最常回放的时刻：胰岛素是你发胖的原因！现在如何降低它

所以当你提到这是胰岛素问题时，能否为我解释一下，就像我的听众中有人完全不了解葡萄糖和胰岛素是什么、它们的作用和意义一样？

So when you say this is an insulin problem, can you explain this to me like I have no idea what glucose and insulin are for any of my listeners out there that have an inexperienced understanding of these terms and what they do and mean.

博士，这至关重要。

Dr It's crucial.

每个人都需要理解糖（即葡萄糖）和胰岛素之间的关系。

Everybody needs to understand the relationship between sugar, which is glucose, and insulin.

当你摄入糖或葡萄糖时，身体必须迅速将葡萄糖从血液中清除，因为葡萄糖在血液中实际上是毒性的。

You consume sugar or glucose, the body has to get rid of that glucose very quickly from the bloodstream because glucose actually is toxic inside the bloodstream.

尽管它是身体用来获取能量的物质，但在血液中，它会与所有血管、血管壁以及血液中的成分和血红蛋白发生糖基化反应。

Even though it is what the body uses for energy, in the bloodstream it glycates all the blood vessels and the walls and the components in blood and hemoglobin as well, glycates it.

这意味着葡萄糖会附着在这些分子上。

That means the glucose attaches itself to that molecule.

于是，这些分子就无法正常运作了。

So now that molecule can't work properly.

这就是为什么你的血糖越高，体内的各种化学物质就越无法正常工作。

That is why the higher your blood glucose, all your chemicals don't work well.

你的酶不能正常工作，你的激素也不能正常工作。

Your enzymes don't work well, your hormones don't work well.

一切都不顺畅，你会因为糖化作用而提前衰老。

Nothing works well and you age prematurely because you're getting glycation.

被糖化的分子无法正常运作，它的功能会失常。

A glycated molecule can't work normally, it doesn't function normally.

所以当你摄入葡萄糖时，葡萄糖必须从血液中清除，身体是如何做到这一点的呢？

So when you consume the glucose, the glucose has to come out of the bloodstream and how does the body do it?

它向胰腺发送信号。

It sends a message to the pancreas.

胰腺说：我会制造一些胰岛素。

The pancreas says, I'll make some insulin.

它将胰岛素释放到血液中，胰岛素进入血液后，将葡萄糖推入细胞。

It pours insulin into the bloodstream, insulin comes into the bloodstream, pushes the glucose into the cells.

它把葡萄糖推到哪里去呢？

And where does it push it in?

进入肝脏、肌肉和身体的每一个细胞。

Into the liver, into the muscles, into every cell in the body.

胰岛素会把葡萄糖推出去。

Insulin will push glucose out.

现在关键问题是，需要多少胰岛素。

Now, how much insulin is the question.

如果我每三小时吃一次东西，摄入葡萄糖、淀粉类食物或碳水化合物，现在请注意我的思路，因为你们已经开始明白我要说什么了。

If I'm eating every three hours and I'm consuming glucose or I'm consuming starchy foods or I'm consuming carbohydrates, now watch where I'm going with this because you're already beginning to know where I'm going with this.

我每两到三小时就摄入葡萄糖和碳水化合物，不断刺激胰腺，刺激胰岛素分泌。

I'm consuming glucose and carbs every two, three hours, I'm stimulating my pancreas, I'm stimulating my insulin.

我的胰岛素水平上升，然后下降。

My insulin goes up, it comes down.

但在它还没来得及下降时，又再次上升了。

But before it even gets a chance to come down, it goes up again.

因此，反复且频繁地摄入葡萄糖，导致我的胰岛素水平持续偏高，因为胰岛素在血液中的存留时间比葡萄糖稍长。

So the repeated consumption of, and frequent consumption of glucose is causing my insulin to stay high because insulin stays a little bit longer in the bloodstream than the glucose.

葡萄糖大约在两到三小时内会下降，但胰岛素会保持较高水平约四小时。

The glucose will come down in about two to three hours, but the insulin stays higher for about four hours.

现在，如果你持续这种生活方式几年的话。

Now what happens is that you continue this lifestyle for a few years.

由于这些都是激素，身体会说：好吧，我现在需要产生更多的胰岛素了。

Now the body, because these are all hormones, will say well you know, I'm going to need to make more insulin now.

你变得对胰岛素产生了抵抗。

You become insulin resistant.

任何在体内长期存在的激素，身体都会对其产生耐受。

Any hormone that stays in your body for a long time, the body becomes immune to it.

所以下次我吃糖的时候，就必须产生更多的胰岛素才能达到同样的效果。

So the next time I eat the sugar I'm going to have to make more insulin to produce the same effect.

这被称为胰岛素抵抗。

That is called insulin resistance.

所以现在你面对的是一个长期摄入碳水化合物、糖和加工食品的患者。

So now you've got this patient who's been eating carbs, sugar, processed foods.

什么是加工食品？

What does that mean processed foods?

