第142期特邀基兰·克里什南！肠道健康决定你的健康！

这种化合物我们如此依赖，如果彻底剥夺你肠道产生丁酸盐的能力，你就会生病、功能紊乱。

So this compound that we are so dependent on that if I took out of your body, the ability to make any sort of butyrate at all from your gut, then you would be sick, dysfunctional.

你的肠道黏膜无法修复，免疫系统失效，很快就会发胖，出现各种代谢问题，胰岛素抵抗也会接踵而至，这一切可能在几个月内发生，最多几年内就会全面爆发。

You would not be able to repair the lining of your gut, your immune system wouldn't work, you would get obese, you would have all these metabolic issues, you'd become insulin resistant, all within a mere period of just months, if not just a few short years.

我们对这些化合物的依赖程度极高，但自己却完全无法合成。

And we're so dependent on these compounds and we cannot make them.

我们必须依靠肠道里的微生物为我们生产它们。

We need the microbes in our gut to make them for us.

天哪。

Wow.

肠道健康在这一切中扮演的角色，远超大多数人所理解的，你总结得没错。

So the amount of role that gut health plays in all of this is beyond what we most actually understand and think is basically what you're saying in a nutshell.

是的，完全正确。

Yeah, absolutely.

如果你看看那些最可怕的疾病状况，对吧？

You know, if you look at the scariest of disease conditions, right?

你看阿尔茨海默病和帕金森病，这两种神经退行性疾病，发病率一直在持续上升，非常令人担忧。

So look at Alzheimer's and Parkinson's, So these are very scary neurodegenerative conditions of which the prevalence rates keep increasing over time.

那你就会想，这到底发生了什么？

And then you go, what is happening?

为什么这类病越来越多了？

Why is this happening more and more?

比如阿尔茨海默病，2017年有一项里程碑式的研究发现，肠道相关的内毒素——也就是LPS——与此密切相关。

Well, you look at in Alzheimer's, for example, there was a study, a landmark study that was published in 2017 showing that gut related endotoxins, this is something called LPS, right?

LPS是一种由肠道中大约一半细菌产生的内毒素。

LPS is an endotoxin that's made by about half of the bacteria in your gut.

但当你肠道屏障受损时，这种内毒素就会渗漏出来，沿着迷走神经进入血液循环，最终到达大脑。

But when your gut is leaky and that endotoxin is allowed to leak through, it can make its way up the vagus nerve and through your circulation and end up in the brain.

它会聚集在大脑的周核区域。

And it ends up in these regions of the brain called the perinuclear region.

它深入到突触的核区，引发该部位的炎症，从而启动蛋白质错误折叠，造成脑组织损伤。

It's deep inside the nuclear region of the synapses And it creates inflammation in that part of the brain, which starts the protein misfolding and the damage that occurs to the brain tissue.

所以他们发现，阿尔茨海默病患者大脑的周核区域含有极高浓度的肠道相关内毒素。

So they found very high concentrations of gut associated endotoxins in the perinuclear regions of the Alzheimer's brain.

因为在此之前，人们一直困惑：为什么大脑里会有炎症？

Because up to that point, the question was, why is there inflammation in the brain?

为什么这些蛋白质会错误折叠？

Why are these proteins misfolding?

为什么会出现这种退化现象？

Why are they starting to see this degeneration?

他们知道，这种退化和蛋白质错误折叠的过程，正是疾病发展的关键环节。

They knew that that degenerative process, that misfolding process was part of how the disease progresses.

但再往深里想，问题又来了：为什么会这样？

But again, you go further and you go, why?

到底是什么原因导致了这一切？

Why is that happening?

那篇2017年的论文指出，其中一个关键原因就是：功能失调的肠道物质，正在进入大脑。

Well, that 2017 paper showed, one of the key reasons is because stuff from a dysfunctional gut, it's making its way to the brain.

同样地，你每天活着，大脑都会发炎，多少会对脑细胞造成一些损伤。

And by that same token, every single day you go through life, you're going to have inflammation in the brain and it's going to damage your brain cells to a certain degree.

你希望的是，睡觉的时候大脑能自我修复，这样第二天醒来，脑子还跟前一天一样。

What you want is when you go to sleep, you want that brain to be able to repair itself so you wake up the next day with the same brain you had the day before.

如果做不到这一点，每天醒来，大脑都会多一点损伤。

If that doesn't happen, every day you're going to wake up with a little bit more damage to the brain.

随着损伤累积，你就会逐渐出现痴呆，以及各种大脑相关的问题。

And as that progresses, you're going to develop dementia and all of these issues around the brain.

那我们该怎么修复大脑呢？

So how do we repair our brain?

这得靠肠道提供一种叫BDNF的物质，也就是脑源性神经营养因子，它会在你睡觉时进入大脑，开始修复当天造成的损伤。

Well, we're dependent on the gut for a compound called BDNF, brain derived neurotropic factor, which is a compound that makes its way to the brain when you're sleeping and starts repairing the damage that occurred that day.

所以你想想这两方面：一个健康的肠道，能在你睡觉时修复并支持你的大脑。

So if you think about those two dichotomies, you have a gut that has the capability of repairing and supporting your brain when you go to sleep.

第二天早上醒来，你的脑子还是跟前一天一样。

You wake up the next morning with the same brain you had the day before.

再来看一个功能失调的肠道，它不仅不进行修复，反而会产生一种加速大脑损伤的物质。

Now take a dysfunctional gut, not only is it not doing that repair, it's actually producing a compound that accelerates the damage in the brain.

这是我特别希望人们能理解的一点：你和肠道之间的关系。

This is one of the things I really want people to understand about their relationship with their gut.

你的肠道，要么保护你，要么推动疾病，就在这条谱系上。

Your gut and its ability to protect or drive diseases on a spectrum, right?

假设谱系的左端是一个理想的肠道，它能保护、修复、提供韧性，供给所有必需的营养和物质，让你的身体、大脑、肌肉全都处于最佳状态。

Let's say the left hand side of the spectrum is an ideal gut that is protecting, repairing, providing resilience, providing all the nutrients, providing all the compounds to make your body, your brain, your muscles, all of that function optimally.

而谱系的右端，则是一个不仅不提供这些功能，反而主动加剧损伤和紊乱的肠道，对吧？

And on the far right hand side is a gut that's not only not doing those things, but actively accelerating damage and dysfunction, right?

所以，功能失调的肠道不只是因为缺乏有益功能而伤害你，它还会通过产生有害物质主动破坏你的身体。

So a dysfunctional gut doesn't just hurt your system by the absence of functions, it deliberately hurts the system by the presence of toxigenic functions.

每个人的肠道，都处在这条谱系的某个位置上。

So everybody's gut is somewhere on that spectrum.

你每天要做的，就是做出一些选择，让自己往左移，而不是继续往右滑。

And what you need to do is make decisions each day that push you more to the left than you are to the right.

而正是在这里，才真正实现了韧性、长寿，以及我们所有人追求的那些东西。

And that is where the magic happens in terms of resilience, longevity, all of the things that we're all seeking.

那么BDNF呢？我们该怎么提升它？是靠补充剂，还是只能通过改善肠道菌群健康？

So BDNF, how do we get is there a way to supplement that or is it just through the microbiome health?

因为按照你刚才说的，这东西极其关键，而且明显值得更多关注，毕竟这事儿平时根本没人提。

I mean, because as you described it, that is a very, very vital and clearly something that we need to really shed more light on because this is another thing you don't hear talked about very much.

你刚才这么一分析，说实话，差点把我吓着了。

And the way you just broke that down, I mean, you put a little fear in me.

我平时可不怎么害怕。

I I don't get scared.

但我现在明白了，我得重视起来，真的很感谢你分享这些信息。

I wanna make I'm addressing this, so I'm thankful for the information.

那我们该怎么稳定它、提升它呢？

But how do we stabilize that, enhance it?

具体该怎么做？

What do we have to do?

是的。

Yeah.

所以，如果你想获得足够量的BDNF，其实只有两个关键因素要注意。

So so there's really only two factors that you need to think about when you if you wanna get you wanna feel like you're getting accurate amount of or adequate amount of BDNF.

第一，你要确保肠道没有渗漏。

Number one, you have to make sure your gut is not leaky.

对吧？

Right?

我们会详细讲讲什么是肠漏，因为肠漏会抵消BDNF、短链脂肪酸、乌洛托品等这些对大脑健康和细胞健康至关重要的有益物质的作用。

And we'll talk about what leaky gut is because a leaky gut counteracts the functions of things like BDNF and short chain fatty acids and urolithins and so on, all of those beneficial compounds that we need for our brain health, cellular health, and so on.

所以第一步，就是要确保肠道不渗漏。

So first thing is we want to make sure that the gut's not leaky.

第二步，是要保证肠道菌群的多样性丰富且积极。

The second part is we want to ensure positive or high diversity in the gut microbiome.

