#311 ‒ 长寿入门：彼得长寿框架的基础指南，涵盖心血管疾病、癌症、神经退行性疾病、营养、运动、睡眠等

来看最后一种疾病，像阿尔茨海默病这样的神经退行性疾病，我们经常被问到。

Looking at the last of a horsemen, neurodegenerative disease such as Alzheimer's, something we get asked about a lot.

从你刚才谈的癌症和心血管疾病预防的角度来看，这种情况如何呢？

How does that look in terms of what you kind of discussed on cancer, cardiovascular disease as it relates to prevention?

我觉得这处于中间位置。

Well I would say it's a little bit in the middle.

换句话说，我们对一些病因其实有了稍好一些的认识，虽然不是所有情况都如此，但针对阿尔茨海默病，我们正越来越清楚哪些人更容易患病，哪些基因在遗传易感性中起作用。

In other words, I think we actually have a slightly better sense of some of the causes, not in all cases, but certainly with Alzheimer's disease we're getting a much better sense of which people are susceptible, what genes play a role from a genetic susceptibility standpoint.

基因在这里确实扮演了相当重要的角色。

And genes do play a pretty big role there.

我们还了解其他影响因素。

And we also understand the other factors.

而其中一部分原因，尼克，是因为一句简单却出奇准确的格言：对心脏好的，对大脑也好。

And part of the reason for this Nick is there's a very simple but surprisingly accurate adage which states, what's good for the heart is good for the brain.

无数研究都证实了以下这一点。

And study after study after study have demonstrated the following.

我们采取的每一项降低动脉粥样硬化性心血管疾病风险的干预措施，都会降低痴呆症的风险。

Every intervention that we take to lower the risk of atherosclerotic cardiovascular disease also reduces the risk of dementia.

这意味着阿尔茨海默病和血管性痴呆——这两种主要类型，以及其他形式的痴呆。

And that means Alzheimer's disease, vascular dementia, which are the two main ones but also other forms of dementia.

因此，这意味着要拥有更好的代谢健康、更低的载脂蛋白B水平、更低的血压，以及不吸烟。

So that means having better metabolic health, having lower ApoB, having lower blood pressure, not smoking.

这些措施不仅能显著降低心血管疾病的风险，也能显著降低阿尔茨海默病的风险。

Those things dramatically reduce your risk of cardiovascular disease and they dramatically reduce your risk of Alzheimer's disease.

现在，在痴呆症的干预方面，有一个领域比心血管疾病更具积极影响，那就是运动。

Now, an area where dementia has an even bigger positive impact in intervention than cardiovascular disease is with that of exercise.

因此，运动能提高人们不得心血管疾病、癌症或痴呆症，或在患病后存活下来的几率，这并不令人意外。

So it's no surprise that exercise improves a person's odds of not getting and or surviving cardiovascular disease, cancer, dementia.

但我认为，关于运动对预防神经退行性疾病益处的证据，无论在效果强度还是可信度上都更为显著。

But I would say that the evidence for the benefits of exercise are both greater in magnitude and greater in confidence when it comes to the prevention of neurodegenerative disease.

这很有趣，因为我确实认为许多人比害怕其他任何疾病更害怕痴呆症，这背后有非常明确的原因。

So it's interesting because I do think that many people fear dementia more than any other condition and there are very obvious reasons why that would be the case.

在我们的实践中，我们可能比大多数人更乐观，这源于我们工作的性质以及前来就诊的患者类型——这些人非常关注预防，仔细研究痴呆的早期迹象，并探讨特定干预措施如何产生影响。

And it might be that in our practice we're a bit more optimistic than most based on just the nature of what we do and the types of people that are in our practice, meaning like people who really study prevention and really look at these early early signs of dementia and look at how specific interventions can make a difference.

但不幸的是，与此相对的是，在所有慢性疾病中，痴呆和神经退行性疾病是目前几乎没有任何有效治疗手段的疾病。

But unfortunately, the flip side of that is that of all the chronic diseases, the dementing and neurodegenerative diseases are the ones for which we have at this time virtually no viable therapeutic options.

因此，对于神经退行性疾病，特别是痴呆类疾病，唯一需要强调的另一个疾病是帕金森病——它是最常见的运动障碍——其首要、第二和第三优先事项都是预防。

So the real name of the game with neurodegenerative diseases, specifically the dementing diseases, and the only other one I'll really mention here briefly is Parkinson's disease because it's the most prevalent movement disorder, is that avoiding them is the first, second and third priority on a list of three priorities.

一旦进入治疗阶段，至少在当前阶段，前景并不乐观。

Once we get into treatment land, at least at this point in time it's not very promising.

因此，这两种疾病中，拥有尽可能高的储备能力都能产生重大影响。

So these are both diseases where having as higher reserve as you can make a big difference.

因此，你的认知储备和运动储备越高，你就越能抵御这些疾病的影响。

So the higher your cognitive reserve and the higher your movement reserve, the more resilient you are to the effects of these conditions.

我认为我应该在这里直接得出结论：我们不能忽视第四位骑手，也就是代谢性疾病的谱系。

I think I should just state the conclusion here that we shouldn't ignore the fourth horseman, which is of course the spectrum of metabolic diseases.

正如我在开头所说，我认为与心血管疾病一样，我们在机制上对导致这些疾病的原因已经有了相当清晰的认识。

As I said kind of at the outset, mean I think along with cardiovascular disease we really have a pretty clear sense mechanistically of what's driving this.

我的意思是，这主要是过度营养的结果。

I mean this appears to be primarily a consequence of overnutrition.

因此，能量失衡是胰岛素抵抗的主要驱动因素，而胰岛素抵抗又是导致从脂肪肝到2型糖尿病等一系列下游效应的根本原因。

So energy imbalance is really the driving factor of insulin resistance and insulin resistance is really the driving factor of the downstream effects that ultimately lead to everything from fatty liver disease, type two diabetes.

而且，这些疾病本身就已经相当有害且具有毁灭性。

And again, these diseases in their own right are quite harmful and devastating.

但它们真正的危险在于对另外三个‘骑士’所产生的影响。

But the real danger of them is the effect that they're having on the other three horsemen.

它们将你的风险提高了百分之二十五到百分之五十。

Where they're increasing your risk by twenty five to fifty percent.

因此，它们实际上是为其他疾病火上浇油。

So they really are gasoline on the fire of the other diseases.

在进入具体策略之前，最后一个基础性问题是：我们刚才谈了这么多关于预防及其重要性，希望对年轻听众能起到激励作用，让他们着眼于更长远的未来。

The last kind of foundational question before we get into tactics would be, we just talk so much about prevention and the importance of it which if anyone who is younger listening, hopefully encourages them to kind of play that longer game.

但那些年纪较大的人呢？

But what about someone who's older?

他们刚刚听了你讲预防的重要性，可能会想：‘对我来说，现在开始考虑长寿是不是太晚了？’

So they just heard you talk about prevention, the importance of it and they might be thinking themselves, I wonder if it's too late for me to start thinking about my longevity.

你对这种想法会怎么说？

What would you say to that?

嗯，我认为理论上有一个答案，实践上也有一个答案，对吧？

Well, mean I think there's like the theoretical answer and the practical answer, right?

我的意思是，理论上讲，只要你还有一口气在，就永远不会太晚去采取行动。

I mean I think the theoretical answer is look, while you still have breath in your lungs, it's not too late to do something.

但我还认为，我们每个人都像在开车，正朝着悬崖边缘驶去。

But I also think that we're all in a car driving towards the edge of a cliff.

如果你在到达悬崖之前就开始减速，那么让车子避开悬崖，或者至少大幅延缓你到达悬崖边缘的时间，就会容易得多。

It's a lot easier to slow the car down and make sure that you either avoid the cliff altogether or at a minimum slow your route to the cliff's edge dramatically if you begin the slowing process before you get there.

换句话说，每个人都明白，看到红灯时，必须在到达红灯前就开始踩刹车。

In other words, everybody understands that when you see a red light, you have to be applying the brakes before you reach the actual light.