这意味着食物会迅速被吸收到血液中。

That means foods that are quickly absorbed into the bloodstream.

加工食品。

Processed foods.

这些是不含纤维的产品。

These are products without fiber.

所以吸收速度非常快。

So the absorption is very quick.

因此，可怜的胰腺必须立刻做出反应。

So the poor pancreas has to react just like that.

产生大量胰岛素，而频繁进食和频繁摄入会使你产生胰岛素抵抗。

Produces a whole bunch of insulin and then the frequent eating and the frequent consumption makes you insulin resistant.

所以现在你需要产生大量胰岛素来降低血糖水平。

So now you produce a whole bunch of insulin in order to bring that sugar level down.

所以你会说，好吧，这没关系，因为胰岛素把血糖降下来了，有什么害处呢？

So then you say, okay, well it doesn't matter because the insulin is bringing the sugar level down, so what's the harm done?

因为你的糖化血红蛋白水平仍然正常，你并没有得糖尿病。

Because your A1C is still good, you're not diabetic.

不，真正破坏你新陈代谢的是这种持续的高胰岛素水平。

No, but it's that background high insulin that is destroying your metabolism.

就是这种持续的高胰岛素水平。

It's that high insulin level in the background.

胰岛素将葡萄糖推入肝脏，导致你患上脂肪肝。

So insulin pushes glucose into the liver and you develop a fatty liver.

它把热量转化为内脏周围的脂肪，内脏指的是腹部，围绕胰腺的区域。

It pushes the calories into production of new fats around your viscera, the viscera means in your belly, around your pancreas.

你会形成内脏脂肪。

You get visceral fat.

这种脂肪是由葡萄糖转化而来的。

Now this fat is produced from glucose.

这是一种不同的脂肪。

It's a different kind of fat.

如果我现在给你一个高热量的饮食，包含各种食物，你会在全身都长胖，明白吗？

Look if I gave you a high calorie diet right now of all sorts of foods, you'll put on weight everywhere, okay.

但如果你摄入的是葡萄糖，大部分脂肪会堆积在腹部，肚子会凸出来，这就是内脏脂肪，它位于身体内部。

But if I give you glucose you put it on mostly in your stomach and your stomach will protrude and that's got visceral fat, it's on the inside.

你捏不到它，因为它在体内。

You can't pinch it, it's on the inside.

围绕在你的器官周围。

Around your organs.

围绕在器官周围。

Around the organs.

这是一种非常有害的脂肪，也是我们今天面临的流行病。

This is very detrimental fat and that's the epidemic that we have today.

而这正是由于食用了淀粉类、葡萄糖和碳水化合物，导致胰岛素升高，进而引发这一系列不良后果——吃错了食物，而且进食太频繁。

And that's a direct result of eating you know, starchy, glucose, carbohydrates, which creates insulin, which creates this downstream effect on Wrong foods and eating too frequently.

吃得太频繁了，好吧。

Too frequently, okay.

因为你要记住，进食的频率也很重要。

Because remember it's also the frequency of eating.

因为在胰岛素有机会下降之前，你又吃下了更多食物。

Because before that insulin gets a chance to come down, you're already popping yourself with more food.

因此你会发展出胰岛素抵抗，胰岛素水平变得非常高，现在需要这么多胰岛素才能把血糖降下来。

And hence you develop insulin resistance, you get a very high insulin, it takes this much insulin now just to bring that sugar level down.

然后有一天，当你无法控制血糖时，血糖就会飙升，这时医生会说你得了糖尿病。

And then the one day when you cannot control that sugar, now that sugar will go out and now your doctor will say you're a diabetic.

但到那时，你已经经历了十年的高胰岛素血症。

But by that time you've already had ten years of hyperinsulinemia.

那么，当你确诊糖尿病时，发现血糖已经非常高，会发生什么？

So what happens if by the time you make a diagnosis of diabetes to say well now your sugar is really high.

血糖高是因为你的身体已经失去了控制它的能力。

It is high because your body has not had the ability to keep it down.

为什么？

Why?

因为即使那么高的胰岛素也无法将你的血糖控制住，你已经成了糖尿病患者。

Because even that high insulin could not keep your sugar level down, you became a diabetic.

你失去了整个预防的机会。

You lost that whole opportunity of prevention.

就是这十年。

It's those ten years.

听好了，当你已经确诊为糖尿病并去看医生时。

Look, by the time you're a diabetic and you come and see Doctor.

在J的心脏科诊室里，你已经患有冠状动脉疾病。

J in his cardiac clinic, you already have coronary artery disease.

就像那个28岁的年轻人。

Like that 28 year old.

那个28岁的年轻人并没有糖尿病，但他已经患有冠状动脉疾病。

That 28 year old didn't have diabetes, he already has coronary artery disease.

当你被诊断出患有糖尿病时，你已经患有冠状动脉疾病。

By the time you are diagnosed as having diabetes, you already have coronary artery disease.

我们有一个绝佳的机会，可以非常早地通过胰岛素水平来筛查这些患者。

We have a great opportunity here to actually start screening these patients with insulin levels very early on.

