#378 ‒ 女性健康与表现：训练、营养与激素在不同生命阶段的相互作用 | 艾比·史密斯-瑞安博士

显然，增加水果和蔬菜的摄入有助于减轻炎症。

Obviously, increasing fruits and vegetables, helping inflammation.

另一件事是，在孕酮升高期间，有数据表明蛋白质转换、分解以及水肿现象会增加。

The other thing is in that progesterone rise, there's some data that suggests that there's an increase in protein turnover, protein breakdown, and this edema.

因此，举例来说，我特别想重点讨论补充剂，但我们研究了像肌酸这样的物质，它确实能将水分拉入细胞。

So for instance, I really wanna focus on supplements, but we looked at something like creatine, which really pulls water into the cell.

我们还评估了卵泡期和黄体期会发生什么变化。

And we evaluated what happens in the follicular versus the luteal phase.

而肌酸能够将细胞外液引入细胞内，从而帮助液体分布在正确的位置。

And creatine was able to take that extracellular fluid and bring it into the cell, so help with fluid in the right places.

因此，这也间接地提升了表现。

And so indirectly, that also supported performance.

我们可以调整一些策略来真正优化这一点。

There's some strategies that we might change to really optimize that.

还有一些有趣的数据表明，咖啡因在黄体期可能更有助于缓解疲劳症状。

There's also some interesting data that suggests caffeine might be more helpful in the luteal phase to help with those fatigue components.

你提到的很多想法听起来都很不错。

A lot of the things you've talked about seem like great ideas all around.

也许欧米伽在那个水平上有点高，你会根据情况来调整摄入量。

Maybe omegas at that level is a bit higher and you would reserve those, you would pulse that in based on that.

但显然镁在任何情况下都至关重要。

But obviously magnesium is critical all around.

我们的观点是肌酸在整个周期中都很有价值。

Our view is that creatine is quite valuable throughout.

如果一个女性不想按周期来管理，是否可以简单地说：如果你喜欢咖啡因，尽管摄入。

If a woman didn't want to have to manage it by cycle, would it just be safe to say, Look, if you enjoy caffeine, by all means take it.

在黄体期你可能会获得更多益处。

You might be getting more benefit in the luteal phase.

肌酸可能通过减少实际浮肿并将水分引入细胞而让你受益更多。

Creatine might benefit you more by reducing actual bloating and pulling the water into the cell.

这一点我之前真的不知道。

Actually never knew that.

我知道肌酸有这个作用。

I knew that creatine did it.

我从未想到它在黄体期会有益处。

I never made the connection that it would be of a benefit during the luteal phase.

这相当有趣。

That's pretty interesting.

顺便问一下，你们是如何给女性服用肌酸的？

By the way, how are you guys dosing creatine in women?

我想我明白你对此的看法，但实际上，在实验室环境下，，我们目前正在进行一项关于肌酸与围绝经期的研究。

I think I know your views on this, but in reality, in a lab based setting, so we have a pretty cool study right now in the first with creatine and perimenopause.

由于实验室限制，我们通常会先进行负荷期以加速肌酸饱和，然后每天补充5克。。

Because we have a lab restriction, we often will load first just to accelerate that creatine saturation and then follow it up with five grams a day.

我深信10克剂量对大脑健康有益。

I'm a big believer that five grams, but even now the data in our midlife women or the brain health is up to 10 Yeah,

我们在这方面的想法已经改变了。

we've changed our thinking on this.

顺便说一句，我完全理解你们采用负荷剂量的做法，因为如果只是维持稳态剂量，需要好几周时间才能达到饱和，耗时太长了。

And by the way, I completely hear you unloading because if you just go steady state, it takes weeks takes to way get to too long.

是的，所以完全认同这种做法。

Yeah, so totally get that.

不过确实挺有意思的，我最近在播客上邀请了Rhonda Patrick，我们讨论了这个话题，录完节目后我突然意识到一件事

But yeah, it's actually funny, I had Rhonda Patrick on the podcast recently, we were talking about that and I came out of that podcast thinking, You know what?