所以我认为，在某个时刻，想要扭转局面会非常困难。

So at some point, I think it is very difficult to back out of a situation.

但我认为这种情况是少数例外，而不是普遍现象。

But I also think that that's the rare exception and not the rule.

因此，我甚至在书中写过一些人，他们在七十多岁才迈出第一步，真正开始关注健康。

So I've even in the book written about individuals who are in their 70s before they take their first committed step towards health.

而这些人在八十多岁时，无论是健康状况还是运动能力，都比他们六十多岁时更好。

And these are individuals that in their 80s now are doing better than they were in their 60s from a health perspective, from a movement perspective.

所以，我希望听到我们对话的人，哪怕觉得自己已经步入晚年，心里想着‘我真希望早点采取行动’，也会问自己：现在还来得及吗？

So I would absolutely hope that a person listening to us in what might be thought of as their twilight years who's thinking, man, I wish I did something about this sooner, is it too late?

我会说，现在还不算晚。

I would say it's not too late.

你必须做出一些调整，要从更缓慢的步伐开始，确保自己不会受伤。

You'll have to make concessions, you need to start slower, you need to make sure you're not getting injured.

我的意思是，这有一整套完整的方案，我们实际上还专门做了一期播客，讨论老年人的锻炼计划应该是什么样子。

I mean there's an entire playbook and we actually have a podcast around this topic specifically around what would an exercise program for the elderly look like.

但我绝对会非常失望，如果有人认为我在传达‘一旦到了某个年龄，一切就都无望了’这样的观点。

But I definitely would be very disappointed if anyone thought I was communicating that once you reach a certain age, it's sort of all bets are off.

那么从健康寿命、实际寿命，现在来谈谈具体策略。

So moving from health span, lifespan to now the tactics.

我想我们会逐一讨论，但一开始如果你能先列出你所谓的‘长寿工具箱’里的五个策略会很有帮助。

I think we'll go through each of them but I think it'd be helpful at the outset if you just kind of list what the five tactics in your quote unquote longevity toolkit are.

好的。

Yeah.

我只是大致把内容分门别类。

I just kind of list things into buckets.

我不会说这是完全穷尽的，我认为还有其他重要的事情，在我看来它们不值得单独列为一类，或者也许我应该提出第六个类别，把所有其他事情都放进去，我们也可以讨论这个。

I wouldn't say this is collectively exhaustive, there are other things that I think matter that don't warrant a bucket in my view or maybe I should come up with a sixth bucket that I would put every other thing into and we could talk about that as well.

但五大类别是营养、锻炼、睡眠、药物学和情绪健康。

But the big five buckets are nutrition, exercise, sleep, pharmacology and emotional health.

再说一次，可以讨论第六个类别，包括污染、极端温度暴露、避免事故。

Again, could talk about a sixth bucket which would be pollution, radical temperature exposure, accident avoidance.

也就是避免有害事故的行为，比如机动车事故之类的。

So behaviors to avoid harmful accidents, automotive accidents, things like that.

所以，如果你愿意的话，也可以加入一个杂项的第六类。

So there's definitely also like a grab bag sixth column that you could include if you wanted to.

但我主要讨论前五类。

But I mostly talk about the first five.

我们从你最喜欢的话题开始吧——这句话并不讽刺，这确实是你的最爱，那就是运动。

We'll start with your favorite, which is not ironic in that statement, it is actually your favorite, which is exercise.

我觉得有帮助的是，你以前谈过这个‘百岁运动员十项全能’的框架，你能简单说明一下这是什么吗？

I think what would be helpful is, you've talked about this before but this framework of the centenarian decathlon, do you wanna just quickly state what that is?

因为我觉得这能为你的运动理念提供一些基础和背景，与其他人谈论运动的方式形成对比。

Because I think it kind of gives some grounding and foundation to how you think about exercise compared to how others may talk about it.

关于这个话题，我能说的太多了。

So there's so much I could say about this.

我本来以为你会抛给我一个常规的问题，先从营养开始，那当然不是我最喜欢的，不过我们也会谈到它。

I really thought you were gonna throw me a usual ball and start with nutrition, which of course is not my favorite but we will talk about it.

但你说得对，运动是我最喜欢的，因为我相信数据非常明确：如果充分利用，运动对延长寿命的影响最大。

But you're right, exercise is my favorite and it is my favorite because I think the data are very clear that exercise, if leveraged to its capacity, has a greater impact on your lifespan.

记住，这关乎你活多久的寿命，以及你活得多好的健康寿命，比其他任何因素都更重要。

Remember that's the how long you live peace and your health span, that's the how well you live peace, than any of the others.

唯一的例外可能是情绪健康。

With the only exception potentially being emotional health.

显然存在这样一种情况：某人的情绪健康已经彻底崩溃，如果不解决这个问题，任何身体上的健康都无济于事，甚至其他一切只是延长痛苦。

There's clearly going to be the case of the individual whose emotional health is in such ruins that until that is addressed, no amount of physical health matters and in fact anything else is just prolongation of agony.

但如果你排除这种情况——我不想淡化这种情况，因为我知道有很多人曾经历过这种境地。

But if you exclude that case, which is I don't want to minimize that case because I think there are many people who have been in that situation.

锻炼确实是干预措施中的王者。

Exercise really is the king of interventions.

你提到了一个我最喜爱的话题，叫做百岁运动员十项全能。

So you alluded to something that is one of my favorite topics, which is called the centenarian decathlon.

我意识到有些人读过这本书，理解它的含义，或者听过我谈论过它。

So I realized that some people have read the book and they understand what this means or they've heard me talk about it.

但我觉得，这个播客的目的正是确保新听众能跟上这个概念，或者为老听众提供一次温习。

But again, the purpose of this podcast I think is to make sure that someone who's new maybe gets up to speed on this or it's a refresher for someone.

所以，百岁十项全能这个想法是在2018年浮现在我脑海中的。

So the centenarian decathlon is an idea that came to me in the 2018.

这是一个瞬间闪现的想法，但实际上是多年——大概四年——痛苦经历的结果。

And it's an idea that occurred in an instant but it was really the result of many years, probably four years of suffering, so to speak.

这种痛苦始于2014年，当时我决定不再参加竞技性骑行。

So the suffering started at the 2014 when I decided to stop competitively cycling.

我不但停止了骑行，而且也不打算再从事任何其他运动。

And not only did I stop cycling but I was not gonna go back to any other sport.

所以我不会再参加大师级游泳或骑行比赛了。

So I was not gonna be competing anymore in masters swimming, cycling.

显然，我也没有任何意愿重返拳击、武术或类似运动的竞技场。

Obviously I had no desire to go back and compete in boxing or martial arts or anything like that.

基本上，我已经告别了竞技，我只想为了锻炼而锻炼。

Basically, I was done competing and all I wanted to do was exercise for the sake of exercise.

对我来说，这无疑是一个奇怪而陌生的概念。

And this for me at least was a bizarre foreign idea.

因为从13岁到那时，也就是41或42岁，我从未没有明确目标地训练过。

Because from the age of 13 until that point in time, which was 41 or 42, I had never trained without a specific purpose.

每一次重复、每一圈游泳、每一次踩踏，我做的一切都始终围绕着某个目标。

Every single rep, every single lap, every single pedal stroke, everything I ever did was always geared towards a purpose.

而如今，我第一次开始想：今天我该做什么？

And now for the first time ever, I was kind of like, what should I do today?

我想我该去跑个步。

I guess I should go for a run.

好吧。

Okay.

我想明天我该去举重。

I guess I'll lift weights tomorrow.

我在健身房举重，我到底是为了什么在举？

I'm in the gym lifting, what am I lifting for?

我以前这么做，所以我想我应该继续做下去。

Well, I used to do this, I guess I should still do this.

但那时我过着一种完全失去方向的生活，这种状态一直持续到2018年，当时我参加了我一位最好的朋友父母的葬礼。

But it was this totally rudderless existence that I had and it stayed that way until the 2018 when I was at the funeral of the parent of one of my best friends.