但大多数医生没有能力或知识来进行胰岛素水平检测。

But most doctors don't have the ability or knowledge to do the insulin level testing.

但这项检测应该做。

But it should be done.

像我这样的人，我现在33岁，损伤是从什么时候开始的？

In someone like me, I'm 33 years old now, when does the damage begin?

从现在就开始了。

It starts right now.

从现在就开始了。

It starts right now.

一旦你到了30岁左右，就已经开始出现麻烦了。

As soon as you're around 30, you're already starting to have trouble.

你必须这么做。

You have to.

但你知道，这就是我的工作。

But you know, this is what I do.

当我看到患者走进我的诊室，如果发现他肚子突出，我就知道他很可能已经出现胰岛素抵抗。

I look at that patient walking into my room, and if I see that he's got a belly sticking out, I already know he's probably got insulin resistance.

因为所有的脂肪都堆积在这里。

Because all the fat is in here.

因为腹部的脂肪让他侧面看起来非常糟糕。

Because the fat that's in the stomach, sideways he looks terrible.

但从背面看，他的身材还不错。

From the back he looks great.

他的腰围增加了。

His waist is increased.

他身体其他部位并没有堆积那么多脂肪。

He doesn't have all the fat everywhere else in his body.

这就是高胰岛素血症患者的典型特征。

That's the phenotype of somebody who has hyperinsulinemia.

同一个人去度假，回来时体重会增加五到十磅，因为他的体内胰岛素水平太高了。

That same person goes on a cruise, he'll come back five to 10 pounds more because he's got so much insulin in his body.

胰岛素是一种储存分子，会把所有东西都储存起来。

Insulin is a storage molecule, puts everything away.

对他来说，减肥非常困难。

And it's very hard for him to lose weight.

为什么更难呢？

Why is it harder?

唯一能让你快速减掉这些脂肪的方法当然是改变饮食，但你必须进行禁食。

The only thing that will make you lose that fat very quickly is to change your diet of course, but you have to do fasting.

因为禁食能降低你的胰岛素水平。

Because fasting brings your insulin levels.

这就是禁食发挥作用的地方。

See this is where fasting comes in.

那么禁食有什么作用？

So what does fasting do?

你是说禁食还是热量赤字？

Do you mean fasting or a calorie deficit?

在你看来，这两者是一回事吗？

Or is it the same thing in your view?

不，它们不是一回事。

No, they're not the same thing.

它们不是一回事。

They are not the same thing.

你看，当你不吃东西时，你的胰岛素水平会下降，因为你不再刺激胰腺了。

You see, when you don't eat, your insulin levels come down because you're not stimulating your pancreas anymore.

所以你需要降低你的胰岛素水平。

So you want to bring your insulin levels down.

世界上最好的做法就是禁食。

The best thing you can do in the world is to do fasting.

因为如果你只是简单地减少卡路里摄入，身体会发生完全不同的生理变化。

Because there's no, look if I just simply cut down on my calories then there's a different physiology that's going to take place in the body.

而当你禁食时，身体的生理机制则完全不同。

And when you fast there's a totally different physiology.

当你减少卡路里时，身体会感知到这种热量缺口，新陈代谢率会发生变化，实际上会变慢。

When you cut down on calories the body senses that this caloric deficit, your metabolic rate changes, it actually slows down.

身体会开始分解一切，包括肌肉。

And the body will start breaking down everything, muscles included.

所以你会减掉脂肪，同时也会流失肌肉。

So you lose fat and you also lose muscles.

另一方面，当你禁食时，这是一种完全不同的生理机制。

On the other hand, when you're fasting, it's a different physiology.

禁食就像是我之前储存了脂肪，现在我要从银行里取出来。

Fasting is I've put on fat, now I'm going to take it out of the bank.

现在银行对我开放了，我可以提取卡路里并加以利用。

Now the bank is going to be available for me to to pull out my calories and use it now.

你会开始燃烧脂肪。

And you start burning the fat.

所以在禁食的前十二个小时里，你会将肌肉和肝脏中以糖原形式存在的葡萄糖全部消耗掉。

So in the first twelve hours of a fast, you take out all the glucose in the form of glycogen from your muscles and your liver.

十二小时后，你就会开始动用脂肪。

After twelve hours, you start pulling the fat out.

脂肪首先被动员出来的部位是内脏脂肪。

And the first place the fat comes out of is going to be visceral fat.

这就是为什么禁食对你有如此大的好处，因为它能清除最糟糕的脂肪——那种具有高度炎症性的脂肪。

That is why fasting benefits you so much because it gets rid of that worst fat, the fat that is very inflammatory.

你想想，如果我对你的内脏脂肪进行活检，再对比如臀部的脂肪进行活检，这两种脂肪是完全不同的。

You see if I did a biopsy of your visceral fat versus a biopsy of let's say a fat forming on your buttock, two different types of fat.

一种富含炎症分子，另一种则不含大量炎症分子。

One is full of inflammatory molecules, the other one is not full of inflammatory molecules.

