最值得回味的时刻：你的食物可能让你抑郁！饮食如何影响心理健康！

嗯。

Yeah.

我们在这个节目中经常谈论饮食和食物。

We talk a lot about diet and food on this show.

尤其是与新陈代谢和心理健康相关的时候，

As it relates to metabolism and mental health,

饮食。

diet.

饮食非常重要。

Diet is huge.

大多数人根本不知道饮食在精神疾病或心理健康中起任何作用。

And most people have no clue that diet plays any role in mental illness or mental health.

95%的精神健康临床医生认为，有人会建议饮食对精神疾病有影响是可笑的。

Ninety five percent of mental health clinicians think it's laughable that anybody would suggest that diet can play a role in mental illness.

他们觉得这很可笑。

They think it's laughable.

你怎么看？

What do you think?

我认为，如果你深入研究科学——我们过去一百年甚至更长时间积累的所有科学证据，包括所有神经影像研究、基因研究、神经递质和激素研究、创伤研究以及不良童年经历研究——如果你深入理解这些因素如何影响人们的大脑和身体，或者这些因素可能造成什么影响，并将所有这些信息整合起来，你就会得出这样一个结论：精神障碍本质上是代谢性的，这一点毋庸置疑。

I think if you do a deep dive into the science, all of the science that we have accumulated over the last one hundred years and longer sometimes, That if you do a deep dive into all of those neuroimaging studies that we've been doing, all of the genetic studies we've been doing, all of the neurotransmitter and hormone studies and trauma studies and adverse childhood experiences studies, If you do a deep dive into the science and you understand what is happening in the brains and bodies of people as a consequence of those things or what could be causing those things, If you put it all together, you come to this sound bite that mental disorders are metabolic in nature, and there is no questioning whatsoever.

饮食在代谢中扮演着巨大而关键的角色，这是无可争议的。

It is incontrovertible that diet plays a massive, huge role in metabolism.

因此，我坚信饮食可能在我们当前面临的精神健康危机中发挥重要作用，同时也可能为希望、康复和恢复提供一条途径。

And therefore, I believe very strongly that diet might be playing a role in the mental health epidemic that we are seeing, and it also might provide an avenue of hope and healing and recovery.

我使用‘可能’这个词，是因为作为科学家和临床医生，我知道我无法确定饮食能治愈那些患有慢性、严重、致残性精神疾病的人。

And I use the word might as the scientist in me, as the clinician in me, I know without certainty it can heal and recover people who have had chronic, horrible, debilitating mental illnesses.

而根据我自己的亲身经历，在医学院和住院医师培训期间，我仍饱受轻度抑郁、强迫症和其他症状的困扰，但同时也出现了所谓的代谢综合征。

And I know from my own personal story, when I was in medical school and residency, I'm still suffering from low grade depression, OCD, other symptoms, But I also developed what's called metabolic syndrome.

我出现了高血压、高胆固醇和前期糖尿病，但我的体重并没有明显超标。

I developed high blood pressure, high cholesterol, prediabetes, and I wasn't really overweight.

我一直在锻炼。

I was exercising.

我当时遵循的是低脂饮食，主要吃加工食品，因为它们更便宜，但这种饮食却被宣传为健康饮食。

I was following a low fat diet, mostly of processed foods because they're cheaper, but that was the diet that was touted as a health a healthy diet.

它脂肪含量低。

It was low in fat.

只要脂肪含量低，就被认为对我们有益。

And as long as it was low in fat, that was supposed to be good for us.

而我的代谢综合征却越来越严重。

And my metabolic syndrome just kept getting worse and worse.

因此，在某个时候，为了治疗我的代谢综合征，我将饮食改为几乎低碳水化合物的饮食。

And so at some point, in order to treat my metabolic syndrome, I changed my diet to essentially a low carbohydrate diet.

三个月内，我的代谢综合征完全消失了。

And within three months, my metabolic syndrome was completely gone.

但让我震惊的是，我的心理健康达到了有生以来最好的状态，我简直不敢相信自己所经历的一切。

But the thing that just dumbfounded me was that my mental health was better than it had ever been in my entire life, and I just couldn't believe what I was experiencing.

我从未想过自己能成为这样的人。

I didn't know that I could be that kind of a person.

我不知道自己可以如此快乐、积极、充满活力且自信。

I didn't know that I could be happy and positive and energetic and confident.

我完全没想到。

I had no idea.

我以为自己不具备这些品质。

I I didn't think that was in me.

通过改变饮食，所有这些变化都发生了。

And by changing my diet, all of those things happened.