你的肠道菌群中有一些微生物，其实本身就能产生BDNF。

There's a number of microbes within your microbiome that actually can make BDNF.

还有一些微生物能触发信号，促进BDNF的生成。

And there are some microbes that stimulate a signal to make BDNF.

要让这些微生物协同工作，唯一的方法就是保持肠道菌群的高多样性。

The only way to ensure that you have all of those microbes working in concert is to have high diversity within your microbiome.

这种多样性是可以检测的。

The diversity can be measured.

市面上有粪便检测可以评估菌群的多样性。

There are stool tests that one can use to measure diversity.

但我们也得采取一些特定的行为，才能确保多样性足够高，对吧？

But there's certain behaviors that we have to engage in to ensure diversity is high, right?

当你提升肠道菌群的多样性时，通常就能一并覆盖我刚才提到的所有功能。

And so when increase diversity in your microbiome, you actually more often than not cover all of these functionalities that I've been talking about.

无论是尿石素的生成、短链脂肪酸和BDNF的产生，还是肠道内血清素、多巴胺这些神经递质的合成——只要肠道菌群足够多样，这些都会一并得到保障。

The urolithin production, the short chain fatty acids of BDNF, the serotonin production in the gut, the dopamine production in the gut, like all of the neurotransmitters, all of those get covered if we have adequate diversity in the gut.

所以我常给人们的建议就是：先堵住肠漏，再提升多样性。

So one of my recommendations to people always is leaky gut, we got to stop the leaky gut and we got to increase diversity.

如果我们做到这两点，你的肠道就会朝着健康有弹性的方向发展，处于保护你、而非引发疾病的那一端。

If we do these two things, then you're well on your way to having a resilient gut that's going to be on that left hand side of the spectrum that's protecting you and not driving disease.

明白了。

Okay.

所以BDNF就像是给大脑施肥的东西，差不多就是这个意思。

So BDNF noted it's kind of like fertilizer for your brain type of thing, guess, essentially.

没错。

Absolutely.

它是在你睡觉的时候，由健康且多样的肠道菌群产生的。

And it's made by a healthy diverse gut microbiome when you go to sleep.

这只能在昼夜节律系统中发生，也就是说，你的肠道和身体一样，遵循24小时的生物钟。

It only occurs where it's a diurnal system so that your gut works on a twenty four hour clock like your body does.

它在等着你。

And it's waiting.

BDNF就是一种在肠道里启动的管家基因，就像另一个叫‘迁移性运动复合体’的东西一样。

So BDNF is one of those housekeeping genes that turns on in your gut, just like something called the migrating mortar complex, right?

这是肠道里的一种神经性清扫机制，用来清除肠内容物，防止废物滞留、腐败发臭，产生气体，甚至长期堆积可能诱发癌细胞。

This is a neurological sweeping that occurs in your bowels to clean out your bowels so stuff doesn't stay there and get putrefied and rot in the wrong places and produce gases and can also produce cancer cells and all that if it stays there.

这就是为什么膳食纤维能降低结直肠癌风险——因为它能把这些废物及时清理掉。

This is why fiber can actually counteract colorectal cancer risk is because it's sweeping things away.

同样的，这种肠道蠕动波和其他相关机制，都是在你夜间休息时才启动的。

Same migrating motor complex, all of those things occur at night when you're resting.

这也是为什么睡眠对健康如此关键。

This is another reason why sleep is so important for health.

它的作用远不止让我们得到休息那么简单。

It goes beyond just the rest that we need.

它其实是激活了我们肠道菌群中的‘清洁基因’和‘维护基因’。

It's actually a way of turning on housekeeping genes and cleanup genes in our gut microbiome.

明白了。

Okay.

我有个问题想问你，因为之前这些数字我可能记不太准，但我印象中自己后来专门研究过，应该差不离。

Let me ask you this because this was and correct my numbers here because I could be a little off, but I'm pretty sure I because I did a lot of studying on this after I had this conversation.

肠道和免疫系统是紧密关联的吗？

Is the gut and the immune system are extremely intertwined?

人体75%的免疫细胞不是都在肠道里吗？

Isn't it like 75% of the body's immune cells are located in the gut?

这个说法大致没错吧？

Does that sound about right to you?

是的。

Yeah.

对。

Yeah.

准确地说，大约75%的免疫监测组织都在肠道里。

It's actually 75% or so of the immune sampling tissue.

所有与免疫相关的组织，都集中在肠道和消化道中。

So all the immune related tissue is in the gut, is in the digestive tract.

没错。

Yeah.

所以免疫系统和肠道是紧密相连的。

So the immune system and the gut are extremely intertwined.

对。

Yeah.

我特别喜欢讲免疫系统和肠道的课，因为这是最令人着迷的生物学关联之一，对吧？

So I actually love doing lectures on immune system and the gut because it is one of the most fascinating biological connections, right?

免疫系统本来就很难理解，哪怕是对这一行有专业训练的人也是如此。

And the immune system is very hard for people to understand, even people who are trained in this field.

要理解它，只能靠比喻。

The only way to understand it is through analogies.

你可以这么想：

And so think about it this way.

把免疫系统想象成一支军队，怎么样？

So imagine the immune system is like the military, right?

他们有士兵、有坦克、有装备，所有打一场仗需要的东西都齐全。

They've got soldiers, they've got tanks, they've got equipment, they've got all of the things to fight a war that they need.

他们没有指挥官，也没有作战计划。

They just have no general, they have no plans.

他们根本不知道敌人是谁。

They don't know who the enemy is.

连敌人长什么样都不清楚，却全都严阵以待。

They don't know what the enemy looks like, but they're all sitting there ready to go.

所以他们需要明确的指引。

So they need direction.

那这套系统真的是这样设计的吗？

Now, is the system built that way?

为什么我们的免疫细胞从骨髓和胸腺里出来的时候，不自带对敌人的识别能力呢？

So why wouldn't our immune cells be born out of our bone marrow and our thymus with innate knowledge of who the enemy is?

这是因为敌人到底是谁，取决于你身在何处、居住环境、年龄大小等等因素。

Well, that's because who the enemy is changes depending on where you are, where you live, what age you are and so on.

我们希望免疫系统能识别出从未见过的新病毒，并把它当作威胁。

We want our immune system to be able to recognize a new virus as a problem, even though it's never seen it before.

如果我从芝加哥的家出发，夏天去欧洲待一周，我希望我的免疫系统能适应这种环境变化。

System If I go from my home here in Chicago, go to Europe for a week in the summer, I want my immune system to be able to adapt to that changed environment.

所以本质上，我们的免疫系统是具有适应性的，但它必须迅速应对我们周围环境的变化。

And so by nature, our immune system is an adaptive part of our system, but it has to adapt very quickly to changes in our ecosystem.

它是怎么做到的呢？

How does it do that?

它依靠微生物组来获取信息，就像眼睛和耳朵一样。

Well, it uses the microbiome as the eyes and the ears.

你可以把微生物组想象成军队里的指挥官或者情报部门。

So think of the microbiome as the general to the army or the intelligence force in the army, right?

免疫系统可以做出反应，但它所依赖的情报，都来自微生物组本身。

So your immune system can respond, but the intelligence it gathers is from the microbiome itself.

那这到底是怎么运作的呢？

Now, how does that work?

我再打个比方，这就是免疫细胞的职责。

And another analogy I'll give you is, and this is the job of the immune cell.

我觉得我们的免疫细胞真的很不容易，对吧？

I feel very bad for our immune cells, right?

因为大多数免疫细胞都分布在我们所谓的黏膜层里，对吧？

Because if you think about most of the immune cells are in our, what we call the mucosa layer, right?

人体内部的黏膜面积加起来大概有四千平方英尺，你知道吗？

So inside our body, we have like 4,000 square feet of mucosa layer, right?

肠道内壁、肺部、大脑、泌尿生殖系统，全都是这种黏膜组织。

Our gut lining, our lungs, our brain, our urogenital tract, everything is this mucus layer.

在这层黏膜上，栖息着整整十万亿个微生物，对吧？

In that mucus layer is covered with 100,000,000,000,000 microbes, right?

这些是长期定居在那里的常驻微生物。

Those are resident microbes that live there.

免疫细胞就在这个区域巡逻，因为所有外来物质都是通过黏膜进入体内的。

And then the immune cells are patrolling that area because that's how all of the things enter into our body is through a mucus layer.

所以它们得在黏膜层里来回巡视，但黏膜上的每一个细胞，不是细菌就是病毒、真菌之类的。

So they're patrolling that mucus layer, but every cell in that mucus layer is a bacteria, virus, fungi or some sort, right?

它们一直在巡逻，寻找细菌、病毒、真菌之类的微生物。

And they're patrolling for bacteria, viruses, fungi, and so on.

