必备知识：如何优化女性荷尔蒙健康，焕发活力与长寿 | 萨拉·戈特弗里德博士

欢迎收听《Huberman Lab 精华版》，我们在这里重温往期节目，为你带来最有效、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，开始我与医生的对话。

And now for my discussion with Doctor.

萨拉·戈特弗里德。

Sara Gottfried.

医生。

Doctor.

戈特弗里德，萨拉，欢迎你。

Gottfried, Sara, welcome.

谢谢，很高兴来到这里。

Thank you, so happy to be here.

是的，我非常高兴，也非常兴奋能和你聊很多很多话题。

Yeah, I'm delighted and very excited to ask you about an enormous number of topics.

你在很多方面都是专家，特别是女性激素方面。

You are expert in so many things, female hormones in particular.

对于任何年龄的女性来说，了解母亲甚至祖母在激素方面的经历，是不是总是有帮助的？

Is it ever informative for a woman regardless of age to know something about her mother's, perhaps even her grandmother's experience vis a vis hormones?

女性应该和自己以及家人进行什么样的对话，才能更好地了解自己的具体需求？

What sorts of conversations should women be having with themselves and with family members to get a window into what their specific needs might be?

我的工作实际上处于遗传和环境之间的交叉点。

So my work is really at interface between genetics and environment.

我认为了解你的祖母，尤其是你的母亲所经历的事情，是至关重要的。

And I think it's essential that you understand what your grandmother went through and especially your mother.

我可能会先从创伤和代际创伤开始，因为我认为这对内分泌系统影响巨大，尤其是皮质醇信号。

So I would probably start first with trauma and intergenerational trauma because I think that affects the endocrine system so hugely, especially cortisol signaling.

还有一些女性疾病有很强的遗传成分，其中大多数在我的家族中都有。

And then there's certain female conditions that have a very strong component genetically, most of which run-in my family.

这包括子宫内膜异位症、子宫肌瘤和多囊卵巢综合征。

So that includes endometriosis, fibroids, and polycystic ovarian syndrome.

要不我们按年龄段来聊聊吧，比如十几岁、已经进入青春期的女孩，她们应该关注哪些生物标志物？

Maybe we could march through and just say for a woman in her teens who's already hit puberty, what sorts of biomarkers should those young women be paying attention to?

同样，二十几岁、三十几岁的女性，我们也可以按年龄段来，从青春期开始，差不多每十年一个阶段。

Likewise for women in their twenties, thirties, maybe we could take it more or less by by decade at starting at puberty.

在十几岁的时候，我觉得真正值得关注的是皮质醇。

In your teenage years, what I think is really interesting is to look at cortisol.

在那个年龄段，观察雌激素和孕激素之间的互动其实帮助不大，因为系统还没成熟，变化太大了。

To look at the dance between estrogen and progesterone in those years is less helpful because I think there's a lot of variability due to the immaturity of the system.

如果月经周期已经很规律，那这个年龄做基准测试可能更合适。

If you've got someone who's got really regular periods, it's probably better to do some benchmarking at that age.

但总的来说，我觉得二十多岁或三十多岁才是做基准测试的最佳时机。

But generally, I find that benchmarking is best performed in your twenties or thirties.

月经刚来的时候，周期长度是不是不太规律？

Are periods not that regular in terms of duration of the menstrual cycle when the menstrual cycle first sets in?

对很多女性来说，确实不规律。

For a lot of women, they're not regular.

还有口服避孕药和其他避孕方式的问题，用了这些你就完全不知道正常周期是什么样的了。

And then there's the whole piece of oral contraceptives and other forms of contraception where you have no idea what the normal cycle is.

但回到你最初的问题，就是关于每个十年的生物标志物。

But getting back to your original question, which is about biomarkers per decade.

二十多岁的时候，就该做雌激素、孕激素和睾酮的基础检测了。

In your twenties, that's when you wanna do some base casing with estrogen, progesterone and testosterone.

很多时候，雌激素在这支舞里占主导地位。

What happens a lot of the time is that estrogen dominates in that tango.

一旦这样，就会增加患子宫肌瘤、子宫内膜异位症的风险。

And when that happens, it sets you up for greater risk of fibroids, endometriosis.

我想了解DHEA和整个雄激素通路的情况。

I'd wanna know about DHEA and sort of the whole androgen pathway.

我想了解雌激素的代谢产物，因为有些是有保护作用的，很有帮助。

I'd wanna know about the metabolites of estrogen because some of them are protective and very helpful.

其他的就像荷马·辛普森一样。

Others are a bit like Homer Simpson.

就是说，它们简直就是在你身体里到处惹麻烦。

I mean, they are just like causing all kinds of problems in your body.

我还想知道她们的排便情况。

I'd also like to know about their stool.

所以我想了解肠道菌群。

So I wanna know about the microbiome.

如果要做血液检测或者针对其他生物标志物做各种检查，比如雌激素、睾酮以及它们之间的比例，女性需要在月经周期的不同阶段去测。

In terms of blood testing or various tests for these other biomarkers, getting estrogen, testosterone, and other ratios, women will need to do it at different stages of their menstrual cycle.

如果只能选一个时间点，要么在卵泡期，要么在排卵周期的黄体期，你会建议她们什么时候去测呢？

If they had to pick one, either in the follicular phase and or in the luteal stage of their ovulatory menstrual cycle, When would you suggest they do that?

要是非得选一个的话，对于二十多岁的人来说，我会说大概在周期第二十一到第二十二天。

So if you force me to pick one, I would say probably day twenty one to twenty '2 for someone in their twenties.

大多数女性的月经周期平均是二十八天。

So for most women, they've got a menstrual cycle day that averages out at twenty eight days.