抱歉重复这些内容，因为我在书里已经写过这些了。

And apologies for repeating this because I do write about this in the book.

但在那场葬礼上，我意识到，虽然我朋友的母亲去世时年龄已算高寿，大约89岁，但她的身体机能早在过去十年里就已严重衰退，以至于她的离世几乎只是一种形式上的终结。

But basically at that funeral I realized that while my friend's mom had died at a relatively old age, I think about 89, her physical life had basically demised so significantly in the past decade that her actual death was almost just a matter of formality.

但她早在十年前就已经失去了做自己最在乎的事情的能力。

But she had lost the ability to do the things that mattered to her most a decade earlier.

因为肩膀的问题，她再也无法打高尔夫了。

So she couldn't play golf anymore because of her shoulder.

因为膝盖、臀部和背部的问题，她也无法再打理花园了。

She couldn't garden because of her knees and hips and back.

她甚至无法和孙子孙女一起玩耍了。

She couldn't even play with her grandkids.

因此，她生命的最后十年大多都处于与世隔绝的状态。

And so she spent most of the last decade of her life largely uninvolved in anything.

并在她生命的最后一年患上了痴呆症，这最终夺走了她的生命。

And did come down with dementia in the final year of her life and that's what ultimately took her life.

但我完全震惊了，我曾经记得的这个充满活力的人，竟然失去了所有，最后一年竟处于这种状态。

But I was just totally blown away by this person that I once remembered as being completely vibrant, losing everything and spending this last year in this state.

就在那一刻，当我实实在在地坐在教堂的长椅上时，我意识到，首先，这种情况其实非常普遍。

And I realized in that moment, as I literally sat in a church pew, first of all this is really common.

其次，这正是我想为之训练的目标。

And secondly, this is what I want to train for.

四年来，我第一次意识到，我想训练的目标是避免这种情况。

For the first time in four years realized, the thing I want to train for is to avoid this.

我想创造一个事件，一个在我生命尽头进行的体育活动，而从现在到那时的一切，都将是为了这个目标而训练。

I want to come up with an event, an athletic event that will be done at the end of my life and everything between now and then will be training for it.

于是，我想出了一个叫做‘百岁十项全能’的构想。

And so I just came up with this idea called the centenarian decathlon.

这并不是意味着必须活到一百岁才能参赛，也不是暗示必须包含十个项目，而仅仅是一个心理模型，用来思考：在我生命尽头时，我最想保持的那些日常活动和表现性活动是什么？我又能如何清晰地定义它们？

Not because it implies that one has to live to a 100 to compete or not even to imply that it has to have 10 events But simply as a mental model to say what are the most important activities, both activities of daily living and activities of performance that I want to be able to do at the end of my life And how well can I define them?

我能在多大程度上理解执行这些活动所需的生理特征？

How well can I understand the physical traits that will be necessary to execute them?

然后，我能从那里反向推导或倒推多少？

And then how much can I reverse from there or back cast from there?

我今天需要做些什么，才能最大程度地提高明天完成这些活动的可能性？

What I need to be doing today to increase the probability of doing those things tomorrow to the highest level.

这显然已经成为我的一个巨大执念，你知道的。

And that has become obviously a huge obsession of mine as you know.

我和另外几个人一起创办了一家公司，名叫ten squared，专门致力于帮助人们训练实现这一目标。

I along with a couple of other folks have started a company around this called ten squared, which is just geared towards training people to do this.

我认为，至少在有人向我展示更好的方法之前，这是当你的目标不是非常具体时最好的训练模型。

And I think that it is at least until someone shows me a better idea, the best model for how to train if your goal is not something very specific.

所以，如果你来找我说：我知道你有多喜欢柔术，如果你说：嘿，六个月后有个比赛，我真的很想参加。

So again, if you came to me and said, I know how much you love jujitsu, if you're like look, there's this tournament coming up in six months and I really wanna compete for it.

那这并不是百岁十项全能。

That's not the centenarian decathlon.

为了参加那个比赛，你在柔术中需要进行非常特定的训练。

That's a very specific type of training you need to be doing in jujitsu to go and compete there.

如果我妻子明年要跑波士顿马拉松，并且她希望达到某个成绩，她绝对不会去练什么百岁全能运动。

If you know, my wife is running the Boston Marathon next year and she wants to run a certain time, she will have nothing to do with training her centenarian decathlon.

她会进行非常非常专门的跑步训练，以确保达成自己的目标。

She is going to be doing very very specific running workouts to make sure she hits her goals.

所以还有很多其他的训练方式，但我的观点是，大多数人并不是为了在本地柔术比赛中夺冠，或者在波士顿马拉松中跑出个人最佳成绩而训练的。

So there are lots of other ways to train but my point is that most people aren't training to be the best at their local jujitsu tournament or to run their PR at the Boston Marathon.

即使他们确实追求这些目标，通常也只是短暂的，而人们真正想训练的是，在人生最后十年里成为最出色、最强大的自己。

And even if they do those things, they're usually fleeting and ultimately what people really wanna be training for is to be the most kick ass versions of themselves in the last decade of their life.

再说一遍，如果这意味着你在80到90岁时的身体状态能像一个非常健康的70岁的人一样，那和大多数人经历的状况完全不同。

And again, if that means your 80 to 90 years are functioning like you're a really good 70 year old, that's a totally different experience from what most people go through.

假设有人在为百岁全能运动训练，他们认同这一点，并说：我想把全部精力都放在这件事上，也就是如何成为一个以生活为重心的运动员？

Let's say someone is training for the centenary decathlon, so they kind of agree and they say, I wanna put all my focus into this which is how do I become an athlete focused on life?

我们不需要在这里详细展开这些内容，因为在节目笔记中，我们会提供多个我们之前讨论过这些话题的链接。

And we don't have to get into these in detail because in the show notes, we'll link to the multiple multiple places we've talked about them.

但对于那些对百年十项全能训练感兴趣的人来说，你认为哪四个组成部分是重要的？

But what are the four components that you think are important for someone who is interested in training for the Centenary Decathlon?

这要从基础开始。

It starts on the foundation.

你必须具备稳定性。

You have to have stability.

你必须拥有底盘。

You have to have the chassis.

简单来说，我认为是底盘和轮胎。

Basically, I'd say the chassis and the tires.

你必须具备所有方面的运动控制、协调性、耗散力量的能力、接受力量的能力以及平衡能力。

You have to have every aspect of the motor control, coordination, ability to dissipate force, ability to receive force, ability to balance.

稳定性涉及的内容太多了，我觉得在书里占了整整一章，它也是最难解释的，但一旦缺失，却非常明显。

There's so much that goes into stability that it I think got a full half chapter in the book and it's far and away the most complicated to explain but it's really obvious to see it when it's not there.

我们每个人在稳定性方面都有所欠缺，当我转向这种训练方式时，这是我最大的重新学习部分。

So every one of us is lacking in stability and it was the biggest re education for me as I pivoted to this way of training.

所以这包括学习如何恰当地增加腹内压，如何打开肋骨，保持适当的重心，如何在需要时进行等长收缩肌肉，如何在控制下完成这些动作，以及如何拥有良好的足部力学，对吧？

So it's everything from learning how to appropriately pressurize your intra abdominal space to how to unlock your ribs, maintain an appropriate center of gravity, how to be able to isometrically contract muscles as necessary, how to be able to do it under control, how to have good foot mechanics, right?

我的意思是，我们已经就稳定性游戏的每个组成部分制作了专门的播客，因为它们都非常精细。

I mean all of these things we've done dedicated podcasts on because each component of this stability game is quite nuanced.

好消息是，虽然大多数人在中年时在这里存在巨大缺陷，但这些都可以重新训练。

And the good news is while most of us show up to the middle part of our life with enormous deficits here, they're all retrainable.

事实上，我们在老年时仍然具有相当大的可塑性。

We're actually still quite plastic in our old age.