从线粒体层面来看，你是说，因为你把饮食改为更天然、更健康的食物，线粒体本身能够更自然、更有效地运作，从而释放出与积极心理健康更一致的化学物质和过程，是这样吗？

At the level of the mitochondria, are you saying do you believe that because you changed your diet to more sort of natural, healthier foods at the level of the mitochondria.

线粒体的运作方式变得更加正常，释放的化学物质和进行的过程也更符合积极的心理健康状态，是这样吗？

The mitochondria were able to function more naturally themselves in more functional way, which meant that they release the chemicals they release and the processes they go through were more consistent with positive mental health.

这是理解这个问题的简单说法吗？

Is that like the simpleton's way of understanding it?

在此之前，你提到过食物中的人工化合物等问题。

And before then, you talked about man made compounds in the foods, etcetera.

我假设你的意思是，我们今天吃的某些现代食品，那些高度加工、含有大量陌生化学物质的食物，线粒体根本不知道如何应对，这会导致与经历极端创伤或其他不利环境时相似的失调和功能障碍。

I'm assuming you were saying that some of the modern foods that we eat, the ultra processed foods that have all of these random named chemicals inside them that we see on the labels, the mitochondria don't know how to deal with that, so it's causing the same sort of dysregulation and dysfunction that they might see if we'd gone through an extreme trauma or something else or some other adverse environmental situation.

正是线粒体的这种功能障碍，引发了我们所看到的一系列连锁反应。

It's just this dysfunction of the mitochondria which is causing the knock on effects we see.

但有很多因素都会导致线粒体功能失调，我们之前已经讨论过其中一些。

But there's many things that can cause dysfunction in the mitochondria, We went through a bunch of them earlier.

这样理解简单吗？

Is that a simple way of understanding it?

百分之百正确。

100%.

好的，太好了。

Okay, great.

完美。

It's perfect.

非常有趣。

Super interesting.

那么关于这一点，我们需要深入探讨饮食这个问题。

So on that point then, have to zoom in on this thing of diet.

如果你希望我的线粒体达到最佳状态，甚至能给我一个你曾治疗过的患者的案例，你会建议我吃哪些食物，避免哪些食物？

If you wanted my mitochondria to be perfect, and maybe even give me a case study of patients you've worked with that you've prescribed a certain diet to, what diet, what food would you tell me to eat, and what would you tell me not to eat?

我实际上没有一种适合所有人的固定方案，这一点我想先说明清楚。

I actually don't have a one size fits all prescription, so I want to say that upfront.

所以我需要了解我面对的是谁，他们的心理和代谢健康状况目前如何？

So I would want to know who am I working with, and how is their mental and metabolic health now?

我。

Me.

所以是你。

So you.

嗯。

Yeah.

所以我需要更多的细节。

So I would want more details.

你有任何心理健康状况的症状吗？

Are you having symptoms of any mental health condition?

我想说没有。

I would say no.

不过，我确实会有一些感到有点焦虑的时刻？

However, I can I can have moments where I feel a little bit anxious?

所以，你知道，我一生中经历了很多压力事件，因为我经营着一家大公司。

So, you know, I've been through a lot of, I'd say, stressful events in my life because I was running a big business.

我们有数百名员工，每次都得发工资。

We had hundreds of employees, paydays all the time.

所以，有一段时间，我一直处于这种持续的轻微压力之中。

So I had this at one point, I had this constant subtle stress.

我想知道，你有没有觉得无缘无故地感到焦虑？

I would want to know, do you feel like you have anxiety for no good reason?

有时候。

Sometimes.

有时候感觉确实有点那样。

Sometimes it can feel a little bit like that.

这种情况非常少见，我想。

It's very infrequent, I'd say.

我也会有某些时刻，只是想到某件事，就会突然产生一种类似战斗或逃跑反应的感觉。

I can also have moments where I just think of something and then I get the same kind of like It's almost like the fight or flight response has just kicked in.

但你是想到一些负面或有压力的事情吗？

But you think of something adverse or stressful?

是的。

Yeah.

对。

Yeah.

关于这一点，我想说的是，我们可以深入讨论更多细节，不过我们现在可能没必要这么做。

So the one thing I would say about that and we could get into a lot more details, which we probably don't wanna do now

我不介意。

I don't mind.

播客。

Podcast.

但根据你刚才说的，我强烈猜测，这种程度的压力和焦虑是所谓的‘正常’的。

But my my strong guess, based on just what you've said, is that that level of stress and anxiety is quote, unquote normal.

好的。

Okay.

因为你正在感受到：我现在必须去做一件非常可怕的事情，或者我必须去做一件可能会毁掉别人人生的事情，嗯。

Because you you are sensing, I have to go do something that's really scary right now, or I have to go do something that's gonna ruin someone's life or Mhmm.

