从经前综合征到更年期：如何调节激素，借助科学减重、改善睡眠、重拾活力

脂肪细胞。

Fat cells.

你没说雌激素姐妹是个脂肪姐妹。

You didn't say that the estrogen sister was a fat sister.

你只是说她是那个派对女孩。

You just said that she was the one that was the party girl.

是的。

Yes.

她，就我们自身而言，提到过在绝经前，雌激素和孕激素主要来自卵巢。

She, in our own, was talking about that estrogen and progesterone that are primarily coming from our ovaries prior to menopause, pre menopause.

明白吗？

Okay?

但当你进入更年期时，你的雌激素水平会大幅下降。

But as you get into menopause, you start to get a very big dip in your estrogen.

这是真的，因为你不会再生育了。

That's true because you're not gonna be producing children anymore.

所以，作为生殖系统一部分的雌激素和孕激素水平也会开始下降吗？

So does the estrogen and progesterone supplies that are part of the reproductive system start to drop?

是的。

Yes.

当你的雌激素和孕激素水平降低时，身体会开始做一些事情来试图补偿这种变化。

And then as your estrogen progesterone gets lower, your body starts to do things to try to compensate for it.

所以身体是在寻找脂肪吗？

So it's looking for fat?

对。

Yes.

我们的手臂也会变得更松垮吗？

Do we also get flabbier around the arms?

我都在想，这些翅膀是从哪儿冒出来的？

I'm like, where did these wings come from?

是的。

Yes.

这是因为雌激素还有另一个作用，它帮助我们维持肌肉质量。

That's because estrogen, the other thing it does, it helps us keep our muscle mass.

所以当你多年雌激素水平下降时

So when you decrease your estrogen over the years

所以我不是疯了。

So I'm not going crazy.

我确实一直在看着我的手臂，对自己说：我的手臂出了问题。

I literally have been looking at my arms and saying to myself, Something is wrong with my arms.

我知道它们还有线条，但以前要紧实得多。

I realize they're toned, but they used to be a lot toner.

我不确定这个词对不对，但现在它们变得松垮了。

I don't know if that's the right word, but they're like flappy now.

我在想：这是什么情况？

I'm like, What is that?

每年流失1%到3%的肌肉质量。

One to 3% of muscle mass.

是的，没错。

Per Yes.

每十年，你可能会损失高达3%。

Decade, you would say up to 3%.

但进入更年期后，流失速度会加快。

But as you go into menopause, it goes faster.

这意味着你正在以很高的速率流失肌肉。

Meaning that you're losing muscle at high rates.

如果你不同时进行力量训练、摄入足够的蛋白质的话。

If you're not also weight training, eating the protein.

关于你的手臂，我能立刻告诉你的唯一疗法——说吧。

The one therapy I can tell you right away for your arms- Tell me.

开始多做力量训练，在以前有肌肉的地方，以及你能进一步增长肌肉的部位，都开始增肌。

Is to start to do more weight training, start to build muscle in the places not only that it was, but that you can build more muscle on.

所以，现在是开始举重的最佳时机。

So this is the best time to pick up some weights.

哦，我在家用过Tonal机器。

Oh, I've used the tonal machine at home.

我正在做医生建议的那些练习。

I'm doing the things doc.

你比以前做得更多了。

More things than you used to.

这才是关键。

That's the key.

这不公平。

That's not fair.

我要告诉你的的是，我们发现当人们进入围绝经期、雌激素水平下降时，他们的活动量会略微减少，而他们自己甚至注意不到。

So what I'll tell you is that what we found is that when people start to go into perimenopause and their estrogen drops, their activity level drops a little bit and they don't even notice it.

所以你可能会增加一些脂肪细胞，这不仅是因为雌激素下降向你的身体发出信号：需要更多脂肪细胞来产生雌激素。

So you may be gaining some fat cells, not only because of the estrogen drop saying to your body, it needs more estrogen from fat cells.

而是因为你的身体不如以前活跃了。

It's because your body is not as active as it used to be.

这非常微妙，你可能根本注意不到，直到你说：哦，你知道吗，我以前总是自然而然地站起来走走，以前每天都能走一万步。

And it's very subtle and you might not even notice it until you say, oh, you know, I used to naturally naturally just just get get up up and and walk walk and and used to get 10,000 steps.

作为一个人，如果我们正在和朋友、和观众交流，你可以做的另一件事是提高你的活动水平，即使你并不想这么做，也要提升你的基础活动量。

And one of the other things you can do as someone, if we're talking to our friends, we're talking to the audience, increase your activity level, your baseline activity, even if you don't want to.

我在TikTok上看到有人说必须举铁，必须多吃蛋白质。

I see shit on TikTok about gotta whiff weights, gotta eat more protein.

你所说的活动水平，指的就是这个吗？

Is that what you're talking about with activity level?

那我们需要改变什么呢？

So what do we need to switch up?

因为我和一个朋友聊过另一件事，她说：我每天都骑Peloton，Mel。

Because the other thing that I was talking with a friend about is she's like, I'm on that Peloton like every day, Mel.

但我一点效果都没看到。

And I am not seeing any results whatsoever.

这可不是Peloton的错。

And it's not Peloton's fault.

我的身体出了点问题。

Something is going on with my body.

是的，确实如此。

Yes, it is.

她并没有疯。

And she's not crazy.

最重要的是，我感到很难过，因为妈妈更年期时，也觉得自己快疯了。

That's the biggest thing is I feel so bad because my mom, when she was going through menopause, felt like she was going crazy.

她有焦虑症。

She's had anxiety.

她晚上睡不着觉。

She couldn't sleep at night.

她一直在长胖。

She was gaining weight.

她说自己真的快要疯了。

And she was like, I feel like I'm literally going crazy.

令人难过的是，这发生在每个人身上。

The sad thing is, is that it happens to all everybody.

顺便说一句，人类是地球上为数不多会经历更年期的动物之一。

Humans are one of the only animals on the planet that go through menopause, by the way.

真的吗？

Really?

大多数动物会一直繁殖到死亡。

Most animals reproduce till they die.

还好我们不是这样。

Well, thank God we don't.

简直太糟糕了。

Absolutely awful.

所以我们能活过生育年龄，这相当独特。

So the fact that we live past our reproductive years is pretty unique.

医生。

Doctor.