第二个组成部分是力量。

Second component is strength.

我认为力量的一个子组成部分是爆发力。

And I would say a sub component of strength is power.

尽管我们在衰老过程中会迅速丧失爆发力，但能保持得越多越好。

So even though we lose power very quickly as we age, the more we can maintain it the better.

没有力量和稳定性，就不可能有爆发力。

And you can't have power without strength and stability.

第三个组成部分，这实际上更像一个连续体，第三和第四部分属于心肺耐力的连续体。

The third component, and this is really more of a continuum, the third and fourth are part of a continuum of cardiorespiratory fitness.

我把这个描述为一个三角形。

I talk about this as being a triangle.

所以三角形的底边是有氧效率。

So the base of the triangle is the aerobic efficiency.

这就是最大的脂肪氧化能力。

So this is the maximum fat oxidation.

这是你全天的配速。

This is your all day pace.

我们希望这个数值尽可能高。

We want that to be as high as possible.

而三角形的顶点是最大摄氧量。

And then the peak of the triangle is the vo two max.

这最恰当的理解方式是发动机的排量。

That's most adequately thought of as the engine size.

这就是有氧能力的峰值输出。

So that's the peak aerobic output.

这四个组成部分是我们在10平方项目中对患者和客户进行训练时所依据的，一旦你明确了某人的百岁目标和十项全能目标，我们就会将其分解为所需的具体指标。

Those are the four components and one of the exercises we do with both our patients and obviously the clients in 10 squared is once you have a person's centenary and decathlon goals, you break them down into what is required.

所以如果你给我你的清单，我们就可以分析说：哦，这项活动需要每公斤每分钟31毫升的VO2 max。

So if you give me your list, we can take that list and we can say oh this requires a VO2 max of 31 milliliters per kilogram per minute.

这项活动需要能够这样坐着，或者这个领域需要如此多的力量。

This requires an ability to sit this way or this requires this much strength in this domain.

这项活动需要这种类型的髋关节负荷，等等。

This requires this type of hip loading etcetera etcetera.

然后我们可以评估一个人当前的状况，并说：好吧，你今天当然能完成所有这些任务，但这些能力未来将如何衰退？到四十年后，你会高于还是低于你的基准目标？

And then we can evaluate where a person is today and then say, oh okay, well obviously today you can do all of those things but here's the predicted trajectory of decline on each of those things and will you be above your benchmarks in forty years or will you be below them?

对我们大多数人来说，包括我自己，在至少某些维度上，到目标年龄时实际表现会远低于标准，因此我们必须现在就提升表现，以确保未来能达成目标。

And for most of us, myself included, at least on some of those dimensions, you're actually considerably below them at your target and therefore you have to raise the performance currently to make sure you hit the targets in the future.

正如我们提到的，对于任何对运动相关内容感兴趣的人，我们在节目说明中会提供多个播客文章等链接，供大家深入探索。

And like we mentioned for anyone who is interested in further on anything exercise in the show notes, we'll link to the multiple podcast articles etcetera so people can dive in.

但从运动转向你第二喜欢的领域——营养，你是如何构建你对营养的看法的？因为你并不像有些人那样认为某种饮食最好或另一种饮食最好。

But moving from exercise to your second favorite, nutrition, what's your framework for how you think about nutrition because you don't necessarily think about nutrition as some people talk about it which is this diet's best or this diet's best.

你看待营养的方式有点不同，所以你能否为人们梳理一下你的框架，以及你如何评估营养状况和一个人当前的营养水平？

You kind of look at it a little bit of a different way and so do you want to walk people through your framework and how you assess nutrition and where someone is at in their nutritional state?

是的。

Yeah.

我的意思是，营养是一个非常复杂的研究领域。

I mean I would say that nutrition is a very complicated thing to study.

我认为它是所有健康支柱中最混乱的，可能甚至比情绪健康还要混乱，尽管这一点或许有争议。

I would say it's the messiest of all the pillars to study, probably even messier than emotional health, although maybe that's debatable.

但原因显而易见，无需重复；正因如此，这个领域中能以极高确定性陈述的结论非常少。

But the reasons for it are obvious and not worth restating But it's for that reason that there were very few things that can be stated in this field with a high, high degree of certainty.

因此，营养领域的挑战在于，很多人说话时充满极端的自信，仿佛他们所说的是绝对正确的，但如果你为他们的说法加上误差范围，这个范围会远远超过他们所宣称的内容。

So unfortunately, the challenge in nutrition is you have a lot of people that speak with such insane conviction and they talk about something as though it is absolutely correct even though if you were putting an error bar on their statement, it would dwarf anything they're saying.

坦白说，我也曾犯过这样的错误。

And truthfully, I have been guilty of this.

我认为十二年前，我在谈论营养时表现出的确定性是不恰当的。

I think twelve years ago, I was talking about nutrition with a level of certainty that I don't think was warranted.

所以正如俗话所说，离岸越远，水就越深。

And so as the adage goes, the further you get from the shore, the deeper the water.

随着年龄增长，我觉得自己已经远离了岸边，意识到这里的水深得惊人，而且几乎没有多少事情能以足够高的确定性被陈述，值得你以近乎盲目的信心去行动。

And I think in my older age, I'm actually quite far out from the shore and I realized the water is awfully deep out here and there aren't a lot of things that can be stated at a high enough degree of certainty that you should act on them with almost blind faith.

所以，以下是我能以极高确定性告诉你的两件事。

So here are the two that I can tell you with a very very high degree of certainty.

第一点是，对一个人整体健康而言，营养中最关键的输入是能量平衡。

The first is that the single most important input from nutrition to a person's overall health is energy balance.

换句话说，食物的能量摄入是健康的第一决定因素。

Stated another way, the energy input of food is the first order determinant of health.

也许换种说法，你摄入的总热量才是最重要的。

Maybe stated another way, the total calories you consume would be the most important thing.

但这并不是唯一因素，我并不想暗示一千卡路里的薄荷糖和一千卡路里的西兰花是一样的，它们显然不是。

Not the only thing, I do not want to suggest that a thousand calories of tic tacs is the same as a thousand calories of broccoli, it is not.

但我也是从常识的角度来谈这个问题的。

But I'm also talking about this through the lens of common sense.

事实上，如果你主要靠太妃糖为食，你会吃下远超一千卡路里的量，因为它们不能带来饱腹感，是垃圾食品，空有热量。

And the truth of it is, if you subside on a diet of tic tacs, you're gonna eat a lot more than a thousand calories of them because they're not satiating and they're junk and they're hollow.

所以我要明确一点：主要的输入是总能量，但它也受到许多其他因素的影响，包括饮食质量、加工程度和宏量营养素分布。

So I wanna be very clear that the primary input is total energy but it is also impacted by many other things including diet quality, processing and macronutrient distribution.

第二点非常明确的是，蛋白质是我们最不应该灵活对待的宏量营养素。

The second thing that is abundantly clear is that protein is the macronutrient we should be least flexible on.

换句话说，我们在满足能量需求时，对碳水化合物和脂肪的摄入量可以相当灵活。

Stated another way, we can be quite flexible on how much carbohydrate and fat we consume to fill our energy needs.

但由于蛋白质并非用于ATP生成（而碳水化合物和脂肪的主要作用正是提供ATP，尽管脂肪也对某些结构功能至关重要），我们在蛋白质摄入上不能过于灵活或妥协。

But because protein is not consumed for the purpose of ATP generation, which is the principal reason we consume carbohydrates and fats, although fats are also essential for some structural purposes, We cannot be too flexible or compromising in our protein requirements.

换句话说，如果你真想给人们一个具体的数字，我会说，平均而言，每个人每天应摄入约1.6克蛋白质每公斤体重。

In other words, if you really wanted to just come up with a single number to give people, I would say on average about 1.6 grams of protein per kilogram of body weight should be consumed by everybody.

