如何改善皮肤健康与外观

我在节目笔记的标题中链接的那项研究，是我之前几期节目中提到过的，它正是这一现象的一个例子。

And the study that I linked to in the show note captions, which I've covered in previous episodes is about one example of that phenomenon.

好了，我们来谈谈防晒霜。

Okay, let's talk about sunscreens.

现在，我之所以改变语气，是因为如果你在网上搜索，会看到一些说法，说我从不使用或不相信防晒霜。

Now, the reason I changed my tone of voice with this is that if you look on the internet, you will see claims that I don't use or believe in sunscreen.

这完全是错误的。

That is just false.

我一辈子都在使用防晒霜。

I've worn sunscreen my entire life.

但我并不一定每天都用。

I don't necessarily wear every day.

我不容易晒伤。

I don't tend to burn easily.

正如我前面提到的，我的皮肤根据遗传因素具有一定的天然色素。

I have some natural level of pigmentation in my skin based on my genetics, as I mentioned earlier.

但正如我们之前讨论的，仅仅避免晒伤并不能保护我或任何人免受阳光引起的皮肤细胞突变和阳光带来的老化影响。

But as we talked about earlier, just avoiding sunburn is not going to protect me or anyone else against certain sun induced mutations in skin cells and the aging effects that sun can have.

因此，我相信某些防晒霜，也就是说，我会在某些日子将防晒霜涂抹在身体的某些部位。

So I do believe in certain sunscreens, meaning I will put sunscreen on certain days on certain parts of my body.

然而，经过与多位皮肤科医生交流并深入研究文献后，我现在认为某些防晒霜中的某些化学物质值得关注。

However, I do believe now having spoken to multiple dermatologists and looked into the literature very deeply that there are certain chemicals in certain sunscreens that are of concern.

我的意思并不是说，如果你使用一两次这些产品就会遭受负面后果。

I don't mean that if you put these on once or even twice that you are going to suffer negative consequences.

我的意思是，这些物质值得关注，意味着我们应该留意它们。

I mean, are of concern, meaning we should pay attention to them.

当有选择时，我们应该选择更健康的产品。

And when given the option, we should opt for the healthier choices.

事实上，已经存在已知的更健康的选择。

And in fact, there are known healthier choices.

为了说得非常清楚，我现在要告诉你皮肤科界目前对此非常明确的观点，好吗？

To make all of this very clear, I'm going to tell you what is very clear to the dermatology community at this point in time, okay?

截至2024年6月，我们现在知道的是这些。

In June 2024, here's what we know.

目前主要有两种类型的防晒霜。

There are two major types of sunscreens out there.

严格来说有三种，我们之前讨论过物理屏障，没有人对物理屏障有争议。

Well, really three, we talked about physical barrier before, no one argues about a physical barrier.

没有人担心物理屏障的化学成分，对吧？

No one's worried about the chemical composition of physical barriers, okay?

当我们谈论防晒霜时，比如乳液、面霜、喷雾等，主要有两种类型。

When we talk about sunscreen, so lotions, creams, sprays, etcetera, there are two major types.

第一种是有机类，其实就是化学防晒霜，明白吗？

The first are organic types, which is essentially chemical sunscreens, okay?

所以当你听到有机防晒霜时，指的就是化学型防晒霜。

So when you hear organic sunscreens, that means chemical type sunscreens.

另一种是非有机类，有时被称为矿物型防晒霜。

And then there are inorganic types, which are sometimes referred to as mineral based sunscreens.

大多数人普遍接受的是，矿物质防晒霜——即含有氧化锌或二氧化钛，或两者兼有的防晒霜——在浓度不超过25%的情况下通常被认为是安全的。

Here's what most everybody seems to accept that mineral based sunscreens, meaning sunscreens that tend to include either zinc oxide or titanium dioxide or both in some cases are generally thought to be safe up to concentrations of 25%.

25%是一个相当高的浓度。

25% is a pretty high concentration.

市面上确实存在含有25%氧化锌或25%二氧化钛的防晒霜。

You can find sunscreens out there that have 25% zinc oxide or 25% titanium dioxide.

不过，这类产品比较少见。

They're rare to find however.

更常见的是含有15%、10%、18%氧化锌的防晒霜，有时是单独使用，有时与二氧化钛混合使用。

More often you'll find sunscreens that have 15%, 10%, 18% zinc oxide sometimes alone, or in combination with titanium dioxide.

市面上也有一些纯二氧化钛防晒霜，虽然它们相对更少见，对吧？

You'll find some pure titanium dioxide sunscreens out there, although those are a bit more rare, right?

找起来稍微难一点。

A little bit harder to find.

关键是，氧化锌和二氧化钛能将紫外线反射回去，这些短波长的光原本可能在表皮层导致皮肤细胞发生突变，明白吗？

Here's the story, zinc oxide and titanium dioxide reflect back UV light, those short wavelengths of light that would otherwise potentially cause mutations in your skin cells at the level of the epidermis, okay?

以及皮肤的最外层。

And the outermost layers of skin.

记住，短波长的光不会深入皮肤。

Remember short wavelength light doesn't pass very deeply into the skin.

含有氧化锌和/或二氧化钛的防晒霜就是为此目的而设计的，用以反射紫外线。

Sunscreens containing zinc oxide and or titanium dioxide were engineered for that specific purpose to reflect back UV light.

这与有机或化学防晒霜非常不同，后者含有某些化合物。

This is very different than organic or chemical sunscreens, which contain certain compounds.

它们有不同的名称，比如氧苯酮、阿伏苯宗。

These go by different names, oxybenzone, avobenzone.

这类化学物质在所谓的有机或化学防晒霜中有很多种类。

There are a bunch of these different chemicals that are contained in so called organic or chemical sunscreens.

这些化学物质通常不是用来反射紫外线，而是吸收紫外线。

Those chemicals in general don't serve to reflect back UV light, but rather absorb UV light.

因此，当它们涂抹在皮肤上时，设计目的是吸收紫外线，防止紫外线对皮肤造成负面影响。

So when they're applied to the skin, they're designed to absorb the UV light so that the UV light can't negatively impact the skin.

这些化学成分，也就是有机防晒霜中的有机成分，有时也被称为化学防晒霜，其设计目的是吸收紫外线；而以氧化锌或二氧化钛为基础的矿物防晒霜，也就是所谓的无机防晒霜，则设计用来反射紫外线。

Those chemical, again, chemical AKA organic components within organic sunscreens, again, sometimes called chemical sunscreens are designed to absorb UV light, mineral based sunscreen so called inorganic sunscreens containing things like zinc oxide or titanium dioxide are designed to reflect back UV light.

我为什么要告诉你们这些？

Why am I telling you this?

这是因为人们普遍认为，含有氧化锌和二氧化钛的防晒霜在浓度高达25%时是安全的。

Well, I'm telling you this because it's generally believed that the zinc oxide and titanium dioxide containing sunscreens are safe up to concentrations of 25%.

而相比之下，化学防晒霜——也就是有机防晒霜中的化学成分，存在一些潜在的内分泌干扰物风险。

Whereas there is some, again, some concern about the chemicals within chemical AKA organic sunscreens as potential endocrine disruptors.

它们可能干扰睾酮合成、雌激素合成以及其他激素。

So disrupting things like testosterone synthesis, estrogen synthesis, and other hormones.

这并不仅仅关乎睾酮和雌激素，朋友们，还有其他许多激素也让人担忧，包括一些评估化妆品和防晒产品安全性的监管机构和组织。

It's not all just about testosterone and estrogen folks, other hormone that many people, including some governing bodies and agencies that assess the safety of different cosmetic and sunscreen products are concerned about.

不过，人们对这些风险的担忧程度取决于你身处世界哪个地区，明白吗？

Now, how concerned they are depends on where you are in the world, okay?

在欧洲，对什么是安全、什么是不安全或仅仅是值得关注的物质，其标准与美国不同。

So in Europe, they have different stringencies for what is considered safe versus unsafe or just of concern as opposed to in The US.

美国的每一位皮肤科医生——因为我采访了他们——都告诉我，建议不要给六个月以下的婴儿使用化学型防晒霜。

Here's what every dermatologist in The US, because those are the ones I spoke to told me, which is that it is advised that on children younger than six months of age, you do not use chemical based sunscreens.

为什么？

Why?

因为婴幼儿六个月以下的皮肤，即使是在身体外部，也更像黏膜组织，能够非常容易地通过皮肤吸收物质。

Well, young skin, even the skin on the external part of the body in children six months or younger acts more like mucosal skin in that it can very easily absorb things transdermally through the skin.

然而，即使随着年龄增长，进入青春期、青年期，乃至老年期，皮肤仍然具有让物质经皮吸收的能力。

However, even as we age, so into puberty, our young adult years, and even into our elderly years, there is still a capacity for things to pass transdermally through the skin.

尽管由于皮肤真皮层和表皮层中形成了额外的屏障，如细胞外基质、胶原蛋白的变化等，化合物经皮吸收的倾向性降低了。

Although because of some of the additional barriers formed within the dermal and epidermal layers of the skin, things like extracellular matrix, the changes in collagen, etcetera, there is less tendency for compounds to pass transdermally through the skin.

这仅仅说明，如果你本人非常年轻，或者为非常年幼的人（可能六个月以下，但也可能更年长，取决于你希望多么谨慎地避免使用化学型防晒霜）涂抹防晒霜时，需要特别注意。

Now that just simply highlights the fact that if you are a very young person or if you're applying sunscreen to a very young person, maybe six months or younger, but also perhaps older depending on how careful you want to be to avoid these chemical based sunscreens.

目前几乎没有证据表明，浓度在25%或以下的矿物型防晒霜会通过皮肤发生经皮吸收并构成风险。

There is very little, if any evidence that the mineral based sunscreens are of concern for transdermal passage into the skin at concentrations of 25% or less.

这意味着，含有氧化锌和二氧化钛的防晒霜可能是安全的，或者至少已被认定为足够安全，因而可以自由上市销售。

Meaning sunscreens containing zinc oxide and titanium dioxide are probably safe or at least have been deemed safe enough that they are freely available on the market.

我们被告知，它们对所有年龄段的人都安全。

And we are told that they are safe for people of all ages.

因此，如果你担心防晒霜中的化学成分，大多数皮肤科医生或从事防晒霜研究的化学家都会告诉你：如果你有顾虑，矿物型无机防晒霜会是更安全的选择。但要注意，化学型防晒霜中的一些成分，当你查阅文献时，确实可能令人担忧——比如氧苯酮、阿伏苯宗以及其他类似化学物质，即使在低浓度下，也被证明具有内分泌干扰作用。

So if you are somebody who is concerned about the chemicals in sunscreen, most every dermatologist or chemist who works on sunscreens will tell you, well, mineral based inorganic sunscreens are going to be your safer option if you're concerned, but get this, the chemical based sunscreens, while some of the chemicals in them indeed can be quite scary when you read the literature, you look at some of these things like oxybenzone, avobenzone and some similar chemicals, even at low concentrations have been shown to be endocrine disruptors.

有人提到，当他们涂抹这些防晒霜时，能在嘴里尝到味道。

People talk about how the fact when they apply these sunscreens, they can taste them in their mouth.

人们对这些成分有很多恐惧。

There's a lot of fear around these.

其中一些恐惧是有依据的。

And some of that fear is substantiated.

当你查阅关于这些化学型防晒霜的研究时，可能会发现一个有趣的事实：这些研究通常要求受试者在极短时间内涂抹大量化学防晒霜，比如两整瓶，然后抽取他们的血液。

When one goes and looks at the studies that have been done on these chemical based sunscreens, you may find it interesting to note that the way these studies were done often involves having people apply a ton of these chemical based sunscreens, like two full bottles of these sunscreens over the course of a very short period of time, and then have their blood drawn.

随后发现，某些化学成分确实进入了血液。

And then it's revealed that some of these chemical components are within the blood.

