#342 ‒ 健康衰老：彼得与养老中心的居民分享延长寿命的策略

大家好。

Hey, everyone.

欢迎收听《Drive》播客。

Welcome to the Drive podcast.

我是你们的主持人，彼得·阿蒂亚。

I'm your host, Peter Attia.

这个播客、我的网站以及我的每周通讯，都致力于将长寿科学转化为每个人都能理解的内容。

This podcast, my website, and my weekly newsletter all focus on the goal of translating the science of longevity into something accessible for everyone.

我们的目标是提供健康与福祉领域最优质的内容，为此我们组建了一支优秀的分析团队来实现这一目标。

Our goal is to provide the best content in health and wellness, and we've established a great team of analysts to make this happen.

对我来说，不依赖付费广告来提供所有这些内容至关重要。

It is 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，这些是免费用户无法获得的。

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

如果你想将你对这一领域的认知提升到一个新的层次，我们的目标是确保会员获得远超订阅费用的回报。

If you want to 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.

如果你想了解更多关于我们高级会员权益的信息，请前往 peteratiamd.com/subscribe。

If you want to learn more about the benefits of our premium membership, head over to peteratiamd.com forward slash subscribe.

欢迎收听Drive播客的特别节目。

Welcome to a special episode of the drive.

这次对话与我们通常的格式略有不同，我的女儿奥利维亚与我互换角色，坐在这里担任采访者，我们一同探访一家养老院，探讨与老龄化人口相关的所有长寿话题。

This conversation is a bit different from our usual format as my daughter, Olivia, trades places with me to take this seat as the interviewer as we visit a senior living center to discuss all things longevity as it relates to an aging population.

背景信息：去年夏天，奥利维亚曾在这所养老院做志愿者，与多位居民建立了联系，这些居民对健康寿命、预期寿命以及如何健康地 aging 表现出浓厚兴趣。

A bit of background, Olivia spent part of her summer last year volunteering at this center where she connected with a number of the residents who had an interest in curiosity about health span, lifespan and strategies for living well as they age.

通过这段经历，他们邀请我为他们的群体做一次演讲，我们决定将这次对话录制下来并分享给你们。

And through that experience they invited me to speak with their audience and we decided to record it and release it to you as well.

在这次对话中，我们讨论了所有这些话题，但特别聚焦于老龄化人口。

In this conversation we speak about all of these topics but with a particular focus around an aging population.

所以我们探讨了长寿的真正含义——不仅仅是延长生命的年限，更是让生命更有质量。

So we talk about what longevity really means, not just adding years to life but life to years.

我们讨论了慢性疾病的四大杀手，探讨了为何任何时候开始改善健康都不算晚，强调了运动尤其是力量训练在维持行动能力、预防跌倒和保持独立性方面的关键作用，以及如何在晚年科学地进行锻炼；还谈到了蛋白质摄入和衰老时期的营养原则。

We talk about the four horsemen of chronic disease, talk about why it's never too late to start making changes for better health, talk about the critical role of exercise, especially strength training in maintaining mobility, preventing falls and preserving independence and how to approach exercise later in life, Talk about the importance of protein intake and nutrition principles for aging.

讨论了睡眠优化。

Talk about sleep optimization.

我们谈到了情绪健康与社会联系、人生目标，以及为什么人际关系与身体健康同样重要。

We talk about emotional health and social connection purpose and why relationships matter as much as physical health.

那么，不多说了，请欣赏本期《驱动》的特别节目。

So without further delay, please enjoy this special episode of The Drive.

欢迎。

Welcome

大家好。

everyone.

我叫奥利维亚·阿蒂亚，今天和我父亲彼得·阿蒂亚一起来到这里。

My name is Olivia Attia, and I'm here with my dad, Peter Attia.

我们今天来这里是为了和大家谈谈长寿。

We are here to talk to you today about longevity.

今年夏天，我在一家名为Quirincia的养老中心做志愿者，正是在那里我认识了萨莉，可惜她今天没能来，因为她生病了。

So over the summer, I volunteered at a senior living center called Quirincia, which is where I met Sally, who unfortunately couldn't be with us today because she's sick.

但我们聊了起来，我发现她对我爸爸的工作非常感兴趣，我相信在座的各位也一样。

But we got to talking and I discovered that she's very interested in my dad's work, as I'm sure all of you are.

所以我们决定今天由我们两人进行45分钟的对话，让内容更有趣。

So we decided that we'll be here today and we'll be doing forty five minutes of conversing between us two to keep it interesting.

最后再留一点时间，让大家向他提问自己感兴趣的问题。

And then a little bit of time at the end for you guys to ask him things that you're interested about.

那么，说了这么多，你们准备好了吗？

So with all that being said, are you ready?

我已经准备好了。

As I'll ever be.

好的。

Okay.

我觉得从‘长寿’这个词本身开始讨论会很有帮助，因为不同的人对它有不同的理解。

I think it'll be helpful to start talking about the actual word longevity because it can mean different things to different people.

当你谈到长寿时，你指的是永生吗？还是你如何定义它？

When you talk about longevity, are you talking about living forever or how are you defining it?

绝对不是永生。

Definitely not living forever.

尽管可以理解，这可能是有些人一想到长寿就会联想到的内容。

Although understandably, that's probably what some people think of when they think of longevity.

我从两个方面来谈论它。

I'm talking about it in terms of two things.

其中一个叫做寿命，另一个叫做健康寿命。

One of them is called lifespan and the other is called health span.

而寿命正是大多数人会想到的部分。

And lifespan is the part that I think most people think of.

它指的是你活多久。

It's the how long you live part.

但还有健康寿命，它指的是你活得有多好。

But then there's health span, which is the how well you live part.