比例是二十万比一。

The ratio is 200,000 to one.

你每有一个免疫细胞在巡逻，周围就有二十万个微生物细胞。

For every one immune cell you have patrolling your system, you have 200,000 microbial cells in that area.

你可以这样理解免疫系统的任务：想象你去参加一场音乐节，场地是个巨大的体育场，入口全封闭了，里面挤了二十万人。

So imagine the job of this immune system and the way I let people understand it is like imagine you're at a music festival and it's in a huge stadium and the stadium's closed off, Then there are 200,000 people in that stadium.

这二十万人里，只有五个是打算搞破坏的，对吧？

There are five people among the 200,000 that intend to do harm to people, right?

而你是这个二十万人体育场里唯一的保安，每个人看起来都一模一样。

And you are the lone security guard in that stadium of 200,000 people and everyone looks the same, right?

你该怎么从二十万人里找出那五个可能出问题的人？

How in the world do you identify the five out of 200,000 that may be a potential problem?

唯一的办法，就是那另外十九万九千九百九十五个人跟你配合，他们用对讲机向你报告，只要看到任何不对劲的地方，立刻告诉你具体位置。

The only way you can do it is if the other 199,995 people are working with you and they're radioed into you and they will tell you if they see anything awkward and they tell you exactly where it is.

对吧？

Right?

它们会主动报告，比如‘嘿，四号售票处有点不对劲’。

They'll radio in and be like, hey, I see something at Concession Stand Number 4 that looks odd.

你最好过来看看。

Maybe you should come over here.

只有这样，你才可能监控得了二十万人的体育场。

That's the only way you can potentially patrol a stadium of 200,000 people.

你的微生物组对免疫系统做的，正是这件事。

And that's exactly what your microbiome does for your immune system.

只要有任何病毒、毒素、细菌或真菌等致病或有毒物质进入你的身体，最先发现它们的往往是该区域的微生物。

Anytime you have a virus, a toxin, a bacteria, a fungi, anything that's infectious or toxigenic that enters into your system, one of the first things that detects it is the microbes in that area.

你体内那些友善的常驻微生物。

Your friendly residential microbes.

它们会说：‘这情况有点异常，你来看看。’

And they go, this looks odd, right?

这地方根本不该有这个东西。

It's not supposed to be here.

它们会向你的免疫系统发出信号，叫免疫系统过来支援。

They radio to your immune system to recruit your immune system to come here.

那它们是怎么给免疫系统发信号的呢？

Now, how do they radio to your immune system?

它们会释放炎症信号，免疫系统一发现炎症，就立刻赶过去，把那个地方的异常东西清除掉。

They shoot off inflammatory flares and your immune system hones in on where the inflammation is and comes to that area and then starts attacking whatever is in that space.

现在有两种很常见的功能失调，这能解释为什么很多人免疫系统总是失灵。

Now two dysfunctions that are extremely common and this will make people understand why lots of people's immune systems don't work the way they should.

记住刚才说的那个过程——有不该出现的东西进来了。

Remember that process, something comes in that shouldn't be there.

我们得把它干掉。

We need to attack it.

我们得把它隔离起来。

We need to quarantine it.

最先发现这个情况的是该区域的微生物。

The first thing that sees that is the microbes in that area.

它们会释放出炎症信号。

They shoot off inflammatory flares.

想象一下，如果你全身都在发炎。

Imagine you had inflammation throughout the body.

你的免疫系统怎么知道该优先响应哪一个信号？

How is your immune system going to know which flare to go after?

它会花上很久，因为得去追每一个出现的炎症信号。

It's going to take it forever because it's going to chase every inflammatory flare it sees.

这就像是消防车接到50个烟雾报警器，可实际上只有一个地方真着火了。

So that's like a fire truck going to 50 different smoke alarms when only one actually breeds fire.

假设一个小区有500户人家，400个烟雾报警器都在响，但真正着火的只有一户，消防车就会懵了：该去哪儿？

So if you're in a neighborhood with 500 homes and 400 smoke alarms are going off, but actually only one house is on fire, the fire truck's going be like, We don't know where to go.

它们会完全找不到方向。

They're going to be lost.

要花上一段时间，他们才能找到真正着火的那栋房子。

It's going to take them a while to find the actual house that's on fire.

所以当你全身都处于慢性炎症时，免疫系统反应起来就慢得多，因为它找不到该去哪，到处都是警报。

So now when you have chronic inflammation throughout your body, it takes your immune system so much longer to respond because it can't find where it needs to go because there's alarms all over the place.

这是一种非常普遍的失常情况。

So that's one very, very common dysfunction.

慢性低度炎症会导致人的免疫系统功能紊乱，因为免疫系统不知道该往哪儿发力。

Chronic low grade inflammation causes immune dysfunction in people because their immune system doesn't know where to go.

第二个很常见的问题是微生物功能异常。

The second very common dysfunction is the dysfunctional microbes.

如果毒素落在了那些功能异常的微生物所在区域，而这些微生物本身就不想被免疫系统发现，它们就不会发出警报。

So if the toxin landed in that area where you had dysfunctional microbes who themselves don't want to be detected by the immune system, they're not going to sound the alarm.

它们会想，没事的。

They're going to go, That's fine.

我不想惊动免疫系统。

I don't want to alert the immune system.

该干嘛就干嘛吧，病毒。

Do what you have to do, virus.

该干嘛就干嘛吧，毒素或者细菌。

Do what you have to do, toxin or bacteria.

所以它们不会向免疫系统发出警报。

So they don't alert the immune system.

因此，免疫系统要花很长时间才能偶然发现这种损伤。

And so it takes the immune system a very long time to accidentally find this damage.

当我们谈论肠道菌群和免疫系统时，必须明白它们紧密相连——菌群失衡，免疫系统就失去了方向和判断力，不知道该去哪儿，也不知道该做什么。

So when we think about the microbiome and immune system, we have to know that they're intimately connected and a dysfunctional microbiome means your immune system has no intelligence, it has no direction, it doesn't know where to go, and it doesn't know what to do.

所以，要让免疫系统正常运作，就必须拥有健康的肠道菌群。

And so we have to have have a healthy microbiome to have a healthy functioning immune system.

每次你生病、出问题，或者患上任何疾病，通常都会去查高敏C反应蛋白。

So, and you know, every time that you're sick or there's a problem or any sort of disease, generally, you're gonna go right to a HSCRP, a high sensitivity c reactive protein.

结果都会看到指标升高。

You're gonna see an elevation.

我的意思是，每次你出问题，几乎百分百都会看到这个指标异常。

I mean, 100% of the time, any problem you've got, that's gonna kinda be the point where it's like, okay.

数值偏高了。

That's high.

我就知道出问题了。

I know I have a problem.

所以你是说，如果这个指标升高了，大概九成以上的情况，根源都出在肠道功能紊乱上？

So do you say then that if that is elevated, that chances are that the core root problem of that elevation is coming from some kind of gut dysfunction, I don't know, ninety some percent of the time or more.

你觉得这个说法靠谱吗？

Do you think that sounds about accurate?

没错，确实如此。

It is, yeah.

如果你长期有轻微炎症，比如HSCRP持续偏高，那几乎可以肯定问题出在肠道。

So if you have chronic low grade inflammation, meaning things like HSCRP are chronically elevated, it almost certainly is a gut related issue.

极少数情况下，也可能有别的原因。

In rare cases, it could be something else.

你皮肤上可能会长出大面积的病变。

You could have massive lesions on your skin.

身体其他部位也可能出问题，但这种情况很少见。

You could have issues elsewhere in the body, that's rare.

最常见的原因就是肠道屏障功能失调，也就是肠漏。

The most common source of it is a dysfunctional leaky gut.

事实上，肠漏是慢性低度炎症最主要的来源，而慢性低度炎症正是大多数慢性疾病的根本起点。

In fact, leaky gut is such a big source of chronic low grade inflammation and chronic low grade inflammation is the start of most chronic disease processes.

所以这一点非常重要：几乎我们能想到的每一种慢性病——无论是糖尿病、心脏病、阿尔茨海默病、痴呆，还是自身免疫性疾病——它们的根源都来自慢性低度炎症。

So that is a very important connection for people to understand that chronic disease, almost every chronic disease we can think of, whether it's diabetes, heart disease, Alzheimer's, dementia, autoimmune conditions, all of these things, they all start with the presence of chronic low grade inflammation.

而这种慢性低度炎症，绝大多数情况下都源于肠道屏障受损和功能紊乱。

And the chronic low grade inflammation almost always comes from a leaky and dysfunctional gut.

因此，肠漏实际上成了慢性疾病最主要的诱因。

So a leaky dysfunctional gut thereby becomes the number one driver of chronic disease.

