我们为何会生病

这对人类当然也是相关的。

And this is relevant to humans, of course.

这主要与我们的睡眠习惯有关，因为睡眠质量差会导致压力激素升高，即使只有一晚睡眠不好，也会导致胰岛素抵抗。

It's mostly relevant to our sleep habits because bad sleep leads to elevated stress hormones, and that will in fact cause insulin resistance even after one bad night of sleep.

幸运的是，一晚好觉就能纠正这个问题，但这只是说明了压力激素的相关性。

Now, thankfully, one good night of sleep can correct it, but it just touches on the relevance of the stress hormones.

所以压力是一个主要原因。

So stress is a primary cause.

另一个原因是炎症。

Another one is inflammation.

现在，炎症这个词几乎成了陈词滥调。

Now inflammation is a term that it's almost cliche.

如今它被频繁使用，而我在这里是谨慎使用的。

It's thrown around so often these days, and I I'm using it quite carefully.

因此，细胞内这些所谓的炎症通路的激活，或者说是激活这些免疫相关通路的生化过程，会在细胞、啮齿动物和人类中引发胰岛素抵抗，因此它是一个主要原因。

So the activation of these what we could call inflammatory pathways within cells or these but the biochemical process of activating these immune related pathways will cause insulin resistance in cells and rodents and humans, and so it's a primary cause.

这一点在自身免疫性疾病中最为明显：如果某人患有自身免疫性疾病，且该病在一段时间内活跃或剧烈发作（因为这类疾病通常会时好时坏），那么胰岛素抵抗就会非常明显。

And this is, most obvious in conditions of autoimmune diseases where if someone has an autoimmune disease and the autoimmune disease is very active or aggressive for a period of time because it tends to ebb and flow, then the insulin resistance will be quite pronounced.

当自身免疫性疾病缓解一段时间后，胰岛素抵抗也会随之减轻，人体重新恢复对胰岛素的敏感性。

Then as the autoimmune disease subsides for a time, so too does the insulin resistance and they're insulin sensitive again.

我不会过多展开这些，因为它们很难控制。

Now, I don't elaborate on those too much because it's hard to control them.

如果你跟别人说，‘降低压力，减少炎症’，他们可能会说：‘谢谢，道理我都懂。’

If, you know, you're talking to someone and you say, well, lower your stress and lower your inflammation, they say, well, thanks.

说起来容易，做起来难。

Know, easier said than done.

现在最突出、最不容忽视的问题，就是我们吃的食物。

The thing that is very potent now is the elephant in the room, and that's the food we eat.

本质上，问题在于我们创造了一种饮食方式和进食模式，导致我们的胰岛素全天持续飙升。

Essentially, the problem is we have created a diet and a way of eating that is spiking our insulin all day.

普通人早上醒来时，经过一夜的代谢，胰岛素水平已经下降，身体也变得更加胰岛素敏感，事实上进入了一种更高的脂肪燃烧状态，因此一些人醒来时可能处于轻微的生酮状态。

So the average individual wakes up in the morning, and overnight, insulin has been coming down and helping the body be a little more insulin sensitive and and frankly get into a higher state of fat burning, which is why some people may be in a very mild state of ketosis upon waking.

但可悲的是，我们做了什么？

And, tragically, what do we do?

早餐实际上已经变成了一种甜点，我们吃的是淀粉和糖分都很高的早餐。

Well, breakfast has become basically a dessert, and we eat a starchy, sugary breakfast.

可能是某种淀粉和糖分高的麦片、淀粉面包、淀粉吐司、含糖橙汁，或者加了大量糖的咖啡，这些都会迅速推高我们的胰岛素水平。

It's some starchy, sugary cereal or a starchy bagel or starchy toast or sugary orange juice or something or a sugar loaded coffee, we then spike our insulin rapidly.

我们知道，这种会推高胰岛素的早餐——也就是说，已经有临床研究在人类身上证实了这一点。

And we know that an insulin spiking breakfast, and by that, I mean, there are there's clinical studies to prove this in humans.

通过早餐推高胰岛素，我们会更快地再次感到饥饿。

By spiking insulin for breakfast, we have quicker return to hunger.

所以我们更早地感到饿。

So we get hungrier sooner.

那么两三个小时后，他们会怎么做？

And so then two or three hours later, what do they do?

他们再次推高胰岛素水平。

They spike their insulin again.

就在胰岛素达到峰值即将下降时，我们又用一份淀粉类上午零食再次推高了它。

Right as insulin was cresting and about to come down, we spike it again with a starchy mid morning snack.

就在胰岛素即将下降时，我们又用午餐把它推上去，下午、晚餐，甚至晚上吃零食时也反复如此。

And right when insulin's about to come down, we bump it up again with our lunch, and we do it again in the afternoon, again for dinner, and again throughout the evening with our snacking.

因此，普通人 waking 的每一刻都处于胰岛素升高的状态，甚至可能有一半的睡眠时间也是如此，因为胰岛素需要几个小时才能回落。

So the average person is living every moment of their waking life in a state of elevated insulin and frankly, into maybe half of their sleeping time too because insulin will take a few hours to come back down.

这种长期升高的胰岛素水平是胰岛素抵抗的主要诱因。

And that chronically elevated insulin is a primary driver of insulin resistance.

当然，我认为这确实指向了我们过量摄入精制碳水化合物的问题。

And of course, that I think really does point the finger at our excessive consumption of refined carbohydrates.

我们稍作短暂休息，插播一段赞助商广告。

We're going take a quick break for you Words From Our Sponsors.

我在健身和健康方面学到的一点是，坚持至关重要。

So something that I've learned with fitness and health is that consistency is key.

我发现，只要把基础事情简化，我就能坚持我的计划。

I found that if you make the basics easy, I stick with my plan.

如果太复杂，我就不会做。

If it's complicated, I won't.

Kochava 在这方面真的帮了我大忙。

That's where Kochava has really helped me.

当我没多少时间的时候，它就成了我运动后首选的快速餐。

It's become my go to quick post workout meal when I don't have much time.

我会在摇杯里加两勺，只用清水，摇一摇就搞定。

I'll do two scoops in a shaker with just water, shake it up, and I'm good.

我最喜欢 Kochava 的巧克力味。

My favorite flavor they have from Kochava is the chocolate one.

虽然很普通，但味道真的很好。

It's standard, but it tastes really good.

Kochava 是一种全营养饮品，采用高品质成分制成，不含人工香料、色素或甜味剂，只有纯净的营养。

Kochava is an all in one nutrition shake made up with high quality ingredients, no artificial flavors, colors, or sweeteners, just clean nutrition.

两勺提供 25 克植物蛋白和 6 克膳食纤维。

Two scoops gives you 25 grams of plant based protein, six grams of fiber.

它还含有绿叶蔬菜、适应原、电解质以及关键的维生素和矿物质，有助于提升能量、促进消化、加速恢复并支持整体健康。

It also has greens, adaptogens, electrolytes, and key vitamins and minerals to support energy, digestion, recovery, and overall wellness.

Kachava方便快捷，味道好，让我更容易坚持目标。

Kachava is quick, it tastes good, and it makes sticking with my goals easier.

坚持你的健康目标。

Stick with your wellness goals.

访问 kachava.com，使用代码 MANLINESS 可享受首单15%折扣。

Go to kachava.com and use code MANLINESS for 15% off your first order.

这就是 Kachava。

That's Kachava.

拼写是 kachava.com，代码 manliness，首单可享15%折扣。

That's spelled kachava.com code manliness and get 15% off your first order.

再次提醒，kachava.com，代码 manliness。

Again, kachava.com code manliness.

Duck.ai 是 DuckDuckGo 推出的一款新产品，其设计理念很简单。

Duck.ai, a new product from DuckDuckGo is built around a simple idea.

人工智能很有用，但你的隐私不应该是使用它的代价。

AI is useful, but your privacy shouldn't be the price of admission.

所以我认为我们都做过这种事。

So I think all of us have done this.

我们发现自己在AI聊天中输入一些私密内容时，会开始想：我真的希望这些内容永远被存储起来吗？

We catch ourselves typing something personal into an AI chat and we start thinking, do I really want this stored somewhere forever?

这种犹豫正是DuckDuckGo推出duck.ai的原因。

That hesitation is exactly why DuckDuckGo built duck.ai.

你访问duck.ai，就可以在一个地方私密地与ChatGPT和Claude等主流AI模型聊天。

You go to duck.ai and you can chat privately with popular AI models like ChatGPT and Claude all in one place.

你的聊天记录不会被用于追踪、训练或画像分析。

Your chats aren't used for tracking, training, or profiling you.

