认知衰退专家：始于而立之年，却夺命于古稀之年的疾病

八次。

Eight.

好的。

Okay.

所以我可以在手机上设个闹钟吗？

So I could set an alarm on my phone?

每小时一次。

Every hour.

只要站起来，或者每四十五分钟站起来做一个空中深蹲。

Just get up, or every forty five minutes, up and do an air squat.

这主要是因为，如果你听说了吃饭时血糖会急剧上升，而将血糖峰值降下来的最好方法就是进行任何形式的运动。

And this is primarily because if you heard that when you eat, you get a massive spike of glucose, And the best way to bring that glucose spike back down is by doing any form of exercise.

你可以选择出去快跑，或者做一个空中深蹲，让血糖水平恢复到基线。

You can, albeit, go out and go for fast run, do an air squat, bring that glucose level back to baseline.

你有没有认真考虑过有氧运动作为预防阿尔茨海默病的手段？

And do you think much about aerobic training as a preventative measure for Alzheimer's?

我喜欢有氧训练。

I love aerobic training.

女性在社交媒体上面临一个困境，因为她们被灌输了太多信息。

Women are facing a dilemma on social media because they're being given so much information.

现在有一个巨大的争议：我该不该做二区运动？

There is this huge uproar of should I do zone two exercise or should I not do zone two exercise?

什么是二区运动？

What is zone two exercise?

我们可以从生理学的角度把运动分成不同区域。

So we can think of, physiology in zones.

一区就是你现在和我所处的状态。

Zone one is what you and I are in right now.

是的。

Mhmm.

对吧？

Right?

第二区是下一个级别，通常是指我们以大约最大心率的60%进行锻炼的时候。

Zone two is that next level up, and that's generally when we're looking at exercising at around 60% of our maximum heart rate.

在这个区间，你可以慢跑，能够说话，但会喘得厉害。

And it's where you can where you're jogging, but you can have a conversation, but where you're huffing and puffing.

当我们锻炼时，我们需要产生能量。

When we're exercising, we need to produce energy.

而这些能量首先是在线粒体中产生的。

And that energy firstly starts in the mitochondria.

所有这些能量都会被制造出来，形成ATP，这让我们能够完成特定的任务。

So we need, all of that energy gets created, we create ATP, and that's how we are able to perform the given task.

一旦我们超出这个区间，进入第三区、第四区和第五区，能量就会在线粒体外的细胞质中产生。

As soon as we get out of that zone and we go into zone three, zone four, and zone five, we're producing energy outside of the mitochondria in the cytoplasm.

而当我们这样做的时候，为了产生能量，我们会通过一种叫做糖酵解的途径，迅速分解葡萄糖。

And when we're doing that, in order to do that, we're breaking down glucose so fast via a pathway called glycolysis.

这个过程的副产品是乳酸，于是我们就产生了乳酸。

The byproduct of that is lactate, and then we produce lactate.

这实际上还是大脑的一种能量来源。

And that's actually a fuel source for the brain.

它也是一种肌因子。

It's also a myokine.

对吧？

Right?

所以当我们进入三区、四区和五区时就是这种情况。

So that's when we're in zone three, zone four, zone five.

很多女性一直在进行二区训练。

So a lot of women have been doing zone two.

她们去健身房锻炼。

They've been going to the gym.

她们一直在做二区训练。

They've been doing zone two.

我正试图推动女性们走出二区，原因有好几个。

And I'm trying to push women to get out of zone two for several reasons.

并不是因为对你们不好。

Not because it's not good for you.

我认为所有的运动形式都对你们有益。

I think all forms of exercise are good for you.

你动得越多，越好。

The more you move, the better.

对吧？

Right?

但让我们坦诚一点。

But let's be really honest.

很多中年人都很忙。

A lot of people in midlife are busy.

他们时间很紧张。

They're time poor.

男性通过进行二区训练实际上能获得更高的回报。

Men actually get a greater return on investment by doing zone two.

女性从二区训练中获得的收益并不像男性那样明显。

Women don't get the same return on investment from doing zone two.

所以我正在鼓励女性先专注于三区、四区和五区的训练。

So I'm trying to push women to first work on zone zone three, zone four, zone five.

如果可以的话，直接做五区训练。

If they can, just do zone five.

然后每周进行两到三次力量训练。

Then do two to three sessions of resistance training a week.

如果你还有时间，那就正好用在这里。

And if you have time left over, that's right there.

我刚刚描述的运动量大约是四小时。

I've just described around four hours of exercise.

如果你还有时间，再加入二区训练。

If you have time left over, then you can work in zone two.

二区训练确实很棒。

Now zone two is great.

如果你出去长跑，你其实是在做很多事情。

If you're going to go out and go for a long run, you're doing many things.

你正在分泌大量的BDNF，而这是我们所需要的。

You are secreting a lot of BDNF, which we need.

它是大脑的一种生长因子。

It's a growth factor for the brain.

你让大量血液流入大脑，这同样非常好。

You're getting a massive amount of blood that's going into the brain, which is great as well.

这种状态是持续的。

It's sustained.

血液为大脑输送氧气和营养物质。

Blood delivers oxygen and nutrients to the brain.

你其实做了很多事。

You're doing a lot of things.

对吧？

Right?

但你并没有对心脏的各个腔室产生完全的影响。

But what you're not doing is having a complete effect on the chambers of your heart.

对我来说，在跑步机上跑五公里好，还是在外面跑好？

Is it better for me to do five kilometers on a treadmill or outside?

我认为对你来说，为了大脑健康，最好进行较少但强度更高的运动。

I would say it's better for you, for the brain, to do a smaller amount of exercise and a higher threshold.

因为我好像曾经读到过，外面跑步对大脑更好，因为它能刺激大脑。

Because I I was I think I read somewhere one time that running outside is better for the brain because it stimulates the brain.

嗯，你在户外，周围有这么多东西。

Of well, you're outside, so you've got so many things around you.

想象一下你的大脑。

Imagine your brain.

我跟你说过，它拥有绝佳的地理位置。

I told you, it's got prime real estate.

大脑的每个部分都负责不同的功能。

Every part of the brain is responsible for a different function.

从你看到的到你听到的，你走出去后能看到这么多东西。

From what you see to what you hear, you go outside and you can see so many things.

你进行向前的行走，这有助于提升你的动力、驱动力和多巴胺。

You've got forward ambulation, so that's going to help you with drive, motivation, dopamine.

但同时你也在接收声音和各种感官刺激。

But then you're also taking in the sounds, the senses.

它能降低炎症反应。

It down regulates inflammation.

因此，这样做能带来很多其他好处。

So you get so many other things from doing that.

是的。

Yes.

但相比户外跑五公里，二十分钟的高强度有氧运动，哪个对大脑更好？

But five kilometers outside compared to twenty minutes of high aerobic physical activity, What is better for the brain?

