第328期 — 健康与长寿

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We don't run ads on the podcast, and therefore it's made possible entirely through the support of our subscribers. So if you enjoy what we're doing here, please consider becoming one. Welcome to the Make It Sense podcast. This is Sam Harris. Today I'm speaking to my friend Peter Attia.

彼得是医生，也是Early Medical创始人。他获得斯坦福大学医学博士学位后，先后在约翰霍普金斯医院接受普外科培训，在美国国立卫生研究院担任肿瘤外科研究员，并在国家癌症研究所深造。同时他还是个人播客《The Drive》的主持人。但今天我们将聚焦他的新畅销书作。

Peter's a doctor and the founder of Early Medical. He received his medical degree from Stanford University, and then he trained at Johns Hopkins in general surgery. He also trained at the NIH as a surgical oncology fellow, and at the National Cancer Institute. And he's also the host of his own podcast, The Drive. But today, we focus on his new bestselling book.

书名是《长寿的科学与艺术》，这也正是我们讨论的核心。我们将探讨健康寿命（而非单纯寿命）的延长之道，从百岁人瑞身上汲取的经验，饮食营养（包括糖分与宏量营养素、酒精、禁食与限时进食等话题），运动锻炼，心脏病、血压、胆固醇、癌症、大脑健康、代谢紊乱等疾病预防，主动医学检测，药物副作用，雷帕霉素等特殊药物，心理健康及其他相关议题。完整对话长达三小时，全面剖析了我们可以调控的各类变量，以最大化健康长寿的可能性。现在有请彼得·阿提亚。我正与彼得·阿提亚对话中。

The title is The Science and Art of Longevity, and that really is our focus. We talk about health span as opposed to mere lifespan, the lessons that can be learned from centenarians and supercentenarians, diet and nutrition, including topics like sugar and macronutrients, alcohol, fasting and time restricted eating, exercise, heart disease, blood pressure, cholesterol, cancer, brain health, metabolic disorders, proactive medical testing, medication side effects, esoteric drugs like rapamycin, emotional health, and other topics. The full conversation runs three hours, so it is a fairly comprehensive look at most of the variables we might control to maximize the chances of living a long and healthy life. And now I bring you Peter Attia. I am here with Peter Attia.

彼得，感谢你的到来。

Peter, thanks for joining me.

山姆，非常感谢你的邀请。

Yeah, Sam. Thank you so much for having me.

你撰写的这本杰出著作《长寿的科学与艺术》——我们稍后会详细讨论——首先我要祝贺你。从奥普拉到各界媒体，这本书可谓好评如潮，影响力非凡。这一定让你倍感欣慰，毕竟任何书籍出版时（更别说是处女作），作者完全无法预料市场反响，而现在的成功程度堪称超乎想象，想必你非常满意。

So you have written this amazing book, which we're going to talk about. The title is The Science and Art of Longevity. And first of all, congratulations on the book. It really appears to have been trumpeted from the ramparts everywhere, from Oprah on down, and it's really getting out there. So it's got to be gratifying, because when you publish any book, to say nothing of a first book, you really have no idea what's on the other side of that printing press, and this is really about as good of an outcome as I can imagine, so that's got to feel good.

确实如此，我想一年前的这个时候，至少在录制这段内容时，我真正感受到效果的时刻是当出版商硬生生把东西从我手中夺走的时候。我记得当时心里想着，我对这事很不满意。它并不完美。诸如此类。我相信这也是你多次思考过的问题，毕竟你显然已经写了好几本畅销书。

It does, yeah, and I think I was this time a year ago, I get effective at least when we're recording this, was when I really had the thing ripped out of my hands by the publisher. And I I remember sort of thinking to myself, like, I'm not happy about this. It's not perfect. Blah blah blah. I'm sure the same thing that you've thought of many times as you've obviously written a number of successful books.

但后来我有个想法让我平静下来，那就是：现在这本书是否达到了让我二十年后愿意让我的孩子们阅读并引以为豪的程度？如果我能对这个问题回答‘是’，那么其他事情就都不在我的掌控范围内了。也许人们会讨厌它，也许会发现一堆错误，这些都是我确信每位作者都会经历的不安全感。但我知道一旦我达到那个境界，想着只要我的孩子们有朝一日能为之骄傲——虽然听起来有点老套——那就没问题了，其余的事情自然就会水到渠成。

But then I had this thought that sort of calmed me, was, look, is it is it at the point now where I will be I will be proud if my kids read this in twenty years? And if I can answer yes to that question, then the rest is sort of out of my hands, and maybe people will hate it, and maybe people will find a bunch of mistakes in it, all of the sort of insecurities that I'm sure every author goes through. But I know that once I kinda got to that point of saying, as long as my kids will one day be proud of it, which I know it sounds a bit corny, it'll be it'll be okay, and then and then I think the rest sort of took care of itself.

是的。这本书非常实用，同时也非常坦诚，你深入细致地讲述了自己的故事。在我们切入正题之前，我们会先梳理一下你的书。显然书中细节更加丰富，我建议想深入了解我们涉及话题的读者去阅读它。我还应该提到你有个播客节目《The Drive》，对我们即将讨论的所有话题以及其他许多内容都有极其详尽的探讨。

Yeah. Well, it's quite a useful book, and it's a very candid book too, which you really go into your story in considerable depth. Before we jump into the the topics at hand, we're going to sort of track through your book. Obviously there's much more detail in the book, and I recommend people read it if they want more detail on any of the topics we touch. I should also say that you have a podcast, The Drive, which really goes into extraordinary detail on all of the topics we'll touch, and many others.

所以你看，我们可能花十分钟讨论脂质对心血管健康的影响，而你的播客可能有十小时专门讲这个话题。我觉得我一点都没夸张。

So you know, we're going to talk for ten minutes about lipids for cardiovascular health, Your podcast probably has ten hours on that topic. I'm not I don't think I'm exaggerating.

我想建议你听我至少有10期，甚至超过10期关于这个的播客。

Think recommend I have 10, more than 10 podcasts on it.

对。好吧。加起来得有三十小时了。

Right. Okay. Takes up thirty hours.

没错。是的。

Yeah. Yeah.

是的，对于任何想深入了解的人来说，这里确实有大量细节等待探索。不过在进入主题之前，或许你可以先概述一下你在医学领域的背景和职业生涯，因为你的经历很特别——关于你是如何开始专注于现在这些研究方向的。

Yeah, so there's quite a wilderness of detail awaiting anyone who wants to follow you into it. But before we jump into the topics, perhaps you can summarize your background and career in medicine, because you you have you've had a kind of an interesting story of how you have come to emphasize the the kinds of topics you have have focused on.

确实。我这辈子从没想过要读医学院，本科也不是预科医学生。实际上我读完工程学位后才改变主意，决定回头学医。和许多人一样，我在医学院时对职业方向也很迷茫。

Yeah. So I, you know, I didn't want to go to medical school at any point during my life. I was not a pre med or anything like that. In fact, I'd already sort of finished engineering when I had a change of heart, decided to go back and do medicine. And in medical school, like many others I'm sure, was a little undecided about what to do.

我一直对肿瘤学感兴趣，刚进医学院时曾考虑从事儿科肿瘤学。但毕业时发现自己更适合外科性格，于是决定做外科医生并专攻肿瘤外科。住院医师培训五年后，由于书中提到的种种原因，我开始对后来称之为'医学2.0'的体系感到沮丧——虽然当时并不明白这种挫败感的根源。最终我选择离开，坦白说觉得过去十年像是虚度光阴。本想回去读个MBA学位，但考虑到债务问题，最后加入了咨询公司麦肯锡，走上了企业金融与风险管理的道路——这个量化分析的领域特别符合我的思维偏好。

Always had an interest in oncology, and when I showed up in med school, kind of thought I might do pediatric oncology. But by the end of medical school, realized I had more of a surgical personality, and so decided to do surgery with the plan to then go on and specialize in surgical oncology. And after five years of my residency, for a number of reasons, some of which I write about in the book, I just became quite frustrated with what I've later come to call Medicine two point zero, although at the time of course I had no idea that that's what was really frustrating me. Then I just decided to kind of leave. I sort of felt like the last ten years had sort of been, you know, not a good use of my time, frankly, and I wanted to go back and get another degree, probably an MBA, felt I already had enough debt, and so instead I joined a company called McKinsey and Company, which is a consulting firm, and you know, sort of went down the path of corporate finance and risk there, which was very appealing to me and to my sensibilities around quantitative things.

我怀念数学背景，在那条路上愉快地走了六年，完全远离医学领域。直到自身健康问题成为首要关注点，这种对健康本质的不懈探索又逐渐把我引回了医疗实践——不过这次是以预防而非急救的全新视角。

I missed my background in mathematics and was sort of happily marching along doing that and sort of spent six years completely away from medicine until my own health became of a high enough priority to me and a high enough interest that the endless pursuit of trying to understand that better kind of gradually led me back into the notion of practicing medicine again, but obviously doing it in a very different way, which is, you know, through this lens of prevention as opposed to last minute treatment.

没错，你在饮食、营养和运动等领域的钻研远超普通医生，这点我们稍后会详细讨论。现在让我们从长寿这个主题的第一章开始——其实你更倾向于用'健康寿命'这个概念对吧？因为这不仅仅是避免死亡的问题。你如何看待主要致死因素和健康寿命缩短的原因？或许我们该先给健康寿命下个定义。

Right, and you've gone very deep into topics like diet and nutrition and exercise, I mean, more than the average physician, I would say, and we will cover that. So let's start with what would be our first chapter here on the topic of longevity and really health span, I think, is your preferred word, because, you know, it's more than a matter of just not dying. How do you think about the main causes of mortality and and the main causes of reduced health span? And maybe maybe we should define health span at the outset here.

我认为长寿最好从两个维度来理解：寿命长度和健康寿命。寿命长度比较容易理解，这是个二元概念——活着还是死亡，有呼吸还是没有。现行医疗体系主要关注的就是这个维度。

Yeah. So I think longevity is best explained, at least for me conceptually, I think of longevity as a function of these two things, lifespan and health span. Lifespan being the easier to understand because it's the binary one. It's the, you know, you're alive or you're dead, you're respiring or you're not. And the current medical system is really focused mostly on lifespan.