不过再说一次，我讨厌这么说，因为真的没有任何一件事能适用于所有人。

Now again, I hate saying that because there's truly nothing that you can say across the board.

显然，有些人根据他们的饮食需要摄入更多的蛋白质，也可能有些人稍微少一点也能应付。

There are clearly people who based on what they're eating will need more protein and there are probably people who can get away with a little bit less.

如果你摄入的是完全高质量的PDCAAS评分为1.0的蛋白质，而且这个人并不特别活跃，他可能只需要1.2克甚至1克就够了。

If you took a perfectly high quality PDCAS one point zero protein in a person who's not over the moon active, they could probably get away with 1.2 grams or even one gram.

但任何低于这个数值的摄入量，你都会严重错过关键营养。

But boy, anything below that and you're starting to really miss out.

顺便说一下，随着年龄增长，由于合成代谢抵抗，这些需求还会增加。

And by the way, as you age, those requirements go up due to anabolic resistance.

所以，我们可以整天谈论各种饮食、各种宗教，以及每个宗教派别下的每个饮食流派。

So again, we can talk all day about every diet under the sun and every religion and every faction of every religion around every dietary tribe.

但事实是，真正找到一位营养学科学家其实很难。

But the truth of it is, it's really hard to find a scientist, an actual nutrition scientist.

我不是在说那些网红。

I'm not talking about an influencer.

我也不是在说那些健康博客。

I'm not talking about a health blog.

我指的是那些在实验室从事营养研究的真正专家，他们会不同意这个说法。

I'm talking about actual people who work in labs doing nutrition who will disagree with that statement.

确实有一些人，但他们属于极少数，有趣的是，他们在讨论这些问题时往往避免使用人类数据。

There are some, but they are in the huge minority and interestingly they tend to avoid using human data when they talk about those things.

但当你将范围限定在你所关注的物种——人类，而不是啮齿动物，并结合实验数据与其他见解时，这两点似乎最为关键。

But when you limit yourself to the species of interest, which is humans, not rodents and you talk about experimental data coupled with other insights, those two things seem to matter the most.

你每天摄入多少卡路里？

How many calories are you getting?

不多不少，刚刚好。

Not too much, not too little.

你摄入的蛋白质足够吗？

Are you getting enough protein?

显然还有其他因素。

Obviously there are other terms.

我们当然也要确保你摄入了足够的微量营养素，并且避免接触毒素。

We certainly want to make sure you're getting enough micronutrients as well and that you're avoiding toxins.

与一百年前相比，今天这个问题通常不那么严重了。

That tends to be less of an issue today than it was a hundred years ago.

但当然，这也很有趣。

But of course that's also really interesting.

但尼克提到的其他很多细节都很重要。

But a lot of the other stuff Nick is details.

因此，当我面对患者时，鉴于这些因素至关重要，我认为从一开始就评估这些方面是有道理的。

So when I'm looking at a patient, given how important those things are, to me it makes sense to be evaluating those things at the outset.

所以当我们第一天对患者进行DEXA扫描时，可以观察到他们的皮下脂肪量、内脏脂肪量、肌肉质量，并进行大量先进的血液检测，了解他们的代谢健康状况、葡萄糖代谢能力以及其他各种指标。

So when we do a DEXA scan on somebody on day one and we can see how much subcutaneous fat they have, how much visceral fat they have, how much muscle mass they have and we can do a lot of advanced blood work and see how metabolically healthy they are, how well they dispose of glucose, all these other things.

我能够迅速回答三个问题。

I can very quickly answer three questions.

甚至在初次接触时就能做到。

Literally on first contact.

你是营养过剩还是营养不足？

Are you overnourished or undernourished?

这实际上归结为能量平衡。

And that really comes down to energy balance.

你的身体有多少脂肪，以及这些脂肪在体内的分布情况如何？

How much fat do you have on your body and how well is it distributed throughout your body?

脂肪分布在哪些部位？

Where is it distributed?

第二个问题：你的肌肉量是否充足，还是肌肉不足？

Second question, are you adequately muscled or are you under muscled?

第三个问题：你的代谢健康状况如何？

Third question: Are you metabolically healthy or not?

当你能快速回答这三个问题时——仅需少量数据就能在很短时间内完成——你就能判断这个人需要增加、减少还是保持相同的总能量摄入，需要更多、更少还是相同的蛋白质，以及为了补充我们的发现，他们应该进行何种类型的运动。

And when you can answer those three questions, which you can in a very short period of time with a relatively small amount of data, that tells you does this person need to eat more, less or the same total energy, the same amount of protein or less and how important and what type of exercise should they be doing to augment our findings.

因为我们讨论的是营养，我最后要说的是，大多数人在进行这种评估时都会被归入轻微营养过剩的类别。

Because we're talking about nutrition, I'll close this out by saying most people when they do this come out slightly in the overnourished category.

这不过是说，大多数人超重或肥胖而已。

That's just another way of saying most people are overweight or obese.

我认为，大约百分之七十的人口属于营养过剩或显著营养过剩。

I think the numbers are probably seventy percent of the population are overnourished or significantly overnourished.

因此，当你走完整个治疗算法时，大多数人会发现自己属于‘需要少吃’的类别。

Therefore, most people when you go through that whole treatment algorithm are going to be in the I need to eat less camp.

如果你属于‘需要少吃’的类别，现在你有三种方法可以做到这一点。

If you are in the I need to eat less camp, you now have three ways to do that.

三种策略，你可以这么理解。

Three strategies if you will.

第一种是直接减少热量摄入。

The first is directly reducing caloric intake.

也就是说，不管吃的是什么、什么时候吃，我就是简单地吃得更少。

So, that says, agnostic to what or when I eat, I will simply eat less.

这是最直接的方法。

This is the most direct way to do it.

这种方法有很多优缺点，我们在其他播客中已经详细讨论过，我们会提供相关链接。

It has lots of pluses and minuses which we have discussed in so much detail in other podcasts that we'll link to.

第二种方法是，我会识别出饮食中某种或某些食物，并将它们从饮食中移除。

The second method is I will identify something or some set of things in the diet that I will remove from the diet.

我会限制这些食物。

I will restrict them.

这被称为饮食限制。

This is called dietary restriction.

你饮食中限制的项目越严格，这种方法就越有效。

And the more restrictive the elements of your diet, the more effective this technique is.

所以，如果你只选择限制生菜，这将没有任何效果。

So, if you only choose to restrict lettuce, this will have no effect.

如果你限制所有食物，只允许自己吃土豆，也就是说，你唯一允许吃的食物是土豆，这会产生巨大的效果。

If you restrict everything but potatoes, meaning if the only thing you allow yourself to eat is potatoes, this will have an enormous effect.

因此，限制得越严格，效果就越好。

So, the more you restrict the better that works.

第三种策略是时间限制，即限制你进食的时间窗口，这个窗口越窄，你就越有可能总体上造成热量赤字。

And then the third strategy is time restriction where you limit the window in which you eat and the narrower and narrower that window, the greater the likelihood that you will overall induce a caloric deficit.

关于营养，我还能说很多。

So there's a lot more I can say about nutrition.

我们可以深入探讨哪些类型的脂肪更好，比如饱和脂肪、单不饱和脂肪、多不饱和脂肪。

We could get into the nuances of which type of fats are better, saturated fats, monounsaturated, polyunsaturated fats.

地中海饮食是否比低碳水或低脂饮食更有效，诸如此类的问题。

Is a Mediterranean diet more efficacious than a low carb diet or a low fat diet and all of those things.

我之前写过、也讲过这些，但我认为从最重要的方面来看，你已经掌握了。

Again, I've written about, I've spoken about but I think from the standpoint of what are the most important things, think you've got it.

你记得午餐吃了什么吗？

Have you remembered what you ate for lunch yet?

我认为营养对话中唯一遗漏的就是这个了。

That's I think the only thing from the nutrition conversation that's missing.

我狼吞虎咽地吃了一些昨天做的西葫芦面，我还吃了什么？

I scarfed down some leftover spaghetti squash that we made yesterday and what else did I have?

