullet and take meds.

作为医生，我知道那意味着什么。

As a physician, I knew what that meant.

我知道我才二十多岁。

I knew that I'm in my twenties.

如果我已经因为代谢综合征要吃三种药，那到四十岁或五十岁的时候肯定完蛋了，说不定还会得心脏病。

If I'm already on three meds for metabolic syndrome, I'm gonna be screwed by the time I'm 40 or 50, and I'm probably gonna be having heart attacks.

我听说阿特金斯饮食法可能对改善胆固醇和糖尿病前期有帮助。

I'd heard through the rumor mill that the Atkins diet could somehow help people improve their cholesterol and pre diabetes.

我当时非常怀疑。

I was highly skeptical.

而且，你知道，我相信医学院教给我的一切。

And I, you know, I believed everything I was taught in medical school.

我的教授们怎么会骗我呢？

Why would my professors lie to me?

他们说的肯定有道理。

They knew what they were talking about.

低脂饮食才是正道。

Low fat diet was the thing to do.

而且阿特金斯饮食法显然既危险又不负责任。

And the Atkins diet was clearly dangerous and reckless.

我多年来一直遵循医学教条，但对我来说并不奏效。

And I had been trying the medical dogma for years, and it wasn't working for me.

所以不管怎样，我决定这是我最后一次尝试不同的方法。

And so for whatever reason, decided this is going to be my last attempt at something different.

如果不行，我就认命，直接吃药。

And then I'll just bite the bullet and go on meds.

于是我就试了阿特金斯饮食法。

So I tried the Atkins diet.

三个月内，我的代谢综合征完全消失了。

Within three months, my metabolic syndrome was completely gone.

在这个过程中我大概减了十磅左右，但所有指标都恢复正常了。

I probably lost about, you know, 10 pounds through this process, but everything got normal.

当我回去看医生时，他非常震惊。

And when I went back to my doctor, he was shocked.

坚持这个饮食三个月后，最让我震惊的不是我的代谢综合征消失了。

The thing that was the most striking to me after doing the diet for three months was not the fact that my metabolic syndrome was gone.

那本来就是我想要的结果。

That was my goal.

而且这看起来像是个奇迹，因为仅仅通过改变饮食，我就把这些问题全都解决了。

And it was a seemingly miraculous achievement because I got rid of everything with one dietary change.

但我真正注意到的是，我的情绪、精力、注意力和睡眠都有了显著的改善。

But the thing that I noticed was dramatic improvement in my mood, energy, concentration and sleep.

我人生中第一次在闹钟响之前就醒来，而且感觉休息得很好。

For the first time in my life, I started waking up before my alarm went off and feeling rested.

这在以前从来没有发生过。

That never happened to me before.

我以前总是精心计划闹钟什么时候响，以及为了准时到达学校、医院或其他地方，我可以按几次贪睡按钮。

I was meticulous about planning when my alarm went off and how many times I could push the snooze button in order to be on time for wherever I needed to be, whether it was school or the hospital or whatever.

在开始这个饮食之前，我一直觉得世界上有两种人。

Prior to the diet, I always felt like there are two types of people in the world.

世界上有两种人，一种是那种开心、精力充沛的人，他们总是很积极，充满活力。

There are these happy, peppy people who just are so positive and they've got energy.

他们还有一句口号，喜欢拼命工作，拼命玩。

And they have this saying, they like to work hard and play hard.

但我从来不明白，谁他妈的想拼命玩啊。

But I never understood who the hell wants to play hard.

谁有那个精力去玩啊？

Like who's got energy for that?

难道你工作那么辛苦不累吗？

Like, aren't you tired from working so hard?

我以为他们只是运气好，有优势。

I assumed that they were just lucky and privileged.

要么基因好，要么童年幸福，要么父母好，或者别的什么。

They either had good genetics or maybe they had good childhoods or good parents or something.

反正我没有的那些东西。

Something that I didn't have.

那你是怎么一步步走到现在做的这些工作的？

What was the journey forward into the work that you're doing now?

几年之内，我就成了主治医生。

So within a few years, I'm an attending physician.

我的临床实践中，有很多患者患有难治性精神疾病。

I've got all these patients in my clinical practice with treatment resistant mental illness.

我在一家三级护理医院工作。

I'm in a tertiary care hospital.

所以我几乎不会遇到那种第一次发作抑郁症、直接从街上来的病人。

So I almost never get somebody off the street with their first episode of depression.

我的职业生涯一开始，接触的就是难治性精神障碍。

Out of the gate, as part of my career, I get treatment resistant mental disorders.

所以来找我的病人，通常已经看过六位以上的精神科医生和治疗师，也试过几十种不同的药物。

So I get people who've already been to six plus psychiatrists, therapists, They've usually tried dozens of different medications.

他们接受心理治疗也有几十年了。

They've been in decades of psychotherapy.

他们通常还做过电休克治疗和其他治疗，但都没什么效果。

They've often had ECT and other things, and nothing's working.

我就在想，这些人还有什么别的选择。

And I'm thinking, options for these other people.

而这种饮食居然有很强的抗抑郁效果。

And this diet is having this really powerful antidepressant effect.

我觉得我得试试，看看我的病人有没有愿意尝试的，说不定能帮到他们。

I think I'm gonna try it and just see if any of my patients are game to try it, to see if it might help them.