无需注册账户，而且完全免费。

There's no account required, and it's completely free.

Duck dot ai来自DuckDuckGo，这家公司自2008年以来一直专注于隐私保护。

Duck dot ai is from DuckDuckGo, the company that's been focused on privacy from 2008.

Duck.ai 专为数据保护而设计，而非数据收集，无需注册，无需订阅，无需学习成本。

Duck.ai is built for data protection, not data collection, no sign ups, no subscriptions, no learning curve.

只需访问 duck.ai 并开始聊天即可。

Just go to duck.ai and start chatting.

你甚至可以在 DuckDuckGo 应用程序内使用它，其中 AI 始终是可选的。

You can even use it inside the duck duck go app where AI is always optional.

再次强调，duck.ai 让你可以私密地使用流行的 AI 聊天工具，而且完全免费。

Again, duck.ai lets you use popular AI chat tools privately and it's free.

如果你想在不放弃隐私的前提下使用 AI，请立即访问 duck.ai/manliness。

If you want to use AI without giving up your privacy, go to duck.ai/manliness today.

那就是 duck.ai/manliness。

That's duck.ai/manliness.

这是来自 DuckDuckGo 的私密 AI 聊天方式，AI 始终可选且私密。

It's a private way to chat with AI from DuckDuckGo where AI is always optional and private.

我已经使用 Leesa Superior Chill Hybrid 床垫将近一年了，我可以诚实地讲，这确实是一次显著的升级。

So I've been sleeping on the Leesa Superior Chill Hybrid mattress for almost a year now, and I can honestly say it was a solid upgrade.

我睡觉时容易出汗。

I tend to sleep hot.

我晚上经常翻身，所以需要一种不会积热、早上不会让我被被子缠住的床垫。

I move around a lot at night, so I need something that wouldn't trap heat or leave me feeling twisted up in the morning.

Leesa的Superior Chill Hybrid床垫采用散热绗缝表层，下方是减压泡沫和弹簧，既能提供舒适的柔软感，又有真正的支撑力。

The Superior Chill Hybrid mattress from Leesa has this heat dissipating quilted top plus pressure relieving foam and springs underneath, so you get that comfortable cushion with real support.

躺下时感觉凉爽，整晚都保持这种状态。

It feels cool when you lie down, and it stays that way throughout the night.

我醒来时身体舒展，不会僵硬。

I wake up feeling aligned instead of stiff.

Leesa床垫在美国设计和组装，提供免费配送、便捷退货和120晚试睡服务。

Lisa mattresses are designed and assembled in The United States, and they come with free shipping, easy returns, and a one hundred and twenty night sleep trial.

他们每年还会向需要帮助的人捐赠数千张床垫。

And they donate thousands of mattresses each year to people in need.

现在就访问lisa.com，在春季促销中享受床垫8折优惠，并使用优惠码AoM再减50美元。

Go to lisa.com right now for 20% off mattresses during their spring sale, plus get an extra $50 off with promo code AoM.

这是专为AoM听众提供的优惠。

This is exclusive for AoM listeners.

就是lisa.com，leesa.com。

That's lisa.com, leesa.com.

在他们的春季促销期间，您可以享受床垫八折优惠。

You'll get 20% off your mattresses during their spring sale.

此外，如果您使用优惠码AoM，还可以额外减免50美元。

Plus, if you use code AoM, you'll get an extra $50 off.

下单后请向他们表明是我们推荐的，以支持我们的节目。

Show your support for our show and let them know we sent you after checkout.

访问lisa.com，使用优惠码AoM。

That's lisa.com, promo code AoM.

当我年轻的时候，我犯过很多愚蠢的财务错误。

So when I was younger, I made a lot of dumb financial mistakes.

我总是把账户余额卡得死死的，忘了账单会扣款，结果一眨眼就透支收费。

I'd cut it close to my accounts, forget what was coming out of my account, and then boom, overdraft fee.

我觉得自己因为不够完美而受到惩罚。

I felt like I was getting penalized for not being perfect.

老实说，我年轻的时候如果能有像Chime这样的服务就好了。

Honestly, my younger self would have benefited from something like Chime.

Chime正在改变人们的银行业务方式。

Chime is changing the way people bank.

免费且更智能的银行服务，专为你设计，而不是像传统银行那样收取透支费、月费和最低余额费。

Fee free and smarter banking built for you, not like old school banks that charge overdraft fees, monthly fees, and minimum balance fees.

Chime不仅仅是一个银行应用。

Chime isn't just another banking app.

他们为普通人提供了更智能的银行服务。

They unlock smarter banking for everyday people.

你可以免费银行，获得可靠的透支保护，甚至在储蓄上获得高达3%的年利率。

You can bank free free, get overdraft coverage you can count on, and even earn up to 3% APY on savings.

这比传统银行高出七倍。

That's seven times higher than a traditional bank.

他们的新Chime卡允许您用自己的资金和符合条件的直接存款来建立信用记录，并在符合条件的消费中获得1.5%的现金返还。

And their new Chime card lets you build a credit history with your own money and with qualifying direct deposits, earn 1.5% cash back on eligible purchases.

无年费，无利息，无附加条件。

No annual fees, no interest, no strings attached.

Chime不仅仅是更智能的银行服务，它还是最值得回报的银行方式。

Chime is not just smarter banking, it's the most rewarding way to bank.

加入数百万已经享受免手续费银行服务的人群吧。

Join the millions who are already banking fee free today.

前往 chime.com/manliness。

Head to chime.com/manliness.

这就是Chime，chime.com/manliness。

That's Chime, chime,.com/manliness.

注册只需几分钟，AoM播客听众最高可额外获得350美元。

It only takes a few minutes to sign up, and AoM podcast listeners can earn up to an extra $350.

这就是 chime.com/manliness。

That's chime.com/manliness.

Chime是一家金融科技公司，不是银行。

Chime is a financial technology company, a not bank.

银行服务和受保障的Chime Visa信用卡由Bancorp银行NA或Stride银行NA提供。

Banking services and the secured Chime Visa credit card are provided by the Bancorp bank NA or Stride Bank NA.

可选服务和产品可能收取费用。

Optional services and products may have fees or charges.

请查看chime.com/feesinfo。

See chime.com/feesinfo.

适用条款。

Terms apply.

限时有效。

Limited time only.

必须开设新账户并完成合格活动才能获得奖励。

Must open the new account and complete qualifying activities to earn rewards.

使用Chime Plus状态时，年化收益率为广告利率；否则，适用1%的年化收益率。

Advertise annual percentage yield with Chime Plus status Otherwise, 1% APY applies.

无需最低余额。

No minimum balance required.

Chime卡的按时还款记录可能对您的信用评分产生积极影响。

Chime card on time payment history may have a positive impact on your credit score.

结果可能因人而异。

Results may vary.

请访问chime.com了解适用条款的详细信息。

See chime.com for details on applicable terms.

现在回到节目。

And now back to the show.

好的。

Okay.

所以，是的，我们这个世界正越来越多地摄入加工碳水化合物和糖分。

So, yeah, we're just the world is increasingly eating more, just pounding away processed carbs, sugar.

稍后我们还会进一步讨论如何提高胰岛素敏感性。

And we'll talk a little more more later on the end about what we can do to become more insulin sensitive.

但除了食物之外，你提到的另一件事是我们变得越来越久坐。

But besides food, the other thing you talk about is we become more sedentary.

运动或缺乏运动在胰岛素抵抗中起什么作用？

What role does movement play or the lack of movement play in insulin resistance?

是的。

Yeah.

对。

Yeah.

肌肉结构的一个好处是，一旦肌肉开始运动、收缩和放松，它就能在不需要胰岛素的情况下吸收葡萄糖。

One of the nice things about the way the muscles are built is that the moment the muscle starts, well, moving, contracting and relaxing, it becomes able to pull in glucose without the need of insulin.

换句话说，即使胰岛素没有来敲门，这些葡萄糖的通道也会打开。

In other words, it opens those glucose doors even though insulin isn't there knocking on them.

因此，这是一种不依赖胰岛素的葡萄糖摄取机制。

And so it's an insulin independent mechanism of glucose uptake.

这非常相关。

And this is very relevant.

你可以让一个吃了淀粉类甜食或餐食的人，只要站起来进行十分钟到二十分钟的适度散步，他们的血糖水平就不会升得那么高。

You can take a person who eats a starchy sugary snack or meal, and if they just get up and go on even a modest walk of ten to twenty minutes, their glucose levels will not get as high as they would have.

血糖只会升到原本的一半左右，并且会快得多地降下来。

It'll only go up to about half as high as it would have, and it comes down much, much faster.