嗯。

That Mhmm.

这可能会威胁到我的成功。

That might threaten my success.

在这些情况下，感到焦虑和压力是正常且实际上健康的。

It is normal and actually healthy to have anxiety and stress in those situations.

焦虑和压力有时会非常有帮助且具有适应性，因为它能让你停下来思考：这真的是我想做的吗？而不是过于自信地盲目推进。

The anxiety and stress can sometimes be quite helpful and adaptive because it can make you pause and reflect on, is this really what I wanna do, as opposed to being overly confident and just proceeding.

你个人的经历几乎肯定会影响你的压力反应水平。

Your own personal history almost certainly informs your level of stress response.

同样，如果你回顾自己的创伤，你会记得当我面临这种情况时，保持高度警觉是有帮助的。

And again, so if you go back to your own traumas, you're going to remember when I'm facing a situation like this, it's helpful to be on hyper alert.

保持高度警惕是有帮助的。

It's helpful to be hyper vigilant.

你的身体和大脑会记住，这帮助你安全有效地应对了这种情况。

And your body and brain will remember that helped you navigate this safely and effectively.

但如果我现在坐在这里，拥有这样的心理特征，接下来十年又大量食用加工垃圾食品，我会不会让我的线粒体陷入混乱，从而增加我患上精神健康障碍的概率？

But if I that if I have that sort of mental profile now as I sit here, and then for the next decade I ate processed junk food, am I going to send my mitochondria into disarray, which is going to increase the probability that I have a mental health disorder?

是的。

Yes.

我认为是的。

I think yes.

我们永远不可能进行一项人类随机对照试验来精确验证这一点

There's no way we will ever be able to do a human randomized controlled trial to test that precise

不道德。

Unethical.

假设。

Hypothesis.

但我们有大规模的流行病学研究，强烈表明那些食用大量超加工食品的人患抑郁症、焦虑症和其他精神障碍的风险更高。

But we have large epidemiological studies that strongly suggest that people who eat a lot of ultra processed food have higher risk for developing depression, anxiety, and other mental disorders.

而且基于科学，特别是细致的科学研究，基于动物模型——我们可以在小鼠和大鼠身上进行这样的实验。

And based on the science, the granular science, based on animal models so we can do that to mice and rats.

事实上，我们在小鼠和大鼠身上确实观察到了这种情况。

And in fact, that's exactly what we see in mice and rats.

我们给它们喂食致肥胖饮食，通常富含脂肪、碳水化合物和超加工食品。

We feed them an obesogenic diet, which is usually high in fat, high in carbohydrates, ultra processed foods.

一些研究人员给大鼠和小鼠喂食自助餐式饮食，即提供大量美味的垃圾食品。

Some researchers have fed rats and mice cafeteria diets where they feed them a lot of delicious junk food.

这些小鼠不仅肥胖率升高，糖尿病和前期糖尿病的发病率也更高。

And those mice develop higher rates of obesity, but also higher rates of diabetes and prediabetes.

而且，顺便说一下，抑郁症和焦虑症的发生率也更高，因为这两者是我们能在小鼠和大鼠身上相对容易测量的指标。

And, oh, by the way, also higher rates of depression and anxiety, because those are the two things that we can kind of measure in mice and rats.

我们很难准确测量注意力缺陷多动障碍（ADHD）的症状。

We can't necessarily measure ADHD symptoms.

真正测量精神病性症状非常困难，但我们能在动物身上较好地测量抑郁和焦虑症状。

It's really hard to actually measure psychotic symptoms, but we can measure depression and anxiety symptoms pretty well in animals.

因此，在动物模型中，这一点是毫无疑问的。

And so in animal models, we know that that's unequivocally true.

但在人类身上我们也看到了同样的情况，因为我读了你的书，在第四章中你提到，患有多动症的人更容易发展为肥胖。

And we see the same in humans though, because I was reading your book, and in chapter four, you say people with ADHD are more likely to develop obesity.

肥胖人群患双相情感障碍的可能性高出百分之五十，患焦虑或抑郁的可能性高出百分之二十五，而青春期前后体重增加会使24岁时患抑郁症的风险增加四倍。

People who are obese are fifty percent more likely to develop bipolar and twenty five percent more likely to develop anxiety or depression, and weight gain around the time of puberty leads to a 400 increase in the chance of depression by the age of 24.

是的。

Yes.