因此，一个很少被讨论但至关重要的问题是：在自然环境下很难控制，但在实验室中却容易控制的——是个人涂抹防晒霜的量、频率以及持续的年数。

So a big issue that's not often discussed because it's very difficult to control for in a natural setting, but is it straightforward to control for in a laboratory setting is how much sunscreen one is applying and how often and across how many years of time.

所以并没有明确的建议说，你只要用一次化学防晒霜就会有问题。

So there's no real prescriptive that can tell you, hey, if you put chemical sunscreens on once, that's problematic.

当然，要特别注意六个月以下的婴儿，这正是我前面提到的准则——不要给很小的孩子使用化学防晒霜。

Although certainly pay attention to that six months and younger, what is essentially a rule that I mentioned earlier and do not put chemical based sunscreens on really young kids.

如果你对这方面要求非常严格，你可能完全避免使用它们。

You might want to avoid them entirely depending on how stringent you are about this stuff.

但说到化学防晒霜，我个人会避免使用，但如果你只能使用化学防晒霜，那就仔细看标签。

But when it comes to chemical based sunscreens, personally, I avoid them, but then it becomes a question of if you could only use a chemical based sunscreen, you simply look at the label.

顺便说一下，有些产品含有氧化锌、二氧化钛和化学成分。

Some of these have, by the way, zinc oxide, titanium oxide and chemical based components.

记住这一点。

Okay, keep that in mind.

有些完全是矿物基的，有些完全是化学基的。

Some are purely mineral based, some are purely chemical based.

但如果你看防晒霜的标签，好吧，这是在非常炎热、紫外线指数很高的日子里唯一能买到的产品，否则我就会被晒伤。

But if you look at a sunscreen label, okay, well, this is the only thing available on this very hot day with a very high UV index and otherwise I'm going get a burn.

如果你非常担心，我会选择使用物理屏障。

Well, if you're really concerned, then I would resort to a physical barrier.

如果你不太担心，你可以告诉自己：好吧，今天可以用一下，但不建议每天都用。

If you are less concerned, then you could perhaps tell yourself, okay, you get to put it on that day, but you might not want to use it every day.

而且你可能只想用少量，对吧？

And you might want to use a small volume of it, right?

或者只涂在脸部、耳朵或脖子等特别容易晒伤的部位。

Or maybe just on parts of your face or your ears or your neck that are particularly sensitive to sun.

这些是需要考虑的因素。

Okay, these are the things that need to be taken into consideration.

但当我们从这一切中抽身出来，回顾所有文献——包括一些评估钛 dioxide 纳米颗粒潜在神经毒性的研究，我会附上这篇综述的链接。

But when we step back from all of this, all of the literature, including by the way, some of the literature that assessed, and I'll put a link to this review, a review on the potential neurotoxicity of titanium dioxide nanoparticles.

我稍后会详细说明。

I'll get into this in a moment.

已经有人探讨过，钛 dioxide 是否比氧化锌更具风险。

It has been explored whether or not titanium dioxide is more risky than zinc oxide.

稍后我们再谈这个。

Talk about that in a moment.

但当你从这一切抽身出来看，你会得到以下结论。

But when you step back from all of this, here's what you get.

物理屏障，没人对此有争议。

Physical barrier, no one argues about that.

没有人认为在避免过度日晒时，衣物本身是危险的。

No one believes that clothing is dangerous per se when it comes to avoiding excessive sun exposure.

再次强调，‘过度’取决于你的肤色、遗传背景、活动类型以及你所处的地理位置和季节，明白吗？

Again, excessive relates to your skin tone, your background genetics, your activities, and where you are in the world and what time of year, okay?

这完全因人而异。

Very specific to your needs.

很少有人担心矿物型无机防晒霜。

Very few folks are concerned about mineral based inorganic sunscreen.

所以，如果你像许多人一样想使用防晒霜，并希望确保它不是内分泌干扰物，也不是神经毒素，或某些化学防晒霜曾被质疑的其他有害物质，那么请选择含有25%氧化锌或二氧化钛的防晒霜。

So if you want to use sunscreen as many people do, and you want to make sure that it's not an endocrine disruptor and it's not a neurotoxin or something else that's been raised for some of these chemical based sunscreens, well then find a sunscreen that has 25% less zinc oxide and or titanium dioxide.

如果你对二氧化钛以及一些仅具提示性的证据更担心一些，这些证据表明二氧化钛可能比氧化锌更具风险，尤其是在其纳米形态下，这种极小的颗粒可能更容易穿透皮肤各层，实现经皮渗透，那么我们就选择一款仅含氧化锌的防晒霜。

If you were a bit more concerned about say titanium dioxide and some of the suggestive evidence, only suggestive evidence that maybe titanium dioxide is more risky than zinc oxide, especially when it's in its nano form, the very small form that may indeed allow it for more easy passage through the layers of the skin, that transdermal passage, we'll then find a sunscreen that is purely zinc oxide sunscreen.

而且，它们总是含有其他成分。

And again, they always have other things in them.

但我的意思是，纯氧化锌防晒霜的唯一活性成分就是氧化锌。

But what I mean is the only active ingredient in a zinc oxide only containing sunscreen is zinc oxide.

此外，还有许多其他成分使其成为乳液状，同样，浓度最高可达25%。

And then there are a bunch of other things that allow it to be a lotion for instance, again, up to 25% concentration.

有人可能会问，为什么有人不愿意使用含高达25%氧化锌的防晒霜，而选择其他产品呢？

Why would somebody not want to use zinc oxide containing sunscreen up to 25% and opt for anything else you might ask, right?

如果这被认为是安全的。

If that's considered safe.

原因是氧化锌的质地非常黏稠、厚重，有点糊状，对吧？

The reason is the consistency of the zinc oxide is it's pretty sticky and thick and and it's kind of pasty, right?

在八九十年代，你们中的一些人可能还记得，那时的氧化锌防晒霜会让鼻子变得全白。

Back in the eighties and nineties, some of you may recall that zinc oxide sunscreens that would actually color the nose white.

所以你能清楚地看到，它在脸上非常明显。

So you could really see it, it was really prominent on the face.

他们曾试图把这变成一种时尚潮流，但随着时间推移，并不怎么受欢迎。

They tried to turn that into a fashion statement and didn't go over so well over time.

但无论如何，在含氧化锌的防晒霜中添加二氧化钛，可以让质地更顺滑，更容易均匀涂抹。

But in any case, the addition of titanium dioxide to those zinc oxide containing sunscreens allow it to be a bit silkier so that it would spread on more evenly.

那你可能会问，既然有风险，为什么防晒霜里还要添加化学成分呢？

And then you may say, well, why even put chemicals in sunscreen at all if there's risk?

化学型有机防晒霜之所以存在，是因为它们可以配制出非常顺滑的配方，能清透地覆盖在妆容上。

The reason why chemical based organic sunscreens even exist is that they can come up with compositions of those sunscreens that are very silky, then that could spread on clear over makeup and things of that sort.

但这些化学成分存在一些担忧，比如可能干扰内分泌，甚至具有诱变性，可能引发其他问题或各种不良影响。

But there are these concerns about some of those chemical components as endocrine disruptors and potentially as mutagens that could cause other issues or any number of different things.

你可以在网上找到各种各样的担忧说法。

You can find all sorts of concerns out there on the internet.

这些担忧大多缺乏依据，但这些化学成分在高浓度下确实可能带来问题。

Most of those concerns are not substantiated, but these chemicals can be problematic at high concentrations.

这就回到了我们之前提到的观点：在那些化学物质的研究中，某些国家禁止使用或发出警告建议的原因在于，实验中使用的化学防晒剂用量极高。

And that takes us back to the point made earlier, which is that in the studies of those chemicals and the reasons in some cases being banned in certain countries and other countries carrying warning recommendations, the amount of those chemical based sunscreens that were applied was exceedingly high.

所以如果你经常使用防晒霜，而且用量很大，那么最好选择矿物型防晒霜。

So if you're wearing sunscreen very often, you're wearing a lot of it, probably best of year towards a mineral based sunscreen.

如果你对化学防晒霜中的成分有任何顾虑，建议使用矿物型防晒霜，或采取物理遮挡措施。

If you are concerned at all about the chemicals in chemical based sunscreen, wear a mineral based sunscreen and or use physical barrier.

如果你根本不相信防晒霜是安全的，那么据我所知，这是个自由的世界，你完全可以不使用防晒霜；但我要提醒你，必须清楚地意识到，阳光会加速皮肤老化，对吧？

And if you're somebody who just doesn't believe that sunscreens are safe whatsoever, well, as far as I know, it's a free world, you don't have to wear sunscreen, but then I would say you need to be very aware of the fact that sun can induce the appearance of accelerated aging in the skin, right?

这确实是一个真实发生的过程。

That's an actual process that takes place.

事实上，这一点毫无争议。

There's really no debating that frankly.

日晒可能加速甚至引发某些皮肤癌，而没人希望这样。

And sun exposure can potentially accelerate or even give rise to certain skin cancers and nobody wants that.

在我们继续讨论如何提升皮肤的年轻态或外观年轻感之前，我们需要再多聊一聊皮肤癌。

Okay, before we move on to a discussion about what can be done to increase the youthfulness of our skin or the appearance of youthfulness in our skin, we need to have a bit more discussion about skin cancers.

注意我说的是皮肤癌的复数形式，因为皮肤癌有多种不同类型。

Notice I said skin cancers plural, because there are many different forms of skin cancer.

其中一些与我们之前讨论过的日晒有关，另一些则无关。

Some of them relate to sun exposure as we discussed earlier, others do not.

事实上，一些更致命的皮肤癌与日晒无关。

And in fact, some of the more deadly skin cancers are independent of sun exposure.

它们可能与遗传和其他因素有关。

They can relate to genetics and to other factors.

因此，关于这一切最直接的说法是，大约80%到90%的黑色素瘤——这是一种皮肤癌，属于非常严重且可能致命的皮肤癌——是在所谓的新生皮肤上形成的。

So the most straightforward story about all of this is that approximately eighty to ninety percent of melanomas, which are skin cancers, and they are very serious skin cancers that can indeed be very deadly arise in what's called de novo skin.

新生皮肤是指非痣皮肤。

De novo skin is non mole skin.

那么，这是否意味着你不应该关注痣的形状及其任何变化？

Now, does that mean that you should not pay attention to the shape and any changes in your moles?

不，你绝对应该关注。

No, you absolutely should.

但对于那些全身天然肤色较深或痣非常少的人而言，仅依靠观察痣的变化来判断皮肤癌的潜在发展是不够的。

But for people who have naturally darker pigmentation everywhere or who have very few moles, then you aren't going to be able to use the monitoring of your moles as the only readout of potential development of skin cancer.

事实上，你应该关注那些与痣或痣的变化无关的更严重的皮肤癌。

And frankly, should be thinking about these more serious skin cancers independent of moles or changes in moles.

以下是每个人都应注意的几点。

Here are a couple of things that everyone should pay attention to.

如果你有类似粉刺的皮损，或者皮肤上任何看似痤疮但持续超过一个月的斑点，或者有长期（如一个月或更久）渗出类似血浆、脓液或血液的区域，一定要尽快找皮肤科医生检查。

If you have a pimple like lesion, or you have any kind of spot on your skin that seems like it's an acne that's lasted more than a month, or you have an area that's seeping something that might look like plasma or pus or blood, and it persists over a long period of time, like a month or more, absolutely get that checked out by a dermatologist, okay?

不要拖延超过一个月，尽快去检查。

Don't wait any longer than a month, get it checked out.

此外，强烈建议你定期找皮肤科医生检查你的痣。

In addition, it's highly recommended that you go in and you get your moles checked by a dermatologist.

而且，坦率地说，你每年至少应让皮肤科医生全面检查一次你的全身皮肤。

And frankly, you get all of your skin checked by a dermatologist at least once per year.

这将有效帮助你预防日晒引起的皮肤癌以及其他类型的皮肤癌。

This is going to really protect you against both the sun induced skin cancers and other forms of skin cancer.

最常见的由日晒引起的皮肤癌是基底细胞癌。

The most common form of sun exposure induced cancers are basal cell carcinomas.