艾米，我非常喜欢听你讲话。

Amy, I love listening to you.

你有一种非凡的能力，能把这些复杂的科学内容简化成我能真正理解的东西。

You just have this incredible knack for taking all this science y complicated stuff and distilling it down into something I can actually understand.

我们先短暂休息一下，马上回来继续与医生对话。

Let's take a quick break and we'll be right back with Doctor.

阿莫斯。

Amos.

请继续关注我们。

Stay with us.

欢迎回来。

Welcome back.

我是梅尔·罗宾斯，正在与医生交谈。

I'm Mel Robbins, and we're talking to Doctor.

艾米·肖，关于更年期、经前综合征、荷尔蒙，还有所有男性。

Amy Shaw about menopause, PMS, hormones, all the men.

我都能听见他们跑远了。

I can just hear them running off into the distance.

别走开。

Do not go anywhere.

这对咱们所有人来说都是一场重要的对话。

This is an important conversation for all of us.

所以，医生。

So Doctor.

艾米，当人们来找你寻求营养和荷尔蒙方面的帮助时，他们最常向你抱怨的五件事是什么？你是怎么解决这些问题的？

Amy, what are the top five things that people complain to you about when they come see you for help with nutrition and hormones and how do you attack fixing them?

好的。

Okay.

首先是体重增加。

So number one is definitely the weight gain.

体重增加非常令人沮丧，因为如果你是个活跃的人，我们本来就生活在一个处处与我们作对的世界里。

The weight gain is very frustrating because if you're an active person, we're already living in a world that's working against us.

默认情况下，我们会属于医学上超重或肥胖的类别。

The default is that we are going to be in the categories of medically overweight or obese.

现在有73%的美国人处于这个状态。

73 of Americans are there now.

哇。

Wow.

不用多久，这个比例就会达到百分之八十五，对吧？

It's gonna be at eighty five percent before we know it, right?

我们大多数人已经面临代谢问题。

Most of us are already metabolically challenged.

我们已经在与这场斗争抗争。

We're already fighting against this battle.

接着我们还得应对雌激素下降的问题，这会让你变得不那么活跃、精力不足，并且流失肌肉。

Then we gotta deal with the estrogen going down, which makes you less active, less energetic and losing your muscle mass.

所以你现在脂肪更多了，情绪也稍微低落了一些，对吧？

So now you have more fat and it's making your mood a little bit lower, right?

我推荐的许多疗法都旨在对抗雌激素水平下降带来的变化。

The therapies that I recommend, a lot of them have to do with things to counteract the changes in the lowering of estrogen.

比如哪些？

Okay, like what?

多走路。

So walking more.

所以我告诉女性，当我们进行高强度运动时，皮质醇水平可能会非常高。

So what I tell women is like our cortisol levels can be really high when we're doing high intensity exercise.

所以最好先以步行作为基础，如果你想的话也可以加入一些高强度间歇训练，但关键是增加整体活动量。

So it's better to have a baseline of walking and you can do bouts of HIIT if you want, but really having more activity.

这被称为NEAT，即非运动性热量消耗。

It's called NEAT, non exercise activity thermogenesis.

NEAT活动实际上才是更重要的驱动因素

NEAT activity is actually a bigger driver

决定我们的体重。

of our weight.

最后一个词是什么？

What is that last word?

热生成是什么意思？

What is thermogenesis?

那就是

That's

不是太注重锻炼。

Not a big on the exercise.

活动产热。

Activity thermogenesis.

热生成就是新陈代谢。

Thermogenesis is metabolism.

好的。

Okay.

那该做什么运动？

So what exercise?

走路并不等于锻炼。

Walking is not Walking.

所以如果你不是为了锻炼而走路，那就戴块手表或者计步器，停车时停得远一点，走楼梯，带狗出去散步。

So if you're not walking for exercise, wear a watch or you wear a pedometer, you park farther, you take the stairs, you take your dog for a walk.

所有这些你并不算作锻炼的活动，都属于非运动性活动产热，这些必须增加。

All the stuff that you don't count as exercise, that's non exercise activity thermogist, that has to go up.

如果你处于围绝经期并且想对抗体重增加，这就是起点。

If you're in perimenopause and you wanna fight the weight gain, that's where it starts.

所以跑步或高强度间歇训练课程对这一类女性来说并不是最好的选择，因为它们会升高你的皮质醇。

And so the reason why running or HIIT classes aren't the greatest thing for women in this category is because it spikes your cortisol.

这和雌激素有什么关系？

And what does that have to do with estrogen?

当雌激素水平下降时，另一个变化是你对压力的耐受能力降低了。

The other thing that happens when your estrogen is going down is you're less stress resilient.

我来举个例子，即使是那些还没进入更年期或围绝经期的女性。

So I'll give an example for women who even aren't in menopause or perimenopause.

在月经来临前的一周，你的抗压能力会下降。

The week before your period, you're just less stress resilient.

你

You

无法应对平时能轻松处理的事情。

can't handle the things that you usually can handle.

是的，医生。

Yes, doctor.

对。

Yes.

你的轻度经前综合症已经持续好几年了。

Your mini PMS is happening for a few years now.

那经前综合症呢？

So is PMS?

一场微型更年期。

A mini menopause.

这是在你正常周期中间雌激素和孕激素水平下降的结果。

It's a drop in your estrogen and progesterone in the middle of your normal cycle.

是的。

Yes.

真有意思。

No shit.

这就是正在发生的事。

That's what's happening.

这时你的身体会想：哦，她没怀孕。

That's when your body's like, Oh, she didn't get pregnant.

卵子没有受精。

The egg didn't get fertilized.

我们得把这层内膜脱落掉。

We gotta shed this lining.

激素水平下降了。

They drop the hormones.

所以你的雌激素和孕激素水平会降到最低点。

So you get to basically the lowest level of estrogen and progesterone.

然后你会脱落子宫内膜，这就是月经。

And then you shed your lining, which is your period.

接着你又重新开始一轮。

And then you start all over again.

哇哦。

Wow.

所以你所说的那些对围绝经期或绝经后女性有帮助的方法，对经前综合症症状也有帮助吗？

So will the things that you're saying that help for somebody in peri or menopause itself also help with PMS symptoms?

是的。

Yes.

这真是一个令人震惊的发现。

That is a revelation.