九岁时出现胰岛素抵抗，会使你发展为精神病高危状态的风险增加五倍，这意味着你患精神分裂症或双相情感障碍的风险大幅升高。

And insulin resistance at age nine makes increases your chances of developing a psychotic at risk mental state, which is like meaning you're at high risk for developing schizophrenia or bipolar disorder five hundred percent.

那阿尔茨海默病呢？

And Alzheimer's?

所有精神障碍都与阿尔茨海默病风险增加相关。

All mental disorders are associated with an increased risk of Alzheimer's disease.

风险最低增加百分之五十，最高可增加两千倍。

Anywhere from the lowest is fifty percent increased risk, and the highest is two thousand percent increased risk.

将所有这些问题联系在一起的线索是新陈代谢。

And the thread that unites all of these problems is metabolism.

新陈代谢。

Metabolism.

归根结底，要理解新陈代谢，你就必须谈论线粒体。

And at the end of the day, you have to talk about mitochondria in order to understand metabolism.

只有百分之七的美国公民没有任何代谢健康问题的迹象，这意味着约百分之九十三的美国居民至少会有一个代谢综合征的生物标志物，即他们患有糖尿病前期、血脂异常、高血压、腹部肥胖或过多的腹部脂肪。

Only seven percent of US citizens have no signs of metabolic health problems, meaning ninety three percent or so of US residents will have at least one of the biomarkers of metabolic syndrome, meaning they have prediabetes or abnormal lipids or high blood pressure or abdominal obesity or abdominal fat, excessive abdominal fat.

那么，我们为这百分之九十三的人提供什么？

So what do we offer those ninety three percent?

因此，对于这些人来说，饮食干预绝对是康复策略的一部分。

So those people diet interventions would absolutely be a part of a healing strategy.

是其中一部分，但不是唯一的策略。

A part of it, not the only strategy.

我想了解他们的睡眠情况。

I would wanna know about their sleep.

我想了解他们的物质使用情况。

I would wanna know about substance use.

我想了解他们的用药情况，还有很多其他方面。

I would wanna know about medications, lots of things.

但对于饮食干预，我想从他们当前的状况出发，先弄清楚：你现在的情况如何？

But for dietary interventions, I would wanna meet them where they're at and just find out, well, where are you at?

你平时吃些什么？

What are you eating?

你对饮食有什么偏好或要求吗？

Do you have preferences or demands for what your diet should be?

你能给我一个案例研究吗？

Could you give me a case study then?

也许是你实践中见过的更极端的案例。

Maybe a more extreme case study from your practice that you've seen.

我可以给你一些简单的案例，这些可能适用于地球上大多数人类。

I could I can give you the simple cases where which probably apply to the majority of human beings on the planet.

但如果可以的话，我更愿意给你一个极端的案例，因为很多人持怀疑态度。

But if it's okay, I'd rather give you the extreme case because a lot of people are skeptical.

他们可能听到我说这些，心想：你只是在谈论一般的健康和保健。

They they probably hear me saying this, they think, well, you're just talking about general health and wellness.

那有真正精神疾病的人呢？

What about people with real mental illness?

那像你母亲这样被精神疾病摧毁生命的人呢？

What about people like your mother whose lives were decimated by mental illness?

这和他们毫无关系。

This doesn't have anything to do with them.

我在这里要说的是：不。

And what I'm here to say is, no.

实际上，这也与他们息息相关。

Actually, this has everything to do with them too.

但没错，它同样适用于普通大众。

But, yes, it applies to just common everyday people.

不过，我想分享一个故事，因为这可能是我所知道的最有力的故事之一。

But, you know, probably so one story that I will just share to just because it's probably one of the most powerful stories I know.

她是一位名叫多丽丝的女性。

It was a woman whose real name was Doris.

在书中，我称她为米尔德丽德，因为我更改了所有人的名字，但她确实允许我使用她的真名。

And, in the book, I called her Mildred because I changed everybody's names, but she actually gave me permission to use her real name.

因此，为了纪念她，我想使用她的真名。

So in honor of her, I wanna use her real name.

她是一位童年遭受严重虐待、经历诸多创伤的女性。

So she was a woman who actually had a horrible abuse of childhood, lots of trauma.

到她17岁时，她开始出现每日幻觉和妄想，并被诊断为精神分裂症。

And by the time she turned 17, she started having daily hallucinations and delusions and was diagnosed with schizophrenia.

在随后的几十年里，她尝试了多种抗精神病药、情绪稳定剂、抗抑郁药和其他药物，但都没有阻止她的症状。

Over the ensuing decades, she tried numerous antipsychotic mood stabilizers, antidepressants, and other medicines, but none of them stopped her symptoms.