这些癌症确实比许多黑色素瘤的致死性低，但它们仍然可能非常严重，甚至致命。

And indeed those are less deadly than many of the melanomas, but they still can be exceedingly problematic and they can be deadly.

因此，及时检查这些病变非常重要。

So it's very important to get these checked out.

现在有一些网站，我将在节目笔记的链接中提供其中一个，你可以通过它们查看各种痣及其随时间变化的示例。

Now there are websites and I'll provide a link to one of them in the show note captions for which you can look at a bunch of different examples of different moles and how they change over time.

如果你发现自己的痣与该图库中的任何痣相似，那么你最好立即去看皮肤科医生，因为这可能是某种形式的癌症。

And if you happen to have a mole that resembles the appearance of any of the moles in that image gallery, then you would be wise to go to a dermatologist right away because it could be, again, could be cancer of some sort.

你不想让这些问题拖延太久。

You do not wanna let these things linger for too long.

同时，许多人会担心某个原本没有不规则边缘的痣，突然出现了不规则边缘。

At the same time, many people get concerned about one mole that didn't have an irregular border and then suddenly has an irregular border.

你从网站上或与皮肤科医生交流时，会学到许多判断病变是否预示或已发展为皮肤癌的不同特征。

There are a lot of different features that you'll learn from the website, if or you talk to your dermatologist that relate to whether or not something is predicting skin cancer or has become skin cancer.

不仅仅是边缘不规则，还包括大小的变化、色素沉着的变化、血管化、出血以及任何渗出现象，这些都有很多不同的表现。

It's not just irregular border, it's changes in size, certainly changes in pigmentation, vascularization, bleeding, any kind of seeping, there are a lot of different things there.

所以，当第一次出现这些迹象时，不必惊慌，但一定要认真对待。

So don't be alarmed at first appearance of one of these things, but do take it seriously.

同时要记住，你的皮肤科医生可以采取一些措施来帮助预防某些皮肤癌。

And keep in mind that there are things that your dermatologist can do to help prevent certain skin cancers.

例如，目前皮肤科医生中正兴起一种趋势，即建议进行皮肤激光磨削。

So for instance, there's a growing trend now among dermatologists to suggest laser resurfacing of skin.

这是一种利用激光破坏表皮最外层、促使其更新再生的技术，因为表皮确实能够再生并产生新的细胞。

That is a laser used to essentially disrupt that epidermal outermost layer, turn it over so that it regenerates because it can indeed regenerate to create new cells there.

请记住，紫外线和其他环境因素可能会导致这一皮肤层发生突变。

Keep in mind that UV light and other factors in the environment can cause mutations within that skin layer.

有时这些突变由遗传因素引起，但更多时候是由阳光、化学物质等环境因素导致的。

Sometimes they're caused by genetic factors, but often environmental factors like sun and chemicals and other things.

通过激光磨削促进皮肤层更新，这不仅可以降低癌症风险，还可能让皮肤看起来更年轻。

And by encouraging turnover of that skin layer through laser resurfacing, which by the way may also increase the sort of youthfulness appearance of your skin.

因此，许多人因为这个原因而选择接受治疗，这可以显著降低某些类型皮肤癌的发病率。

So many people are motivated to do it for that reason can dramatically reduce the incidence of certain kinds of skin cancer.

事实上，我所交谈的一位皮肤肿瘤学专家表示，由于这种再生表皮层的能力，激光换肤可以使皮肤癌发病率降低百分之三十。

In fact, the dermatologist that I spoke to, who's an expert in derm oncology, okay, cancers of the skin said that laser resurfacing can cause a thirty percent reduction in skin cancers because of this ability to rejuvenate that epidermal layer.

这一点在面部、耳朵、颈部、手背等部位尤其明显，因为这些部位常年暴露在阳光下，最容易受到损伤。

And that's especially true for areas of the body like the face, ears, neck, tops of the hands, etcetera, for which the sun often induces the most damage because those are the most exposed parts of the body on a regular basis.

顺便说一下，关于皮肤癌的这个问题，其规模绝非微不足道。

And by the way, this whole thing about skin cancer is not a trivially small number.

这是一个庞大的数字。

It's a big number.

仅在美国，每年就有高达四百万例鳞状细胞癌的病例，这是其中一种皮肤癌类型。

In The US alone, there are up to four million cases per year of what's called squamous cell carcinoma, one of these forms of skin cancer.

因此，建议每年至少接受一次专业皮肤科医生的检查，如果你特别担心，或者有家族遗传性皮肤癌史，甚至应该更频繁地检查。

So getting checked out by a highly qualified dermatologist on a yearly basis, maybe even more if you're really concerned about this because you have a lot of familial genetically inherited skin cancers, things of that sort is really highly advised.

我想稍作休息，感谢我们的赞助商Element。

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

Element 是一种电解质饮料，含有你所需的一切。

Element is an electrolyte drink that has everything you need.

这意味着它含有适量且比例正确的电解质：钠、镁和钾，且不含任何不必要的成分，比如糖。

That means the electrolytes, sodium, magnesium, and potassium in the correct amounts and ratios and nothing you don't, which means no sugar.

现在，我和其他嘉宾在这个播客中都讨论过，补水对大脑和身体的正常运作至关重要。

Now I and others on this podcast have talked about the critical importance of hydration for proper brain and body functioning.

即使轻微的脱水也会降低认知和体能表现。

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

确保摄入足够的电解质也很重要。

It's also important that you get adequate electrolytes.

电解质——钠、镁和钾——对身体所有细胞的功能至关重要，尤其是你的神经元，也就是神经细胞。

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

将 Element 溶解在水中饮用，能轻松确保你获得充足的水分和电解质。

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

为了确保自己摄入足量的水分和电解质，我每天早上起床后，将一包 Element 溶解在约四百七十三到九百四十六毫升的水中，并且第一时间喝掉。

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

我还会在进行任何体育锻炼时饮用溶解了Element的水，尤其是在炎热的日子里大量出汗、流失水分和电解质时。

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

Element有多种美味的口味可供选择。

They have a bunch of different great tasting flavors of Element.

我最喜欢的是西瓜味，尽管我承认我也喜欢覆盆子味和柑橘味。

My favorite is the watermelon, although I confess I also like the raspberry and the citrus.

基本上，我喜欢所有口味。

Basically, like all the flavors.

此外，Element刚刚推出了一款新的罐装气泡Element产品。

And Element has also just released a new line of canned sparkling Element.

这些不是需要溶解在水里的粉末包，而是像普通碳酸饮料一样可以直接打开饮用的罐装Element，而且不含糖，却能补充水分和电解质。

So these aren't the packets you dissolve in water, these are cans of Element that you crack open like any other can drink like a soda, but you're getting your hydration and your electrolytes with no sugar.

如果你想尝试Element，可以访问drinklmnt.com/huberman，购买任何Element饮品混合粉即可免费获得一份Element试用装。

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

再次提醒，访问drinkelement.com/huberman，免费领取试用装。

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

关于我们之前讨论过的日晒、防晒霜和皮肤癌，如果我不提一项经常被用来在网络争论中作为论据或武器的研究，那就失职了，这项研究涉及日晒、皮肤癌与死亡率的关系。

Now with respect to everything we've talked about about sun exposure, sunscreen, and skin cancer, I'd be remiss if I didn't discuss a study that's often used kind of as a wedge or a weapon in the online debates about sun exposure, skin cancer, and mortality.

这项研究的标题是《避免日晒作为风险因素，日晒作为主要死因的风险因素：来自南瑞典黑色素瘤队列的竞争风险分析》。

And the title of this study is Avoidance of Sun Exposure as a Risk Factor, that's right, Sun Exposure as a Risk Factor for Major Causes of Death, A Competing Risk Analysis of the Melanoma in Southern Sweden cohort.

这项研究的基本设计是评估人们多年来的自我报告日晒量，然后将其与全因死亡率相关联，并进一步分析不同疾病死因，特别是心血管死亡，同时与吸烟者进行比较。

So the basic design of this study was to evaluate people's self reported amount of sun exposure across many years, and then to correlate that with all cause mortality, And then to relate it to different causes of disease in particular cardiovascular death, compare this to smokers.

请记住，报告日晒量的一些人是吸烟者，另一些则不是。

Keep in mind that some of the people who were reporting their sun exposure were smokers, some weren't.

这项研究得出的结论引起了广泛关注，并持续引发热议，其摘要中写道：‘避免日晒的非吸烟者，其预期寿命与最高日晒组的吸烟者相似。’

And the conclusion of this study that drew a lot of attention and continues to draw a lot of attention is the following, quote, and here I quote from the abstract, non smokers who avoided sun exposure had a life expectancy similar to smokers in the highest sun exposure group.

好，我再重复一遍。

Okay, I'm going to repeat that.

避免日晒的非吸烟者，其预期寿命与最高日晒组的吸烟者相似。

Non smokers who avoided sun exposure had a life expectancy similar to smokers in the highest sun exposure group.

因此，许多人由此推断：避免日晒和吸烟一样危险，对吧？

So what many people take this to conclude is that avoiding sun exposure is as dangerous as smoking, okay?

这不是我想让你得出的结论，因为这项研究实际上表明的是——我继续说——与阳光暴露最多的人群相比，避免阳光暴露者的预期寿命减少了0.6至2.1年。

That's not the conclusion that I'd like you to take away because what this study basically shows is, and here I continue, Compared to the highest sun exposure group, life expectancy of avoiders of sun exposure was reduced by zero point six to two point one years.

所以你会想，等等，这真的可能吗？避免阳光暴露的人预期寿命反而比经常晒太阳的人还短？

So you go, wait a second, can this really be true that people that are avoiding sun exposure have a lower life expectancy than people who get sun exposure?

事实上，在这项研究中，情况似乎确实如此，但对此的解读并不完全直接明了。

And indeed in this particular study, that does seem to be the case, but the interpretation of this is not completely straightforward.

这是我们所知道的。

Here's what we know.

适度的阳光暴露似乎对预期寿命有益。

Getting some degree of sun exposure appears to be good for life expectancy.

这是真的。

That is true.

但这是否直接由阳光暴露引起？

But is it directly related to sun exposure?

这是一个关键问题。

That's a critical question.

而当你晒太阳时，增加的日照是否与其他问题有关，特别是黑色素瘤的发展？

And is the increased sun exposure that one gets, if you do get sun exposure linked to other issues in particular, the development of melanoma.

正如你所记得的，黑色素瘤甚至出现在这项研究的标题中。

As you recall, melanoma was even in the title of the study.

因此，这是我看待这项研究的方式。

So here's how I think we should think about this study.

看起来晒太阳确实与更长的寿命相关，但背后可能有无数种不同的原因。

It does appear that getting sun exposure is correlated with longer life expectancy, but there could be any number of different reasons for that.

例如，经常晒太阳的人 presumably 也在促进维生素D通路的激活，而维生素D与许多其他事情相关。

For instance, people that are getting regular sun exposure presumably are also enhancing activation of the vitamin D pathways, which is related to any number of different things.

他们无疑会感受到更强的幸福感。

They no doubt are experiencing increased feelings of well-being.

我之前提到过一些支持这一观点的研究。

I talked about papers that have substantiated that earlier.

坦白说，我们甚至不需要科学实验来证实这一点，尽管有研究支持总是很好的。

And frankly, we didn't even need a scientific study to substantiate that although it's always great to have it.

我们知道，每天在阳光下待一段时间，只要不被晒伤，就会感觉很好。

We know that being out in sunshine for some period of time each day, as long as we don't get burned in the sun feels good.

为什么会感觉好呢？

Why does it feel good?

它会促进睾酮、雌激素以及一些通常让我们感觉良好的内啡肽的产生。

It leads to the production of testosterone, estrogen, some of the endorphins that generally make us feel good.

这与多巴胺释放相关的通路直接相关。

It is directly related to the pathways associated with dopamine release.

关于多巴胺的合成，无论是人类还是其他动物，都有一整套关于季节性的研究。

There's a whole story there about seasonality, both in humans and other animals about dopamine synthesis.