那差不多就是她们来月经前一周左右。

So this is about a week before they start their period.

对于月经不太规律的女性来说，这样做就比较难了。

For women who are more irregular, it's harder to do that.

随着女性年龄增长，月经周期通常会变短一些。

As women get older, usually the cycle gets a little shorter.

所以当她们的孕酮分泌开始下降时，月经间隔会变短。

So as they start to decline in their progesterone production, their period gets a little closer together.

那时候，你就要提前测试，比如在第十九天、第二十天。

At that point, you wanna test sooner, like day nineteen, twenty.

抽血检查是最便宜的方法。

Blood test is the cheapest thing.

而且通常保险都会覆盖。

It's usually what's covered by insurance.

但我更倾向于做干尿检测，这样除了激素水平，还能得到代谢组学的数据。

But my preference would be to do dried urine so that I get metabolomics in addition to the levels of these hormones.

如果非要用的话，我会选择抽血检查。

And if I'm forced to, I'll use blood testing.

它没有那么全面。

It's not as comprehensive.

而且你知道，就是针扎在血管里的那三十秒，快速抓取一个瞬间的样本。

And as you know, it's a quick little snapshot while the needle's in your vein for, you know, thirty seconds.

让我再回头补充一点关于生物标志物的内容。

Let me go back and say one other thing about biomarkers.

我在给病人做表型分析时，很大一部分检测是基于精准医疗的实践。

A big part of the testing that I do in phenotyping my patients, I practice precision medicine.

我几乎总是从营养检测开始。

I like to almost start with nutritional testing.

在你二十多岁时，做这个可能很有帮助。

That would be potentially a helpful thing to do in your twenties.

随着年龄增长，你可能会出现更多的微量营养素缺乏，这时它就没那么重要了。

Becomes less important as you get older and you develop more micronutrient deficiencies.

但微量营养素在激素生成中起着巨大的作用。

But micronutrients play a huge role in terms of hormone production.

比如说，镁在身体排出雌激素的过程中起着非常重要的作用。

Magnesium is hugely involved in the way that you get rid of estrogen, as an example.

所以微量营养素检测，我通常会把血液和尿液检测结合起来做。

So micronutrient testing, what I usually do is a combination of blood and urine.

我会检测所有可以测量、并且有临床科学依据的微量营养素。

And so I'm looking at all of the micronutrients that we can measure that have some clinical scientific basis behind them.

蔬菜和多酚的摄入量，是预测未来乳腺癌风险的重要因素，比如到五十岁、六十岁的时候。

Intake of vegetables, polyphenols, is such an important predictor of future risk of breast cancer, like when you're 50, 60.

而最关键的时间段是十几岁的时候。

And the most important time is when you're a teenager.

如果你有证据能展示给一个17岁的孩子看，让他们知道自己有微量营养素缺口，我觉得这会激励他们在那个关键时期改变饮食。

If you have evidence that you could show a 17 year old that they've got micronutrient gaps, I think that would be a motivator for them to eat differently at a time when it's so critical.

尽管这可能是二十五年后的事，但可能改变他们的人生轨迹。

Even though it's twenty five years in the future that it's gonna potentially change this arc that they're on.

我想先插播一下，感谢我们的赞助商之一，LMNT。

I'd like to take a quick break and acknowledge one of our sponsors, LMNT.

LMNT 是一种电解质饮料，你需要的都有，不需要的都没有。

LMNT is an electrolyte drink that has everything you need and nothing you don't.

也就是说，电解质钠、镁、钾的比例刚刚好，而且不含糖。

That means the electrolytes, sodium, magnesium, and potassium in the correct amounts, but no sugar.

适当的补水对大脑和身体的正常运作非常关键。

Proper hydration is critical for optimal brain and body function.

即使是稍微缺水，也会影响你的认知和体能表现。

Even a slight degree of dehydration can diminish cognitive and physical performance.

还有一点很重要，你要摄入足够的电解质。

It's also important that you get adequate electrolytes.

钠、镁、钾这些电解质对全身所有细胞的正常工作至关重要，特别是那些神经元，也就是神经细胞。

The electrolytes, sodium, magnesium, and potassium are vital for functioning of all the cells in your body, especially your neurons or your nerve cells.

将 LMNT 溶解在水里喝，保证你水分和电解质都补得满满的。

Drinking LMNT dissolved in water makes it very easy to ensure that you're getting adequate hydration and adequate electrolytes.

为了确保水分和电解质充足，我每天早上一醒来就喝一袋 LMNT，泡在大概十六到三十二盎司的水里，基本上是起床后的第一件事。

To make sure that I'm getting proper amounts of hydration and electrolytes, I dissolve one packet of LMNT in about sixteen to thirty two ounces of water when I wake up the morning, and I drink that basically first thing in the morning.

我在做任何体育锻炼时也会喝溶解在水里的Element，尤其是在热天，我大量出汗，流失水分和电解质的时候。

I'll also drink Element dissolved in water during any kind of physical exercise that I'm doing, especially on hot days when I'm sweating a lot and losing water and electrolytes.

Element有很多口味，都很好喝。

Element has a bunch of great tasting flavors.

我喜欢树莓味，也喜欢柑橘味。

I love the raspberry, I love the citrus flavor.

现在，LMNT有一款限量版的柠檬水口味，真的超级好喝。

Right now, LMNT has a limited edition lemonade flavor that is absolutely delicious.

我不想说我偏爱某一种口味，但这个柠檬水口味和我最喜欢的树莓或西瓜口味不相上下。

I hate to say that I love one more than all the others, but this lemonade flavor is right up there with my other one, which is raspberry or watermelon.

再说一次，我选不出最喜欢的口味。

Again, I can't pick just one flavor.