这个可量化的指标自然就成了管理重点。而健康寿命作为非二元概念带有主观性，本质上关乎生活质量。虽然人们都懂这个道理——如果问某人是否愿意活到100岁但最后20年认知或身体功能严重受损，多数人会立刻拒绝。没有健康寿命支撑的超长寿命显然没有意义。

It's the metric that gets measured, and it's the metric obviously that therefore gets managed. Health span, which is obviously not binary, is somewhat subjective as well, really speaks to quality of life. And while I think that everybody intuitively gets that, certainly I'm sure if you ask a person, you know, would you want to live to a 100 if the last twenty years of your life you were cognitively or physically debilitated? I think most people would immediately say no, not really. So very long very long lifespan in the absence of health span is not desirable.

但同样地，仅有健康寿命而实际寿命不足也是不可取的。Sam，如果我告诉你，你会在60岁去世，但从现在到60岁期间，你的身体状态和认知能力都能保持在二十多岁的水平。我认为我们仍会视之为悲剧，因为你的寿命被缩短了。所以我们真正追求的是两者兼得，但过去五年我最大的领悟是：如果持续专注于延长健康寿命，你自然就能——

But similarly, wonderful health span with insufficient lifespan is also undesirable. You know, Sam, if I said, you know, you're gonna die at 60, but you're gonna be from now until 60, you're gonna be as strong and cognitively sharp as you were in your twenties. I I still think we would view that as tragic as well. Your lifespan was cut short. So what we're really trying to do is optimize both, but I think the biggest insight I've had in the past five years is that if you focus relentlessly on health span, you get

——同时获得寿命的延长。如果反其道而行，则未必如此。那么我们能从百岁老人——或者你说的超级百岁老人（那些活到100岁甚至更久，且多数情况下生活质量极高的人）身上学到什么？他们的健康寿命似乎比普通人群延长了二十年以上。我们从他们身上获得了哪些启示？你认为在多大程度上应该以他们为标杆，来制定延长寿命与健康寿命的策略和方法？

the lifespan benefits typically along the way. If you do the reverse, that's not necessarily true. So what what can we learn from centenarians and, I guess, you call them supercentenarians, people who who live to be 100 and beyond and, in many cases, really thrive I mean, it's almost like their their health span is extended by two decades or more with respect to the average population. What have we learned from them, and and to what degree do you think they're the correct lens through which to look at the goal here and and the strategy and tactics we might use to extend longevity and health span?

这个问题我研究了约十年。有两位学者对百岁老人、百岁老人后代乃至110岁以上的超级人瑞进行了大量研究。他们都在美国：一位是波士顿大学的Thomas Perls，另一位是纽约爱因斯坦医学院的Nir Barzilai。可以理解，Perls和Barzilai的研究主要聚焦于高科技层面——即探寻与超常寿命相关的基因，因为很明显这些罕见个体拥有基因赋予的优势。

Well, this is a question I've been interested in for about a decade, and there are two people who have really done a lot of work on the centenarians, the offspring of centenarians, and even the supracentenarians, those who live to be 110 and beyond. And these two folks are both here in The US. So one is a guy named Thomas Perls at Boston University, and the other is near Barzilai at Albert Einstein College in New York. Now, understandably, most of the work that Perls and Barzilai have put into this have been focused on kind of, you know, the more high-tech side of the question, which is, you know, what are the genes that are associated with this exceptional longevity? Because it's pretty clear that it's a genetic benefit that's been bestowed on these very infrequent individuals.

从行为学角度看，观察典型百岁老人的生活方式很有趣。平均而言，他们吸烟酗酒概率更高，运动更少，饮食习惯更差。人们很快意识到这些人赢的是基因彩票，而非过着苦行僧生活。因此研究重点自然落在基因上，我在书里也探讨过这点。

In fact, from a behavioral standpoint, you know, you'll it's kind of amusing to look at the the typical lifestyle of the average centenarian. Know, on average, they're more likely to smoke, more likely to drink to excess, less likely to exercise, and more likely to have poor eating habits. So it didn't take long for people to figure out that these guys were, you know, winning the genetic lottery and not, you know, living like monks. And understandably, I think most of the effort has been on what are those genes. I touch on that in the book.

但我的关键顿悟发生在2014年左右。当时我读到一篇关于百岁老人死亡率的论文，发现他们的死亡率曲线与常人非常相似——只是整体推迟了二十年。这听起来显而易见，实则不然。这意味着百岁老人最终同样会死于心脏病或癌症——

But for me, the big moment came roughly 2014 when I was kind of reading a paper about centenarian mortality, and I realized that if you look at the mortality tables of centenarians, it looks very similar to the mortality of the rest of us. It just has a twenty year phase shift. And that might sound really obvious, but it's actually not, right? Because what it says is centenarians are just as likely to die from heart disease eventually. They're just as likely to die from cancer eventually.

——而且一旦确诊癌症，他们的死亡率与常人无异。这说明他们的超能力（同样源于基因）在于延迟疾病发作，而非患病后的抵抗力。

And by the way, they're just as likely to die from cancer once they get a cancer diagnosis as the rest of us. What this tells us is that their superpower, which again is brought on genetically, is a delay in the onset of disease, not in a resilience to a disease once they have it.

我想单独用一章讨论可能从百岁老人基因组研究中衍生的特定药物和补充剂，比如雷帕霉素和二甲双胍。但你是如何将目前对百岁老人的认知融入医疗实践和个人生活的策略与方法的？或许你可以区分一下在长寿问题上策略与战术的差异。

I want to have a separate chapter here on specific medications and supplements that might be derived from any insights we've had into the genomes of centenarians and through other means, so things like rapamycin and metformin. But how do you use what we've learned about centenarians so far in your thinking through the strategy and and tactics you employ in in your in your medical practice and just, you know, personally? And I and perhaps you you wanna differentiate between strategy and tactics in in how you think about longevity.

是的。我认为这是一个很好的切入点，这个洞察虽然听起来有些‘那又怎样’，但对我来说确实是个警醒。它让我意识到，要想延长寿命，唯一的方法就是从更长远的角度思考预防。我们必须假设自己80岁时的冠状动脉状态，要设法让它们看起来像60岁时那样健康。而实现这一点的唯一途径，就是考虑原始预防而非所谓的初级预防。让我们以冠状动脉疾病为例，因为它是全球范围内导致男性和女性死亡的最普遍原因。

Yeah. So I think that that that's that's a great way to lead into this, which is that insight, which as I say it sounds relatively so what ish, I think for me was a real wake up call, and it made me realize that the only way one is going to somehow improve their longevity is to think about prevention through a much longer lens. So we have to pretend that our, you know, our coronary arteries at the age of 80, we need to position them to look like they would otherwise look at 60. And the only way to do that is to think about primordial prevention as opposed to just quote unquote primary prevention. So let's use coronary artery disease as an example of that because it is the most ubiquitous cause of death in The United States globally for men and for women.

它确实是...你知道...最公平的死因。早在上世纪70年代初、60年代末，通过对越南战争中阵亡年轻士兵的尸检研究我们就发现，即便是18岁的年轻人，虽然没有明显的动脉粥样硬化症状（即你切开他们的冠状动脉也看不到血栓），但从组织学上看，这一过程已经开始。换句话说，在显微镜下观察他们的冠状动脉，你会看到泡沫细胞——那些吞噬了动脉壁氧化胆固醇的巨噬细胞，这时你就会意识到：这个过程其实从童年就开始了。

It really is the, you know, the the great equalizer. We know this from as early as the early nineteen seventies, late nineteen sixties when they were doing autopsy studies on young men who were dying in Vietnam, that even, you know, 18 year old men have, while not gross evidence of atherosclerosis, I. E. You wouldn't open up their coronary arteries and see clots, histologically they already have the process embedded. So in other words, if you look under a microscope at their coronary arteries, you'll see the foam cells, you know, the macrophages that have ingested cholesterol that's been oxidized in the arterial wall, and you realize that that process is actually beginning as we're children.

这个缓慢发展的过程使得对大多数人来说，直到65岁左右才会出现临床症状。约50%的男性患者和1/3的女性患者会在65岁前经历冠状动脉事件，这让你对时间跨度有了概念。如果我们想预防，就不能等到50岁才开始——这才是问题的关键所在。

And the slow burn of that process is such that for most people it doesn't become clinically relevant until you hit about 65. So about fifty percent of men who are going to have a coronary event in their life will have it before the age of 65, and about a third of women who will have a coronary event in their life will have it before the age of 65. So that gives you a sense of the time scale. Well, if we want to prevent that, we can't really wait until you're 50. That's that's effectively the point here.

我们必须更严肃地对待预防，并尽早显著改变疾病发展曲线。这方面已有成功案例：比如家族性高胆固醇血症患儿，这种不算罕见的遗传病会导致胆固醇异常升高，这些患者可能在二十多岁就发生心肌梗死。但如果从幼年开始积极用药，这些孩子完全可以过上正常生活。

We have to take prevention much more seriously, and we have to significantly bend the arc of the disease curve basically as soon as possible. And we do have examples of this working already, right? So if you take children who are born with something called familial hypercholesterolemia, which is a not terribly uncommon genetic disorder that results in unusually high levels of cholesterol, these are indeed people who can have, you know, MIs, myocardial infarction heart attack, in their twenties. And these are kids that actually have to be medicated as youngsters. And if you do that, and if you do it aggressively, these kids can go on to live normal lives.

关于心脏健康和心血管疾病我们会有专门章节讨论。现在先谈谈饮食营养——这确实是大多数人考虑预防衰老疾病、保持健康时的首要议题。我认为医学界至今对健康饮食构成仍存在不确定性，这简直是科学界的重大丑闻。这个话题存在如此多分歧观点实在令人震惊。

Well, we'll have a separate chapter on heart health and and, you know, cardiovascular disease here. But let's talk about diet and nutrition. This is really the the first stop in most people's thinking with respect to how to prevent, you know, really all of the diseases of aging and to live a healthy life. You know, I consider it one of the great scandals of medicine and science generally that there's still any uncertainty about what constitutes a healthy human diet. I mean, it's just amazing to me that there's such a diversity of opinion on this topic.