当我们晒太阳时，多巴胺、血清素、睾酮和雌激素水平会上升，同时也会增强幸福感和性欲。

When we get sunlight, there's elevated dopamine and serotonin and testosterone and estrogen and feelings of well-being and libido.

这些在动物模型和人类中都得到了充分证实。

This is all well substantiated in animal models and humans.

因此，晒太阳会让人们感觉良好。

So getting sun exposure makes people feel good.

当人们感觉良好时，压力往往会降低。

When people feel good, they tend to be lower stress.

当人们感觉良好并充满能量时，这与日光照射直接相关，尤其是早晨对眼睛的光照，能提升情绪、警觉性和精力。

When people are feeling good and they have energy because they're indeed as a direct relationship between sun exposure, especially to the eyes early in the day and our feelings of elevated mood and alertness and energy.

他们更倾向于多运动、多走路。

They tend to exercise more, walk more.

当然，如果你在外面多运动、多走路、骑车或游泳，也会获得更多日光照射。

And of course, if you're outside exercising more, walking more, cycling, swimming, you're also going to get more sun exposure.

我们知道，运动与延长寿命密切相关，对吧？

And we know that exercise is strongly related to improved or extended life expectancy, okay?

所以这项研究基本上表明，相比极少晒太阳，适当晒太阳有利于延长寿命，但并没有说要晒太多太阳，对吧？

So the study basically says getting sunlight as opposed to very little sunlight is good for life expectancy, but it doesn't say get too much sunlight, right?

因为有趣的是，很明显，那些因晒太阳更多而寿命更长的人，也更容易患上癌症，包括黑色素瘤。

Because, and this is interesting, it is very clear that the people who lived longer because they were getting more sunlight also tended to have more cancers, including melanoma.

但这是一个非常重要的观点。

But this is a very important point.

而且，一个人活得越久，患上癌症的可能性就越大，对吧？

It's also the case that the longer one lives, the more likely you are to develop a cancer, okay?

所以你可以看到，很多人从这些研究中得出一个简单的结论：晒太阳少的人比晒太阳多的人寿命更短。

So as you can see these studies that many people just draw one straightforward conclusion from such as people get less sun exposure, don't live as long as people to get more sun exposure.

这确实是事实。

Well, that's true.

但当你获得更多阳光照射时，你很可能也在做其他事情，比如锻炼和感觉更好，这些都与长寿有关。

But when you get more sun exposure, very likely you're doing other things like exercise and feeling better that relate to living longer.

因此，要在这个案例中将阳光照射这一单一变量孤立出来作为关键因素，是非常困难的，甚至不可能的。

So it's very difficult, if not impossible to isolate one single variable in this case, sun exposure as the key variable.

不过，我愿意明确表态：我们从大量动物模型和人体研究中知道，日出时分当太阳在天空较低时的阳光照射，有助于调节昼夜节律，而日落时分的阳光照射也是如此——我不是说在正午暴晒导致晒伤之类的情况，而是指日落前后，尤其是眼睛接受阳光照射，能强烈调节你的昼夜节律，提升白天的情绪、专注力和警觉性，并改善睡眠。

However, I'm happy to go on record saying that we know from so many studies of animal models in humans that sun exposure, early day sun exposure when the sun is low in the sky to set your circadian rhythm and late day sun exposure, okay, I'm not talking about middle of the day getting baked in the sun and sunburned or things of that sort, but around the time of sunset, especially sun exposure to the eyes is powerfully modulating your circadian rhythm to elevate daytime mood focus and alertness and improve sleep.

这两者都与心理健康、免疫系统功能、幸福感提升和认知能力增强密切相关。

Both of which are strongly correlated with improvements in mental health, immune system function, feelings of well-being, enhanced cognition.

我的意思是，关于阿尔茨海默病患者和昼夜节律及睡眠紊乱之间存在一整套关联。

I mean, there's this whole story about people with Alzheimer's and disruptions in circadian rhythms and sleep.

因此，阳光照射眼睛以调节生物钟，对延长寿命和提升即时健康有显著效果。

So sun exposure to the eyes in terms of setting circadian rhythm, powerful, powerful improvement of life expectancy and immediate health.

阳光照射皮肤无疑能强烈调节某些激素和神经调节因子通路，比如多巴胺、睾酮、雌激素等，让人感觉良好，并促使他们做出对自身有益的行为。

Sun exposure to the skin, no doubt very powerful positive modulators of certain hormone and neuromodulator pathways, such as dopamine, testosterone, estrogen, and so forth that make people feel good and do things generally that are good for them.

好的，一般来说，并非所有因多巴胺、睾酮和雌激素升高而做出的行为都是有益的。

Okay, generally not all the things people do with elevated dopamine testosterone and estrogen are good for them.

我们对此非常清楚。

We know that for sure.

但适量接受阳光，尤其是早晨早期照射眼睛（不要直视太阳，避免损伤眼睛），以及在一天的早晚时段让皮肤适度接触阳光，显然与心理健康、身体健康，以及不出意料地与寿命延长等多种健康指标呈正相关。

But getting some sunlight that is some appropriate dosage of sunlight, especially to the eyes early in the day, don't stare at the sun, don't damage your eyes, but getting some of that sun exposure to your eyes early in the day and some to the skin, especially in the early and later part of the day clearly is positively correlated with various health metrics in terms of mental health and physical health and not surprisingly with lifespan.

我提到这项研究，是因为我觉得它确实非常有趣，对吧？

So I mentioned the study because I do think it's very interesting, right?

我觉得非常有意思的是，完全避免阳光的人，寿命不如那些适度接触阳光的人长。

I think it's really interesting that people who completely avoid sunlight are not living as long as people who get some sun exposure.

这其中的一些影响，实际上与吸烟所造成的后果相当。

And some of this actually is on par with what's experienced with cigarette smoking.

我认为有一件事是所有人都认同的，那就是对寿命有害，而且绝对不利于大脑和身体的许多系统。

I think something that everyone agrees is negative in terms of life expectancy and certainly is not good for a great number of different systems within the brain and body.

但我认为这项研究有时被用来强调一个错误的结论，即阳光本身在延长寿命。

But I think the study sometimes is used to highlight the wrong conclusion, which is that sunlight itself is extending lifespan.

我认为这种过于简单的结论可能被过度解读，反而会削弱一些同样重要的信息，比如过度日晒会导致皮肤癌等问题，我们之前已经讨论过，以及如何通过一些措施来降低这些风险，比如，如果需要的话，使用物理屏障，或者选择使用化学防晒霜。

I think that that very simple conclusion can be taken too far and can start to negate some of the equally important messages about excessive sunlight exposure causing certain problems as it relates to skin cancers, which we talked about earlier, as it relates to things that you can do in order to offset some of that risk with, if I were to suggest a physical barrier, if you need it, a chemical based sunscreen, if you choose to use sunscreen.

当然，这是每个人必须为自己做出的独立选择。

And of course, that's an independent choice that each of us have to make for ourselves.

好的，我们来谈谈皮肤的年轻态或皮肤的年轻外观。

Okay, let's talk about youthfulness of skin or the appearance of youthfulness in skin.

在录制这一集之前，我在社交媒体上征集了关于皮肤和皮肤健康的问题。

Before I did this episode, I put the call out on social media for questions about skin and skin health.

我必须说，绝大多数问题都与这个话题相关。

And I must say that the vast majority of questions related to this topic.

这是一个非常有趣的话题，因为它关系到人们在做什么、买什么或不买什么方面的诸多决定。

And it's a very interesting one because it relates to a lot of decisions that people are making about what to do, what to buy or not buy as the case may be.

这是一个规模巨大的产业，可能价值数千亿甚至上万亿美元。

And it is an enormous, probably hundreds of billions of dollars industry, if not trillion dollar industry over time.

这个领域涉及各种设备、产品和程序，旨在逆转衰老或皮肤衰老的外观，甚至从头合成胶原蛋白和皮肤等物质，使皮肤看起来更年轻。

This business of devices, products, and procedures to try and reverse aging or the appearance of aging in skin, or even create de novo new synthesis of collagen and skin and other things to make skin look more youthful.

那么，如果我们从整个领域退一步来看，我们必须问自己：我们确切知道什么能让皮肤看起来年轻？又有哪些方法能让皮肤看起来更年轻？

Okay, so if we step back from this whole area, we have to ask ourselves, what do we know for sure about what makes skin look youthful and what can be done to make skin look more youthful?

要理解这些问题的答案，我们只需回到今天讨论的开端，稍作回顾。

And to understand the answers to those questions, we simply have to go back to the beginning of today's discussion for just a moment.

记住，我们的皮肤有表皮层、真皮层，还有血管和毛细血管，以及神经末梢。

Remember that we have the epidermal layer of skin, we have the dermal layer of skin, we have the vasculature, the blood vessels and capillaries, you have the nerve inputs there.

皮肤中还有多种不同类型的细胞，比如角质形成细胞。

And you have a bunch of different cell types in there, the keratinocytes.

这些细胞内含有胶原蛋白、弹性蛋白等不同蛋白质，它们会因阳光中的紫外线等因素发生突变，随着时间推移逐渐失去弹性，从而导致皱纹和皮肤松弛。

You have different proteins within those cells like collagen, elastin that over time can yes, be mutated by things like UV rays from the sun, but that over time tend to lose their elasticity which leads to wrinkles and sagging skin.

还有皮肤保湿的问题，对吧？

You also have this issue of hydration of the skin, right?

皮肤中含有大量水分成分，也就是实际的水分。

Skin has a lot of watery components within it, actual water within it.

这些水分成分赋予了皮肤饱满、湿润、平滑的外观，而不是极端干燥、松弛、起皱的样子。

And those watery components are what give it its kind of plump moist look, smooth look, as opposed to desiccated sagging wrinkled look to speak in extremes.

市面上有成百上千种不同的化学物质，皮肤科医生、整形外科医生，以及产品制造商都声称它们对皮肤有益。

And there are hundreds, not thousands of different chemicals out there that dermatologists as well as cosmetic surgeons, as well as just frankly manufacturers of products assert are going to be good for skin.

那么，让我们来谈谈有哪些方面有充分的证据表明，你可以通过某些方法来提升皮肤的年轻感或年轻外观。

So let's talk about where there is a lot of evidence for certain things that you can do if your goal is to increase the youthfulness or the appearance of youthfulness in your skin.

其中最主要的一种就是胶原蛋白本身。

And one of the main ones is collagen itself.

现在我必须承认，当我查阅这些文献时，我感到非常惊讶，但这种惊讶是积极的。

And now I have to admit, I was very surprised when I looked at this literature, but I was positively surprised.

原因如下。

Here's why.

正如你所知，食物中含有各种宏量营养素。

As you know, there are various macronutrients present in foods.

你可以摄入蛋白质、脂肪和碳水化合物。

You can have proteins, fats, and carbohydrates.

当我们摄入牛肉、鸡肉、鱼、鸡蛋等蛋白质，以及一些植物性蛋白来源如豆类、扁豆或豆腐时，它们含有不同数量的各种必需氨基酸。

When we ingest proteins such as beef, chicken, fish, eggs, as well as some vegan sources of proteins like beans or lentils or tofu, things of that sort, they contain different amounts of different essential amino acids.

这些必需氨基酸和其他氨基酸被用作构建我们肌肉、肌腱以及身体几乎所有器官系统的蛋白质的基石。

And those essential amino acids and other amino acids are used as the building blocks for proteins in our muscles, in our tendons, in essentially all the organ systems of our body.

脂质也被用于细胞膜等结构，明白吗？

The lipids are also used for cell membranes, etcetera, okay?

这一点之前在这档播客中已经多次讨论过，比如诺顿医生。

This has been discussed various times on this podcast before people like Doctor.

加布里埃尔·莱昂医生和其他人。

Lane Norton, Doctor.

这已经被广泛证实：当这些蛋白质在肠道中被分解时，部分氨基酸会用于组织修复。

Gabrielle Lyon and others.

它已被广泛证实：当这些蛋白质在肠道中被分解时，部分氨基酸会用于组织修复。

It's well established that when these proteins are broken down in the gut, some of those amino acids go and serve for the purpose of tissue repair.