哦，我吃了一盒黑莓，还吃了一些鹿肉。

Oh, I had a container of blackberries and I had some venison.

就是这样。

There you go.

很好。

Great.

接下来谈谈睡眠。

Moving on to sleep.

睡眠是你写过的一个话题，你现在比过去更重视它了。

So sleep is something you've written about where you take it much more seriously now than maybe you used to in the past.

所以你愿意谈谈为什么你觉得睡眠不仅是寿命，也是健康寿命的重要组成部分吗？

So do you wanna talk about why you think sleep is such an important component of not only lifespan but also health span.

我认为数据本身已经比我的阐述更有说服力了。

Well, I think the data really make the case more compellingly than I need to.

幸运的是，短期睡眠不足很容易研究，它明确地证明了对认知、体能表现、胰岛素抵抗等健康生理指标以及食欲的显著负面影响。

Fortunately, short term sleep deprivation is easy to study and it unequivocally demonstrates a remarkable negative impact on cognition, on physical performance, on physical markers of health such as insulin resistance, on appetite.

人体内所有可能出问题的事情，在睡眠不足时都会出问题。

Everything that can go wrong in the human body goes wrong when you are sleep deprived.

而且，这一点的好处在于，你不需要进行五年期的研究就能弄清楚这个问题。

And again, what's nice about this is you don't need to do five year studies to figure this out.

你可以进行两到三周的研究，让人们的睡眠时间减少到每晚四小时，然后在他们清醒的时段内，彻底破坏他们的各项生理指标。

You can do two week, three week studies where you take people down to four hours a night of sleep and you can absolutely destroy them in every physiologic measure during the wakeful period of their lives.

因此，我们可以由此推断，如果你每晚只睡五个半小时或六小时，可能不会受到那么严重的负面影响。

So we can then extrapolate from there that okay, well if you're only sleeping five and a half or six hours a night, you're probably not getting as much of the negative effects.

但当我们观察到其他程度较轻的负面影响时，似乎很容易将它们归因于睡眠减少。

But when we see and measure other effects that are negative to a lesser extent, it seems pretty easy to attribute them to the reduction of sleep.

换句话说，当你观察那些睡眠不足程度不如短期研究中受试者那么严重的人时，他们也会出现许多相同的问题，只是程度没那么极端。

So in other words, when you look at a person who's not sleeping as inadequately as people are typically studied in short term studies geared towards identifying the risks, they get many of the same problems but just not as extreme.

这表明睡眠减少存在剂量效应。

Suggesting there's a dose effect to sleep reduction.

坦率地说，我认为如今社会比十年前更愿意接受这一点。

And truthfully, I think that this is something that I think society is far more willing to entertain today than ten years ago.

我认为马特·沃克——他也是我非常亲密的朋友——对此起到了很大作用。

I think Matt Walker, who's also a very close personal friend, has had a lot to do with this.

阿里安娜·赫芬顿为此带来了大量关注。

Ariana Huffington has brought a lot of attention to this.

所以我认为，有很多人正在说：‘我死后再说睡觉吧’，这种曾经是我的座右铭的想法，现在看来，如果你坚持这种态度，你会死得更快。

So I think there are many people out there that are saying, hey, this whole idea of I'll sleep when I'm dead, which used to be my mantra is like, you're gonna be dead quicker if you adopt that mantra.

你确实会在死后睡觉，但你会比你希望的更早死去。

So you will indeed sleep when you're dead and you'll be dead sooner than you wanna be.

所以，我认为这一点不需要太多说服力。

So again, I think that this one doesn't require a lot of convincing.

但如何做到这一点，当然要复杂一些。

But how to do it of course is a little more complicated.

好消息是，现在有很多优秀的行为干预方法，最终对某些人来说，还可以使用药物或机械辅助手段，比如患有睡眠呼吸暂停的人可以使用CPAP，无论是药物还是其他技术，都能在这里提供很大帮助。

The good news is there's really a lot of wonderful behavioral tools and ultimately for some people pharmacology or mechanical assistance such as CPAP, if a person has apnea, there are technologies both pharmacologic and otherwise that can really help here.

但对于大多数人来说，行为干预方法就足够了。

But for most people the behavioral tools do the work.

这真的是少数人需要看医生来帮助入睡或解决睡眠问题的情况之一。

This is really one of those things where very few people need to see a physician to help them sleep or to troubleshoot a sleep problem.

当你这么做的时候，幸运的是，医学界有一个专门研究睡眠生理学的分支。

And when you do, fortunately there's an entire branch of medicine dedicated to sleep physiology.

确实有一些医生专门研究这一领域，如果有必要，我们绝不排斥寻求他们的帮助。

There are actual physicians who specialize in this and we're certainly not afraid to use them when it's necessary.

还有一种名为认知行为疗法（CBT-I）的行为疗法，这是一个专门针对失眠期间可使用的认知工具的完整学科。

There's also a field of behavioral therapy called cognitive behavioral therapy for insomnia that is an entire discipline that is dedicated towards the cognitive tools that you can use during periods of insomnia.

因此，我们诊所总会遇到一些睡眠状况极其糟糕的患者，而在我们面临的所有问题中，这个问题是我最乐观地认为能在相对较短时间内提供帮助的。

So we always get patients in our practice who just have what can only be described as the most abjectly horrible sleep and of all the problems we face, this is the one that I tend to be most optimistic about our ability to help in a relatively short period of time.

我们有一个专门讨论睡眠的AMA，还有多期马特·沃克的节目。

We have a whole AMA dedicated to sleep along with multiple Matt Walker episodes.

所以我认为我们不需要深入到极端细节，因为我们会把相关资源链接在节目说明中。

So I don't think we needed to get into insane detail because we will link it in the show notes.

但你提到了一些行为工具，如果有人表示：‘我需要更多关注我的睡眠，需要做更多事情来改善睡眠质量。’

But you mentioned a few of the behavioral tools and so if someone says, okay, I need to take more awareness of my sleep, I need to do more to get better sleep.

那么他们可以关注和评估哪些方面呢？

What are some of the things that they can look at and evaluate?

我会说，如果我们乘电梯，只有从一楼到十五楼这段时间让我告诉你所有重要的事，我会说：每天尽量在同一时间上床睡觉、在同一时间起床。

I would say if we were in an elevator and we had only between the 1st Floor and the 15th Floor for me to tell you everything that mattered, I would say try to go to bed at the same time and wake up at the same time every day.

给自己大约八小时的卧床时间，让房间尽可能黑暗、尽可能凉爽，并在睡前两小时远离任何刺激性事物，尤其是工作、社交媒体这类令人不安的内容。

Give yourself about eight hours to be in bed, make the room as dark as possible, as cold as possible and detach yourself from anything stimulating, especially upsetting which is work, social media, that kind of stuff for two hours before bed.

如果我们还没说到十五楼，我会说：睡前三小时内尽量不要吃东西或饮酒。

And if we haven't hit the 15th Floor yet, I would say try to not eat or drink any alcohol for three hours before bed.

这些就是零风险、零后悔的举措，可以帮助你改善睡眠。

Those would be the no risk, no regret moves to try to fix your sleep.

这已经很多了，顺便说一句。

And that's a lot by the way.

我并不是说，对于一个目前一项都没做到的人，这些很容易做到。

I'm not suggesting that would be easy to do for someone who's doing none of them.

但如果你给我一百个抱怨睡眠不好、或者客观数据显示睡眠质量差的人，如果他们全都这么做，我认为其中大约八十人会有所改善。

But if you gave me a 100 people who were complaining of poor sleep and or objectively had measurements of poor sleep and all a 100 of them did that, think 80 of them would get better.

我们来谈谈药物和补充剂。

Moving to drugs and supplements.

关于药物和补充剂，如果我们查看所有不同的药物和药理学内容，以及所有补充剂，我们有海量的信息，根本不可能在这里回答所有提出的问题。

This is something that if you look at all the different drugs, pharmacologic, if you look at all the supplements, we have an insane amount of content on, impossible to answer all the questions here that come in.