有人会说全谷物和豆类是最健康的食物，也有人会同样自信地宣称它们纯属毒药，各种饮食法都基于这些对立观点营销。我原以为目前营养学唯一没有争议的观点是精制糖有害——也许现在依然如此，糖经常被比作饮食界的香烟。但就在昨天准备这次对话时，我看到有个YouTuber声称连续100天只吃2000卡路里冰淇淋+500卡蛋白粉加酒精，居然减了32磅还改善了血脂——当然这只是个案，真假难辨。

Mean, there are people who will tell you that whole grains and legumes are among the healthiest things you can eat, and there are people who will tell you with equal confidence that they're just pure poison, and there are whole diets marketed around these antithetical views. And, you know, so I had thought prior to this conversation that the one totally uncontroversial point in nutrition now is that refined sugar is generally bad for us, and maybe that's still the case. Methodist is generally described as the the dietary equivalent of smoking. But right before getting on the on the mic with you, I think I think it was yesterday, I stumbled upon this YouTuber who apparently spent a hundred days on a diet consisting of nothing but 2,000 calories of ice cream and 500 calories of protein powder plus booze, and he lost 32 pounds and totally revamped his lipid profile. Obviously, that's just an N of one, and who knows if it's true?

那么目前我们究竟能确定哪些饮食营养真理？让我们按确定性程度来梳理：有哪些原则你认为适用于绝大多数听众？哪些是你认为极可能正确的？让我们在讨论各个话题时，用这两个标准来标注认知确定性。人们应该如何思考饮食营养问题？

But what do we absolutely know is true about diet and nutrition at this point? I mean, so let let let's go from through gradations of certainty here. What what are you what are you sure of with respect to diet and nutrition that is generically applicable to more or less everyone who would listen to this, and what what do you think is just very likely to be true? And let's just sort of track through with those two flags with respect to our epistemic certainty as we touch the various topics. How should people think about diet and nutrition here?

在这片领域中，是否存在像‘吸烟有害健康’这样公认的确定性真理？我认为这一点健康智慧如今已被我们彻底掌握了。

And is there anything on this landscape that is the equivalent of a generic certainty like it's not a good idea to smoke cigarettes, which I think is a piece of health wisdom we have truly conquered at this point.

是的，Sam，我喜欢你提问的角度。这其实很有趣，因为正如你所知，这本书有17章——其中两章讲营养，三章讲运动，其他内容各占一章。

Yeah. I like the way you framed the question, Sam. And it's sort of funny because, you know, as you know, you've read the book, there's like 17 chapters. Two of them are on nutrition, three of them are on exercise. Everything else gets one chapter.

对吧？显然运动和营养得到了额外关注，部分原因是营养学的复杂性以及运动的影响力。不过初稿时，我对你描述的问题实在太恼火，甚至顽皮地给编辑发了一页纸的营养章节，说‘这才是这章该有的样子’，内容就是你刚才说的——‘这就是我们所知的全部’。

Right? So clearly, exercise and nutrition get a little extra attention in part due, I suppose, to their complexity in the case of nutrition and the impact in the case of exercise. However, during the first writing of the book, I was so annoyed by the problem you describe that I very, sort of cheekily sent my editor a one page version of the nutrition chapter, I said, this is the chapter. And it was what you just said. It's like, here's what we know.

大概就六条要点。我说干脆就这样吧，省得我和读者还要面对后面那些充满不确定性的废话。不用说，这个提议没被采纳。但我核心观点是：我们明确知道营养摄入过多或过少都有问题，只是通常体现在不同时间维度上。

And it was like, I don't know, six bullet points. And I said, how about I just do this and spare myself and the readers all of the crap that follows where I have to start getting into some uncertainty? Needless to say, that didn't go over very well. But what I basically said is here's what we know. We know that when it comes to nutrition, too much and too little are problematic, though generally on different timescales.

让我们展开说说。人类存在的时间——取决于你如何界定智人的起源——就简单说几十万年吧。在这段历史中，食物大部分时间都相对匮乏。

Let's expand on that for a second. We've been around for, you know, depending on where you wanna draw the line in the sand of where we began as, you know, homo sapiens versus, you know, previous forms. Let let's just make it easy and say, like, a couple hundred thousand years. Right? And for most of that period of time, food has been relatively scarce.

这是事实一。事实二我认为——Sam你应该会同意——人类与其他物种的根本区别在于我们的大脑，这才是我们的超能力。

So that's fact one. Fact two is, I would argue this. I think you would probably agree, Sam. What separates us as humans from every other species on this planet is our brain. That's that's the sort of that's our superpower.

对吧？我们的优势绝不是力量、速度或其他体能，真正让我们与众不同的就是大脑。这个器官能耗惊人——虽然只占体重的2%，却消耗了我们约25%的热量需求。

Right? It's certainly not how strong we are or how fast we are or any other sort of physical power. It's it's really it's it's it's really our brains that differentiate us. That brain is an insanely energetic organ. So roughly 25% of our caloric need goes to servicing that organ that constitutes 2% of our mass.

因此，让我们能够——且唯独我们——从进化沼泽中跃出、领先于其他物种的关键诀窍，就是储存能量的能力。理解这一能力的深远意义至关重要。对吧？如果我们无法储存数周的能量，人类就不会存续至今。我们主要以脂肪形式储存能量——显然，过量脂肪会转化为脂肪储存，过量碳水化合物也会超出少量糖原储存能力（糖原不过是葡萄糖储存形态的 fancy 说法）转化为脂肪。在短期禁食时，我们分解这些脂肪供能；在长期禁食时，则将脂肪转化为酮体作为能源。

Therefore, the trick that allowed us, and only us, to leapfrog out of the swamp ahead of every other species was the capacity to store energy. And it's important to understand just how profound that is. Right? If we couldn't store weeks and weeks of energy, we wouldn't be here. Now, we store most of that as fat, so obviously excess fat gets stored as fat, excess carbohydrate gets stored as fat beyond the paltry amount we can store as glycogen, which is just a fancy word for the storage form of glucose, and in times of relatively short fasts we just break that fat down and use it as energy, and in relatively long periods of fasts we turn that fat into something called ketones and we use those as energies.

但无论如何，人类可以相对长时间不进食。相比之下，老鼠饿两天就会死亡，而即便精瘦的人也能禁食二三十天。那么这种超能力的代价是什么？事实上，直到近代之前，我们根本无需为此付出代价。

But regardless, we can go a relatively long time without food. By comparison, of course, a mouse can go like two days without food before it dies. Even a lean person could go twenty or thirty days without eating. So what's the price we pay for that superpower? Well, up until relatively recently, we've paid no price for that superpower.

直到最近百年来，当人类从数十万年食物匮乏史突然转向食物过剩的悲剧性局面时，我们才开始发现这种卓越储能能力带来的弊端——具体表现为X/Y/Z等代谢后果。重申一下，这些都是慢性而非急性问题。从长远进化尺度来看，食物短缺仍是更严峻的生存威胁。事实上可以说，自然选择对营养过剩问题根本毫无兴趣。回到你的问题，我能绝对肯定地说什么？我能断言：长期营养过剩必然有害（稍后详述），而短期营养不足则会立即造成危害。

It's only in the last hundred or so years where we have shifted from hundreds of thousands of years of food scarcity to tragic food abundance, are we starting to show that actually the the drawback of this remarkable capacity to store excess energy is x, y, and z, and there were these metabolic consequences of doing so. Now, again, those are chronic problems, not acute problems, and therefore, on a relatively long time scale, food scarcity or food shortage is still a much greater evolutionary concern. In fact, you would argue the natural selection has really no interest in the problem of overnutrition. But to go back to your question, what is what can I say definitively? I can say that too much nutrition is gonna be bad chronically, we'll go into more detail, and too little nutrition is gonna be bad acutely.

这是第一事实。第二事实是：某些氨基酸和脂肪酸对生命绝对必需。这意味着我们必须通过饮食摄入特定类型的食物（主要是脂肪和蛋白质），否则将导致灾难性后果——不仅是普遍的热量营养不良，更会造成软骨、骨骼、肌肉等组织的缺陷。同样，某些必需维生素和矿物质也对生命绝对关键。

That's fact one. Fact two is, there are certain amino acids and fatty acids that are absolutely essential for life. Meaning, there are certain types of foods, primarily in the form of fats and proteins, that we must consume in some quantity from the outside world, and failure to do so will result in horrific consequences. So, you know, not just general caloric malnourishment, but, you know, deficiencies in cartilage, bone, muscle, things of that nature. There are also certain, nutrients, you know, essential vitamins and minerals that are absolutely essential for life.

当然，人人都听过水手因维生素C摄入不足导致坏血病这类典故。有些物质会立即对我们产生毒性——比如某些细菌（食物中的大肠杆菌就相当麻烦）。基本就这些了，Sam。

Everybody, of course, knows the story of story of the, you know, sailors who were not given enough vitamin c and their rations developed scurvy, etcetera, things like that. There are certain things that are toxic to us acutely. So, you know, we don't do very well with certain types of bacteria. So, you know, e coli in our food, relatively problematic. That's about where it ends, Sam.

这些就是我能用大写'T'标榜的真理——即那些毫无争议的普适事实。若深入探讨'每日需要多少克蛋白质'或'为何有人日摄2000卡路里糖分仍能减肥'这类问题，我虽有许多见解（可能比普通推特用户更深入），但我们确实难以给出确凿结论。这揭示了问题的另一本质：人体在营养代谢方面具有惊人的缓冲调节特性。

That's, you know, that's about all I can tell you with capital t truth written all over it, meaning those are the things that are kind of universally true for which there's no ambiguity. If we start to get into how many grams of protein a day do you need, why is it that someone can eat 7,000 or pardon me, 2,000 calories of sugar per day and still lose weight, I mean, I I have lots of thoughts on those things, and I hopefully have more insight on those things than maybe the average person on Twitter. But, we are we are definitely less able to reliably say things. And I guess that speaks to another nature, another element of the problem, which is the human body is it has a remarkable dampening factor quality when it comes to nutrition. Right?

就像工程系统有输入输出那样，我认为身体就是个神奇的缓冲器——输入物质后，它会压制输出信号，导致短期内很难察觉输入对输出的影响。以体重为例：信不信由你，从热量角度看，前一天饮食对次日体重的直接影响其实微乎其微。

Like so so if you think of a system, like an engineering system, where you put inputs into it and then you get the outputs out, I think of the body as this remarkable dampener where when you put things in, it it sort of squashes the output, so it's very difficult to, in the short term, discern how the input affected the output. Right? So Mhmm. Body weight is an example. You know, what you ate the day before from a caloric standpoint, believe it or not, doesn't have an enormous impact on your body weight the next day.