这两者都很重要。

And both of these things are important.

我认为它们同等重要，只追求其中一个而忽视另一个是不理想的。

I would argue that they're of equal importance and an extreme of one without the other is not ideal.

换句话说，我不认为在座的任何人会说：‘我希望活到一百岁，但想在最后二十年里无法行动。’

In other words, I don't think there's anybody sitting here who says, I'd love to live to a 100, but I want to spend the last twenty of those years unable to move.

我的意思是，这并不理想。

I mean, that wouldn't be ideal.

同样地，我认为，如果一个人拥有精彩健康的生活，却在50岁时过早离世，也没有人会觉得这是理想的。

And similarly, I think the idea of living an amazing healthy life, but that life being cut short prematurely at 50, nobody would think that that's ideal.

所以当我想到长寿时，我真正想的是同时最大化生命的长度和生活的质量。

So when I think of longevity, what I'm really thinking about is maximizing both the length of life and the quality of life.

而生活质量还可以进一步细分为身体层面的部分。

And again, quality could be further broken down into sort of a physical piece.

所以我是否大部分时间都远离疼痛？

So am I free of pain most of the time?

我还能做我喜欢做的那些体力活动吗？

Am I able to physically do the things I enjoy doing?

这可以包括日常生活和自我照顾，也可以包括休闲活动。

And that could range from just the activities of daily living and self care to recreational activities.

如果你喜欢园艺，你希望还能做多久？

If you like to garden, how long do you want to be able to do that?

如果你喜欢打高尔夫、散步、远足或游泳。

If you play golf, if you like to go for walks and hikes or swim.

然后还有一部分是认知能力。

And then there's a cognitive piece.

所以我不认为，哪怕是我这个年纪的人，会完全期待我的大脑像她那样敏锐。

So I don't think anybody would fully expect, even at my age, that my brain is kind of as sharp as hers is.

但我仍然希望相信我的思维依然很敏锐。

But I still want to believe that my mind is pretty sharp.

我想我们都希望尽可能长时间地保持这种状态。

I think we all sort of want that for as long as possible.

而最后一部分是情感层面，涉及幸福感、人生意义以及与他人的联系。

And then the final piece is an emotional piece that deals with happiness, sense of purpose, connection to others.

你可以想象这样一种情况：某人拥有完美的身体健康寿命，意味着他们在身体上可以做任何想做的事。

And again, you can imagine a scenario where somebody has perfect physical health span, meaning they can do anything they want to do physically.

他们的头脑也很敏锐，但却没有朋友，也没有任何人际关系。

Their brain is sharp, but they have no friends and no relationships.

我想我们都同意，这并不是真正理想的生活，也不认为任何人会向往这样的生活。

And I think we would all agree that that's not really an ideal life and I don't think anybody would aspire to that.

所以这些内容很多，但当你把所有这些因素综合起来时，对我来说，这就是长寿的含义。

So that's a lot there, but when you put all those things together, to me that's what longevity is.

如果在座的有些人正在疑惑，现在开始关注长寿和延长生命是不是太晚了？

If some people here are wondering, is it too late to start caring about longevity and living longer?

你会对他们说什么？

What would you say to them?

我会说，情况并非如此。

I would say that that's not the case.

我会说，一方面，一个人越早开始采取措施延长寿命，就越有更多机会。

I would say that on the one hand, sure, the earlier a person begins to take steps to increase their longevity, the more opportunity they have.

这有点像投资。

It's sort of like investing.

什么时候是开始为退休储蓄的最佳时机？

When is the best time to start saving for retirement?

大概是你在十几岁或二十几岁开始拿到第一份工资的那一刻。

Probably the minute you start earning your first paycheck in your teens or twenties.

但这是否意味着你年纪大了就不该存钱了？

But does that mean you shouldn't save money when you're older?

不，不是这样的。

No, it doesn't.

我们还有大量来自老年人临床试验的数据，证明例如那些一生从未举过重的人，到了六七十岁才开始举重，也能获得显著的好处。

There's also a lot of data that we have from clinical trials that are done with seniors that demonstrate that, for example, people who have never lifted weights in their life before, who start lifting weights for the first time when they're in their sixties and seventies have a remarkable benefit.

这不仅适用于力量训练，也适用于任何形式的锻炼。

This is not just true of weight training, it's true of any sort of exercise.

所以简短的回答是，无论何时开始认真考虑这个问题，都不算晚。

So the short answer I guess is that no, it's never too late to really start thinking about this.

但显而易见，种树最好的时间是昨天，其次是今天。

But obviously, the best time to plant the tree is yesterday, if not today.

如果他们以前从未做过，为什么还会受益呢？

Why do they have a benefit if they haven't done it before?

这是因为有效的训练。

Well, there's an effective training.

具体来说，锻炼方面，人体本质上是一个‘用进废退’的器官或器官系统，肌肉就是很好的例子。

So specifically thinking of exercise, the body is really a use it or lose it organ or collection of organs and the muscles are a great example of that.

这对年轻人和老年人都适用。

So it's actually true of young people and old people.

锻炼最大的效果通常出现在那些从完全久坐不动到开始进行轻微锻炼的人身上。

The greatest effect of exercise is generally seen in the person who goes from being completely sedentary to even a mild amount of training.

所以，如果你看看像我这样一直锻炼的人，或者像你这样一直锻炼的人，如果我们各自每周再增加三小时的训练量，实际上并不会产生巨大的影响。

So if you look at somebody like me who exercises all the time or someone like you who exercises all the time, if we added three hours a week to your training or to my training, it actually wouldn't have an enormous impact.

如果你让一个完全不运动的人每周运动三小时，说实话，每天三十分钟、每周六天，这要求并不高。

If you took an individual who did zero exercise and you took them to three hours a week, which let's be honest guys, thirty minutes a day, six days a week is not a huge ask.