她一直保持着精神分裂症的所有症状。

She remained with all of the symptoms of schizophrenia.

她的体重急剧增加。

She ended up gaining a massive amount of weight.

到70岁时，她的体重达到了约三百三十磅。

She ended up weighing about three hundred and thirty pounds by the time she was 70.

这个诊断彻底摧毁了她的生活。

Her life was devastated by this diagnosis.

她有一位法院指定的监护人来管理她的财务和其他事务。

She had a court appointed guardian to manage her financial affairs and other affairs.

有专业人士定期到她家中帮助她支付账单、购买杂货等，因为她自己无法完成这些事，这对精神分裂症患者来说并不罕见。

She had professionals coming into her home to help her with paying bills and grocery shopping and stuff like that because she couldn't do it for herself, which is not at all unusual for people with schizophrenia.

在68岁到70岁之间，她至少六次试图自杀，并因此多次住院治疗。

And between the ages of 68 and 70, she tried to kill herself at least six times and was hospitalized for those suicide attempts.

她憎恨自己，也憎恨自己的生活。

She hated herself and she hated her life.

当她70岁时，她的医生告诉她：‘你超重了，需要减掉一些体重。’

When she was 70 years old, her doctor told her, you're overweight and you need to go lose some weight.

她被转介到杜克大学的一个减肥诊所，而那里恰好正在使用生酮饮食作为减肥手段。

And she was she was referred to a weight loss clinic at Duke University where they just so happened to be using the ketogenic diet as a dietary inter as a weight loss tool.

不知为何，她决定试一试。

And for whatever reason, she decided to give it a try.

于是她尝试了生酮饮食，两周内不仅开始减重，还注意到自己的幻觉和妄想显著减少。

And so she tries the ketogenic diet, and within two weeks, not only does she start losing weight, but she notices dramatic reduction in her hallucinations and delusions.

几个月内，她所有的精神分裂症症状完全缓解。

Within months, all of her symptoms of schizophrenia were in full and complete remission.

她开始逐渐停用精神类药物。

She starts tapering off her psychiatric meds.

大约六个月内，她停用了所有精神类药物，精神分裂症的症状也持续缓解。

Within about six months, she was off all of her psychiatric meds, and her symptoms of schizophrenia remained in remission.

多丽丝又健康地生活了十五年，无症状、不服药、不再住精神病院，也没有再出现自杀行为。

Doris went on to live for another fifteen years, symptom free, medication free, out of psychiatric hospitals, no more suicide attempts.

她很快就不再看精神健康专业人士，因为在她看来，他们没什么用。

She stopped seeing mental health professionals pretty quickly because they were kind of worthless in her mind.

他们其实并没有提供多少帮助。

They hadn't really helped all that much.

她减掉了150磅，并且直到去世都保持住了体重。

She lost a 150 pounds and kept it off until the day she died.

她最终在85岁时死于新冠肺炎。

She ended up dying at the age of 85 of COVID pneumonia.

但她的故事告诉我们，如果我们愿意，我们本可以做到，但并不一定非得如此。

And but her story tells us like, we could get if if you want, we don't have to.

我们可以深入研究生酮饮食及其对新陈代谢和线粒体的作用。

We could get into the science of ketogenic diet and what it's doing to metabolism and mitochondria.

我很想知道。

I'd love to know.

但有一个完整的故事，能帮助我们理解她身上发生了什么，以及这如何导致了她那非凡甚至近乎奇迹般的康复。

But there's an entire story that helps us understand what happened to her and how exactly that resulted in her really spectacular and almost miraculous recovery.

大多数人并不知道，大多数人认为生酮饮食是一种时尚饮食，而且很多人对此非常担忧。

Unbeknownst to most people, most people know that ketogenic diet is a fad diet, and a lot of people are really worried about it.

他们听说这种饮食很危险，会导致心脏病发作，甚至会致命。

They've heard that it's dangerous, that it'll give you a heart attack, you'll die.

大多数人并不知道，生酮饮食早在一百多年前就由一位医生开发出来，其目的只有一个。

Unbeknownst to most people, the ketogenic diet was developed over a hundred years ago now by a physician for one and only one purpose.

它被开发出来是为了控制癫痫发作。

It was developed to stop seizures.

事实上，过去一百年来，生酮饮食对大脑的影响已被广泛研究，它是一种有科学依据的癫痫治疗方法。

And in fact, the ketogenic diet has been studied extensively for its effects on the brain over the past hundred years, and it is an evidence based treatment for epilepsy.

这一点之所以重要，是因为我们经常在精神病学中使用癫痫的治疗方法。

And the reason that is so important is because we use epilepsy treatments in psychiatry all the time.