对我而言也是如此。

It is for me too.

我对自己说，哇，我们在月经周期中为改善营养所做的一切，其实只是在此基础上进一步扩展。

I thought to myself, wow, the same things that we are doing to improve our nutrition during our cycle, we just expand on that.

黄体晚期——也就是月经周期中的经前综合症阶段——正是正在发生的情况。

The late luteal phase, which is that PMS phase of the cycle is what's happening.

我本来想说，说‘我正处于黄体晚期’听起来更酷一些，而不是

I was gonna say, I think it's sexier to say I'm in my late luteal Not

更年期。

menopause.

黄体晚期。

The late luteal phase.

黄体期。

Luteal phase.

但你刚才说的是，那是一个经期

But you're talking, that's a period

体重。

of weight.

那是你月经来之前的那一周。

That's the week before your period.

有一件令人惊讶的事情是，人们需要明白：激素替代疗法对体重增加并没有帮助。

That's One surprising thing that people have to understand is that hormone replacement therapy does not help with the weight gain part.

体重增加并不是去接受激素治疗的理由。

The weight gain part is not an indication to go get hormones.

我之前跟你说过的那些方法，比如增加日常非运动活动量、多做力量训练，这些都有助于减重。

The things that I told you about more NEAT activity, more weight training, that's gonna help the weight loss.

好的，我们还需要做些什么来减重呢？

Okay, what else do we need to do for the weight loss?

因为我知道大家都很关注这个问题。

Because I know everybody's leaning in.

我以为只要用了贴片或生物同质激素，你的体重就会自动恢复到以前的水平。

Because I thought if you get the patch or the bioidenticals, your body will snap back into the weight of us.

这真的让人很沮丧，因为潮热确实会好转，对吧？

And that's what's so frustrating for The hot flashes definitely get better, right?

这就是激素疗法的一个适应症。

Like that's one of the indications for hormonal therapy.

人们在性交时会感到疼痛或出现干燥。

People will have pain with sex or have dryness.

激素替代疗法确实对这些问题有帮助。

Definitely HRT definitely helps with that.

但体重增加这部分不能仅靠激素来解决，因为涉及多个因素。

But the weight gain portion is not so easy to address just with hormones because there's multiple things going on.

比如你活动量减少，肌肉质量流失，睡眠也紊乱。

Like you're less active, you're losing more muscle mass, your sleep is dysregulated.

因此，由于睡眠质量差，你的食欲、渴望和饥饿感都会增加。

So then your appetite, your cravings, your hunger, your appetite are all increased because you're not sleeping well.

是的

That

单靠补充激素是无法解决这个问题的。

can't just be solved by adding hormones.

我觉得添加激素就像给汽车加油。

I think about adding hormones, like putting gas in your car.

你可以给汽车加油，但如果遇到交通堵塞，你还是哪儿也去不了。

So you can add gas to your car, but if there's a traffic jam, you're not going anywhere.

我们的激素就像一张复杂的高速公路网，全都堵住了。

So our hormones are like a complicated web of highways that are backed up.

不管你往车里加多少油，它都动不了。

And doesn't matter how much gas you pump into the car, it's not going to go anywhere.

要疏通这些拥堵、让交通保持顺畅，就需要睡眠、运动、力量训练和饮食选择。

So the ways to unclog that traffic to keep that traffic moving is the sleep, the exercise, the weight training, the food choices.

你睡眠越好，减重效果就会越好，因为睡眠不足时，你的饥饿激素会严重失调。

The more you can improve your sleep, the better that weight loss part will become because your hunger hormones are really dysregulated when you don't sleep.

所以你希望有个好睡眠，但常常因为激素紊乱而睡不着。

And so you wanna have a good night's sleep, but often you can't sleep because your hormones are disrupted.

这就形成了一个循环。

So it's like the cycle.

所以我告诉人们的一件事是，尽最大努力改善你的睡眠卫生。

So one of the things I tell people is really, really try your best to improve your sleep hygiene.

如果你还没有开始建立改善睡眠卫生的惯例，现在在围绝经期就开始吧。

If you haven't started a routine to improve your sleep hygiene, start it now in perimenopause.

好的，告诉我们你的前三项建议。

Okay, that's Tell us your top three things

为了

for

获得更好的夜间睡眠。

a better night's sleep.

改善夜间睡眠的前三项建议。

Top three things for a better night's sleep.

保持房间凉爽。

Cold room.

你的体温必须下降一度才能入睡。

Your body temperature has to drop by one degree to fall asleep.

那么，你如何最快地做到这一点呢？

So how do you get that done fastest?

你可以洗个澡，也可以降低房间温度。

You could take a shower, you can cool down the room.

你需要降低你的核心体温。

You want to cool your core body temperature.

这样你才能睡着。

That's how you'll fall asleep.

太棒了。

Love that.

完全黑暗。

Pitch black.

如果你无法控制窗帘和光线，那就戴个眼罩或睡眠面罩。

If you can't control the curtains and the light then wear a face mask or eye mask.

我们现有的少数研究中，有一项是针对更年期女性的。

The few studies that we have, one is on menopausal women.

即使房间里有环境光，比如从窗户透进来的光，如果你正在减肥，它也会阻碍你的减重效果。

Even if you have an ambient light in the room, like a light coming through the window, it will stop weight loss if you're on a weight loss plan.

真的吗？

Really?

昼夜节律紊乱，尤其是在那个时间段，似乎会严重扰乱相关的激素分泌。

Circadian rhythm disruption, especially during that time seems to really mess up the hormones in that sense.

所以你希望房间完全漆黑。

So you wanna have a pitch black room.

第三件事是你的作息规律。

And then the third thing is you routine.

你要为大脑和身体做好入睡准备，因为你的身体喜欢规律。

So you wanna prepare your brain and your body for sleep because your body loves routines.

我们的身体是建立在节律和周期之上的。

Our bodies are built on rhythms and cycles.

如果每天晚上你都在9点睡觉，那么在8:45，你就该关掉所有灯，收起手机，开始刷牙，这样就是在向身体发出信号：该睡觉了。

And if every night you go to sleep at 9PM, so at 08:45, you start to turn off all the lights, you put away your phone, you start to brush your teeth, you're cluing in your body that it's time for sleep.