这种影响是巨大的。

The impact is enormous.

这很奇怪。

That's strange.

这可不是你原本会想的。

That's not what you'd think.

你能谈谈让生命更有质量而非单纯延长寿命的重要性吗？这对你的意义是什么？

Can you talk about the importance of adding life to years rather than just years to life and what that means to you?

是的，这对我来说意义重大。

Yeah, it means a lot to me.

我认为这对在座的每个人都会意义重大，因为大多数人想到的指标是预期寿命。

I think it will mean a lot to people here because the metric that most people think of is life expectancy.

你听过多少次了？

How many times have you heard it?

预期寿命在增加，预期寿命在下降。

Life expectancy is increasing, life expectancy is decreasing.

我认为原因很简单，因为这是最容易衡量的指标——它客观、量化，而且只是一个单一的数字。

And I think the reason for that is frankly it's just the easiest thing to measure because it's objective, it's quantitative and it's a single number.

这个数字可以从死亡证明上直接获取。

It's a number that shows up and it can be measured from a death certificate.

我们确切地知道一个人活了多少年，精确到天。

We know exactly how many years to the day that a person lived.

如果我们追踪这个数据，我们当然能从中了解一些关于他们的信息。

And if we keep track of that, we certainly know something about them.

但我的观点是，这并不是最重要的。

But my argument would be that it is not the most important thing.

我想挑战大家去想象一个个体，如果给他选择的机会——虽然现实中人们从不需要做这种选择，但为了思想实验，假设你被告知：你可以活到80岁，期间拥有卓越而完美的健康状态，然后生命在瞬间突然结束；或者你可以活到100岁，但最后20年都在痛苦的衰退中度过。

And I would challenge us to find an individual who would, if given the choice, and I don't think one ever has to make this choice, but for the purpose of the thought experiment, if you said, look, you could live to 80 in remarkable and perfect health and then when your life is over, it ends very quickly and suddenly versus you could live to a 100 but you spend that last 20 in a painful state of decline.

我认为，即使后者寿命更长，也很少有人会选择后者。

I think very few people would choose the latter even though they're living longer.

我认为，在这些极端但常见且悲惨的例子之外——人们年轻时就去世了——大多数人更看重生活质量而非寿命长短。

And I think what most people want is quality of life over quantity outside of these extreme examples, which are common and tragic where people die and they're young.

但当我真正开始思考这些问题时，据我观察，大多数人更关心的是生活质量。

But I think when you really start to think about pushing those things, most people in my experience are more interested in quality of life.

谈到一个人的死亡风险时，你将最大的风险称为四大杀手。

When it comes to someone's risk of dying, you characterize the biggest risks as the four horsemen.

你能解释一下那是什么吗？

Could you explain what those are?

是的。

Yeah.

讨论这个话题时不可能不提到四大杀手，这听起来可能有点沉重，但没必要回避不可避免的事实——我们每个人迟早都会离开人世。

You can't have a discussion on this topic without talking about the four horsemen, which might seem a bit grim, but there's no reason to avoid talking about the inevitable, which is every one of us in this room is not going to be alive at some point.

我认为，直面‘如何’死亡是很重要的。

And I think to confront the how is important.

从统计学上讲，我们每个人最终都会死于以下四种疾病或病理过程之一。

So statistically speaking, all of us in this room are going to succumb to one of four processes or disease processes.

因此，按排名顺序，第一个是心血管和脑血管疾病。

So in rank order, the first of those would be cardiovascular and cerebrovascular disease.

这是美国头号死亡原因。

That's the leading cause of death in The United States.

这也是全球头号死亡原因。

That's the leading cause of death globally.

这是男性和女性的头号死亡原因。

It's the leading cause of death for men and it's the leading cause of death for women.

就此打住。

Full stop.

也就是说，心肌梗死和中风。

So that's a heart attack, a stroke.

第二位，在美国紧随其后的是癌症。

The number two, and it's not that far behind in The United States is cancer.

当然，癌症并不是一种单一的疾病，我们把它统称为一类疾病。

And of course cancer isn't just one disease, we lump it all together.

但显然，前列腺癌和乳腺癌的差异，就像皮卡和卡罗拉一样大。

But of course prostate cancer and breast cancer are frankly as different as a pickup truck and a Corolla.

它们都有四个轮子，但相似之处也就到此为止了。

They both have four wheels, but that's about where the similarity ends.

第三位是痴呆症和神经退行性疾病。

Number three would be the diseases of dementia and the neurodegenerative diseases.

这里面包含了很多种类。

There's a lot of things in here.

比如阿尔茨海默病是最常见的痴呆类型，但还有其他许多非神经退行性的痴呆类型，比如血管性痴呆。

So you have Alzheimer's disease, which is the most common form of dementia, but you also have lots of other types of dementia that are not neurodegenerative such as vascular dementia.

第四类则是一系列我们称之为代谢性疾病的疾病谱。

And then the fourth horseman is kind of a spectrum of diseases that we call metabolic diseases.

其中最极端的表现就是2型糖尿病。

The most extreme version of this would be type two diabetes.

但当然，在这中间还存在脂肪肝、胰岛素抵抗等状况。

But of course, all along the way you have conditions like fatty liver disease and insulin resistance.

所有这些状况构成一个连续谱。

And all of these conditions form a continuum.

关于这些状况，最重要的是要知道，虽然直接死于这些疾病的人并不多，但只要你处于这个连续谱上的任何一端，你患上另外三种‘骑士’疾病的风险就会增加约百分之五十。

And the most important thing to know about them is while not that many people will die directly from those diseases, if you have anything along that continuum, it's increasing your risk by about fifty percent of the other three horsemen.