我认为我们应该把日常维持剂量从5克提高到10克

I think we should move our maintenance dose from five to 10.

所以我们基本上就这么做了。

And so we've kind of just done that.

那太好了。

That's great.

是的。

Yeah.

我们通常在负荷期后会服用五克。

We typically will do five grams following that loading.

嗯哼。

Uh-huh.

这就是我们现在正在做的。

That's what we're doing now.

而你的

And your

加载期是多久？

load is how long?

通常是五天。

It's usually five days.

五天，二十天。

Five days, twenty days.

嗯哼。

Mhmm.

那五天分成四次，每次五克的剂量。

That five days split in four, five gram doses.

是的。

Yep.

好的。

Okay.

但对于不想参与研究的普通人来说，每天服用十克，我们觉得效果相当不错。

But for the average person who's not trying to enter a study, just go to ten a day and we feel pretty good about it.

所以再次强调，这是个非常有趣的观点，我很想听听女性们的体验，这是否能减轻她们在黄体期出现的水肿。

So again, really interesting point and I'd love to hear what women are experiencing if this is reducing some of the edema that they're getting during that luteal phase.

再详细谈谈蛋白质的问题。

Talk a little bit more about the protein issue.

那么你的意思是，在黄体早期，肌肉蛋白质合成可能效率较低吗？

So are you saying that potentially during early luteal phase, muscle protein synthesis is not as efficient?

目前这是个有争议的话题。

This is a debatable topic right now.

首先我要说，在黄体期，我们还倾向于观察到代谢率的上升。

And I'll just say first in the luteal phase, we also tend to see an increased metabolic rate.

你认为是什么驱动的？

And what do you think that's driven by?

是温度吗？

Is that temperature?

是

Is that

我的意思是，可能是温度，也可能是黄体期内膜或子宫内膜。

I mean, maybe temperature, maybe the luteal lining or the utero lining.

我不太确定。

I'm not exactly sure.

有许多代谢过程。

There's a number of metabolic processes.

可能是黄体酮。

Maybe it's the progesterone.

顺便问一下，具体是多少？

How much is it by the way?

通常大约是几百卡路里。

It's usually like a couple 100 calories.

每天几百卡路里的

Couple 100 calories a day of

能量消耗。

Energy expenditure.

我认为这很重要，因为实际上，200到300卡路里意味着什么？

And I think that's relevant because in reality, what's 200 to 300 calories?

但这往往是女性和女孩们感觉最糟糕的时候。

But it's often when women and girls feel their worst.

她们可能不会在体重秤上察觉到，因为如果有什么变化的话，她们正在保留更多的水分。

And they might not appreciate it on the scale because if anything, they're retaining more water.

体重秤可能显示你在增重。

The scale might suggest you're gaining weight.

但实际上，你正在消耗储存的能量。

But in reality, you losing stored energy.

对。

Right.

如果体重秤显示我在增重，我有细胞外液，感觉不舒服，我就不会多吃。

And if I'm gaining weight on the scale, I have extracellular fluid, I don't feel very good, I'm not gonna eat more.

通常我会吃得更少。

Often I eat less.

这也是我们观察到更多内容的时候。

And this is also when we see those increased cravings.

所以这往往就是食物摄入不足的完美风暴。

So it is this perfect storm for often under consumption of food.

其中一部分只是吃够量，我们研究了月经周期中不同营养素的变化，但归根结底还是要摄入足够。

Some of it is just eat enough, and that's really we've looked at different nutrients across the menstrual cycle, but it comes back to getting enough.

如果我们讨论蛋白质成分，我们有一篇关于年轻女性月经周期中蛋白质合成的研究论文正在审阅中。

So if we talk about the protein component, we have a paper in review right now looking at protein synthesis across the menstrual cycle in young women.