胰岛素也是如此，因为当你把大量刚吃下的葡萄糖涌入体内时，一旦开始活动肌肉，肌肉作为身体主要组织，通过质量占比，是葡萄糖最主要的消耗者。

The same goes with insulin because, yeah, you're you're flushing your body, your blood with all that glucose you just ate, but the moment you start moving those muscles well, by mass, muscle represents the primary tissue in the body, and it is overwhelmingly the main consumer of glucose.

大约80%从血液中清除的葡萄糖都会进入肌肉。

Roughly 80% of the glucose that gets cleared from our blood goes into the muscle.

所以，如果我们只是站起来活动一下肌肉，就开始吸收葡萄糖。

And so if we just get up and start moving our muscles around, we start just pulling in.

肌肉会贪婪地消耗所有这些葡萄糖。

The muscles begin greedily consuming all of that glucose.

因此，当胰腺的β细胞正准备向体内注入大量胰岛素时，它们会察觉到血糖正在自行快速下降。

And so insulin, right when the beta cells of the pancreas were about to load the system with all that insulin, they sense that the glucose is dropping rapidly on its own.

于是，本应是巨大的胰岛素释放，就变成了非常温和的释放，因为肌肉已经拯救了局面。

And so what would have been enormous insulin release becomes a very modest insulin release because the muscles have essentially saved the day.

因此，这至少部分解释了运动在餐后立即发挥作用的威力，尤其是在摄入淀粉类或含糖餐食之后。

So that that's that's at least some part of the power of exercise used in that acute moment after eating a starchy or sugary meal.

但其影响更为广泛：如果一个人经常锻炼，尤其是进行高强度运动，他们就有可能增加或至少保持肌肉质量。

But the implications are broader where if someone is exercising frequently, especially if it's a a higher intensity exercise, then they have the potential to gain or at least retain muscle mass.

正如我提到的，肌肉是葡萄糖的主要消耗者。

And as I mentioned, muscle is the main consumer of glucose.

所以，如果你拥有更多肌肉，你就拥有更多‘小嘴巴’，它们会迅速消耗掉血液中的所有葡萄糖。

So if you have more muscle, you simply have more little mouths that are gonna eat up all that glucose from the blood.

这一点确实得到了验证。

And this certainly plays out.

肌肉质量较高的人，即使体重相同，也能比肌肉质量较低的人更快地清除血液中的葡萄糖。

People with higher muscle mass can clear glucose much, much faster from the blood than people with less muscle mass, even if they weigh the same.

好的。

Okay.

所以我认为我们对胰岛素抵抗及其成因已经有了不错的理解。

So I think we have a good idea of what insulin resistance is, what causes it.

正如我们之前所说，当人们想到胰岛素抵抗时，通常会将其与代谢性疾病联系起来，比如糖尿病前期或2型糖尿病。

And as we said before, when people think about insulin resistance, they typically connect it to metabolic conditions like prediabetes or type two diabetes.

但在你的书《我们为何生病》中，你提到，无论是胰岛素过少还是过多，不仅会导致糖尿病，还会引发其他疾病。

But in your book, Why We Get Sick, you talk about, well, no insulin or too much insulin not only contributes to diabetes, but it's contributing to other sicknesses as well.

我们在对话中已经提到了一些。

And you've kind of mentioned them throughout our conversation.

第一个是心脏病和心血管疾病。

The first one is heart and cardiovascular disease.

胰岛素抵抗在这些疾病中扮演了什么角色？

What role does insulin resistance play in those?

是的。

Yeah.

事实上，这种关联极为密切。

In fact, that's a, that's an enormously intimate association.

心脏病是一个宽泛的术语，涵盖了多种特定的心血管问题。

The heart disease is a very broad term that that applies to a lot of specific cardiovascular issues.

最常见的是高血压或血压升高，因此我或许就专注于这一点，因为胰岛素抵抗与胰岛素对血压的直接调控作用密切相关。

The most common is hypertension or elevated blood pressure, and so I might maybe I'll just focus on that one for the But sake of with insulin resistance, insulin has a direct effect on controlling blood pressure.

最明显的一点是，当胰岛素水平升高时，会迫使肾脏保留盐分。

The most obvious one is that insulin, when it's elevated, will force the kidneys to hold on to salt.

正常情况下，如果盐分摄入增加，比如你我吃下大量盐，肾脏会轻松将其排出，不会造成任何问题，我们的血压也不会有明显变化。

Normally, kidneys, if salt goes up, if you and I were to eat a load of salt, our kidneys would just excrete it all very easily without any complication, and our blood pressure wouldn't really change a blip.

但当胰岛素水平升高时，比如你吃下高盐食物的同时摄入了会引发胰岛素飙升的淀粉或糖类——坦白说，很多人都是如此，咸脆食物是大多数人饮食中的一种小嗜好——这时肾脏就无法有效排出盐分了。

But when insulin is elevated, let's say you eat that salty food with an insulin spiking starch or sugar, and let's face it, a lot of people do, salty and crunchy is one of the kind of vices of most people's eating, then now the kidneys can't excrete that salt.

因此，它们不得不保留这些盐分。

And so they have to hold on to that salt.

盐在哪里，水就会跟到哪里。

And where salt goes, water follows.

所以，当血液保留盐分的同时，也保留了本应排出的大量水分，更多的水分意味着更大的血容量。

And so as the blood is holding on to the salt, now it's holding on to all that water that it wanted to excrete, and more water means higher volume of blood.

而根据物理规律，更大的体积意味着更高的压力，于是我们的血压就升高了。

And as physics demands, more volume means more pressure, and so we have an increased blood pressure.

同时，当血管本身对胰岛素产生抵抗时，它们无法像以前那样有效扩张。

At the same time, as the blood vessels themselves are becoming insulin resistant, they can't dilate as well as they used to.

如果血管能够扩张，就意味着那里的空间变大了，因此压力会下降。

And naturally, if a blood vessel can dilate, it's expanding, and that would mean, you know, that the volume of the space there has gotten bigger, and so the pressure will go down.

但这种情况不会发生。

But it can't happen.

当血管本身对胰岛素产生抵抗时，它们会保持在更收缩或狭窄的状态，这不仅维持了高血压，还会进一步推高血压。

When the blood vessels themselves become insulin resistant, now they stay in a more constricted or narrowed state, and naturally, that keeps blood pressure or not it keeps it high, but it pushes it even higher.

再举最后一个例子，因为还有更多我无法一一列举的情况。

And then maybe one last example, because there are even more than I could mention.

当胰岛素水平长期升高时，会激活一种叫做交感神经系统的机制。

When insulin levels are chronically elevated, it activates something called the sympathetic nervous system.

我相信您的观众都听说过这个，这就是著名的战斗或逃跑反应。

And I'm sure your audience has heard of this, but this is the infamous fight or flight response.

因此，当胰岛素水平高时，心率会加快、跳得更用力，血管再次收缩。

And so when insulin's high, the heart rate starts beating harder or higher and harder, and the blood vessels once again constrict.

这是正常交感神经反应的一部分，比如当我们需要逃离危险或迅速做出反应时，这种情况下的益处是非常明显的。

That's part of the normal sympathetic response, Like, if we needed to run away from danger, for example, or react very quickly, that's it's a pronounced benefit in that circumstance.

但在这个情况下，由于胰岛素长期升高而引发的这种人为的交感神经反应，就完全变成了病理性的或致病性的。

But in this case of this kind of artificial sympathetic response because of the chronically elevated insulin, it becomes purely pathological or pathogenic.

它开始损害心血管系统的血管。

It starts to hurt the blood vessels in the cardiovascular system.

好的。

Okay.

所以胰岛素过多、胰岛素抵抗对我们的心脏或心血管系统不好。

So insulin, too much insulin, insulin resistance is not good for our heart or cardiovascular system.

你还谈到了胰岛素对我们生殖系统的影响。

You also talk about the effect of insulin on our reproductive system.

你提到了一种女性生殖问题，也就是多囊卵巢综合征。

And you mentioned, you know, a female reproductive issue, which is PCOS.

那男性呢？

What about men?

过多的胰岛素或胰岛素抵抗会影响男性的生殖健康吗？

Does does too much insulin or insulin resistance affect, male reproductive health?

是的，确实会。

Yes, it sure does.

我很高兴你提到这一点，因为我一直不太愿意只谈多囊卵巢综合征，生怕让女性朋友们觉得我是在针对她们。

I'm thrilled you mentioned that because I I I'm always reluctant to just mention PCOS and think the gals are and have the gals just think I'm kinda coming after them.

但这个问题对男性同样重要。

No, it's certainly relevant to the guys as well.