因此，我们真的需要制定一种策略，来减轻这四种状况的影响，并尽可能延缓它们的发生。

So we really wanna think about a strategy at mitigating all four of these conditions and delaying them as long as possible.

对于那些已经正在应对与衰老相关的慢性疾病的人，您会对他们说什么？在这些时期，您会给出什么建议，帮助他们维持高质量的生活并保持希望？

What would you say to someone that may already be navigating these chronic diseases that come with aging and what advice would you give them on how to manage a high quality of life and keep hope during these times?

这取决于我们具体讨论的是哪一种疾病。

You know, it would matter very specifically on which one we're talking about.

我当然不会要求举手示意，但根据在场每个人的年龄，我无法想象这里没有人已经遭遇过这些疾病中的某些情况。

I certainly won't ask for a show of hands, but just based on the age of everyone in this room, it's impossible for me to imagine that nobody in this room hasn't already faced some of these diseases.

所以，如果你坐在这个房间里，并且已经接受了冠状动脉支架植入术，那就说明你已经与冠状动脉疾病有过接触。

So if you're sitting in this room and you already had a stent placed in your coronary arteries that says, look, you've already had a brush with coronary artery disease.

也许在场的某位听众已经经历过心脏病发作，并且幸运地活了下来。

Maybe someone in this audience has already had a heart attack and you're fortunate enough to have survived it.

简短地说，你能够活下来已经很棒了，这意味着你获得了第二次机会。

Well, short answer is look, the fact that you've survived it is great and that means you get a second chance.

很多人并没有这样的运气。

Many people don't.

对很多人来说，第一次遭遇心脏病就是致命的。

So many people's first brush with heart disease is death.

事实上，平均而言，大约百分之五十的心脏病发作患者，也就是每两个人中就有一个，会立即死亡。

In fact, on average about fifty percent of people, one in two people that have a heart attack, it's immediately fatal.

所以，如果你属于这一群体，或者你曾经历过心脏病发作，或者你认识的人经历过并幸存下来，那么他们就是幸运者，他们应该尽一切努力不仅防止再次发作，还要增强身体素质。

So if you're in that group or you've had that heart attack or you know somebody who has and they've lived to tell about it, they're in the lucky camp and what they should be doing is everything in their power to not only prevent it from happening again, but to strengthen their body.

因此，我首先会问自己：当初是什么状况导致了这次心脏病发作？

And so the first thing I do is I ask myself, what were the conditions that I had that led to this heart attack in the first place?

有些状况你并不能很好地控制。

Now some of these conditions you don't have a lot of control over.

遗传在这里起着重要作用。

Genetics play a strong role here.

但有很多因素是可以控制的，比如胆固醇水平、血压和吸烟。

But there are many things that can be controlled such as cholesterol levels, blood pressure, smoking.

这三大因素最为关键。

Those would be the big three.

我们有办法管理所有这些方面。

And we have ways to manage all of those things.

此外，要明白运动起着非常重要的作用，代谢健康也是如此。

Also, know that exercise plays a very important role as does metabolic health.

我见过许多人在首次心脏病发作时与死神擦肩而过，但最终活了下来。

So I've met many people who have had that near brush with death from that point of a first heart attack, they survive it.

那他们接下来会怎么做呢？

And what do they do?

他们扭转局面，说：我要减掉30磅。

They turn it around and they say, Look, I'm going to lose 30 pounds.

我要戒烟，或者更好地控制我的血压和胆固醇。

I'm going to stop smoking or I'm going manage my blood pressure cholesterol better.

我要开始锻炼。

I'm going to take up exercise.

我知道有些人在这类事件发生后又活了三十年，当时他们可能才60岁，却一直活到了九十多岁。

And I know people that have gone on to live thirty years after that event that might have happened when they were 60 and they live until they're in their nineties.

所以我想，我总是会从这个角度去思考：我是否足够幸运，能够从这次事件中幸存下来？

So I guess I would always frame it through the lens of, Hey, am I fortunate enough to have survived this thing?

如果是的话，我接下来该怎么做？

And if so, what am I going to do going forward?

所以这里有人问，随着年龄增长，我们的平衡能力会怎样变化？

So someone here asked, what happens to our balance as we age?

在我们的老年群体中，跌倒似乎非常普遍。

Falls seem to be so prevalent here in our senior community.

我们能否帮助遏制这些问题随着年龄增长而加剧？

Can we help these problems from increasing as we age?

可以。

Yes.

如果存在第五位骑士，那就是意外死亡。

If there's a fifth horseman out there, it's accidental death.

现在，不同年龄段对意外死亡的定义差异很大。

Now, what constitutes accidental death varies a lot by age.

当我们谈论奥利维亚这个年龄段的人时，最常见的意外死亡原因是车祸和药物过量。

So when we're talking about people that are Olivia's age, the most common cause of accidental death is going to be car accidents and overdoses, drug overdose.

当你谈到我这个年龄段的人时，最常见的意外死亡原因毫无疑问是药物过量。

When you talk about people my age, the most common cause of accidental death is overdose by far.

当你谈到你这个年龄段的人时，情况完全逆转，意外死亡的发生率上升了五到六倍，且几乎全部与跌倒有关。

When you talk about people your age, it's a total flip and the prevalence of accidental death goes up by five or six fold and it is virtually all related to falling.

所以我想有两个问题。

So I guess there's two questions.

为什么跌倒如此致命？

Why are falls so lethal?

也许更重要的是，为什么65岁以上的人跌倒的频率要高得多？

And maybe more importantly, why do people above the age of 65 fall so much more?

顺便问一下，为什么女性摔倒的频率比男性高得多？

And by the way, why do women fall disproportionately more than men?

