沉默的科学家：阿尔茨海默症的解药早已存在？！医生被困在破碎的体系中！口腔感染与癌症的关联！

如果你有肠胃问题，你就去看胃肠科医生。

If you've got a GI problem, you go to a gastroenterologist.

如果你有神经系统问题，你就去看神经科医生或精神科医生。

If you've got a neurological problem, you go to a neurologist or psychiatrist.

但这些学科之间互不交流。

But none of these disciplines talk to one another.

所以神经科医生治疗该病症的方式会与心脏科医生大不相同，也与胃肠科医生截然不同。

So if you go to that neurologist is going to treat that condition much different than the cardiologist would, much different than the GI doc would.

但如果我们面对的是完全相同的根本病因呢？

But what if we're looking at the exact same root cause?

因此我的理念是，建立一个卓越中心，把所有相关专家都聚集在一起。

And so my philosophy, well, let's create a center of excellence, and let's bring everybody in the room.

召集胃肠科医生、神经科医生、心脏科医生、遗传学家、肺科医生、肾脏科医生都参与进来。

Let's bring the GI docs, the neurologists, the cardiologists, the geneticists, the pulmonary docs, the kidney docs, the renal docs.

让我们理解这个齿轮组般的系统，因为所有问题都发生在亚细胞层面的线粒体和能量生产过程中。

And let's understand this kind of wheel and cog, because everything occurs at the mitochondria, subcellular level, and energy production.

基本上所有症状都可能由此显现。

And then basically everything can manifest from that.

但我很快意识到，当你去MD安德森癌症中心这样的地方试图治疗癌症时，没人对治愈癌症真正感兴趣。

But what I quickly realized when you go to, for instance, MD Anderson and trying to treat cancer, No one is interested in curing cancer.

没人对治愈人类疾病真正感兴趣。

No one is interested in curing human disease.

因为我顿悟到：医疗是一门生意。

Because the epiphany for me came because medicine is a business.

这是一门以盈利为目的的生意。

It's a for profit business.

事实上，这是全球最大的商业经济模式，年产值达万亿美元。

In fact, it's the largest business and economic model in the world, trillion dollar annualized market.

这些制药公司大多通过资助科学期刊（如JAMA、新英格兰医学杂志等主流出版物）来施加影响，进而左右监管政策甚至FDA的决策。

And most of these drug companies who influence and pay and support scientific journals JAMA, New England Journal of Medicine, the major publications, the major journals and they're influencing regulation and policy and FDA.

当你意识到这些营利企业存在不当影响时就会明白——正如你们企业家和商界人士所知——商业的首要法则就是获取客户并尽可能长期留住客户。

And so when you figure out that there's undue influence by these for profit companies because the number one rule of business, as you know as an entrepreneur and a business guy, is acquire a customer and keep that customer as long as you can.

称之为客户的终身价值。

Call it lifetime value of that customer.

这就是医疗的本质。

And that's what medicine is.

他们将你发展为客户。

They acquire you as a customer.

让你开始服用某种药物。

They put you on a drug.

这种药物会产生副作用。

That drug has side effects.

他们不得不让你服用另一种药物来缓解前一种药物的副作用。

They have to put you on another drug to mitigate the side effects of that drug.

现在你又因多种药物联用产生了新的副作用。

Now you get side effects from that polypharmacy.

他们必须再给你开另一种药来缓解这些副作用。

They have to put you on another drug to mitigate those side effects.

现在你看看，50到60岁及以上的人要服用十种、十二种甚至十八种不同的药物。

And now you look up, and people who are 50 to 60 years old and older are on ten, twelve, 18 different medications.

这是世界上最好的财务模型。

That's the best financial model in the world.

所以这是个很棒的财务模型，但代价是我们的健康以及世界上每个人的健康。

So it's a great financial model, but it's at the expense of our health and the health of everybody living in the world.

而在美国，我们拥有全球最不健康的人口。

And in The US, we have the sickest population in the world.

现在，西方医学史上首次出现了医患之间的讨论：如何让你逐渐停用这种药物？

Now, for the first time in the history of Western medicine, have discussions between physician and patient, how do we wean you off this drug?

这种对话以前从未有过。

That conversation has never had before.

因为以往总是这样：如果这个药没效果，就回来，我会给你开更多药。

Because it's always, if this doesn't work, come back, and I'll prescribe you more drugs.

让我们反其道而行之。

Let's do the opposite.

你回来，我们一起来了解疾病的根源。

You come back, and let's understand the root cause of disease.

比如说，好吧，如果我们解决了这个问题，你就不需要这种药物了。

Let's say, Okay, well, if we are addressing this, you don't need this medication.

如果你不需要这种药物，那你也不需要那种药物。

And if you don't need this medication, you don't need this medication.

现在，你第一次开始让患者逐渐停用药物，结果会怎样？

And now, for the first time, you start weaning patients off of drugs, and what happens?

你现在正在侵蚀这些价值数十亿美元制药公司的市场份额，它们靠收买影响力、制定政策、影响政策为生。

You're now impeding upon the market share of these multibillion dollar drug companies who make their living buying influence, regulating policy, influencing policy.

而FDA就是通往大型制药公司董事会席位的垫脚石。

And the FDA is a stepping stone to a board seat of Big Pharma.

过去二三十年间，美国每一位前FDA官员最终都会成为大型制药公司高薪聘用的员工。

Every former FDA official in The US for the past twenty or thirty years goes on to become multimillion dollar salaried employee from Big Pharma.

这种情况必须停止。

It has to stop.

尽管美国将GDP的近20%用于医疗保健，但在高收入国家中，美国的健康结果总体排名垫底，包括婴儿死亡率最高和预期寿命最低。

Despite spending nearly 20% of The United States GDP on health care, The US ranks last overall on health outcomes among high income countries, including having the highest infant mortality rates and the lowest life expectancy.

这简直难以置信。

It's unbelievable.

我是说，这太令人沮丧了。

Mean, that's depressing.

我是说，但这些都是事实。

Mean, but those are the facts.

你必须明白，这些都是无可争议的数据。

And you have to understand, those are indisputable data.

所以当人们听到这些时，他们会说...但当你审视这个系统时——我并不责怪医生，因为医生进入这个领域...我曾在UT医学院招生委员会工作多年。

And so when people hear that, they go, but when you look at the system and I don't blame doctors, because doctors get into this field I was on the admissions committee to UT Medical School for a number of years.

所以我们面试了很多年轻学生，了解他们的动机，判断他们是否能在医学领域取得成功。

So we interviewed a lot of these young kids, figured out what their motivation was, will they have a successful career in medicine?

几乎所有人——我是说总有例外——但大家选择从医都是因为他们想有所作为。

And almost everyone, I mean, there's always the exception, but everyone gets into medicine because they want to make a difference.

他们被好奇心驱使着。

They're driven by curiosity.

他们大多希望留下持久的影响并帮助他人。

And most of them want to leave a lasting legacy and help people.

这正是人们进入医疗行业的驱动力。

That's what drives entry into health care.

但当你审视他们受训的体系时，就会发现这体系在束缚他们。

But when you look at the system in which they're trained in, it prevents them.

这基本上就像给他们戴上了手铐。

It basically handcuffs them.

因为当你了解医疗的经济模型时就会发现，一旦做出诊断，你就只能针对这个可诊断疾病采取有限的应对措施，对吧？

Because when you figure out the pay, the economic model of medicine, once you make a diagnosis, now you've got a diagnosable disease to which you have a finite number of responses, right?

如果你做出的诊断符合ICD-10编码（可报销代码），这就是你获得报酬的方式。

If you make this diagnosis that's called an ICD-ten code, which is reimbursable, And that's how you get paid.