因此，保持相同的时间和作息对良好的睡眠至关重要。

So keeping that same time and routine is essential for good sleep.

人们有时晚上9点睡觉，第二天又睡到11点，接着又打乱了睡眠周期。

People will sleep one day at 09:00 and the next day at eleven and the next day they're massively disrupting their sleep cycles.

现在有一些数据显示，保持固定的就寝时间可能比总的睡眠时长更重要。

And there are some data now that shows that it's maybe more important to stay on the same bedtime than even the total number of hours slept.

哇。

Wow.

有没有某些食物我们应该多吃或少吃，以帮助缓解更年期症状和荷尔蒙调节？

Are there certain foods that we should be eating more of or less of to help with the menopause symptoms and hormone regulation.

为了大家的利益，我想提醒一下，这是您第二次做客。

And for everybody's benefit, I just want to remind everybody this is your second appearance.

我们之前做过一期关于饥饿、渴望以及其神经科学和生物学机制的节目。

And we did a huge show on hunger and craving and the neuroscience and biology of it.

那期节目的链接会放在节目说明中，还有你们两位的书籍。

That will be linked in the show notes along with both of your books.

但如果你要给那些真正想通过饮食调节激素的人一个最核心的建议，你会说什么？

But if you had to bottom line it for people that are really wanting to use food to regulate hormone, what are

最重要的建议是什么？

the top recommendations?

记住，我把这比作经前综合症，因为你对压力的耐受性降低了。

Remember that I likened it to PMS in the sense that you're less stress resilient.

我的意思是，现在那些会升高你皮质醇水平的东西，即使在更低的阈值下也会产生更强的影响。

So what I mean is that the things that spike your cortisol are just now more and at a lower threshold.

咖啡因、酒精、糖。

Caffeine, alcohol, sugar.

天哪，难道我们现在也不能享受生活了吗？

Shit, are

我们难道现在也不能开心了吗？

we not gonna have fun now too?

我的意思是

I mean

人们经常对我说：我一直以来都喝这么多咖啡因，吃这么多糖。

People say to me, I always drank this much caffeine and I always ate this much sugar.

是的。

Yes.

或者喝一杯葡萄酒，做点别的，到底发生了什么？

Or had a glass of wine or did whatever, what the hell is going on?

对。

Yeah.

这是因为现在你的荷尔蒙发生了变化，新陈代谢也变了。

And that's because now your hormones have changed and your metabolism's changed.

你的胰岛素敏感性也降低了。

You're also less insulin sensitive.

你可能听说过胰岛素抵抗这个术语。

So you've heard the term insulin resistance.

是的，那是什么意思？

Yes, what does that mean?

这在更年期期间会发生。

So that happens during menopause.

胰岛素抵抗是什么意思？

What is insulin resistance?

胰岛素抵抗意味着当糖分试图进入细胞时，胰岛素需要打开门让糖分进入，这就是胰岛素的作用。

Insulin resistance means that when those sugar is trying to get into your cells, the insulin has to open the door to let the sugar in, that's insulin.

那当你胰岛素抵抗时意味着什么？

So what does it mean when you're insulin resistant?

门是关着的，门是关着的

The door is shut, the door is The door

门关着，你也不太容易听到声音了。

is shut and you don't hear it as easily.

你越来越用力地敲门，想进去。

You're knocking louder and louder to try to get in.

胰岛素会说：老兄，我们刚让糖分进来了。

And the insulin's like, Dude, we just let sugar in.

我们不会让更多的糖进来了。

We're not gonna let more sugar in.

身体却说：不行，我得把糖从血液里清除掉。

And the body's like, no, but I need to get it out of the bloodstream.

我得把它储存起来。

I need to put it.

胰岛素却说：不行，细胞已经装满了。

And the insulin's like, no, but the cell is packed.

它再也装不下更多的糖了。

It can't take any more sugar.

就在它们这样争执的时候，这就叫胰岛素抵抗。

And so while they're having these fights, that's called insulin resistance.

当胰岛素抵抗发生时，身体会收到信号，要储存脂肪，说：得把糖从这里弄走，因为它进不了细胞。

And so when insulin resistance happens, the body gets signals to store fat, to say, let's get this sugar out of here because it's not going into the cell.

所以我们得给它找个地方存放。

So we gotta put it somewhere.

所以，你不仅因为血糖长期过高而更容易患上二型糖尿病，身体还接收到更多储存脂肪的信号。

So not only do you have a higher risk of getting type two diabetes because your sugar level is so high all the time, you also have more signaling to store fat.

天哪。

Oh man.

因此，胰岛素抵抗是我们可以通过控制来改善的：如果细胞已经充满了糖分，无法再吸收更多糖分——

So insulin resistance is something that we can control by saying, well, if the cells are so full of sugar and they can't let any more sugar in-

你最好多吃点蔬菜。

You better eat some vegetables.

你最好减少摄入这些糖分，增加一些有助于降低体内血糖的东西，比如膳食纤维。

You better just cut some of that sugar out and add in some things that help you lower the blood sugar in your body, which is fiber.

多摄入纤维，让体内的血糖水平得到调节。

Add more fiber so that your blood sugar can be regulated in your body.

多运动，就像我们说的那样。

Move more, like we said.

加上力量训练。

Add in weight training.

多睡觉。

Sleep more.

记住我们在上一期提到的水，我们的口渴中枢和饥饿中枢常常混淆，这些信号可能会混在一起。

And remember the water that we talked about in the other episode, our thirst centers are often mixed with our hunger centers, like the signals can be mixed.

所以你要喝足够的水，避免无意识地进食。

So you wanna hydrate enough so that you are not eating mindlessly.

所以对于那些没听过上一期节目的人，这里有个小技巧：当你感到食欲上来时，为了判断这是否只是无意识的渴望，你可以问自己：我现在想吃一碗蔬菜吗？

So in the trick there, just for those of you that have not heard the other episode is when you feel your appetite coming on, in order to determine whether or not you just have a mindless craving, you can say, Would I like a bowl of vegetables right now?

如果答案是否定的，那就说明你其实并不饿。

And if the answer is no, that means you're not actually hungry.

另一个技巧是喝一杯水，因为这通常能缓解突然出现的食欲。

Another trick is drink a glass of water because that typically can satiate that appetite that flares up.