其他的则用于其他目的。

Others are for the purpose of other things.

营养学领域大多数人同意的观点，也是我坚信的，如果你说吃一点肝脏，对吧？

What most people in the field of nutrition agree upon and what certainly I believe is that if you were to say eat a little bit of liver, right?

你可能会吃一点煮熟的肝脏，或者吃一点像牛排那样的骨骼肌，但从你吃的肝脏中分解出来的氨基酸并不会被选择性地输送到你的肝脏，对吧？

You might have a little bit of cooked liver or a little bit of skeletal muscle in the form of like a steak, that there's no selective trafficking of the amino acids that are broken down from the liver that you eat to your liver, right?

所以当你听到‘吃肝脏有助于肝脏健康’时，这可能是由于某些氨基酸、维生素和脂质等通过广泛的作用支持你的肝脏以及其他器官和组织系统，但并非专门针对你的肝脏。

So when you hear that eating liver supports your liver, it may do that by the broad process of certain amino acids and vitamins and lipids, etcetera, serving your liver and other organ and tissue systems of the body, but not selectively your liver.

然而，当我们谈论胶原蛋白时，这种蛋白质是构成我们皮肤本质特征的最重要成分之一，它具有弹性、一定的抗张强度，受压后能恢复原状，尤其是在充分水合的情况下，能让我们的皮肤在年轻时显得非常年轻有活力。

However, when we talk about collagen, this protein that forms one of the most essential aspects of what makes our skin what it is, which is elastic to have some tensile strength, can push on it, it returns to its original position, especially if it's well hydrated and makes our skin very youthful in appearance when we're young.

而随着年龄增长，胶原蛋白逐渐降解，就会导致皮肤出现皱纹、松弛等老化迹象。

And then as it degrades, when we get old, makes it look less youthful wrinkles and sagging and so forth.

那么，为什么摄入胶原蛋白——它可以从多种不同来源获取，比如鱼类、不可思议的动物蹄部，或者肌腱等多种来源——会特别被输送到我们皮肤中的胶原蛋白呢？

Well, then why would eating collagen protein, which can come from any number of different sources, it can come from fish sources, it can come from believe it or not animal hoof sources, can come from any number of different sources, tendon, etcetera.

为什么摄入的胶原蛋白会被选择性地转运到我们皮肤中的胶原蛋白呢？

Why would ingesting collagen be selectively trafficked to the collagen in our skin, right?

这与我们所知的一切都不相符。

That doesn't square with everything we know.

然而，当你查看研究时，包括对那些服用胶原蛋白粉的人进行的荟萃分析，这些粉末通常来自鱼类或肌腱等多种来源，当人们这样做并测量皮肤外观、皮肤弹性时，有许多可以在实验室中对人类进行的测量指标。

And yet when you look at studies, including meta analysis of studies where people supplement with collagen powders and these powders typically come from fish or tendon, any number of different sources, When people do this and then measures are taken as to skin appearance, skin elasticity, there are bunch of measures that can be done in humans in the laboratory to do this.

你经常会发现一些研究显示，胶原蛋白成分和皮肤外观有统计学上的显著改善，甚至皱纹的减少等现象也有所体现。

You often will find studies that show statistically significant improvements in collagen composition and skin appearance, and even the appearance of reduction in wrinkles and so forth.

因此，这是一个有趣的例外：摄入某种天然大量存在于某些组织（如皮肤）以及其他组织（如肌腱、韧带等）中的蛋白质，似乎有助于胶原蛋白的修复与再生，或促进胶原蛋白合成的其他方面，从而改善人体皮肤的胶原成分和外观。

So this is an interesting exception where the ingestion of a particular protein that naturally exists in abundance in certain tissues, such as skin, but also other tissues like tendon, ligaments, etcetera, seems to be assisting in either the repair and rejuvenation of collagen, or perhaps some other aspect of collagen synthesis that leads to improvements in collagen composition and the appearance of skin in humans.

这非常有趣。

That's very interesting.

而我特别感兴趣的一项研究，我会在节目笔记的标题中提供链接。

And the study that I find particularly interesting is one that I'll link to in the show note captions.

它的标题是《水解胶原蛋白口服补充对系统性综述与荟萃分析的影响》。

It's entitled, Exploring the Impact of Hydrolyzed Collagen Oral Supplementation on A Systematic Review and Meta Analysis.

这项研究以及其他荟萃分析和其中包含的研究的基本结论是：当人们每天补充5到15克水解胶原蛋白，特别是与维生素C联合使用时（不需要大量维生素C，有时就能观察到效果），可以观察到皮肤成分的明显改善，比如皱纹减少，甚至部分皱纹逆转、皮肤松弛减轻、外观更显年轻，以及皮肤更具弹性恢复能力。

And the basic takeaway of this and other meta analyses and the studies within this meta analyses is that when people supplement with anywhere from five to fifteen grams, okay, grams of hydrolyzed collagen per day, in particular in combination with vitamin C, it doesn't have to be a lot of vitamin C that one can observe, okay, not always, but can observe some visible improvements in skin composition, meaning less wrinkles, even some reversal of wrinkles, less skin sagging, more youthful appearance, more kind of, let's just call it rebound elasticity of the skin.

我意识到这不是一个准确的技术术语，但皮肤在你按压后能够从凹陷中弹回的能力，而不是下垂或松弛。

I realize that's not the appropriate technical term, but the ability of the skin to bounce back from an indentation when you push down on it, as opposed to saying down or sagging.

如果考虑到人们实际上只是将一些水解胶原蛋白混合后每天喝一次，这些结果已经相当令人印象深刻了。

So some pretty impressive results when one considers that what people are basically doing here is just mixing up some hydrolyzed collagen protein and then drinking that down once per day or so.

但这并不意味着你必须补充水解胶原蛋白，为什么呢？

Now that is not to say that you have to supplement with hydrolyzed collagen, why?

因为胶原蛋白也存在于各种食物中。

Well, collagen is also present in various foods.

例如，饮用骨汤，比如牛肉骨汤或鸡肉骨汤，是胶原蛋白的丰富来源。

So for instance, drinking bone broth, beef bone broth, chicken bone broth is a rich source of collagen.

你可以在网上通过简单的网络搜索找到相关信息。

You can go online and simply look up just by web search.

你只需搜索‘哪些食物富含胶原蛋白’，就会得到一份清单，希望其中有一些不仅适合你的口味，而且是你真正喜欢的，这样你就可以将它们纳入日常饮食；当然，你也可以选择补充水解胶原蛋白。

You can just say, you know, what foods contain high levels of collagen and you'll get a list of things back Hopefully a few of those are not just palatable to you, but you actually like, and you can start to include those in your daily diet, or you could supplement with hydrolyzed collagen protein.

这些来源有非常多不同的选择。

There are any number of different sources for these.

有趣的是，虽然我确实不认为，而且事实上也完全没有证据表明，从特定器官来源摄入的氨基酸会定向转运到该特定器官，但摄入水解胶原蛋白（无论是作为补充剂还是从骨汤等食物中获取）似乎确实能促进胶原蛋白合成或改善皮肤外观，使其更显年轻。

It's interesting that while indeed I don't believe, and there is frankly zero evidence for selective trafficking of amino acids arising from a particular organ source to that particular organ when you ingest it, it is interesting that consuming hydrolyzed collagen in the form of a supplement or deriving it from foods like bone broth, etcetera, does seem to be able to improve collagen synthesis or the appearance of skin, making it more youthful.

对于那些希望通过摄入胶原肽来改善皮肤年轻态的人，我要指出，不同研究中使用的剂量范围有所不同。

For those of you that are interested in ingesting collagen peptides as a way to improve the youthfulness of your skin, should mention that the dosages there come in a range depending on the studies that you've looked at.

我咨询的皮肤科医生表示，如果决定通过补充或从食物中获取胶原蛋白，建议每天摄入15至30克胶原肽。

And the dermatologist that I spoke to said, if one decides to go down this route of supplementing or getting collagen from food sources, you want to aim for anywhere from fifteen grams to thirty grams of collagen peptides per day.

这个剂量比许多研究中使用的量略高，但确实有研究使用了30克的剂量。

Okay, that's a bit higher than what was used in a number of studies, but you'll find studies that use thirty grams.

此外，这一过程还可以通过摄入500至1000毫克的维生素C来增强和改善。

And that that whole process can be augmented, can be improved through ingestion of five hundred to a thousand milligrams of vitamin C as well.

但请检查你可能正在补充的胶原肽产品的标签，因为很多时候它们已经包含了500至1000毫克的维生素C。

But check the label on those collagen peptides that you might be supplementing with because oftentimes they already include that five hundred to a thousand milligrams of vitamin C.

我还应该提到，我咨询的皮肤科医生表示，他们不仅因为上述原因推荐胶原蛋白补充，还因为胶原蛋白具有其他多种益处，比如潜在的抗炎作用。

I should also mention that the dermatologist I spoke to said that they like collagen protein supplementation, not just for the reasons discussed up until now, but that they liked them for a number of other reasons, such as the potential anti inflammatory effects of collagen proteins.

老实说，我不清楚这背后的精确机制是什么。

To be honest, I don't know what the exact mechanism of that is.

也许当你达到某种蛋白质摄入阈值时，炎症会减轻，但无论如何，这对我来说仍然很神秘。

Maybe if you get a certain protein threshold, inflammation is down, but anyway, that's still cryptic to me.

但无论如何，他们确实描述了一些胶原蛋白摄入可能改善皮肤年轻化表现的潜在机制。

But in any case, they did describe some of the potential mechanisms by which collagen ingestion can do its thing in terms of improving youthfulness.

它在血液中被分解为二肽和三肽，然后被皮肤中的胶原蛋白利用。

It's broken down in the blood into dipeptides and tripeptides, which then are used within the collagen itself of the skin.

这是一种假说，认为它能增加成纤维细胞的趋化性和移动性，而成纤维细胞构成了部分皮肤组织，并使皮肤呈现更年轻的状态。

This is the hypothesis and that it can increase the chemotaxis, the mobility of fibroblasts, which make up some of the skin tissue and give rise to the appearance of more youthful skin.

还有证据表明，摄入水解胶原肽可以改善皮肤屏障外部的弹性，对吧？

There's also evidence that ingestion of hydrolyzed collagen peptides can improve the elasticity of the skin barrier on the outside, right?

让皮肤看起来紧致有光泽。

Make it look nice and taut.

如果我们说‘好看’，其实是在用主观标准来评判，这种紧致感是通过增加某些与胶原无关的蛋白质，如丝聚蛋白、弹性蛋白等实现的。

If I guess we say nice, we're sort of passing subjective readout on this, make it appear taut through the increase of certain proteins unrelated to collagen such as filagrins, elastins, etcetera.

那其他肽类呢？

What about other peptides?

好的，这现在是个热门话题，尤其是在网络社区中。

Okay, so this is a big topic nowadays, especially in the online communities.

我做过一整期播客，专门讲肽。

I did an entire episode of this podcast about peptides.

请记住，胰岛素是一种肽，司美格鲁肽本质上是胰高血糖素样肽-1的激动剂，现在这是一种非常流行的处方药，用于治疗肥胖和糖尿病。

Keep in mind that insulin is a peptide, Ozempic, what is essentially an agonist for glucagon like peptide one, this is a very popular prescription drug now for the treatment of obesity and for the treatment of diabetes.

有很多东西都属于肽。

There are lots of things that qualify as peptides.

肽就是一段短小的氨基酸链。

A peptide is simply a small chain of amino acids.

多肽是稍长一些的氨基酸链，而蛋白质则是由氨基酸组成的。

A polypeptide is a bit longer chain of amino acids and then proteins are made up of amino acids.

好的，当我们说肽时，这意味着很多不同的东西。

Okay, so when we say peptides, that means many, many things.

但如今，当你在在线社区中听到肽时，通常人们指的是外源性给予的肽。

But these days when you hear about peptides, especially in online communities, generally people are referring to exogenously given, okay?