所以一旦确诊，你能采取的措施就只有清单上列出的有限选项。

So once you make a diagnosis, you only have a finite list of things you can do.

你不能提出这个问题然后说，好吧，真正的原因是什么？

You can't ask that question and go, Well, what's really causing this?

然后花九十分钟在那个病人身上，因为大多数医生每天要看六十、七十、八十个病人才能支付账单，覆盖开销。

And spend ninety minutes with that patient, because most physicians have to see sixty, seventy, 80 patients a day to pay the bills, to cover their overhead.

所以这是个工厂。

So it's a factory.

你进来，你看看，你有个转录员，你做出诊断。

You come in, you look at, you've got a transcriber, you make a diagnosis.

好的，我要开这个药，两周或六个月后再来，我们看看你的情况。

Okay, I'm gonna prescribe this medication, Come back in two weeks or six months, and we'll see where you are.

然后这就变成了流水作业。

And then it's just it's a churn.

这就是一餐饭。

It's a meal.

但正如你所说，数据不会说谎。

But as you meant, the data don't lie.

作为世界上最工业化的国家，我们却拥有最不健康的群体和最高的婴儿死亡率。

Sickest population, highest infant mortality in the most industrialized nation in the world.

根据数据显示，美国人一生中约有13年时间与疾病相伴，这一数字远高于许多其他高收入的西方国家。

And according to the data, Americans are spending about thirteen years of their life living with disease, and that is significantly higher than many other high income Western countries.

因此尽管预期寿命可能达到70、80岁，但你将有近15年时间是在与疾病抗争中度过的。

So although life expectancy might be 70, 80 years old, you're going to spend almost fifteen years of that time living with disease.

所以你的健康寿命才是更值得关注的重点，而非单纯的生命长度。

So your health span is really probably the more important thing to be focusing on, not your lifespan.

当我们谈到一氧化氮时，我听你称它为长寿分子。

And so when we talk about nitric oxide, I've heard you describe it as the molecule of longevity.

确实如此。

For sure.

为什么这么说？

Why'd you say that?

为什么这么说？

Why'd you say that?

长寿学是一个新兴领域，核心问题是我们如何活得更久？

Well, again, longevity is this emerging field that's driven by how do we live longer?

我们如何延长健康寿命和整体寿命？

How do we increase our healthspin and longevity?

因为我想我们都同意，没人愿意活到100岁，却要在最后25年失能卧床、穿着尿布、无法起身。

Because I think we can all agree that nobody wants to live to be 100 years old if we spend the last twenty five of that years incapacitated, in a diaper, unable to get out of bed.

那根本不叫活着。

That's not living.

所以当我研究长寿时，我关注的是长寿的标志性特征是什么？

So when I look at longevity, I look at kind of what are the hallmarks of longevity?

什么定义了长寿？

What defines longevity?

我们如何才能活得更长久、更健康，远离疾病？

How do we live longer, healthier life free of disease?

实际上有三个客观衡量标准。

And really, there's three objective measures.

有干细胞。

There's stem cells.

整个再生医学领域都基于调动我们自身的干细胞或向全身部署干细胞来修复和替换功能失调的细胞。

This whole field of regenerative medicine is based on mobilizing our own stem cells or deploying stem cells throughout the body to repair and replace dysfunctional cells.

所以这些干细胞就像是能为我们身体任何部位提供修复的创可贴一样的细胞？

So these stem cells are cells that can basically act as like Band Aids, repairs, for any part of our body?

我们称它们为多能干细胞。

Well, we call them pluripotent stem cells.

这意味着其中一些来源于骨髓，还有一些我们称之为基质血管部分，可以从脂肪组织中获取。

So mean that and some of these are bone marrow derived, some of these are what we call stromal vascular fraction that you get from the adipose tissue or the fat.

多能性意味着多能性意味着

Chloripotent would mean Chloripotent multiple means that

干细胞可以变成神经元。

stem cell can go and become a neuron.

干细胞可以进入心脏并成为功能性心肌细胞。

That stem cell can go to the heart and become a functional myocyte.

它可以分化成巨噬细胞或免疫细胞、白细胞。

It can go and become a macrophage or an immune cell, white blood cell.

因此多能性意味着它能根据需要变成多种细胞类型。

So pluripotent means it can become many things, whatever it needs to be.

在某些情况下，我们骨髓中的干细胞数量会随着年龄增长而减少。

In some cases, the amount of stem cells present in our bone marrow get smaller with age.

细胞数量会随着年龄增长而下降。

The number of cells decrease with age.

但无论幸运与否，随着年龄增长，我们体内沉积的脂肪会越来越多。

But fortunately or unfortunately, the older we get, the more fat we deposit.

因此我们脂肪组织中含有大量干细胞，脂肪中的干细胞数量实际上增加了。

And so we have a number of stem cells in our fat, so we increase the number of stem cells in our fats.

所以衰老和长寿的问题在于我们失去了调动自身干细胞的能力。

So the problem with aging and longevity is when we lose the ability to mobilize our own stem cells.

我们无法修复和替换功能失调的细胞，于是就会形成所谓的僵尸细胞或衰老细胞。

We can't repair and replace dysfunctional cells, so we have what we call zombie cells or senescent cells.

它们存在，但无法正常工作。

They're there, but they can't do their job.

它们功能失调。

They're dysfunctional.

而这正是导致衰老的原因。

And that's what leads to age.

第二点是端粒。

Number two, it's telomeres.

端粒是我们DNA染色体的末端。

And telomeres are the ends of the chromosomes of our DNA.

它们位于最末端。

And so they're the very end.

就像鞋带末端的塑料头可以防止鞋带散开一样。

So it's like the tips of the shoestrings that prevent the shoestring from fraying.

这些就类似于端粒的作用。

And those are like the telomeres.

只要你的端粒功能正常且能防止其缩短，那么端粒越短，寿命就越短。

So as long as you have a functional telomere and it prevents it from getting shorter, then shorter telomeres, shorter lifespan.

端粒越长，寿命越长。

Longer telomeres, longer lifespan.

因此当端粒变短时，我们的寿命和长寿程度就会降低。

So when telomeres get shorter, it decreases our lifespan and longevity.

第三个是线粒体功能。

And then the third one is mitochondrial function.

在每种与年龄相关的慢性疾病中，每个细胞的线粒体数量都会减少，且存在的线粒体功能不正常。

In every age related chronic disease, you have a lower number of mitochondria per cell, and the mitochondria that are present aren't functional.

因此你会得到所谓的线粒体内膜中电子传递链的解耦，你将无法有效地产生细胞能量或ATP。

So you get what's called an uncoupling of the electron transport chain inside the inner mitochondrial membrane, and you can no longer effectively produce cellular energy, or ATP.

所以一氧化氮是基础的长寿分子，因为一氧化氮是体内信号，告诉我们干细胞动员和分化。

So nitric oxide is the foundational longevity molecule because nitric oxide is the signal in the body that tells our stem cells to mobilize and differentiate.

没有一氧化氮，你的循环干细胞数量就会减少。

Without nitric oxide, you have less number of circulating stem cells.

一氧化氮能激活端粒酶，从而防止端粒缩短。

Nitric oxide activates the enzyme telomerase, which prevents telomere shortening.

缺乏一氧化氮时，端粒酶无法被激活，端粒就会缩短。

Without nitric oxide, you don't get activation of telomerase telomeres shorten.

一氧化氮还是细胞内的信号分子，它能促使细胞产生更多线粒体，并提高线粒体效率，在耗氧更少的情况下生成更多细胞能量。

And then nitric oxide is the signal in the cell that tells the cell, I need more mitochondria, and I need these mitochondria to be more efficient, generate more cellular energy with less oxygen.