一种会分泌白细胞介素六和肿瘤坏死因子，而另一种则不会。

One is producing interleukin six and tumor necrosis factor, and this other fat is not.

这两种是不同的脂肪储存方式。

These are two different fat storages.

内脏脂肪非常有毒，具有很强的炎症性。

Visceral fat is very toxic, it's very inflammatory.

这就是为什么患有内脏脂肪的患者会产生这么多炎症分子。

And that is why patients who have visceral fat make all these molecules.

所以当我做血液检查时，我会发现：你的炎症指标很高，白细胞介素六升高了，肿瘤坏死因子也升高了，C反应蛋白也偏高。

So when I do the blood test I see that oh you've got so much inflammation, you've got interleukin six is high, tumor necrosis factor is high, your CRP is running high.

造成这种情况的原因不仅仅是肠漏和其他我关注的问题，在你的情况中，还因为你体内有大量异位脂肪。

And one of the reasons for this is not just leaky gut and other things that I look at, but in your case it is also because you have a lot of ectopic fat.

异位脂肪。

Ectopic fat.

现在人们逐渐认识到，异位脂肪不仅存在于肝脏和胰腺周围，也存在于心脏周围。

Ectopic fat is now realizing is not just only around the liver and around your pancreas, it's also around your heart.

当我们观察冠状动脉时，会看到冠状动脉周围布满脂肪，你刚才那张图就非常清晰。

So when we look at the coronary arteries and we see all those fat around the coronary arteries, you had a very nice diagram right there.

你可以看到每条动脉周围都有那种黄色。

And you can see that around each artery is that yellowness.

这种黄色全是斑块。

That yellow is all plaque.

周围有脂肪，而且正在形成斑块。

Fat, there's fat around that and it's plaque forming.

正在形成斑块。

It's plaque forming.

它会刺激斑块形成。

It stimulates plaque.

这是有炎症的。

It's inflammatory.

现在我们可以通过CT扫描来检测动脉周围脂肪中的炎症程度。

And now we can do CT scans that will actually detect how much inflammation is in the fat around the arteries as well.

异位脂肪分布在冠状动脉周围、肝脏和胰腺中，并且具有很强的炎症性。

Ectopic fat is around the coronary arteries, it's in your liver, and in your pancreas, and it is very inflammatory.

关于禁食这一点，如果有人来找你，他们的体型呈现出一些突出的腹部脂肪，你说比起单纯的热量限制，禁食是更好的方法。

On this point of fasting, so if you have someone come to you and they have that physique where there's a bit more of that protruding belly fat, you said that fasting is a much better approach than just sort of a calorie restriction.

一些研究显示，任何形式的热量赤字都能减少内脏脂肪，但禁食更有优势，因为你提到的胰岛素敏感性因素。

Looking at some studies that said research shows that calorie deficits of any kind can reduce visceral fat, but fasting will give it an edge because of the insulin sensitivity stuff that you talked about as well.

一个人应该选择哪种禁食方式呢？

What kind of fast should one be doing?

因为这些禁食方式有这么多不同的名称。

Because there's so many different names for these fasts.

有人进行四十天的水禁食，也有人进行间歇性禁食。

People do these forty day water fasts and they do intermittent fasting.

这是个很好的问题。

It's a great question.

禁食的方式有很多种。

So there are many, many different types of fasting.

这取决于你的目标，以及你为特定患者希望达到的效果。

Depending on your goal, on what do you want for that particular patient.

如果患者只是想减少内脏脂肪，我会从12:12开始，也就是12小时内不吃任何东西，只喝不含热量的液体，另外12小时是进食窗口。

So if a patient is just simply looking to reduce his visceral fat, then I start with twelve twelve, which means twelve hours you don't eat anything, you just drink liquids with no calories in it, and then twelve hours is your feeding period.

我们先从这个开始。

We start with that.

坚持两到三周后，我们会迅速过渡到18:6。

And we do that for about two to three weeks, then we quickly move to eighteen:six.

18:6意味着你有6个小时可以进食。

Eighteen:six means six hours you get to eat.

其余18小时只能喝水、黑咖啡、绿茶，不能摄入任何热量。

Eighteen hours it's only water, black tea, black coffee, green tea, no calories.

18:6，18:6。

Eighteen:six, eighteen:six.

这是一种禁食方式。

And then that's one type of fasting.

但如果患者非常肥胖，患有糖尿病，目标是逆转糖尿病，需要减掉60磅，那么这类患者有特殊的需求。

Now, if a patient is very overweight, a patient has diabetes and your goal is to reverse the diabetes, the patient needs to lose 60 pounds, then those patients have a special type of need.

对于他们，我会让他们每周进行一次48小时禁食。

For them, I will take them to a 48 fast once a week.

有时我会每九天进行一次三天的水禁食。

Sometimes I'll go to a three day water fast every nine days.