虽然多囊卵巢综合征是女性不孕最常见的原因，但男性对应的最常见不孕问题是勃起功能障碍。

So while PCOS is the most common form of infertility in females, the counterpart in males, the most common infertility is erectile dysfunction.

而这完全是一个血管问题。

And that is entirely a problem of blood vessels.

事实上，我刚才就提到了，或者解释了这个问题：当血管对胰岛素产生抵抗时，它们就无法像以前那样充分舒张或扩张。

And in fact, I actually alluded to it or explained the problem just now, where when the blood vessels become insulin resistant, they can't dilate or open as well as they used to.

而这对于男性实现正常生育能力来说，是一个至关重要的生理变化。

And that, of course, is an essential physiological change in a fellow in order to have normal fertility.

因此，如果他的血管突然无法扩张，那么他就会出现勃起功能障碍，而这完全是血管对胰岛素抵抗的结果。

And so if he suddenly has blood vessels that cannot dilate, well, then he is then he has erectile dysfunction, and it's entirely a consequence of the insulin resistance at the blood vessels.

很多人误解了勃起功能障碍，认为它是睾酮水平低造成的。

A lot of people misunderstand erectile dysfunction and they'll claim that it's a result of low testosterone.

这完全不是真的。

That is just not true.

越来越多的研究人员正在研究这个问题。

More and more individuals study this.

事实上，几年前发表了一篇论文，其标题就揭示了所有你需要知道的信息。

In fact, there was a paper published just a couple years ago and the title reveals everything you need to know.

论文的标题类似于：勃起功能障碍是男性胰岛素抵抗的最早表现吗？

And it was something like, is erectile dysfunction the earliest manifestation of insulin resistance in men?

这篇论文的标题正是以这样一个问题的形式提出的。

That was, you know, so the the title of the manuscript was kind of posed as that question.

而整篇论文的答案都是：是的，确实是。

And the answer throughout the manuscript was, Yes, it is.

而且，这仅仅是胰岛素抵抗影响血管的问题。

And again, it's simply a matter of insulin resistance affecting the blood vessels.

一旦受到影响，血管就无法扩张，而缺乏扩张就意味着勃起功能障碍。

And once affected, they can't dilate, and a lack of dilation means a lack, a, a erectile dysfunction.

我对于内分泌学的粗浅理解是，激素会影响其他激素。

One thing my sort of rudimentary understanding of endocrinology is that hormones affect hormones.

我们是否知道胰岛素以任何方式影响睾酮？

Does do we know if insulin affects testosterone in any way?

是的。

Yeah.

这是个很好的问题。

That's a great question.

它通过将雄激素转化为雌激素的反应来实现这一点。

It does through the reaction of converting androgens to estrogens.

因此，你可能会想，如果同样的情况发生在男性的睾丸中，那么他应该释放更多的雄激素，因为女性卵巢中胰岛素升高会导致睾酮升高。

And so you'd think, well, if the same thing is happening in a guy's testes, then he should have more androgens being released, you know, because that's what's happening in the woman with her ovaries, higher insulin is resulting in higher testosterone.

但在睾丸中并不会发生这种情况。

But that does not happen in the testes.

没有同样的效应。

There's not that same effect.

不幸的是，胰岛素对睾酮没有直接影响，但通过脂肪细胞会产生间接影响。

And, unfortunately, there's not a direct effect of insulin on testosterone, but there's an indirect effect through the fat cell.

当胰岛素促进脂肪细胞生长时（这一点它很容易做到），脂肪细胞最终会像卵巢一样发挥作用。

As insulin is promoting the growth of the fat cell, which it does very readily, fat cells end up acting kind of like ovaries.

因此，男性身上增长的脂肪细胞会摄取睾酮，并因此释放雌激素。

And so the fat cells that are growing on the man actually will pull in testosterone and pump out estrogens as a result.

它会像女性卵巢那样，将雄激素转化为雌激素。

It'll convert the androgens to estrogens just like the woman's ovaries are doing.

好的。

Okay.

我们已经讨论过生殖健康了。

So we've talked about reproductive health.

我读这一章时觉得有点吓人，因为胰岛素抵抗在癌症中的作用或潜在作用。

This chapter is kind of scary when I read it is insulin resistance role or potential role in cancer.

有没有某些特定类型的癌症与胰岛素抵抗有很强的关联？

Are there particular cancers where there's a strong connection with insulin resistance?

是的，确实有。

Yes, yes, there sure is.

我跟你有同样的感受，对癌症持一种令人清醒的看法。

I share that kind of sobering sentiment that you do, that sobering view of cancer.

我非常敬畏它，也有些害怕，因为感觉这种病我们能做的很少。

I have a very hearty respect for it and a fear of it because it seems like one of those things that you can't do much about.

在某些情况下，这确实是事实，因为癌症是一种起源不明的复杂疾病。

Well, some instances that's undoubtedly the case because cancer is such an unknown beast of unknown origins.

但最常见的癌症——乳腺癌和前列腺癌——有很强的证据表明它们与胰岛素抵抗有关。

But the most common cancers, breast and prostate cancers, have very strong evidence linking them to insulin resistance.

例如，乳腺肿瘤常常会出现一种突变，就是胰岛素受体的突变。

For example, breast tumors will one of the many mutations that they'll manifest with is a mutation in the insulin receptor.

乳腺肿瘤中的胰岛素受体数量甚至比周围非癌变的乳腺组织还要多出七倍。

And breast tumors will have about seven times more insulin receptors than even neighboring breast tissue that's not cancerous will have.

从更广泛的角度来看，即使排除肥胖等其他变量——而肥胖是乳腺癌和前列腺癌的危险因素——胰岛素抵抗仍然是一个更相关的风险因素。

And at the kind of broader level, independent of any other variable like obesity, for example, that is a risk factor for breast and prostate cancers, you can control for obesity and insulin resistance still persists as a more relevant risk factor.

因此，证据表明：一方面有直接证据显示胰岛素受体突变增强了胰岛素对癌细胞的作用，另一方面也有这些相关性的间接发现。

So the evidence is there's some direct evidence of insulin receptor mutations enhancing the effect of insulin on the cancer cells, and then there's that more indirect finding just these correlations.

但其相关性还有另一个方面，那就是葡萄糖。

But the relevance also has one other aspect to it, which is glucose.

癌细胞摄取葡萄糖。

Cancer cells eat glucose.

葡萄糖是它们的主要能量来源。

That is their primary fuel.

它们消耗的葡萄糖量是正常细胞的约200倍。

They eat about 200 times more glucose than the normal cell does.

因此，对于那些胰岛素和葡萄糖水平持续升高的普通人来说，悲剧在于：高水平的胰岛素在促进癌细胞生长，而高水平的葡萄糖则为这种爆炸性增长提供了燃料。

And so the tragedy, of course, in the average individual who has rising insulin and rising glucose is that you have all that insulin signaling the growth or stimulating the growth of the cancer cell, and you have all that glucose fueling all of that explosive growth.

好的。

Okay.

所以这个是你在书里没提到的，因为书出版的时候这个还没出现。

So here's the one that you didn't talk about this in your book because it the book came out before this hit.

但我猜想，作为一名研究胰岛素抵抗的科学家，新冠疫情为你提供了一个研究胰岛素抵抗与新冠之间关联的机会。

But I imagine as a scientist who researches insulin resistance, the COVID pandemic provide an opportunity to study the connection between insulin resistance and COVID.

这方面有做过研究吗？

Has there been any research done in that area?

是的。

Yes.

确实有，但非常非常少。

There there has been, but very, very little.

关于新冠，这一点是毫无疑问的。

Now there's no question aspect to COVID.

尽管可能会冒犯一些人，但尽管很多人想说这是未接种疫苗者的疫情，我觉得这样说并不公平。

And at the risk of offending some, while many wanna claim that this is a pandemic of the unvaccinated, I I just don't think that's fair.

我认为这种说法不准确。

I don't think that's accurate.

我认为更准确的说法是，这是一场由基础疾病引发的疫情，因为每一项研究都持续证实，如果一个人存在这些相关的或潜在的代谢性基础疾病，他们更容易出现严重感染，并且病毒载量更高，因此传播的可能性也更大。

I think it is more accurate to say it's a pandemic of preexisting conditions because that just continue every single study continues to confirm that if a person has these relevant or underlying metabolic preexisting conditions, they are much, much more susceptible to having a serious infection, and they're they carry a much higher load, so there's higher potential for transmission.

我们还进一步知道，这些人的疫苗效果较差。

And we know even further that the vaccines are less effective in these individuals.

现在，我不希望这听起来像是在指责任何人，我真的不是这个意思。

Now and I hate for that to sound incriminating in any way, and I really do.