因此，恢复一氧化氮水平能同时解决长寿的三大关键因素。

So when you restore nitric oxide, you address all three aspects of longevity.

而人体内没有其他分子能实现这种综合效应。

And And there's no other molecule in the body that does that.

你认识布莱恩·约翰逊对吧？

You know Brian Johnson, don't you?

认识。

Yes.

你对布莱恩·约翰逊有什么看法？

What do you think of Brian Johnson?

我绝不会模仿或尝试做他所做的事。

I would never replicate or try to do what he does.

我认为这不是正确的方法。

I don't think it's the proper approach.

我并不是要批评别人，因为整个生物黑客这个领域。

And I don't mean to criticize people because this whole field of biohacking.

有些人既没有科学背景，也没有医学或生化背景，却在那里影响着数百万追随他的人。

You get people who have no science background, no medical background, no biochemical background, and yet they're out there influencing millions of people that follow him.

很多时候他们给出了非常糟糕的建议，虽然不是故意的。

And many times they're giving really bad advice, not intentionally.

这是因为无知。

It's because of ignorance.

他们只是不知道。

They just don't know.

他们不懂科学。

They don't know the science.

他们不了解背后的医学原理。

They don't know the medicine behind it.

所以在追随任何网红或生物黑客之前，第一点，先看看他们的资质。

So before you go and follow any influencer or biohacker, number one, look at their credentials.

如果他们没有任何科学背景，如果他们是正式的技术专家或来自科学和医学以外的领域，你真的需要深入了解一下，确保他们提供的内容或建议在科学上是有效的。

And if they don't have any science background, if they're formal technologists or come from anything besides science and medicine, you really need to do a little bit of deep dive and make sure that what they're giving you is scientifically valid or recommending.

他似乎是氧化氮在长寿方面作用的拥护者。

He seems to be a fan of the role of nitric oxide as it relates to longevity there.

他似乎对氧化氮及其改善心血管健康的影响给予了积极评价。

He seems to have said positive things about nitric oxide and its impact on improving your cardiovascular health.

是的，我认为随着科学的发展，我们更多地用通俗语言传达复杂的科学知识，让非科学家、非医学专业人士能够理解和欣赏，我想会有更多人接受这一点。

Yeah, I think as we advance the science and we do more to communicate the complex science into layman's terms, where the non scientists, non medical professionals can understand it and appreciate it, I think more people are going to pick up to that.

但也有一些拥有数百万粉丝的知名生物黑客仍然声称氧化氮是一种抑制线粒体呼吸的毒素，应该避免。

But there's also some well known biohackers with influences of millions of people that still say that nitric oxide is a toxin that inhibits mitochondrial respiration, and it should be avoided.

不过，是否存在氧化氮过多的情况呢？

Is there such thing as having too much nitric oxide, though?

因为如果人们今天听到这段对话，就冲出去过度补充一氧化氮，进行各种疗法，是否存在风险？

Because if people hear this conversation today and they rush out and they I don't know overdo their nitric oxide by doing a bunch of therapies, is that a risk?

当然。

Absolutely.

我们知道水是必需品，对吧？

We know water is essential, right?

但我们也可能因饮水过量而丧命。

But we can drink too much water and kill ourselves.

每年新闻都会报道几例低渗性溶解的案例。

You see it on the news a couple of times a year called hypotonic lysis.

所以没错，剂量决定毒性。

So yeah, dose dictates poison.

因此我们必须确保维护该领域的诚信，确保市面上一氧化氮产品不会因使用过量导致健康问题或致人死亡，否则可能毁掉整个领域。

And so what we have to do is make sure maintain the integrity of the field to make sure that if there are nitric oxide products out there, that, number one, you don't overdo it and lead to health issues or kill a consumer or kill a patient, because that could kill the entire field.

但我们也明白，一氧化氮只有两种中毒迹象。

But we also understand that there's only two signs of toxicity for nitric oxide.

所以这其实相当简单明了。

So it's really pretty straightforward.

第一，如果摄入过多一氧化氮，你的血压会不安全地下降。

Number one, if you take too much nitric oxide, you're going to get an unsafe drop in blood pressure.

想想这个道理。

Just think about this.

如果你服用一氧化氮或通过任何方式增强一氧化氮产品，都会导致全身性血管扩张。

If you take nitric oxide or you're enhancing nitric oxide products through whatever means, it's going to lead to systemic vasodilation.

现在同样的血液量要在更粗的血管里流动，血压自然会下降。

Now you've got that same volume of blood pumping through much larger pipes, and you're going to have a drop in blood pressure.

一旦失去灌注压，由于要对抗重力泵血，大脑将无法获得足够灌注，你会感到头晕继而昏厥。

And if you lose perfusion pressure, you're not going to be able to perfuse the brain because you've to pump against gravity, and you're going to get lightheaded and you'll pass out.

若持续时间过长，将导致缺血性器官损伤甚至器官衰竭，这可能致命。

And if that's prolonged, it leads to ischemic and organ damage and organ failure, and it can be deadly.

这就是第一点。

So that's number one.

然后是第二点，一种叫做高铁血红蛋白血症的情况。

And then number two is a condition called methemoglobinemia.

这是个专业术语，意思是它会氧化血红蛋白中的铁，降低你的携氧能力。

And that's a big word, meaning that it oxidizes the iron of hemoglobin and reduces your oxygen carrying capacity.

所以你会出现紫绀。

So you'll become cyanotic.

嘴唇周围会发青。

You'll get blue around the lips.

由于缺乏灌注或氧气，你的四肢会大面积变色。

Your extremities will turn wide from lack of perfusion or lack of oxygen.

但你从不会看到这种情况。

But you never see that.

我是说，临床上你几乎见不到高铁血红蛋白血症的病例。

I mean, you really never see clinical methemoglobinemia.

幸运的是，在高铁血红蛋白积累到危险水平之前，你的血压早就降到不安全范围了。

Fortunately, your blood pressure will drop to an unsafe level long before you get any accumulation of methemoglobinemia.

那么在长寿这一点上，你提到的其中一个方面是端粒长度。

So on this point of longevity then, one of the points you mentioned there was telomere length.

我听说过端粒长度，因为我了解到他们在老鼠和其他啮齿类动物身上做过相关研究。

And I've heard about telomere length because I've heard about studies they've done in rats and I think other rodents around telomere length.

研究发现端粒较短的个体死亡率几乎是端粒较长者的两倍。

So it was discovered that individuals with shorter telomeres had a death rate nearly twice of those with longer telomeres.

而你告诉我已有研究表明一氧化氮可以增加端粒长度？

And you're telling me that there has been research done that shows how nitric oxide can increase telomere length.

完全正确。

Absolutely.

我们从DNA层面、细胞核层面了解到，一氧化氮作为共定位分子与雌激素受体结合，使细胞能够启动端粒酶基因的转录和翻译。

So we understand at the DNA level, at the nuclear level, that nitric oxide what's called a co localizes with estrogen receptor to allow for the cell to turn on transcription and translation of the telomerase enzyme.

因此它不仅影响该蛋白质的基因转录，还调控着酶的活性。

So it's not only affecting the genetic transcription of that protein, but it's also regulating the function of the enzyme.

所以缺乏一氧化氮时，端粒酶数量会减少，而且这种酶的活性也会丧失。

So without nitric oxide, you have less telomere telomerase enzyme, And that telomerase enzyme isn't functional.

好的，所以一氧化氮对端粒酶有影响。

Okay, so nitric oxide has an impact on the telomerase.

端粒酶。

Telomerase enzyme.

没错。

That's right.

端粒酶。

Telomerase enzyme.

每次细胞分裂时，这些端粒可能会变短。

So what happens with each cellular division, those telomeres can get shorter.

对。

Right.