这更多可能是水分和钠盐的作用，而非食物本身的重量，因为大多数食物含有大量水分。因此，一天称五次体重并不是判断能量平衡的好方法。体内还存在许多其他动态系统。此外，我们处理营养物质的系统存在很大变数，比如与睡眠等其他因素相关。我们稍后可能会讨论睡眠，但一晚睡眠不佳对胰岛素信号的影响远超多数人想象，连续几晚睡眠不佳的影响则更为显著。

That's probably more a function of water weight and sodium than the actual weight of the food because most food comes with so much water in it. So therefore, looking at your body weight five times a day is not really a good way to determine energy balance. There's so many other movement systems in it. Furthermore, there's so much variability in our system with how we process nutrients with respect to other variables, such as sleep. So we'll maybe talk about sleep, but a poor night of sleep impacts insulin signaling more than most people would appreciate, and certainly several nights of poor sleep would have an even bigger effect.

这种影响——即胰岛素敏感性对能量分配的作用（指你如何储存摄入的营养，又如何从储备中提取能量）——实际上相当重大。在食物摄入几乎相同的两种情况下，两晚不同的睡眠也可能造成影响。所有这些因素使得研究这个问题变得异常困难。

And the impact of that, I. E. Insulin sensitivity on fuel partitioning, meaning how you store the nutrients, you consume them, and then how you go back to the energy well to draw them from storage, is quite significant actually. So under two nearly identical circumstances, food wise, two different nights of sleep could also impact things. So all of these things make it very difficult to study the problem.

确实。关于进化论有个观点——你在书里也提到过——进化根本看不见我们在乎的任何事。让很多人惊讶的是，它也看不见决定我们五十岁后健康寿命和长寿的那些变量，对吧？

Yeah. Yeah. Well, so one point about evolution, you actually make this in the book. I mean, evolution can't see really anything we care about, and and surprisingly to many people, it can't see the variables that that would determine our health span and longevity past certainly past our fifties. Right?

我的意思是，进化根本不在乎你是否能活到耄耋之年还能挥动壶铃。它只关心你能否繁衍后代，或许还能帮助子女度过他们的生育期——这样从进化角度看，你或许能成为年轻的祖辈并保留一些基因效用。但之后，进化对我们关心的一切就完全视而不见了。所以当我听到某种饮食法以进化环境为参照时——比如原始人饮食法，它似乎非常看重过去二十万年的历史——我总会犹豫。我在想，你如何看待这种借鉴的局限性？在我看来，我们现在简直活在科幻世界里。

I mean, we're just it's it just simply doesn't care about you living to a ripe old age and being able to swing kettlebells into your eighties. It just cares about you spawning and maybe helping your children secure their spawning period so that, you know, maybe there's a you can be a young grandparent from the point of view of evolution and still have some genetic utility. But after that, there's just no evolution is blind to what we care about. And so I I guess I I'm always hesitant to when I hear of a diet that is using our evolved environment as a reference point, so like a like a the paleo diet, right, where it seems to put a lot of stock in the two hundred thousand years that preceded the the present moment, I just I'm wondering that the about the how you view the the limitations of the lessons we can draw from that. It just seems to me that we're living in the in the world of science fiction now.

如果我们想活到120岁并保持基本健康，就必须基于进化从未预料到的原理来解决问题。

If we care about living to a 120 with anything like a a modicum of health span, we're you know, we have to figure it out on the basis of principles that evolution has never anticipated.

这是个非常有趣的问题，也是我经常思考的。顺便说，你完全正确。其实我可以举几个例子——有些基因因进化优势保留下来，如今却成为明显劣势。比如LP表型（源自LPA基因）和APOE4基因，这两个基因如今非常普遍，却分别与心血管疾病和阿尔茨海默病高度相关。

Yeah. That's a very interesting question, and it's one I think a lot about. And you're you're absolutely right, by the way. In fact, I could just taking us back for a second, I could point to a couple of genes that persisted because of, you know, evolutionary advantage that are a distinct disadvantage today. So the LP phenotype, which comes from the LPA gene, and the APOE4 gene, so these are both genes that are highly prevalent today, and highly associated with disease, cardiovascular disease and Alzheimer's disease respectively.

人们可能会问：这些基因到底为什么存在？我们知道APOE基因的E4亚型原本是最早的亚型。最简单的解释一是进化不关心阿尔茨海默病，因为没人会在生育前得这个病；二是ApoE4亚型在传染病肆虐的时代具有保护作用。LPA基因可能也是同理。

It might be tempting to ask the question, why the heck do these genes exist? And we know that the APOE gene, the E4 isoform was the original isoform. Well, I think the easiest answer is one, evolution doesn't care about Alzheimer's disease because nobody's getting it before reproduction. But even two, it's that the ApoE4 isoform offered protection in a world where infection ran rampant. And the same is probably true of LPA.

这确实增加了血液凝固能力，如果你想想的话，这在数十万年前（如果不是几百年前）会是一个巨大优势。在受伤时更易凝血在当时是极大的优势。但如今这已不那么有利，而幽门螺杆菌的所有负面影响都对你不利。

It certainly increased blood clotting, which would have been a huge advantage if you can think about it, right, hundreds of thousands of years ago, if not just a few 100 ago. To have more, you know, to have a greater likelihood of clotting in the event of a cut would have been an enormous advantage. Today, it's not so much an advantage, and all all of the negative consequences of L. L. Pylori work against you.

综上所述，这类情况有很多例子。谈到营养，我很难证明任何极端饮食是最佳饮食，但我倾向于从进化角度思考——我们曾是机会性最强的杂食动物。我当然可以为治疗疾病采用极端饮食辩护，比如对二型糖尿病患者，某种极端饮食限制可能是最优选择。但若从健康基线出发，我认为不必如此严苛。这个观点部分源于现存狩猎采集社会的证据，他们确实有人能活到高龄，而他们的饮食本质上是机会主义的杂食性饮食。

So so with all that said, lots of examples of of of those situations. When it comes to nutrition, I find it hard to make the case that any extreme diet is our optimal diet, but I find myself relying on an evolutionary example here, which is we were the most opportunistic omnivores around. So I can certainly make the case for extreme diets to treat disease, meaning if a person has type two diabetes, then maybe some extreme diet or or some sort of extreme dietary restriction is the optimal diet. But I would certainly argue that if you don't have you know, if you're just starting from a place of health, I feel like one shouldn't have to be that restrictive. Though maybe I find myself, you know, making this argument based on the fact that we have lots of evidence that at least to certain age and and this, of course, is based on looking at the the few remaining hunter gatherer societies that do still manage to make it into, you know, old age consuming, you know, basically opportunistic arn omnivore diets.

所以这既有进化论的成分，也包含对现存狩猎采集社会的观察，比如澳大利亚和非洲的那些群体。

So so it's a little bit of evolution, but it's also a little bit of looking at, you know, for example, you you know, certain hunter gatherers that still do exist, for example, in Australia and Africa.

好的，我们来谈谈宏量营养素。就是脂肪、蛋白质和碳水化合物。回到我开头说的那个疯狂例子——那个人只吃冰淇淋，或者2000卡路里冰淇淋加500卡路里蛋白粉和酒精。

Okay. So let's talk about macronutrients. Right? We're talking about fat, protein, and carbs. I guess to to come back to the crazy example I I started with of the guy who ate nothing but ice cream or 2,000 calories of ice cream plus 500 calories of protein powder and alcohol.

听起来他至少第一周玩得很开心。选择冰淇淋而非彩虹糖让我觉得这故事可能没表面那么离谱。我记得曾连续14天监测血糖，惊讶发现冰淇淋（可能因脂肪缓冲了糖分）的血糖负荷比许多看似更健康的食物低得多——比如一个素食卷饼就让我的血糖飙升，而冰淇淋反应平平。总之，你对脂肪、蛋白质和碳水化合物的基本看法是什么？对大多数人大多数时候的需求，我们能总结出什么通用原则？如何从中推导出——就算不是完美饮食——至少是非常稳妥的健康饮食方案？

So he he sounded like he had fun, at least for the first week. The fact that it was ice cream rather than Skittles makes me think that maybe there was it's not quite as insane a story as as it might seem, because I remember the the one time I tracked my my blood glucose for, you know, fourteen days. Was actually surprised to find that that ice cream, I assume because the the sugar is being mediated by fat, was not as as a high glycemic load as as many other things that were ostensibly much healthier that I might eat, like a I remember a a a vegetarian burrito just sent my blood sugar, you know, off the charts, whereas ice cream was pretty, you know, unspectacular. But in any case, so I I how do you think about fat, protein, and carbs in general for what generically can you say about what most human beings most of the time require on that front, and how can you extrapolate from from those principles to what we might assume is a, if not the perfect diet, at the very least, a very safe bet for a healthy one.

我用一种可能稍显刻板的公式化方式思考这个问题（虽然我自己未必严格执行）。如果将其视为工程问题，其实相当简单。但在那之前，有必要探讨'冰淇淋实验'的可信度。假设这个案例属实（这个假设本身需谨慎对待），

So so I think about this in in kind of a formulaic way that maybe takes a little bit of the romance out of eating, which doesn't mean that I necessarily adhere to it with that rigor. But if if I'm going to think about this as an engineering problem, it's actually, I think, quite simple. So but before I do that, I think it's worth kind of addressing the, perhaps, the the mystery in the ice cream man. So let's assume that this is correct, and and I think that's a that's not an assumption one should take lightly. Right?

毕竟'我在YouTube上做过所以是真的'这种说法需要保持合理质疑，更值得期待的是临床实验验证。但假设真有临床试验表明：700名超重者在基线期平均摄入X热量，之后采用你描述的那种制造25%热量缺口的饮食方式——你认为他们会减重吗？我的答案是肯定的。换言之，我认为能量失衡才是体重变化的最关键决定因素——或许这么说更准确：体重减轻的最大决定因素就是能量负平衡。

So I think the the whole, you know, I did this on YouTube, therefore, it's true, is is is one needs to have a healthy degree of skepticism, and it would be more interesting to see that in a clinical trial. But let's just assume there was a clinical trial that said we took, you know, 700 overweight people whose, you know, whatever average caloric intake in the run-in period was X and we created a 25% caloric deficit that consisted of what you just described, do you think they're going to lose weight? My answer to that question would be yes. I would be I would expect them to lose weight. In other words, I think that the single greatest determinant of energy balance is indeed, or maybe a better way to say this, the single greatest determinant of of weight loss is going to be energy imbalance, would be maybe the most accurate way I could say that.