果然，真的有效。

Sure enough, it did.

不是对所有人都有效，也不是所有人都感兴趣或者能做到。

Didn't help everyone and not everybody was interested and or able to do it.

但那些能做到的人里，有些确实产生了显著而强烈的抗抑郁效果。

But some of the ones who were able to do it ended up having a remarkable and powerful antidepressant effect.

有个女士甚至在一个月内就出现了轻躁狂状态。

One woman actually became hypomanic within a month.

她之前几乎不间断地抑郁了五年多。

And she had been depressed pretty much nonstop for over five years.

长期抑郁，有自杀倾向，反复住院。

Chronically depressed, suicidal, in and out of hospitals.

我看到她变得轻躁狂，心想，哇，这抗抑郁效果真的很强。

And I saw her become hypomanic and I'm thinking, wow, this really is a powerful antidepressant effect.

这太神奇了。

Like this is amazing.

这就像药物一样，但更好，因为对她真的有效。

This is like a medication, but better because it actually is working for her.

那时候，我们几乎没有关于阿特金斯饮食对减肥或糖尿病安全性和有效性的临床试验，更不用说对任何精神疾病了。

At that point, we didn't have many clinical trials of the safety or efficacy of Atkins diet for even weight loss or diabetes, let alone any mental disorders.

所以我真的觉得自己是在边缘地带。

And so I really actually felt like I'm on the fringe here.

这不会得到任何人的赞赏。

And this is not going to be met with praise by anyone.

所以我打算低调一点。

So I'm just going to lay low.

我会把它推荐给病人。

I'm going to offer it to patients.

我一直这样做到2016年。

I went along that way up until 2016.

我想快速休息一下，感谢我们的赞助商Eight Sleep。

I'd like to take a quick break and acknowledge our sponsor Eight Sleep.

Eight Sleep生产智能床垫套，具备降温、加热和睡眠追踪功能。

Eight Sleep makes smart mattress covers with cooling, heating, and sleep tracking capacity.

确保你睡个好觉的最佳方法之一，就是保证睡眠环境的温度合适。

One of the best ways to ensure you get a great night's sleep is to make sure that the temperature of your sleeping environment is correct.

这是因为，为了入睡并保持深度睡眠，你的体温实际上需要下降大约一到三度。

And that's because in order to fall asleep and stay deeply asleep, your body temperature actually has to drop by about one to three degrees.

而为了醒来时感觉神清气爽、精力充沛，你的体温实际上需要升高大约一到三度。

And in order to wake up feeling refreshed and energized, your body temperature actually has to increase by about one to three degrees.

Eight Sleep会根据你的个人需求，整夜自动调节床的温度。

Eight Sleep automatically regulates the temperature of your bed throughout the night according to your unique needs.

我睡Eight Sleep的床垫套已经快五年了，它彻底改善了我的睡眠质量。

I've been sleeping on an Eight Sleep mattress cover for nearly five years now, and it has completely transformed and improved the quality of my sleep.

最新的Eight Sleep型号是Pod 5。

The latest Eight Sleep model is the Pod five.

我现在用的就是这款，我非常喜欢。

This is what I'm now sleeping on and I absolutely love it.

它有很多很棒的功能。

It has so many incredible features.

比如，Pod 5有一个叫自动驾驶的功能，这是一个AI引擎，能学习你的睡眠模式，然后根据不同的睡眠阶段调节你睡眠环境的温度。

For instance, the Pod five has a feature called autopilot, which is an AI engine that learns your sleep patterns and then adjusts the temperature of your sleeping environment across different sleep stages.

如果你打鼾，它还会抬高你的头部，并做出其他调整来优化你的睡眠。

It'll even elevate your head if you're snoring and it makes other shifts to optimize your sleep.

如果你想试试Eight Sleep，可以访问eightsleep.com/huberman，购买新款Pod 5最高可优惠350美元。

If you'd like to try Eight Sleep, go to eightsleep.com/huberman to get up to $350 off the new Pod five.

Eight Sleep 发货到全球许多国家，包括墨西哥和阿联酋。

Eight Sleep ships to many countries worldwide, including Mexico and The UAE.

再说一遍，访问 eightsleep.com/huberman 可以节省高达 350 美元。

Again, that's eightsleep.com/huberman to save up to $3.50.

所以低碳水饮食，当然低糖。

So low carbohydrate diet, certainly low sugar.

对。

Yeah.

我猜你不是营养师，那你如何为病人制定营养计划？

I'm assuming you're not a nutritionist, so how did you prescribe a nutrition plan for your patients?

最初几个病人，就是让他们试试阿特金斯饮食法，我想看到酮症。

The first few patients, it was try this Atkins diet, I want to see ketosis.

所以我强烈建议病人达到尿酮症。

So, I was strongly recommending that patients achieve urinary ketosis.

有趣的是，我注意到一个规律，当他们尝试这种饮食但没有产生酮体时，往往也没有得到临床上的改善。

And the interesting thing is I noticed a pattern, that when they were trying the diet and not getting ketones, they often did not get a clinical benefit.

一旦他们进入酮症状态，我才开始注意到临床上的改善。

It was once they got into ketosis that I began to notice the clinical benefit.