我都喜欢。

I love them all.

如果你想试试LMNT，可以访问drinklmnt.com/huberman，购买任意Element饮品混合物即可免费获得一份Element样品包。

If you'd like to try LMNT, you can go to drinkelement.com/huberman, spelleddrinklmnt.com/huberman to claim a free Element sample pack with a purchase of any Element drink mix.

再说一次，去 drinkelement.com/huberman 就能领取免费样品包。

Again, that's drinkelement.com/huberman to claim a free sample pack.

对于那些不喜欢吃蔬菜，或者因为某种原因无法或不愿每天摄入五种颜色的蔬菜来支持肠道菌群的年轻女性，你会怎么做？

What do you do for a young woman who doesn't like vegetables or is not somehow able or willing to get those five colors a day of vegetable to help support the microbiome?

还有哪些其他工具，无论是行为上的还是其他方面的，是有用的？

What other sorts of tools, behavioral or otherwise, are useful?

我尽量让她们喝思慕雪。

What I try to get them to do is to have a smoothie.

如果我能让她们每周喝三次思慕雪，并在里面加一些蔬菜，那就会产生很大的不同。

If I could get them to have a smoothie three times a week and to throw some of these vegetables in, that makes a huge difference.

我的意思是，我们知道这对肠道菌群的变化有影响。

I mean, we know that makes a difference in terms of microbiome change.

比如，我让她们用冷冻的蒸西兰花，因为它的味道很淡。

Like I have them do steamed broccoli that's in the freezer because it's got very little taste.

她们可以把它放进巧克力思慕雪里。

They could do that in a chocolate smoothie.

他们可以加一些绿色蔬菜。

They could add some greens.

我喜欢绿色蔬菜。

I like greens.

粉末状的非常方便。

Powders are super convenient.

所以加上他们喜欢的口味，无论是巧克力（我的大多数客户都想要这个），还是香草加浆果之类的。

So that with, you know, kind of a a taste that they like, whether that's chocolate, which is what most of my clients want, or, you know, vanilla with berries and that sort of thing.

所以如果你不喜欢吃蔬菜，这也能起到很大作用。

So that can go a long way if you don't like vegetables.

如果做不到的话，我会建议一些补充剂，但我觉得那远不如做冰沙来得好。

In short of that, I would say some supplements, but I would say that's a distant second to making a smoothie.

测试微生物组的最佳方法是什么？

What is going to be the best way to test the microbiome?

对于营养检测，我喜欢做一个检查抗氧化剂的检测组合。

What I like to do with nutritional testing is run a panel that's looking at antioxidants.

所以比如维生素A、维生素C、α-硫辛酸、植物性抗氧化剂，因为这些都能在血液里检测到。

So like vitamin A, vitamin C, alpha lipoic acid, plant based antioxidants because you can measure that in the blood.

我喜欢看一些关键维生素，尤其是B族维生素这一大类。

I like to look at some of the key vitamins, especially the b vitamin range.

因为你也知道，如果带有某些特定的基因变异，你可能就不太容易吸收到足够的维生素B9、叶酸、维生素B12等等这些。

Because as you probably know, if you've got particular genetic polymorphisms, you might be less likely to be absorbing the right level of vitamin b nine, folate, vitamin b twelve, etcetera.

同时我也看回抗氧化剂里的谷胱甘肽，因为我觉得这个东西特别重要，是个很关键的调节点。

I'm also looking going back to the antioxidants at glutathione because I think that's such an important lever.

然后还会看一些矿物质。

And then I'm looking at some of the minerals.

镁是最重要的，我们知道大概百分之七十到八十的美国人身体里都缺镁。

Magnesium is really the most important, and we know that somewhere around seventy to eighty percent of Americans are deficient in magnesium.

这算是立竿见影、最容易入手的一个点了。

That's like the lowest hanging fruit.

我挺好奇的，就比如说镁，如果有那么多人缺乏，那是不是意味着其中大多数人就应该有意识地多吃含镁的食物，或者额外补充镁剂呢？

I would be curious for instance, like with magnesium, if that number of people are deficient, does that mean that that number of people should be targeting their nutrition towards foods that contain magnesium and or supplementing with magnesium?

如果是的话，应该补充哪种形式的镁？

And if so, what forms of magnesium?

你得测红细胞里的镁，就是全血。

You have to measure red blood cell magnesium, like whole blood.

关于缺乏镁，补充起来挺有意思的。

And with deficiency, it's interesting with supplementation.

对我的病人来说，那些容易便秘的，说实话，我照顾的女性里大概有百分之八十都这样。

For my patients who tend toward constipation, and that's frankly about eighty percent of the women that I take care of.

真的吗？

Really?

是的。

Yes.

哇。

Wow.

我很好奇为什么会这样。

I'd be curious as to why that is.

父权制、愤怒、松果体系统。

Patriarchy, rage, the pine system.

对。

Right.

心理学、免疫学、神经和内分泌因素结合在一起。

Psychology, immunology, neural and endocrine factors combined.

是不是

Is that

是的。

Yes.

然后我觉得还有另一个因素。

And then I would say there's another factor.

身为女性本身就是一种健康风险。

Being female is a health hazard.

所以我们的抑郁和失眠率是两倍。

So we've twice the rate of depression, insomnia.

我们患多发性硬化症的风险是男性的三到四倍。

We've got three to four x increased risk of multiple sclerosis.

我们患甲状腺功能紊乱的风险是男性的五到八倍。

We've got five to eight times the risk of thyroid dysfunction.

所以如果你只看这一点，再看看轻微的临床前甲状腺功能障碍，我照顾的很多女性都有甲状腺问题，这导致了便秘。

So if you just look at that and you look at subtle preclinical thyroid dysfunction, a large number of the women that I take care of have thyroid dysfunction that's contributing to constipation.