为什么在经前期综合征和更年期期间焦虑会增加？

Why is there an increase in anxiety during PMS and menopause?

记得那位姐妹，孕酮姐妹吗？

Remember that sister, the progesterone sister?

她是个让人平静的人。

She was a calming one.

她总是让你保持放松和谨慎。

She was the one who was keeping you chillaxed and careful.

当孕酮水平下降时，你就失去了这个让你放松的人。

And when progesterone goes down, you don't have that chillaxer anymore.

你不再有人帮你保持冷静。

You don't have someone to keep you calm.

就像那个姐妹在说：别紧张，没事的，梅尔。

Like that sister that was saying like, calm down, it's okay, Mel.

你知道的，你会好起来的。

Like, you know, you'll be fine.

你的孕酮水平降低了。

Your progesterone levels are lower.

突然间，你对一切都感到焦虑。

And all of a sudden you are anxious about everything.

以前从不会让你焦虑的事情，现在却让你感到焦虑。

The things that never made you anxious before are making you anxious.

睡眠方面，你会在半夜醒来，心想：天哪，我简直不敢相信X、Y和Z发生了。

The sleep, you wake up in the middle of the night and you're like, oh my God, I can't believe X, Y, and Z happened.

这会引发一连串的焦虑情绪。

And it starts a whole anxiety spiral.

许多女性在更年期期间都会经历严重的焦虑。

And a lot of women during menopause have crippling anxiety.

激素替代疗法对缓解焦虑有帮助吗？

Does hormone replacement therapy tend to help with anxiety?

是的，孕激素替代疗法。

Yes, progesterone replacement.

明白了。

Gotcha.

我不确定

I'm not sure

我知道如何解释什么是激素以及它的作用。

I would know how to explain what a hormone is and what it does.

是的。

Yeah.

人们对激素有很多误解。

There's so much confusion about hormones.

激素是一种化学信使。

Hormones is a chemical messenger.

所以在我关于高速公路的比喻中，它就是汽车。

So in my analogy of the highway, it's the car.

它就是汽车。

It's the car.

它从你的大脑或卵巢出发，前往它需要到达的任何地方。

It travels from your brain or from your ovaries to wherever it needs to go.

它可以到达肌肉。

Can go to the muscle.

它也可以到达心脏。

It can go to the heart.

所以它是一个移动的信使。

So it's a traveling message.

我们的身体离不开荷尔蒙。

Our bodies cannot function without hormones.

人们常常对荷尔蒙感到烦躁，但没有荷尔蒙你根本无法正常运作。

Like people get so annoyed with hormones, but you cannot function without your hormones.

甚至皮质醇也是如此。

Even cortisol.

皮质醇是一种有益的荷尔蒙。

Cortisol is a good hormone.

它必须保持平衡。

It has to be balanced.

那么雌激素是什么？

So what is the estrogen?

哦，我现在明白了。

Oh, I'm getting this now.

所以是那个爱玩的姐妹。

So the fun party sister.

那个社交型的。

The social one.

社交型的在开一辆车。

The social one is driving one car.

是的。

Yes.

当她到达时，就是派对时间了。

And when she arrives, it's time to party.

是的。

Yes.

孕酮姐妹在开另一辆车。

The progesterone sister is driving another car.

她一到，派对就结束了。

When she arrives, party's over.

是的。

Yes.

她能让大家都平静下来。

And she calms everybody down.

大家别闹了，放松一下。

Let's just chillax now, guys.

咱们低调点吧。

Let's just tone it down.

胰岛素是一种激素吗？

Is insulin a hormone?

胰岛素是一种激素。

Insulin is a hormone.

真的吗？

Really?

所以当胰岛素进入体内时，胰岛素在告诉你什么？

So when insulin gets in the car, what is insulin telling you?

胰岛素在告诉你打开门，让葡萄糖进来。

Insulin is telling you open the door to let the glucose in.

它是一个储存信号，意味着我们的身体会分泌胰岛素，说：嘿，我们需要在这里多储存一些葡萄糖，因为有葡萄糖正在进入。

It's a storage signal, meaning that our body sends insulin out to say, Hey, we need to store a little more glucose here because there's glucose coming in.

所以它是一个信使。

So it's a messenger.

所以人们以为，甲状腺激素只是关于体重的。

So people think, oh, thyroid hormone is just about weight.

不，它不仅控制体重和体温，还控制心率。

No, controlling weight, temperature, it's controlling heart rate.

它在调控着上百万件事。

It's controlling a million things.

它并不是只针对一个目标。

It's not just going to one destination.

哇。

Wow.

所以你不能只是简单地补充激素，就以为它只会产生一种效果。

So you can't just replace hormones and think that it's gonna have one effect.

比如，我们看到有些人服用非常高剂量的甲状腺激素。

So for example, we see people getting high, high doses of thyroid hormone.

我对人们说，更多并不总是更好，对吧？

And I say to people that more is not always better, right?

因为它不是只做一件事，而是在同时做五件不同的事。

Like it's not just doing one thing, it's doing five different things.

其中一件事是它作用于心脏。

And one of the things it's doing is it's going to the heart.

如果你向心脏输送过多的甲状腺激素，就会引发各种问题，包括心律失常和心悸。

And if you send too much thyroid hormone to the heart, you're going to have all kinds of problems, including arrhythmias, heart palpitations.

服用过量甲状腺激素的人常常会出现心脏问题。

People that are taking too high doses of thyroid hormone will have heart problems often.

这就像玩火一样。

It's like playing with fire.

哇。

Wow.

所以她们只是朝着错误的方向前进，或者没有到达以往能到达的状态，这才是变化的原因。

So they're just kind of driving in the wrong directions or they're not arriving where they used to arrive and that's what's making the changes.

因此，荷尔蒙是经前综合症和更年期的根本原因。

So the hormones are the root cause of PMS and menopause.

是的。

Yes.

哇。

Wow.

对于某些症状，荷尔蒙替代疗法可以缓解症状。

And for some of the symptoms, hormone replacement therapy will alleviate symptoms.

但对于其他方面，比如脂肪重新分布或肌肉张力下降，你就必须改变生活方式。

But for other things like the fat redistribution or the losing muscle tone that you're gonna have to make lifestyle changes.

我们还没谈到的另一种激素，但对女性来说同样非常重要，那就是睾酮。

So the other hormone that we didn't talk about, but that's really important even in women is testosterone.