2015年发表在《免疫学前沿》上的一篇论文就非常清晰地展示了这一点，研究者们梳理出了其中的机制和所有关联路径。

This was actually very well illustrated in a paper in 2015 in a journal called The Frontiers of Immunology, where the researchers worked out the pathways and all the connections.

他们发现，肠漏症，也就是功能失调的肠漏，是导致死亡和疾病的第一大原因。

What they showed was that a leaky gut, a dysfunctional leaky gut, was the number one cause of mortality and morbidity.

也就是说，它在全球范围内最直接地增加了死亡和患病的风险。

So risk of death and disease worldwide.

它之所以成为全球死亡和疾病的主要推手，是因为研究清楚地展示了功能失调的肠漏如何引发炎症——一种长期、低度的慢性炎症。

It's a number one driver of death and disease worldwide because they showed how a dysfunctional leaky gut causes inflammation, a chronic low grade inflammation, which is a very specialized type of inflammation.

而这种慢性低度炎症，会直接触发身体内的疾病进程。

And then that chronic low grade inflammation basically sets the process of disease in the body.

它甚至会改变某些细胞的运作方式。

It even changes how certain cells behave.

我最近一直在研究关节健康，因为我特别关注如何缓解全球致残的主要原因。

I've been doing a lot of work in joint health because one of my passions is alleviating the biggest drivers of disability worldwide.

全球第二大致残原因是骨关节炎。

So the second biggest driver of disability worldwide is osteoarthritis.

骨关节炎是一种关节退行性疾病。

And osteoarthritis is a joint degenerative condition.

当你开始研究它的病理机制时，到底发生了什么？

And when you start studying the pathology, what's happening?

为什么关节会主动退化？

Why is the joint actively degenerating?

这种情况在超过九成的成年人身上都会出现，对吧？

And it happens in over ninety percent of adults, right?

基本上，所有三十岁以上的成年人，关节都存在一定程度的退化。

It's basically present in every adult over the age of 30, there's some degree of degeneration happening.

真正发生的是，身体内慢性低度炎症的增加，影响了一种叫软骨细胞的细胞，这些细胞本来负责为你生成软骨。

Basically what is happening is the increase in chronic low grade inflammation in the body takes these cells called the chondrocytes, which are the cells that normally build the cartilage for you.

它们修复你的软骨，帮你重建软骨。

They repair your cartilage, they build it right.

你这一辈子，它们一直在为你做这件事。

All your life, they've been doing this for you.

它们不断构建、修复并维持你的软骨。

They've been building, repairing your cartilage and maintaining your cartilage.

当慢性低度炎症达到一定程度时，这些细胞就会从建造者变成破坏者。

When chronic low grade inflammation is high enough, these cells switch going from a building cell to a breakdown cell.

它们原本是合成细胞，也就是负责构建的细胞。

So they were an anabolic cell, which is a building cell.

现在它们变成了分解细胞，不仅不再建造软骨，反而在主动破坏它。

Now they become a catabolic cell where they're not only no longer building cartilage, they are actively degenerating it.

你可以想象，当这类细胞出现在你的肌肉、大脑、心脏里——你全身上下那些一辈子都在为你修复和建造的细胞。

And so you could see when And those kinds of cells are present in your muscles, in your brain, in your heart, everywhere you have these building cells that have been building and repairing things your whole life.

但因为慢性低度炎症足够高，它们全都被迫转变成主动破坏的细胞。

But because chronic low grade inflammation is high enough, it switches those cells to an active degenerating cell.

于是你身体的每一个部分都在加速退化，包括肠道内壁和其他组织。

So now everything in your body is actively degenerating, including the lining of your gut and other areas.

所以你就明白为什么慢性低度炎症会成为推动身体和生理变化、最终引发疾病的主因了。

And so you can start to see why chronic low grade inflammation becomes this massive driver of change in your body and physiology that leads to disease.

对吧？

Right?

肠道在这其中扮演了最主要的角色。

And and and the gut is most responsible for that.

如果一个人有这方面的问题，我待会儿会详细解释什么是肠漏，但我想先问你一下。

So if one is suffering, and I'm gonna get you into the breakdown of what leaky gut is, but I wanna ask you this.

如果一个人有肠漏，是不是很难吸收营养补充剂？

If one has a leaky gut issue, are they going to find it difficult to absorb supplements?

比如说，健美运动员怎么练都没效果，或者像我之前跟你说的，我一直以来都很难吸收钾和其他一些营养素。

Like, let's say bodybuilders aren't getting the response they're supposed to get or somebody like I was telling you, I've always had a inability that seems to absorb potassium well and other things I run into.

这会不会很大程度上是肠道问题导致的？

Is that more than likely some sort of gut issue that's causing that problem?

是的。

Yeah.

对。

Yeah.

这不仅是肠道问题，也跟肝脏有关。

It's a gut and a gut liver issue as well.

你通过肠道吸收的物质，大概有80%到85%都会先送到肝脏，然后肝脏得处理它，对吧？

So about 80% or 85% of everything you absorb through the lining of the gut goes to the liver first, and then the liver has to process it, right?

再把它们送到该去的地方。

And send it to the right places.

有时候，肝脏还得合成一些载体，才能把物质运到目标组织。

Or in some cases, the liver has to make carriers for it in order to get it to the right tissue.

肠道渗漏的问题在于，不仅吸收功能因为肠壁发炎、受损而下降，而且肠道里产生的毒素，有80%也都直接冲着肝脏去了。

The problem when you have a leaky gut is not only is the absorption part compromised because the lining is inflamed and damaged and so on, but all of the toxins that are being produced in that leaky gut, 80% of it goes to the liver.

这样一来，肝脏承受了巨大的毒素负担，根本没法正常工作。

And then the liver is undergoing massive amounts of toxicity and can't do the work that it's supposed to do.

这其实正是西方世界脂肪肝如此普遍的根本原因。

This is actually why we have such a crazy prevalence of fatty liver disease in the Western world.

就在五十年前，肝硬化的主要原因还只有肝炎和酗酒。

So the number one reason for cirrhosis of the liver used to be either hepatitis or alcohol, just five decades ago.

现在这两种原因已经很少见了，因为如今的肝硬化大多来自脂肪肝，而脂肪肝本质上是个代谢问题，根源就在肠道渗漏。

Now, those two are so low in their prevalence because our cirrhosis is coming from fatty liver disease, which is a metabolic issue that starts with leakiness in the gut.

没错，完全正确。

So yeah, absolutely.

当肠道屏障受损时，营养物质的吸收会受到严重影响。

The absorption of nutrients is heavily compromised when your gut lining is compromised.

我来给你详细解释一下，因为这套机制其实非常精妙，你知道吗？

And I'll give you a little bit of a deeper explanation for that because this system is super elegant in how it works, right?

在小肠里，也就是你吸收所有营养的地方，有着像手指一样的细小突起，叫做微绒毛。你可能见过海藻林的照片，那种茂密的海藻森林。

So in the small bowel, which is where you absorb all your nutrients, you've got these beautiful finger like projections called the glycocalyx, So the glycocalyx So you've probably seen pictures of the kelp forest, what the kelp forest looks like.

它们就像一条条美丽的藤蔓。

So it's got these beautiful vines.

这些黏膜结构彼此缠绕，交织成网。

These are these mucosal vines that are all tangled up together and all that.

在这些结构的边缘，分布着一种叫刷状缘酶的东西。

At the edge of them, have something called a brush border enzymes.

这些酶就在这里工作，帮助你分解食物，并让营养物质穿过肠壁被吸收。

That's where enzymes sit to help you break down and bring in nutrients through the lining of the gut.

但这里有个关键点：你的身体并不希望你随便吸收所有经过的东西，对吧？

Now, this is an important checkpoint because your body doesn't want you to just actively absorb anything that's coming through, right?

因为里面可能有些有害的东西。

Because there could be some bad stuff in there.

所以这个像海藻森林一样的糖萼层，会作为一个检查站，筛选出你真正该吸收的营养和食物。

So this glycocalyx, this kelp like forest acts as a checkpoint for all of the nutrients and food and all that that you're supposed to be absorbing.

而这个糖萼海藻森林的生成与结构，完全由你肠道里的微生物来调控。

And the production and the structure of this glycocalyx kelp forest is governed by microbes in your gut.

一旦肠道微生物失衡、死亡，或者被有害菌占据，这个海藻森林就会崩塌，不复存在。

So then when microbes in your gut are dysfunctional or dying off, or you have bad microbes, it's sort of good microbes, this kelp forest breaks down and no longer exists.

这时候，你的身体就渐渐失去判断该吸收什么、怎么吸收的能力。

And your body's ability to discern what to absorb and how to absorb it starts to shut down.

所以即使你吃得不少，也照样会营养不良。

So you absolutely become nutrient deficient even though you're eating adequately.

所以我们现在只是把所有这些点一个个过一遍。

So we're just going down the list here of everything.