我们开给精神科患者的许多药物实际上都是抗癫痫药物。

Lots of the medications that we prescribe to psychiatric patients are in fact epilepsy treatments.

因此，我们知道癫痫和精神疾病之间存在大量重叠，能够帮助癫痫的治疗方法也可能对精神疾病有效。

And so we know that there's a lot of overlap between epilepsy and mental illness, and that treatments that help with epilepsy can also help with mental illness.

事实上，我们对生酮饮食的生物学机制及其对大脑的影响的了解，超过了任何其他饮食干预方式。

And so we actually know more about the biology of the ketogenic diet and its effects on the brain than we do any other dietary intervention.

它改变神经递质系统。

It changes neurotransmitter systems.

它减少大脑炎症。

It decreases brain inflammation.

它以有益的方式改变肠道微生物组。

It changes the gut microbiome in beneficial ways.

它实际上改变基因表达或表观遗传。

It actually changes gene expression or epigenetics.

但最重要且与我的理论最相关的是，它改善了线粒体和线粒体功能。

But most important and relevant to my theory is it improves mitochondria and mitochondrial function.

如果你坚持足够长的时间，经过足够长的周期，你实际上可以修复细胞中的线粒体功能障碍——至少对某些人来说，之后就可以停止这种饮食。

And if you do it long enough, over a long enough period of time, you can actually repair mitochondrial dysfunction in cells, at least for some people, and and then you can actually stop the diet.

在癫痫领域，神经科医生使用这种饮食来控制癫痫发作时，通常并不需要终身坚持。

So in the epilepsy world, when neurologists use this diet to stop seizures, it's usually not a lifetime treatment.

他们通常只需要坚持这种饮食两到五年左右。

They usually only need to do the diet for anywhere from two to five years.

许多患有难治性癫痫的人，大约三分之一会完全不再发作，另外三分之一——合计三分之二——会显著减少发作频率。

Many people, about a third of people who have treatment resistant seizures will become seizure free, and another third so two thirds total, another third will have a dramatic reduction in seizure frequency.

因此，仍有三分之一的人效果不佳，但这些人本就是难治性癫痫患者，没有任何一种治疗能对所有人都有效，因为我们还需要考虑其他所有相关因素。

So that leaves a third for whom it's not really working, but these are people with treatment resistant epilepsy, and there's no treatment that's gonna work for everybody because we need to look at all the other things involved.

如果有人通过生酮饮食实现了癫痫发作的停止。

If, say, somebody has seizure cessation, they get rid of their seizures on a ketogenic diet.

通常他们需要坚持两到五年，具体时长由医生帮助决定。

Usually, they have to do it for two to five years, somewhere in there, and their clinician will help them decide how long they should do it.

然后他们可以停止饮食，而大多数情况下，癫痫发作不会再复发。

And then they can stop the diet, and most often, the seizures don't come back.

它似乎真的能修复大脑。

It seems to actually heal the brain.

这种饮食给身体增加了什么或减少了什么，从而产生了如此显著的效果？

What is that diet adding or subtracting from the body that's causing that pretty phenomenal effect?

人们知道吗？

Do people know?

真正的答案是我们并不完全理解。

The real answer is we don't entirely understand.

我们不知道。

We don't know.

我的意思是，生酮饮食去除了糖分，例如。

I mean, the ketogenic diet removes sugar, for example.

是的。

It does.

基本上完全去除。

Pretty much entirely.

我的意思是，我曾经坚持过这个饮食大约八周左右，只是为了试试看，那时我几乎不能吃任何含糖的东西。

I mean, I've been on that diet for about I was on the diet for about eight eight weeks or so just to try, and I could I couldn't have anything with sugar in it pretty much.

不能吃糖，不能吃碳水化合物，几乎不含碳水化合物。

No sugar, no carbohydrates, very few carbohydrates.

所以有些人会说，这个饮食是去除了麸质，而麸质可能是有毒的东西。

So some people will argue, well, the diet is getting rid of gluten, and gluten is maybe the toxic thing.

另一些人则认为，这个饮食增加了蛋白质或肉类，可能是在补充某种营养缺乏，比如维生素B12缺乏或铁缺乏。

Other people will argue, oh, the diet is adding, like, some extra protein or meat, and maybe that's replacing a nutrient deficiency like vitamin b twelve deficiency or something like that or iron deficiency.

这些说法对某些人来说可能都是对的。

And all of those things might be true for some people.

但我不认为这些是主要原因。

I don't think those are the primary explanation.