因此，通常是通过口服药片、药膏，或更常见的是注射设计用于实现特定生物或生理效果的肽类物质。

So pills, ointments, or more typically injections of peptides that are designed to achieve some specific biological or physiological outcome.

如今这些肽类中较为常见的一种，是我之前提到过的BPC-157，全称是身体保护化合物157，它本质上是我们每个人胃液中天然存在物质的合成版本。

And one of the more common of these peptides being used nowadays is one that I've talked about before called BPC-one hundred fifty seven, body protection compound one hundred fifty seven, which is essentially a synthetic version of something found in gastric juice in all of us.

已知肠道内某些肽类——BPC-157正是模拟或部分复制了这些肽类的序列——能够促进各种组织和伤口的修复，包括肌腱以及所有涉及成纤维细胞的组织，这些效果已在体外实验中得到充分证实。

It's known that certain peptides within the gut that BPC-one hundred fifty seven is known to mimic, or it actually is a synthetic version of that exact sequence or a portion of that sequence can assist in tissue and wound repair of different kinds, tendon, anything involving fibroblasts, all of that has been well demonstrated in vitro in a dish, okay?

在某些情况下，这些效果也已在活体动物模型中得到验证，但尚未在人体内充分证实。

So not in vivo as well as in vivo in certain cases, but only in animal models.

据我所知，目前仅有一项关于BPC-157在人体中应用的研究，而且坦白说，这项研究质量非常差。

To my knowledge, there's only one study, and frankly, it's not a very good study at all on BPC-one hundred fifty seven in humans.

然而，仍有许多人通过口服胶囊或药片，或更常见的是通过注射的方式服用BPC-157。

And yet a lot of people are taking BPC-one hundred fifty seven either orally in the form of a capsule or pill, or more typically injecting it.

它在人体内究竟起什么作用？或者很可能起什么作用？

What does it do or what does it likely do in humans?

我们从动物模型中已知，BPC-157能促进血管生成，即毛细血管和血管的生长，这一点是明确的。

We know from animal models that BPC-one hundred fifty seven increases angiogenesis, the growth of capillaries and blood vessels, we know this.

它可以通过增加成纤维细胞的移动性来加速伤口愈合。

It can accelerate wound healing by virtue of increasing fibroblast motility.

因此，它被用于运动损伤后的恢复、希望增加肌肉的人群、耐力运动员，以及美容目的。

For this reason, it's used post injury in sports, it's used by people who want to build more muscle, it's used by endurance athletes, it's used for cosmetic purposes.

每当人们为了这些目的使用BPC-157时，很可能部分原因是想增加特定组织的血流量及其修复能力。

Anytime people are using BPC-one hundred fifty seven for any of those purposes, it's likely that they're using it in part to increase the blood flow that's available to a given tissue and the repair of that tissue.

不过，我确实要提醒大家，除了人们 anecdotal 地声称自己愈合得更快之外，目前在人体中几乎没有，几乎是没有任何证据支持这一点。

Now, again, I do want to caution people that there is very little, basically no evidence in humans besides the anecdotal evidence that people say they healed faster.

我知道的是，只要组织发生血管化，就会带来血流的改善。

What I do know is that anytime you get vascularization of tissue, you're going to get improved blood flow.

因此，从机制上讲，这一切都是合理的。

So it all makes sense mechanistically.

我还知道，即使BPC-157是局部注射到某个组织中，其引起的血管化也可能在整个身体范围内发生。

I also know that vascularization due to BPC-one hundred fifty seven, even if it's injected locally into a given tissue is likely to occur globally throughout the body.

这就是为什么一些人口服BPC-157，或仅在胃部皮下（皮肤下）注射，却报告远端肢体如手部或足部神经损伤等部位的伤口愈合更快的原因。

This is why some people taking oral BPC-one hundred fifty seven or injecting it just subcutaneously at the level of their stomach a little bit under the skin at the level of their stomach report faster wound healing even in a distal limb or like a hand or a nerve injury in their foot or something like that.

这也告诉我们，其他组织如皮肤、以及如果存在肿瘤的话，肿瘤组织的血管化也会增加。

That also tells us that there's going to be increased vascularization of other tissues such as skin, such as tumors, if tumors exist.

所以你需要非常小心。

So you need to be very careful.

我必须提前说明这一点作为警示，因为很明显，许多人已经开始注射BPC-157，或将其以局部药膏的形式使用，以期增加皮肤的血管化，从而使皮肤看起来更年轻。

I need to say that upfront as a cautionary note because it is very clear that many people are starting to either inject BPC one hundred fifty seven or apply it in the form of a topical cream in effort to get more vascularization of skin in order to make that skin appear more youthful.

市场上含有BPC-157的产品正变得越来越多。

And more and more products are out there that contain BPC one hundred fifty seven.

我无法出于良心推荐这些产品。

I can't in good conscious recommend those products.

我只能向你说明它们如果有效，可能的作用机制，同时提醒你：目前尚不清楚BPC-157在局部涂抹时是否能穿透皮肤。

I can only offer to you the likely mechanism by which they work if they work and also offer you the caveat that it is unclear that BPC-one hundred fifty seven can go transdermally if it's applied topically.

所以如果你把它涂在脸上有皱纹的部位，比如我有鱼尾纹，鱼尾纹是由衰老、微笑或两者共同引起的。

So if you put it on a, say wrinkly portion of your face, so like I've got crow's feet, crow's feet come from either aging, smiling or both.

鱼尾纹是当你微笑时，从眼角向外延伸的皱纹；对我来说，因为我48岁了，即使不笑也可能出现这些皱纹。

The crow's feet are the kind of wrinkles that extend out the corners of your eyes when you smile or for me, because I'm 48, and probably do that even when I don't smile.

逻辑是，如果你使用含有BPC-157的面霜涂抹在该区域，就能促进该部位的血管新生，增加生长因子和营养物质的输送，从而使皱纹的衰老进程停止，甚至逆转。

The logic would be that if you take a cream containing BPC-one hundred fifty seven and you put it on there, that you'll get increased vascularization of that area, delivery of more growth factors and nutrients, and those wrinkles will either be halted in their aging progression or that they will reverse.

这就是背后的逻辑。

That's the logic.

据我所知，目前还没有任何临床研究。

To my knowledge, there are no clinical studies.

如果你们尝试过这些产品，我很想听听你们的经历，请在YouTube评论区分享你们的使用体验，让我们了解大家是否真的从中获得了良好效果。

And I'd love to know from you if you've tried these products, please put your experience of those in the comments on YouTube so we can get a sense of whether or not people are having good results with this.

当然，这并不是一项对照研究，但我非常好奇想知道。

That of course is not a controlled study, but I'm very curious as to know.

顺便说一下，许多含有BPC-157的产品也含有铜。

Many of the products that contain BPC-one hundred fifty seven, by the way, also contain copper.

铜是一种微量元素，存在于我们的日常饮食中。

Copper is a trace mineral, it's found in your diet.

有一些证据表明，铜对胶原蛋白以及皮肤合成途径中的其他成分至关重要。

There is some evidence that copper is important for some of the collagen and other elements of skin synthesis pathways.

因此，从机制和生化角度来看，理论上是成立的。

And so the mechanistic logic and the biochemical logic is there on paper.

然而，显然摄入过多的铜会引发炎症反应，导致与人们使用含铜和BPC产品所期望的完全相反的效果——即延缓或逆转皮肤老化迹象。

However, it's also clear that ingesting too much copper can induce an inflammatory response and would lead to the exact opposite desired effect that people who are using copper and usually copper BPC containing products are taking them for which is to halt or reverse the appearance of aging in their skin.

我为什么要详细讨论BPC-157和铜的这些内容呢？

Why am I going through this whole gymnastics of, you know, BPC-one 157 and copper?

这是因为如今许多产品开始宣称含有所谓的‘肽’以实现皮肤再生。

Well, because nowadays many, many products are starting to include quote unquote peptides for skin rejuvenation.

而这些肽大多属于铜肽或BPC-157类型。

And most often those peptides are of the copper variety of the BPC one hundred fifty seven variety.

而且常常还涉及与胶原蛋白合成相关的东西，有时甚至直接添加胶原蛋白。

And oftentimes also with things related to collagen synthesis, sometimes collagen directly.

因此，你会看到一些口服产品，以药片形式服用，含有BPC-157、铜和胶原蛋白，或能促进胶原蛋白合成的成分。

So you'll find oral products that one takes by pill form that are BPC one hundred fifty seven, copper, and collagen or things that promote synthesis of collagen.

你也会看到纯BPC-157的药膏，但目前尚不清楚它们是否能有效透皮吸收。

You'll find ointments that are pure BPC one hundred fifty seven still unclear if those go trans dermal.

好的，这仍然是一个非常年轻的研究领域，大部分内容尚未在随机对照试验中得到探索。

Okay, so this is still a very, very young science and most of this is not being explored in randomized controlled trials.

不过，我知道你们中有些人非常喜欢尝试新事物。

However, I know some of you out there are pretty experimental.

你们喜欢尝试这类东西。

You like experimenting with this kind of stuff.

你们喜欢了解别人在使用什么有效方法。

You like hearing what's working for other people.

我建议你们这样做。

Here's what I suggest.

如果某种防晒霜、乳液、药片或注射剂声称含有肽类成分以帮助皮肤再生，请务必查看具体包含哪些肽，并了解BPC-157相关的风险——它可能加速肿瘤生长，虽然这一点尚不明确，但其作用机制与BPC-157促进血管生成的机制一样有力，无论是在肌肉、肌腱、韧带还是皮肤中。

If a sunscreen or a lotion or a pill or an injection is asserted to contain peptides to help with skin rejuvenation, make sure you look and see which specific peptides are included, know the risks associated with BPC-one hundred fifty seven, it's uncertain risk about acceleration of tumor growth, but the mechanistic logic is just as strong for that with BPC-one hundred fifty seven as it is for BPC-one hundred fifty seven encouraging vascularization of any other tissue, muscle, tendon, ligament, or skin for that matter.

所以我不是在告诉你们该怎么做，只是希望你们清楚自己在做什么，并理解在缺乏任何随机对照试验的情况下，背后的可能机制。

So I'm not telling you what to do, just know what you're doing and understand the likely mechanisms behind it in the absence of any of these randomized controlled trials.

我会强调一下，确保你们的饮食或补充剂中含有足够的微量矿物质铜。

I will say in service to making sure that your diet and or supplementation includes enough trace mineral copper.

铜已被证明在DNA修复中发挥关键作用，而DNA修复是皮肤中胶原蛋白及其他蛋白质更新的重要组成部分。

Copper has been shown to play a key role in DNA repair, which is a critical component of the turnover of collagen and other proteins in skin.

它已被证明能减少所谓的活性氧，因此起到一种所谓的抗氧化剂作用。

It has been shown to reduce so called reactive oxygen species, so it serves as a so called antioxidant.

这与我刚才提到的减少炎症有关，但铜摄入过多会带来问题。

And this relates to what I just said, reduced inflammation, but too much copper is a problem.

所以我不建议你跑去大量补充铜，请不要这样做。

So I wouldn't run out and start supplementing with excessive amounts of copper, please don't do that.

但你要确保从饮食中摄取足够的铜。

But you want to make sure that you're getting sufficient amounts of copper from your diet.

你可以简单地上网查一下，作为微量元素，铜的推荐摄入量是多少。

And you can simply look up online what sufficient amounts of copper are given it's a trace mineral.

而且，如果你摄入任何一种复合维生素矿物质补充剂或基础营养补充剂，它很可能含有一定量的铜。

And it's very likely that if you ingest any kind of supplement that is a multi vitamin mineral supplement or a foundational nutrition supplement that includes at least some copper.

因此，你体内的铜含量很可能已经足够，但不太可能过量。

So it's likely that you're sort of topped off in terms of the amount of copper that you need, but very unlikely to be excessive amounts of copper.

但如果你开始补充超过所需量的铜，同样可能引发炎症反应。

But if you start supplementing with copper beyond that, again, you can induce an inflammatory response.