然而，真正颠覆我作为精神科医生所有认知的，是在2016年帮助一位患者的时候。

The thing that completely upended everything that I knew as a psychiatrist, though, was when I helped a patient in 2016.

那是一位33岁、患有分裂情感性障碍的男性。

A 33 year old man with schizoaffective disorder.

他做我的病人已经八年了。

He'd been my patient for eight years now.

他每天都有幻听。

He had daily auditory hallucinations.

他有偏执妄想。

He had paranoid delusions.

他无法在公共场合露面而不感到恐惧。

He could not go out in public without being terrified.

这个男人被他的疾病折磨得痛苦不堪。

This man was tormented by his illness.

这毁了他的生活。

It ruined his life.

他已经试过17种不同的药物，但没有一种能止住他的症状。

He had already tried 17 different medications, and none of them stopped his symptoms.

他体重340磅。

He weighs three forty pounds.

不管出于什么原因，他脑子里就认定，要是不减点肥，就永远找不到女朋友。

And for whatever reason, he gets it in his head, I'm never gonna get a girlfriend if I don't lose some weight.

他也意识到，自己永远不会有出息，因为自己是个失败者，有精神分裂症，跟父亲住在一起，一事无成。

He also recognizes, I'm never going to get a because I'm a loser, I'm schizophrenic, I live with my father, you know, I have nothing going for me.

出于多种原因，我们最终决定尝试生酮饮食。

For a variety of reasons, we ended up deciding to try the ketogenic diet.

他决定试一试。

He decides to give it a try.

不到两周，他不仅开始减肥，而且我开始注意到这种显著的抗抑郁效果。

Within two weeks, not only does he start losing weight, but I begin to notice this dramatic antidepressant effect.

他的眼神交流更好了。

He's making better eye contact.

他笑得更多了。

He's smiling more.

他话也多了很多。

He's talking a lot more.

我心里想，你这是怎么了？

I'm thinking like what's gotten into you?

感觉你整个人都活过来了。

Like you're coming to life.

我从来没听你说过这么多话。

I've never heard you talk this much.

我从来没见过你这么兴奋、这么投入、这么有活力。

I've never seen you so excited or present or alive.

我完全没改过他的药。

I haven't changed his meds at all.

让我这个精神科医生彻底颠覆认知的事情是，大约六到八周后，他突然开始主动说，你知道我一直听到的那些声音吗？

The thing that upended everything that I knew as a psychiatrist was six to eight weeks in, he spontaneously starts reporting, You know those voices that I hear all the time?

它们正在消失。

They're going away.

然后他说，你知道我一直觉得有很多家庭在控制我的思想，想害我，还专门针对我吗？

And he says, You know how I always thought that there were all these families who were controlling my thoughts and out to get me and they had targeted me?

我心里想，哦对，这个话题我们聊了八年了。

And I'm thinking, Oh yeah, we've been talking about that for eight years.

我们又可以聊这个了。

We could talk about that again.

他说，现在想想，我觉得那不是真的。

He says, Now that I think about it, I don't think that's true.

而且我现在说出来，听起来有点疯狂。

And now that I say it, it sounds kind of crazy.

可能从来就不是真的。

It probably never was.

我可能一直都有精神分裂症，就像大家一直告诉我的那样，我觉得它正在消失。

I've probably had schizophrenia all along like everybody's been trying to tell me, and I think it's going away.

他现在已经减掉了160磅，并且一直保持到现在。

He's now lost 160 pounds and kept it off to this day.

哇。

Wow.

他能够做那些自从确诊以来一直做不到的事情。

He was able to do things he had not been able to do since the time of his diagnosis.

他完成了一个证书课程。

He was able to complete a certificate program.

他能够出门，不再疑神疑鬼。

He was able to go out in public and not be paranoid.

他在现场观众面前表演了即兴喜剧。

He performed improv in front of a live audience.

有一段时间，他搬出了父亲的家，独立生活。

At one point, he was able to move out of his father's home and live independently.

他有没有继续服用抗精神病药或其他药物？

Did he stay on any kind of antipsychotic or other medication?

我们一直在慢慢尝试让他停药。

We have slowly but surely tried to taper him off his meds.

他已经服药几十年了。

He has been on meds for decades.

他很小的时候就开始服药了。

He started medications when he was a young child.

他的大脑是在各种精神科药物的影响下发育的。

His brain is developed in response to all sorts of psychiatric medications.

而且让他停药并不容易。

And it has not been easy to try to get him off.

我想对所有听众说，停药非常困难且危险，你需要在心理健康专业人士或处方医生的监督下进行。

And I just want to say for any listeners, getting off your meds is very difficult and dangerous, and you need to do it with supervision with a mental health professional or a prescriber.

为了保持

To stay in

关于生酮状态，你希望病人的血酮水平达到多少？

ketosis, what sort of blood levels of ketones do you like to see in your patients?

你觉得大多数人能努力达到的范围是多少？

What is the range that you think most people could aspire to?

说实话，这真的取决于病人和我在治疗什么。

So it really depends on the patient and what I'm treating, quite honestly.

而且我觉得不是每个病人都需要生酮饮食。

And I don't think every patient needs the ketogenic diet.

比如，对有些病人来说，光是戒掉垃圾食品就能对情绪障碍产生很大的改善。

For some patients, simply getting rid of junk food can make a huge difference in a mood disorder, for instance.