为什么女性因摔倒而受伤的程度比男性更严重？

And why are women more injured by falls than men?

这些问题我认为值得我们花一点时间探讨一下。

These are the questions that I think we should spend a moment on.

那我们先从‘为什么会摔倒’开始吧。

So let's start with the why do falls happen?

你刚才提到过这一点。

You touched on it a moment ago.

随着年龄增长，我们不仅会失去平衡能力，还会失去其他一些我们这个年龄段以及她这个年龄段的人习以为常的东西，那就是反应能力。

As we age, we don't just lose our balance, but we're losing something else that people my age and certainly her age take for granted, which is called reactivity.

前几天我去了一片树林，因为我的一个孩子不小心把足球踢进了树林里。

So the other day I was in the woods because one of my kids accidentally kicked the soccer ball down into the woods.

我得进去把球找回来。

I had to go and get it.

正如你所想象的，地面非常不平，上面覆盖着树叶、小树枝和枝条。

And as you can imagine, the ground is very uneven and it's covered in leaves and twigs and branches.

所以你根本看不到脚下踩的是什么。

So you can't even see what you're stepping on.

我相信你们都能清楚地想象出这是什么情景。

I'm sure you can all picture exactly what this is like.

每一步都可能是扭伤脚踝的隐患。

Every step is a sprained ankle waiting to happen.

果然，有一次我踩到了一个看起来不像那样的东西，身体猛地一晃，不得不迅速用腿做出反应，把脚放到正确的位置，以免摔倒。

And sure enough, at one point I step into something that wasn't as it appeared and I got jolted And I had to react very quickly with my leg to put it in the right place so I wouldn't fall.

我做到了。

And I did.

我现在坐在这里谈论这件事，甚至都记不清是哪条腿了。

And I'm here sitting here talking about it and I don't even remember which leg it was.

这事儿小到几乎不值一提。

That's how insignificant this was.

但完成这个动作所需的肌纤维类型，如果我们从技术角度来说，叫做2A型肌纤维，正是负责爆发性运动的肌纤维。

But the type of muscle fiber that was necessary to do that, which if we want to get technical is called a 2A muscle fiber, is the type of muscle fiber that is responsible for explosive movement.

这种肌纤维是人体最强大的肌纤维类型。

It's the type of muscle fiber that is the most powerful muscle fiber.

肌纤维大约从25岁开始逐渐变弱、萎缩。

Well, muscle fibers start getting weaker and weaker and shrinking at about the age of 25.

所以我已经过了50多岁的巅峰期，但依然保留着足够的力量支撑我。

So I'm long past my peak in my early 50s, but I still have enough to hold me on.

但到了某个阶段，它们会急剧减少。

But at some point they really, really start to diminish.

等到你这个年纪时，这些肌纤维就只剩下几根了。

And by the time someone's your age, you got threads of those things left.

所以你正在不断失去它们。

So you're losing those things.

好消息是，你可以训练这些肌纤维，但唯一的方法就是举起非常重的重量。

Now, the good news is you can train these muscle fibers but the only way to train them is to move very heavy weights.

听起来很疯狂，违背直觉，但这就是我们必须做的。

Sounds crazy, counterintuitive but that's what we have to do.

我们必须举起非常重的重量，并训练类似的动作模式，比如弹跳、左右移动、跳绳。

We have to move really heavy weights and we have to train in movement patterns like that, which means for example, bouncing, moving side to side, jumping rope.

这些训练对我们的双脚保持年轻时的反应能力至关重要。

Things like that are necessary for our feet to have the reactivity that you had when you were young.

随着年龄增长，另一个明显的问题是骨密度和肌肉质量的下降。

A second obvious issue as we age is a reduction in bone density and a reduction in muscle mass.

这就是为什么女性比男性更容易受到这些伤害的原因，因为显而易见，女性平均肌肉质量较少，骨密度也较低。

And this is the reason why women are more susceptible than men to these injuries because for obvious reasons women have less muscle mass on average and have lower bone density on average.

部分原因是许多女性在绝经后没有接受激素替代治疗，随着雌激素水平下降，她们的骨骼比男性更脆弱，因为雌激素实际上是维持骨密度最重要的激素。

In part due to the fact that many women didn't receive hormones after menopause and as their estrogen levels went down after menopause, their bones got disproportionately weaker relative to men because estrogen turns out to be the most important hormone in preserving bone density.

因此，所有这些因素共同导致我们无论在哪个年龄段都必须高度重视跌倒风险，但到了65岁以上，这个问题的影响就更加显著了。

And so all of these things taken together are what mean that falling is something we have to be very mindful of at any age, but boy does it play a bigger role above the age of 65.

我不会要求举手示意，但我很惊讶，如果在座的没有人认识——哪怕不是自己——经历过严重跌倒导致髋骨或股骨骨折的人。

And again, won't ask for a show of hands but I would be shocked if no one in this audience knew somebody, if not personally, who hadn't experienced a significant fall that resulted in a broken hip or a broken femur.

而这类事故的悲剧在于，许多情况下是无法完全康复的。

And the tragedy of that type of accident is that in many cases it's not fully recoverable.

因此，有一部分人会因此丧生。

So you have the proportion of people that will die as a result of that.

但即使活下来的人，通常大约有一半再也无法恢复到之前的活动水平。

But even the people who live, often about fifty percent of them never regain the same level of mobility they had before.

所以，所有这些都让我回到一个观点：我们应当尽可能多地锻炼。

So all of this to me points back to the idea that we want to be exercising as much as possible.

我会像老调重弹一样再说一遍，但你真的需要让身体尽可能做好准备，因为身体素质在预防这类伤害中至关重要。

I'm going to sound like a broken record saying this, but you're going to want to have your body as prepared as possible because that physical piece is so important in preventing these types of injuries.