真的吗？

Really?

实际上，女性体内的睾酮水平比雌激素或孕激素高出四倍左右，水平是很高的。

Testosterone is actually in higher levels, like four times the level of estrogen or progesterone, like it's high.

在女性身上？

In women?

是的。

Yes.

真的吗？

Really?

我们总是认为睾酮是一种男性激素，对吧？

We always think about testosterone as like a male hormone, right?

当然，男性的睾酮水平远高于女性，但相对于我们体内的其他激素，我们的睾酮水平也相当高。

Of course, males have much higher levels of testosterone than women, but our testosterone is also high compared to our other hormones.

所以睾酮就像是不住在姐妹们附近的那个妹妹，但睾酮却是领导者。

So testosterone is the sister that doesn't live as close to the other sisters, but testosterone is the leader.

它是肌肉发达的、富有攻击性的、作为领导者的妹妹。

It's the muscular, it's the aggressive, it's the leader sister.

所以在排卵期，我们的睾酮水平会激增。

So we get a spike of testosterone at ovulation.

如果你了解自己的生理周期，大致在月经结束一周后，你的睾酮水平会达到峰值。

So if you know your cycle, roughly a week after your period is when your testosterone levels are peaking.

这时候是你增肌的最佳时机。

That's when you wanna build the most muscle.

这时候你的性欲也会达到最高点。

That's when your libido will be the highest.

你的自信心水平会接近另一性别的水平。

Your confidence levels will be similar to the other gender.

有些人如果服用过多睾酮，比如在进行替代治疗时过量，就会变得易怒、具有攻击性，甚至出现冒险行为。

People that take too much testosterone, for example, when they're taking a replacement and they go overboard, they'll be angry, aggressive, and maybe even a risk taking behavior.

我们知道，少量的睾酮是有益的，尤其是对于更年期前和月经周期中睾酮水平偏低的女性。

We know that testosterone can be good in small amounts, especially for women during perimenopause and during the cycle if you're lower than you need to be.

但当然你不能过量，而很多人确实会过量。

But of course you don't wanna overdo and people overdo it all

你能弄清楚该服用什么吗？

do you the figure out what to take?

是的，我知道。

Yeah, I know.

明白。

Know.

现在网上有太多错误信息了。

There's so much misinformation out there.

对于那些重要的方面。

For the big ones.

对，给我讲讲那些主要的误区吧。

Yeah, give me some of the big myths.

一个典型的例子。

Big example.

所有医生都同意的一点是，人们所使用的那种植入物根本没用。

The one thing that all doctors can agree about is that those pellets that people get are no good.

我不

I don't

我不知道那玩意儿是什么。

know what the hell a pellet is.

我只是听说过这个。

I've just heard about this.

那玩意儿到底是什么？

What the hell are pellets?

所以植入物是一种缓释型睾酮，它们被植入皮下。

So pellets are testosterone releasing, like extended release testosterone that they implant under the skin.

它被设计用来释放睾酮。

And it's supposed to release testosterone.

你把这个留在体内好几个月，好吗？

You keep this in there for months, okay?

然后你需要更换它。

And you get it replaced.

而问题是，你无法调节激素水平，对吧？

And what's happening is that you can't adjust the levels, right?

而且这些植入物大多会释放超治疗剂量的睾酮。

And most of these pellets are giving you super therapeutic levels.

正如我所说，激素不是你想加就能加的东西，因为它们除了你想要针对的那一个作用外，还会产生很多其他影响。

And like I said, hormones are not something that you just wanna add because they're doing a lot of other things besides maybe the one thing that you're targeting.

而且

And

那你为什么要使用一种无法调节剂量、通常释放过量的可植入睾酮呢？

so why would you use an implantable testosterone that can't be titrated, that usually releases too much?

你为什么要这么做？

Why would you do that?

答案是可以收费。

And the answer is that you can charge.

你可以对睾酮植入物收费。

You can charge for testosterone pellets.

当你使用睾酮乳膏或口服剂时，医生并不能从中获利。

And when you do testosterone like a cream or a ingestible, it's not money in the pocket of the practitioner.

我记得我曾在社交媒体上说过这句话，结果人们都炸了，因为他们说：我非常喜欢我的睾酮植入物。

And so I know once I said this on social media and people went crazy because they said, I love my testosterone pellets.

我说：很好，但一定要确保你的激素水平是你想要的，而不是高得离谱。

And I said, great, but make sure your levels are at the level that you want it and not way high.

因为我打赌，很多使用睾酮植入物的人，其激素水平都远远超过了治疗所需。

Because I bet you that a lot of people who are taking testosterone pellets are at super therapeutic levels.

我们已经见过太多因这些过高水平而产生的负面副作用。

And we've seen so many negative side effects from those levels.

因此，激素替代疗法可以非常有效，但一定要找对医生，选择合适的剂量。

So hormone replacement can be so amazing, but go to the right person, choose the right dosing.

即使你选择植入剂，也不错，但要确保你的激素水平不会超过身体所需的上限。

And even if you do pellets, great, choose what's right for you, but make sure you're not getting levels that are too high for your body.

我很高兴你提到这一点，因为另一位本身也在使用植入剂的出色人士对此如此兴奋，以至于我也想赶紧去弄一些植入剂。

I am so glad you said this because another amazing person who uses pellets herself was so excited about them that I'm like, I gotta get me some pellets.

我得去一趟。

I gotta go.

我得赶紧去打植入剂。

I gotta get in there and get the pellets.

我要补充睾酮。

I testosterone.

克里斯·罗宾斯，准备好吧，因为性欲要回来了。

Chris Robbins, get ready because the libido is coming back.

但很高兴你给出了理由，这样我们才能为自己做出选择。

But I'm glad that you gave us the reason why so that you can make a choice for yourself.

这是真的吗

Is it true

不同种族的女性经历更年期的方式不同吗？

that women of different races experience menopause differently?

是的。

Yes.

问题在于，梅尔，我们不仅没有向医生或公众普及更年期知识，甚至连不同背景、不同种族、不同族裔之间的差异都还不清楚。

And the problem is again, Mel, is that not only are we not educating our doctors or population about menopause, we don't even know the differences between different backgrounds, different races, different ethnicities.