我会说，五区强度对大脑更好。

I would say that the Zone five is better for the brain.

五区训练对心脏的各个腔室也有很大好处。

The Zone five training does a lot for the chambers of your heart as well.

现在我要拿这个。

Now I'm going grab this.

我们这里有一个小模型。

We've got a little model here.

我们可以看到左边有一个腔室。

And we can see that we have a left chamber.

右边也有一个腔室。

We have a right chamber.

心脏实际上有四个腔室。

We have actually four chambers of the heart.

但心脏里还有一个叫做心室的结构。

But we have something in the heart called a ventricle.

我们有左心室和右心室。

We've got a left ventricle, and we've got a right ventricle.

左心室将富含氧气的血液输送到全身。

Now the left ventricle delivers oxygenated blood to the entire body.

这非常有趣，因为左心室的腔室就像一块肌肉。

It's really interesting because the chamber of the left ventricle is like a muscle.

它负责将血液泵送到全身。

It's responsible for pumping blood to your entire body.

它首先将血液输送给大脑，这意味着大脑是你身体最重要的部分。

It first gives blood to the brain, which means it's the most important part of your body.

在完成向大脑供血后，血液会继续流向身体的其他部位。

After it's done giving blood to the brain, it goes through to the rest of the body.

随着年龄增长，我们的动脉会硬化，心脏的所有动脉都会变硬，并出现一种叫做左心室肥厚的情况。

As we get older, we get stiffening of these arteries, stiffening of all of the arteries in the heart, and we something called left ventricular hypertrophy.

也就是说，左心室开始变厚。

So that's when the the left ventricle, it starts to get thicker.

当它变厚时，就意味着它不再那么有力了。

And when it gets thicker, that means that we can't it's not as strong.

它无法像年轻时那样向全身泵送大量血液。

It can't pump a lot of blood as much as it could when it was younger to the rest of the body.

本·莱文医生，一位运动心脏病专家，进行了一项具有里程碑意义的研究，这项研究改变了我对五区训练的看法。

Ben Levine, doctor Ben Levine, he's a sports cardiologist, and he did this landmark study which changed how I thought about Zone five training.

他招募了一组久坐不动的男性，平均年龄大约在47到55岁之间，也就是50岁左右，并对他们的心脏进行了扫描。

He took a group of sedentary males, average age I think it was around 47 to 55, so around 50 years old, And he scanned their hearts.

他做了超声心动图。

He did echocardiograms.

他拍摄了心脏的照片。

He took photos of the heart.

他尽其所能，在参与者刚开始执行该方案时，观察他们的心脏状况。

He did everything he could to see when they were first starting the protocol, what does their heart look like?

然后，他让这些人每周进行大约四小时的锻炼，并将锻炼方式分为每周一次力量训练。

He then subjected them to around four hours of exercise per week, and that was stratified against he did one resistance training session a week.

其中一次是高强度运动，心率维持在最大心率的90%左右，即VO2最大值对应的心率。

One was high intensity physical activity at around 90% of the maximum heart rate, the VO two max heart rate.

而在其间，他还进行了一些长时间的训练。

And then in between, he did some long sessions as well.

对吧？

Right?

但所有这些运动都是中等强度到高强度的，并且持续了两年。

But it was all moderate to rigorous exercise, and that was done over two years.

两年后，他发现自己的心脏年轻了二十岁。

At the end of those two years, what he found was that he remodeled the heart by twenty years.

他逆转了心脏与年龄相关的功能退化，将50岁的心脏恢复到了30岁的心脏状态，仅仅依靠体育锻炼就做到了。

So he reversed the age related effects and defects of the heart by twenty years, essentially turning the 50 year old hearts into 30 year old hearts just from physical activity alone.

每周四小时，持续两年？

Four hours a week for two years?

每周四小时，持续两年。

Four hours a week for two years.

那是什么样的运动？

And what kind of exercise was it?

所以他让他们采用某种方案，比如以最大心率的90%进行锻炼。

So he got them to do let's say, for example, one of the protocols was exercising at 90% of your maximum heart rate.

当我们这样做时，通常是为了提高我们的最大摄氧量。

So when we do this, we're generally looking at increasing our v o two max.

你可能听说过，最大摄氧量和力量一样，是预测全因死亡率最强的指标。

So you've probably heard that v o two max, along with strength, the v o two max is the strongest predictor of all cause mortality.

对吧？

Right?

所以如果你想提升最大摄氧量，并希望获得他那样的心脏改善效果，你每周只需进行20分钟的最大摄氧量训练，就能维持你的最大摄氧量，因为它从35岁左右开始逐年下降。

So if you want to improve your v o two max and if you wanna get the heart related changes that he did, What you wanna do is you wanna do twenty minutes of v o two max per week just to keep your v o two max because it does decline year on and year out starting at the age of around 35.

我们开始看到最大摄氧量的下降。

We start to see a decline in v o two max.

所以如果我们想提升最大摄氧量，就应该进行所谓的挪威四乘四训练法。

So if we want to work on our v o two max, we wanna be doing a what we call the Norwegian four by four.

这是提升最大摄氧量的黄金标准。

It's the gold standard of increasing your v o two max.

你需要让心率提升到90%到95%，持续四分钟，然后休息四分钟，重复四次。

So you wanna get your heart rate elevated to 90 to 95% for four minutes on, four minutes off, repeat four times.

那我该怎么做到呢？

So how do I do this?

我实际上每周做两次，因为做得越多，效果越好。

Well, I actually do this twice a week because the more you do, the better.

我用踏步机来做。

I do this on a stepper.

我在健身房做这个。

I do this at the gym.

我把踏步机调到大约14级，正在逐步提升强度，并且每次坚持四分钟。

And I put my stepper onto, I think I'm at like a level 14, and I'm working my way up and I'm staying on there for four minutes.

然后我会完全停下来，彻底休息四分钟。

And then I'm having a complete stop and a complete rest for four minutes.

我重复这个过程四次。

And I'm repeating that four times.

在那一刻，我所做的不仅仅是让大量血液涌入大脑，这固然很好。

So what I'm doing in that moment, I'm not just getting a massive shunting of blood to the brain, which is good.

我也不仅仅是向大脑大量释放肌因子和外泌因子。

I'm not just getting a massive release of myokines and exokines to the brain.

我还在重塑心脏。

I'm also remodeling the heart.

我正在抑制肿瘤细胞的生长。

I'm down regulating tumor cell growth.

我正在提升我的认知表现。

I'm improving my cognitive performance.

我所做的远不止单纯的锻炼。

I'm doing so much more than just exercising alone.

在利文的研究中，每周一次这样的运动就能让这些人的心脏年轻二十岁。

So that's once a week in Levine's study that reversed these guys' hearts by twenty years that you do that once a week.