换句话说，无论你吃什么，只要热量摄入不足。

So other in other words, a caloric deficit no matter what you're eating.

无论由什么构成。没错。所以如果我们再做一次思想实验，假设我们找一千名明显超重的人，为了简化模型，假设他们基因基本相同，就像一群实验鼠。他们目前每天摄入3500卡路里，体重在3500卡路里时保持稳定。我们会把他们分成两组，第一组每天摄入2800卡路里的垃圾食品。

No matter what it's constituted by. That's right. So so so if we if we did another, you know, thought experiment and we said, look, we're gonna we're gonna take, you know, a thousand people who are all ostensibly overweight, and let's just make it really elegant and say that they're all basically genetically equivalent, so it's just like a bunch of mice. And they're all coming in at 3,500 calories per day, and their weight's stable at 3,500 calories per day. We're going to divide them into two groups, and the first group is going to go on a 2,800 calorie a day diet of junk food.

另一组则每天摄入4000卡路里的天然食品。对吧？就是你能想到的最理想饮食。我毫不怀疑，每天吃4000卡路里的那组人在试验结束时体重会比另一组更重。而且顺便说一句，他们可能健康状况也更差。

The other group is going to go on a 4,000 calorie a day diet of whole foods. Right? The best, you know, whatever, come up with your favorite best diet. There's no doubt in my mind that that group eating 4,000 calories per day is going to be heavier when the trial is done than the other group. And by the way, they might also be less healthy.

差距如此之大。嗯。对吧？这引出了我们该讨论的问题：为什么过剩的能量有害？因为这不仅仅是外观问题。

That that big of a gap. Mhmm. Right? Because of something we we should probably talk about, which is why is it that excess energy is harmful? Because it's not the aesthetics.

对吧？不是因为你的腹肌消失了就意味着不健康。背后有更重要的机制需要理解。综上所述，我如何看待这个问题？我认为实际上还存在第四种宏量营养素，山姆，我们至少该提一下，就是酒精。

Right? It's it's it's it's not because you lose your six pack that you're unhealthy. There's something going on that's much more important to understand. So with all of that said, how do I how do I think about the problem? I think about the problem by saying and there's really a fourth macronutrient, Sam, that we should at least mention, which is alcohol.

嗯。原因是酒精的热量密度极高。对吧？多数人知道碳水化合物和蛋白质每克约4大卡，脂肪是9大卡，而乙醇是7大卡。

Mhmm. And and the reason is alcohol is so calorically dense. Right? So I think most people know that, you know, carbs and proteins are roughly four kilocalories per gram. Fat is nine calorie kilocalories per gram, while ethanol is seven.

所以想减肥的人必须注意不要无节制饮酒。至少有两个原因：首先是能量问题，其次——如果你和我一样——没有什么比几杯酒更能瓦解我对食物的自制力了。所以我从蛋白质说起，因为我认为它最重要。衡量方式有很多，但我想先说RDA（推荐膳食摄入量）明显是错误的，我在书里花了大量篇幅解释这点。

So one has to be mindful if they're in the business of trying to lose weight of just mindlessly consuming alcohol. For at least two reasons, the first being the energetic reason, the second being if you're anything like me, there's no greater way to reduce my inhibition around food than to give me a couple of drinks. Yeah. So I start with protein, because protein is the most important in my view. And there's different ways to think about this, but I would just start by saying that the RDA, the recommended dietary allowance, is clearly incorrect, and I go to great lengths in the book to kind of explain this.

我在其他地方也写过相关内容。我做过多个关于这个话题的播客。RDA（推荐每日摄入量）建议每公斤体重摄入约0.5克蛋白质，或者0.5到0.8克左右。你知道，这基本上就是避免营养不良的最低标准。但如果我们想讨论最佳健康状态，特别是对50岁以上人群，可能需要每磅体重摄入0.8到1克蛋白质。

I've also written about this elsewhere. I've got multiple podcasts on the topic. The RDA, which offers something to the tune of point five grams of protein per kilogram of body weight, or sort of point five to point eight, I think, is the RDA. You know, that's sort of what it takes to not have malnourishment. But if we want to really talk about thriving, especially in people 50, it's probably closer to point eight to one gram per pound of body weight.

这中间存在巨大差异，对吧？以体重175磅（约80公斤）的人为例，RDA建议每天60克蛋白质就够了。而我主张这类人群应该摄入150到180克。这个差距非常大，而且持这个观点的远不止我一人——很多比我聪明得多的人都认同这个观点。

So again, that's a huge difference, right? So if you take a person who weighs one hundred and seventy five pounds or eighty kilos, the RDA would say that person can get away with 60 grams of protein. I'm arguing that person should be between about one fifty and one eighty. So it's a huge difference, and I'm certainly not saying this alone. Some some some, you know, people much smarter than me would would agree with that.

我们先明确这一点。接下来要考虑的是你的碳水化合物耐受性。你刚才提到曾佩戴过血糖监测设备，应该是连续血糖监测仪戴了几周吧？这类工具能很好帮助人们理解什么是碳水化合物耐受性。

So we start with that. The next thing I'm think I'm thinking about in the, in the formula is what is your carbohydrate tolerance? So you mentioned a moment ago that you'd you'd worn a a glucose tracking device, I assume a continuous glucose monitor for a couple of weeks. Yeah. So I think those are really helpful tools to give people a sense of what I mean by carbohydrate tolerance.

碳水化合物也非常重要——说来惭愧，我过去可能过分妖魔化它们了。但事实上，碳水化合物确实重要，它们是我们最丰富、最快速的能量来源。没有什么能比葡萄糖更快转化为ATP能量，而且它还是大脑的首选燃料。即使在完全饥饿状态下——1960年代哈佛大学的George Cahill曾研究过40天禁食的受试者（这种研究现在不可能复制了）——大脑50%的能量仍来自葡萄糖，另外50%来自酮体。

Carbohydrates are also very important, and I I unfortunately bear a tiny bit of responsibility in a in a previous life for probably demonizing them too much. But but the reality of it is, you know, carbohydrates are are are important. They're our most abundant and quickest source of energy. So there's nothing you can do to turn food source into ATP quicker than glucose, and it is the preferred fuel of our brains. In fact, even in a state of total starvation, forty days without food, which believe it or not was actually studied by George Cahill at Harvard back in the 1960s, not a study to be replicated, they had subjects that fasted for forty days, they were still getting 50% of the energy to their brain was coming from glucose, the other 50% was coming from ketones.

你可能会问饥饿时葡萄糖从何而来？这是因为在生成酮体分解脂肪的过程中，会产生一种名为甘油的副产品，它能被循环转化为葡萄糖。总之葡萄糖很重要，问题是长期过量摄入有害——短期高血糖不致命，我们更需要防范的是低血糖风险。

If you ask where does that glucose come from when you're starving, it's because making the ketones and breaking down the fat to do so creates a byproduct that gets recycled into glucose called glycerol. But anyway, glucose is important. The problem with glucose is too much of it chronically is harmful. Not acutely. Acutely, we are much more interested in protecting against the downside and not having enough of it.

低血糖会立即致命，而高血糖除非在极端情况下（如1型糖尿病）通常不会。从进化角度看，人体对150mg/dL的血糖值（比正常高50%）并不敏感。但长期高血糖的破坏力是毁灭性的。

So hypoglycemia is acutely fatal. Hyperglycemia is not outside of very extreme circumstances that can only exist if you have type one diabetes. So the body, again going back to kind of the evolutionary thing we talked about earlier, isn't really working that hard to protect you from a blood glucose of 150 milligrams per deciliter, which is about 50% higher than normal. It doesn't truly care. However, the effect of that over many years is devastating.

它会摧毁肾脏、心脏，以及体内所有具有微小血管的器官——包括大脑。这就是为什么2型糖尿病患者患大多数疾病的风险都翻倍：癌症、心脏病、阿尔茨海默症等等。

It will destroy your kidneys, it will destroy your heart, It will destroy anything in your body, including your brain, that has small blood vessels. And that's why people with type two diabetes have twice the risk of most diseases. Right? Cancer, heart disease, Alzheimer's disease, etcetera.

嗯。

Mhmm.

但这差别并不大，对吧？所以我们需要弄清楚自己的极限在哪里。我认为可以从两个角度来思考：你的平均血糖值是多少？以及你的饮食中有多大的波动性？

But that's that's not a huge difference. Right? So we have to figure out what's our limit. And I think there's sort of two ways to think about this. What's your average blood glucose, and how much variability is there in what you eat?

再说一次，你可以通过传统生物标志物来测算，也可以用连续血糖监测仪来了解。但基本上，一旦你确定了自己所需的蛋白质量，下一个问题就是：在保持这些参数的前提下，你能耐受多少碳水化合物？我对此有一些建议，但如果你想表现得非常积极，甚至想在这份报告单上拿个A+的话，我会说将平均血糖控制在每分升100毫克以下（这个数值已考虑了所有峰值和谷值）可以被视为优秀。这大约相当于5.0的糖化血红蛋白水平。那么什么因素决定这个数值呢？你的活动水平、肌肉量、胰岛素敏感性、睡眠质量、皮质醇水平，当然遗传因素也起着重要作用。

And, again, you can figure this out using traditional biomarkers, you can figure this out using a continuous glucose monitor, but basically once you figure out how much protein you need, the next question is how much carbohydrate can you tolerate while keeping yourself in those parameters? And I offer some suggestions for these, but I think if you're going to be really aggressive and have, if you want sort of an A plus on your report card here, I would say having an average blood glucose below 100 milligrams per deciliter, so that takes into account all the peaks and valleys, be considered excellent. And that would correspond to about a hemoglobin A1C of five point zero. Now, what determines that? Well, your activity level, how much muscle mass you have, how insulin sensitive you are, how well you sleep, how much hypercortisillemia is going on, genetic factors certainly play a role in it.