只要你摄入足够的蛋白质，这不是我特别担心的事情。

Like, if you're getting adequate amounts of protein, it's not something I'm super concerned about.

你定义的充足量是高于1.6吗？

And you're defining adequate above 1.6?

是的，大约1.6。

Yeah, about 1.6.

我认为你还可以通过调整训练前后的营养摄入时间来避免问题。

And I think you can also get away with nutrient timing around the workouts.

如果你在训练前后优化氨基酸摄入，就不会出现那些负面效应。

If you're optimizing amino acids around training, you won't see those negative side effects.

明白了。

Got it.

但1.6克这个量并不总是容易达到。

But one point six again is not always easy to get.

我刚结束一段长时间的出差回来。

I just came back from a long travel stint.

我离开了大约一周，行程非常奔波。

Was gone for about a week and I was all over the place.

我不认为有哪一天接近过我的目标——每公斤体重摄入两克蛋白质，实际上连一天都没达到过。

I don't think there was a single day I got near I'm targeting two grams per kilo, not one day that I hit it.

我之所以总是把目标定在两克甚至略高，是因为即便没达标，至少也能超过1.6克。

The reason I always target two to even slightly more is that if I fall short, can beat 1.6.

但我敢保证，那段时间里有一半的日子我连1.6克都没达到。

But I promise you, there were half those days I didn't hit 1.6.

首先，你能坦诚说出这点很有价值，我认为大家需要听到这样的真实情况。

I think one, it's really valuable that you say that and I think people need to hear that.

我也推荐同样的做法。

I recommend the same thing.

我的目标是每磅体重摄入一克蛋白质。

I go about one gram per pound is my goal.

有很多天我都没能达到这个目标，但关键在于保持一贯性和优化摄入时机。

And there's many days I don't get that, but it's still that consistency and optimizing timing.

我不会连续五小时不摄入蛋白质，这样血液中就能维持氨基酸水平来帮助保持状态。

I'm not going for five hours without getting protein, so I have amino acids in the bloodstream which can help maintain.

是啊。

Yeah.

我对自己非常恼火，因为我通常都会带蛋白质零食旅行，比如大卫能量棒和鹿肉干之类的。但不知怎么的，这次打包时太匆忙了。

I was so frustrated with myself because I normally travel with protein snacks, got my David bars and my venison sticks or whatever And I just, for whatever reason, I was in such a rush when I packed.

我一样都没带。

I didn't take any of that stuff.

当时在亚洲，虽然整天都在吃这些精致美味但分量极小的鱼料理，但...

And I was in Asia and you're eating these tiny quantities of amazing fish all the time but like

你能感觉到差异吗？

Could you tell a difference?

你的身体能察觉到不同吗？

Could your body feel a difference?

能。

Yeah.

我觉得部分差异在于我的训练量也大幅减少了。

I mean, think part of the difference is my training volume was also so much lower.

更低。

Lower.

是的。

Yeah.

所以或许可以这样认为，尽管我每天可能只摄入了每公斤体重1.2克的蛋白质，但我确实按照计划每天都进行了力量训练，不过我认为训练强度远不如平时。

So you could perhaps argue that, yes, even though I was probably getting only 1.2 grams per kilo of protein per day, I did actually lift every day that I was supposed to lift, but I don't think the lifts were nearly as intense as they Sure.

酒店健身房和我的健身房没法比。

The hotel gym's not the same as my gym.

我的有氧运动，有点敷衍了事。

My cardio workouts, was kind of phoning them in.

所以再说一次，我觉得很幸运只有一周。

So again, look, I feel fortunate it's just a week.

但如果有人经常出差，这就更严重了，他们必须更加注意。

But if there's a person who's traveling constantly, this is a bigger deal and they've got to pay more attention to it.

重要的是要知道，即使我们知道正确答案，也很难遵循。

It's important to know that even when we know the right answers, it's hard to follow it.