我无意让它听起来像在指责，但作为一名科学家，我希望表达得精确一些，我认为即使数据有些不便，也不应忽视它。

I don't intend for it to sound like that, but, as a scientist, I do want to be precise, and and I don't think there's any value in ignoring data even if it's a little inconvenient.

我认为在这方面，没有人会从中受益。

I think nobody benefits in that regard.

关于胰岛素抵抗与新冠之间的联系，我知道有一项研究考察了胰岛素水平与血糖水平，总体发现是两者都具有预测价值。

So the connection between insulin resistance and COVID-nineteen, there's one study that I know of that has looked at insulin levels versus glucose levels, and the general finding was that they both appear to be predictive.

但我可能会更侧重于血糖方面，尽管这可能会削弱胰岛素抵抗的相关性。

But I will maybe more focus on the glucose aspect and at the risk of diminishing insulin resistance, the relevance of insulin resistance.

但当一个细胞被病毒感染后，往往会以更高的速率利用葡萄糖。

But when when a cell has become infected with a virus, it tends to start using glucose at a higher rate.

因此，对于这种代谢不健康的人群来说，我们有可能在为病毒的增殖提供养分。

So once again, in this metabolically unhealthy individual, we have the potential where we're fueling this growth.

我不会在这上面多做展开，因为担心会偏离主题，但脂肪细胞是新冠病毒非常理想的宿主。

And not to I'll I'll be very brief on this because I fear that it would be getting off topic, but fat cells are a very welcoming host for COVID-nineteen.

病毒与细菌有本质区别，细菌是独立的完整细胞。

A virus is very distinct from a bacterium where the bacteria is its own self contained cell.

病毒仅仅是由多肽组成的颗粒，它需要侵入一个细胞，然后该细胞开始产生更多的病毒。

A virus is simply a particle of peptides, and it needs it needs a cell to to infect, and then that cell begins producing more of the virus.

为了进入细胞，病毒需要一个共受体。

And in order to get in a cell, a virus needs a co receptor.

它本质上需要一扇门让自己进入，而脂肪细胞拥有的这种‘门’比身体中几乎任何其他细胞都多。

It basically needs its a doorway that allows it to come in, and fat cells tend to have more of those doorways than almost any other cell in the body.

因此，自然地，如果你拥有更多的脂肪细胞，就意味着病毒有更多潜在的入侵宿主，随后病毒会将这些宿主变成生产更多自身的工厂。

And so naturally, if you have more fat cells, you have more potential homes for the virus to come into, and then it turns the home into a factory producing ever more of itself.

好的。

Okay.

那我们来谈谈另一个与胰岛素或胰岛素抵抗相关的疾病，那就是肥胖。

So let's talk about another problem or disease that we associate insulin or insulin resistance with, and that's obesity.

正如胰岛素抵抗在人群中不断上升，肥胖也是如此。

So just as insulin resistance has been increasing across populations, so has obesity.

所以问题是，是胰岛素抵抗导致了肥胖，还是肥胖导致体重增加进而引发胰岛素抵抗？

So the question is, is it the insulin resistance that's causing obesity, or is it the obesity increasing body weight causing insulin resistance?

是的。

Yeah.

对。

Yeah.

对于这个双向问题，答案是：是的，布雷特。

So the answer to that two sided question is yes, Brett.

我本来不想说但是，我会简要展开一下。

I hate to hate to take a but I'll elaborate very briefly.

毫无疑问，当脂肪细胞在增长时，它们会变得胰岛素抵抗，并开始促进胰岛素抵抗。

So there's no question that when fat cells are growing, they are becoming insulin res that they start to promote insulin resistance.

这种情况确实毫无疑问会发生。

There's no question that happens.

脂肪组织可以通过多种方式增长，但如果它是通过一种叫做肥大的过程增长，即每个单独的脂肪细胞在变大，而不是我们招募新的脂肪细胞来增加脂肪细胞的数量。

So fat tissue can grow through different ways, but if it's growing through a process called hypertrophy, or each individual fat cell is growing rather than we are pulling in new fat cells and making new have an increased number of fat cells.

但如果通过肥大，即每个脂肪细胞不断变大，它们就会开始变得越来越胰岛素抵抗。

But if it's through hypertrophy or each individual fat cell getting bigger and bigger, then they start to become increasingly insulin resistant.

它们这样做是为了试图控制自身的增长，因为脂肪细胞本质上是在向胰岛素发出信号：你希望我继续增长，但我已经接近最大尺寸，无法再继续膨胀了，所以我需要变得稍微有点胰岛素抵抗。

And they do that to try to control its own growth because the fat cells essentially signaling to insulin, insulin, you want me to continue to grow, but I'm reaching a point of maximum dimension and I can't grow beyond this, so I need to become a little insulin resistant.

这就是为什么大多数人对能长多胖都有一个极限。

And that's why most people have a limit to how fat they can get.

你知道，那些在纪录片里极度肥胖的人，普通人根本不可能胖到那种程度。

You know, the the individuals that are on these documentaries where they're super, super morbidly obese, the average person can't get that fat.

那些人属于极少数通过高增生过程发胖的人，也就是说，他们的脂肪细胞本身尺寸并不大，但一直在不断产生新的脂肪细胞。

They those are the few individuals who are getting fat through a process called hyperplasia, which is when the fat cells themselves are pretty modestly sized, they just start making new fat cells all the time.

因此，脂肪增长几乎具有无限的潜力。

So there's almost this limitless potential for fat growth.

而悖论的是，布雷特，尽管这些人变得异常超重和肥胖，他们实际上仍保持着相当高的胰岛素敏感性。

And paradoxically, Brett, while these people become remarkably overweight and obese, they actually maintain a pretty high level of insulin sensitivity.

这是因为脂肪细胞始终愉快地储存更多能量，而且从未变得过大。

And that's because the fat cells are always happily storing more energy, and they're never getting too big.

因为一旦它们开始变大，就会立即产生新的脂肪细胞。

Because anytime they start to get a little big, well, then they just have a new fat cell get created.

所以，不管怎样，我们回到讨论上来。

So, anyway, back to the discussion.

毫无疑问，如果脂肪组织通过肥大方式增长，就会导致胰岛素抵抗。

There's no question that fat tissue, if it's growing through hypertrophy, will contribute to insulin resistance.

但也有证据表明相反的情况：当身体的胰岛素水平越来越高时——这正是胰岛素抵抗所导致的——这实际上先于体重增加发生。

But there's also evidence to suggest the opposite, that as the body has higher and higher levels of insulin, which is happening with insulin resistance, that that precedes weight gain.

来自不列颠哥伦比亚大学的吉姆·约翰逊的研究表明，在他进行的动物实验中，这种情况必然发生：没有升高的胰岛素，就无法促进脂肪增长。

And evidence from a guy named Jim Johnson, who's at the University of British Columbia, he finds that in these animal studies that he's done, that has to happen, that that you can't promote the fat growth without the elevated insulin.

我确实想强调胰岛素在脂肪细胞中的作用。

I'm certainly suggesting the relevance of insulin at the fat cells.

所以我认为，认为超重或脂肪细胞增长会导致胰岛素抵抗的观点是绝对共识。

So there's I I I think the view that excess weight or the growing fat cells will cause insulin resistance is absolute consensus.

每个人都会对此点头同意。

Everyone would nod their heads to that.

但对于胰岛素抵抗可能先于体重增加甚至促进体重增长这一点，共识则较少。

There's less of a consensus that insulin resistance can proceed and even contribute to weight gain.

有证据支持这一观点，我刚刚也提到了，但这是一种不太主流的看法。

There's evidence to support it, and I just cited it, but it it's a much less prominent view.

但我认为这是一个很有价值的观点。

But I think it's a valuable one.

我猜想这之间是相互影响的。

And I imagine that there's it it goes back and forth.

因此，当胰岛素抵抗导致脂肪细胞体积增大时，这种脂肪细胞的增大又会进一步加剧胰岛素抵抗。

So as you as insulin resistance causes an increase in fat cell size, that fat cell size is gonna cause more insulin resistance.

所以这就像一个恶性循环。

So it's sort of like this vicious cycle that's going on.

是的。

Yeah.

没错。

That's right.

我的观点是‘脂肪优先’的视角，即脂肪细胞通常是最先出现胰岛素抵抗的，因为正如我刚才提到的肥大过程。

And and my view is a is a fat first perspective, which is the fat cell is generally the first to become insulin resistant because through the process I just mentioned of hypertrophy.

然后这种胰岛素抵抗会通过其他机制扩散到全身。

And then that starts to spread the insulin resistance through other mechanisms, basically through the rest of the body.