如果我们回到那个控制系统，下丘脑-垂体-肾上腺-甲状腺-肠道轴，她们承受着很大的压力，同时甲状腺功能又处于临界状态，而主流医学的医生都没告诉她这是个问题。

And if we go back to that control system, hypothalamic pituitary adrenal thyroid canal gut axis, And they have a lot of perceived stress together with this borderline thyroid function that no mainstream medicine doctor has told her is a problem.

然后她还有雌激素和孕激素之间的平衡问题。

And then she's got a problem with the tango between estrogen and progesterone.

她就会倾向于便秘。

She's going to tend toward constipation.

女性比男性更容易便秘。

Women have a lot more constipation than men.

女性的肠道比男性长约10英尺，而且她们更有可能有迂曲的结肠。

The gut is about 10 feet longer in women compared to men, and they are much more likely to have a torturous colon.

而要知道这一点，就得做结肠镜检查。

And the way you know that is you get a colonoscopy.

女性比男性经历更多的创伤。

Women experience more trauma than men.

这是公认的事实。

This is well established.

如果你看看1998年CDC和Kaiser做的ACE研究，我们知道，大多数中年男性中，大约有50%的人经历过显著的创伤，这是根据ACE问卷定义的。

If you look at the ACE studies that were done by the CDC in Kaiser in 1998, we know that men, for the most part, middle aged men, have about about fifty percent of them experience significant trauma as defined by the ACE questionnaire.

女性的比例是60%，而且这个数据从1998年以来一直很稳定。

Women are at sixty percent, and that's pretty durable since 1998.

她们遭受的虐待形式不同，更可能遭受性虐待。

They do have different forms of abuse, much more likely to have sexual abuse.

她们的下丘脑-垂体-肾上腺轴反应和男性不同。

They have a different HPA response than men.

她们感受到的压力往往更高，当然我这是针对整体人群来说的。

Their perceived stress tends to be higher, and I'm generalizing for a population.

所以如果你看女性的生理结构，我觉得便秘以及那种需要控制、约束和憋住东西的感觉，其实是生理的一部分。

And so if you look at the physiology of a female, I think that constipation and that need to, like, control and restrain and hold things in, I think that's part of the physiology.

我虽然偏离了科学，但我确实认为这是一个非常重要的信号，值得高度关注。

So I'm veering away from the science, but I do think that it is a really important signal to pay a lot of attention to.

你推荐人们用什么方法来缓解便秘呢？

What sorts of tools do you recommend people use to relieve constipation?

听起来减轻压力会是一个很大的方法。

Sounds like reducing stress is going to be a huge one.

是的。

Yes.

你最喜欢的减压工具是什么？

What are your favorite stress reduction tools?

那些能真正降低基线水平的方法。

Things that can really lower the baseline.

其实我不太赞成降低压力。

So I'm not a fan of lowering stress.

我支持的是降低感知到的压力。

I'm a fan of lowering perceived stress.

我觉得每个人都有一个适合自己的菜单，选择最有效的方法。

I think all of us mean a la carte menu of what is most effective.

所以我现在这个年纪适合的方法，和我大学时做的超觉冥想已经不一样了。

So what works for me now at my age is different than the TM I did as a college student, transcendental meditation.

我三十多岁时就拿到了瑜伽教练证书。

I became a certified yoga teacher when I was in my thirties.

那对很多人来说非常有效。

That is very effective for a lot of people.

我也会做全息呼吸练习。

I do holotropic breath work.

我觉得大家开始认识到，缓解压力的方式不只有度假这一种。

I think people are starting to appreciate that there are ways that they can relieve their stress that that don't all only fall under the categories of vacation

对。

Right.

还有冥想。

And meditation.

但我想说，冥想显然是一个很棒的工具。

But I want to say that meditation is obviously a wonderful tool.

当然，它确实是个好工具，而且背后有很强的科学依据，但这份菜单上还有很多其他选项。

Well, certainly it's a great tool and it's got such a scientific basis behind it, but there's so many things on this a la carte menu.

性爱、高潮、连接、感到被倾听、被看见、被爱。

Sex, orgasm, connection, feeling heard and seen and loved.

我想借此机会，第一，记住这一点，然后回到我之前没说完的问题，这是我的错。我现在很清楚，一个十几岁末、二十出头的女性应该了解自己的睾酮、雌激素、甲状腺、皮质醇水平，至少应该开始考虑自己的肠道菌群，应该关注每天排便的次数和时间。

I wanna use this as an opportunity to, A, keep this in mind as we turn to a question that I didn't close the hatch on earlier and it's my fault, which is, I'm now clear on the fact that a woman in her late teens, early twenties ought to know something about her testosterone, estrogen, thyroid, cortisol levels, should start at least thinking about her microbiome, should be thinking about how many bowel movements and the timing of those bowel movements per day.

我猜我刚才说的这些对二十多岁、三十多岁、四十多岁、五十多岁，一直到一百岁的女性也都适用。

And I'm assuming that what I just described is also true for women in their twenties, thirties, forties, fifties, on up to hundreds.

对吗？

Is that correct?

对。

That's correct.

但我要说的是，每个十年阶段，机会都是不一样的。

But I would say that there are differential opportunities by decade.

所以我很高兴她把话题拉回到青少年和睾酮上，因为我觉得如果你在十几岁的时候就知道自己的雄激素偏高，而且这种潜在的表型可能要到很远的未来才会显现，你甚至可能都注意不到。

So I'm glad she circled it back to teenagers and testosterone because I think if you know, for instance, in your teenage years that you have high androgens and that you've got this potential phenotype way into the future that you may not even notice.