每九天，你会进行OMAD，OMAD意思是每天只吃一餐，连续九天。

Every nine days you will do OMAD, OMAD means one meal a day only, every day for nine days.

然后你会进行三天的水禁食。

And then you're going to give me a three day water fast.

同样的建议适用于女性吗？因为显然她们要应对各种激素波动和雌激素，我知道女性身体对这类压力（如禁食）的反应不同。

Is the same advice applicable to women because obviously they're contending with a variety of hormone fluctuations and estrogen, and I know that the female body responds differently to these kinds of stresses like fasts.

我也被患者问过很多次这个问题。

I've been asked that question so many times from patients as well.

大多数女性实际上是可以承受的。

Most of the women can actually handle it.

唯一无法承受的是那些正在备孕或已经怀孕的女性。

The only women that cannot are those who are trying to become pregnant or they have, though they're already pregnant.

我认为女性在禁食计划方面并没有太大不同。

I think that women are not that different when it comes to the fasting program.

所以根据我的经验，我已经让女性成功进行了禁食。

So in my experience, I've been able to get women to fast.

我刚刚才完成了一位女士长达72天的禁食。

I just finished a fast on one lady just now for seventy two days.

72天！

Seventy two days!

她当时严重超重，患有糖尿病、高血压、高脂血症，正在接受髋关节和膝关节置换手术，还有关节问题、皮肤问题，我们为她进行了72天的禁食。

She was terribly overweight, she had diabetes, she had hypertension, she had hyperlipidemia, she was having hip replacements, knee replacements, joint problems, she had skin problems and we fasted her for seventy two days.

在这72天里，她喝的是什么？饮料、电解质、咖啡，她具体摄入了什么？

What did she have in those seventy two days in terms of drinks, electrolytes, coffee, what was she?

好问题。

Great question.

她会喝无糖茶、黑咖啡和水。

So she would have black tea, black coffee, water.

每天在水里，我会让她加一些电解质。

And in the water once a day, I tell her to put some electrolytes in there.

有一种叫Element Tea的电解质，有时候我只是告诉他们去买一些凯尔特盐，放半茶匙进去，每天一次服用。

So there's electrolyte called element tea or sometimes I just tell them to go buy some celtic salt and put half a teaspoon in there and once a day you take that.

如果你感到饥饿难耐，可以取一茶匙MCT油，加入水中一起饮用。

If you get cravings and you feel really really hungry, take some MCT oil, a teaspoon, and put it in your water and you can drink that as well.

我认为有必要强调，各位女士先生们，你们不应该在家尝试这种方法，因为这里显然需要医疗监护。

I think it's worth saying that probably you shouldn't try this at home, ladies and gentlemen, because obviously medical supervision is critical here.

但就那位女士的情况而言，这七十二天禁食前后的变化如何？

But in the case of that lady, what was the before and after of that seventy two day fast?

糖尿病，消失了。

So diabetes, gone.

血压，恢复正常了。

Blood pressure, normalized.

体重减轻，减掉了大量的体重。

Weight loss, tremendous weight loss.

我的意思是，我

I mean I

我觉得她减了大约55到60磅。

think she lost about 55 or 60 pounds.

哇哦。

Wow.

好的。

Okay.

而且她不仅减掉了所有那些体重，腹部的脂肪完全消失了，连手臂下方和脸部的脂肪也都减掉了。

And not only did she lose all that weight, yes, all that weight from her belly was gone, but even her face under the arms.

所以，在禁食计划中减重和通过限制热量减重是完全不同的。

So when you lose weight in a fasting program, it's very different from losing weight when you are restricting calories.

你的皮肤真的会收紧，因此整个身体都会发生明显变化。

You actually retract your skin, so you get real changes in your entire body.

我有一位患者在监督下禁食了183天。

I had one patient that fasted for one hundred and eighty three days under supervision.

他从四百磅减到了二百一十磅。

He went from four hundred pounds to two ten pounds.

当他走进办公室时，你根本看不出他刚刚减掉了这么多体重。

And when he walked into the office you would not recognize that he's just lost all this weight.

因为他看起来并不是皮包骨头，也不需要做手术来切除多余的皮肤。

Because he did not look like skin on top of bones and then having to have surgery to remove all that excess skin.

禁食是一种完全不同的生理机制。

Fasting is a totally different physiology.

在禁食期间，身体会进行许多截然不同的活动。

In fasting, the body is doing a whole lot of things that are very different.

我们可以深入探讨禁食的生理机制，因为这非常有趣。

And we can go into the physiology of fasting because that's fascinating.

这是一种我们早已不再使用的生理机制。

It's a physiology that has not been used by us.

我们已经失去了它。

We've lost it.

现代生活的一个问题是，我们已经失去了禁食的生理机制。

So one of the things about modern living, modern living, we have lost this physiology of fasting.

首先，为什么我们体内仍然保留着这种生理机制？

First of all, why do we still have that physiology in us?

因为它的存在是有目的的。

It's because it's supposed to serve a purpose.

因为我们本应交替进行禁食和进食。

Because we're supposed to be fasting and feasting.