你只需要每周做一次这样的运动。

You only have to do that once a week.

但他每周还保持了约70%最大心率的运动，持续约两小时，并且还加入了一次力量训练。

But he also did, he did around 70% of maximum heart rate for around two hours a week, and he also threw in one resistance training session.

所以坚持是关键。

So consistency is key.

我正在查看这项研究的一些发现，其中一个令人惊讶的结果是，它表明心脏逆转存在一个生物学上的时间窗口。

I'm just looking at some of the findings of that study, and one of the surprising things is it showed that there is a biological exploration date per se for the reversal of the heart.

是的。

Yeah.

而心脏保持可塑性、自我重塑的能力直到65岁。

And then the heart retains its plasticity, the ability to remodel itself until the age of 65.

如果这种干预在65岁之后才开始，心脏就已经太僵硬，无法通过物理方式重塑以实现二十年的逆转。

If this intervention had started after the age of 65, the heart was too stiff to be physically remodeled to get to that twenty year reversal.

没错。

Yep.

你必须在中年后期就开始。

You have to start in late middle age.

没错。

Exactly.

所以中年是大脑健康和长寿的关键窗口期。

So midlife is the window of opportunity for brain health and for longevity.

我没想到你居然可以自己重塑心脏。

I didn't realize you could sort of remodel the heart yourself.

这很有趣。

That's interesting.

是的。

Yeah.

你可以重塑心脏。

You can remodel the heart.

而且心脏非常神奇，你看主动脉的情况。

And the heart is amazing, okay, because what you see with the aorta.

对吧？

Right?

主动脉向上延伸，而大脑的主要血液供应来自椎动脉。

So the aorta goes up, and we've got we've got two we've got the main blood supply for the brain exists in the vertebral arteries.

明白吗？

Okay?

因此，从主动脉分出的椎动脉，负责向大脑后部和小脑供血。

So there's branching off of the aorta, comes from the heart, vertebral arteries which supply the posterior part of the brain and the cerebellum with blood.

此外，还有颈动脉，左右两侧各一条，从主动脉分出，为大脑的前部和中部供血。

And then you've got the carotid arteries, so one on each side branching off the aorta, which supply the, frontal and middle part of your brain with blood.

大脑是全身血管最丰富的器官。

The brain is the most vascular rich organ in the entire body.

在压力时期，比如高血压（血压升高）时，我们会发现最微小的血管——毛细血管——可能会受损死亡。

In times of stress such as hypertension, that is elevated blood pressure, we see that we can actually kill off the tiniest parts of the blood vessels which are called the capillaries.

你可以在这里看到毛细血管。

You can see the capillaries up here.

它们甚至为血脑屏障提供血液。

They supply even the blood brain barrier.

因此，它们主要为大脑的外层皮质供血。

So they supply mainly the outer cortex of the brain with blood.

当我们血压升高时，就开始破坏大脑中这些微小的毛细血管。

When we have elevated blood pressure, we are starting to kill off those tiny little capillaries of the brain.

这些毛细血管为大脑中的不同神经元供血，同时也为血脑屏障供血。

Those capillaries are feeding different neurons in the brain and also feeding the blood brain barrier.

因此，当这些毛细血管断裂时，我们就会失去血液供应和氧气供应，血脑屏障本身也会遭到破坏，这非常可怕，我们在患有轻度认知障碍的患者身上就能看到这种现象。

So when we get breaking off of these, we lose the blood supply, we lose the oxygenation, we get a breakdown of the blood brain barrier itself, which is scary, and we see that in patients who have got mild cognitive impairment.

你听说过‘肠漏’，我们也可以称之为‘脑漏’。

You've heard of leaky gut, we can call it leaky brain.

如果你有脑漏，最终会发生什么呢？你的血脑屏障就像这样排列着。

If you have a leaky brain, what happens eventually is so your blood brain barrier sits like this.

明白吗？

Okay?

其中有一些细胞，比如我们称之为寄生虫的那些，它们通过紧密连接彼此结合。

And there are cells, and we call them parasites, for example, and they're bound together by tight junctions.

这就是血脑屏障的作用。

That's what the blood brain barrier is.

你可以把血脑屏障想象成夜总会的门卫。

It's like a you think of the blood brain barrier as the bouncer of a nightclub.

它们都站在那里，负责谁可以进入、谁不可以进入，并且阻止某些分子进入。

They are all standing there like this, responsible for who can come in and who can't, and they don't allow some molecules to get in.

但随着时间推移，当血脑屏障开始退化并变得渗漏时，这些细胞就会逐渐分离。

But over time, when this starts to degrade and become leaky, they start to spread apart.

一旦它们分离，就会有大量分子被动扩散进入，这对大脑非常有害。

And when they do, you can have the passive diffusion of all these molecules coming in, and that's really bad for your brain.

因此，我们需要通过维持毛细血管的健康来保持血脑屏障的完整性。

So we want to maintain the integrity of the blood brain barrier by maintaining the capillary health.

我们不希望毛细血管死亡。

We don't want the capillaries to die.

它们只有一层细胞厚。

They're one cell thick.

任何类型的损伤都可能损害并杀死它们。

Any type of damage can damage them and kill them.

高血压。

Hypertension.

有一项非常出色的研究。

There was a really great study.

它被称为SPRINT试验，现在已成为推荐120/80的金标准。

It was called it was actually the SPRINT trial, It's now the gold standard for the recommendation of 120 over 80.

那是什么？

What's that?

当你测量血压时，我们会得到收缩压和舒张压。

So when you have your blood pressure taken, we get the systolic over diastolic.

你可能已经知道，我不知道你是否每天测血压，但每天测量血压是一种非常经济有效的工具，有助于维持大脑健康。

And you've probably, I don't know if you take your blood pressure, but doing your blood pressure every day is a really great inexpensive and effective tool for maintaining good brain health.

所以当你测量血压时，如果血压偏高，也就是收缩压超过135，这时问题就开始出现了。

So you measure your blood pressure and if you are hypertensive, this is anywhere over 135, systolic over 135, that's when things start to break down.

这时，那些仅由单层细胞构成的毛细血管开始出现损伤。

That's when we start to get the breakdown of those small one cell thick capillaries.

因此，在这项SPRINT试验中，研究人员发现，当他们积极管理这些患者并降低其血压时，是通过一种名为ACE抑制剂的药物实现的。

So in this trial, in the SPRINT trial, what they found was that when they aggressively manage these patients and they bring their blood pressure down, they did it pharmacologically through something called an ACE inhibitor.

这是一种用于降低血压的药物。

It's a medication to drive down blood pressure.

当他们通过药物将血压降低后，这些患者的脑部、灰质和认知功能都得到了保留。

When they bring it down pharmacologically, these patients preserved their brain, gray matter, and their cognitive functions.