但只要端粒酶保持活性，它就能防止染色体末端的缩短。

But as long as that telomerase enzyme is active, it prevents the shortening of the very ends of the chromosome.

明白了。

Okay.

为了让不太了解的人明白，随着年龄增长，我们通过不断的自我复制来修复和更新细胞。

And just for people that don't understand, every replication, as we age, we're continually replicating ourselves to restore and repair them.

但在复制过程中，有时会造成损伤。

But in that replication process, harm is occurred sometimes.

不同细胞类型有不同的复制速率，对吧？

And different cell types have different replication rates, right?

比如肠道上皮细胞就具有高度再生能力，对吗？

So the epithelium of the gut is highly regenerative, right?

它是可复制的。

It's replicatable.

你一直在替换这些细胞，因为它们直接接触外部环境，需要持续更新。

You're replacing these cells all the time because it's the outside environment that you're having to continue to replace those cells.

而神经元则恰恰相反，天生不具备再生能力。

Neurons, to the exact opposite, aren't regenerative by nature.

所以我们通常不会——我是说，虽然也有可能。

So we don't typically make I mean, we can.

人们曾一度认为神经元是不可再生的。

It was once thought that you can't regenerate neurons.

但现在我们知道这是可能的。

But today, we know we can.

不过确实，它对不同器官系统的影响各不相同。

But yes, so it affects different organ systems differently.

但数据很明确：端粒越短，寿命越短。

But the data are clear: shorter telomeres, shorter lifespan.

在我们深入探讨如何提高或维持一氧化氮水平之前，我想先和你聊聊一氧化氮与口腔微生物组的关系。

The other thing that I wanted to talk to you about before we really get into the heart of how do I improve my nitric oxide levels or keep them at a healthy range while I age is nitric oxide's relationship with the oral microbiome.

对。

Yeah.

我不久前在这个播客里就讨论过口腔微生物组的话题。

I had a conversation on this podcast not too long ago about the oral microbiome.

这又是一个我过去没怎么思考过的课题。

Again, another subject I hadn't thought much about.

但这两者之间是否存在关联呢？

But is there a relationship there?

毫无疑问。

No doubt.

这个

This

这大概是二十年前的科学发现，那时微生物组项目可能刚刚完成。

is probably twenty year old science, where we find that probably twenty years ago, the microbiome project was complete.

这意味着我们体内外的细菌群落已被完全绘制出来。

And what that means is that the bacteria that live in and on our body were completely mapped out.

这些菌群最初是在肠道——胃肠道中被发现的。

And these communities were identified in the gut, started in the gut, the gastrointestinal tract.

然后你可以培养皮肤菌群。

And then you can culture the skin flora.

我们的皮肤上也有细菌存活。

There's bacteria that live on our skin.

我们的结肠里也生活着细菌。

There are bacteria that live in our colon.

女性阴道内同样栖息着细菌。

There are bacteria in women that reside in the vagina.

这些生活在人体内外不同生态区域的细菌，它们的存在是为了帮助人类宿主——我们称之为共生关系。

And so all of these different ecologies of bacteria that live in and on the body are there to do things to help the human host, what we call the symbiosis.

我们为细菌提供生存环境，细菌则为人类宿主带来益处。

We're providing benefit to the bacteria, the bacteria providing benefit to the human host.

因此，如果我们使用抗生素或抗菌剂杀灭体内外的细菌，就会引发人类疾病。

And so if we use antibiotics or antiseptics to kill the bacteria that live in and on our body, you get human disease.

这一点很明确。

That's clear.

最典型的例子就是：世界上没有医生会建议你或我终生每日服用抗生素。

And the best example is that there's no physician in the world that would recommend you or I take an antibiotic every day for the rest of our lives.

对吧？

Right?

要

Do

你 是的。

you Yeah.

同意吗？为什么这么说呢？

Agree with And why is that?

因为抗生素会杀死有益细菌。

Because the antibiotics are killing the good bacteria.

它们不仅杀死致病菌，还会破坏整个微生物群。

They kill the infectious pathogen bacteria, but they also destroy the entire microbiome.

一旦微生物群被破坏，就会引发全身性疾病。

And when you disrupt the microbiome, you get systemic disease.

你会患上血管疾病。

You get vascular disease.

还会得阿尔茨海默症。

You get Alzheimer's.

你会得肠漏症。

You get leaky gut syndrome.

你会得自身免疫性疾病。

You get autoimmune disease.

你会得高血压。

You get high blood pressure.

你会得酵母菌感染。

You get yeast infections.

你会得念珠菌过度繁殖。

You get overgrowth of candida.

你会得寄生虫感染。

You get parasites.

所以细菌实际上是人体免疫系统的警察。

So the bacteria are really the police of the human surveillance.

所以我们体内构成人体的细菌细胞数量是人体细胞的10倍。

So we have 10 times more bacteria cells that make up the human than we have human cells.

所以我们体内的细菌数量是人体细胞的10倍。

So we're 10 times more bacteria than we are human.

因此，如果你破坏了这种微生物群，就会导致系统性疾病。

And so if you destroy that microbiome, then it leads to systemic disease.

我们生活在一个不断试图消灭细菌的文化中，对吧？

We live in a culture where we're constantly trying to kill bacteria, right?

尤其是疫情后，我们使用各种洗手液和抗菌剂。

Especially post pandemic, we're using all kinds of hand washes and antiseptics.

显然，我们通常使用的主要化学物质之一就是漱口水这类产品。

And obviously the the big, I guess, chemicals that we all typically use are things like mouthwashes.

是的。

Yeah.

它们同样试图清除我们口腔中的所有细菌。

With which are, again, trying to just clean out all the bacteria from our mouths.

你会如何告诫人们谨慎使用这些东西？

What how would you caution someone on using these things?

甚至是那些所谓的抗菌产品

And even the, like, the antibacterial

是啊

Yeah.

这可不是什么好事

It's bad news.

真的吗？

Really?

对啊

Yeah.

我们给孩子用这些是因为想让孩子保持干净，不要沾染细菌

We give it to our children because we want our kids to be clean and not to have

孩子需要接触脏东西

Kids need to be dirty.

我再说一次，你看看流行病学数据就明白了

If I and, again, you look at epidemiological data.

看看那些在农村长大的孩子，他们在自然环境中生活，在泥土里打滚，身上沾满泥土，也接触了大量细菌。

Peep kids who grow up in the in a rural area, they're out in the environment, they're rolling in dirt, they get dirt on them, and they're inoculated with a lot of bacteria.

这些孩子是最健康的人群。

Those kids are the healthiest people.

从长远来看，他们患心血管疾病和糖尿病的发病率更低，免疫系统功能更好，自身免疫性疾病也更少。

You look later in life, they have lower incidence of cardiovascular disease, diabetes, they have better immune dysfunction, less autoimmune disease.

这就是所谓的卫生学原则或疾病卫生假说。

So there's this whole hygienic principle or hygienic hypothesis of disease.

我认为这已经不再是假说了。

And I don't think it's a hypothesis anymore.

我认为它已经被证实了。

I think it's proven out.

所以我不禁要问，我们为什么要这样做？

So for me, I go back and I go, why are we doing this?

为什么我们还要在牙科诊所使用含氟漱口水？

Why are we using fluoride rinses in dental offices?

为什么我们的牙膏里含有氟化物？

Why is there fluoride in our toothpaste?

为什么美国72%的市政供水中都添加了氟化物，而氟化物明明是一种已知的抗菌剂？

Why is there fluoride in the municipal water of seventy two percent of municipalities in The US when fluoride is a known antiseptic?

它是一种化学毒物，会损害甲状腺功能，还会对神经系统造成伤害。

It's a chemical toxicant, it's a thyroid toxin, it kills your thyroid, and it's a neurological toxin.