所以这本质上是一个剂量上的平衡问题。

So it's a dosage kind of middle ground issue there.

你不希望你的铜含量过低。

You don't want your copper too low.

你不希望你的铜含量过高。

You don't want your copper too high.

你希望它正好处于中间水平。

You want it right there in the middle.

好的，正如我之前提到的，我们会讨论其他对皮肤健康有益的食物成分。

Okay, as I mentioned before, we will talk about other components of food that are great for skin health.

我们还会讨论某些食物中的成分，比如晚期糖基化终末产物。

And we'll also talk about components of certain foods like advanced glycation end products.

我不知道你以前是否听说过这些，但它们非常有趣，属于你最好避免的不良物质，尤其是当你关注的是年轻健康的皮肤以及整体健康时。

I don't know if you've heard of those before, but very interesting, not good stuff that you want to avoid if you can, especially if your concern is youthful looking skin and healthy skin and frankly health overall.

但在那之前，我认为值得关注一些可能显著改善皮肤年轻态的物质，这些物质有坚实的科学依据支持。

But before we do that, I think it's worth paying attention to a few things that you can potentially take that can really improve the youthfulness of your skin for which there is excellent science to support it.

当我咨询毕业于顶尖机构的认证皮肤科医生时，他们提到人们可以采取哪些措施来改善皮肤的年轻外观，并且这些说法必须有同行评审的研究支持。

Okay, so when I spoke to board certified dermatologists who trained at excellent institutions, what people can do to improve the youthfulness or the appearance of youthfulness in their skin and that there specifically be peer reviewed studies to support their statements.

他们提到了水解胶原蛋白与维生素C的组合。

They mentioned hydrolyzed collagen protein in combination with vitamin C.

我们之前已经讨论过这一点。

We talked about that earlier.

他们还提到了一些关于日晒和营养等方面的建议和禁忌，其中一些我们已经讲过，还有一些我们尚未涉及，但很快就会谈到。

They mentioned a bunch of do's and don'ts as it relates to sun exposure and nutrition, etcetera, some of which we've covered, some of which we are yet to cover, but will soon.

他们还提到了补充烟酰胺。

And they mentioned supplementing with niacinamide.

烟酰胺是维生素B3的一种形式。

Niacinamide is a form of vitamin B3.

它有时也被称作尼克酰胺。

It is also sometimes referred to as nicotinamide.

我被告知，每天服用两次，每次剂量为五百毫克，总计每日一千毫克，烟酰胺补充剂可以增加神经酰胺的生成，而神经酰胺是皮肤中与保湿相关的脂质。

And I was told that when taken at twice per day at a dosage of five hundred milligrams per dose for a total of one gram or one thousand milligrams per day, that niacinamide supplementation can increase the production of ceramides which relate to the lipids in skin that improve the moisture in skin.

顺便说一句，皮肤的水分是保持皮肤年轻或饱满外观的关键因素。

And by the way, moisture in skin is a key component of the youthfulness or plump appearance of that skin.

当我提到‘饱满’时，并不是指外表明显圆润的饱满感。

When I say plump, I don't necessarily mean outwardly rounded plump.

我的意思是，皮肤最外层——也就是你现在已经知道的表皮——看起来紧致，皮肤表面呈现出水润、平滑的状态，这些都能通过烟酰胺补充得到改善。

I mean, the fact that the skin looks like the outermost layer of the skin, which you now know as the epidermis is kind of taut and the skin looks hydrated and smooth at the level of its outer appearance, all of that is improved by niacinamide supplementation.

但这种效果需要持续补充三到六个月甚至更长时间才能显现。

But that the supplementation has to be carried out for three to six months or more before that effect is noticed.

现在，烟酰胺对皮肤年轻化的影响，也可能与其能够整体减少皮肤炎症的证据有关。

Now, the origin of the niacinamide effect on the youthfulness of skin could also be related to the fact that there's evidence that niacinamide supplementation can reduce inflammation of skin overall.

我们之前很少讨论皮肤与免疫系统的关系。

We haven't talked so much about the immune skin relationship.

尽管我在本集开头已经暗示过，这种关系至关重要。

Although as I alluded to at the beginning of the episode, this is a key relationship.

但对于患有玫瑰痤疮或痤疮的人，玫瑰痤疮表现为皮肤发红，我们稍后会详细讨论针对它的具体应对方法。

But for those of you suffering from rosacea, from acne, so rosacea being a reddening of the skin, we're going to talk more about it later and specific things that can be done for it.

痤疮几乎总是伴随着皮肤特定部位的发红，常常是疼痛性的红肿。

Acne almost always involves some reddening, often painful reddening of specific pox on the skin.

有时还会出现脓包，这类情况也可能因烟酰胺补充剂减少炎症而得到改善。

Sometimes even the appearance of pus filled bumps, this sort of thing that niacinamide supplementation may also assist there because of the reduction in inflammation.

我们会全面探讨炎症与痤疮之间的关系。

And we'll talk all about the relationship between inflammation and acne.

无论你是否患有玫瑰痤疮或痤疮，烟酰胺补充剂都可能对你有益。

Regardless of whether or you suffer from rosacea or acne or not at all, that niacinamide supplementation may benefit you.

此外，烟酰胺补充剂似乎能调节皮肤的油脂分泌，皮肤需要油脂，毛孔深处也需要油脂，但不能过多，它确实有助于减少毛孔堵塞的外观。

Also because niacinamide supplementation appears to balance the level of oil production in the skin, you need oil in the skin, you need oil down in those pores, but not too much, and that it can definitely help reduce the appearance of clogged pores.

如果你担心毛孔显得过大，这种情况通常发生在面部，尤其是鼻子周围和上脸颊，尽管身体其他部位也可能出现，烟酰胺补充剂也可能对此有所帮助。

And if you're concerned about pores that appear too large, this typically happens in the face around the nose, on the upper cheeks, although other regions of the body as well, niacinamide supplementation may assist with that as well.

此外，还有一些人对皮肤上出现的特定色素沉着斑点感到困扰。

There's also a number of people out there that are concerned with specific spots that they see as hyper pigmented spots.

因此，无论你的皮肤整体是非常白皙还是色素沉着较深，补充烟酰胺都能减少特定部位黑色素的聚集现象，甚至可能减少黑色素的实际积累，也就是一些人出于各种原因（通常是美容原因）不希望出现的深色色斑。

So regardless of whether or not overall your skin is very light or very heavily pigmented, supplementation with niacinamide can reduce the appearance of accumulation and maybe even the actual accumulation of melanin at particular spots so called dark pigmented spots that some people decide that they don't want for whatever reason, usually just cosmetic reasons.

尽管某些区域的色素沉着可能与皮肤癌有关。

Although there may be reasons why hyperpigmentation in a given area could relate to skin cancers.

我们之前已经讨论过这一点。

We talked about that earlier.

另一个理由是，至少每年一次，不仅要检查你的痣，还要全面检查你的皮肤。

Another reason to go get not just your moles, but all of your skin checked at least once per year.

现在，如果你决定补充烟酰胺，你可以选择每天服用两次各一千毫克，或两次各五百毫克的剂量。

Now, if you decide to supplement with niacinamide, you have the option of either taking that thousand milligrams and two five hundred milligram dosages per day.

你也可以选择使用市面上各种不同的外用烟酰胺药膏或精华液。

You also have the option of using any number of different topical niacinamide ointments or serums that exist out there.

请注意，许多护肤品中已经含有烟酰胺，所以请查看成分标签。

Keep in mind that many skincare products already contain niacinamide, so check the label.

皮肤科医生告诉我，要达到效果，这些药膏或精华液中的烟酰胺浓度至少需要达到2%，最高可达10%。

And there the dermatologists tell me that to be effective, the niacinamide needs to be present at least a two and as high as 10% concentration within those ointments or serums.

请注意，许多精华液和药膏还含有透明质酸。

Keep in mind that many serums and ointments also contain what's called hyaluronic acid.

透明质酸是皮肤的天然成分，能为锁水提供物理基质。

Hyaluronic acid is a natural component of the skin that provides a physical substrate for holding in water.

因此，皮肤中的水分，它在细胞外基质及其他细胞间区域还发挥着许多其他重要作用。

So moisture within the skin, it does a bunch of other important things too within the extracellular matrix and elsewhere, the regions between the cells that is.

由于烟酰胺已述的种种效果，如今市面上含有透明质酸和烟酰胺的补充剂、药膏或精华液非常普遍。

And supplementation with hyaluronic acid or ointments or serums that contain hyaluronic acid and niacinamide are pretty common out there because of the already stated effects of niacinamide.

而透明质酸还能作为所谓的保湿剂，帮助在皮肤表层锁住水分。

And the fact that hyaluronic acid can serve as what's called a humectant, something that serves to sort barrier in moisture at the level of the skin.

这样就能让皮肤呈现出饱满、水润的外观，这是年轻肌肤的典型特征，而非衰老肌肤。

Okay, so it gives that kind of plumping moist look of skin that's characteristic of youthful skin as opposed to aged skin.

我曾与一群背景多元的专家交流，为本集做准备，所有与我交谈过的皮肤科医生和整形外科医生都一致认为，他们建议患者补充胶原蛋白、维生素C、烟酰胺和透明质酸。

The dermatologists and the cosmetic surgeons that work on faces that I spoke to, I told you I consulted with a fairly large and diversified group of folks in preparation for this episode, all agreed that supplementation with collagen, vitamin C, niacinamide, and hyaluronic acid was something that they suggest to their patients.

另一种补充剂——实际上通常是皮肤科医生推荐的处方治疗——如果目标是让皮肤看起来更年轻，那就是视黄醇等视黄醇通路中的成分。

The other supplement, well, actually it's a prescription treatment most often that dermatologists recommend if the goal is youthful appearing skin are things within the so called retinoid pathway, such as retinol.

好的，你们很多人可能听说过这个，这与维生素A和皮肤之间的关系密切相关。

Okay, many of you have perhaps heard of this and it's a whole story related to the relationship between vitamin A and skin.

好的，它的通用名称是维A酸。

Okay, so tretinoin is the common name for it.

虽然你们中有些人可能知道它叫维A酸，而类似这种的处方药基本上都是维生素A的衍生物，为什么呢？

Although some of you may know it as retin A and prescription drugs that are similar to that are basically derivatives of vitamin A, why?

为什么这些成分被用于护肤？

Why are these used for skincare?

为什么它们能帮助皮肤显得更年轻？

Why are they used to increase the youthfulness of skin?

维生素A进入皮肤细胞后，会转化为一种叫做视黄醛的物质，再进一步转化为视黄酸。

Well, vitamin A gets into skin cells and is converted into something called retinaldehyde then into something called retinoic acid.

需要注意的是，视黄酸参与了许多不同的细胞过程，尤其是在神经发育过程中。

Now, important to know that retinoic acid is involved in a lot of different cellular processes, especially during neural development.

这就是为什么，而且请特别注意这一点：孕妇或哺乳期女性应避免使用这些产品，因为它们可能严重干扰胎儿的发育。

This is why, and please pay careful attention to this, this is why women who are pregnant or breastfeeding should avoid taking these products because it can seriously disrupt the development of the fetus.

好的，请记住，很多人在一段时间内并不知道自己怀孕了。

Okay, and keep in mind that many times people don't realize they're pregnant for some period of time.

因此，这是极其重要的问题。

So this is of paramount concern.

我们可以详细讨论视黄酸在胎儿发育中的作用，但你绝对不希望干扰这条通路。

Okay, we could have a whole discussion as to the role of retinoic acid in fetal development, but you don't want to tamper with that pathway.

可能会出现非常严重的后果。

Okay, very serious consequences can occur.

当视黄酸进入细胞时，可以激活所谓的转录因子。

Okay, so when retinoic acid gets into cells, can activate what's called transcription factors.

转录因子会结合到DNA上，也就是你的遗传密码，并诱导DNA转录为RNA，RNA再翻译为特定类型的蛋白质。

Transcription factors bind to DNA, okay, your genetic code, and can induce the transcription and translation of DNA into RNA and RNA into proteins of particular type.