所有这些因素都很重要，而且对同一个人来说也会变化。比如我当年是自行车运动员时，每天可以摄入800克碳水化合物仍能保持在这个区间。但现在这个数值低得多。所以你需要了解自己的情况。最后一点是：脂肪用来填补差额，而摄入的脂肪总量本质上是个调节阀——它决定了你需要达到怎样的能量平衡。

All of these things will matter, and even for a given individual, they'll change. So when I was, you know, a cyclist, I could consume 800 grams of carbohydrates a day and still be within that band. Today, it's much lower than that. So you sort of have to know what that looks like. And then the final point is that fat makes up the difference, and the total amount of fat that goes in as basically a plug is to determine where you need to be on energy balance.

信不信由你，在相对健康的饮食中，你的食欲可以作为一个合理的制动机制来控制进食量。顺便说回你举的那个整天吃冰淇淋的有趣例子——我一直好奇的是（不知道视频里那人是否提到过）：他的饱腹感如何？换句话说，当每天摄入2000卡路里的冰淇淋时，他对其他食物有什么样的渴望？他感到满足吗？晚上睡觉时是觉得'我吃饱了'，还是因为身体实际需要更多营养而饿着肚子入睡？

So believe it or not, in a reasonably healthy diet, your appetite can serve as a reasonable backstop for how much you need to eat. And by the way, going back to the funny example you gave of the guy eating ice cream all day, one thing I'm always interested in, and I don't know if the guy talked about this in his video, is what was his degree of satiation? You know, in other words, when you're eating 2,000 calories of ice cream a day, what kind of cravings was he having for other food? And was he satiated? Did he go to bed at night feeling like I'm full, or did he kind of go to bed starving because his body was actually demanding more, but he was kind of capping it artificially?

他提到这点了吗？

Did he comment on that?

我不记得了。我记得最后的结论是他在这种饮食方式下非常痛苦。尽管体重和血脂指标有所改善，但他对自己如此不快乐感到惊讶——总之他过得并不愉快。

I don't remember. I I remember that the punchline was that he was ultimately quite miserable on this diet. I mean, he was surprised to be as unhappy as he was despite the improvements in his weight and lipid profile, but he was not having fun ultimately.

但这其中还有另一个因素，对吧，我想你之前问过类似的问题，就是

But there's another component to that, right, which I think is, you know, I think you asked earlier, like

什么

what

我们能否就什么是普遍真理达成共识？换个方式提问就是，如果把所有专家聚在一起，他们能否就现代肥胖流行的驱动因素达成一致？这是个不同的问题，但两者相关。对吧？是的。

would we agree on is universally true? Another way to ask that question is, if you had all the experts in the room, could they agree on what is the driver of the modern epidemic of obesity? So it's a different question, but they're related. Right? Yeah.

那么，为什么我们从未得到过这个问题的答案？我认为答案在于科学的本质——大多数人只研究某一条途径或某一种机制。而在肥胖问题上，我认为存在太多可能性，至少有十几种看似合理的解释。可能每个肥胖个体的成因都是由其中两三种主导因素驱动的。例如，有一种肥胖理论认为现代食物的营养密度远不如从前。这其实是我在书中很想写但没写的内容，因为实在没有足够篇幅深入探讨营养密度问题，比如土壤健康如何影响植物健康，进而影响动物健康等等。但毫无疑问，如今的食物——无论是菠菜、牛肉还是大麦——其营养成分都比百年前少得多。

Well, why have we never had an answer to that? And I think the answer is that the nature of science is that most people study one pathway or one one vehicle, and in obesity, I think there are so many that I think there are a dozen plausible explanations, and it may be that every individual who's obese is, you know, their obesity may be driven by two or three of those as the dominant drivers versus others. So for example, one theory of obesity is that our food is so much less nutrient dense than it used to be. There's this is one thing I actually didn't write about in the book that I really wanted to, but there simply wasn't enough room to get into nutrient density and to talk about, for example, soil health and how soil health impacts plant health and that how how that impacts animal health, etcetera. But there's very little doubt that the the food today, whether it be spinach or beef or barley or whatever, has fewer nutrients in it than it did a hundred years ago.

而且

And

问题在于：我们是否天生就被设定要获取特定量的营养素？随着食物营养密度的下降，我们是否只是在通过摄入更多热量来满足营养需求？这是一种观点。另一种类似观点认为：我们天生需要获取特定量的蛋白质，但随着蛋白质来源被稀释，我们不得不通过摄入更高热量的食物来满足相同的蛋白质需求。

the question is, are we intrinsically innately wired to seek a certain volume of nutrient? And as the density of our food, nutrient density of our food goes down, are we simply seeking more calories to meet our nutrient needs? That's that's an argument. There's another argument that says the same thing. We're hardwired to get a certain amount of protein, but as our sources of protein are getting diluted, we're seeking out higher and higher caloric volumes of food to meet the same protein requirements.

当然还有理论认为这完全由适口性驱动——食物越美味，我们就越容易过量摄入。所以你看，存在多种理论。也有可能这些理论都部分正确。

Other theory, of course, is that it's all driven by palatability. The more palatable the food, the more likely we are to seek it out. So you you get the idea that there's multiple theories. It's also possible they're all kind of partially right.

关于蛋白质这个问题，我认为你在书中强调的观点——正如你在这里所说——随着年龄增长，关注蛋白质摄入量变得更为重要。对于素食者或纯素食者而言，按照你定义的标准（比如每磅体重摄入一克蛋白质），获取充足蛋白质的前景如何？我意识到这个话题可能会触怒素食主义者的敏感神经，但你对随着年龄增长而完全剔除肉类甚至所有动物蛋白、同时仍能获取所需蛋白质量有何看法？

So on this question of protein, I think in your book you you emphasize, as you did here, that as you get older, it becomes even more important to focus on how much protein you're getting. What are the prospects of getting sufficient protein, as sufficient as to just defined by you, something like a gram per pound of body weight if you're a vegetarian or a vegan. I realize this is dangerous territory with respect to getting put on the radar of the vegan mafia, but what are your thoughts about cutting meat and even all animal protein out of one's diet and still getting the requisite amount of protein as one gets older?

我认为仍然可行，只是难度更大。这毫无疑问是个权衡问题。你提到的是合成代谢抵抗现象，这种情况大约从五十岁开始出现，之后确实可能呈非线性加剧。

I mean, I think it's still possible. It just gets harder. There's there's no question. It's a trade off. What you're referring to is anabolic resistance, and that kind of, you know, starts, yeah, roughly in your fifties, but but certainly increases probably nonlinearly from there.

这时你可能需要接近每磅体重一克蛋白质的摄入量，以维持最大程度的肌肉蛋白质合成——即肌肉分解与重建的过程。其重要性在于肌少症是老年人面临的重大健康问题。肌少症是指肌肉量减少的病症，伴随肌少症和虚弱而来的是极高的死亡率。我认为这堪称老龄化进程中的隐性流行病。

And that's where you probably have to start getting closer to that one gram per pound of body weight to maintain maximal muscle protein synthesis, the process by which muscle gets broken down and rebuilt. And the reason this is so important is that sarcopenia is an enormous problem of the elderly. Sarcopenia is the disorder of low muscle mass. And with sarcopenia and frailty comes enormous mortality. I think this is actually kind of the hidden epidemic of aging.

我在书中确实写过相关内容，不过在运动章节讨论得更多些：当人年过65岁后，如果跌倒导致髋部骨折——山姆，我敢说现在听我们说话的听众里，没人不认识遭遇过这种情况的亲友对吧？比如朋友母亲之类的。上周我就接诊过两位父母经历此事的患者。65岁以上人群若发生股骨颈或股骨骨折，未来12个月内死亡概率高达15%至30%。即便存活下来（即那70%到85%的幸存者），其中50%的人余生将面临行动能力全面下降。

You know, do write about this, but I think I write about it a little bit more in the exercise chapter, which is once a person reaches the age of 65, if they fall and break their hip, and I can't imagine there's a person listening to us speak now, Sam, who doesn't know somebody for whom that's happened, right? It's like, oh, my friend's mother or somebody, right? I I've literally talked to two patients in the last week who have had parents go through this. So if you're over the age of 65, you fall and break your femoral neck or your femur, there's a fifteen to thirty percent chance you will be dead in the next twelve months. And if you don't die in the next twelve months, of those who survive, meaning of the seventy to eighty five percent who survive, there's a fifty percent chance you will have a full scale reduction in your mobility for the remainder of your life.

具体来说：若事发前能自由行走，此后将终身依赖拐杖；若原本使用拐杖，则将升级到助行器，最终可能沦落至轮椅。跌倒导致的意外死亡已成为75岁以上人群的首要意外死因，其严重程度甚至超过65岁以上人群的意外用药过量。而多数人现在应该知道，用药过量已成为65岁以上人群最常见的意外死因，超越了交通事故。综上所述，虚弱和肌少症不仅是死亡证明上的冰冷数据，更因其对健康寿命的掠夺而成为重大社会问题。

Meaning, if before this incident you walked freely, you will forever be using a cane. Before this incident you were using a cane, you will be in a walker, etcetera etcetera, all the way down to a wheelchair. So accidental deaths due to falling is the leading cause of accidental death for people over the age of 75 at a level that exceeds even what we see for accidental overdose for people 65. And I think most people are probably now aware that accidental death due to overdose has become the most common cause of accidental death for people 65, eclipsing even automotive accidents. So, with all of that said as the background, frailty and sarcopenia are an enormous problem, and not just because of what they do showing up on death certificates, but because of how much they rob people of health span.

即便不致命，它也足以毁掉你人生最后十年。因此解决之道就是尽可能增加肌肉量、增强力量、保持体态。我常开玩笑说——但这是事实——纵观人类历史，山姆，现在全球有80亿人口，在我们之前存在过的总人口又有多少亿呢？

So even if it doesn't kill you, it can easily ruin the last decade of your life. So with all that said, the antidote to this is to have as much muscle as possible to be as strong as possible to be as fit as possible. I make this joke all the time, but it's true. In the entire hit I mean, how many people have existed, Sam? Do we have it's like there's 8,000,000,000 now.

是不是还有约

How many billion were there before us? Isn't there about another

我认为大约是1100亿。

I think it's about a 110,000,000,000.