所以，好吧，我们来谈谈胰岛素抵抗可能引发的所有这些问题。

So, okay, let's talk about we talked about all these problems that can be, caused by insulin resistance.

那你要怎么应对呢？

What do you what do you do about it?

第一个问题是，你怎么知道自己是否胰岛素抵抗？

So like first question is like, how do you even know if you're insulin resistant?

有没有什么测试可以检测你的胰岛素水平是否升高？

Is there a test you can take to see if your insulin levels are elevated?

因为通常你会去CVS买血糖测试仪，但我没在那里见过胰岛素测试。

Because usually, you know, you you go to the the CVS and buy blood glucose test, but I haven't seen an insulin test there.

不，没有这种测试。

No, no, there isn't one.

这确实是一个持续存在的障碍，也是为什么血糖检测在这一讨论中仍占据主导地位，因为它实在太容易测量了。

And that's certainly an ongoing hurdle and why glucose continues to occupy the primary position in this discussion because it's just so much easier to measure.

但确实，你可以检测胰岛素水平，这是你为了确定自己是否胰岛素抵抗所能做的最起码、也最应该做的事。

But yeah, you can get insulin measured and that is kind of the least thing you can do or you ought to do in order to determine your insulin resistance status.

所以下次有人去抽血检查时，不妨恳求、哀求、劝说，甚至贿赂你的医生，让他们勾选一项：检测胰岛素。

So next time a person's going in for a blood test, just kind of beg, plead, cajole, pay off your clinician to check the box and say measure the insulin.

如今，任何临床实验室都能做这项检测。

That's something that every lab can do nowadays, a clinical lab.

关键只在于医生是否愿意去做。

It's just whether or not the physician will do it.

而且有时候保险是否承保也是一个问题，但越来越多的情况下保险会覆盖了。

And and sometimes whether or not the insurance will pay for it, but more and more it will.

即使不承保，一个人通常也能以大约20美元的价格完成检测。

Even if it won't, a person can get it done usually for like $20 or something.

所以，是的，去检测一下你的胰岛素水平，了解你的胰岛素浓度情况。

So, yeah, get your insulin measured to know where your insulin levels are.

这是了解自身状况的一个非常好的方法。

That's a great, great way to get a feel for where you're at.

现在，也有一些替代指标，比如一种简易的评估胰岛素抵抗状态的方法，可以通过观察血液中脂质水平的比例来实现。

Now, there are some surrogates here, like a poor man's method of measuring insulin resistance status can be done just by looking at a ratio of your lipid levels in your blood.

因此，幸运的是，每次验血都会检测甘油三酯，也会检测高密度脂蛋白胆固醇。

And so if a person every blood test, thankfully, will measure triglycerides, and every blood test will measure HDL cholesterol.

而这正是你需要关注的两个指标。

Well, those are the two ones you need.

所以，取甘油三酯的数值，除以高密度脂蛋白的数值。

So take the triglycerides number and divide it by HDL.

所以是甘油三酯除以高密度脂蛋白胆固醇。

So triglycerides over HDL cholesterol.

如果这个比值小于1.5，那就表明你的胰岛素敏感性非常好。

If that answer is less than 1.5, then that's a very good sign that you are insulin sensitive.

如果这个比值高于1.5，并且继续上升到2或3，数值越高，说明你的胰岛素抵抗越严重。

If that answer is above 1.5 and getting higher into the twos or the threes, the higher it's getting, the more insulin resistant you are.

所以这是一个非常可靠的指标。

So that's a very reliable indicator.

如果你无法测量胰岛素水平，至少可以看看你的血脂指标，这些指标总是会被检测的，这能让你对自己当前的状况有个不错的了解。

So if you can't get your insulin measured, then at least look at your lipids, which again are always measured, and that'll give you a pretty good idea of where you're at.

当你测量胰岛素水平时，达到什么数值你会认为胰岛素抵抗可能已经发生了？是的，没错。

When you do measure insulin levels, what's the level where you're like, okay, insulin resistance is probably happening Yeah, right yeah.

对，没错。

Right, right.

是的，我应该提到这一点。

Yeah, should have said that.

大约是每毫升十微单位。

It's around ten micro units per mil.

在美国，我们使用这些单位来衡量胰岛素。

So here in The US, those are the units that we'll use with insulin.

每毫升。

Per mil.

在其他国家，可能使用皮摩尔。

In other countries, it may be picomoles.

我们这里不用这种单位。

We don't do that here.

如果一个人的空腹胰岛素水平在10或以下，这是非常好的迹象。

So if a person's if you're fasting insulin is around 10 or less, that's a great sign.

好的。

Okay.

假设某人有胰岛素抵抗，很可能现在听这段话的人就有，因为大约十分之九的美国人存在胰岛素抵抗。

Let's say someone has insulin resistance and chances are person listening to this right now probably does because about nine in ten Americans have insulin resistance.

胰岛素抵抗可以逆转吗？

Is insulin resistance reversible?

如果可以，有哪些方法可以逆转胰岛素抵抗？

And if so, what are some things you can do to reverse insulin resistance?

是的，好消息是它几乎可以立即逆转。

Yeah, yeah, the good news is it is almost immediately reversible.

而且实际上几周内，你就可以让一个胰岛素抵抗非常严重的人恢复。

And really within weeks, like you can take someone with profound insulin resistance.

他们已经深陷二型糖尿病了。

They're really Type II diabetic, deep into Type II diabetes.

他们就是那么胰岛素抵抗。

They're that insulin resistant.

但仅仅几周后，他们的胰岛素敏感性就会大幅提升，甚至可以停用所有药物，当然，这需要在临床监督下进行。

And within just weeks, they become so insulin sensitive that they can get off all their medications, you know, of course, under clinical supervision.

所以在我看来，有四个步骤，或者说四个支柱。

So in my view, there are four steps or or four pillars rather.

因为这些不需要按顺序进行，所以我不能称之为步骤。

Because it doesn't need to be sequential, so I shouldn't say steps.

四个支柱，可以用来构建促进胰岛素敏感的饮食基础。

Four pillars that can be used to build the, proper foundation of an insulin sensitizing diet.

第一个是控制碳水化合物。

And the first one is control carbohydrates.

我不是说完全不吃，但这些是最主要的问题来源。

I'm not saying don't eat any, but those are the biggest offenders.

所以要控制它们。

So control them.

不要从袋子或带条形码的盒子里摄取碳水化合物。

Don't eat your carbohydrates from a bag or a box with a barcode.

专注于生的碳水化合物，或者轻微烹饪或加工过的。

Focus on raw carbohydrates, you know, you know, mildly cooked or processed.

水果和蔬菜是主要应该食用的食物。

Fruits and vegetables, those are the mains one main ones to eat.

要特别小心谷物。

Be very careful with with grains.

它们通常含有更多的淀粉，会导致更高的血糖和胰岛素反应。

They always have much more starch and will have a higher glucose and insulin effect.

而且，加工程度越高就越要避免，比如把水果和蔬菜榨汁。

And and then, of course, the more processed it is, like even juicing the fruits and vegetables, wanna avoid.

吃水果和蔬菜，不要喝它们。

Eat your fruits and vegetables, don't drink them.

这就是我所说的控制碳水化合物。

That's what I mean by control carbohydrates.

接下来，优先选择蛋白质。

And then next, prioritize protein.

蛋白质对胰岛素的影响较小，但这是可以接受的。

Protein has a modest effect on insulin, but it's fine.

影响非常轻微，而蛋白质是必不可少的。

It's a very modest effect, and proteins are essential.

大多数人摄入的蛋白质不足以维持他们的瘦体重，即肌肉和骨骼。

And most people aren't getting enough to sustain their lean mass, namely muscle and bone.

因此，要注重蛋白质的摄入，经常食用，并优先选择动物性来源。

And so focus on protein, eat it frequently, and get it from animal sources.

这在当今社会对一些人来说可能很难接受，但事实不容置疑。

It's it's a very uncomfortable thing for some these days, but there's no question.

动物蛋白在所有可想到的指标上都优于任何植物蛋白。

Animal protein is superior to any plant protein, every conceivable metric.

我知道这让人不舒服。

And I know this is upsetting.

很多人对我这么说感到被冒犯，但我不会为了迎合政治正确而否认人体的生理事实。

A lot of people truly are offended by me saying this, but I'm not going to deny human physiology just to be, you know, politically correct.

每一种动物蛋白都优于任何植物蛋白，这一点毋庸置疑。

Every animal protein is superior to any plant protein, full stop.

所以一定要确保摄入足够的动物蛋白。

So make sure you're getting the animal protein.