细胞功能异常可能源于肠道，脑部问题，甚至心理健康问题也可能来自肠道，免疫系统问题、肝脏问题，归根结底都跟肠道有关。

So cellular dysfunction could be coming from the gut, brain issues, and even mental health issues could be coming from the gut, immune system problems coming from the gut, liver problems coming from the gut.

说白了，我们平时处理的几乎所有问题，很可能都跟肠道功能紊乱有关。

So essentially every damn thing that we operate on could probably be caused by some sort of gut issue.

是的，这绝对是最常见的根本原因。

Yeah, that is the most common driver I would say.

我觉得这么说一点都没夸张。

And I don't think that's hyperbolic to say it.

研究数据其实支持得很清楚，尤其是在普通人群中。

I think the research supports it very well, especially among the population.

如果你看看这些健康问题背后最普遍的共同点，绝大多数人的问题都出在肠道功能失调上。

If you just look at the biggest commonalities of drivers of all of these issues, it is a dysfunctional gut in most people.

这也解释了为什么，哪怕是最基本的肠道不适，依然是人们去医院或看医生时最常报告的症状。

This is also why even basic gut symptoms are still the top symptoms that people go to hospitals with or go to see their doctor.

就是一些很普通的消化问题。

Basic digestive issues.

因为我们刚才聊的这些肠道与大脑、免疫系统之间的关联，都属于更深层的问题。

Because all of these things that we're talking about with the gut's connection to the brain and immune system and all that, those are even deeper dysfunctions.

但在这些问题出现之前，人们最先感受到的其实是腹胀。

But prior to those dysfunctions happening, people are feeling it as bloating.

还有消化不良、腹泻、排便不规律，对吧？

They're feeling it as indigestion, as loose stool, as irregular bowel movements, right?

这些其实是最早期的预警信号，可大多数人要么忽视，要么就随便吃点药应付一下。

Those are the early canary in the coal mines that people tend to ignore or maybe they use band aids, right?

他们可能会吃点胃药，或者用其他非处方消化药来缓解症状。

They might use Pepto or they might use some other over the counter digestive thing to try to reduce the symptoms.

但他们没意识到，这些症状其实就是警报，说明你的肠道已经快进入严重失衡的状态了。

But what they're not understanding is that those are the canary in the coal mines saying, Hey, your gut is moving into a severe state of dysfunction.

身体正从健康的一端，慢慢滑向严重失调的另一端。

It's going from the left hand side of that spectrum towards the right hand side.

等到某一天，就会爆发更深层的问题——免疫失调、脑雾、关节疼痛、肝脏负担，全都来了。

And at some point, they're going to experience a deeper dysfunctions like we talked about, the immune, the brain, the joint, the liver, all of that stuff.

好的。

Okay.

不过一小时后，我们终于要讲到肠漏问题了，我之前就说过会谈到这个。

Well, an hour later, we're finally going to get to leaky gut because I told you what was going to happen beforehand.

我早知道会这样。

I knew this.

你知道的东西实在太多了。

There's too much that you know.

咱们得好好理一理，让大伙儿真能听明白。

So let's break this down adequately for people to actually understand.

我知道你一定行。

I know you will.

这个问题我问过多少遍了，你清楚我有多难得到一个清晰简单的回答。

I have asked this question so many times, and you know how hard it is for me to get a straight, easy, sufficient answer.

你能不能干脆利落地给我讲清楚？

Could you just please break it down?

什么叫肠漏？能不能说说一些具体的迹象和症状，让我们能确定这确实是问题所在？

What is exactly leaky gut and maybe give some real signs and symptoms where we know that that is the exact problem that we have.

肠漏是最重要的概念之一，而你找对人了，因为我可是这方面的权威作者。

Leaky gut is one of the most important things to understand and in fact you've got the right person here because I kind of wrote the textbook on it.

这本是Springer Health出版的参考书，研究人员和医生们都在用。

This is a Springer Health reference book that researchers, doctors and all that use.

Springer Health是医学教材里最知名的出版社之一。

Springer Health is one of the most well known in textbooks and all that.

上过大学的人，几乎都用过Springer Health的教材。

Everyone went to university has Springer Health textbook.

内毒素血症就是肠漏的临床定义，而我正是写了这一章的人。

Endotoxemia is the clinical definition of leaky gut and I wrote the chapter on it.

事情是这样的，你得先明白关键点。

Here's what's happening, Here's what's important to understand.

你的肠道内壁，本来是用来吸收营养的，小肠其实是一道半透膜屏障。

So your lining of your gut where you're supposed to absorb stuff, so your small intestine is a semi permeable barrier.

这就让情况有点复杂，因为这层屏障的设计本就是要吸收某些物质，同时阻挡其他东西。

That's what makes it a little bit difficult because it's designed to be able to absorb certain things and ward off other things.

它跟我们的皮肤不一样，皮肤是完全封闭的屏障。

It's not like our skin, which is supposed to be a complete barrier.

我们并不该通过皮肤或头骨吸收太多外来物质。

We're not supposed to be absorbing too many things to the skin or our skull for example.

这些屏障系统要坚固得多，但肠道内壁却是一个高度活跃的半透性屏障——食物进入后，会被分解，直到我之前提到的那些像海藻森林般的微绒毛末端。

Those barrier systems are much more hardened barriers but the lining of your gut is a very dynamic semi permeable barrier, which means that food comes in, you break down food, it starts to break it down to the tips of that kelp forest that I mentioned.

然后，大量表面积就派上用场了，营养物质通过这里进入血液循环，运送到肝脏，再由肝脏输送到全身。

And then you've got all of this surface area where those nutrients are supposed to be able to come through, enter into circulation, to the liver, and then the liver sends it around the rest of the body.

但与此同时，食物里也带着细菌、病毒、真菌和毒素这些东西。

But with that food comes bacteria, viruses, fungi, toxins, all that.

这个能吸收的动态系统，本该能有效阻挡所有有害物质。

This dynamic absorbable system is supposed to be able to ward off anything that's negative.

那它到底是怎么做到的呢？

So how does it actually do that?

肠道内壁其实有几个关键的检查点，只有这些检查点正常运作，选择性通透才能实现，对吧？

Well, are a number of checkpoints in the lining of the gut that have to be working appropriately in order for the selective permeability to function, right?

第一个检查点就是黏液层。

So the first checkpoint is this mucus layer.

你的所有肠细胞都紧密地排在一起。

So all of your intestinal cells are sitting shoulder to shoulder.

这层结构只有一层细胞厚，明白吗？

It's a one cell thick layer, right?

比如你的皮肤有几百层细胞厚，但肠道内壁就只有一层细胞。

Your skin, for example, is like hundreds of cells thick, but your gut lining is only one cell thick.

这些细胞肩并肩地排列着，它们之间的空隙叫做紧密连接。

And these cells are sitting next to each other, shoulder to shoulder and the space in between them is called a tight junction.

想象一下，这些细胞就像士兵肩并肩站成一排，而在它们前方，有一大坑黏液。

So imagine these soldiers standing shoulder to shoulder on top of them, or let's say in the case of we're looking at a fort and you've got soldiers protecting the fort in front of them is a giant pit of slime, right?

为什么会有这么一大坑黏液呢？

Why is there a giant pit of slime?

因为当有东西攻击这些士兵时，黏液会抓住它们，减缓它们的速度，给士兵们时间判断哪些是好的、哪些是坏的，然后做出决定。

Because as things are attacking the soldiers, the slime grabs those things and slows them down And it allows for the soldiers the time to evaluate which of those things are good and which of those things are bad and then make decisions.

如果来的是坏东西，士兵们就能射箭把它消灭掉，对吧？

If the thing that's coming through is bad, they can shoot an arrow at it and take it out, right?

如果是好东西，他们就会放行让它通过。

If the thing is good, they'll allow it to come through.

这层黏液对减缓通过肠道屏障的物质移动速度至关重要。

That slime pit is really, really important to slow down the transit of things coming through the lining of the gut.

当士兵们发现需要放行的东西时，他们之间的缝隙就会打开，也就是那个紧密连接，同时释放出一些蛋白质。

And those soldiers, when they see something that they do want to allow, the space in between them opens up that tight junction, they release these proteins.

他们之间大约有四十种这样的蛋白质。

There's about 40 proteins in between them.

缝隙打开，物质通过后，它们又会重新收紧闭合。

They open up, the stuff comes through and then they cinch up close again.

所以，这些环节都得正常运作才行。

So you have to have these few things functioning.

你得有个黏液层，也就是我们说的 slime pit，它能放慢一切东西的移动速度。

You have to have a slime pit, which we call the mucus layer that slows everything down.

它能把东西困住，同时减缓它们的前进。

It traps things and slows everything down.

接着，黏液层里还有抗体，能中和那些有害的东西。

Then you've got these antibodies in the mucus layer that neutralize bad things.