但我认为，帮助人们理解药物和补充剂应有的关系、应该如何看待它们、又不应该如何看待它们，以及当患者带着一份多达20种补充剂的清单前来就诊时，你该如何与他们沟通？

But I think helping people understand just what the relationship with drugs and supplements should be, how they should think about it, how they should not think about it, How do you talk to patients about that who come in to the practice and maybe have a list of 20 supplements that they show up with?

是的，这确实是一种典型情况。

Yeah, that's definitely one phenotype.

我想简单地谈谈这两种极端情况。

I would say just to kind of address both extremes.

有些人认为所有问题都能靠药物和补充剂解决，而另一些人则认为绝对不该服用任何药物或补充剂。

You have some people who think everything is solved by drugs and supplements and then you have people who think you should never take a drug or a supplement.

所以我总是提醒人们，药物和补充剂只是一种工具。

And so I just always kind of try to remind people, drugs and supplements are just a tool.

说‘我永远不想吃药’，就像对承包商说：‘请好好帮我盖房子，但千万别用锤子，也别用十字螺丝刀。’

To say I never wanna take a drug is kind of like telling a contractor, hey, please do a good job building my house but just never use the hammer or never use the Phillips screwdriver.

你可以用罗伯逊螺丝刀，但不能用十字螺丝刀。

You can use the Robertson but not the Phillips.

你只是想要一些工具。

You just wanna have tools.

我们只是想要工具，最好的承包商、木匠和技工都会拥有最多的工具，并且最熟悉如何以及何时使用它们。

We just wanna have tools and the best contractor and carpenter and tradesman is gonna have the most tools and the most facility with knowing how and when to use them.

因此，说到补充剂，我们确实有一套框架，因为正如你所说，补充剂的数量是无限的。

So, that said, we do kind of especially on the supplement side, have a framework because as you said, there's an infinite number of supplements.

受监管的药物数量是有限的，但补充剂的数量却是无限的。

There's a finite number of regulated drugs but a non finite number of supplements.

所以你必须为这件事建立一个框架。

So you have to have a framework for this thing.

因此，对于任何外源性分子，我首先问自己的问题是：这个分子是用来延长寿命还是改善健康寿命的？

And so the first question I'm always asking myself with any exogenous molecule is is this a molecule that is being taken to lengthen lifespan or improve health span?

你可能会惊讶于，我问过多少次服用补充剂的人，他们是为了这两个目标中的哪一个而服用的。

You would be amazed at how many times I ask somebody who's taking a supplement which of those two they're taking it for.

通常你会得到一片茫然的表情。

Usually you get a very blank stare.

我吃这个是因为网红建议我吃。

I'm taking it because influencer told me to take it.

好的。

Okay.

假设我们可以确定你是出于以上其中一个原因服用这个。

So let's say we can establish that you are taking this for one of those reasons.

它要么能让我活得更久，要么能改善我的身体、认知或情绪健康。

It's either gonna make me live longer and or it's going to improve my physical, cognitive or emotional health.

下一个问题我会问：如果这是延长寿命的物质，能让你活得更久，它是通过针对某种特定疾病起作用，还是一种广谱的抗衰老分子？

The next question I would say is okay, if this is a lifespan enhancer, if this is gonna make you live longer, is it doing it by targeting a specific disease or is it a broad gero protective molecule?

同样地，如果你说这是增强健康寿命的物质，它是专门提升认知健康、体能表现、情绪健康，还是通过某种我们还不清楚的机制起作用？

Similarly, if you're telling me this is a health span enhancer, is it specifically enhancing cognitive health, physical performance, emotional health or is it sort of acting through some mechanism we don't understand?

我会问，这种物质是否有安全性的数据？

I would ask if we have safety data on this.

我会问，这种物质在人类身上是否有有效性数据，如果没有，那在动物身上是否有？

I would ask if we have efficacy data in humans and or in animals if not.

如果是在动物身上，那有多大的相关性？

And if in animals, how relatable is it?

如果这是一种补充剂，我会问如何控制纯度？

If it's a supplement, I would ask how can we control for purity?

我们怎么知道瓶上标注的成分确实存在，而没有不该有的东西？

How do we know that what the bottle says is in it, is actually what's in it and that nothing that's not supposed to be in it isn't in it?

还有几个其他问题，但这就是主要的了。

There are a few more questions but that's the long and short of it.

因此，我认为每个人都需要经过这样的思考过程，对每一件事都应用这种筛选标准，只有在那之后，我们才应该考虑：我们到底想使用哪些补充剂？

And so, I think one needs to go through that type of exercise and put that type of filter to everything and then and only then I think should we go down the path of okay, what supplements do we want to use?

我们该在哪些方面转向药物、激素等手段？

Where do we want to turn to pharmacology, hormones, those things.

我们来谈最后一个策略，你之前稍微提到过，因为情绪健康也属于健康寿命的范畴。

Moving to the last tactic and you talked a little bit about this because emotional health fits in the health span bucket as well.

但当人们谈论长寿时，情绪健康通常不会被经常提及。

But when people think about longevity, emotional health is not something that usually comes up a lot.

那么，你会对那些已经在改善饮食、锻炼、睡眠、药物和补充剂，却未必关注情绪健康的人说什么呢？

And so what would you say to someone who maybe is taking the steps in their nutrition, their exercise, their sleep, drugs and supplements, but not necessarily focusing on their emotional health?

你对他们的建议是什么？情绪健康虽然并不总是与长寿直接相关，但你认为它是重要的一环？

What would your advice to them be on how emotional health, you don't necessarily correlate it all the time with longevity, but you find it to be an important aspect?

嗯，我觉得有两个方面。

Well, mean, think there's two components.

我认为有足够的证据表明——虽然你永远无法完全证明——那些更能管理压力、更快乐、拥有更好人际关系的人，可能也活得更久。

I think there is enough evidence, though you could never prove it, that a person who's managing their stress better, who's happier and who has better relationships, probably also lives longer.

流行病学数据确实支持这些观点，这一点并不模糊。

Certainly the epidemiology suggests all of that, that's not unclear.

但我承认，要证明这种因果关系会非常困难。

But I'm acknowledging that that would be very difficult to demonstrate causality.

人们可能是因为健康状况更好，才变得更快乐、拥有更好的人际关系。

People could be happier and have better relationships and all those things because their health is better.

所以，这里可能存在反向因果关系。

So it could be reverse causality there.

但我认为，实际上有足够的证据表明，两者之间至少存在双向因果关系。

But I think there's actually enough evidence that there's at least bidirectional causality there.

但我觉得，要帮助某人思考这个问题，我会说：别管这些了。

But I think to help somebody think about this, would say just forget that.

我们假设痛苦、孤独和愤怒反而能让你活得更久。

Let's pretend that being miserable, lonely and angry helped you live longer.

而如果你快乐、拥有良好的人际关系、内心和谐，反而会缩短寿命。

And that if you were happy and you had great relationships and you were in harmony, you would live shorter.

在这种前提下，谁会选择前者呢？

Who would choose the former when you frame it that way?

除了极端情况，比如快乐的人活不过30岁，而痛苦的人能活到100岁。

Outside of extremes, like okay, happy people can't live past 30, miserable people can live to a 100.

我敢肯定，很多人会说：那我宁愿痛苦地活到100岁。

I'm sure a lot of people would say, well I'd rather be miserable at a 100.

但事实是，即使这样假设，也显得荒谬至极。

But the truth of it is, even framed that way it seems ridiculous.

所以，所有这些都说明，作为一个思想实验，干脆把寿命这部分抛开。

So all of that is to say as a thought experiment, just forget the lifespan piece of this.

只从常识的角度来思考这个问题。

Just think of it through the lens of common sense.

你为什么要选择不快乐呢？

Why would you ever choose to be unhappy?

这毫无道理。

It doesn't make sense.