好吧。我愿意打赌，虽然我不知道我们如何验证这一点，但我敢说在1000亿人的整个历史中，临终前绝不会有人说‘我希望肌肉少点’或‘我希望自己不那么强壮’。这根本不可能。

Okay. I'm willing to bet, and I I don't know how we could ever verify this, but my bet would be in the entire history of that 100,000,000,000 people, I would bet that no one in the final days of their life said, I wish I had less muscle. Mhmm. I wish I was less strong. It it's simply not possible.

因此蛋白质摄入是维持肌肉量的关键因素，当然抗阻训练也是。回到你的问题：一个在道德或哲学上不愿吃肉、不愿摄入动物蛋白的人能否避免肌肉减少症？我认为答案是肯定的，但他们必须承认这条路会更艰难——意味着他们需要在饮食上比你我更费心思。如果我们愿意摄入肉类和动物制品的话。

So protein intake is an essential component of maintaining muscle mass, and of course resistance training is as well. So to your question, can a person who morally or philosophically philosophically doesn't wanna consume meat or who doesn't wanna consume animal protein still, you know, avoid sarcopenia? I think the answer is yes, but they have to acknowledge that they're in for a harder ride, meaning they're going to have to work harder at eating than maybe you or I do Mhmm. If we're willing to consume meat and animal products.

关于保留肌肉量这个问题，我想有两个疑问。其中一个实际上对进化论提出了潜在谜题：当你停止进食、开始禁食甚至挨饿时，既然依赖脂肪储备是进化允许的，为什么身体不会系统性地保留肌肉直到脂肪耗尽？据我理解，禁食期间确实存在显著风险会导致瘦肌肉量流失。

Yeah. On this issue of sparing muscle mass, mean, so there's this, I I guess, two questions. Well, one actually has a potential poses a potential puzzle with respect to evolution. So when you just stop eating, when you start fasting and and even start starving, and you rely on your fat stores, yeah, as evolution has permitted, why doesn't that reliance spare muscle systematically until you lose all your fat? I mean, my understanding is if you if you start fasting, there is some considerable risk that you you are going to be losing lean muscle mass during that fast.

为什么会这样？进化本应认识到更多肌肉对各方面都有益，而脂肪储备的存在正是为了在这种情境下被利用。那为什么不能系统性地优先保留肌肉呢？

Why is that? It seems like evolution would have recognized that that more muscle is generally better for all sorts of things, and the fat store has been put there for a reason to be utilized in under just these circumstances. So why why doesn't it just spare muscle systematically?

这是个很好的问题。当低于特定热量阈值时，我们会动用蛋白质供能。比如每天只摄入1000卡路里且全部来自250克蛋白质（约1000卡路里），这样虽然会减重，但肌肉也可能流失。那么原因何在？

Yeah. It's a it's a great question. So below a certain calorie threshold, we will use protein for energy. So for example, if if you went on a thousand calorie a day fast, but that thousand calories was 250 grams of protein, right, so 250 grams of protein is about a thousand calories, you'd lose weight, but you'd probably lose muscle as well. So so so why is that?

首先，身体确实拥有防止肌肉完全消耗的非凡机制——酮症。之前提到的糖原是葡萄糖的储存形式，像你我体型的人大约能储存400克碳水化合物：肌肉中约300克（1200卡路里），肝脏中100克。若不进行其他调整，这些能量仅够维持一天。

Well, first of all, the body does have a pretty remarkable tool to prevent the complete emaciation of muscle, and that is ketosis. So earlier I mentioned glycogen, which is the storage form of glucose. So we can store, I don't know, somebody your size or my size, Sam, we could probably store 400 grams of carbohydrates. So you could probably put 300 grams of glucose into your muscles, so that's about 1,200 calories, and you can put another 100 into your liver. And by itself, if you never made any other tweak to the system, that's like a day's worth of energy.

显然，我们经常需要超过一天不进食，至少我们的祖先是这样。这时候你最不该做的就是立即开始消耗肌肉。因为如果这样做，肌肉会以极快的速度分解。换句话说，如果我们分解肌肉获取氨基酸，并将这些氨基酸输送到肝脏进行糖异生过程，就会用肌肉制造葡萄糖。我得计算一下具体数值——虽然从未算过——但估计只需一周左右你就会完全垮掉。

Obviously, lots of times when we need to go more than a day without eating, as as, you know, sort of our ancestors at least did. So what you don't wanna do at that point is immediately start tapping muscle. Because if you did, you would break down muscle in a in a really rapid fashion. So in other words, if we broke down muscle for amino acids and sent those amino acids to the liver to undergo a process called gluconeogenesis, we would make glucose out of the muscle. I'd have to do the math on it, I've never done it, but I think it would be just a matter of a week or so until you'd be completely broken down.

所以

So

虽然这种情况确实会发生，但更多是因为我们没有为肌肉蛋白质合成提供新的氨基酸。我们不断分解肌肉，部分用已分解的肌肉氨基酸替代，部分用摄入的新氨基酸替代。实际上，唯一能在研究中厘清这个问题的方法就是进行标记研究——给人们带有示踪剂的氨基酸，这样就能区分肌肉蛋白质合成中有多少来自外源性氨基酸，多少来自内源性氨基酸，结果你会发现两者共同构成了氨基酸池。

while that is happening somewhat, it's more happening because we are not providing new amino acids for the muscle protein synthesis. So we constantly break down muscle and replace it partially with amino acids that we already have break broken off muscle, and partially with new amino acids that we're eating. So it's actually a very the only way you can tease this out, by the way, in research is to do labeled studies. So you give people amino acids that have tracers on them Yeah. And then you can distinguish between how much of the muscle protein synthesis is coming from the exogenous amino acids versus the endogenous amino acids, and what you realize is it's actually a pool of both.

不知道听众是否听明白了。我想你应该理解我的意思。简而言之，在饥饿状态下，你失去了外源性氨基酸池这一半来源，只能依靠内源性氨基酸池进行肌肉蛋白质合成，这就是为什么会出现肌肉流失。但这已经好得多，至少你没有通过糖异生作用消耗肌肉来制造葡萄糖——那将是一场灾难。

So I don't know if I'm making sense to the listener. I I think you understand what I'm saying. But basically, in a form of starvation, you've taken away half of your amino acid pool, which is the exogenous pool, and you're only able to then rely on the endogenous pool for muscle protein synthesis, and that's why you will experience muscle wasting. But that's far better because at least you're not using muscle to then make glucose via gluconeogenesis. That would be a catastrophic problem.

所以你的问题本质可能是：为什么人体没有进化出不需要外源性氨基酸就能进行肌肉蛋白质合成的机制？但说实话，这就像在问'我们为什么需要食物'一样。

So I guess what your question is is, why hasn't the body figured out a way to undergo muscle protein synthesis without exogenous amino acids? But honestly, I think that's sort of like asking, why do we need food?

嗯。那么，我们最后谈谈禁食和限时进食的营养学话题吧，我知道你个人做过很多相关实验，很多人也把这视为减少热量摄入的方法——通过缩短进食时间窗口来避免长期处于热量过剩的毒性状态。你现在对此有什么看法？

Mhmm. Mhmm. So, yeah, let's touch this final topic under nutrition of of fasting and time restricted eating, because I know you've experimented a lot with this personally, and many people are interested in this as just a a way of reducing caloric intake. I mean, just shrinking the time window in which you eat as a strategy for not not living with this with a toxic surplus of calories. What are your thoughts on this now?

我猜这显然与长寿研究的某个方向相关，在所有被研究过的物种中，热量限制似乎都与长寿相关。你现在如何看待这个现象？

And I guess you've obviously, it connects with a certain strand of research in on the topic of longevity, where caloric restriction has, I think across, you know, every species in which it's been looked at, shown to be correlated with longevity. How do you think about this now?

所以我想把这一切放在更广泛的问题背景下讨论。对吧？如果问题是当一个人营养过剩时该怎么办——我认为这只是技术性地表示他们储存了过多能量，超过了效用点，现在这些能量溢出到其他区域造成问题，比如脂肪渗入器官间隙，直接进入肌肉，进入胰腺，这些都是有毒的，对吧？它具有炎症性，会增加胰岛素抵抗，从而加剧问题。解决方法是减少能量输入，对吧？

So I guess I would just sort of put this all in the context of the broader problem. Right? So if the problem is what do you do in the case when an individual is overnourished, which I think is just kind of a technical way to say they have too much stored energy and it is exceeding the point of utility, and it's now, that energy is spilling over into other areas and causing problems, so that fat is spilling into the space between their organs, it's getting into their muscles directly, it's getting into their pancreas, and it's toxic, right? It's inflammatory, it increases insulin resistance, which exacerbates the problem, all of these things. The solution to that is reduction of energy input, right?

因此在这种情况下必须制造热量缺口。大致来说有三种方法。第一种是直接日复一日、分秒必争地考虑减少摄入量。就像我们刚才讨论的例子——比如我每天摄入3000卡路里，但需要减脂。

So you have to create a caloric deficit in that situation. Broadly speaking, there are three ways to do that. The first is to directly, day in and day out, minute by minute, think about reducing intake. So that's the example I think of, you know, what we've just been talking about, right? It's like, I've been, you know, I eat 3,000 calories a day and I I need to I need to lose fat.

就必须降到2500卡。我会追踪这些宏量营养素，每天严格控制在2500卡。第二种方法是饮食限制。制定限制性饮食，尽可能排除多种食物，限制性越强越容易造成能量失衡。比如只吃生菜沙拉显然限制性不足。

I have to reduce that to 2,500. I'm gonna track those macros and make and count up to 2,500 calories a day. The other way to do it is dietary restriction. Come up with a restrictive diet and focus on, you know, excluding as many things as possible, and if you the more restrictive that diet, the more likely you are to achieve energy imbalance. So, you know, if you go on the no lettuce diet, it's not gonna be very restrictive.

这样不会减重。但如果采用纯土豆饮食，几乎肯定会瘦。第三种策略就是你提到的时间限制——将进食窗口压缩到足够窄，最终自然形成能量缺口。所以热量限制是直接方法。

You're not gonna lose weight. But if you go on the potato only diet, you almost assuredly will lose weight. Now the third strategy is what you're talking about, which is time restriction. Just create a narrow enough window in which to eat such that at some point, the window becomes narrow enough that you're going to create an energy deficit. So calorie restriction is the direct way to do it.