当你回顾牙科历史时会发现，一百多年前就首次发现：急性心脏病患者的致命血栓中检测出来自牙菌斑的口腔细菌。

And so when you go back and look at the history of dentistry, over one hundred years ago, was first identified that oral bacteria can be found in the plaque that killed someone from an acute heart attack.

那些心源性猝死患者的尸检显示，堵塞冠状动脉的血栓或栓子中，活检发现了引发心脏病或中风的口腔致病菌。

People who died from sudden cardiac death, they'll take the thrombus or the embolus that occluded that coronary artery, and they basically biopsy it, and they find oral bacteria in that plaque that caused the heart attack or stroke.

这证实了口腔与全身健康存在关联。

So that told us there's an oral systemic link.

口腔病原体存在细菌易位现象。

There's bacterial translocation of the pathogens.

这就是为什么牙龈出血很危险——因为口腔细菌会通过伤口进入血液循环。

That's why bleeding gums are a problem, because you've got bacteria in the mouth.

如果你有牙龈出血，这些细菌就能通过开放的血管进入我们的血液系统。

If you've bleeding gums, there's open blood vessels for those bacteria to get into our blood supply.

现在它们会遍布全身，引发炎症、斑块破裂，最终导致心脏病发作和中风。

Now they become systemic, cause inflammation, plaque rupture, and heart attack and stroke.

所以一百年前，他们出于合理且充分的理由决定：'让我们用抗菌剂来治疗吧'。

So one hundred years ago, with reason, with good reason, they go, well, let's treat with an antiseptic.

我们必须杀灭口腔中的所有细菌，这样即使牙龈出血，细菌也不会进入全身循环，从而预防心脏病或中风。

We have to kill all the bacteria in the mouth so if you have bleeding gums, there's no translocation of that in the systemic circulation, and we can prevent heart attack or stroke.

那都是一百年前的事了，这一百年来我们已经学到了很多。

That was one hundred years ago, and we've learned a lot in those one hundred years.

首先，当时人们尚未认识到我们体表和体内都存在微生物组。

Number one, it wasn't recognized that we have a microbiome on our body, in our body.

所以现在，当我不断询问牙医为何使用氟化物时，

So now, when I ask dentists all the time, why do you use fluorine?

他们总是回答：'因为这方法已经沿用一百年了'。

And they go, well, it's been used for one hundred years.

我说，好吧，我不在乎问题是什么。

And I go, well, I don't care what the question is.

这是你能给出的最糟糕的答案，仅仅因为‘我们一直这么做’就继续做下去。

That's the worst answer you could provide, just because we're doing it because that's the way we've always done it.

所以现在我们必须明白，如何在保持健康微生物群的同时选择性杀灭病原体？

So now we have to understand, how do we selectively kill the pathogens while maintaining a healthy microbiome?

这个领域大概始于90年代——最早的一些论文表明，使用漱口水会破坏口腔微生物群，导致血压升高。

And so this field started probably in the I mean, some of the first papers were published probably in the '90s, showing that there were if you used mouthwash, it destroyed the microbiome, and we saw an increase in blood pressure.

这些论文发表于2000年代末期。

These papers were published in the late 2000s.

我们大约在2008、2009年发表了相关研究。

We published on this probably in 2008, 2009.

我们建立了一个关联关系。

We created what's called an association.

口腔细菌最健康且多样性最丰富的人群，其血压状况最佳。

So people who had the healthiest and most diverse bacteria in their mouth had the best blood pressure.

口腔微生物群多样性最低的人群，且我们无法培养出任何这些产生一氧化氮的细菌，似乎具有最高的血压。

People who had the least diverse oral microbiome, and we could not culture any of these nitric oxide producing bacteria, appeared to have the highest blood pressure.

这就是我们所说的关联性。

So that's what we call association.

这不是因果关系，但这是一个很好的关联。

It's not causation, but it's a nice association.

于是在2019年，我们发表了一篇论文表明：现在让我们看看，如果我们选取血压正常的年轻健康人群（他们具有良好的一氧化氮水平和血压），然后仅让他们每天使用两次漱口水持续七天，以杀灭整个口腔微生物群。

So in 2019, we published a paper showing, Okay, now let's see if we take normal tensive patients, young, healthy people with good nitric oxide, good blood pressure, and we just give them mouthwash twice a day for seven days to kill the entire oral microbiome.

接着我们进行舌苔刮取以检测是否杀灭了细菌。

And then we do tongue scrapings to see if we're killing the bacteria.

同时我们进行血压测量。

And we do blood pressure measurements.

我们每天这样操作两次，持续七天。

And so we do that twice a day for seven days.

七天后，我们让他们回来复查。

Seven days, we bring them back in.

我们测量他们的血压。

We measure their blood pressure.

然后我们停止四天。

And then we stop for four days.

我们说，好吧，这四天不要使用漱口水。

We say, Okay, don't take mouthwash for four days.

然后回来。

Then come back.

让我们重新测量你的血压，并做舌苔刮取，看看这些细菌群落发生了什么变化。

Let's remeasure your blood pressure, and let's do tongue scrapings and figure out what's happening to these bacterial communities.

我们发现，如果消灭这些细菌，七天内你的血压就会上升。

And what we found was that if you eradicate the bacteria, within seven days, your blood pressure goes up.

所以如果你使用漱口水，七天内血压就会上升？

So if you use mouthwash, within seven days, your blood pressure goes up?

我认为这个现象出现得更早。

I think it occurs earlier.

但我们观察的是七天的情况。

But we looked at seven days.

我们只在第一天基线、第七天以及停用漱口水后四天进行了观察。

We only looked at day one at baseline, seven days, and then four days after stopping the mouthwash.

但在一名21岁的年轻人身上，他的血压升高了26毫米汞柱。

But in one 21 year old kid, his blood pressure went up 26 millimeters of mercury.

请帮我解释一下这个数值的意义。

Which is put that in context for me.

那已经达到临床高血压标准了。

That's clinically hypertensive.

血压每升高1毫米汞柱，心血管疾病风险就会增加1%。

So for every one millimeter increase in blood pressure, that increases your risk of cardiovascular disease by one percent.

所以在七天内，我们仅通过使用漱口水，就让这个年轻人的心血管疾病风险增加了26%。

So within seven days, we increase this kid's risk of cardiovascular disease by twenty six percent simply by giving him mouthwash.

请用通俗易懂的语言解释一下其中的作用机制。

And explain to me in layman's terms the mechanism there.

发生什么事了？

What's going on?

嗯，我们仍在努力理解其中的机制。

Well, we're still trying to understand mechanism.

再次强调，我们处于观察层面，这一点无可争议。

Again, we're at the observational level that's really indisputable.

因为这些细菌是我们所谓的硝酸盐还原菌。

Because these bacteria there's what we call nitrate reducing bacteria.

而人类并不具备这种酶。

And humans do not have this enzyme.

硝酸盐正是绿叶蔬菜中所含的物质。

So nitrate is what's found in green leafy vegetables.

这些植物以硝酸盐的形式吸收土壤中的氮。

These plants assimilate nitrogen in the soil in the form of nitrate.

我们食用这些蔬菜。

We consume these vegetables.

硝酸盐在肠道中被吸收。

The nitrate is taken up in the gut.

它会在我们的唾液腺中浓缩。

It's concentrated in our salivary glands.

然后细菌将硝酸盐代谢为亚硝酸盐和一氧化氮。

And the bacteria perform this metabolism of nitrate into nitride and nitric oxide.

而人类并不具备完成这一过程的功能性酶。

And humans do not have the functional enzyme to do this.

我们100%依赖这些细菌。

We're 100% dependent upon the bacteria.