这个年龄段的人现在还能做些什么来维持或增强肌肉吗？

Is there anything that people of this age can do now to preserve that muscle or strengthen it?

还是说必须在二十多岁的时候就做才行？

Or did it have to be done while it was still like in their twenties?

显而易见，如果你能回到过去，我把你用时间机器送回20岁，带着你今天的认知，也许你会更积极地锻炼。

Obviously, if you could go back in time and I put you all in a time machine to when you're 20, knowing what you know today, maybe you would exercise more.

但这是一个无关紧要的点。

But that's sort of an irrelevant point.

我想说的是，我们今天所做的才最重要。

I would say the point is what we do today is what matters.

几个月前，我在我的播客中采访了一位名叫贝琳达·贝克的女性。

There's a woman named Belinda Beck that I interviewed on my podcast a few months ago.

她是澳大利亚的一名研究人员，做了一项我非常欣赏的研究，叫做‘Liftmore研究’。

She's a researcher in Australia and she did a study there that I really was fond of called the Liftmore study.

这是一项针对一群女性的研究，她们都超过65岁，且都患有极低骨密度的疾病。

So this is a study that was done with a group of women, all of whom were over 65 years old and all of whom had a disease condition of very, very low bone density.

这是一群65岁及以上的女性，她们的骨骼非常脆弱，平时只做瑜伽和散步。

So it was a group of 65 and plus year old women who had very brittle bones, who didn't exercise beyond yoga and walking.

她们并不是完全不活动，但从未举过重物。

So it's not like they were inactive, but they'd never lifted weights.

这些女性被随机分为两组，一组继续原有的运动方式，另一组则进行了非常高强度的力量训练。

And these women were randomized into two groups, one that continued with that type of exercise and then one that engaged in really, really heavy strength training.

我特别喜欢这段视频在YouTube上，它绝对是我一生中最喜欢的十个视频之一，因为这些女性在研究结束时看起来如此虚弱，但有些人竟能抬起自身体重，完成自身体重的硬拉。

And I love that there's a video of this on YouTube that is easily one of my 10 favorite videos of all time because these women who look so frail by the end of the study are able to in some cases pick up their own body weight off the ground, do a deadlift with their own body weight.

她们在指导下安全地进行训练，并且力量得到了提升。

And they're coached on how to do this safely and they gain strength.

她们真的在进行高强度的力量举训练。

And they really do hardcore power lifting exercises.

她们不是拿着两磅的小哑铃做弯举。

Like they're not holding the little two pound dumbbells doing curls.

她们在做深蹲、硬拉，甚至尝试引体向上、卧推等各种动作。

They're doing squats, they're doing deadlifts, getting to pull ups, bench press, all sorts of things.

研究结束时，她们打破了我们原本认为不可能的事情——我们从没想过骨密度还能增加。

By the end of this study, they defied something that we thought was possible, which is we never thought it was possible to increase bone density.

我们原本以为最好的情况也只是维持骨密度，或者稍微减缓其下降速度。

We thought the best you could do was maintain bone density or maybe slightly prevent the rate of decline.

但令人惊讶的是，根据对这些女性骨骼的CT扫描，她们的骨密度确实提高了。

But amazingly in these women, based on the CT scans of their bones, they actually increased bone density.

我认为这是关于衰老最鼓舞人心、最重要的发现之一。

I find this to be one of the most uplifting and important findings with respect to aging.

我认为这说明了‘举重是年轻人或男性专属’这种想法是完全错误的。

And I think it speaks to how the idea that lifting weights is a young person's thing or a male thing, I think both of those are just incorrect.

举重是地球上每个人都应该做的事情。

Lifting weights is something every person on this planet should be doing.

从风险转向行动。

Moving from risks into action.

你能否快速介绍一下你长寿工具箱中的方法？

Do you want to quickly walk through the tactics in your longevity toolkit?

然后我们可以逐一深入探讨每一个方法。

And then from there we can go into detail on each of them.

总的来说，我们有五个方面可以掌控，以影响我们正在讨论的所有这些事情。

Broadly speaking, there are five buckets of things that we have control over to impact all of these things we're talking about.

我们刚才谈过的一个方面就是锻炼。

So one we just talked about, exercise.

你大概能看出来，我的倾向是，这在大多数情况下是最重要的一个。

And you can probably tell my bias is that that's the single most important one for the most part.

其次，按无特定顺序的话，是营养。

So the second in no particular order would be nutrition.

你吃的东西很重要。

So what you eat matters.

我们肯定会更详细地讨论这一点。

We'll talk about that I'm sure in more detail.

第三个是睡眠。

The third one would be sleep.

睡眠质量好与不好，对你的大脑有巨大影响，同时也影响你的代谢健康，而代谢健康又间接在其他疾病中扮演重要角色。

So the difference between sleeping well and not sleeping well has an enormous impact on your brain, but also on your metabolic health, which then indirectly plays a great role in other diseases.

第四个是所有药物和补充剂、药品，无论是医生开的还是你可以在柜台买到的。

The fourth would be all of the medications and supplements, drugs, anything that your doctor prescribes or that you can buy over the counter.

它们的有效性各不相同。

And these are of varying degrees of efficacy.

其中一些非常可疑。

Some of them are incredibly dubious.

其中一些可以救命。

Some of them can be lifesaving.

但同样，我们都需要考虑这些因素。

But again, all of those things we'd want to think about.

最后一个类别是我们用来改善情绪健康和幸福感的所有工具。

And then the final bucket would be kind of all the tools that we would have at our disposal to improve our emotional health and well-being.