因此，我们现在有了一个金标准。

So we now have a gold standard.

这也是我建议每个人采取的做法。

And this is what I would recommend anybody.

在亚马逊上，一台自动血压计大约25美元。

On Amazon, it costs about $25 for an automatic blood pressure monitor.

每天早上都测量一下，监测你的血压。

Do it every single morning, and watch your blood pressure.

如果血压高，我该怎么办？

And then if it's high, what do I do about it?

除了药物治疗，如果我们不想吃药，那就通过锻炼来增强体质。

Well, outside of pharmacology, if we don't want to take a medication, we want to get stronger, and we want to do this via exercise.

压力是导致高血压的最主要因素之一。

Stress is one of the biggest things driving high blood pressure.

通过锻炼、睡眠以及大自然赋予我们的各种方式，来管理压力、皮质醇和慢性炎症。

Manage stress, manage cortisol, manage chronic inflammation by way of exercise, sleep, all of the things that mother nature gave us.

我刚刚在看一项让心脏年轻了二十年的研究，想弄清楚他们做了哪些运动。

I was just looking at the study that reversed the heart by twenty years and trying to figure out what exercises they did.

正如你所说，第一种是高强度训练，也就是四乘四法。

And as you said, the first one was a high intensity workout, the four by four.

是的。

Yep.

然后他们还进行了长时间的有氧运动。

Then they did a long aerobic exercise.

这所有内容每周只做一次。

Again, this is all once a week.

所以每周一次，进行六十分钟的长时间运动，比如徒步、网球或骑自行车。

So sixty minutes once a week doing a longer exercise like it could be hiking or tennis or cycling.

中等强度的锻炼，三十分钟，采用对话测试法，你应该能出汗，但仍然能正常说话。

A moderate intensity workout, thirty minutes, where they did the talk test, you should be able to break a sweat but still be able to speak.

所以这也是每周一次。

So that was once a week.

最后，每周进行一次力量训练。

And then lastly, strength training once a week.

因此，正是这种多样化的运动对心脏产生了如此深远的影响。

So it's really a variety of exercises that cause such a profound impact on the heart.

我认为心血管疾病是头号杀手。

And I think cardiovascular diseases are the single biggest killer.

是的。

Yeah.

心血管疾病。

Cardiovascular disease.

痴呆是英国女性的头号杀手。

Dementia is the number one killer of women in The UK.

头号。

The number one.

真的吗？

Really?

在澳大利亚，它是男性和女性的首要死因。

It's the number one cause of death in Australia for both men and women.

它是怎么致人死亡的？

How does it kill you?

因为我们都会想到记忆力减退之类的问题。

Because we all think about memory loss and stuff like that.

是的。

Yeah.

这才是真正令人痛心的部分。

And so this is the actual devastating part.

我们并不是直接死于阿尔茨海默病。

We don't die of Alzheimer's disease specifically.

随着时间推移，这些患者的情况是这样的：你要记住，阿尔茨海默病就像晚期癌症。

Over time, what happens is in these patients, you have to remember, Alzheimer's disease is like end stage cancer.

一旦确诊，就没有任何治愈的可能。

Once you get the diagnosis, there is no cure.

无法逆转。

There is no going back.

无法恢复。

There is no reversal.

你得了这种病，这才是最可怕的部分。

You have the disease, and that's the scariest part.

轻度认知障碍，你可以减缓它的进展。

Mild cognitive impairment, you can slow the progression of that.

正如我跟你说的，这个过程会持续二十年。

Like I said to you, it goes for twenty years.

轻度认知障碍，你可以减缓轻度认知障碍的进展。

Mild cognitive impairment, You can slow the progression of mild cognitive impairment.

但一旦在那可怕的一天，你的母亲或朋友被诊断出患有阿尔茨海默病，那就是一个悲伤的日子。

But as soon as you get diagnosed on that awful day that your mother or your friend gets diagnosed with Alzheimer's disease, it's a sad day.

而这些患者最终可能死于窒息。

And what ends up happening with these patients is you can die of asphyxiation.

你的大脑会失去吞咽的信号。

Your brain loses the signal to swallow.

它会失去平衡感，导致你摔倒。

It loses the signal to maybe you fall because you've lost balance.

这是一个非常可怕的情景。

It's a really scary moment.

但你并不是直接死于阿尔茨海默病本身。

But it's not like you die of Alzheimer's disease specifically.

如果你被诊断出患有阿尔茨海默病，这真是个有趣的反应。

If you were diagnosed with Alzheimer's disease That's an interesting reaction.

因为我将毫无希望。

Because I would have no hope.

我觉得更好的问题是

I think a better question is

你会毫无希望。

You'd have no hope.

如果我被诊断出患有阿尔茨海默病，我什么都做不了。

If I was diagnosed with Alzheimer's disease, there is nothing I could do.

这会如何改变你的生活和你所做的决定？

How would that change your life and the decisions you make?

或者根本不会改变吗？

Or would it at all?

我会积极地、非常积极地锻炼。

I would aggressively, aggressively exercise.

我会监控我的饮食。

I would monitor my diet.

我会严格监控我的饮食，甚至可能采用生酮饮食。

I would aggressively monitor my diet, and I would potentially have a ketogenic diet.

因为我们的发现是，在大脑出现代谢危机时，你会失去将葡萄糖作为主要能量来源的能力。

Because what we've found is that during this metabolic crisis that happens in your brain, where you lose the ability to use glucose as your primary fuel source.

所以大脑不知道如何将葡萄糖作为主要能量来源，因此它处于被攻击的状态。

So the brain doesn't know how to use glucose as its primary fuel source, so it's under attack.

在阿尔茨海默病期间。

During Alzheimer's.

在阿尔茨海默病期间，但女性在围绝经期也会出现这个窗口期。

During Alzheimer's, but also during this window in for women as well in the perimenopause state.

当脑细胞受到攻击，无法有效利用葡萄糖，又缺乏能量时，它就会开始考虑生存。

So the brain cell, when it's under attack and it can't utilize glucose effectively and it doesn't have any energy, it starts to think about survival.

它会想，我能做些什么？

It starts to think, what can I do?

我正在遭受攻击。

I'm under attack.

因此，它开始分解髓鞘。

So it starts to break down the myelin sheath.

在那一刻，实际上是星形胶质细胞。

And in that moment, it's actually the astrocytes.

它们是大脑的支持细胞。

They're the supporters of the brain.

也就是大脑细胞的支持者。

So of the brain cells.

所以它们开始想，好吧。

So they start to think, okay.

让我们分解髓鞘。

Let's break down the myelin sheath.

从中，星形胶质细胞会产生酮体。

From that, the astrocytes produce ketone bodies.