所以，可以把转录因子想象成设定了一张不同蛋白质的菜单，最终会形成这些蛋白质，明白吗？

So think of transcription factors as sort of setting a menu of different proteins that ultimately will be formed, okay?

通过结合到DNA上，然后实现DNA到RNA、RNA到蛋白质的转化，你就得到了与特定过程相关的一组蛋白质。

By binding to DNA, and then you get DNA to RNA, RNA to protein, and you're getting a set of proteins related to a particular process.

这通常是转录因子的工作方式。

That's generally how transcription factors work.

维A酸、他扎罗汀以及类似物质会促进皮肤内胶原蛋白的生成，以及其他与新皮肤形成相关的蛋白质，从而替代老旧退化的皮肤。

And Retin A, tretinoin, and things similar to that are going to induce the formation of collagen protein within skin, as well as other proteins that relate to the formation of de novo skin, new skin, and can replace old degenerated skin.

所以我所接触的皮肤科医生都对这一点非常乐观：尽管听起来不可思议，但他们认为只要不怀孕、不哺乳或不计划怀孕，人们从二十岁开始就可以使用维A酸或类似物质，以刺激更多皮肤生成，显得更年轻。

So the dermatologists that I spoke to were really bullish about the fact that believe it or not, they felt that people starting in their twenties could very well, as long as they're not pregnant or lactating or planning to get pregnant could take Retin A or things similar to it in order to stimulate the production of more skin and look more youthful.

对于已经二十多岁的人，即使他们已经结婚，皮肤依然年轻，但他们至少可以在二十多岁时开始使用这些成分，并持续终生。

Now for people already in their twenties, by married, they're already youthful, but that they could initiate the use of these compounds at least in one's twenties and continuing on really as long as they wanted through life.

他们还向我讲述了令人惊叹的效果。

And they told me about remarkable results.

于是我问，为什么没有人知道这一点呢？

So I said, well, why isn't everyone aware of this?

为什么没有人使用这些物质呢？

Why isn't everyone taking them?

事实是，这些不同成分还会增加皮肤对光线的敏感性，使人更容易晒伤，甚至可能受到屏幕或人工光源对皮肤的其他影响。

Well, it turns out that these different compounds can also increase sensitivity to light, make you more prone to sunburn, to some of the other effects of light on skin, even from screens or from artificial lights.

因此，必须小心避免过度增加皮肤对各种光线的敏感性，不仅限于阳光，还可能引起发红或干燥。

So one has to be careful about inducing too much skin sensitivity to light of all kinds, not just sunlight, that they can also induce some redness or dryness.

因此，必须正确掌握剂量和使用频率，这些物质使用起来可能有点棘手，但一旦找到合适的剂量和频率，皮肤科医生认为这是改善皮肤年轻态或外观最有效的方法之一。

So one has to get the dosage right, the frequency of use right, and they can be a little bit tricky to work with, but that if one can home in on the right dosages, the right frequency, etcetera, the dermatologist felt like this was one of the best things that one could do to improve the youthfulness or the appearance of youthfulness in one's skin.

现在，这在许多方面都让我感到有趣。

Now, find this interesting for a number of reasons.

首先，我听说过维A酸，对吧？

First of all, I've heard of Retin A, right?

我以前听说过这些化合物，但从未听说过它们据说能带来如此显著的效果，比如改善皮肤的血管生成和血管化。

I've heard of these compounds before, but I hadn't heard about all these reportedly spectacular things like improved angiogenesis, vascularization of the skin.

这就是为什么人们会服用我之前提到的、尚属实验性且未经验证的BPC-157。

This is why people are taking the rather experimental untested BPC-one hundred fifty seven that I talked about before.

皮肤弹性的改善，似乎与这些化合物清除皮肤中老化弹性蛋白、促进新生合成，以及增加皮肤中成纤维细胞数量的能力有关。

The improved elasticity of skin, which somehow seems related to the ability of these compounds to remove degenerated elastin within the skin to clear that out, as well as to induce de novo synthesis and even the number of different fibroblasts that are present in skin.

因此，产生更多新皮肤，清除旧皮肤，改善血管化。

So more new skin, clearing away of old skin, improved vascularization.

尽管这一切听起来有点好得令人难以置信，但其宣称的作用机制都是成立的。

And while all of this sounds a little bit too good to be true, the mechanisms by which it's asserted to work all hold up.

所以这总是让人感到安心，对吧？

So that's always reassuring, right?

机制并不是一切，但能看到这些机制确实很好。

Mechanism isn't everything, but it's really nice to see there.

例如，这些化合物已知能够进入细胞核，对吧？

For instance, these compounds are known to get into the nucleus of cells, right?

影响基因表达，我们之前提到过。

To impact gene expression, we talked about that before.

细胞表面有受体，对吧？

You have receptors on the surface of cells, okay?

所以细胞表面受体之外，还有核受体，某些物质我们称之为配体，但它们本质上是化学物质，对吧？

So cell surface receptors, you also have nuclear receptors and the ability of certain things we call them ligands, but these are chemicals, right?

在维生素A通路中，这些物质能够进入细胞核并影响基因表达。

In this case, in the vitamin A pathway to get into the nucleus of cells and impact gene expression.

这实际上就是睾酮和雌激素等激素如何在青春期显著改变人的外貌的方式。

This is actually how hormones like testosterone and estrogen change the way that people look so dramatically during puberty.

它们实际上是通过与细胞表面受体结合来发挥作用的。

They actually, they operate by binding to cell surface receptors.

它们也能进入细胞的核内区域。

They also get into the nuclear compartment of the cell.

它们与核受体结合，激活一系列完整的基因程序，导致声音变低沉、毛发生长或乳腺组织发育等变化。

They bind to nuclear receptors and they turn on entire genetic programs that cause for instance, deepening of the voice or the growth of hair or breast tissue, etcetera.

因此，这些化合物非常强大。

So these are powerful compounds.

现在，我咨询了一位专门从事面部整形的美容外科专家。

Now I talked to a cosmetic surgeon expert in face specifically.

请记住，整形手术涉及身体的多个部位，但这位专家专门研究面部以及这类皮肤治疗。

Remember cosmetic surgery is done for a number of different areas of body, but for face specifically who also specializes in these sorts of treatments for skin.

他们已经开始使用，并且对可以涂抹在皮肤表面的视黄醇酯类物质充满信心。

And they've started using and are frankly quite confident in the use of retinoid esters that can be applied to the surface of the skins.

这些产品无需处方即可购买。

These things are available not by prescription.

关于这类化合物的研究还很少，但许多使用过的人报告说皮肤变得更加年轻有活力，因此这些产品正变得越来越受欢迎，人们对此非常热衷。

There's far less research on these sorts of compounds, but these compounds get enough positive support from the people that have tried them reporting improved youthful ness of skin, etcetera, that some of them are becoming quite sought after and people let's just say are very enthusiastic about them.

在与这些整形外科医生和一些皮肤科医生讨论这些机制时，我认为其逻辑是成立的。

And I will say that in discussing the various mechanisms of this with these cosmetic surgeons and some dermatologists, the logic holds up.

所以，你开始越来越多地看到这些产品。

So you're starting to see more and more of these.

正如我在本集开头提到的，我、这个播客，以及任何营销与皮肤健康和护肤相关血清、面霜或处方药的人之间，都不存在任何商业关系。

Now, as I mentioned at the beginning of today's episode, there is zero business relationship between me, the podcast, or any of these people that have marketed serums or creams or prescription drugs for that matter related to skin health and skincare.

不过，我在节目笔记的链接中提供了一些这类产品的来源。

However, I have provided a couple of links in the show note captions of some of the different sources of these.

显然，如果你对视黄醇、维A酸、维生素A通路感兴趣，像他扎罗汀或类似药物是需要处方的，你必须咨询一位有资质的皮肤科医生，如果他们认为适合你，可能会为你开具处方。

Obviously, you need a prescription for something like tretinoin or something similar, because you're interested in this whole retinol, retin A, vitamin A pathway story, you need to talk to a board certified dermatologist who could potentially prescribe that for you if they decide it's right for you.

但就这些外用药膏、血清、面霜等产品而言，我确实提供了一个使用视黄醇酯的至少一个来源链接。

But in terms of these topical ointments and serums and creams and things like that, I do provide a link to at least one source of those that uses the retinoid ester.

请记住，这些不同的药膏和精华液尚未有随机对照试验来支持它们，而我们之前讨论的一些其他成分则已有此类研究支持。

Just keep in mind that these various ointments and serums do not yet have the randomized control trials to support them that some of the other compounds that we were discussing do have.

现在，我想谈谈一些不涉及服用任何物质或涂抹任何药膏、精华液等方法，来改善皮肤健康和外观的措施。

Now, I'd like to talk about things that one can do to improve the health and appearance of one's skin that don't involve taking anything or putting on any kind of ointment or serum or anything like that.

我所指的是光疗。

And what I'm referring to is phototherapy.

在本集的前半部分，我谈到了不同波长的光，比如紫外线和长波长光，如何以不同深度穿透皮肤，以及这可能带来的负面和正面影响。

Now, at the earlier part of the episode, I talked about how different wavelengths of light like UV light and long wavelength light can penetrate skin to different depths and some of the negative, but also positive things that that can do.

例如，我们讨论过紫外线如何突变细胞中的DNA，可能引发癌症、加速衰老等。

So for instance, we talked about UV light mutating DNA in cells and potentially causing cancers, accelerating the aging process and so forth.

但正如你所回忆的，长波长光，即所谓的红光和近红外光（波长更长），可以深入穿透皮肤组织。

But as you also recall long wavelength light so called red light and near infrared light, which is even longer wavelengths of light can penetrate deep into the skin tissue.

它们能穿过表皮层，到达皮肤的真皮层，接触到血管、神经以及皮肤深层的一些腺体。

So pass that outer epidermal layer into the dermal layers of the skin and can access the vasculature, the neurons, some of the glands located deeper in the skin.

当然，这些区域的细胞，比如表皮层中的细胞，含有线粒体等结构，而红光已被证明对这些结构有益。

And of course the cells there like cells in the epidermis, I should point out contain things like mitochondria for which red light has been shown to be beneficial.

为什么？

Why?

红光和近红外光光疗已被证明可以减少活性氧物种，从而改善细胞中的线粒体功能。

Red light and near infrared light phototherapy has been shown to reduce reactive oxygen species and thereby to improve mitochondrial function in cells.

这反过来被证明对细胞内所有涉及线粒体的过程都有益处，当然包括能量生产，但也包括其他许多方面。

And that in turn has been shown to be beneficial for all the different processes within cells that involve mitochondria, which of course include energy production, but a bunch of other things too.

所以当我提到光疗对身体细胞有益时，这并不仅仅指皮肤细胞。

So when I say that phototherapy has been shown to be beneficial for cells of the body, it's not just cells of the skin.

事实上，早在20世纪初，就因使用光疗治疗红斑狼疮而授予了诺贝尔奖。

In fact, a Nobel Prize was granted in the early 1900s for the use of phototherapy for the treatment of lupus.

因此，这并不是一项新技术。

So this is not a new technology.

同时，尽管有许多研究探讨光疗在改善皮肤健康和外观方面的应用，但大多数研究的样本量都较小，不过这类研究数量很多。

At the same time, while there are many studies exploring the use of phototherapy for improvement of skin health and appearance, most of those studies have fairly low sample sizes, but there are a lot of those studies.

幸运的是，如今已有几项荟萃分析和综述，综合了大量使用不同波长光、照射面部不同部位、针对不同目的（如治疗痤疮，甚至将红光或近红外光照射在面部一侧以实现所谓的自身对照，比较面部两侧皮肤变化或无变化的情况）的研究。

And fortunately by now, there are a few meta analyses and reviews that take into account lots of different studies using slightly different wavelengths of light applied to different portions of the face for different purposes, treatment of acne, maybe even putting red light near infrared light on one half of the face to have a so called within person control to compare the changes in skin or lack of changes in skin as the case may be between one side of the face and the other.