所以垃圾食品指的是高度加工的食物，就是能在货架上放很久的那种。

So junk food meaning highly processed food, food that could last on the shelf a very long time.

高度加工的食物通常糖、碳水化合物和脂肪含量都很高。

Highly processed foods that are usually high in both sugar, carbohydrate, carbs and fats.

那些似乎是最糟糕的食物，那种高糖高脂的组合，似乎对代谢健康是最不利的。

Those seem to be the worst foods, that combination, high sugar, high fat, seems to be the worst combination for metabolic health.

结果你猜怎么着，现在有越来越多的数据强烈表明，这对心理健康也不好。

And lo and behold, we've got emerging data that strongly suggests it's also bad for mental health.

所以咱们退一步来看。

So to step back from that.

对某些病人，我可能只需要降低他们的血糖和胰岛素水平，而戒掉甜食就能做到这一点。

So for some patients, I might just want to decrease glucose and insulin levels, and I can do that by getting rid of sweets.

对其他病人，比如患有分裂情感性障碍、精神分裂症或双相情感障碍的病人，尤其是慢性病的情况，如果我是把它当作大脑治疗来用，那我确实会推荐生酮饮食，而且通常希望血液酮体水平相当高。

For other patients, like patients with schizoaffective disorder or schizophrenia or bipolar disorder, especially if it's chronic, If I'm using it as a brain treatment, then I do want a ketogenic diet, and I usually want reasonably high levels of blood ketones.

对于抑郁症，我希望至少看到大于大概0.8毫摩尔。

For depression, I want to see at least greater than probably 0.8 millimole.

对于精神病性障碍和双相情感障碍，我通常希望看到水平大于1.5。

For psychotic disorders and bipolar disorder, I usually want to see levels greater than 1.5.

这就是我尽可能追求的目标。

That's what I'm shooting for, if at all possible.

我想很多听众和熟悉饮食或运动改变如何积极影响睡眠、体重等各方面的人，都会明白这些变化会带来连锁反应，让人感觉更好。

I think that for a lot of listeners and people out there who are familiar with how changing your diet or changing your exercise can positively impact sleep and weight and all these things, and it cascades into feeling better.

这完全说得通。

That makes perfect sense.

但对世界上很多人来说，用营养作为分析工具或治疗手段来理解和治疗精神疾病，这个想法仍然有点异端，对他们来说，这有点像伪科学之类的。

But for a lot of the world still, the idea that changing or using nutrition as a dissection tool or as a treatment tool to understand and treat mental illness is still a kind of heretical idea, that to them it kind of falls in the, okay, well, that's like a woo science or something like that.

他们马上会想，阿特金斯不是死于心脏病吗？

They immediately think, didn't Atkins die of a heart attack?

你知道，我经常听到这种说法，我觉得这确实是因噎废食，但不管怎样，这确实是个有趣的现象。

You know, I hear that a lot, you know, which I do think is throwing the baby out with the bathwater, but it's an interesting thing nonetheless.

然后我觉得大多数人处于中间立场，他们只想看到科学和医学能拿出有效的治疗方法。

And then I think that the majority of people sit in the middle and just want to see science and medicine come up with treatments that work.

而且我得说，听到你之前说的话，我真的很欣慰，你从没说人们应该停药，只靠生酮饮食就能治愈一切。

And I have to say, I'm very relieved to hear what you said earlier, which was, you never said that people should come off their medication and just go on a ketogenic diet and everything will be cured.

你当然不是那个意思。

You're certainly not saying that.

对。

No.

而且你更想说的是，如果我理解得没错的话，营养需要被视为有效工具中的一个重要工具，而且它可以非常有效。

And rather you're saying, if I understand correctly, that nutrition needs to be considered one of the major tools in the landscape of effective tools, and that it can be very effective.

我们来谈谈癫痫，以及生酮饮食不仅用于治疗癫痫，而且是最早的、甚至可能是最早的使用营养来治疗神经系统疾病的例子，这种疾病可能非常令人衰弱，甚至致命。

Let's talk about epilepsy and how the ketogenic diet is not just used for epilepsy, but is one of the oldest, if not the oldest examples of the use of nutrition to treat a condition of the nervous system that can be incredibly debilitating, even deadly.

是的，实际上，这些文献、临床历史以及我们所有的研究，对我来说简直是天赐之物，让我能够做我正在做的工作。

Yeah, the reality is that this literature and this clinical history and all of the research we have was the godsend that I needed to do the work that I'm doing.

否则，我第一天就会被质疑。

Otherwise, I would have been discredited on day one.

生酮饮食，大多数人不知道，其实是一百年前，也就是1921年，由一位医生为了唯一一个目的而发明的：治疗癫痫。

The ketogenic diet, unbeknownst to most people, was actually developed one hundred years ago, 1921, by a physician for one and only one purpose: to treat epilepsy.

它不是作为减肥饮食被发明的。

It wasn't developed as a weight loss diet.

它也不是作为所有人都应该遵循的饮食被发明的。

It wasn't developed as the diet that all human beings should follow.

它被发明的原因，是因为自希波克拉底时代以来，人们就长期观察到，禁食可以阻止癫痫发作。

And the reason it was developed is because of this long standing observation since the time of Hippocrates, that fasting can stop seizures.