还有你的免疫细胞，能顺利到达那个位置。

You've got your immune cells that can make their way there.

还有那些士兵，装备着精准的武器，能锁定那些穿过黏液层、被他们识别为有害的物质。

You've got the soldiers that have weaponry that can actually target things that are coming through that mucus layer that they detect is not good.

而那些该通过的东西，一旦到达士兵面前，士兵就会让开，打开间隙，让它们顺利通过。

And then the things that should get through when they make it to the soldiers, they can step aside, open up the gap and allow things to go through.

整个系统本来就是这么运作的。

That's how the system is supposed to work.

正因如此，我们才能像一层半透膜那样发挥作用。

That's how we can act as a semi permeable membrane.

现在问题开始出在哪里了呢？

Now where things start to fall apart, right?

就是因为刚才我说的那些东西——那个黏液层，也就是所谓的黏液陷阱，

Is because all of those things I just described, the slime pit, the mucus layer, right?

还有士兵之间的蛋白质、那些漂浮着、掌控全局的免疫抗体和细胞，

Which is a slime pit, the proteins in between the soldiers, the immune antibodies and cells that are there kind of hovering and governing everything.

所有这些都依赖于你的肠道菌群。

All of those are dependent on your microbiome.

这些结构、这些关口的信号传递、发育和调控，全由菌群决定。

All of the signals, development and management of these structures, these checkpoints, if you will, are determined by the microbiome.

一旦你的菌群失衡，黏液层就会变得特别薄。

So when you have a dysfunctional microbiome, your mucus layer is super thin.

在某些地方，甚至完全消失了。

If not, in some areas, it's completely gone.

这意味着，原本能减缓外来物入侵的那层黏液屏障，已经不复存在了。

That means that that pit of slime that slows things down is not there.

各种东西会突然冲进系统里。

Things can bum rush the system.

免疫系统根本来不及反应。

It doesn't give the immune system.

那些免疫细胞没时间识别闯入的是什么，也就没法做判断。

It doesn't give the soldier cells enough time to see what's coming through and make decisions.

于是它们只能进入默认模式，见什么就攻击什么，连你吃进去的食物颗粒也不放过。

So the default mode then they attack everything, everything that comes through, including your own food particles and all that.

在疯狂攻击的同时，还会在局部引发炎症。

And as it's attacking everything, it's creating inflammation in that area.

你可能会觉得是消化不良，或者吃某些食物后出现食物不耐受；久而久之，这种持续的攻击和炎症会严重损伤免疫细胞，导致细胞之间出现大缝隙，什么东西都能直接漏过去，完全没了屏障。

You might feel it as indigestion, you might feel it as food sensitivities when you eat certain foods and then eventually that attack, that inflammation will damage those soldier cells enough where then big gaps appear in between them and anything can just leak through without any sort of checkpoint.

所以我们需要那层黏液屏障。

So we need that slime layer, that mucus layer.

我们还需要那些免疫细胞，以及它们之间的蛋白质，让它们能正常地开合。

We need those soldier cells and the proteins in between them to open and close.

我们需要那个区域的免疫系统正常运作，时刻监控着各种物质。

We need the functioning immune system in that area, surveying things.

所有这些功能都依赖于肠道菌群。

All of those things are dependent on the microbiome.

一旦你的肠道菌群失衡，这一切就会崩溃。

When your microbiome is unhealthy, all of those things fall apart.

你不再拥有一个半透膜了。

You don't have a semi permeable membrane anymore.

你有的是一个完全通透、什么东西都漏得出去的膜。

You have a fully permeable membrane that leaks through.

最让人惊讶的是这一点。

And here's the crazy thing about it.

你要知道，小肠大概有六米长。

Remember the small intestine is like 20 feet long.

你的肠道可能只有六英寸的区域出现渗漏，其他部分还是正常的。

You can have this leakiness in your gut for say six inches of your gut and the rest of it is okay.

也可能是六英尺，影响会非常严重，甚至可能长达十六英尺，那就更糟糕了。

Or it can be six feet and it can be very profound in terms of its impact, or it can be 16 feet and it can be extremely profound.

所以，肠漏对健康的影响有多大，取决于肠道漏掉的范围有多广。

So how impactful leaky gut is to your health is determined by how much of your gut is leaky.

这问题会越来越严重，除非你及时干预并逆转它。

And it's a progressive issue unless you stop it and reverse it.

我想聊聊这个话题的几个方面。

I would like to discuss several facets of this.

现在有很多博主和我很尊重的人，总爱讨论哪些食物会导致肠漏，但我觉得那些食物其实对身体很好，他们是在制造焦虑。

Now, there's a lot of influencers and people that I actually hold in high regard that like to get into different foods that cause this and actually foods that I think are quite good for you and I think they're fear mongering.

我特别想先和你聊聊这些观点，不过在那之前，我有几个问题，相信很多人也会想知道。

And I'm curious as to I want to get into some of those with you first, but before we get into that, I have a couple questions that I think a lot of people are going to wonder.

第一，有没有办法检测出肠漏问题？

One, is there a way to test for a leaky gut issue?

如果没有，那怎么才能知道自己有没有这个问题呢？

And if not, how would one really know if they have it or don't?

然后我们再聊聊哪些食物有助于预防这个问题，还有哪些生活方式可以帮助避免它，类似这样的方面。

And then we'll get into like factors of foods that we should eat to prevent it, lifestyle things that we could do to avoid it, things of that nature.

但当你提到‘可能是六英寸，也可能是六英尺’的时候，显然如果症状比较严重，你自己就能感觉到问题更严重。

But when you make a comment like, man, it could be six inches or six feet, obviously, I think if you have higher symptoms, you'll know there's a bigger issue there.

但我更想知道有没有可测量的指标或科学数据，而不是靠猜测。

But I'm looking for measurables or data ways to understand as opposed to just guessing.

是的，这点非常重要。

Yeah, yeah, no, that's really important.

我做过并发表过几项关于肠漏的研究。

And I've done and published a few studies on leaky gut.

我们可以在实验室里检测它。

We can test it in the laboratory.

实验室里有一些非常可靠的检测方法，但可惜目前还没有准确的商业化检测手段可用于肠漏。

There are some really good assays that you can use in the laboratory, but unfortunately there isn't a commercial test that's accurate at all for leaky gut.

原因之一是，这是一个动态变化的过程。

Part of the reason is because it's a very dynamic process.

你需要在一个更受控的环境下采集样本，然后在实验室里进行测量。

You need a much more controlled environment to take samples of certain things and then measure it in the lab.

最准确的检测方法其实是测量一种叫LPS的内毒素是否渗漏出来。

The best way to measure it is actually the leaking through of something called LPS, which is an endotoxin, right?

这种LPS是由肠道里那些微生物产生的，你可以把那里想象成一个黏液池。

So that LPS is made by the microbes in that slime pit, if you will.

如果肠道健康，黏液池也正常，LPS就会被牢牢困在里面，不会造成任何问题。

Normally, if your gut is healthy and you have a healthy slime pit, that LPS is just stuck in there, it doesn't create any problems.

但一旦肠道出现渗漏，LPS就会跑出来进入血液循环，这时候就能在血液里检测到了。

But when your gut is leaky, that LPS is allowed to leak through and ends up in circulation and you can measure it in the blood.

如果血液里LPS水平很高，就明确说明你的肠道有渗漏，而且水平越高，渗漏越严重。

And when you see high levels of this LPS in the blood, it's very indicative that your gut is leaky and it's directly proportional to how leaky your gut is.

不管是基础水平还是非常高，都能通过这个指标看出来。

Whether you have a basal layer, a level of it or you're very high level.

实际上，检测这个最好的时机是在吃饭的时候。

And in fact, the best way to test for that is when you're eating a meal.

因为吃东西的时候，你的肠道里会掀起一场大乱。

Because when you eat a meal, there's all kinds of havoc that goes on in your gut.

大量盐酸被分泌出来，消化酶活跃，各种细菌死亡，食物翻滚流动，还有碳酸氢盐、胆汁，一大堆化学物质在里头剧烈搅动。

Lots of hydrochloric acid is being released, enzymes, all these bacteria are dying, the food is tumbling through and there's bicarbonate and bile and all of this crazy chemical churning.

如果你的肠道有渗漏，当这些情况在肠道里全面发生时，内毒素就会大量渗出来。

If your gut is leaky, when all of that stuff is happening throughout your bowel, you get a lot of leaking through of that endotoxin.

所以我们实验室里评估肠道渗漏程度、在研究中用的方法是：让受试者空腹来，然后给他们吃一顿高热量餐，比如2000大卡的饭，再测量内毒素水平的上升情况。

And so the best way we measure leakiness in the lab and we use it in published studies is we take individuals, they come in fasted, we give them a high caloric meal, like a 2,000 calorie meal, and then we measure the rise in endotoxins.