然后酮体被运送到大脑，这就是我们大脑利用能量的方式。

And then the ketone bodies get shuttled into the brain, and that's how we use, energy in the brain.

所以在这种代谢危机状态下，我会确保自己摄入富含酮体的饮食，或者补充外源性酮体。

So in that state of metabolic crisis, I would make sure that I am having a ketone rich diet or I may be getting exogenous ketones.

我会积极锻炼。

I would aggressively exercise.

我会积极管理我的血脂。

I would aggressively manage my lipids.

我会大量摄入欧米伽-3脂肪酸。

I'd have a high intake of omega-three fatty acids.

如果我还能保持认知功能，我会通过与人交谈、外出、社交，以及进行有深度的对话来尽可能地保留它。

And I would preserve, if I could, any form of cognitive function by way of talking to people, by going outside, socializing, having hard conversations if I was intact and I could do so.

我会把网球扔向墙壁。

I would throw tennis balls to the wall.

关于生酮饮食，原因是酮体是葡萄糖的替代能量来源。

So on that point of the ketogenic diet, the reason is because ketones are an alternative fuel source to glucose.

是的

Yep.

大脑喜欢酮体。

And the brain likes ketones.

大脑非常喜爱酮体，实际上比葡萄糖更有效地利用它们，但葡萄糖仍是大脑的主要能量来源。

The brain loves ketones and actually utilizes them more effectively than glucose, but glucose is the primary fuel source for the brain.

这里有一件非常有趣、对女性来说也令人沮丧的事情。

And here's what's really interesting, and devastating, if you will, for females.

在围绝经期开始时，当我们看到雌激素水平下降时。

During the onset of perimenopause, when we see a decline in estrogen.

我们看到雌激素水平下降。

We see a decline in estrogen.

结果是大脑葡萄糖代谢减少了30%。

What happens is a 30% reduction in brain glucose metabolism.

因此，当这些受体开始死亡，因为我们血液中的雌激素已经不再充足时，会发生什么？

So when these receptors start to die because we don't have, we don't have a lot of estrogen circulating in the bloodstream anymore, what happens?

我们无法有效利用葡萄糖。

Well, we can't utilize glucose as effectively.

因此，在这种状态下，我们开始分解髓鞘，将其转化为酮体，作为大脑的替代能量来源。

So during that state, that's when we start to get the breakdown of the myelin sheath, to use that as ketone bodies as an alternative brain fuel source.

所以，你认为经历更年期的女性应该考虑生酮饮食吗？

So do you think women going through menopause should be considering a ketogenic diet?

是的，我认为应该。

Yes, I do think that.

我认为，正在经历围绝经期并深受这种大脑能量危机影响的女性，如果可能的话，应该采用生酮饮食。

I think that women who are going through perimenopause and who are at the mercy of this brain energetic crisis should be adopting, if they can, a ketogenic diet.

这是对大脑最好的饮食之一。

It's one of the best diets for the brain.

我之前并不理解这个观点，即在更年期时，大脑会出现葡萄糖缺乏或代谢问题。

I didn't really understand this idea that during menopause, there was a glucose deficiency or metabolism problem in the brain.

大脑葡萄糖代谢下降了30%。

30% reduction in brain glucose metabolism.

这就是为什么女性会报告出现脑雾和其他类似症状的原因吗？

Is this why women report having brain fog and all these kinds of things?

是的，完全正确。

Yeah, absolutely.

因为当大脑无法有效利用其能量来源时，会发生什么？

Because when the brain can't utilize its fuel source effectively, what happens?

嗯，代谢物开始发生变化。

Well, metabolites start to shift.

我们睡不好觉。

We don't sleep properly.

大约百分之六十到六十五的更年期女性报告有潮热或夜间盗汗。

Around sixty percent to sixty five percent of women in menopause report having a hot flash or night sweats.

这会让她们在夜间醒来。

It wakes them up at night.

这也导致了认知衰退和脑雾。

That's also causing cognitive decline and brain fog.

所以这张图相当令人震惊。

So this graph is pretty shocking.

你能解释一下它展示了什么吗？

Can you explain what it shows?

哦，这张图显示了女性从出生时的雌激素水平，经历青春期、围绝经期，最终进入绝经期的整个生命周期变化。

Oh, this is showing the estrogen levels at birth going through all of the life cycles that a woman will go through puberty, perimenopause, and then eventually menopause.

有一件事是确定的。

There is one thing that is certain.

我之前提到过，年龄之后，女性身份是患上这种疾病最强的危险因素。

After age, I mentioned earlier, being a woman is the next strongest risk factor for getting this disease.

忘记阿尔茨海默病。

Forgetting Alzheimer's.

忘记阿尔茨海默病。

Forgetting Alzheimer's.

而这主要源于绝经期发生的雌激素水平下降。

And that largely lies in menopausal shift that occurs, the downsizing of estrogen.

然而，我们确实有可以补充的雌激素形式。

However, we do have forms of estrogen that we can supplement with.

所以我只需要保持雌激素水平，这样大脑健康就能保持正常。

So I just need to keep the estrogen up because then the brain health is going to be up and normal.

这正是争议所在，是也不是。

This is where the controversy lies, yes and no.

我想让每个人都明白，我现在就坐在这里，我的整个博士论文都聚焦于女性和阿尔茨海默病。

I want everyone to understand, I am sitting right now, so my entire doctoral thesis is focused on women and Alzheimer's disease.

在激素替代疗法方面，我现在就像瑞士一样中立。

And I'm Switzerland right now when it comes to hormone replacement therapy.

那就是补充你的激素。

That is replacing your hormones.

你就像瑞士。

You're Switzerland.

我是瑞士，意思是目前没有证据表明。

I'm Switzerland, meaning that there is no evidence to suggest.

目前，我们还没有大规模的随机对照试验来证明激素替代疗法可以预防痴呆。

Right now, we don't have large scale randomized control trials to show that hormone replacement therapy prevents dementia.

所以我要告诉你们的是，这只是一个信号。

So what I will tell you is this, it is a signal.

它是一种支持因素。

It is a supporter.

它能帮助你采取那些降低痴呆风险的措施。

It will help you do the things that can lower your risk of dementia.

我们已经多次看到，接受激素替代疗法可以将患阿尔茨海默病的风险降低多达百分之三十。

We've seen multiple times that having hormone replacement therapy can reduce your risk of getting Alzheimer's disease by up to thirty percent.

这一点我们是清楚的。

We know that.

但这并不是因为雌激素单独降低了你的风险。

But it's not because estrogen alone is minimizing your risk.

而是因为当你有雌激素时，它有助于缓解潮热。

It's because when you have estrogen, it helps get rid of the hot flashes.

它有助于缓解夜间盗汗。

It helps with the night sweats.