大多数人觉得不吃饭是坏事，把它和挨饿等同起来。

Most people think going without food is bad, and they equate it with starvation.

但实际上，不吃饭会引发新陈代谢的巨大变化，无论是大脑还是身体的新陈代谢。

But in fact, when we go without food, it causes tremendous shifts in metabolism, both brain and body metabolism.

它会让身体进入自噬状态，节约资源，还有各种对健康有益的事情。

And it puts the body into a mode of autophagy and conservation of resources and all sorts of things that are beneficial to human health.

这就是为什么几千年来，几乎每种文化和宗教都把禁食当作一种治疗手段。

And this is why fasting has been used as a therapeutic intervention in almost every culture and almost every religion for millennia.

但大多数时候，这些都被认为是宗教迷信。

But for the most part, that was all thought to be religious folklore.

1921年，一位医生用间歇性禁食治疗一个癫痫患儿，结果发现，嘿，这些宗教迷信还真有点道理。

In 1921, one physician used intermittent fasting on a child with seizures and found that, oh, lo and behold, this religious folklore stuff has something to it.

它确实有效。

It actually worked.

禁食的问题在于，你只能禁食那么久，否则就会饿死。

The problem with fasting is that you can only fast for so long before you starve to death.

这可不是个有效的治疗方法。

And that's not a very effective treatment.

一旦人们恢复正常饮食，癫痫通常马上就会复发，而且往往来势汹汹。

As soon as people start eating a normal diet again, their seizures usually come right back, oftentimes with a vengeance.

所以它可以作为短期干预手段。

And so it can be a good short term intervention.

禁食可能需要几天时间，因为进入酮症状态需要几天。

The fasting can take a few days because it can take a few days to get ketosis.

然后你就能缓解慢性癫痫发作。

And then you can get some relief from chronic seizures.

但这不是好的长期治疗方案，因为，再说一遍，人会饿死的。

But it's not a good long term treatment because, again, people will starve to death.

一旦开始吃东西，癫痫就会复发。

As soon as they start eating, seizures come back.

所以，实际上是梅奥诊所的拉塞尔·怀尔德医生发明了生酮饮食，而且目的只有一个。

So it was actually doctor Russell Wilder at the Mayo Clinic who developed the ketogenic diet with one and only one purpose.

他想看看，能不能用这种特殊饮食来模拟禁食状态，从而长期控制癫痫发作。

He wanted to see, can we mimic the fasting state using this special diet to see if it might stop seizures long term.

结果你猜怎么着，还真管用。

And lo and behold, it worked.

早期的效果出奇地好。

Early results were extraordinarily positive.

使用生酮饮食的患者中，有百分之五十的人癫痫完全不再发作。

Fifty percent of patients who use the ketogenic diet became seizure free.

另外还有百分之三十五的人，发作频率减少了百分之五十以上。

And another thirty five percent had a fifty percent or greater reduction in their seizure frequency.

所以有效率大概在百分之八十五左右。

So about eighty five percent efficacy rate.

到了二十世纪五十年代，药物开始出现，我们有了更多抗惊厥的治疗方法。

By the 1950s, pharmaceuticals were coming out and we had many more anticonvulsant treatments.

毫无疑问，这些药对很多人确实有效。

And there's no question, they work for a lot of people.

那太好了。

That's great.

而且吃药比做这种饮食容易多了。

And taking a pill is so much easier than doing this diet.

但你知道吗，直到今天，大约百分之三十的癫痫患者对现有的治疗方法没有反应。

But lo and behold, even to this day, people with epilepsy, about thirty percent don't respond to the current treatments that we have available.

这百分之三十的人属于难治性癫痫，也就是说，不管他们吃多少抗癫痫药，甚至做了脑部手术，癫痫发作还是停不下来。

Thirty percent will have treatment resistant epilepsy, which means they continue to have seizures no matter how many anticonvulsants they're taking, even if they've had brain surgery.

就是没办法控制住发作。

It just doesn't stop their seizures.

所以到了七十年代，约翰霍普金斯大学重新启用了生酮饮食，专门针对这些难治性病例。

And so in the 1970s, the ketogenic diet was resurrected at Johns Hopkins for these treatment resistant cases.

结果你猜怎么着，真的有效。

And lo and behold, it works.

不是对所有人都有效，但确实有效。

Not for all of them, but it works.

大约三分之一的人不再发作。

And about one third become seizure free.

这些人已经试过所有方法，但都没用。

And these are people who've tried everything and nothing's working.

所以三分之一的人不再发作。

So one third becomes seizure free.

另外三分之一的人有临床改善，也就是说发作频率减少了50%或更多。

Another third get a clinical benefit, meaning a 50% or greater reduction in their seizure frequency.

剩下的三分之一，似乎没什么效果。

And the other third, it doesn't seem to work.

对我来说，最幸运的是，我们对生酮饮食及其对大脑的作用已经有几十年的神经科学研究。

And so the reality, the godsend for me, is that we have decades of neuroscience research on the ketogenic diet and what it is doing to the brain.

我们知道生酮饮食会影响神经递质水平，特别是谷氨酸、GABA和腺苷。

We know that the ketogenic diet is influencing neurotransmitter levels, in particular glutamate, GABA, adenosine.