如果在餐后三四个小时内，血液里的内毒素水平飙升了五倍，我们就知道他们的肠道渗漏非常严重。

If we see a 5x increase in circulating endotoxins within three or four hours of the meal, we know that they have profound leaky gut.

但他们可能一点症状都没有，对吧？

But they may still be asymptomatic, right?

所以你没法在家自己检测。

So, you can't test it at home.

但我可以这么说，几乎每个人都有理由默认自己有肠道渗漏，因为很可能你确实有。

But I would say this, it would be very smart for virtually everyone to assume they have leaky gut because they likely do.

即使他们没有症状——大多数人长时间都是这样，直到出现免疫紊乱、代谢问题、大脑功能异常、焦虑这些情况，才开始显现出来——在此之前，你可能真的毫无感觉。

And even if they're asymptomatic, which most people are for a long period of time until you start seeing immune dysfunctions and metabolic issues and brain issues and anxiety and all that, Until you start seeing those and those start becoming apparent, you may be asymptomatic.

我们做的第一项研究，对象是健康年轻大学生，当然，所谓‘健康’是按FDA的标准来说的。

In our first study that we did, we did in healthy young college students, if there is such a thing, but by the FDA definition, right?

按照FDA在临床试验中的定义，‘健康正常人’就是没有患病、没在服药、体重正常、BMI也在标准范围内的人。

So healthy normals by FDA definition in a clinical trial are people that don't have any disease conditions, they're not on any medication, their normal body weight, they know normal body mass index and all that.

他们才二十二三岁，身体正处于最佳状态，没有任何疾病，也没有任何不适。

They're 22, 23 years old, physically in the prime of their lives, no conditions at all, no complaints.

但这些人的百分之五十五到六十，竟然都有严重的肠漏问题。

About fifty five percent to sixty percent of those people had very severe leaky gut.

如果连这些人都有严重肠漏，那如果你有肠胃不适、免疫系统异常、容易焦虑、晚上睡不好、皮肤有湿疹、牛皮癣、痤疮，或者有自身免疫性疾病，那这些都和肠漏密切相关——你大概率也有肠漏。

And so if those people have severe leaky gut, if you have any gut symptoms, if you have any immune symptoms, if you're anxious, if you have issues sleeping at night, if you have any skin conditions like eczema, psoriasis, acne, if you have any autoimmune conditions, all of those things are related to a significant leaky gut, so you probably have leaky gut.

天啊。

Wow.

明白了。

Okay.

我之前根本不知道这一点，尤其是像牛皮癣和湿疹这种病，网上说法多得数不清，我每次都搞不清楚到底怎么回事。

See, that's another thing I wasn't aware of, especially with things like psoriasis and eczema because there's a million different people that seem to know how that happens or occurs, and I'm always just confounded by that one.

这一点挺有道理的。

So that's a that's a good one.

那个LPS检测，如果我想在Quest实验室做，能自己下单吗？一般该怎么操作？

So the LPS test, is that something that if I got on Quest Labs that I could order, or how how would one go about getting that?

可惜Quest实验室不提供这项检测。

They they don't have it on Quest, unfortunately.

是的。

Yeah.

原因是，检测血液或血清中的LPS时，它一抽出来就会迅速降解。

Because and the reason is because when measure LPS in circulation and you pull blood or serum out, LPS starts to degrade very quickly.

四个小时内，浓度就会下降一半左右。

And within four hours, it loses about half of its concentration.

所以我们实验室的做法是，抽完血样后立刻冻起来，保持在零下80华氏度，才能保存住。

So what we do in the lab instead is we pull the syrup sample out and then we have to freeze it at minus 80 degrees Fahrenheit to preserve it, right?

但在商业实验室里这么做根本不现实，因为他们会摇晃样本之类的。

And that's just not practical to do in a commercial lab because they shake the samples and all that.

所以商业检测非常困难，但你要知道，每个人体内都存在一定水平的内毒素，而且通常能在较短时间内改善。

So it's very hard to test it commercially, but just know that everyone has it to a certain degree and you can resolve it in a relatively short amount of time as well.

所以我建议大家都采取措施来修复肠道屏障，因为几乎人人都有一定程度的肠漏问题。

So I would just encourage everyone to do the things that are needed to stop the leakiness of the gut because virtually everybody has some degree of leakiness.

那如果有人刚吃完饭，或者五到十分钟内就必须上厕所，每次吃饭都这样，这种情况你怎么看？

So what about somebody that is, let's say right after they eat or within five or ten minutes they're just having to go to the bathroom, you know, having the excretion and it becomes like something that happens every time they eat.

这能说明是肠漏吗？

Is that indicative of leaky gut?

我见过不少这样的情况。

Because I've seen that with a lot of people.

是的。

Yeah.

有可能。

It can be.

这通常被称为内脏高敏感性。

So that is often a condition called visceral hypersensitivity.

对吧？

Right?

你的肠道里分布着一个极其密集的神经网络，叫做肠神经系统。

So your your gut is laced with this really, really dense neurological system called the enteric nervous system.

它的神经末梢数量仅次于大脑。

It has the second highest nerve endings next to your brain.

甚至比脊髓还要多。

It's even more so than our spinal cord itself.

所以有人管它叫‘第二大脑’。

So it's thought of as like the other brain, if you will.

如果肠道有渗漏，通常意味着肠道菌群失衡、功能紊乱。

If your gut is leaky, you've got a dysbiotic and dysfunctional gut.

当食物进入系统后，就会引发这种神经层面的混乱。

What happens is when food starts to hit the system, it creates these havoc, this type of neurological havoc, if you will.

这就导致肠道出现痉挛性收缩，而不是平稳有节奏地推动食物前进，对吧？

And then that causes spasmodic activity in your bowels instead of a very smooth rhythmic contraction that moves the food along, right?

痉挛性收缩会让食物在小肠里加速通过。

You get the spasmodic activity and that spasmodic activity accelerates the food through the small bowel.

而大肠很可能发炎，无法正常吸收水分。

And then the large bowel is likely inflamed and so the large bowel cannot absorb water.

我们身体大部分的水分吸收其实都发生在大肠。

So most of your water absorption occurs in the large bowel.

由于大肠吸不了水，加上食物在小肠里跑得太快，结果就是根本停不住的稀便，想憋都憋不住。

And as a result of the large bowel not absorbing water and the food being accelerated through the small bowel, you end up getting loose stool that's just coming out whether you want it or not.

这就是内脏高敏感性。

That is visceral hypersensitivity.

还有那些一吃第一口饭就感觉胀气的人，也是这种情况。

That's also the people that when they eat the first bites of food, they get bloated.

我经常听到有人这么说。

I hear that from people all the time.

他们说，不管吃啥，哪怕只是喝点水，都会觉得胀气。

They're like, no matter what I eat, even if I drink water, I get bloated.

这可不是胀气，因为食物还没来得及到达肠道发酵产气。

And that's not gas because there's not enough time for the food to get there and ferment and create gas.

这其实是身体对肠道炎症和肠黏膜功能紊乱产生的免疫和神经反应。

That is an immunological neurological response to inflammation and a dysfunctional gut lining.

所以这还是跟肠道问题有关。

Okay so that's again related to a gut issue.

确实如此，就拿焦虑来说吧，现在这情况太普遍了。

Yeah and if you look at anxiety for example right, so anxiety is so prevalent these days.

荷兰曾做过一项长达九年的研究，叫《荷兰焦虑与抑郁研究》。

There was a nine year long study in The Netherlands called The Netherlands Study on Anxiety and Depression.

这是一项由政府资助的项目，旨在弄清楚为什么焦虑这么普遍，尤其是年轻人中。

And it was basically a government funded study to understand what are the drivers of this high prevalence of anxiety, especially in younger people.

现在，焦虑的发病年龄越来越小了。

We're seeing it in younger and younger individuals.

他们连续九年追踪了这些人的各种生物标志物，就是为了找出哪些标志物和风险因素与焦虑和抑郁的发生及发展有关。

And so they were following all of these biomarkers in individuals for nine years and just to correlate different biomarkers and risk factors for the presence and the development of anxiety and depression.

结果发现，有一个生物标志物的预测性最强。

What they found was that there was one biomarker that was the most predictive.

即使在长达九年的随访中，只要这个人体内存在这个标志物，他就一定会出现焦虑。

And even over a nine year follow-up period, if that biomarker was prevalent in that individual, that individual always had anxiety.

而且，这个标志物的浓度越高，焦虑的严重程度也越明显。

And depending on the severity of the concentration of the biomarker, it predicted how severe the anxiety was.

而这个关键的生物标志物，就是血液里的LPS——脂多糖，一种内毒素。

And that one biomarker was that LPS lipopolysaccharide, that endotoxin in circulation.

血液中出现LPS，只可能来自肠漏症。

And LPS in circulation only comes from a leaky gut.