第三点是，不要害怕脂肪。

Now the third one is don't fear fat.

脂肪对胰岛素没有影响，而且我们几千年来一直在食用脂肪，或者说，自从人类出现以来就一直在吃脂肪。

Fat has no effect on insulin, and we've been eating it for millennia, Well, since the beginning of of who we are.

无论人类是如何演化的，从一开始我们就一直在吃脂肪，尤其是动物脂肪。

However humans came to be, we've been eating fat since the beginning, and that includes animal fat most especially.

所以要注重动物脂肪和水果脂肪。

So focus on animal fats and fruit fats.

水果脂肪包括椰子、牛油果、橄榄，尽可能避免种子油、精炼种子油，有些人通过巧妙的市场营销称之为植物油。

The fruit fats are coconuts, avocados, olives, and as much as you can, studiously avoid the seed, the refined seed oils, or what some people will call through an act of clever marketing, vegetable oil.

这跟植物根本没关系。

There's nothing vegetable about it.

这些是来自大豆、棉籽或玉米等种子的精炼种子油。

These are seed oils refined from soybeans, cottonseed, or corn seeds, etcetera.

要像躲避瘟疫一样避开它们。

Avoid them like the plague.

而不幸的是，或者说幸运的是，如果你避免从袋装、盒装或有条形码的食品中获取碳水化合物，那你已经做得很好了，因为这些加工碳水化合物中的主要脂肪来源正是这些种子油。

And unfortunately well, fortunately, if you're avoiding if you're not getting your carbs from a bag or a box or with a barcode, then you're doing a good job already because it's those processed carbs and the main fat in them will be from these seed oils.

所以进食时，大胆地多摄入动物和水果来源的脂肪。

So as you're eating, be very liberal with fats from animals and fruits.

我们的身体早已适应了这些脂肪。

We're well adapted to those.

最后一个，第四条原则是：别一直吃个不停。

And then the last one, the fourth pillar, is take a break from eating all the time.

你并不需要每天都吃三餐。

You don't need to eat three meals a day all the time.

你尤其不需要每天都吃六餐。

You don't you especially don't need to eat six meals a day all the time.

如果你想改善胰岛素敏感性，就让身体从持续进食中休息一下，尝试某种形式的间歇性禁食。

If you want to improve your insulin sensitivity, give your body a break from eating and engage in some form of intermittent fasting.

实现这一点的方法有很多，但关键是让身体从不间断的进食中得到休息。

There are so many ways to do this, but just give your body a break from eating all the time.

偶尔，甚至可以尝试24小时禁食，期间只喝水，不摄入任何热量。

Occasionally, maybe even do a twenty four hour food fast where you're just drinking water, no calories during that time.

此外，偶尔跳过早餐，或吃非常清淡的晚餐，有助于让胰岛素更快下降或维持较低水平更长时间。

And then on occasion, skip a breakfast or eat a very, very modest dinner, in order to just help insulin get down a little faster or stay low longer.

除了饮食，运动在预防胰岛素抵抗中起什么作用？

Besides diet, what role does movement play in preventing insulin resistance?

是的，没错。

Yeah, yeah.

非常好的问题。

Excellent question.

我经常被问到哪种运动最好，我的幽默回答是：你会坚持做的那种。

I'm often asked what's the best exercise and my, my kind of witty response is the one you'll do.

但我真的是认真的。

And, but I do mean it.

任何形式的活动都有益，所以只要站起来活动起来就好。

Any form of movement is going to be beneficial, so just get up and move.

如果你知道每天只有三十分钟可以锻炼，可以有策略地安排。

You can strategically do that if you only know if you know you've only got thirty minutes a day to exercise.

在三十分钟内，你能做很多事情。

Well, you can do a hell of a lot in thirty minutes.

但如果你年纪较大，身体能力有限，可以将锻炼与摄入最多淀粉类食物的那餐结合起来，就像我前面解释的那样。

But maybe if you're older and less capable physically, then couple that with the meal in which you eat the most starches just like I explained earlier.

在那之后进行一次快走。

Do a brisk walk at the end of that.

但对于身体能力更强的人来说，越剧烈的运动越好。

But for those of us that are more capable physically, then the more aggressive we can be, the better.

尽可能频繁地进行高强度锻炼。

Have a high intensity workout as often as you can.

不需要很长时间。

It doesn't need to be long.

我的锻炼通常只有三十分钟左右。

Mine are only around thirty minutes.

我今年四十多岁，这样的锻炼已经足够维持我的肌肉了。

And I'm in my mid forties, and it's been sufficient to keep my muscle.

我每组训练都几乎做到力竭，只做非常非常短暂的休息。

I just do very, very brief rests, basically to failure every set.

但无论你做什么，都要尽量活动肌肉，尤其是尽可能增加肌肉质量。

But whatever you're doing, do what you can to move the muscles and especially do what you can to increase your muscle mass.

是的。

Yeah.

力量训练就像让你的身体在没有胰岛素的情况下免费吸收葡萄糖，这可以

And strength training, like you're getting free pumping of glucose into your body without insulin, which is

没错。

That's right.

通过增加肌肉质量，你每天的每一刻都在拥有更好的葡萄糖代谢能力。

And by helping increase your muscle mass, you're walking around every moment of the day with a better glucose sync, so to speak.

还有一些其他奇怪的方法你可以尝试。

And there's some other weird things you can do.

我的意思是，我不会依赖这些小技巧来提高胰岛素敏感性，但它们确实很有趣。

I mean, I wouldn't like bank on these little things to do to increase insulin sensitivity, but they're interesting.

就像我们之前在网站和播客中讨论和读到的冷水浴一样，实际上有研究指出冷水浴可以提高胰岛素敏感性。

Like we've talked about and read about cold showers on the website and the podcast before, and there's actually research that say that cold showers can increase insulin sensitivity.

是的。

Yeah.

对。

Yes.

这背后有两种不同的机制。

There's two distinct mechanisms.

一种是通过颤抖。

One is just through shivering.

当你颤抖时，肌肉会痉挛，这是一种肌肉收缩。

And when you're shivering, your muscles are spasming, and that's a muscle contraction.

因此，肌肉会像你运动时一样开始吸收葡萄糖。

So they start pulling in the glucose just like they would if you were exercising.

而在寒冷暴露期间，第二个机制是激活一种独特的脂肪，称为棕色脂肪。

And then the second thing during cold exposure is you're activating this unique type of fat called brown fat.

而棕色脂肪奇怪的是具有非常高的代谢率。

And brown fat, oddly, has a very high metabolic rate.

它不像白色脂肪细胞那样用于储存脂肪。

It's not designed to store fat like your white fat cells are.

它的作用是消耗能量、葡萄糖和脂肪来产生热量。

This is designed to burn energy, glucose and fat, to produce heat.

因此，寒冷疗法会强烈激活棕色脂肪，让你更快地消耗葡萄糖。

And so cold therapy will activate brown fat very aggressively, and then you're just chewing through your glucose that much faster.

好的。

Alright.

这些都是人们可以做出的简单生活方式改变。

So these are all simple lifestyle changes that people can make.

但如果一个人做了所有这些事，胰岛素水平仍然居高不下，该怎么办？

What if they what if someone does all these things, the insulin is still staying high?

你有没有想过，也许你可能需要服用其他药物，或者采取一些医疗干预措施？

Is there a certain point where you thought, well, I might have there's other medications you take, or there are medical interventions you might have to do?

是的。

Yeah.

说实话，布雷特，通常他们不需要，但为了讨论方便，我们假设他们可能需要，以便引入药物。

So frankly, Brett, usually they won't, but just for the sake of, argument, let's let's say that maybe they would just to introduce the drugs.

当然。

Sure.

但同样，它们的效果远没有那么好。

But again, they're not nearly as effective.

即使最有效的药物——我稍后会提到的第一种——其效果也仅相当于轻微生活方式改变的一半。

Even the most effective drugs, and that'll be the first one I mentioned in a moment, is only half as effective as even modest lifestyle changes.

所以如果生活方式的改变不起作用，那你基本上就没什么办法了。

So if the lifestyle changes don't work, then you're you're hosed, pretty much.

通常情况下，人们都是在药物失效后才转向生活方式的改变。

So usually, it's people go to lifestyle changes once the drugs stop working.

这通常是情况的发展方向，因为药物的收益会大幅递减。

That's usually the way it goes because drugs do have heavy diminishing returns.

但最常被开具的药物是二甲双胍，因为它疗效显著且副作用最小，毕竟每种药物都有副作用。

But the most common that is prescribed because of its efficacy and the minimal side effects, because every drug has a side effect, is one called metformin.