我的意思是，也许你会注意到下巴上多了几根毛或者类似的。

I mean, maybe you notice you've got a few extra hairs on your chin or something.

如果你知道你的睾酮或其他雄激素偏高，这可能会改变你照顾自己的方式。

If you know that your testosterone is elevated or some other androgen, it might change the arc of how you take care of yourself.

所以我觉得这在青少年时期会很有帮助。

So I think that could be very helpful in your teenage years.

到了二十多岁，像我当时那种压力很大的人，比如27岁在UCSF的病房里，如果当时我知道自己是高皮质醇体质，我想我会做出不同的选择。

In your twenties, for people who are a stress case like me, so age 27 on the wards at UCSF, if I had known that I was such a high cortisol person, think I I would have done things differently.

我会改变自己的行为。

I would have changed my behavior.

睾酮水平从二十多岁就可能开始下降，这取决于你的身体承受的压力有多大。

Your testosterone can decline starting in your twenties kind of depending on how much stress your matrix is under.

所以对于女性来说，最早28岁就可能开始下降，通常睾酮每年下降大约1%。

So for women that can start as early as 28, usually your testosterone declines by about 1% per year.

那25岁之后，你希望女性体内的睾酮水平维持在什么范围呢？

What level of testosterone do you like to see in a woman once she's sort of post let's say after age 25?

我在播客上通常这么说，就是正常范围的上半段。

So the way I tend to describe this on podcasts is the top half of the normal range.

我收到很多关于多囊卵巢综合征的提问。

I get a lot of questions about PCOS.

对。

Yeah.

多囊卵巢综合征确实是个被误解很深的病症。

So PCOS is one of those really poorly understood conditions.

它通常不怎么显山露水，直到女性想要怀孕或者遇到其他问题去看医生，才会被发现。

It kinda flies below the radar until a woman wants to get pregnant or she's got some other issue that drives her to a physician.

问题在于它是一种综合征。

The problem is that it is a syndrome.

对吧？

Right?

所以多囊卵巢综合征，有时候也叫多囊性卵巢综合征。

So polycystic ovary syndrome, sometimes polycystic ovarian syndrome.

而综合征并不一定都有非常清晰的诊断标准。

And syndromes don't necessarily fit together into a really clear diagnostic criteria.

所以在这种情况下，我们需要参考三个不同的标准。

So in this instance, there are three different criteria that we look for.

比如卵巢囊肿，还有高雄激素血症的临床表现。

So cysts on the ovaries, having clinical manifestations of hyperandrogenism.

这可能包括多毛、痤疮等其他症状，通常还会伴有月经不规律。

So that could be hirsutism, acne, other things, and then usually irregular periods.

根据最新的诊断标准，至少定义为每三十五天或更短的时间内来一次月经。

And the way that that's defined at least by the latest criteria is having a period every thirty five days or less.

所以典型的周期长度是二十八天，或者三十五天。

So typical cycle length twenty eight days, thirty five days.

你会时不时地跳过一个月经周期。

You're skipping a period here and there.

这些就是我们用来诊断多囊卵巢综合征的标准。

So those are the criteria that we use to diagnose PCOS.

文献里大概有四种不同的诊断系统，这也是让人困惑的地方。

There are about four different systems out there in the literature for diagnosing PCOS, which is where it starts to get confusing.

有些女性卵巢上有囊肿，但她们也有多毛症和月经不规律。

So there's some women who have noses on their ovaries, but they've got hirsutism and they've got irregular periods.

你能定义一下多毛症吗？

Could you define hirsutism?

多毛症就是毛发生长过多，通常长在不想要的地方。

Hirsutism is increased hair growth usually in places that you don't want it.

对女性来说，可能是那种男性型毛发分布。

So for women, it can be, you know, kind of male pattern.

她们可能会在乳房或胸部长毛。

They might notice it on their breasts, on their chest.

我们知道，多囊卵巢综合征不只是月经不规律、怀孕困难那么简单。

What we know is that PCOS is not just a problem in terms of irregular periods and then difficulty getting pregnant.

这些问题大多出现在二十多岁、三十多岁和四十出头的时候。

So those are mostly problems in your twenties, thirties, early forties.

但随着年龄增长，它是心血管代谢疾病的一个巨大风险因素。

But it is a massive risk factor for cardiometabolic disease as you get older.

所以很多人倾向于把多囊卵巢综合征看作仅仅是育龄期的问题。

So many people tend to pitch and hole PCOS is a problem of reproductive age.

我们得在女性整个生命周期中去考虑它。

We have to be thinking of it over the entire female life cycle.

而且我想说，50岁以后考虑它甚至更重要。

And I would say it's even more important to consider it over the age of 50.

你知道，绝经的平均年龄是51到52岁，因为我们知道，升高的睾酮和高雄激素很可能是多囊卵巢综合征女性患心血管代谢疾病的最大诱因。

You know, average age of menopause is 51 to 52 because we know that that elevated testosterone, the high androgens are probably the greatest cardiometabolic driver of disease for women with PCOS.

我们还没谈到胰岛素和血糖的作用。

The thread we haven't talked about is the role of insulin and glucose.

所以对于某些类型的多囊卵巢综合征，问题出在高胰岛素血症，血液里胰岛素太高，会刺激卵巢的膜细胞过度分泌睾酮。

So for some of the phenotypes of PCOS, the problem is hyperinsulinemia, high insulin in the blood is driving those theca cells in the ovaries to overproduce testosterone.

你是不是动态血糖仪的粉丝？

Are you a fan of continuous glucose monitors?

我是动态血糖仪的铁杆粉丝，超级喜欢。

The hugest, most gigantic fan of CGMs.