它还会改变钙通道的调节和钙水平，这对细胞功能非常重要。

It changes calcium channel regulation and calcium levels, which is really important in the function of cells.

它还会改变基因表达，减轻大脑炎症，改变肠道微生物群，而肠道微生物群现在是个热门话题。

It changes gene expression, it reduces brain inflammation, it changes the gut microbiome and there are gut microbiomes a huge topic right now.

有些研究人员认为，这正是生酮饮食的主要好处。

And there are some researchers who argue that is the primary benefit of the ketogenic diet.

它以有益的方式改变肠道微生物群。

It's changing the gut microbiome in beneficial ways.

所以它的作用很多。

So it's doing a lot of things.

它显然能改善胰岛素抵抗，降低血糖和胰岛素水平，从而改善胰岛素信号传导。

It obviously improves insulin resistance, lowers glucose levels, lowers insulin levels, which improves insulin signaling.

对我所概述的研究来说，关键在于这种饮食能刺激两个与线粒体相关的过程，这才是真正的神奇之处。

The key for my research that I've outlined, the real magic is that this diet stimulates two processes that relate to mitochondria.

它刺激一个叫做线粒体自噬的过程，就是清除老旧或有缺陷的线粒体，并用新的线粒体替换它们。

It stimulates a process called mitophagy, which is getting rid of old and defective mitochondria and replacing them with new ones.

它还刺激一个叫做线粒体生物发生的过程，这意味着人们坚持生酮饮食一段时间后，比如几个月或几年，他们身体和大脑中的许多细胞会有更多的线粒体，而且这些线粒体也会更健康。

And it also stimulates a process called mitochondrial biogenesis, which means that after people have done the ketogenic diet for a while, months or years, many of their cells in their bodies and brains will have more mitochondria and those mitochondria will be healthier.

我相信这就是为什么生酮饮食不仅对癫痫，而且对慢性精神障碍患者也是一种非常有效的治疗方法。

And I believe that is the reason the ketogenic diet is such a powerful treatment, not only for epilepsy, but also for people with chronic mental disorders.

如果你在寻找随机对照试验来证明这些疾病在大量患者中的疗效，我们目前还没有这样的研究。

If you're looking for randomized controlled trials, documenting efficacy in large numbers of patients with these disorders, we don't have them.

这些研究正在进行中，但结果还没出来。

They're underway now, but we don't have them yet.

我想快速休息一下，感谢我们的赞助商BetterHelp。

I'd like to take a quick break and acknowledge our sponsor, BetterHelp.

BetterHelp提供由持牌治疗师进行的专业治疗，完全在线进行。

BetterHelp offers professional therapy with a licensed therapist carried out entirely online.

我接受治疗已经很久了。

I've been doing therapy for a long time.

虽然这并不总是容易的，但每次治疗结束后，我都感觉更好，并且知道这段时间花得很值。

And while it's not always easy, every time I do a therapy session, I come away feeling better and knowing that the time was well spent.

这是因为每次治疗结束后，我都能获得宝贵的见解或新的视角，无论是关于工作、个人生活中的关系，还是我与自己的关系。

And that's because whenever I finish a therapy session, I come away with a valuable insight or new perspective on something I'm working through, whether that's with work, with relationships in my personal life, or with my relationship to myself.

我一直都觉得，有效的心理治疗能带来很多好处。

I've just consistently found that there's so much benefit that comes through effective therapy.

通过BetterHelp，他们让你很容易就能找到专业的心理治疗师，帮你获得有效治疗带来的好处。

With BetterHelp, they make it extremely easy to find an expert therapist who can help provide the benefits that come through effective therapy.

而且数据也证明它是有效的。

And the data say it works.

BetterHelp的在线咨询平均评分是4.9分（满分5分），基于超过170万条客户评价。

BetterHelp has an average rating of 4.9 out of five for its live sessions based on over 1,700,000 client reviews.

如果你想试试BetterHelp，可以访问betterhelp.com/huberman，第一个月可以优惠10美元。

If you would like to try BetterHelp, go to betterhelp.com/huberman to get 10 off your first month.

再说一遍，网址是betterhelp.com/huberman。

Again, that's betterhelp.com/huberman.

也许我们可以先简单聊聊线粒体，然后再讨论这两个主要的影响。

Maybe we could just talk about mitochondria for a moment and then talk about these two major effects.

在神经元以及大脑的其他细胞中，线粒体还有哪些重要的功能呢？

What are some of the other things that mitochondria are important for in neurons and maybe other cells of the brain.

如果你把细胞想象成一台电脑，很多人会把线粒体看作是那台电脑的电源线，因为它们提供能量，事实上它们确实是那台电脑的电源线。

If you think of the cell as a computer, a lot of people think of mitochondria as the power cord to that computer because they're providing the power, and they are in fact the power cord to that computer.

但实际上，它们真正的功能是那台电脑的主板。

But actually, their real function is the motherboard of that computer.

所以线粒体在细胞中负责指导和分配资源。

So mitochondria are directing and allocating resources throughout a cell.

这是它们的主要功能。

That is their primary function.

而它们恰好也是能量工厂。

And then they happen to be powerhouses as well.