而饮食和时间限制是间接方法。大约六七年前我曾认为——因为当时缺乏数据——时间限制除热量缺口外还有额外益处。也就是说，我原以为每天禁食18-20小时本身就能带来独立于热量缺口的代谢好处。但过去两三年至少有两项对照研究推翻了这种观点，它们证明：第一，时间限制饮食的所有益处似乎都源于热量减少。

Dietary and time restriction are the indirect ways to do it. I was sort of, I would say probably six, seven years ago, of the view, because we really didn't have the data at the time, that thought there was something beneficial to time restriction beyond the caloric deficit. In other words, I believed that the act of not eating for eighteen to twenty hours per day in and of itself brought a metabolic benefit independent of the caloric deficit. I would say that that view has been refuted by at least two studies in the past three years, two years, that have, when controlling for intake, demonstrated two things. The first is that actually all of the benefits of time restricted feeding seem to come down to the reduction in calories.

但更重要的发现是，时间限制饮食可能存在弊端——许多人在狭窄窗口期内无法摄入足够蛋白质。虽然体重下降，但肌肉流失比例可能过高。

But a more important finding has been that there may actually be a downside to time restricted feeding, which is that many people are incapable of consuming sufficient enough protein in that window. And while they do lose weight, they may disproportionately be losing muscle.

有意思。稍微回溯一下——关于特定食物的限制，你认为存在代谢魔法吗？比如有人采用纯肉饮食就能减肥。如果强调某一宏量营养素，归根结底是否仍只是热量平衡问题？某些限制性饮食的减重效果，是否存在超越基础热量物理学的代谢机制？

Interesting. Just to backtrack for a second. So the restriction of specific foods, do you think there's any metabolic magic there where you hear someone who's, you know, you know, on a an all meat diet, say, and they're they're losing weight versus any other strategy. If you are emphasizing one macro over another, do you think it isn't, at the end of the day, just a matter of calories in with respect to, you know, energy balance? Is it just is is there metabolism working above the mere caloric physics that accounts for weight loss on certain restricted diets?

我不这么认为。现在回想你最初提出的关于营养的问题，我们显然需要保持谦逊，承认我们正在讨论未知领域。但根据现有文献，我的直觉是从能量平衡的角度看，卡路里就是卡路里。

I don't think so. And I do think now we're clearly if we go back to the way you posed the questions at the outset of our discussion vis a vis nutrition, I think we are clearly in the area where we need to have a lot of humility and and just acknowledge we're now speaking in the unknowns. But but my intuition, based on the existing body of literature, is that from an energy balance perspective, a calorie is a calorie.

对。

Right.

因此我不认同这种观点，因为唯一可能的例外是影响能量消耗。嗯。那么身体代谢这些卡路里和那些卡路里是否不同？简而言之，确实存在细微差别。

So I do not believe that we are because because the only way that it's not is to say you are impacting energy expenditure. Mhmm. So does the body metabolize these calories different from those calories? And and and the short answer, I guess, is yes. There's a little bit of that.

食物存在热效应现象——分解蛋白质比分解碳水化合物和脂肪需要更多能量。所以代谢效率会略有折扣。至于这是否解释肉食性饮食（通常由三分之一蛋白质和三分之二脂肪构成）带来的显著减重效果？

So there's something called the thermogenic effect of food, where we require more energy to energize, to break down protein than we do carbohydrates and fats. Right. And so there is a slight discount metabolically that comes from that. Do I think that that is why a carnivore diet being basically, I don't know, it depends on what kind of meat you consume, but a carnivore diet could easily be one third protein, two thirds fat from a macro perspective. Do I think that that explains the profound weight loss that people experience when they experience it on a carnivore diet?

我不这么认为。真正原因应该是摄入量减少。但这里涉及关键点：饱腹感。这是最难研究的因素，因为在严格控制的研究中需要定量喂食，反而掩盖了饱腹感变化的影响。而现实中，饱腹感可能是决定长期依从性的最重要因素。

I don't think so. I think that really comes down to just reduced intake. But this gets to an important point, right, which is the point of satiety. And this is the hardest thing to study because, you know, if you're doing a really well controlled study, you actually want to feed people prescribed amounts of food, thereby ignoring or negating the benefits or disadvantages of a change in satiety. But in the real world, satiety might be the single most important factor in determining long term compliance.

对吧？我不相信大多数人能长期忍受持续饥饿。虽然有人能做到，但绝非普遍现象。因此社会性能量失衡的根源必然与饱腹感有关。

Right? Right. I I I don't believe that most people can exist in a state of perpetual hunger day in and day out. Clearly, people can, but I don't think that's the norm. And therefore, whatever is at the root of the societal energy imbalance we have must have at its basis something to do with satiety.

除非你认为人类只是无意识的进食机器。而我还不准备完全接受这个观点。所以你刚好...

Unless you believe people are just mindless eating machines. And I I'm just not sure I'm ready to fully concede that point yet. So Do you happen

了解那些将热量限制原则推向极致的人们的体验是怎样的？我是说，我知道有食品科学家、医生和其他一些人已经认定数据确凿。我们知道老鼠会发生什么，知道酵母菌会发生什么。如果将热量摄入降至绝对最低维持水平，寿命会大幅延长。

to know what the experience is of people who have taken the caloric restriction principles to a proper extreme? I mean, I know there are food scientists and doctors and a few other people who have decided that the data are in. We know what happens to mice. We know what happens to yeast. If you dial down the calories to the absolute minimum maintenance level, you increase lifespan by an enormous amount.

所以有些人过着这样的生活，我不知道他们的热量上限是多少，可能是1500卡路里左右。他们常年坚持这种极度节制的饮食。他们的体验是持续感到饥饿，还是身体会重新调整，感受到某种正常的饱足感？

And so there are people walking around, you know, I don't know what their caloric ceiling is, maybe something like 1,500 calories. They're they're living on a diet that abstemious for years at a stretch. Is their experience one of being perpetually hungry, or do they do they reset and experience kind of a normal level of satiety?

我没有研究过他们。只是从一些轶事中略知一二，我有几位同事甚至参加过他们的会议并发言，因为确实存在热量限制社团，这些人做的正是你所描述的事情。我想他们每日摄入量可能更接近1800到2000卡路里。

I haven't studied them. I I know anecdotally a little bit just from I have, you know, a couple of colleagues who have even gone and spoken at their conferences because there are societies of CR out there. There's caloric restriction societies of people who do exactly what you're describing. You know, I think it's probably closer to 1,800 to 2,000 calories per day.

嗯。

Mhmm.

但，是的，我认为这是个有趣的问题。实际上那里有两个有趣的问题对吧？至少两个。对吧？

But but, yes, I think it's it's an interesting question. I mean, there's two interesting questions there. Right? So the the least two. Right?

第一个问题是：他们的主观生存状态如何？是否时刻想着食物？我要说，我确实和许多健美运动员聊过，他们在减脂期的热量摄入就是那个水平。是的。

So one is, what is their subjective state of existence? Are they constantly thinking about food? I will say this. I've definitely spoken to a lot of bodybuilders, and that's about the amount of calories they're on during a cutting phase. Yeah.

山姆，我从没遇到过哪个健美运动员不说自己在那个阶段想结束生命的。

And Sam, I've never spoken to one of them who hasn't said that they don't wanna end their life during that phase.

是的。是的。

Yeah. Yeah.

那么现在，再次强调，你可以争辩说，他们只进行了十二周的研究，可能这段时间不足以适应，而且他们对自己要求很高，因为在这期间必须坚持锻炼。所以这不是一个完全对等的比较，但这是第一个问题。我认为更重要的问题是，尽管学术上很有趣，但他们采取的严厉措施是否能转化为目标物种（即人类）寿命和健康寿命的改善？你所说的都是事实，对吧？我们知道在实验室环境下，酵母、蠕虫、果蝇和啮齿动物在热量限制（CR）条件下会活得更长。

So now, again, you could argue, well, they're only doing that for, you know, twelve weeks, and maybe that's not long enough to acclimate, and they're also asking a lot of themselves because they have to exercise during that period of time. So so that's not an apples to apples comparison, but that's question one. I think the more important question, in as much as it's academically interesting, is does the draconian step that they're taking translate to an improvement in lifespan and healthspan for the species of interest, which is humans? So everything you said is true, right? We know that yeast and worms and fruit flies and rodents, at least in a laboratory environment, will live longer under CR conditions.

但我们不知道这是否适用于现实世界中的人类。正如我在书中可能用了半章篇幅讨论的那样，当我回顾美国国立卫生研究院（NIH）威斯康星国家老龄化研究所（NIA）对恒河猴的实验时，结果甚至不清楚CR在那里是否有益。

But we don't know if that's true for humans who live in the real world. And as I devote probably half a chapter to in the book, when I go through the NIH Wisconsin NIA experiment with rhesus monkeys, it turned out to not even be clear that CR was beneficial there.

是的。你提到酒精作为第四种宏量营养素。我本想以生活方式为主题询问你这个问题，但或许我们可以在这里讨论。可能已经过去十到十五年了，自从出现了一批关于酒精健康益处的乐观文章，其中一些我认为，回想起来，是由酒精行业赞助的。这并不是说利益冲突总是证明科学有问题，但我们对酒精的健康影响了解多少？

Yeah. You mentioned alcohol as a fourth macro here. I was gonna ask you about it under the heading of lifestyle, but maybe we'll just discuss it here. Is maybe it's been ten, fifteen years since the emergence of a kind of cottage industry in hopeful articles about the health benefits of alcohol, some of which I think, in retrospect, were sponsored by the alcohol industry. It's not to say that a conflict of interest always proves that the science is bad, but what do we know about the health impacts of alcohol?

或许我们可以将其简化为一个个人结论。我的意思是，你自己是如何处理这个问题的？你决定在自己生活中接受怎样的风险回报权衡？

And perhaps we can boil it down to kind of a personal punchline. I mean, just how how is it that you approach this yourself personally? What have you decided is the the risk reward trade off that you're comfortable with in in your own life?

是的。我的意思是，我会直接给你我的个人答案，然后我可以解释或辩护，或者说明为什么它可能不合逻辑。所以我的观点是我确实继续饮酒。但从风险角度来看

Yeah. I mean, I'll just give you my answer for me, but then I can sort of explain it or defend it or explain why it might be illogical. So so my view is I do continue to consume alcohol. But I think from a from a risk standpoint

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