但现在我们却一直在进食，从不禁食。

But now we're only feasting all the time and we're not fasting.

为了回归正常状态，你应该进行禁食。

In order to go back to normal, you should be fasting.

禁食本应是你生活中正常的一部分。

Fasting is supposed to be a normal part of your existence.

这才是你被设计的本来方式。

That's the way you were designed.

不是我们人类历史上这短短一瞬才出现的现代工业化生活方式。

Not this modern industrialized living that we've been doing in the last fraction of a millisecond in the total existence of the human race.

我们现代人的生活方式改变太多了，但我们的基因和生理机能却跟不上。

We've changed our lifestyle so much, modern man has, but our genetics and our physiology has lagged behind.

我们本应将禁食与进食作为正常生理程序的一部分。

We were supposed to use fasting and feasting as part of our normal program, as our normal physiology.

这就是为什么我们至今仍保留着这种机制。

That's why we still have it.

这就是为什么在禁食十二小时后，你的身体会开始产生更多的酮体。

That is why after twelve hours you start making some more ketones in your body.

而酮体来源于脂肪。

And the ketones come from fat.

你正在将储存的脂肪动员出来。

You're moving that fat out of storage.

酮体是什么？

What is a ketone?

啊，酮体。

Ah, ketones.

酮体是一种由肝脏产生的能量分子。

So ketones are a energy molecule produced by the liver.

它是怎么产生的呢？

How does it make it?

它是从脂肪中产生的。

It makes it from fat.

脂肪被释放出来，顺便说一下，只有当你的胰岛素水平下降时，脂肪才会开始移动。

So the fat gets liberalized and by the way the fats only start moving when your insulin levels are down.

所以因为禁食，你现在体内的胰岛素水平非常低，明白吗？

So because of fasting your insulin levels are really low now, okay?

因为你一直在禁食，对吧？

Because you've been fasting, right?

所以现在脂肪开始溶解了。

So now the fats start dissolving.

所以你会得到游离脂肪酸。

So you get free fatty acids.

游离脂肪酸会进入血液循环。

The free fatty acids float into the bloodstream.

游离脂肪酸是脂肪的分解产物。

Free fatty acids are fat products.

它们进入血液循环，然后到达肝脏。

They float into the bloodstream, they go to your liver.

你的肝脏会将这些脂肪酸转化为酮体。

Your liver converts those into ketones.

酮体是身体的一种能量来源，是葡萄糖的替代能源。

Now ketones are an energy source of the body, an alternative source to glucose.

总的来说，你要么依靠葡萄糖和葡萄糖代谢供能，要么依靠酮体供能。

So in general terms you are either going to be running on glucose and glucose metabolism or you're running on ketones.

明白吗？

Okay?

所以当葡萄糖不存在时，酮体就会出现。

And so ketones basically show up when glucose isn't around.

完全正确。

That's absolutely right.

酮体实际上是对身体更清洁的燃料。

So ketones, and ketones are actually a cleaner fuel for the body.

从产生活性氧物种的角度来看，也就是你的线粒体工作的方式，当你处于酮症状态时，产生的活性氧物种更少，而活性氧对你的生理是有害的。

And in terms of producing reactive oxygen species in the metabolism, the way your mitochondria work, you actually produce less reactive oxygen species which is damaging to your physiology when you're in ketones.

酮体还是信号分子，能以多种方式改变你的生理状态。

And ketones are signaling molecules that also change your physiology in a number of ways.

第一，它会促进在酮生成过程中产生脑源性神经营养因子。

Number one, it causes the production of brain derived neurotropic factor that occurs under ketogenesis.

脑源性神经营养因子意味着你会变得更聪明，会长出新细胞，反应更快，视觉敏锐度更高。

Brain derived neurotropic factor, which means that you become smarter, you're growing new cells, your reflexes are better, your visual acuity is better.

为什么？

Why?

因为大自然希望你成为更优秀的个体，以便出去捕获下一次猎物。

Because nature wants you to become a better specimen so you can go out and get your next kill.

既然酮症这么神奇，那我们为什么不一直保持在酮症状态呢？

So why don't we all just stay in a state of ketosis then if it's so miraculous?

这是个很好的问题。

Well, that's a great question.

你不应该一直处在酮症状态，因为我们的生理机制并不是为此设计的。

You don't want to be in ketosis all the time because that's not what our physiology was made for.

因为那样的话，你就会一直燃烧脂肪、燃烧脂肪、一直燃烧脂肪，这也不是一种长期保持的好状态。

Because then you'll just be burning fats, burning fats, burning fats all the time and that's not a good state to be in constantly either.

所以你需要能够兼顾两种状态。

So you want to be able to do both.

你应该同时拥有活期账户和定期账户。

You're supposed to get your current account and your deposit account.

你应该学会运用这两种方式。

You're supposed to work with both of them.

这是正常的生理状态。

That's the normal physiology.

因此，不仅脑源性神经营养因子会增加，干细胞也会增加。

So not only brain derived neurotropic factor increases, but also stem cells.