所以我们已经稍微谈到了为什么锻炼很重要。

So we've already touched a little bit about why exercise is important.

但对于这个观众群体来说，他们如何在管理身体限制的同时安全地开始锻炼？

But for people in this audience, how can they start to safely exercise while also managing physical limitations?

很难对此做出一刀切的陈述，因为每个人的情况都不同。

It's hard to provide a blanket statement on that because everybody's going to be different.

但我认为可以肯定地说，人们的韧性比他们自己想象的要强。

But I think it's safe to say that people are less fragile than they believe.

我遇到很多人，比如那些有背部损伤的人，他们会说：‘我有背部损伤，什么都不能做。’

And I meet many people, for example, who have back injuries and say, Look, I have a back injury, I can't really do anything.

但事实上，如果你进一步深入了解，就会发现真正让他们的背部更痛的，往往是缺乏活动。

And the reality of it is when you probe a little bit further, what you realize is nothing tends to make their back hurt more than inactivity.

我不记得是谁说过这句话了。

I don't remember who made the statement.

但我非常喜欢这句话，多次引用或化用过。

I loved it and I paraphrased it or plagiarized it many times.

久坐之于下背痛，就像波本威士忌之于酗酒。

Sitting is to lower back pain what bourbon is to alcoholism.

你们中任何一位曾因背痛受苦的人，听到这句话大概都会想：‘他说得还真有道理。’

Any of you whose back has hurt will probably think about that and go, You know, he's kind of right.

当我背部疼痛时，最不想做的就是坐着，或者长时间开车后，疼痛会更严重。

When my back hurts, sitting is the one thing I don't like to do or after a long drive it hurts worse.

而对大多数人来说，保持活跃反而会让他们感觉更好。

And for most people actually being active makes them feel better.

现在，让我们说清楚。

Now, let's be clear.

有些情况是特定的，比如如果你的膝盖软骨已经完全磨损，多走路并不会让你感觉更好。

There are certain activities, like if you have no cartilage left in your knee, more walking won't make you feel better.

你必须去看骨科医生。

You're going to have to see an orthopedic surgeon.

他们可能需要为你做膝关节置换手术。

They might need to do a knee replacement.

但我要告诉你，在当今时代，2025年，膝关节置换、髋关节置换，甚至肩关节置换能实现什么？

But boy, I will tell you in this day and age, in 2025, what can be done with a knee replacement, a hip replacement, even a shoulder replacement?

我的意思是，这些手术已经取得了巨大进步，为无数人显著提升了生活质量。

I mean these operations have come along so far and they have restored so much quality of life to individuals.

因此，每一个案例都必须单独管理。

So every one of these cases has to be managed individually.

但如果你有一位非常优秀的物理治疗师或康复专家，他们能分辨出哪些情况可以通过更多训练或强化康复改善，而哪些确实需要医疗干预。

But if you have a really good PT or rehab professional who knows what's fixable with more training or more conditioning versus, Hey, this actually does need some medical attention.

我认为目标应该是：我怎样才能尽可能保持活跃？

I think the aspiration should be, What can I do to get as active as possible?

从运动转向营养，我们看到有人提出了关于不同饮食方式的问题，他们不确定该选择哪一种。

Moving from exercise into nutrition, we saw questions come through that different diets are being talked about and they aren't sure which one they should follow.

那么，你认为哪种饮食最好吗？还是说这取决于个人？

So is there a diet that you think is best or does it depend on the individual?

我不认为有一种饮食是最好的。

I don't think there's a diet that is best.

我认为有一些基本原则很重要，每个人都应该找到最适合自己坚持这些原则的饮食方式。

I think there are principles that matter and everyone should find the diet that best allows them to adhere to the principles.

那么，这些原则是什么？

So what are the principles?

原则就是：不要吃太多，也不要吃太少。

The principles are not to eat too much and not to eat too little.

听起来很傻，但事实就是如此。

That sounds dumb, but it's just the reality of it.

我认为每个人在这一谱系的不同端点上都会遇到困难。

And I think everyone struggles with a different end of that spectrum.

有些人就是不太喜欢吃那么多。

There are some people who just don't like to eat that much.

他们就像小鸟一样。

They're like little birds.

随着年龄增长，这会成为一个大问题。

And as they get older, that becomes a huge problem.

他们太虚弱了。

They are too frail.

在谱系的另一端，像我这样的人喜欢吃得多。

At the other end of the spectrum, you have people like me who like to eat too much.

我们会花一生大部分时间与想吃太多的冲动作斗争。

And we will spend most of our life fighting against the urge to eat too much.

随着年龄增长，这也会成为问题，因为体重越重，对每一个关节造成的负担就越大。

And that also becomes a problem as you get older because the heavier you are, the more weight you're putting on each and every one of those joints.

而且，我们还在思考所有这些随着年龄增长而对我们不利的因素，更不用说吃太多带来的其他并发症了。

And again, we're thinking about all these things that are working against us as we age, not to mention other complications that come from eating too much.

但我想说的是，在老龄化人口中，我最想强调的是摄入足够的蛋白质。

But I would say that in an aging population, the most important thing I want to emphasize is getting enough protein.

首先，我觉得对很多人来说，要摄入足够的蛋白质其实挺难的。

First of all, I just think for many people it's kind of hard to get enough protein in.

即使是我，也得留意这一点，而我并不缺吃的。

Even I have to pay attention to it and I don't have a problem eating.

但我需要提醒自己：我今天摄入足够的蛋白质了吗？

But I need to be mindful of, Hey, did I get enough protein?

对我来说，获取大量的碳水化合物简直轻而易举。

It's really easy for me to get all the carbs in the world.

我不用特意去多吃脂肪。

I don't have to go out of my way to eat more fat.