我认为，我晚年时的一个重要领悟是：对此你其实可以做点什么。

And I think what maybe for me was a big insight late in life was you can do something about this.

每个人都有自己的故事、经历和背景，这些塑造了现在的你，但它们都是可以改变的。

Everybody's got a story, everybody's got a history, everybody's got a background that brings them to the table, but it's all modifiable.

重点是，这个软件是可以被修改的。

So the software can be modified is the point.

关于这一点，我们有大量内容，显然我在这里无法详细展开。

And we've got so much content on this that I obviously couldn't go into it in any detail here.

但我认为，就本次讨论而言，最重要的是，这一领域的重要性与所有其他领域相当，甚至可能更为重要，因为如果这一项没有掌控好，其他所有都无从谈起。

But I think the most important thing for the purpose of this discussion is that this entire area is as important, potentially more important than all of the others because without this one in check, the other ones don't matter.

彼得，我觉得这基本涵盖了我们原本希望讨论的内容。

Peter, I think that kinda wraps what we were hoping to cover.

而且，正如我们一开始提到的，我们的目的并不是深入每一个细节，我们会提供相关链接，但更侧重于介绍长寿领域的基础入门知识，帮助新手或需要温习的人理解一些核心要点。

And again, as we kind of mentioned on the outset, the idea is not to get into the super intense details on everything, we'll link to that but more so cover high level longevity one zero one, how you think about some core aspects for people who are newer, people who need a refresher.

我想最后我们应该谈一下，如果有人是新手，正在听这段对话，可能会感到不知从何开始，对吧？

I think the last thing that we should end with is just if someone is new and they're listening to this and they maybe feel a little bit overwhelmed on where they should start, right?

关于寿命、健康寿命、不同疾病和各种方法，我们刚才讲了很多信息。

A lot of information came out of them on the lifespan, health span, different diseases, different tactics.

对于正在听这段话、想更认真对待这个问题但又不知从何入手的人，你会给什么建议？

What advice would you give someone who is listening and they would say, I wanna take this more seriously but I'm a little overwhelmed on where to start?

我会说，先选一个。

I would say just pick one.

这不是竞赛，我认为找到你觉得自己能成功做到的一件事，是最好的起点。

It's not a race and I think finding something that you think you're gonna be successful in would be the best first place to start.

所以，如果你在听完我们刚才讨论的所有内容后，觉得有那么一点特别触动你？

So if after listening to everything we just talked about, you're kind of like, you know what really resonates with me?

我的睡眠质量可能很差。

My sleep probably sucks.

那我会说，别去改变你的饮食，别去改变你的锻炼，别做其他任何事，也别买任何补充剂，就专注于我们谈过的睡眠改善。

Then I would say, how about you change nothing in your nutrition, nothing in your exercise, Don't do anything else, don't buy a supplement, just work on implementing the stuff we talked about on sleep.

因为如果你能把睡眠改善好，它会带来两个效果。

Because if you get that better, it's gonna do two things.

它会让你更容易去应对其他方面，同时也会给你信心和掌控感，让你觉得：嘿，我其实能掌控这件事。

It's gonna make it easier for you to address the other things and it's going to give you the confidence and agency that says, hey, I actually have control over this thing.

这并不是我无能为力的。

It's not out of my hands.

太棒了。

Awesome.

好了，Peter，希望听众们喜欢这期特别节目，感谢你抽出时间，我们下期再见。

Well, Peter, hopefully people enjoyed this special episode, but thank you for your time and we'll see you on the next one.

听起来很棒。

Sounds great.

感谢您收听本周的《The Drive》节目。

Thank you for listening to this week's episode of The Drive.

对我来说，提供所有这些内容而不依赖付费广告至关重要。

It's extremely important to me to provide all of this content without relying on paid ads.

为此，我们的工作完全依赖于我们的会员支持。

To do this, our work is made entirely possible by our members.

作为回报，我们为会员提供独家内容和额外福利，远超免费内容所能提供的。

And in return, we offer exclusive member only content and benefits above and beyond what is available for free.

所以，如果您想将您对这一领域的知识提升到下一个层次，我们的目标是确保会员获得的回报远超订阅费用。

So if you wanna take your knowledge of this space to the next level, it's our goal to ensure members get back much more than the price of the subscription.

高级会员包含多项福利。

Premium membership includes several benefits.

首先，提供详尽的播客节目笔记，涵盖每一集中讨论的每一个主题、论文、人物和事项。

First, comprehensive podcast show notes that detail every topic, paper, person, and thing that we discuss in each episode.

而且街谈巷议都说，没人能比得上我们的节目笔记。

And the word on the street is nobody's show notes rival ours.

第二，每月一次的问答环节（AMA）。

Second, monthly ask me anything or AMA episodes.

这些节目由对订阅者问题的详细回答组成，通常聚焦于单一主题，旨在为会员特别关注的话题提供极大的清晰度和深度。

These episodes are comprised of detailed responses to subscriber questions, typically focused on a single topic and are designed to offer a great deal of clarity and detail on topics of special interest to our members.

当然，你还能获得这些节目的节目笔记。

You'll also get access to the show notes for these episodes, of course.

第三，接收我们由专职研究分析团队制作的高级通讯。

Third, delivery of our premium newsletter, which is put together by our dedicated team of research analysts.

这份通讯涵盖与长寿相关的广泛主题，内容比我们免费的每周通讯更加详尽。

This newsletter covers a wide range of topics related to longevity and provides much more detail than our free weekly newsletter.

第四，访问我们的私人播客源，让你能收听所有剧集，包括不含你现在所听的这段开场白的AMA内容，与你常规播客源中的版本不同。

Fourth, access to our private podcast feed that provides you with access to every episode including AMA's sans the spiel you're listening to now and in your regular podcast feed.

第五，Qualys，这是我们为会员特别制作的额外播客，相当于精选集，汇集了《The Drive》过往各期的精彩片段。

Fifth, the Qualys, an additional member only podcast we put together that serves as a highlight reel featuring the best excerpts from previous episodes of the drive.

这是一种很好的方式，可以无需逐个回听以往的每一集来了解之前的内容。

This is a great way to catch up on previous episodes without having to go back and listen to each one of them.

最后，还有一些陆续增加的其他福利。

And finally, other benefits that are added along the way.

如果你想了解更多并获取这些会员专属福利，可以前往 peterateamd.com/subscribe。

If you wanna learn more and access these member only benefits, you can head over to peterateamd.com forward slash subscribe.

你也可以在 YouTube、Instagram 和 Twitter 上关注我，我的用户名都是 PeterAttiaMD。

You can also find me on YouTube, Instagram, and Twitter, all with the handle PeterAttiaMD.

你也可以在 Apple Podcasts 或你使用的任何播客平台上给我们留下评价。

You can also leave us review on Apple Podcasts or whatever podcast player you use.

本播客仅用于一般信息目的，不构成医学、护理或其他专业医疗服务，包括医疗建议。

This podcast is for general informational purposes only and does not constitute the practice of medicine, nursing, or other professional healthcare services, including the giving of medical advice.

不形成医患关系。

No doctor patient relationship is formed.

使用本信息及与本播客相关的材料，风险由用户自行承担。

The use of this information and the materials linked to this podcast is at the user's own risk.

本播客的内容不应用于替代专业的医疗建议、诊断或治疗。

The content on this podcast is not intended to be a substitute for professional medical advice, diagnosis, or treatment.

用户不应忽视或延迟寻求针对自身健康状况的医疗建议，应向医疗专业人员寻求帮助。

Users should not disregard or delay in obtaining medical advice from any medical condition they have, and they should seek the assistance of their health care professionals for any such conditions.

最后，我非常重视所有利益冲突问题。

Finally, I take all conflicts of interest very seriously.

关于我所有的披露信息以及我投资或咨询的公司，请访问 peterateamd.com/about，那里会保持一份最新且活跃的全部披露清单。

For all of my disclosures and the companies I invest in or advise, please visit peterateamd.com/ about where I keep an up to date and active list of all disclosures.