举几个明确的例子，线粒体在生产和释放以及调节一些关键的神经递质方面直接发挥作用，包括血清素、多巴胺、谷氨酸、乙酰胆碱，这些都是相当重要的神经递质。

To give some clear examples, mitochondria play a direct role in the production and release and regulation of some really key neurotransmitters, including serotonin, dopamine, glutamate, acetylcholine, those are pretty powerful neurotransmitters.

是的，我会称它们为，我知道你列出的不止三种，但它们是神经传递的基本颜色。

Yeah, I would call those, I would consider those the, I know you listed more than three, but the sort of primary colors of neurotransmission.

对。

Yes.

你知道，这些神经递质中任何一种过多或不足，都会对神经系统产生严重的负面影响。

You know, any one of those in excess or deficiency is going to have profound negative effects on a nervous system.

线粒体为这些分子提供了一些基础材料，可以说是它们的构建模块。

Mitochondria are providing both some of the building blocks, if you will, for some of those molecules.

它们是克雷布斯循环，也就是柠檬酸循环的一部分。

They're part of the Krebs citric acid cycle.

这个循环中的一些中间产物，实际上会参与制造这些神经递质。

Some of the intermediate products actually go into making those neurotransmitters.

更重要的是，线粒体为神经递质的合成提供了能量。

Much more importantly, mitochondria provide the energy for the production of those neurotransmitters.

有趣的是，线粒体还直接参与神经递质的释放过程。

And fascinatingly, mitochondria are directly related to the release of neurotransmitters.

仅仅有ATP是不够的。

ATP alone is not enough.

一些研究发现，线粒体会沿着突触的膜移动，来释放一批批含有神经递质的囊泡。

There've been some research studies that have actually found that mitochondria move along the membrane of the synapse to release batches of vesicles of neurotransmitters.

而且如果从突触中移除线粒体，研究人员即使给细胞灌满ATP，神经递质通常也不会释放。

And that if the mitochondria are removed from the synapse and researchers flood that cell with ATP, neurotransmitters usually are not getting released.

线粒体还在做其他事情。

Mitochondria are doing other things.

我们甚至不完全了解它们到底在做什么，或者是怎么做的。

We don't entirely even understand what all they're doing or how they're doing it.

但它们做的不仅仅是提供能量。

But they're doing other things than just providing the power.

线粒体至少在人体的所有应激反应方面都扮演着角色。

Mitochondria at least play a role in all of the aspects of the human stress response.

所以当人类感到压力时，无论是身体上的还是心理上的，会发生几件事。

So when humans are stressed, either physically or psychologically, there are several things that happen.

应激反应会导致皮质醇、肾上腺素、去甲肾上腺素增加，炎症反应，以及特别是海马体中的基因表达发生变化。

Increased cortisol, increased adrenaline, noradrenaline, inflammation, and gene expression in particular in the hippocampus occur with the stress response.

有一组研究人员通过四种不同的方式对线粒体进行基因改造，发现这四类应激反应都以某种方式受到了影响。

And one group of researchers actually genetically modified mitochondria in four different ways and found that all those four buckets of stress response were impacted in one way or another.

这暗示着线粒体在那些方面也扮演着某种角色。

Implying that mitochondria are somehow playing a role in those.

就它们在皮质醇中的作用而言，我们知道线粒体实际上拥有合成类固醇激素所需的酶。

In terms of their role in cortisol, we know that mitochondria actually have the enzyme required for the synthesis of steroid hormones.

这包括皮质醇、雌激素、睾酮和孕酮，这些名字可能大家都听说过。

So that includes cortisol, estrogen, testosterone, and progesterone, some names that maybe everybody's heard of.

所以这意味着，如果线粒体供应不足或功能失调，这些激素的产生可能会变得失调。

So that means that if mitochondria are in short supply dysfunctional, the production of those hormones may become dysregulated.

线粒体在炎症中直接发挥作用，它们参与开启炎症系统，至少也在开启和关闭炎症系统中扮演角色。

Mitochondria play a direct role in inflammation, and they turn the inflammatory system both on, or they at least play a role in turning the inflammatory system both on and off.

《细胞》杂志上的一篇论文实际上将线粒体确定为关闭某些炎症细胞的关键调节者。

One paper in Cell actually identified mitochondria as the key regulator in turning certain inflammatory cells off.

当你抑制线粒体功能时，那些细胞就不会关闭。

And that when you inhibit mitochondrial function, those cells don't turn off.

线粒体中的活性氧水平是关闭炎症细胞过程的关键信号机制。

Mitochondrial levels of reactive oxygen species are a key signaling process to turn the inflammatory cell process off.

另一项研究发现，巨噬细胞，也就是一种重要的免疫细胞，在愈合过程中起着作用。

Another study found that macrophages, so macrophages are an important immune cell that play a role in healing.

比如你割伤了自己，身体就会向那个部位发送炎症信号和免疫细胞，试图愈合你的皮肤。

So if you cut yourself, your body will get, you know, send inflammation that way and send immune cells that way to try to heal your skin.

而巨噬细胞在这个过程中扮演着重要角色。

And macrophages play an important role in that healing.

有一组研究人员试图弄清楚，巨噬细胞是如何知道在伤口愈合的不同阶段之间切换的？

One group of researchers tried to figure out how do macrophages know to switch between the different phases of wound healing?