在我用过的所有工具里，我从没见过像动态血糖仪这样能改变人们行为的东西。

I've never seen any tool that I've ever used in medicine change behavior the way that CGMs do.

我觉得真正弄明白影响血糖的因素很重要的。

Like, I think really understanding what the mediators are of your glucose control is essential.

不过话说回来，这也算是一个比较晚期的效果。

Now that said, it's also kind of a later effect.

其实我倒是更想知道你的胰岛素水平。

I mean, I'd rather know your insulin.

而且我们从怀特霍尔研究里知道，胰岛素，尤其是餐后胰岛素和空腹胰岛素，早在血糖变化好几年前就开始变了。

And we know from, the white hat Whitehall study that insulin, especially postprandial insulin, fasting insulin too, can change years and years before you get a change in glucose.

所以，那更多是针对糖尿病前期和糖尿病的。

So, that's more for prediabetes and diabetes.

第三点是它让数据民主化。

Third thing is it democratizes data.

目前我在健康领域看到的最有希望、最令人兴奋的事情之一是，我们正在从那种医生掌握权力、是数据守门人的家长式关系，转变为患者和客户能够更多地接触到自己身体化学和生物学的奥秘。

One of the most hopeful and exciting things that I'm seeing right now in the health space is that we're going from this patriarchal relationship where doctors hold the power and are the gatekeepers of data to patients and clients having much more access to that enchantment about their own chemistry and their own biology.

教患者成为自己的临床医生，在我看来，这是一个充满善意和正直的循环，对创造健康至关重要。

Teaching the patient to be their own clinician, to me that is a loop of benevolence and integrity that I think is essential to creating health.

我们有一个疾病护理系统。

We've got a disease care system.

我们需要数据的民主化，才能成为一个以健康为基础的系统。

We need the democratization of data to become a health based system.

我想快速休息一下，感谢我们的赞助商AG1。

I'd like to take a quick break and acknowledge our sponsor AG1.

我很高兴地告诉大家，AG1刚刚推出了他们的最新配方，AG1 Pro。

I'm excited to share that AG1 has just launched their newest formulation, AG1 Pro.

AG1 Pro 在原有经过临床验证的 AG1 配方基础上，添加了维生素、矿物质、益生菌和适应原，并新增了三种重要成分：一水肌酸、HMB 钙和锌肌肽。

AG1 Pro takes the clinically backed AG1 formula, which is a blend of vitamins, minerals, probiotics, and adaptogens, and adds three important new ingredients, creatine monohydrate, calcium HMB, and zinc carnosine.

每份含有五克一水肌酸，有助于增强肌肉力量和运动表现，同时也有益于大脑健康。

Each serving has five grams of creatine monohydrate to support muscle strength and performance, as well as brain health.

HMB 钙有助于肌肉恢复，减少肌肉分解；锌肌肽则有助于支持和改善肠道内壁。

Calcium HMB to support muscle recovery and reduce muscle breakdown and zinc carnosine to support and improve the lining of your gut.

这三种成分都有充分的科学依据支持，所以我很高兴看到它们被加入到现有的 AG1 配方中。

All three of these ingredients have compelling science to support them, and therefore I love seeing them added to the existing AG1 formula.

你们大多数人都知道，我每天服用 AG1 已经将近十四年了。

As most of you know, I've been taking AG1 every day for nearly fourteen years now.

我早在知道播客是什么之前就开始服用它了。

I started taking it long before I even knew what a podcast was.

这是一款很棒的产品，现在新的 AG1 Pro 配方让它变得更好。

It's a great product and it's now made even better with the new AG1 Pro formula.

如果你想尝试 AG1 Pro，可以访问 drinkag1.com/huberman 获取特别优惠。

If you would like to try AG1 Pro, you can go to drinkag1.com/huberman to get a special offer.

AG1现在正在搞活动，首次订阅就送一瓶Omega-3辅酶Q10。

AG1 is giving away a free bottle of omega-three coenzyme Q10 with your first subscription.

再说一遍，去drinkag1.com/huberman，首次订阅AG1就能免费获得一瓶Omega-3辅酶Q10。

Again, go to drinkag1.com/huberman to get a free bottle of omega-three coenzyme Q10 with your first AG1 subscription.

如果你有一根魔法棒，可以给两三个“不要做”的建议来最大化活力和长寿，我们先聚焦女性患者，但如果也适用于男性患者，你希望他们不要做什么？

If you had a magic wand and you could give two or three don'ts to maximize vitality and longevity, let's focus first on female patients, but if it extends to male patients as well, what would you like to see them not do?

我会说睡眠、酒精、高感知压力、吃错食物、有毒的关系，还有孤立。

So I would say sleep, alcohol, high perceived stress, eating the wrong foods, toxic relationships, and isolation.

然后第六个，就是动得不够，或者运动方式不适合自己的身体。

And then number six, not moving enough or not moving and exercising in a way that really fits with your body.

那我们就从那个开始吧，当然。

We'll start with that one actually, Sure.

因为这个问题太……然后我们倒着来。

Because it's such a And then work backwards.

对。

Yeah.

对我来说，因为我的身体特征会产生很多胰岛素，这取决于我状态好不好，我血糖会很高，所以我得运动更多来消耗这些葡萄糖。

Well, I think for me, because I have a phenotype that produces a lot of insulin, kind of depending on how I'm on my game, I have a lot of glucose, so I have to exercise a lot more to dispose that glucose.

所以我觉得你不能只靠面向大众的医学建议或处方，而是要针对个人情况找到合适的方案。

So I think you then have to move from medicine for the population or prescriptions for the population to what works for the individual.

其中一个我认为很重要的中介因素，特别是对那些进行我所谓的“长期有氧运动”的人，我以前就是这样，就是皮质醇。

One of the mediators that I think is important, especially for people who do what I call chronic cardio, which is what I did, is cortisol.