是因为他们没有研究吗？

Because they're not studying it?

他们根本就没有研究。

They're just not studying it.

我的意思是，我们甚至连女性心脏病发作的表现与男性不同这一基本事实都刚刚开始了解。

I mean, we're just at the basic levels of finding out that women present differently with heart attacks than men.

女性会因为一些真实存在的症状而受到指责，因为人们只是觉得：‘哦，她就是爱抱怨。’

And women will be shamed for symptoms that are actually real because they just think, oh, she's just a complainer.

还有另一件事，我之前真的没有意识到，那就是人们终于承认了你会变得更健忘。

Well, and then the other thing that I have really not appreciated is that there is an acknowledgement that you get foggier.

而且大家也承认，你会开始感觉身体松垮，并在以前从未长过脂肪的地方开始增重。

And there's an acknowledgement that you will start to feel flabbier and start gaining weight in places that you've never had it before.

但没有人知道该怎么办。

But there's no what to do.

它就像是这样，哦，是啊，我也是。

That it's sort of this, Oh, well, yeah, me too.

或者，是的，这种情况会发生，等你到了60岁，或者进入这个阶段十年后，一切都会回到正常状态。

Or Yep, that'll happen and everything will kind of go back to where it should be when you're 60 or you're ten years into this.

很抱歉，我不能接受这种状况。

And I am sorry, I'm not settling for that.

这也是其中一个原因，医生。

And that's one of the reasons, Doctor.

艾米，我请你来是因为。

Amy, I wanted you on.

所以，如果你能为我们详细介绍一下，你建议任何人如何更好地管理经前综合症，或者建立一套符合你的建议和现有科学依据的日常习惯，以帮助我们调节荷尔蒙并采取积极措施，在这些非常正常的生理变化中感觉更好，那将非常有帮助。

And so I think it'd be really helpful if you could walk us through the day of what you would recommend for anyone to either better manage PMS or have a better routine that's aligned with your recommendations and the science out there to help us both regulate our hormones and do the proactive steps to feel better during these very normal changes?

是的。

Yeah.

这是个很好的问题。

That's a great question.

我会先说，我们生活在一个对女性变老存在偏见的社会中，对吧？

I'll start with saying that we live in a society that has a problem with women getting older, right?

我们基本上一直被灌输这样的观念：如果你不符合社会对年轻、有生育能力女性的理想标准，你就不再有价值，不再美丽，不再被需要，不再聪明或有动力。

Like we basically have been told that if you don't fit into the societal ideals of young, fertile women, that you're no longer worthy, you're no longer beautiful, that you're no longer wanted, that you're no longer smart and motivated.

我认为，这是我们下一代必须面对的最大挑战之一——即使到了四五十岁，我们依然能感觉良好。

And I think that that's one of the biggest challenges that we are going to have to face in this next generation where we feel good even into our forties and fifties.

如果我们做我们即将讨论的这些事，这种状态可以持续到七十岁，让我们看起来更年轻，感觉也更年轻。

If we do the things that we're gonna talk about, this could last till our seventies and we can look younger and feel younger.

我们已经知道，我们的生物年龄和实际年龄完全不同，可以相差二十岁，所以你现在实际上只有35岁。

We already know the biological age, like our age of ourselves is completely different, twenty years different than our chronological So you're really just 35 right now.

谢谢。

Thank you.

谢谢。

Thank you.

这就是为什么我生气，因为我阴道干涩、夜间出汗，感觉自己像个老太太。

Which is why I'm pissed off that I have a dry vagina and I sweat at night and I feel like somebody's grandmother.

没错。

Exactly.

接下来我们来看看如何度过一天。

So here's how we move through the day.

你最好能不用闹钟自然醒来。

You wake up hopefully without an alarm.

这非常重要，因为我们之前谈过睡眠如何帮助调节食欲。

This is really important because we talked about sleep, how it helps with appetite regulation.

而作为社会，我们却轻视睡眠，不允许自己好好睡觉。

And we just, as a society, shit on sleep and don't allow ourselves to sleep.

所以去露营吧，去一个没有环境光、没有社交媒体干扰的地方，看看你什么时候睡觉、什么时候醒来。

So go camping, go somewhere where there's no ambient light and there's no distractions in social media and see what time you sleep and wake up.

我打赌你其实并不是你想象中的夜猫子。

I bet you you're not a night owl like you thought.

所以你会获得充足的睡眠。

So you're gonna get an adequate night of sleep.

你会在早上去接触阳光。

You're gonna go get that sunlight in the morning.

因此，昼夜节律生物学，你早上接触到的光线会告诉身体的每一个细胞：现在是早晨。

So circadian biology, again, the light that you get in the morning tells every cell in your body that it's morning.

这样做的好处是，我们的激素需要这种信号。

And the benefit of that is that our hormones need that input.

如果我们的激素没有从大脑和身体接收到信号，提醒它们：该释放皮质醇了。

If our hormones don't get input from our brains and our bodies that, Hey, it's time to release now cortisol.

皮质醇在早晨刚醒来时水平最高。

Cortisol is high first thing in the morning.

如果缺乏这种信号，就会导致激素失调，这正是人们常说的‘整天都觉得很累’或‘肾上腺疲劳’的原因。

Then it causes hormonal dysregulation, which is like how people say, Oh, I feel so tired all day or adrenal fatigue.

就像我觉得自己精疲力尽。

Like I feel so burned out.

并不是肾上腺耗竭了。

It's not that the adrenals are burned out.

根本不存在肾上腺耗竭这种说法。

There's no such thing as adrenal burnout.

肾上腺疲劳这种说法让人觉得这些腺体累了。

Adrenal fatigue makes it sound like these adrenal glands get tired.

是的，它们并没有。

Yeah, they don't.

不，我们说的这条激素高速公路堵住了。

No, it's this hormonal highway that we're talking about gets clogged.

不只是肾上腺，问题还来自甲状腺和大脑。

It's not just adrenals, it's coming from the thyroid, it's coming from the brain.

整个交通堵塞是因为其他各种因素，比如生活方式和与年龄相关的激素变化。

The whole traffic jam is happening because of all the other things, the lifestyle, the age related hormone changes.

所以你想重新调整这些生物钟。

So you wanna retune those clocks.

如果长期错位，这些生物钟可能会受损。

Those clocks can get damaged if misalign them so long, so many times.