干细胞非常神奇。

Stem cells are amazing.

在我的患者身上，我当然能看到这一点。

And in my patients, of course I see that

什么是干细胞？

What is a stem cell?

干细胞。

Stem cells.

干细胞就是，我们每个人都有干细胞。

So stem cells are, we all have stem cells.

而且我们每个人仍在不断产生干细胞。

And we all still make stem cells.

它们由骨髓产生。

And they are produced by the bone marrow.

这些是多能细胞。

These are pluripotent cells.

这些细胞会被制造出来，然后前往身体各处，转化为它们需要成为的任何细胞。

Cells made that will then go out and become whatever they need to become.

因此，它们可以进入你的血液循环，变成肌肉细胞、视网膜细胞、皮肤细胞，能转化为任何类型的细胞。

So they can go out into your circulation, become a muscle cell, they can become a retinal cell, a skin cell, they can transform into anything.

所以，当你结束禁食时，会有一波干细胞从骨髓中释放出来。

So what happens then when you break your fast, you get a surge of stem cells coming out of your bone marrow.

其中一些会变成免疫细胞。

Some of them become immunocytes.

这就是为什么我们知道禁食也能增强免疫力。

That is why we know that fasting also boosts your immunity.

坚持禁食的人感染更少，喉咙痛、咳嗽、感冒以及周围流行的病毒也更少。

People who fast get less infections, get less sore throats and coughs and colds and the viruses that are going around.

免疫力更好了。

The immunity is better.

干细胞本身并不是我特别关注的，我真正感兴趣的是所谓的祖细胞，即内皮祖细胞。

The stem cells are not, I'm particularly interested in the stem cells because of a thing called the progenitor cells, endothelial progenitor cells.

祖细胞是这样的，你总是会损伤到血管，血管的内壁。

Progenitor cells are, you see you're always hurting your blood vessels, the lining of the blood vessels.

而血管内壁需要不断修复，这些修复工作是由祖细胞完成的。

And the lining of your blood vessels have to be constantly repaired and they are repaired by the progenitor cells.

当你进行间歇性禁食和限时进食时，会产生更多的祖细胞——这一点已在多项研究中得到证实。

When you do intermittent fasting and time restricted feeding, you will produce more, and this has been shown in numerous studies, more progenitor cells.

这些祖细胞会去修复你的血管。

And these progenitor cells go and repair your blood vessels.

为什么我会对这个感兴趣？

Do what, why am I interested in this?

因为我是一名血管科医生。

Because I'm a vascular doctor.

我希望我的血管能够持续自我修复日常生活中造成的损伤。

I want my blood vessels to constantly be repairing themselves from the damage that we do in day to day life.

所以是干细胞动员、脑源性神经营养因子、生长激素。

So stem cell mobilization, brain derived neurotropic factor, growth hormone.

禁食时你的生长激素会分泌得更多。

You make more growth hormone in fasting.

那么你在禁食期间什么时候锻炼最合适？

So when should you exercise when you're fasting?

在禁食的高峰期。

At the peak of your fast.

如果我打算晚上6点结束禁食，我会建议患者在下午4点去健身房。

So if I'm going to break my fast at 6PM I tell patients to go to the gym at 04:00 in the afternoon.

但我会说，医生，我怎么可能做到呢？

But I say, but doc how can I do that?

你会发现，你会增加更多肌肉，同时也能更好地保留肌肉，因为你的生长激素水平更高。

You will find that you will put on more muscle and you'll retain more muscle as well because you have higher growth hormone.

增加生长激素分泌最快也最好的方法是进行间歇性禁食。

The fastest way and the best way to actually increase your growth hormone production is to do intermittent fasting.

当我与斯塔西·西姆斯医生交谈时。

When I sat with Doctor.

她主要从事女性生理学和女性运动表现的研究，她告诉我，如果女性在空腹状态下锻炼，身体会分解肌肉，因为她指出女性的身体更依赖下丘脑，对血糖水平的变化更为敏感，因为身体在试图保护怀孕等生理功能。

Stacey Sims, who does a lot of work on women's physiology and women's performance, one of the things she said to me is that if a woman in particular tries to do a workout fasted, the body will break down the muscle in a woman because she said a woman's body is much more the hypothalamus, it's much more sensitive to changes in a woman's glucose levels because it's trying to defend against pregnancy and all these kinds of things.

如果血液中葡萄糖不足，女性的月经周期就会停止。

It shuts down the menstrual cycle if there's not enough glucose in the blood.

所以她建议，女性尤其应该在锻炼前吃点东西，否则身体会分解肌肉，因为身体对这种情况非常敏感。

So she said for women in particular, do want to have eat something before you work out or it will your body will take from the muscle and it would definitely won't the body is very sensitive.

如果体内没有足够的葡萄糖能量，身体就不会帮助你增肌。

It won't want to help you build muscle if there's not enough glucose energy in the body.