因此现在，由于硝酸盐在人体内是惰性的，我们依赖细菌将这种分子代谢成可利用的形式，从而制造一氧化氮。

So then now, because nitrate is inert in humans, we rely on the bacteria to metabolize this molecule into a usable form where we can make nitric oxide.

所以当你杀死这些细菌时，硝酸盐只是被重新循环，但你会通过尿液排出，因为它被肾脏过滤了。

So when you're killing the bacteria, now the nitrate is just being recirculated, but you're urinating because it's filtered across the kidneys.

你会通过粪便排出，也会通过汗液排出。

You poop it out, and you sweat it out.

因此它完全保持不变，除非你有正确的细菌。

So it's completely unchanged unless you have the right bacteria.

而我们发现的是，这种在胃酸环境中由口腔产生的亚硝酸盐和一氧化氮，正在以某种方式调节阻力动脉的扩张，从而使全身血压正常化。

And what we're finding is that that oral production of nitride and nitric oxide being produced in the acid environment of the stomach is somehow regulating resistance arteries in dilation to normalise systemic blood pressure.

所以如果我没有健康的口腔微生物群，

So if I don't have a healthy oral microbiome,

那么你的血压就会升高。

then You have an elevation in blood pressure.

而且你今天跟我讨论的许多饮食改变措施都不会有任何效果，因为我需要细菌将其转化为一氧化氮。

And much of the things you're talking to me about today in terms of dietary changes won't have any effect anyway, because I need the bacteria to convert it into nitric oxide.

就相关性而言，食物中的许多营养素，尤其是植物性食物，确实能带来多种健康益处。

As it relates, there are many benefits of many nutrients in foods, particular plants, that confer some health benefits.

但当我们特别关注饮食中一氧化氮的益处时，如果你没有正确的口腔细菌，你的饮食就完全无法获得一氧化氮的益处。

But when we focus specifically on the benefits of nitric oxide from your diet, if you don't have the right oral bacteria, you get zero nitric oxide benefits from your diet.

显然，你还是能从食物中获取维生素A、维生素C、维生素D、纤维素和其他植物营养素。

Now, you're going to get, obviously, hopefully, vitamin A, vitamin C, vitamin D from foods, fiber, other phytonutrients.

但就植物性饮食的降压效果而言，如果没有正确的细菌，你就完全无法从中获益。

But in terms of the blood pressure lowering effects of, for instance, a plant based diet, if you don't have the right bacteria, you get zero benefits of that.

你发现过口腔健康与癌症之间的联系吗？

Have you seen a link between oral health and cancer?

是的，绝对有。

Yes, absolutely.

你观察到什么现象？

What have you seen?

那些有牙科感染、根管治疗或既往拔牙部位形成空洞的人，通常都会患癌症。

People that have dental infections, root canals, cavitations from previous extraction sites, have typically cancer.

这为癌细胞的生长和扩散创造了条件。

It sets the stage for cancer cell growth and proliferation.

我在之前的播客中发表过一个有争议的观点：首先声明我不是肿瘤学家。

I made a controversial statement on a previous podcast where I say, number one, I'm not an oncologist.

但那些患有晚期转移性疾病、尚未准备好死亡、被送回家接受临终关怀的患者，总会通过各种方式找到我，询问：你能帮我治疗这个癌症吗？

But people who have terminal metastatic disease who aren't ready to die, who are sent home to die on hospice, somehow find me and go, can you help me with this cancer?

所以我总是让他们先去看牙医，检查是否存在可能导致原发性肿瘤形成的活动性口腔感染？

So the first thing I always send them to is a dentist to see, do you have any active oral infections that may have led to the development of the primary tumor in the first place?

但显然，癌症已经转移，意味着现在遍布全身。

But obviously, it's metastatic, meaning that it's now everywhere.

它已经从原发肿瘤扩散出去。

It's migrated outside that primary tumor.

但几乎毫无例外，他们都存在活动性口腔感染。

But almost always without fail, they have an active oral infection.

这种感染可能是有症状的——他们自己知道并感到牙痛；也可能是无症状的，他们甚至不知道自己有牙齿感染。

And it may be a symptomatic infection to where they know it and they have a toothache, or it may be an asymptomatic infection where they don't even know they've got a dental infection.

在你接诊并转介给牙医的癌症患者中，有多大比例存在口腔感染？

What percentage of cancer patients that you see that you then refer to a dentist have an oral infection?

对于原发性实体肿瘤患者（我们将癌症分为血源性癌症如淋巴瘤、白血病、多发性骨髓瘤，以及发生在乳腺、结肠、前列腺、肺或肝脏的实体原发肿瘤），百分之百都存在牙齿感染。

People with primary tumors, solid tumors so we categorize these in blood borne cancers, something like lymphoma, leukemia, multiple myeloma, which is a blood borne cancer and those that have a solid tumor a primary tumor that starts in the breast, the colon, the prostate, the lungs, or the liver without fail, one hundred percent of them have dental infections.

但这里无法确定因果关系，对吗？

But cause and effect is not possible to establish here, right?

因果关系不，我认为我们还没到那一步。

Cause and effect no, I don't think we're there yet.

我想随着科学的进步和人们开始关注这一点，因为你可以想象，如果你患有癌症，并且已经看过世界上最好的癌症医生，经历了手术、化疗、放疗，完成了标准治疗方案，但癌症还是复发了。

I think probably as the science advances and people start to look at this, because you may imagine, if you have cancer and you've been to the best cancer doctors in the world, and you've done surgery, you've done chemo, you've done radiation, you've gone through the standard of care, and the cancer comes back.

这是终末期的。

It's terminal.

这是转移性的。

It's metastatic.

我告诉人们，你需要去看牙医，很多人会笑，他们会说，你刚才到底在说什么？

And I tell people, well, you need to go see a dentist, I mean, many people laugh, and they go, what in the hell did you just say?

我得癌症了。

I've got cancer.

我没有牙齿问题。

I don't have a dental problem.

然后我会说，也许你有牙齿问题。

And they go, well, perhaps you do.

因为再次强调，如果你回顾历史——我总是回顾历史，那些亘古不变的真理是什么？

Because again, if you go back and I always look at back, what's held true throughout ages?

如果你研究阿育吠陀医学，研究传统中医，研究针灸疗法，回溯历史观察——如果你不知道要寻找什么，就永远找不到答案。

And if you look at Ayurvedic medicine, if you look at traditional Chinese medicine, if you look at acupuncture, if you go back and you look, if you don't know what to look for, you're never going to find it.

如果你知道寻找什么，答案就在那里。

If you know what to look for, it's out there.

它就在已发表的文献中。

It's in the published literature.

但身体的每颗牙齿都与某个器官系统相连。

But every tooth in the body is connected to an organ system.

这些就是经络，针灸的经络。

And so these are the meridians, the acupuncture meridians.

打个比方说，它们就像电路断路器。

The analogy is they're circuit breakers.

就像家里跳闸的断路器，那条电路就会断电。

So if you trip a breaker in your home, there's no electricity going through that circuit.

所以你的烤箱不工作，冰箱不工作，灯也熄灭了。

So your oven doesn't work, your refrigerator doesn't work, your lights go out.

人体也是带电的。

Well, the body is electric.

我们如何判断死亡？

And how do we diagnose death?

通过心电图或脑电图检测不到电活动。

No electrical activity, either through an EKG or an EEG.

所以人体是带电的，我们就是电池。

So the body is electric, and we're batteries.

当手机亮起红灯显示电量低时，所有人都会惊慌失措地找充电器充电，对吧？

And so that red light comes on on our phone, it says we have a low battery, everybody panics and goes and plugs it in and charges, right?

人体也是完全一样的。

And the human body is the exact same.