因为在伤口愈合的不同阶段，巨噬细胞做的事情是不同的。

Because the macrophages do different things in the different phases of wound healing.

他们所有研究的结论是，关键在于线粒体。

And the conclusion of all of their research was that it's mitochondria.

线粒体发出关键信号，改变巨噬细胞的状态，从而诱导伤口愈合的不同阶段。

Mitochondria are sending the essential signals that change the state of the macrophages to induce these different phases of wound healing.

所以刚才我谈到了神经递质、激素、表观遗传表达和炎症。

So I've just talked about neurotransmitters, hormones, epigenetic expression, inflammation.

熟悉心理健康领域的人都知道，这些是研究人员几十年来一直在努力解决的一些关键变量，试图弄清楚它们是如何相互关联的。

For anybody familiar with the mental health field, they know these are like some of the key variables that researchers have been struggling with for decades, trying to figure out how do these fit together.

我们知道，在患有精神障碍的人身上，所有这些类别都可能出现紊乱。

We know that all of the those buckets can be disrupted in people with mental disorders.

而我们这个领域一直在努力理解，但它们到底是怎么联系在一起的？

And our field has struggled to understand, but how do they fit together?

我们该如何理解这种紊乱？

How can we make sense of this disruption?

我相信，一旦你理解了线粒体的科学，你就能把精神疾病谜团中的所有线索都串联起来。

I believe once you understand the science of mitochondria, you can actually connect all of the dots of the mental illness puzzle.

我听到的是，线粒体除了是细胞中重要的能量生产和输出来源（这当然是事实）之外，可能还有其他作用，而且也许有一天，我们所说的线粒体实际上会分成两三种不同的亚细胞器。

What I'm hearing is that mitochondria, in addition to being important sources of energy production and output in cells, which of course they are, probably have other roles, and that maybe someday what we call mitochondria will actually be two or three different little subcellular organelle.

在科学教育的背景下，人们常常会想，好吧，能量生产，然后会有一张线粒体展示肌肉的图片或卡通。

In the landscape of science education, oftentimes people think, okay, energy production, there'll be a picture or a cartoon of mitochondria flexing its muscles.

人们会说，好吧，能量，线粒体，强大的线粒体。

People go, okay, energy, mitochondria, mighty mitochondria.

然后他们会想，哦，知道吧，它们就像是细胞里那种四肢发达头脑简单的角色，对吧？

And then they'll think, oh, know, they're just sort of like a dumb jock portion of the cell, right?

它们没在做什么复杂的事。

They're not doing anything sophisticated.

而你刚才列出的那些，说明它们在细胞内做了很多复杂精细的事情。

And everything you listed off is that they are doing many sophisticated, intricate things within cells.

既然现在大家都清楚线粒体在以一种非常受调控的方式做着大量非常重要的事情，那我们来说说线粒体自噬。我猜这是指线粒体被有意或无意地吞噬，大概是为了用更新、更健康的线粒体来替换它们，对吗？

So now that everyone is well aware that mitochondria are doing a large number of very important things in a very regulated way, Let's talk about mitophagy, which I have to presume is the intentional or not gobbling up of mitochondria, presumably to replace them with newer, healthier mitochondria, is that right?

是的。

It is.

所以从很多方面来说，线粒体自噬是自噬的一个子集，但它有自己的名字，因为它专门针对线粒体。

So in many ways, mitophagy is a subset of autophagy, but it's got its own name because it is specific to mitochondria.

与更广泛的自噬相比，线粒体自噬确实有一些独特的调控因子。

There do appear to be some unique regulators of mitophagy compared to autophagy more broadly.

线粒体实际上在自噬过程中本身就扮演着角色。

Mitochondria actually are playing a role in autophagy itself.

这很合理，因为从整体来看，自噬是由禁食状态或模拟禁食状态所激发的。

And this makes sense because one of the, so the global picture of autophagy is stimulated by fasting states or fasting mimicking states.

所以当你的身体感觉到食物不足时，它就会进入一种节省模式，开始以一种精心协调的方式回收那些老旧、死亡的细胞部分。

So when your body senses that you don't have enough food, it actually hunkers down and starts to recycle dead old parts in this kind of carefully orchestrated way.

然后把这些部分送到溶酶体里，它们被分解，分解后的产物要么用来提供能量，要么用来构建新的东西。

And it takes them to lysosomes, they get degraded, and then those degradation products get used for either energy or to build new things.

自噬其实一直在低水平进行，但你可以通过禁食、热量限制、模拟禁食饮食等方式来强烈刺激这个过程。

Ontophagy is always occurring at a low level, but you can really hyper stimulate the process through fasting, calorie restriction, fasting mimicking diets, other things.

这也是为什么禁食和热量限制现在在医学界这么热门，因为它们被证明能延长寿命。

And this is why fasting and calorie restriction is so kind of such hot topics in the medical field now is because they've been shown to induce longevity.

我们认为这很可能就是通过这个过程，刺激身体变得精简和节约，在资源分配上更加保守。

And we think it's probably through that process that you're stimulating the body to become lean and conservative in terms of its allocation of resources.

而且身体不会只破坏那些

And the body doesn't just destroy the

最健康的组织，连同老旧死亡的部分一起。

healthiest tissue along with the old dead stuff.