坚持锻炼的好处之一就是偶尔一两周不练也不会产生严重的负面影响？

One of the benefits of exercising consistently is that a week here and there is not going to have these severe negative side effects?

如果女性每公斤体重摄入1.6到2克蛋白质，我们就不用担心这个问题。

If a woman is getting one point six to two grams per kilo, we don't have to worry about it.

但举个例子，如果一位女性是素食主义者，那她要达到这个摄入量就会非常困难。

But if a woman, for example, she's a vegetarian, so she's going to have a real hard time hitting that.

你要知道吗，在排卵期后这段时间，你.

You're going to maybe make a note that says, Look, right after your ovulation, this is actually a time to pay even more attention to protein intake because of this reduced NPS.

确实如此。

Absolutely.

尤其是对于老化肌肉而言。

Especially with an aging muscle.

年轻女性的肌肉和男性肌肉更具韧性，但如果我们处于四五十岁的年龄段，根据一些关于合成抵抗力的科学研究。

So a young female muscle and male muscle is resilient, but absolutely if we're into our forties, fifties, based on some of the science around anabolic resistance.

显然，在那个时间段内荷尔蒙的变化方式也不同。

And obviously the hormones change differently in that timeframe.

但在黄体期，它确实有助于缓解酸痛、促进恢复、预防受伤等多个方面。

But yes, in that luteal phase, it could help with soreness, recovery, a number of components, injury prevention.

现在我们不谈团队运动员。

Now let's not talk about a team athlete.

我们只讨论个人情况。

Let's just talk about an individual.

我们早已离开大学校园。

We're long done with college.

我们不再属于任何团队。

We're not on a team anymore.

作为个体，我们要对自己的训练负责。

We as the individual are in charge of our own training.

那么对于正在收听的活跃女性听众——无论是像我爱人这样正在备战马拉松，还是仅为保持身材而锻炼的女性——你会给出什么建议？关于如何根据生理周期调整训练强度和量？

So a woman who's listening to this, who is herself active, whether it's my wife, she's training for marathons or whether it's a woman who's just training to stay in shape, what guidance are you giving around, if anything, how you would change intensity and volume throughout the cycle?

如果我们讨论的是四十多岁的女性，我认为应该根据其他因素来周期性地安排训练强度和量。

If we're talking about, let's just say someone in their forties, I mean, I would say we're just trying to exercise and that intensity and volume would be periodized based on something else.

明白了。

Got it.

换句话说，你会根据围绕赛事高峰和减量的较长中周期来调整强度和训练量。

So in other words, you're gonna change intensity and volume based on longer mesocycles that are around peaking and tapering for whatever the events are.

但我们不会根据月经周期每月起伏调整，这意味着你接受这样一个事实：有时训练状态会不如周期中的其他时候。

But we're not gonna do a monthly up and down based on the cycle, which means you are accepting the fact that you will sometimes train not feeling as good as you do during other times in the cycle.

对。

Right.

对此我有两点想法。

I have two thoughts on that.

我们是否应该——或者说你那四周周期训练计划——能否与我们的生理期和月经周期同步？

Should we or does your periodized four week program, could we align it with our period and our menstrual cycle?

这可能是我们需要研究的方向。

That might be something that we need to look into.

你只是在调整你的四周中周期安排。

You're just shifting your four week mesocycle.

但是，没错，百分之百地，我们随时都会训练并关注那些长期效果，但同时也要给自己一些宽容，比如，如果你没达到目标或配速之类的，可以退一步思考：我的荷尔蒙在其中扮演了什么角色？

But, yes, a 100%, we are gonna train whenever and do those long term effects, but then also giving ourselves some grace of like, oh, if you didn't hit your goals or your minute per mile or whatever it may be to take a step back and say, oh, where do my hormones play a role?

或者我可能也需要稍微长一点的恢复时间。

Or I also maybe need a little bit longer recovery.

而且关于工作与休息比例也有一些有趣的数据。

And there's some interesting data too with work to rest ratio.