因为在更年期，当我们大脑中的雌激素出现失调时，下丘脑——大脑中控制体温调节的区域——就会受到影响。

Because during menopause, when we actually have a dysregulation of estrogen in our brain, what happens in the hypothalamus, which is an area in the brain that controls our temperature regulation.

当女性失去调节体温的能力时，一旦感觉稍微热一点，体温就会略微上升。

When we lose the ability to monitor our temperature for a woman, what will happen is when she feels the slightest bit hot, her temperature, you know, is rising a little bit.

下丘脑不知道该如何应对。

The hypothalamus doesn't know what to do.

于是它发出信号：我热得不得了。

So it signals, I'm super hot.

于是体温会急剧升高，这就是潮热，随后又迅速下降。

So it'll raise your temperature right up and that's a hot flash and then it'll bring her right down.

因此，这导致女性夜间难以入睡。

And as a result, this is keeping women up at night.

我们知道，睡眠不足是阿尔茨海默病的一个风险因素。

And we know that sleep deprivation is a risk factor for Alzheimer's disease.

当然，是的。

Of course, it is.

睡眠不足会加剧淀粉样蛋白β在大脑中的积累。

Compounding sleep deprivation will accumulate amyloid beta in your brain.

如果我们能通过激素替代疗法作为信号和支持来帮助我们夜间入睡，那将是好事。

So if we can replace if we can use hormone replacement therapy as a signal and as a support to help us sleep at night, then that's a good thing.

另一点：雌激素对肌肉有合成作用。

Another thing: estrogen is anabolic to muscle.

那是什么意思？

What does that mean?

这意味着它有助于肌肉蛋白质合成。

It means that it helps with muscle protein synthesis.

哦，它能帮助我长肌肉？

Oh, it helps me make muscle?

是的。

Yeah.

我们的骨骼上有雌激素受体。

We've got estrogen receptors on our bone.

我们的肌肉上也有雌激素受体。

We've got estrogen receptors on our muscle.

所以如果雌激素对肌肉有合成作用，能促进肌肉蛋白合成，还能改善骨密度，那么在更年期阶段补充雌激素将有助于降低阿尔茨海默病的所有风险因素。

So if estrogen is anabolic to muscle, if estrogen helps with muscle protein synthesis, if estrogen helps with bone mineral density, then replacing estrogen during that menopause state is going to help us with all of the risk factors of Alzheimer's disease.

那么雌激素是什么时候……我的意思是，在这个图上它突然急剧下降？

So when does estrogen I mean, it really, in this image, drops off a cliff.

是的，而且因人而异。

Yeah, and it varies.

通常平均在45岁左右开始，而围绝经期大约持续十年。

So it tends to generally happen at around 45 years old as an average, and that perimenopause stage lasts around ten years.

但在这张图上，它大约从30岁就开始下降了。

But it starts going down on this graph at about 30.

它确实开始下降了，但每个人的情况都不同。

It starts to go down, and everyone's different.

明白吗？

Okay?

有些女性在三十九岁后期就会进入围绝经期，而通常的年龄范围是42到45岁。

You can have a woman in her late thirties go into perimenopause, or the general age is around 42 to 45.

我所接触的大多数妇产科医生都表示，你最好在40岁左右就开始定期咨询医生，排查这种情况。

Most OBGYNs that I've spoken to say that you need to start checking in with your doctor at around 40 years old to check for this.

所以，想到我的未婚妻，你认为像她这样的人在40岁时应该接受激素替代疗法吗？

So do you think thinking about my fiance now, do you think that someone like her should go on hormone replacement therapy at like 40?

嗯，这正是个关键问题。

Well, so that's the big question.

这是个悬而未决的难题。

That's the elephant in the room.

你该不该接受激素替代疗法？

Should you go on hormone replacement therapy, or should you not?

这绝对是需要你和你的医生深入讨论的问题。

And that's definitely a conversation between you and your physician.

然而，目前我们有大规模的研究表明，我们不必对激素替代疗法感到恐惧。

However, we've got large scale studies right now to show that we don't have to be afraid of hormone replacement therapy.

而且不深入细节的话，有一项名为女性健康倡议的大型研究曾让女性因恐惧而放弃使用激素替代疗法，这是正确的。

And without going too deep into the weeds, there was a massive study that was done, the Women's Health Initiative, that scared women out of taking hormone replacement therapy in fear Correct.

我们从百分之四十的女性使用激素替代疗法，骤降至仅百分之四的女性使用。

Of getting breast We went from having forty percent of women on hormone replacement therapy to just four percent of women on hormone replacement therapy.

我们知道，即使在绝经初期，女性发生心脏相关事件的风险会增加三倍。

We know that even at the onset of menopause, a woman's risk of having a heart related event triples.

女性患阿尔茨海默病的风险也会增加。

A woman's risk of getting Alzheimer's disease increases.

因此，这里确实存在激素替代疗法的潜在益处，而我们尚未充分研究。

So there is something to posit here about the benefits of hormone replacement therapy that we still haven't yet studied.

你会接受激素替代疗法吗？

Will you do hormone replacement therapy?

我肯定会接受。

I definitely will.

那是什么类型的荷尔蒙？

And what kind of hormone?

而且，这其实很有趣。

And look, so this is really interesting.

这是朋友给我的。

So this was given to me by a friend.

这是胶囊。

And this is the capsule.

这是雌二醇和孕酮。

So this is estradiol and progesterone.

孕酮是那种能帮助你晚上入睡的成分。

Progesterone is that one that's going to help you sleep at night.

这个是阴道雌激素。

This one here is vaginal estrogen.

这是一种乳膏，根据使用方式，它可以被置入阴道。而阴道雌激素如果涂抹在脸上，可能是你所能使用的最佳护肤方式。

This is a cream that actually gets, depending on how it is, it can get inserted and the vaginal estrogen apparently, if you put it on your face, it's probably the best form of skin care that you could ever have.

是的，我们的组织，包括皮肤，到处都有雌激素受体。

Yeah, we have estrogen receptors all over our tissues including our skin.

这些是雌二醇植入物，所以不是那种乳膏本身。

These are estradiol inserts, so that's not the cream itself.

但如果你使用乳膏形式的阴道雌激素，可以把它涂在脸上，有助于提升皮肤弹性、胶原蛋白和真皮厚度。

But if you get vaginal estrogen in the form of a cream, you can put it on your face, and it can help with skin elasticity, collagen, dermal thickness.

这就是我对此真正感到兴奋的原因。

This is why I'm actually most excited about it.

所以我的意思是，这是进行激素替代的唯一方式吗？

So I mean, is this are these the only ways that one can do hormone replacement?

不是。

No.

还有贴片，大多数女性都选择这种方式。

There's also a patch, and that's what most women are opting in for.

你会怎么做？

What will you do?

经皮贴片。

The transdermal patch.