但我确实需要有意识地保证摄入足够的蛋白质。

But I do have to be cognizant of getting enough protein.

足够的蛋白质是一个相当大的数字。

And enough protein is a pretty big number.

大约是每磅体重需要一克蛋白质。

It's about one gram per pound of body weight.

所以我挑战你们每个人留意一下：如果你体重150磅，你每天摄入的蛋白质是否达到了150克？

So I would challenge each of you to pay attention to hey, if you weigh one hundred and fifty pounds, are you getting 150 grams of protein a day?

我敢打赌，尤其是这里的女性，这会更难做到。

And I would bet that especially for the women here, that's even harder.

如果你稍微达不到这个量，也没关系。

Now, if you fall a little bit short of that, it's okay.

但如果你只达到了一半，那你就远远没有摄入足够的蛋白质。

But if you're at half of that, you're really not getting the optimal amount of protein.

随着年龄增长，我们会出现一种叫做‘合成代谢抵抗’的现象，这意味着我们的肌肉越来越难以利用摄入的氨基酸——也就是蛋白质中的基本组成单元——来合成和生成新的肌细胞。

And as we age, we develop something called anabolic resistance, which means that it is harder and harder for our muscles to synthesize and grow new muscle cells with the given amount of amino acids, which are the building blocks in protein that we get by eating protein.

因此，我们需要越来越多的蛋白质来克服这种现象。

And therefore we actually need more and more protein to overcome that.

所以我们经常谈论肥胖问题。

So we talk a lot about obesity.

我们经常谈论骨质疏松和骨量减少，但衰老还有一种称为肌肉减少症的状况，即肌肉流失。

We talk a lot about osteoporosis and osteopenia, but there's another condition of aging called sarcopenia, which is the condition of muscle loss.

这是一个严重的问题，解决它实际上有两种相辅相成的方法。

And that's a huge problem and there's really two ways in concert, two ways to address that.

一种是摄入足够的蛋白质，另一种是进行足够的抗阻训练。

One is consuming enough protein and the other is doing enough resistance training.

所以，无论你是素食者，无论你偏好地中海饮食，还是喜欢牛排配土豆，都没关系。

So again, it doesn't matter if you're a vegetarian, doesn't matter if you like a Mediterranean diet, doesn't matter if you like steak and potatoes.

只要你能坚持这些原则，你的生活就会更轻松。

If you can adhere to those principles, that's going to make your life easier.

如果你是纯素食者，坚持这些原则会更难吗？

Is it harder to adhere to those principles if you're a vegan?

是的，这要难得多。

Yeah, it's a lot harder.

但这并不是不可能的。

But it's not impossible.

我知道很多人已经做到了。

I know lots of people who have done it.

但使用手机上的饮食追踪应用来花一周时间评估你摄入了多少克蛋白质，是个很好的方法。

But looking at a food tracking app in your phone is a great way to spend a week evaluating how many grams of protein you're getting.

我认为你会惊讶地发现，对我们许多人来说，我们可能摄入得还不够。

And I think you'll be surprised that for many of us, we're probably underdoing it.

现在我们来谈谈睡眠。

Now moving on to sleep.

睡眠是你写过很多的内容，你说你过去并不太重视它，但现在你非常重视，这确实是事实。

Sleep is something that you've written a lot about, and you said that you didn't used to take it very seriously, but now you do take it very seriously, and that's true.

他每天晚上八点就上床睡觉。

He goes to bed at like eight every night.

你认为这为什么如此重要？

Why do you think it's so important?

最近我一般都熬到九点。

I think I'm up till nine these days.

睡眠很重要，你说得对。

Sleep is important and you're right.

大概十二年前，我的座右铭还是‘死了再睡’，那时候我总是尽量少睡觉。

I used to probably until twelve years ago, I think my mantra was I'll sleep when I'm dead and I just would try to sleep as little as possible.

但证据非常充分，尤其是从短期和长期的大脑功能来看，睡眠非常重要。

But the evidence are pretty overwhelming, especially for both near term and long term function of the brain that sleep is very important.

现在，我认为在你这个年纪，会出现一些独特的挑战。

Now, I think at your age, a couple of unique challenges emerge.

同样，我认为大多数人在过了65岁或70岁之后，并不是因为想通宵派对而抗拒睡觉。

Again, I think most people, once they're over 65 or 70, they're not fighting the will to sleep because they want to be out partying all night.

更多是因为其他事情干扰了睡眠。

It's more that other things are getting in the way.

我们知道，随着年龄增长，人们的睡眠会变浅，睡眠结构也会发生一些变化。

So we know that as a person ages, they tend to sleep a little bit lighter and their sleep architecture tends to change a little bit.

我们还知道，其他因素也会干扰睡眠，尤其是对男性而言，夜间越来越难不起来上厕所。

We also know that other things get in the way, especially for men, which is it gets harder and harder to make it through a night without having to get up to pee.

我已经到了这个阶段，每周至少有两晚，如果我不注意最后一次喝水的时间，凌晨两点或三点就得起来上厕所。

I'm already at that stage where at least two out of the seven nights a week, if I am not mindful about when I had my last glass of water, I'm going be up at two or three in the morning to pee.

有时候，起来之后再睡回去反而更难。

And sometimes that's harder to go back to bed after.

那么，我们有哪些事情是可以掌控的呢？

So what are the things that we have under our control?

其中之一绝对是喝水的时间。

Well, of them is absolutely timing of water.

不过，水确实非常重要。

Now again, water is super important.

人年纪越大，就越容易脱水。

The older a person gets, the more susceptible they are to dehydration.

人年纪越大，口渴感作为身体水分状态的指示就越不可靠。

The older a person gets, the less reliable thirst is as an indicator for fluid status.