我想我们或许需要首先让女性能够坦然说出：你的月经周期是什么时候？

We might just need to, I think, empower women to say, first of all, when is your menstrual cycle?

或者那会是什么样子？

Or what does that look like?

多久？

How long?

这有助于我们了解何时发生变化。

Which helps us understand when it changes.

你出血持续多久？

How long are you bleeding?

你是否因为这些荷尔蒙变化而感到更疲惫？

And are you more tired based on those hormonal things?

还是有其他原因？

Or is it something else?

这对一些女性来说可能是个解脱，因为这让她们更容易接受这个事实：我不需要过度科学化这件事。

So this might be a relief to some women to hear that because it makes them maybe accept the fact that, hey, I don't need to like over science this thing.

事实就是如此，我无法想象作为一个男性会怎样，我的荷尔蒙水平几乎保持不变，而如果这些强大的雄激素在一个周期内上下波动，表现的不确定性会相当令人沮丧。

It is what it is, and I can't imagine what it would be like as a guy where my hormones are pretty much always the same and yet if these very powerful androgens are moving up and down throughout a cycle, a lack of predictability in how you're going to perform can be pretty frustrating.

但似乎自我宽容是一种高尚美德。

But it seems like grace with yourself is a high virtue.

是的。

Yeah.

我想说这是我作为科学家的原因之一。

I'd say that's one of the reasons I came as a scientist.

我掌握大量数据和证据，但如何在现实生活中应用。

I have a lot of data and evidence, but how I do it in real life.

我是说，有些日子我很幸运。

I mean, some days I'm lucky.

我早上五点就开始训练，持续一整天。

I'm training at five in the morning all day.

就像，我们能完成训练就很幸运了。

Like, we're lucky just to get it in.

所以坚持很重要。

And so consistency matters.

我想说，赋能女性很重要——我们从未被教导了解自己的出血模式、荷尔蒙变化、什么是正常现象，甚至包括大脑和心理健康的变化。

And I would say empowering women, we were not taught about our bleeding patterns, our changes in hormones, what's normal, even down to the changes in brain and mental health.

因此我反思并认为，如果我们能测量这些数据并让女性追踪记录，这会非常赋能，而不是只会感叹‘天啊我感觉糟透了’或者‘我到底怎么了？’

And so I kick that back and say, if there's a way that we can measure that and a woman can track that, it's really empowering versus, wow, I just feel terrible, or what am I doing?

这让我们能够分辨出何时需要做出改变，无论是营养、药物还是其他方面。

It allows us to tease out when there is something we need to change, whether it's our nutrition, our meds, or whatever it may be.

但首先要问：好吧，我的荷尔蒙在其中扮演了什么角色？

But first and foremost asking, okay, well, where do my hormones play a role?

随着年龄增长，这会如何变化？

And how does that change as I do get older?

现在，如果女性服用不含安慰剂周的口服避孕药，即在整个周期持续摄入激素，这显然完全抑制了排卵从而完全抑制了月经周期，这样做是否存在运动表现优势？

Now, if a woman is on an oral contraceptive without the placebo week, so if a woman is just taking the hormone throughout the cycle, obviously completely suppressing ovulation and therefore completely suppressing a menstrual cycle, Is there a performance advantage to that?

换句话说，如果你正力争参加奥运会，这可能会成为备选策略吗？

In other words, if you were trying to make that Olympics, would that potentially be the strategy?

根据文献记载，我认为这更多是间接影响。

It's more indirect, I would say, based on the literature.

与女性运动员合作时发现，这种一致性长期来看可能带来更少的变异性。

And even working with female athletes is that that consistency, potentially over time, there's less variability.

因此在训练中能保持更高的一致性。

So there is more consistency with the training.

间接地，很多时候女性会服用激素避孕药来缓解经期症状，无论是情绪波动还是痛经。

And indirectly, a lot of times women are taking a hormonal contraception to help with symptoms of their cycle, whether that be mood or cramps.