这是全球最广泛使用的降糖药，而且有充分的理由。

That's the most widely prescribed antidiabetic drug in the world and for good reason.

它非常便宜，因为专利已经过期，而且通常副作用很小，效果也很显著。

It's very affordable because it's it's off patent now, and it's it's very effective with generally minimal side effects.

因此，这通常是首选药物，也是我给所有可用药物中评分最高的。

So that's typically the first one, and that's one that I give the highest grade to of all the available drugs.

但还有更多药物，要详细讲解会花费太多时间。

But there are so many more that would take too much time for me to get into.

所以我就说到这里。

So I'll just end it there.

通常，二甲双胍会是首选药物。

Usually metformin will be the first one.

而且幸运的是，它的效果很好，副作用很小。

And and thankfully, works pretty well with minimal side effects.

但你的核心观点是，你最好进行这些生活方式的改变，因为第一，它们是免费的，而且没有副作用。

But the point your take home point is that you're better off doing these lifestyle changes because one, they're free and there's no side effects.

而且它们有效。

And they work.

而且唯一的，是的。

And the only yep.

这完全正确。

That that's exactly right.

是的。

Yeah.

所以你可以想象，当一位医生告诉某人：好吧，你患有二型糖尿病，或者你正处于糖尿病前期的边缘。

So you could imagine someone whose physician says, alright, you have type two diabetes or you're really prediabetic, you're on the doorstep of type two diabetes.

你有两个选择。

You have two options.

一种选择是进行生活方式的改变，如果你明智地去做，很可能逆转这种疾病。

One is to go and do a lifestyle change, and then and you'll probably reverse the disease if you're smart about it.

另一种选择是离开我的诊室时，拿到一份二甲双胍的处方。

Alternatively, you can leave my office with a prescription for, say, metformin.

如果你只选择这条药物治疗的道路，你就永远无法停药。

If this is the only path you take, the drug path, you will never get off the drugs.

唯一会发生的是，正如我这里听起来可能有点夸张，但实际情况确实如此：患者会被开出处方。

All that will happen and this sounds like I'm being hyperbolic here, but this is exactly how it goes, where the person will be given a prescription.

结果只会是逐渐增加药物剂量，当这种药越来越无效时，就会再加另一种药，接着再加另一种，从而让他们走上一条永远无法逆转疾病的道路。

The only outcome is that they increase the dose of that drug, and then as that becomes increasingly ineffective, then they have a different drug that they add on to it, and then a different one, and that puts them on this path of never reversing the disease.

这就是为什么传统医学会说2型糖尿病是不可逆的。

That that is why conventional medicine will say type two diabetes is irreversible.

因为如果你用药物这种传统方式治疗它，它确实是不可逆的。

Because if you treat it in the conventional way with drugs, it is.

药物永远无法解决根本问题。

The drugs will never solve the problem.

然而，如果你承认2型糖尿病本质上是一种由我们所吃食物引起的疾病，食物既是病因也是疗法，那么你就可以让食物成为疗法，并据此做出相应的改变。

If, however, you acknowledge that Type II diabetes is a disease of the food we eat essentially, that the food is the culprit or the cure, then you can let it be the cure and start making changes accordingly.

好了，本杰明，这次对话非常精彩。

Well, Benjamin, this has been a great conversation.

人们可以去哪里了解更多关于这本书和你的工作呢？

Is there some place people can go to learn more about the book and your work?

是的。

Yeah.

非常感谢你，布雷特。

Thanks so much, Brett.

这本书在任何卖书的地方都能买到。

The book is available anywhere books are sold.

再次提醒，书名是《我们为何生病》。

Again, the title is Why We Get Sick.

请注意，我没有在书名中说‘胰岛素抵抗为何重要’，原因正是我们花了一个小时详细阐述的那些。

And notice, I didn't say, you know, in the title why insulin resistance matters, for the very reasons we've spent an hour elaborating on.

这是因为大多数人不了解胰岛素的价值，所以他们从未从货架上拿过它。

It's because most people don't know the value of insulin, so they wouldn't have never they've never pulled it off the shelf.

所以，是的，总之，去买这本书《我们为什么会生病》吧。我在社交媒体上还算活跃，主要在Instagram上，我通常每周发布几个关于人体新陈代谢见解的视频。

So, yeah, anyway, go buy the book, Why We Get Sick, and I I'm moderately active on social media, mostly Instagram, where I usually put out a few videos a week just about insight into human metabolism.

然后做个毫不掩饰的推广，我和几个兄弟一起做了一点小生意，生产低碳水化合物的代餐奶昔，人们可以访问网站gethealth.com了解更多。

And then one shameless plug, I have a little business with a couple of my brothers, a little family business where we make, low carb meal replacement shakes, and people can learn more about that by going to the website gethealth.com.

而health的拼写是hlth，网址是gethlth.com。

And health, health is spelled hlth, gethlth.com.

太棒了。

Fantastic.

好了，本杰明·比克曼，感谢你抽出时间。

Well, Benjamin Bikman, thanks for your time.

很高兴与你交谈。

It's been a pleasure.

我也很荣幸。

My pleasure.

非常感谢，布雷特。

Thanks so much, Brett.

今天我的嘉宾是本杰明·比克曼博士。

My guest today was doctor Benjamin Bikman.

他是《我们为何生病》一书的作者。

He's the author of the book Why We Get Sick.

这本书在亚马逊.com和各大书店均有售。

It's available on amazon.com and bookstores everywhere.

你可以在他的网站bikmanlab.byu.edu上了解更多关于他的研究和工作。

You can find out more information about his research and work at his website, bikmanlab.byu.edu.

如果你想了解更多关于他的补充剂Health Code，可以访问GITHEALTH。

And if you wanna learn more about his supplement health code, you can go to GITHEALTH.

health的拼写是h l t h。

That's health, just h l t h.

如果你想了解更多相关信息，不妨去了解一下。

Check it out if you wanna learn more information about that.

另外，请查看我们的节目笔记 @aom.isslashsick。

Also, check out our show notes @aom.isslashsick.

精炼的链接，帮助你更深入地了解这个话题。

Refine links to resources where you delve deeper into this topic.

好了，这期AoM播客就到这里了。

Well, that wraps up another edition of the AoM podcast.

请务必访问我们的Art of Manliness网站 artofmanless.com，那里有我们的播客存档，以及多年来撰写的成千上万篇文章，涵盖你想到的几乎所有主题。

Make sure to check out our Art of Manless website at artofmanless.com where you find our podcast archive, well as thousands of articles written over the years about pretty much anything you think of.

如果你想享受无广告的AoM播客剧集，可以通过Stitcher Premium实现。

And if you'd to enjoy ad free episodes of the AoM Podcast, you can do so on Stitcher Premium.

前往 stitcherpremium.com，注册时在结账时使用代码 manless，即可获得一个月的免费试用。

Head over to stitcherpremium.com, sign up, use code manless at checkout for a free month trial.

注册后，下载Android或iOS上的Stitcher应用，即可开始收听无广告的AoM播客剧集。

Once you're signed up, download the Stitcher app on Android or iOS, and you can start enjoying ad free episodes of the AoM Podcast.

如果你还没有这么做，我希望能花一分钟在Apple Podcasts或Stitcher上给我们留下评价。

If you haven't done so already, I'd appreciate if you take one minute to give us review on Apple Podcasts or Stitcher.

这帮助很大。

It helps out a lot.

如果你已经这么做了，谢谢。

If you've done that already, thank you.

请考虑把节目分享给一位你认为会从中受益的朋友或家人。

Please consider sharing the show with a friend or a family member who you think would get something out of it.

一如既往，感谢您的持续支持。

As always, thank you continued for support.

下次再见，我是布雷特·麦凯，提醒您收听AoM播客，但更要将所学付诸实践。

Until next time, it's Brett McKay, reminding you to listen to AoM podcast, but put what you've heard into action.

在离开之前，这里还有另一集值得加入您的播放列表。

Before you go, here's another episode worth adding to the queue.

在第821期节目中，我们探讨了为什么例行公事，尤其是过于僵化的例行公事，反而会让生活变得更艰难，而不是更轻松。

In episode number eight twenty one, we explore why routines, especially over rigid ones, can actually make life harder, not easier.

我们谈论了不偏执的自律、非刻板的结构，以及真正的成长来自何处。

We talk discipline without obsession, structure without rigidity, and where real growth comes from.

你可以在 aom.is/routines 找到它。

You can find it at aom.is/routines.

那就是 aom.is/routines。

That's aom.is/routines.

去看看吧。

Go check it out.

第八百二十一期。

Episode number eight twenty one.