所以，这项历时九年、覆盖全国的研究表明，肠漏以及由此导致的血液中LPS升高，是决定一个人是否患上焦虑的首要因素。

So basically what they showed over a nine year long study across their country was that the presence of leaky gut and the resulting LPS in circulation was the number one determining factor of whether or not you developed anxiety.

而在九年期间持续出现LPS水平升高的那些人，他们的焦虑也一直持续着。

And for the people that over the nine year period continued to have elevation of LPS, they continued to have anxiety.

对于那些LPS水平下降的人，不管是什么原因。

For the people that LPS came down for one reason or the other.

也许是改变了饮食，或者做了其他调整，他们并没有刻意控制这些因素。

Maybe they changed their diet, they did something, they didn't control for that stuff.

结果焦虑症状就消失了。

Anxiety went away.

这充分说明了LPS的存在和肠道渗漏对各种疾病发展的影响有多大。

So it just shows you just how impactful the presence of this LPS and the leakiness of the gut is in all of these disease pathologies.

事实上，我在这本教材里的章节就是讲LPS水平升高与各种常见疾病之间的关联。

In fact, my chapter in this textbook is all about all of the disease connections between increased LPS circulation and all of the common disease pathologies associated with it.

明白了。

Okay.

你这么一说，我突然把一些事情串起来了。

So I'm piecing some things together here now that you say this.

好的。

All right.

那我问你一个问题。

So let me ask you this.

我们已经谈到了它和焦虑的关系。

We've got the relation to anxiety.

很多人，包括医生在内，都会说——你之前提到过皮肤问题，像银屑病其实是压力和焦虑引起的。

A lot of people will tell you, doctors included, that and because you brought up the skin conditions earlier, that psoriasis is caused by stress and anxiety.

所以这里的关联可能是：肠漏导致LPS释放，进而引发焦虑，而焦虑又进一步诱发湿疹或银屑病。

So the correlation here could be that the leaky gut is then releasing the LPS, which is causing higher anxiety, which is then also leading to the eczema or the psoriasis.

我这么理解对吗？

Am I onto something here?

你说得完全对。

That's exactly right.

对。

Yeah.

痤疮也是同样的情况，对吧？

And this is true of acne as well, right?

有痤疮的人，焦虑的概率高出三倍半到四倍。

So people with acne have, I think it's three point five to four times higher likelihood of having anxiety.

这其中一部分当然是因为他们对自己外貌不满意。

Now part of that is of course because they're unhappy with the way they look.

但那种和LPS有关的焦虑，和抑郁是不一样的。

But the anxiety part of it, which is different than depression, related to the amount of LPS.

因为有研究显示，LPS水平升高会直接引发痤疮皮损。

Because then there's studies that show that elevated LPS is a driving force behind acne lesions.

而同样的LPS，也是导致焦虑的元凶。

And that same LPS is a driving force behind anxiety.

所以这些病症之间存在这种关联。

And so that's why these conditions correlate to one another.

LPS水平升高还会显著增加患二型糖尿病的风险。

There's also a dramatically increased risk of type two diabetes with having elevated LPS.

事实上，有一项研究叫CardioPreb研究。

So in fact, there's a study called the CardioPreb study.

这是一项2021年发表的研究。

This is a 2021 study that published.

研究追踪了490名前期糖尿病患者，观察他们是否会发展为糖尿病。

Four ninety patients that were following pre diabetics to see if and until they became diabetics.

研究人员分析了所有能预测胰岛素抵抗加剧的生物标志物，直到患者确诊糖尿病。

And they were looking at all of the biomarkers that were predictive of an increase in insulin resistance until the point they became diabetics.

结果发现，只有一个生物标志物在98%以上的情况下都能准确预测。

And there was only one biomarker, only one that was predictive over 98% of the time.

那就是血清中的脂多糖（LPS）水平。

And that was the serum LPS, lipopolysaccharide levels.

就是这种脂多糖，会引发焦虑，也会导致银屑病和痤疮，和我们之前提到的、引发大脑炎症并启动阿尔茨海默病进程的，是同一种物质。

The same lipopolysaccharide that creates anxiety, same thing that creates psoriasis, that creates acne, the same LPS that creates the inflammation in the brain we talked about earlier, that starts the process of Alzheimer's.

同样也是这种脂多糖，会破坏肠神经系统，从而触发帕金森病的发展。

And the same lipopolysaccharide that creates the dysfunction in the enteric nervous system that starts the process of Parkinson's.

他们在帕金森病患者身上也发现了同样的情况，对吧？

They found that to be true in Parkinson's as well, right?

所以你看，这些看似毫不相关的疾病背后，竟然有同一个根源，这就让你明白真正的问题出在哪里了，对吧？

And so you look at this common cause among all of these seemingly unrelated conditions and you start to understand where the root driver of all of this is, right?

也就能理解，为什么这些病现在都同时越来越多了，对吧？

And why all of these conditions are concurrently increasing in prevalence, right?

因为我们每个人都在各自对付这些病，吃这个药、那个药，可它们真正的共同根源，我们根本没好好解决。

Because we're doing medications and this, that and the other for each of them, but all of them have a common root cause that we're not addressing effectively enough.

明白了。

Okay.

天啊，这太惊人了。

So, man, this is insane.

你简直在把我变成福尔摩斯，我跟着你的思路，你一路给我留下这么多线索。

You're turning me into Sherlock Holmes here because I'm following your and you're leaving me all these clues.

那我问你一个问题。

So let me ask you this.

现在关于膳食纤维的讨论特别多。

You know, there's a lot of discussion around fiber.

市面上有好多纤维补充剂，各种粉剂我都试过，结果发现有些可能过量了，反而加重了原本想解决的问题。

There's a lot of fiber supplements, a lot of powders, a lot of different things I've tried too, and I find that a lot of them it might be overdoing it or it could be actually exacerbating or creating a bigger problem that it's supposed to intended to be fixing.

这些补充剂和粉剂会引发肠漏吗？

Are these supplements causing leaky gut, these powders?

是不是纤维摄入太多了？

Is there too much fiber?

毕竟任何东西过量都不好，对吧？

Is that gonna cause, like you know, I mean, too much of anything isn't good.

是不是我们为了弥补不足，反而弄巧成拙了？

Is that becoming a problem by trying to overcompensate?

你能帮我把这些点串起来分析一下吗？

Can you correlate that together for me?

是的，没错。

Yeah, yeah.

其实，纤维可能是我们饮食中最重要的营养素之一，对吧？

You know, the fiber is probably one of the most important nutrients foods that we need to consume, right?

不过，确实有正确的方法。

So, but there's a way to do it.

这才是最关键的部分。

And that's the really important part.

你看到网上很多人在 TikTok 和社交媒体上疯狂摄入纤维，但这并不是正确的方式，因为纤维的真正价值在于你的肠道菌群能正确利用它。

Like you see the fiber maxing and things that people are doing on TikTok and social media, that's not necessarily the way to do it because fiber, the magic of fiber comes from your microbes utilizing it properly.

增加膳食中的纤维种类，无论是通过补充剂还是食物，都需要循序渐进，这样才能让菌群把它转化成对你有益的物质，明白吗？

And there's a very stepwise manner to increase the types of certain types of fiber within your diet, either as a supplement or through food sources to improve the utilization so that your body, not your body, but your microbes are converting it into the right compounds, right?

再深入说说纤维的重要性，已经有好几项大规模的荟萃分析了。

So just double click on the importance of fiber, there's been a couple of large scale meta analysis.

在我看来，这绝对是最好的生物优化手段之一。

And to me, this is one of the best bio hacks there is, right?

我们总在聊各种延寿的技巧。

We talk about all of these longevity bio hacks.

听听关于纤维的这些发现吧。

Listen to this about fiber, right?

最新的这项研究是2020年的一项荟萃分析，今年又有一项最新研究专门针对某些特定疾病。

So the latest one, a 2020 meta analysis, and then there's been a very recent one just this year looking at very specific conditions.

这项荟萃分析涵盖了超过一百万名受试者。

And these involve over a million patients, over a million subjects in this meta analysis study.

研究发现，每天多吃10克膳食纤维，就能降低全因死亡率。

What they showed was that for every 10 grams of fiber you add to your daily diet, you reduce your all cause mortality.

也就是说，无论死于哪种疾病，风险都能降低百分之十。

That means dying from any disease by ten percent, right?

每增加10克，都是这样。

For every 10 grams.

这个效果能一直提升到接近百分之四十到四十五。

And that's all the way up to almost forty to forty five percent.

如果你每天能摄入四十到四十五克合适的膳食纤维，那么你死于任何疾病的概率就能降低将近百分之四十五。

So if you can get yourself to forty to forty five grams per day of the right kinds of fiber, you'll reduce your risk of dying from anything by almost forty five percent.

对吧？

Right?