我们知道跑步的人，尤其是马拉松选手，那些做大量有氧运动但很少做力量训练的人，他们的皮质醇水平往往会比较高。

So we know that runners, especially marathon runners, people who do a lot of cardio and don't do much resistance training, they tend to have much high cortisol levels.

你可以通过补充维生素C来缓冲这个问题。

And you can buffer that with vitamin C.

维生素C可以减轻这种影响，但长期有氧运动并不总是对人有好处。

Vitamin C can decrease the effect, but chronic cardio doesn't always serve people.

当我第一次给自己测激素指标时，我去找医生，我说我35岁。

When I first started measuring hormone panels in myself, I went to my physician and I said, I'm 35.

我这辈子从来没这么累过。

I've never been so exhausted in my life.

我就感觉像在把一块大石头推上山。

I just feel like I'm pushing a rock up the hill.

我肚子上有赘肉，我自己都不喜欢，而且我也不想跟丈夫有亲密接触。

I've got this belly fat that I don't like, and I don't wanna have sex with my husband.

那我们能怎么办呢？

What can we do about this?

他的建议就是给我开避孕药和抗抑郁药。

And he offered a birth control pill and an antidepressant.

哦，天哪。

Oh, goodness.

所以我离开了他，自己去实验室做了激素检查，结果显示我的皮质醇水平是正常值的三倍。

So I left him and I went to the lab and I ran a hormone panel, and my cortisol was three times what it should have been.

我的胰岛素都到二十多了。

My insulin was in the twenties.

我当时是空腹的。

I was fasting.

我的血糖是105。

My glucose was a 105.

我的甲状腺有点异常。

My thyroid was mildly abnormal.

我的孕酮很低。

My progesterone was low.

这让我开始明白，作为一名医生，尤其是在照顾女性患者的时候，我并没有触及那些至关重要的根本原因。

And that set me on this course of realizing that what I was doing as a physician, taking care especially of women, was not getting to some of these root causes that are so essential.

首先我不得不从皮质醇入手。

And I would say I had to start first with cortisol.

那时候，我每周跑三次或四次，每次跑四英里。

At that time, I was running four miles, three times a week, four times a week.

但这只会进一步抬高我的皮质醇。

Was just raising my cortisol further.

所以那对我来说并不是一种合适的运动。

So that was not the right exercise for me.

我需要更适应性的锻炼。

I needed more adaptive exercise.

我开始做普拉提，更多的瑜伽。

I started doing pilates, more yoga.

那帮助降低了我的皮质醇。

That helped to lower my cortisol.

我的意思是，这让我开始改变管理感知压力的方式，也改变了我的补充剂方案。

I mean, it started me on changing the way I was managing perceived stress, and it also changed my supplement regimen.

我想确保我们回到避孕药的话题。

I'd like to make sure that we circle back to birth control.

特别是口服避孕药。

In particular, oral contraceptive birth control.

你有什么担忧？

What are your concerns?

你喜欢口服避孕药的哪些方面？

What do you like about oral contraceptives?

那你讨厌它哪一点呢？

What do you dislike about them?

从好处来说，我觉得，尤其是刚出来的时候，甚至现在，它给了女性生育选择权，这非常关键。

In terms of benefit, I think that, especially when they first came out and even now, it gives women reproductive choice, and that's essential.

所以在这方面我很支持，而且我们有很多数据来展示它的风险和好处。

So I'm a big fan in that regard, and we've got a lot of data to show both the risks and also the benefits of it.

那我先说说好处吧，因为关于风险我可能会有点激动。

So I'll speak first into the benefits because I'm gonna get on a soapbox a little bit about the risks.

我们知道它能降低卵巢癌的风险。

So we know that it reduces the risk of ovarian cancer.

所以这种持续排卵的想法对女性身体并不好。

So there's something about this idea of incessant ovulation that is not good for the female body.

比如，看看修女，她们不吃口服避孕药，在生育年龄每个月都来月经，她们患卵巢癌的风险就更高。

So if you look at, for instance, women who are nuns, who don't take oral contraceptives and they have a period every single month of their reproductive lives, they have a greater risk of ovarian cancer.

再看看那些生过几个孩子的女性，她们怀孕期间不排卵，之后又哺乳一段时间，她们患卵巢癌的风险就较低。

So if you look then at women who have several babies and they've got a period of time when they're pregnant that they're not ovulating and then they breastfeed for some period of time, they have a lower risk of ovarian cancer.

所以口服避孕药有助于减少排卵，从而降低风险。

So oral contraceptives help with reducing ovulation and reducing risk.

我们知道，如果服用口服避孕药大约五年，可以将卵巢癌的风险降低百分之五十。

We know that if you take the oral contraceptive for about five years, it reduces your risk of ovarian cancer by fifty percent.

这很重要，因为我们在早期诊断卵巢癌方面表现很差。

And that's significant because we're so poor at diagnosing ovarian cancer early.

真的没有什么特别有效的方法。

There's really no method that's really effective.

我们使用CA125和超声筛查，尤其是对有较大遗传风险的女性。

We use CA-one hundred twenty five and ultrasound screening, especially in women who are at greater genetic risk.

但即便如此，很多时候我们发现时已经是晚期了。

But even that, often we diagnose it, you know, in a later stage.

也许这句话会让很多人想到一个问题：不用抽血检查，人们最早能察觉到的症状有哪些？

Maybe just because that statement is going to highlight for a number of people, the question of what are some of the earliest symptoms that people can recognize without a blood test?

那么卵巢癌，会不会是疼痛？

So is ovarian cancer, is it going to be pain?