我的意思是，如果一个人确实缺乏维生素B12，那么补充维生素B12是至关重要的。

I mean, obviously, if somebody has vitamin b twelve deficiency, replacing vitamin b twelve is essential.

嗯。

Mhmm.

如果有人缺铁，是的，识别出来并进行补充。

If somebody has iron deficiency, yes, recognizing that and replacing it.

但大多数人并没有这些缺乏症，他们仍然可能出现心理症状或心理健康问题。

But most people don't have those deficiencies, and they can still have mental symptoms or mental health problems.

我相信这种饮食的作用是迫使大脑和身体的新陈代谢发生转变。

I believe what the diet is doing is it it forces a transition in brain and body metabolism, essentially.

而这种转变实际上是由线粒体介导的。

And that act though, that transition is actually mediated through mitochondria.

因此，生酮饮食迫使你的肝脏开始产生酮体。

So the ketogenic diet forces your liver to start producing ketone bodies.

它迫使你的肝脏分解脂肪。

So it forces your liver to break down fat.

你正在从脂肪储存中减脂，但这些脂肪被转运到了肝脏。

So you're you're losing fat from your fat stores, but that fat is being shuttled to the liver.

然后肝脏将这些脂肪分解。

And then the liver takes that fat and breaks it down.

而且，我的意思是，我不该说所有的脂肪都被运送到肝脏。

And, I mean, I shouldn't say all of the fat is being shuttled to the liver.

有些脂肪会直接供给肌肉和其他组织使用，但相当一部分脂肪确实被运送到肝脏。

Some of the fat is going to muscles and other tissues and just being used directly, but a fair amount of the fat is actually being shuttled to the liver.

然后这些脂肪被转化为酮体。

And then that fat is being converted into ketone bodies.

其中一部分会被转化为葡萄糖，以维持正常的血糖水平。

Some of it is being converted into glucose so that you maintain normal glucose levels through this.

这些酮体会进入大脑，为脑细胞提供能量，但它们的作用远不止于此。

Those ketone bodies are then going up to the brain and fueling brain cells, But those ketone bodies are actually doing so much more.

它们正在改变线粒体的功能。

They're they're changing mitochondrial function.

它们正在改变表观遗传学。

They're changing epigenetics.

它们正在改变神经递质、炎症以及各种其他方面。

They're changing neurotransmitters and inflammation and all sorts of things.

但归根结底，我确信真正重要的是代谢变化和线粒体变化，这些变化对于显著改善症状（如停止癫痫发作或消除幻觉和妄想）至关重要且具有关键作用。

But at the end of the day, I'm convinced that it's really the metabolic changes and the mitochondrial changes that are so important and that are so instrumental in these dramatic improvements in things like stopping seizures or stopping hallucinations and delusions.

那禁食呢？

What about fasting?

尤其是最近有很多关于禁食及其对我们心理健康影响的讨论。

There's been a lot of talk especially recently about fasting and the impact that that can have on our mental health.

你认为禁食对我们的心理健康有积极影响吗？

Do you think fasting is a positive for our mental health?

这要看个人情况。

It depends on the person.

好的。

Okay.

生酮饮食实际上模拟了禁食状态，这就是它被提出的原因。

The ketogenic diet actually mimics the fasting state, that's why it was produced.

哦，对。

Oh, right.

生酮饮食实际上是由一位医生开发的，他认识到禁食可以对大脑产生强大的影响，包括阻止癫痫发作。

The ketogenic diet was actually developed by a physician recognizing that fasting can have really powerful brain effects, including stopping seizures.

如果你在岛上，朋友们开始不受控制地抽搐，最好的做法是让他们禁食。

If you're out on an island and your friends start seizing uncontrollably, the best thing to do is to fast them.

即使抽搐只是间歇性停止，你可能会想，哦，还是给他们吃点东西，维持体力，照顾他们，但如果朋友连续数天或数月反复抽搐，最好的做法是让他们禁食，告诉他们：‘几天不吃东西吧’，这就能停止抽搐。

Even if the seizures stop intermittently, you would think, oh, let's feed you to, you know, keep up your sustenance and, you know, take care of you, the best thing to do for your friend, if they are seizing repetitively over days or months, the best thing to do is to fast your friend and to tell them, let's have you go without food for a few days, and that can stop the seizures.

哇。

Wow.

禁食的挑战在于，如果持续时间过长，你可能会饿死，这显然不是在岛上对朋友的明智治疗方法。

The the challenge with fasting is that you could starve to death if you do it long long enough, and that's not a that's not a very good treatment for your friend on the island.

这位开发生酮饮食的医生意识到了这一点。

And this physician who developed the ketogenic diet recognized that.