我们的电压会随时间流逝而降低。

We lose voltage over time.

如果你的牙齿感染导致断路器跳闸，就没有电压，也没有电流通向滋养各个器官的经络。

And if you've got a trip breaker from an infected tooth, there's no voltage, there's no circuitry going to that meridian that feeds individual organs.

最好的例子就是根管治疗，百分之百的根管治疗牙齿都存在感染，人们会说‘这不是真的’。

So the best example is if you've got a root canal, and one hundred percent of root canal teeth are infected, and people go, well, that's not true.

那么，想想什么是根管治疗。

Well, think about what a root canal is.

你曾因感染而牙痛过。

You had a toothache at some point because of an infection.

于是你去看牙医，他们从那颗牙齿中抽出了牙神经。

So you go to the dentist, and they pull the nerve root out of that tooth.

这样你就感觉不到疼痛了，因为那里已经没有神经。

So you don't feel the pain anymore because there's no nerve root there.

他们还切断了那颗牙齿的血液供应。

And they pull the blood supply out of that tooth.

现在那颗牙齿已经没有了血液供应。

Now you have no blood supply to that tooth.

牙齿是一种晶体结构。

And a tooth is a crystalline structure.

它是活的器官。

It's a living organ.

没有血液供应和神经根，那就是死组织。

With no blood supply and no nerve root, that's a dead tissue.

举例来说，如果我们切除你的胆囊，并切断其血液供应和神经供应，七到十天内你就会因败血症死亡。

So if you were to go in and we'd disconnect your gallbladder, for example, and just cut the blood supply to it, the nerve supply to it, within seven or ten days, you'd be dead from sepsis.

没有人会把死组织留在体内。

Nobody leaves dead tissue in the body.

那么当你离开牙医诊所时，他们会怎么做？

And so then what happens is, when you leave the dentist, what do they do?

他们会给你开口服抗生素。

They put you on an oral antibiotic.

但他们肯定忘了自己已经切断了感染部位的血液供应，所以口服抗生素无法到达感染部位。

But they must have forgotten they took out the blood supply to that infected site, so an oral antibiotic isn't going to reach the site of infection.

我是说，当你坐下来仔细想想，就会问：这到底是谁干的？

Mean, to me, when you sit back and think about this and go, Who the hell does this?

他们为什么要这么做？

And why do they do it?

嗯，因为这就是我们一直以来的做法。

Well, it's because of what we've always done.

于是这些厌氧菌就开始繁殖，它们不需要氧气。

So then what happens is these anaerobic bacteria, they don't need oxygen.

它们就待在那个厌氧低氧环境里，不断侵蚀你的下颌骨。

They're sitting there in an anaerobic, low oxygen environment, and they're just eating away at your jawline.

它们就像我们一样。

They're just like us do.

它们会新陈代谢。

They metabolize.

它们会吸收物质。

They take stuff in.

它们排出废物。

They poop waste out.

这些废物不断积累。

Those waste products accumulate.

这会关闭电压。

It shuts down voltage.

它们会侵蚀你的下颌线。

And they eat away at your jawline.

于是你得了骨坏死、骨髓炎，却浑然不知。

So then you've got osteonecrosis, osteomyelitis, and you don't even know it.

而X光片也检测不出来。

And an X-ray will not show it.

遗憾的是，大多数牙医仍在使用X光片，而非更高分辨率的CT。

And most dentists, unfortunately, still use X rays instead of a higher resolution CT.

这真的很有意思。

It's really interesting.

我为这次对话做了些关于口腔微生物组与癌症关联的研究准备。

I was doing some research in preparation for this conversation around the subject of oral microbiome and cancer and the link there.

有一项特别的研究发表在《纽约邮报》上，是由一个研究团队完成的，纽约大学也参与了这项工作。

And one particular study that was done and published in The New York Post, but done by a team of researchers found that this was done at New York University as well.

所以这项研究由《纽约邮报》发表，并在纽约大学完成。

So it was published by the New York Post and done at New York University.

他们分析了超过16万名参与者长达十五年的唾液样本。

They analysed saliva samples of over 160,000 participants over fifteen years.

你熟悉这项研究吗？

Are you familiar with this study?

他们发现了十多种与头颈癌高风险相关的细菌种类，某些细菌甚至将患癌风险提高了50%。

And they identified over a dozen bacteria species linked to a high risk of head and neck cancers with certain bacteria increasing the risk by fifty percent Yeah.

患上癌症的风险，这相当令人震惊。

Of getting a cancer, which is pretty shocking.

真的，我都想立刻发消息让助理预约口腔清洁并更换漱口水了。

Literally, I I feel like texting my assistant and asking us to book a oral hygienist and to change my mouthwash.

无论我身处世界何处，似乎人人都在喝抹茶。

No matter where I am in the world, it seems like everyone is drinking matcha.

而你喝的那杯抹茶，很可能出自我投资超过七位数的公司——Perfect TED，他们也是本播客的赞助商，因为Blank Street Coffee、Joe and the Juice等全球众多咖啡馆都使用这个品牌。

And there's a good chance that that matcha you're drinking is made by a company that I've invested more than 7 figures in, who are a sponsor of this podcast called Perfect TED, because they're the brand used globally by cafes like Blank Street Coffee and Joe and the Juice and many, many more.

不仅能在咖啡馆喝到Perfect Ted抹茶，现在还能用我面前这些调味抹茶粉在家自制，更便宜也更快捷。

Not only can you get Perfect Ted Matcha in cafes, but you can now also make it at home, much cheaper, in seconds using our flavored matcha powders that I have here in front of me.

Perfect Ted抹茶是日本进口的 ceremonial grade（茶道级）品质。

Perfect Ted Matcha is ceremonial grade and sourced from Japan.

它口感顺滑，天然甘甜，不像我以前尝试过的那些带草腥味的抹茶。

It is smooth, it is naturally sweet, not like those bit of grassy matchas that I tried before Perfect Ted.

如果你曾告诉自己不喜欢抹茶，很可能是因为你还没尝过我们的Perfect Ted抹茶。

And if you are one of those people that have told yourself you don't like matcha, it's probably because you haven't tried our Perfect Ted Matcha.

在英国Tesco、Sainsbury's、Holland & Barrett和Waitrose能买到，荷兰的Albert Heijn也有售。

And you can find Perfect Ted Matcha in The UK in Tesco, Sainsbury's, Holland and Barra and in Waitrose or Albert Heijn if you're in The Netherlands.

美国可通过亚马逊购买，或登录perfected.com选购全线产品。

And on Amazon in The USA or get the full range online at perfected.com.

使用优惠码diary40，首单可享40%折扣。

You can get 40% off your first order using code diary 40.

这一改变彻底重塑了我和团队的运动方式及对身体的理解。

This one change has transformed how my team and I move train and think about our bodies.

当博士。

When Doctor.

丹尼尔·利伯曼做客《CEO日记》时，他解释了现代鞋履的缓冲支撑设计如何削弱我们的足部功能，使其无法完成自然赋予的使命。

Daniel Lieberman came on the Diary of a CEO, he explained how modern shoes with their cushioning and support are making our feet weaker and less capable of doing what nature intended them to do.

我们丧失了足部天生的力量与灵活性，这正导致背痛、膝痛等问题。

We've lost the natural strength and mobility in our feet, and this is leading to issues like back pain and knee pain.

当时我已购入一双Viva Barefoot裸足鞋，丹尼尔·利伯曼看到后确认这正是能帮助恢复自然步态、重建足部力量的理想鞋款。

I'd already purchased a pair of Viva Barefoot shoes, so I showed them to Daniel Lieberman, and he told me that they were exactly the type of shoe that would help me restore natural foot movement and rebuild my strength.