问题是症状太模糊了，太不具体了。

So the problem is the symptoms are so vague and they're so nonspecific.

最常见的症状之一就是腹胀。

One of the most common symptoms is bloating.

我们之前也提到过便秘。

And we've already talked about constipation.

我们说过女性的肠道更长。

We've talked about how women have this longer track, GI track.

所以腹胀对大多数女性来说是非常常见的体验。

And so bloating is a really common experience for most women.

还可能会有腹部胀满的感觉，就是觉得小腹被顶出来。

You can have bulk symptoms, you know, feeling like your your lower belly is kind of pressed out.

我们指导女性注意这一点的方法，就是让高风险人群定期做妇科检查，比如因为某种原因做超声时发现可疑的肿块。

The way that we inform women in terms of watching for this is to get regular gynecologic exams for women who are at high risk where they have, for instance, an ultrasound for some reason, it shows a mass that we're concerned about.

然后根据情况来决定她们需要什么样的进一步检查。

There's a way to triage that in terms of what kind of evaluation that they need.

在这种情况下，你可能会做一个叫做CA-125的血液检查。

And that's the situation where you might get a blood test called the CA-one hundred twenty five.

服用雌激素从而减少排卵频率可以降低患卵巢癌的风险。

Taking estrogen and thereby reducing the frequency of ovulation lowers the risk of ovarian cancer.

那些即使没有性生活的女性，也就是说并不是在积极备孕或避孕，但如果她们没有性生活，她们是否应该定期使用激素类避孕药来抑制排卵，仅仅是为了降低患卵巢癌的风险呢？

Should women that are, even women who are not sexually active, so they're not actively trying to get pregnant or avoid getting pregnant, but if they're not sexually active, would they be wise to suppress ovulation for periodically using hormone based contraception just so that they can offset the risk of ovarian cancer?

这是个非常合理的问题。

That's a very rational question.

我得说，这正是主流医学推荐口服避孕药的原因，不仅仅是给那些有避孕需求的女性，还用于治疗痤疮、痛经，以及各种情况，他们都会给开口服避孕药。

And I would say that's what mainstream medicine has had at its back to recommend oral contraceptives, not just for women who are seeking contraception, but for acne, for painful periods, for really kind of the drop of a hat, they're prescribing oral contraceptives.

我被教导的就是这样。

That's what I was taught to do.

我觉得很大一部分原因是制药公司的影响。

And I think a lot of that is pharmaceutical influence.

口服避孕药含有两种激素。

The oral contraceptive is two hormones.

它含有炔雌醇和一种孕激素。

It's ethinyl estradiol, and it's a progestin.

所以它不是你的身体、卵巢和肾上腺正常产生的孕酮。

So it's not the normal, progesterone that your body makes, that your ovaries make, and your adrenals make.

它是一种合成形式的孕酮。

It is a synthetic form of progesterone.

而且它和女性健康倡议中显示有危险和刺激性的孕激素属于同一类。

And it is the same progestin, similar same class that was shown to be dangerous and provocative in the women's health initiative.

所以我不喜欢孕激素。

So I'm not a fan of progestins.

我不推荐任何女性使用它们，除非它们能在某种程度上给她们带来一些自由。

I do not recommend them for any woman unless it it gives them some freedom in some way.

所以就像几乎所有药物一样，口服避孕药会消耗某些微量营养素。

So like with almost any pharmaceutical, the oral contraceptive depletes certain micronutrients.

镁，还有一些特定的B族维生素会被消耗掉。

Magnesium, there's certain vitamin b's that are depleted.

它还会影响肠道菌群。

It also affects the microbiome.

这方面的数据不是特别充分，但似乎确实有一些影响。

That data is not as strong, but there seems to be some effect.

而且，它还会增加患炎症性肠病和自身免疫性疾病的风险。

And there's also an increased risk of inflammatory bowel disease in autoimmune condition.

它会增加体内的炎症水平。

It increases inflammatory tone.

根据我看过的研究，它会使炎症标志物——高敏C反应蛋白——的水平升高大约两到三倍。

So the studies that I've seen increase one of the markers of inflammatory tone, high sensitivity CRP, by about two to three x.

它似乎会让下丘脑-垂体-肾上腺轴变得更加僵硬，这样一来，你就不能像不吃避孕药时那样灵活应对压力，皮质醇的分泌也不能自然地起伏变化。

It seems to make the hypothalamic pituitary adrenal axis more rigid so that you can't kind of roll with the punches and wax and wane in terms of cortisol production the way that you can off the birth control pill.

它还可能影响甲状腺功能。

It can affect thyroid function.

任何时候你服用口服雌激素，它都会提高性激素结合球蛋白的水平。

Anytime you take oral estrogen, it raises sex hormone by globulin.

凯尔，我觉得你之前和其他播客嘉宾也聊过这个话题。

And you've talked to other podcast guests about this, Kyle, I think.

对。

Mhmm.

性激素结合球蛋白，我把它想象成一块海绵，会吸收游离的雌激素和游离的睾酮。

Sex hormone binding globulin, I think of as a sponge that soaks up free estrogen and free testosterone.

所以当你服用避孕药时，你的性激素结合球蛋白水平会升高。

So when you go on the birth control pill, you raise your sex hormone binding globulin.

它尤其会吸收游离睾酮。

It soaks up especially free testosterone.

对某些女性来说，这没什么大不了的。

And for some women, it's not a big deal.

她们不会感觉到太大的差异。

They don't notice much of a difference.

但还有一种情况，可能跟雄激素受体上的CAG重复序列有关，这些女性对游离睾酮的下降特别敏感。

But then there's a phenotype maybe related to CAG repeats on the androgen receptor who are exquisitely sensitive to that decline in free testosterone.