因此，他开发生酮饮食的目的，就是想看看是否能通过饮食模拟禁食状态，从而获得更长期的益处。

And so that's why he developed the ketogenic diet, was really looking to see, can we mimic the fasting state with a diet and and get these longer term benefits.

所以回到你的问题，禁食能发挥作用吗？

So back to your question, can fasting play a role?

100%。

100%.

是的。

Yes.

禁食可以发挥作用。

Fasting can play a role.

禁食所做的事几乎和生酮饮食一样。

And fasting is doing pretty much the same thing that the huge ant diet is doing.

它改变了线粒体生物学。

It's changing mitochondrial biology.

它改善了线粒体功能，改变神经递质，改变肠道微生物组，改善胰岛素信号传导和胰岛素抵抗。

It's improving mitochondrial function, changing neurotransmitters, changing the gut microbiome, improving insulin signaling and insulin resistance.

它带来了各种有益的效果。

It's doing all sorts of beneficial things.

不过，禁食也有一些注意事项。

There are a couple of caveats with fasting, though.

一是体重过轻的人不应该禁食。

One is that people who are underweight should not fast.

这包括患有进食障碍而极度消瘦或体重过轻的人，但也包括因严重抑郁而体重下降的人，或因癌症而显著减重的人。

So that includes people with eating disorders who are emaciated or underweight, but it also includes people, like, who have had severe depression and lost weight as a result of their severe depression, or people with cancer who have lost a significant amount of weight.

禁食对他们不利。

Fasting is not good for them.

像生酮饮食这样的模拟禁食饮食，实际上可能对这些人非常有效，但必须在安全、受监督的医疗环境下进行。

Fasting mimicking diets, like ketogenic diets, may in fact be very powerful for those people, but it but they it needs to be done in a safe, supervised, medical way.

糖。

Sugar.

这对线粒体有什么影响？

What impact does that have on the mitochondria?

如果我摄入大量糖分，这会以某种方式影响我的线粒体，从而影响我的新陈代谢吗？

If I've got a super high sugar diet, is that impacting my mitochondria in some way and therefore my metabolism?

确实如此。

It is.

因此，对于其他方面健康的人来说，低糖摄入是完全没问题且可以接受的。

So low intake of sugar in people who are otherwise healthy is perfectly fine and acceptable.

所以，很多人偶尔吃点甜食，或者每周吃几次甜点，或者在特殊节日里享受一下，都是可以的。

So, you know, lots of people can consume treats every now and then or desserts a few times a week or, you know, special holiday.

他们甚至可能在节日期间大量摄入糖分，但也不会因此出现问题。

They can maybe even binge on sugar over the holidays, and they don't have any problems as a result of it.

如果这种情况对他们是适用的，那就没问题。

And that is fine if that's the way it's working out.

再次强调，只有百分之七的人口是代谢健康的。

Again, only seven percent of the population Yeah.

代谢健康的人只占少数。

Is metabolically healthy.

因此，大多数人的情况并非如此。

So the majority of people, that's not the way it's working out.

因此，长期摄入高糖会损害线粒体功能。

So high levels of sugar over time, we know can impair mitochondrial function.

因此有一个术语叫做氧化应激，而氧化应激主要与线粒体直接相关，因为线粒体产生能量，而这种能量的产生会导致氧化应激。

So there's this term called oxidative stress, And oxidative stress is primarily it's directly related to mitochondria because mitochondria are producing the energy, and then that energy production results in oxidative stress.

我们几十年来都知道，氧化应激对细胞有害，并且与所有代谢性疾病和所有精神疾病高度相关。

And and oxidative stress, we've known for decades, is bad for cells, and it is highly correlated with all of the metabolic disorders and all of the mental disorders.

在不同细胞、不同人群、不同诊断中，高水平的氧化应激是一个共同主题，但这反映了线粒体功能障碍。

High levels of oxidative stress in different cells, in different people with different diagnoses, high levels of oxidative stress are a unifying theme, but that is a reflection of mitochondrial dysfunction.

因此我们知道，如果你长期摄入大量糖分，会导致血糖水平失调，而高血糖水平会引发线粒体功能障碍，最终可能陷入恶性循环。

So we know that if you eat if you eat a lot of sugar over time, it can dysregulate glucose levels, and then those high glucose levels can cause mitochondrial dysfunction, and you can end up kind of on the downward spiral.

你刚才听到的是之前一集中最常回放的片段。

What you just listened to was a most replayed moment from a previous episode.

如果你想收听完整节目，我已经在下方提供了链接。

If you wanna listen to that full episode, I've linked it down below.

请查看描述。

Check the description.

谢谢。

Thank you.