到时候再说。

When the time comes.

我可能会选择贴片。

I will probably do the the patch.

为什么？

Why?

因为最方便。

Because it's the easiest.

这是我研究得最多的那种。

That's the one that I've researched the most.

我对激素替代疗法完全不害怕。

I'm not afraid of hormone replacement therapy in the slightest.

每个人都要咨询自己的医生。

Everyone has to check with their doctor.

但我确信，这将成为缓解正在发生的阿尔茨海默病危机的一项重要措施。

But I definitely think that this is going to be one thing that is going to help with the Alzheimer's disease crisis that is occurring.

请说。

Go ahead.

我之前提到过斑块。

I mentioned earlier plaques.

很多人会问，阿尔茨海默病与其他类型的痴呆症有什么区别？

A lot of people ask, well, what distinguishes Alzheimer's disease from the rest of the dementias?

这归结为两种蛋白质：淀粉样蛋白β和tau蛋白。

And it comes down to two proteins, amyloid beta and tau protein.

这里的事情变得非常有趣，实际上可以追溯到1901年，第一位阿尔茨海默病患者奥古斯塔·迪蒂。

And here's where it gets really interesting and actually dates back to 1901, the first ever Alzheimer's disease patient, Augusta Ditti.

她当时52岁，去了医院。

She was 52 years old, and she went to the hospital.

她和丈夫一起前来，主诉存在找词困难、语言流畅性下降，而且记不住钥匙放在哪里。

Her and her husband went complaining of difficulties of word finding, word fluency, and she couldn't remember where she put her keys.

她的丈夫说她神志不清。

And her husband said she is delirious.

奥古斯都告诉医生，他是一名精神科医生。

And Augustus told the doctor on board he was a psychiatrist.

他的名字叫爱罗斯·阿尔茨海默。

His name was Eloise Alzheimer.

她对他说：‘我引用一下，我不再知道自己是谁了。’

She said to him, and I quote, I don't know who I am anymore.

正如我提到的，这种疾病会夺走你的自我。

As I mentioned, this disease robs you of who you are.

1906年，奥古斯特·迪蒂去世了。

In 1906, Auguste Ditti died.

她是第一位被记录患有阿尔茨海默病的患者。

And that was the first ever patient to be recorded of having Alzheimer's disease.

因此，死后他们切开了她的大脑，发现她的脑中有这些斑块。

And so postmortem, they cut her brain open, and they found that she had these plaques in her brain.

当时他们其实并不了解这到底是什么，但这是社会上首次记录到这种疾病。

And they didn't really know they didn't really understand what it was, but that was the first ever induction of this disease in society.

从那以后，我们一直在努力应对这种疾病。

And ever since then ever since then, we are still trying to tackle this disease.

在二月份，我们曾认为阿尔茨海默病是淀粉样蛋白级联假说，也就是说，阿尔茨海默病意味着大脑中堆积了大量淀粉样蛋白这种有毒物质。

In the February, we had this notion that Alzheimer's disease was the amyloid cascade hypothesis, meaning that, great, Alzheimer's disease means when you get a head full of amyloid, this toxic protein that builds up.

因此，我们把这种蛋白妖魔化了。

So we were demonizing this protein.

我们把这种在大脑中堆积的肽蛋白视为敌人，于是出现了静脉注射药物的治疗方法。

We were demonizing this peptide protein that builds up in the head, and so then came the medications in the form of IV drugs.

你去医院，接受静脉注射，寄希望于它能清除淀粉样蛋白。

So you go to the hospital, you get an IV in the promise that it will clear out amyloid.

太好了。

Great.

我们找到治愈方法了。

We've got a cure.

但他们发现，当清除这些大脑中的淀粉样蛋白时，同时也移除了脑组织，导致了微出血。

But what they found was that when they were taking out the amyloid in these brains, they were taking with them brain tissue and causing microhemorrhages.

在一些患者身上，这甚至导致了死亡。

And in some patients, it was resulting in death.

所以我们现在知道，问题并不在于淀粉样蛋白。

So we now know that the problem here isn't amyloid.

事实上，淀粉样蛋白是一种抗菌肽。

In fact, amyloid is a antimicrobial peptide.

因此，淀粉样蛋白实际上是有益的。

So amyloid is actually a good thing.

淀粉样蛋白β是有益的，因为它保护着脑细胞。

Amyloid beta is a good thing because it protects the brain cells.

现在来看看会发生什么。

Now here's what happens.

在睡眠期间，我们的身体会经历一个美妙的过程。

We have this beautiful process during sleep that occurs.

当我们进入深度睡眠时，会激活类淋巴系统。

When we get into deep sleep, we activate the glymphatic system.

明白吗？

Okay?

所以，类淋巴系统这个词来源于胶质细胞（glial cells）。

So the glymphatic system comes from the word glials, glial cells.

我们的大脑中存在胶质细胞。

We have glial cells in the brain.

它们位于神经元外部，负责免疫功能。

They sit outside of the neurons, and this is what, is responsible for immunity.

它们是我们主要的免疫反应细胞。

They're our chief, immune response cell.

在深度睡眠期间，它们会收缩。

During deep sleep, they shrink.

当它们收缩时，漂浮在脑脊液中的所有淀粉样蛋白β都会被冲走。

And when they shrink, all of this amyloid beta that's floating around in the cerebral spinal fluid gets washed out.

所以这就像你大脑里的一台洗衣机。

So it's like a washing machine that occurs in your brain.

对吧？

Right?

但阿尔茨海默病患者往往没有机会清除这些淀粉样蛋白。

But what tends to happen in Alzheimer's patients is they don't get a chance to wash out the amyloid.

在围绝经期和绝经期，由于潮热，你无法进入深度睡眠，因为你会因为潮热和夜间盗汗而频繁醒来，导致睡眠碎片化。

What happens in perimenopause and menopause due to the hot flashes, you don't get to get into deep sleep because you're having a fragmented sleep because you're waking up due to hot flashes and night sweats.

所以这正是导致淀粉样蛋白堆积的原因。

So that is what's do that is what's causing the buildup of amyloid.

现在请继续听我说。

Now stick with me.

我们再来谈谈另一种阿尔茨海默病的标志性蛋白。

We've got another protein that is a hallmark of Alzheimer's disease.

它就是Tau蛋白。

It's tau protein.

而tau蛋白存在于细胞的轴突中，也就是我之前提到的被髓鞘包裹的那部分。

And tau lives in the axon of the cell, the one that I said is covered in the myelin sheath.

在压力情况下，这种tau蛋白会发生磷酸化。

And what happens under times of stress, what happens is this tau protein phosphorylates.

因此它会脱落，而tau蛋白的主要作用是稳定微管。

So it breaks off, and basically, tau protein stabilizes the microtubules.