是的，比如你从不外出，或者白天长时间待在室内。

Yeah, like if you never get outside or you spend hours and hours and hours like in the daytime inside.

我喜欢这一点，因为我觉得保持这个比喻很有帮助，视觉形象真的让我更容易理解一切。

Well, what I love about this is I think just to kind of keep with the analogy because the visuals really help me put it all together.

昼夜节律和早晨的阳光就像是你身体的启动器。

It's almost as if the circadian rhythm and the sunlight in the morning is like the remote starter to your Yes.

保持这些通路畅通和清洁。

It's keeping those roads open and clean.

这样你就能知道，好了，该出发了。

So you can know, okay, it's time to drive.

就像所有道路都畅通无阻了。

Like everything's opened up.

所以你理解了昼夜节律。

So you get the circadian rhythm.

如果你开始损坏这些车辆，就会产生一种叫做衰老细胞的东西。

If you start to damage those cars, you get these things called senescent cells.

这个词非常科学，但本质上意思是你的细胞变成了僵尸细胞，不再能正常工作。

So the word is a very scientific word, but basically it means your cells become zombie cells and they no longer can work.

车子无法运行了。

The car doesn't work.

但这些车子排放出的是炎症信号。

But the emissions from the car is inflammatory signals.

衰老以及伴随衰老的一切，都是这些抛锚的车子向你全身发送炎症信号的过程。

And aging and all the things that come with aging is these cars that are broken down and they're sending off these inflammatory signals to your whole body.

这就是衰老的过程。

That's the process of aging.

我们需要清理这些车子，把它们移走，如果它们已经无法工作了，对吧？

We need to clean those cars up and get those out of there if they're not working, right?

继续用这个比喻，我们不希望出现衰老细胞，这是抗衰老研究中的一个重要领域。

So just keeping with that analogy, that's what we don't want Senescent cells is the big area of anti aging that we're trying to understand.

我们该如何更快地清除这些细胞？

Like how do we clear those out faster?

我们该如何避免身体机能衰退？

How do we not break down?

研究表明，早晨锻炼确实不是唯一理想的锻炼时间，但却是坚持锻炼习惯的最佳时间。

So working out in the morning actually has been shown in studies to be the Not necessarily the only ideal time to work out, but the best time to stay with a routine.

人们在早晨锻炼时更容易坚持下来。

So people are compliant with exercise when it happens in the morning.

就是这样。

Well, this.

这很合乎常理，因为你的白天不会被其他事情抢占你的精力和时间。

It's common sense because your day doesn't hijack your energy and your time.

我明白了。

I see

一遍又一遍，尤其是在女性身上，因为我们一直在为所有人操劳。

it over and over again, especially in women because we are doing everything for everyone.

我们的精神负担从早晨就开始了。

Our mental load starts from the morning.

所以如果你没在早晨锻炼，之后很可能就没时间了，因为孩子需要接送。

And so if you don't get that workout in, there's a big chance you're not going to make time for it later because the kid needs a ride.

你的丈夫需要你回家。

Your husband needs you to be home.

你知道的，会议突然来了，有人需要你去某个地方。

You know, the meeting came up, somebody needs you to be somewhere.

所以如果可能的话，就在早晨把锻炼做完。

So get it done in the morning if possible.

还有一个次要的高峰期，就是下午晚些时候。

There's a second peak time, late afternoon.

下午晚些时候是增肌更好的时间。

And late afternoon is a better time to muscle build.

所以如果你做了太多锻炼，可以把它分开来做。

So if you're doing too many workouts that you could just split it up.

然后要高蛋白。

And then high protein.

高蛋白。

High protein.

蛋白质是更年期前期女性最容易忽视的重要营养素，因为女性往往以为自己要追求瘦。

Protein is one of the biggest things that doesn't happen with women in perimenopause, because what happens is women think that you're trying to be skinny.

当她们发现自己腰部开始发胖时，常常会进一步减少摄入，陷入极度严格的热量限制。

And when they start to see themselves gaining some middle section weight, they often cut down even more and you're in this very tight calorie restriction.

而你真正需要做的是多吃蛋白质、多吃纤维、多吃天然食物，少吃那些高度加工的垃圾食品。

And what you really need to do is eat more protein, more fiber, more real foods, and less of that ultra processed crap.

所以要吃高蛋白的早餐，比如多豆蛋白早餐，还要高纤维。

So having a high protein breakfast, dopa bean booster breakfast, high fiber.

我们在上一期节目中已经多次提到过这一点。

We talked about that a lot in the other episode.

然后你希望在一天的早些时候完成最重要的集中任务。

And then you wanna do your biggest concentrated tasks of the day early in the day.

这样你

So that you

就不会让皮质醇飙升。

don't spike your cortisol.

没错。

Exactly.

太好了，我明白了。

Boom, I'm getting this.

我明白了。

I am getting this.

如果你能进行冥想或小憩，最佳时间是在皮质醇自然较低的时候，比如下午一点到四点。

If you're someone who can do a meditation or a nap, the best time to do it is when your cortisol is naturally low, like one to 4PM.

当皮质醇下降时，这是进行二十分钟强力小憩、冥想或做些放松活动的绝佳时机。

When your cortisol dips, it's a great time to either do a power nap twenty minutes, do a meditation, do something calming.

因为你要记住，当孕酮水平下降时，你更容易感到焦虑和不知所措。

Because remember when your progesterone's dropping, you're likely more anxious, you're overwhelmed.

这是个不错的休息时机，你可以做些让你平静下来的事情，比如祈祷，不管是什么方式。

It's a nice break from the day when you can do it, Do something that's very centering prayer, whatever it is.

我听说过一个可能是个迷思的说法。

I've heard what I think is probably a myth.

有人说，只要熬过三年，梅尔，挺过潮热、干燥、易怒，还有脑雾，一切就会好起来。

That if you just ride it out, just like three years, Mel, ride out the hot flashes, the dryness, the bitchiness, all this stuff, the brain fog.

三年后，你就会突然恢复如初。

And in three years, you'll just snap right back.

这真的吗？

Is that true?

实际情况是，你的身体会逐渐适应这种状态。

Well, what happens is that your body just starts to get used to it.

所以你会在一个新的稳定水平上继续生活。

And so you're operating at a level that's just stable.