她说，对男性来说情况略有不同，因为男性身体更坚韧，我们的身体本就适应狩猎。

She said for men it's slightly different because we're a little bit more robust and we were meant to hunt.

如果我们处于空腹状态，身体仍会维持正常功能，以帮助我们完成狩猎。

If we were fasted, our body is, you know, designed to kind of keep up its normal processes to help us complete a hunt per se.

所以我想向你提出这个问题，关于女性运动和禁食。

So I guess I throw this question out to you about about women exercise and fasting.

是的。

Yeah.

我觉得这是一个很好的观察。

I think that's a great observation.

那么，这位女性进行的是哪种运动呢？

So again, it's what kind of exercise is the woman doing?

你明白吗？

You see?

现在有两种基本的运动类型。

Now there's two kinds of basic exercises.

一种是有氧运动。

One is aerobic activity.

另一种是抗阻训练。

And one is resistance exercises.

你还可以把高强度间歇训练也纳入其中。

And you can also throw into that high intensity interval training.

所以当我谈到在空腹状态下进行训练时，我更倾向于力量训练。

So when it comes to the training that I'm talking about in a fasting state, I like resistance training.

在力量训练中，葡萄糖问题不会成为困扰。

So in resistance training that glucose issue is not going to become a problem.

但如果你让这位女性患者走上跑步机，让她长时间跑步，比如让她在跑步机上跑四十分钟，我认为你说得完全对。

Now if you're going put that female patient on a treadmill and make her run for a long period of time, let's say you're going to make her run for forty minutes on the treadmill, I think that yes, you're absolutely right.

你会耗尽她的葡萄糖，可能会引发一些问题，导致肌肉开始分解。

You are going to deplete her glucose and you may cause some problems and then the muscle will start breaking down.

但根据我与患者们的全部经验，当我告诉她们进行HIIT（高强度间歇训练）时，所有女性的表现都和男性一样出色。

But I do believe from all the experience that I've had with my patients, that when I tell them to do HIIT, which is high intensity intel training, all the women do just as well as the men.

因为你只是在高强度地锻炼肌肉，做一些力量训练，然后充分休息。

Because all you're doing is you're intensely working the muscles and you're doing some resistance exercises and then you're totally resting as well.

我在这方面看到了非常出色的效果。

And I see fantastic results with that.

关于生酮状态，你会在生酮饮食中循环进出吗？

In terms of ketosis, do you cycle in and out of a ketogenic diet?

对于不了解的人，生酮饮食是一种碳水化合物含量极低的饮食，通常每天碳水化合物摄入量少于50克。

And just for anyone that doesn't know, a ketogenic diet is a diet that's very, very low in carbohydrates, so less than 50 grams of carbohydrates a day typically.

你会在生酮饮食中循环进出吗？

Do you cycle in and out of that diet?

是的，你必须这样做。

Yes, yes you have to.

因为我不想让他们一直保持在生酮状态。

Because I don't want them to stay in a ketogenic state all the time.

所以我会，我会，我会这样做。

So I do, I do, I do.

我会告诉他们：你在这里的目标是什么？

I tell them look, what is your goal here?

你的目标是什么？

What is your goal?

如果你的目标是减掉70磅，那就一直坚持到达成目标为止。

If your goal is that okay I need to lose 70 pounds, then you're to do this till you get to your goal.

一旦达成目标，你就回到限时进食，也就是18:6。

Once you get to your goal, then you're going to go back to time restricted feeding, which means eighteen:six.

这样你仍然会产生一些酮体，并且可以间歇性地进行36小时的禁食。

So you'll still make some ketones and then intermittently you can still do a thirty six hour fast.

这意味着正常健康的人，像你和我，每个月至少应该进行一次36小时的禁食。

That means normal healthy people, you and me, we should still be doing one thirty six hour fast at least once a month.

我们会做到这一点，我们会坚持的。

So we'll go to that, we'll go to that.

禁食仍应成为你生活的一部分，但你不需要一直保持生酮状态。

Fasting must still become part of your prayer, but you don't need to stay in ketogenesis all the time.

还要记住，当你处于生酮状态时，你也同时处于自噬状态。

Remember also that when you are in ketogenesis you are also in autophagy.

你能进行多少自噬呢？

How much autophagy can you do?

这意味着你在回收细胞内部的所有细胞器。

That means you're recycling all organelles inside your cells.

对于不了解自噬这个词的人来说，这简单来说意味着什么？

What does that mean in simple terms for someone that doesn't know the term autophagy?

所以

So

简而言之，细胞感知到没有新的部件输入进来。

bottom line is the cell senses that there is no new parts coming in here.

因此，它会将细胞内多余的细胞器分解掉。

So it takes the redundant organelles inside the cells and breaks them down.

将它们打包成小包裹，然后排出细胞外。

Packages them up into these little packets and exports them out of the cells.

因此，你身体里的所有细胞现在都以高效得多的水平运作。

So these cells, all your cells in the body, now are functioning at a much more efficient level.

线粒体也会发生自噬。

So mitochondria also have autophagy.