明白吗？

Okay?

想象一下轴突中这些像铁轨一样的结构，沿着轴突上下延伸。

Imagine these railroad tracks in the axon, okay, just going up and down the axon.

轴突是在细胞里，还是在大脑里？

The axon's in the in the cell or in the brain?

大脑细胞本身，也就是神经元，其细胞体是主体，而轴突就像树干一样。

So the the the brain cell itself, the neuron, is the neuron cell body, and the axon is like the trunk of the tree.

好的。

Okay.

对吧？

Right?

是的。

Yep.

支撑这棵树的是微管。

So holding up the tree are microtubules.

这些微管由tau蛋白结合固定。

And those microtubules are bound by tau proteins.

tau蛋白保持微管完整，使树干稳定并保持原位。

The tau proteins keep the microtubules intact so the trunk of the tree is stabilized, and it sits there.

为什么需要稳定呢？

Why does it need to be stabilized?

因为这是思维速度传递的方式。

Because that's how speed of thought travels.

信息处理的速度就沿着这里传递。

Information processing speed travels up there.

当tau蛋白发生磷酸化时，它会开始形成缠结。

When the tau protein phosphorylates, it starts to form tangles.

这些被称为神经原纤维缠结。

They're called neurofibrillary tangles.

所以这种情况发生在轴突中。

So that happens in the axon.

当所有这些缠结聚集在一起时，我们会看到轴突的崩溃，以及微管的崩溃。

And when all these tangles clump together, we get the collapse of this axon, the collapse of these microtubules.

因此，我们不仅在大脑的脑脊液中和细胞外经历一场环境灾难的连锁反应。

So we're not just having a cascade of environmental disaster inside the cerebrospinal fluid of the brain and inside the brain, outside the cells.

我们还在细胞体内部经历着同样的连锁反应。

We've also got this cascade happening inside the cell body itself.

因此，大脑同时在细胞内和细胞外遭受攻击。

So the brain is under attack inside the cell and outside the cell.

为什么？

Why?

具体为什么？

Why exactly?

为什么？

Why?

为什么会这样？

Why does this happen?

因为我们对待大脑的方式。

Because of how we treat our brains.

因为我们对待大脑的方式。

Because of how we treat our brains.

是的。

Yes.

你的大脑发生过度磷酸化、这些tau蛋白发生过度磷酸化的原因有很多。

The reason why your brain is hyperphosphorylated and the reason why these tau proteins are hyperphosphorylated is because of many things.

其中之一是我们一再发现，脑细胞轴突内存在雌激素受体。

One is we have seen time and time again that we have estrogen receptors that are in the brain cell themselves in the axon.

所以当我们缺乏足够的雌激素时，雌激素其实非常聪明。

So when we don't have adequate estrogen, estrogen actually is so smart.

它的作用是阻止一种负责使tau蛋白磷酸化的酶。

What it is doing, it's blocking an enzyme that is responsible for phosphorylating the tau.

如果我们没有雌激素，这种酶就会存在并使tau蛋白磷酸化，分解它，从而形成神经原纤维缠结。

So if we don't have the estrogen there, then the tau, the enzyme, is there to phosphorylate the tau and break it down and cause these neurofibrillary tangles.

但假设你是个男性，你不需要雌激素，尽管睾酮具有神经保护作用。

But let's just say you're a man, and you don't need the estrogen there, although testosterone is neuro protective.

睾酮实际上会转化为雌激素，这就是为什么你在生活中实际上获得了额外的保护。

Testosterone actually aromatizes into estrogen, which is why you actually have an extra added protection in your life.

还有什么会导致这种情况？

What else causes this?

嗯，你正在

Well, You're

谈论睡眠，丹。

talking about sleep, Dan.

是的

Yeah.

所以睡眠，我认为是我们拥有的最被低估的阿尔茨海默病预防工具。

So sleep is, I think, by far the most underrated Alzheimer's disease prevention tool that we have.

它被低估是因为我们一生都在做这件事，以为只要上床睡觉，奇迹就会自然发生。

It's underrated because we have been doing it all our lives, and we think that we can just go to sleep and the magic happens.

但我觉得在2026年，我们实际上需要为睡眠进行训练。

But I think now in 2026, we actually need to train for sleep.

在深度睡眠期间，我们会激活类淋巴系统。

So during deep sleep, we activate the glymphatic system.

遗憾的是，有很大一部分人无法进入深度睡眠。

And sadly, a large proportion of us aren't getting into deep sleep.

所以睡眠是原因之一，如何

So sleep is one of the reasons How

你睡得怎么样？

do you sleep?

是的，我确保每晚睡七个半小时。

Yeah, I make sure I sleep seven and a half hours a night.

本信息由Apple Card赞助。

This message is brought to you by Apple Card.

现在申请Apple Card是个绝佳时机。

It's a great time to apply for Apple Card.

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You'll love earning unlimited daily cash back on every purchase.

这包括在Apple购买最新iPhone、AirPods和Apple Watch时享受3%的日现金回馈。

That includes 3% daily cash when you buy the latest iPhone, AirPods, and Apple Watch at Apple.

通过这项特别推荐优惠，申请新的Apple Card即可获得额外日现金回馈。

Through this special referral offer, when you get a new Apple Card, you can earn bonus daily cash.

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To qualify, you must apply at apple.co/ get daily cash.

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Apple Card issued by Goldman Sachs Bank USA, Salt Lake City branch often may not be available everywhere.

条款和限制适用。

Terms and limitations apply.

我只需要把脑子里的想法全写下来就行。

All I had to do was brain dump.

想象一下，如果总有一个人在你身边，能把你脑海中的想法提取出来，借助人工智能优化表达，让它们更流畅、更语法正确，并帮你记录下来。

Imagine if you had someone with you at all times that could take the ideas you have in your head, synthesize them with AI to make them sound better and more grammatically correct, and write them down for you.

这正是WhisperFlow在我生活中的作用。

This is exactly what WhisperFlow is in my life.

它就像一个思维伙伴，帮助我理清想表达的内容。现在，无论我是在路上、独自在办公室，还是外出时，都可以通过语音回复邮件、Slack消息、WhatsApp以及其他所有设备上的信息。

It is this thought partner that helps me explain what I want to say, and it now means that on the go, when I'm alone in my office, when I'm out and about, I can respond to emails and Slack messages and WhatsApps and everything across all of my devices just by speaking.

我非常喜欢这个工具，几个月前我就在我的幕后频道里提到过它。

I love this tool, and I started talking about this on my behind the scenes channel a couple of months back.

然后创始人联系了我，说：‘我们发现很多用户是因为你才来使用我们的工具的。’

And then the founder reached out to me and said, we're seeing a lot of people come to our tool because of you.

所以我们很希望成为您的赞助商。

So we'd love to be a sponsor.