但我想我患的是足底筋膜炎，突然之间双脚开始持续疼痛。

But I think it was plantar fasciitis that I had where suddenly my feet started hurting all the time.

此后我决定通过穿着Vivo Barefoot来强化自己的足部功能。

And after that, I decided to start strengthening my own foot by using the Vivo Barefoot.

利物浦大学的研究也证实了这一点。

And research from Liverpool University has backed this up.

他们证明穿着Vivo Barefoot鞋六个月可以增强足部力量高达60%。

They've shown that wearing Vivo Barefoot shoes for six months can increase foot strength by up to 60%.

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Visit vivobarefoot.com/doac and use code DOAC20 for 20% off.

网址是vivobarefoot.com/doac，优惠码是DOAC20。

That's vivobarefoot.com/doac Use code DOAC20.

强健的身体始于强健的双足。

A strong body starts with strong feet.

如果我刚才听完你说的所有内容，想改善口腔微生物群，我该怎么做？

If I've just listened to everything you've just said there, and I want to improve my oral microbiome, what should I be doing?

我认为最重要的是我们明白了不该做什么。

Well, I think the most important thing we've learned is what you shouldn't be doing.

没错。

Yeah.

所以问题不在于我们该做什么，而在于我们不该做什么。

So it's not what should we do, it's what we shouldn't be doing.

第一，我们必须去除氟化物。

Number one, we have to get rid of fluoride.

就在上周末，我在盐湖城的一个牙科会议上发表了演讲。

Just this past weekend, I was speaking at a dental conference in Salt Lake City.

现场有来自美国国家毒理学计划的人员，这个机构负责评估环境毒物暴露风险——当存在任何潜在暴露风险时，他们负责进行毒理学研究以判断风险程度。

And there were people there from the National Toxicology Program, which in The US is the organization tasked with, if there's any kind of risk of exposure of a environmental toxicant, they're charged with doing the toxicology studies to see if there's an increased risk.

风险究竟有多大？

What is the risk?

是否存在绝对安全的无风险剂量？

And is there a safe level that is without risk?

他们的报告指出：氟化物没有任何益处，全是风险。

And what they report is that fluoride there's no benefit of fluoride, and it's all risk.

它会使儿童智商最多降低7个点。

It lowers IQ in kids by as much as seven points.

而且它会抑制你的甲状腺功能。

And it shuts down your thyroid function.

它是一种神经毒素。

And it's a neurotoxin.

正如我之前提到的，大多数牙膏都含有氟化物。

And as I mentioned before, most toothpaste has fluoride in it.

如果你仔细阅读牙膏背面说明，至少在美国会看到——我不清楚其他国家的情况——上面写着：如果误吞，请立即联系毒物控制中心，因为这是有毒物质。

And if you read the back of your toothpaste, it will tell you at least in The US, I don't know about in other countries but it says, if you swallow this, call poison control, because it's a poison.

他们在牙膏里下毒。

They're putting poison in toothpaste.

而且如果你注意看，上面写着：牙刷上只挤豌豆大小的牙膏量。

And then if you also pay attention, it says, only put a pea size amount of toothpaste on your toothbrush.

豌豆大小。

A pea size.

但我认识的所有人都会把牙膏挤满整个牙刷。

But everybody that I know fills the entire bristle of the toothbrush with toothpaste.

所以这相当于10到15颗，有时甚至是20颗豌豆大小的牙膏量。

So that's about 10 or 15, sometimes 20, pea size amounts of toothpaste.

而一颗豌豆大小的牙膏量大约含有半毫克的氟化物。

And a pea size amount of toothpaste contains about half a milligram of fluoride.

如果你使用的量是豌豆大小的十倍、二十倍，那么你现在就暴露在五毫克、十毫克的氟化物中。

Now, if you're using ten, twenty times more than that pea size, now you're exposed to five milligrams, ten milligrams of fluoride.

而且你甚至不需要吞下去。

And you don't even have to swallow it.

这是一个非常小的分子，分子量只有19。

This is a very small molecule, a molecular weight of 19.

所以它能直接通过口腔黏膜被吸收，进入全身循环系统。

So it's absorbed directly across the buccal mucosa, the oral cavity, and it becomes systemic.

我以后不会再用了。

I'm not going to use it anymore.

是的，你不应该再用。

No, you shouldn't.

那我该用什么代替呢？

What should I use instead?

你得用不含氟的牙膏。

You have to use a non fluorinated toothpaste.

那像刮舌器这类工具呢？

And what about things like tongue scrapers?

关于刮舌器，数据再次证明这是经过时间检验的。

Now, tongue scrapers, the data again, that's time tested.

这是一种古老的做法。

That's an ancient practice.

在我们的研究中还发现，使用刮舌器的人口腔微生物群更多样，似乎口腔健康状况也更好。

And even in our study, we found that people who do tongue scraping have a more diverse oral microbiome, and they seem to have better oral health.

为什么会这样？

Why is this?

我女朋友一直在我耳边唠叨这个。

My girlfriend's been banging on to me.

她总是对的。

She's always bloody right.

我女朋友过去两年一直在跟我唠叨要用刮舌器，而我基本都无视她。

My girlfriend's been banging on to me about tongue scraping for the last two years, and I've kind of just ignored her.

我就敷衍说‘好的，宝贝，知道了’。

I've just kind of, yeah, babe, sure.

当她不在浴室时，我根本不用她的刮舌器，因为那东西看起来太奇怪了。

And when she's not in the bathroom bathroom, I'm not using her tongue scraper because it just looks strange.

以我对口腔微生物组和微生物组的了解，我总在想：我该把细菌都刮掉吗？

For me, based on what I knew about the oral microbiome and the microbiome generally, I'm like, should I be scraping off all my bacteria?

这么说吧，如果你要种花园，会在没翻过的土壤上直接种吗？

Well, if you're going to plant a garden, do you plant a garden on untilled soil?

听着，我对园艺一窍不通。

Listen, know nothing about gardening.

你问错人了。

You ask for the wrong guy.

所以也许，是的。

So maybe, yes.

嗯，我自己种食物。

Well, I grow my own food.

所以你必须翻土。

So you have to till the soil.

你得松土让种子能透气，同时破坏那层生物膜。

You've got to break up the soil so the seeds actually can be aerated, and you break up that biofilm.

是的，用舌刮背面刮到几乎要引发呕吐反射的程度，然后你就能看到那些脏东西被刮下来。

Yeah, you take the back of the dorsal tongue, almost to the point of the gag reflex, and you just pull that, ideally copper, tongue scraper forward, and you're going to see this goop coming in there.

但这有点像翻土，能增加舌背微生物群的多样性。

But it's kind of like tilling the soil, and it's increasing the diversity of the dorsal part of the tongue, the microbiome.

所以我女朋友是对的。

So my girlfriend was right.

在这一点上，是的。

In that regard, yes.

但我们发现，那个孩子的血压上升最为明显。

But what we found was, in that one kid, saw the greatest increase in blood pressure.

如果你既刮舌苔又用抗菌漱口水，那是最糟糕的情况。

If you tongue scrape and use antiseptic mouthwash, that's the absolute worst scenario.

有意思。

Interesting.

如果

If

你想想看

you Just think about this.

你在刮舌苔时打开了毛孔，现在使用漱口水，它能更容易深入舌头的隐窝，更有效地杀灭细菌。

You're tongue scraping, you're opening up the pores, and now you're using mouthwash, It's better to it can easily penetrate deep in the crypts of the tongue and more effectively kill the bacteria.

所以你是建议先刮舌苔，然后用不含氟牙膏的牙刷刷牙？

So you want a tongue scrape and then use a toothbrush without fluoride toothpaste?

完全正确。

Absolutely.