所以很多时候女性会感觉更好。

And so a lot of times females feel better.

而且总的来说，不用经历出血。

And then just in general, not having to bleed.

我认识的一些女性 would, 她们会跳过安慰剂周，这样就不用处理那些事了。

Some women I know skip the placebo week so that they don't have to deal with that.

这本身就是一个无需担心的事情2。

And that in itself is a nice thing not to have to worry about.

好的。

All right.

那么现在我们来谈谈女性进入围绝经期阶段的情况，这个阶段对某些女性来说可能相对短暂，而对另一些人则可能持续较长时间。

So let's talk about now as women enter the perimenopausal stage of life, which obviously for some women can be relatively short and brief and for others can sort of drag on for a while.

但如果我们通过某种不规律性（如缓慢上升的FSH水平）来识别这一阶段，你会建议女性在这个可能持续数年的生命阶段如何调整运动和饮食方式？

But if we identify it based on some sort of irregularity, a slowly upward drifting FSH, what are the ways you would advise a woman to start thinking about how she exercises and eats during that phase of her life, which again could last for years?

这正是大量数据引导我思考的方向。

This is where a lot of the data has led me.

幸运的是，随着我深入研究，虽然进展并非如我所计划，但我很高兴能获得更多数据支持。

Luckily, as I roll into it, it's not how I planned it, but I am happy to have more data.

你正在成为自己即将步入的人生阶段的专家，是啊，某种程度上来说，

You're becoming an expert into the period of life you're going into Yeah, at some point,

并非刻意为之。

not really intentionally.

我认为这很大程度上是由症状驱动的。

I would say that it very much symptom driven.

所以我们常常不知道自己的FSH水平何时上升，或者没有进行相关检测。

And so often we don't know when our FSH is rising or we're not getting our measures.

因此，首要的是在三十多岁时就进行血液检测非常有价值，这样我们就能知道个人激素水平何时开始变化。

So first and foremost, getting blood work done is really valuable into our even starting in our thirties so that we know individually when that changes.

我们利用家庭激素尿液分析，通过每日尿液测量，这确实能反映出‘好吧，也许我的激素正在变化’。

We have leveraged at home hormone urine analyses where you measure daily urine, which really starts to say, Okay, well maybe my hormones are changing.

你在尿液中测量什么指标？

And what are you measuring in the urine?

我们使用了几种不同的设备，这只是从科学角度出发。

There's a couple of different devices that we've used and this is just in the science perspective.

大多数设备测量的是某种形式的雌激素、孕激素、促卵泡激素(FSH)和黄体生成素(LH)，都是通过类似验孕棒的尿液试纸检测。

Most of them are measuring some form of estrogen, some form of progesterone, FSH, LH, all in like a pea stick, a urine stick.

与血液检测相比，它们的准确度如何？

And how accurate are they relative to blood?

我常说它们提供的数据并不完全相同，但我们正在努力进行一些验证工作。

They're not I always say they're not telling us the exact same thing, but we're trying to work on some of that validation.

所以你可以将你在

So you can correlate what you're seeing in the

重要的是，我们现在能够观察到这种日常波动。

importantly, we're now able to see that daily variation.

因此，比如如果我或我们的参与者出现激素激增或骤降，感觉非常糟糕或好转，你就能开始识别这种关联。

And so like if I have a spike or one of our participants does or it's a drop and I feel terrible or I feel better, you can start to identify that.

或者如果完全没有峰值，影响了睡眠或引发潮热，这些工具确实能让我们明确地说：看，这就是正在发生的情况，而不是仅凭单次验血结果来判断。

Or if there's no peak at all, it's impacting sleep or hot flashes, it really allows us to have those tools to say, okay, no, this is what's happening versus that single point in time we're getting our blood work done.

那么所测量的雌激素，是仅指雌二醇，还是包括雌三醇、雌酮等所有类型？

And the estrogen that's being measured, is it just estradiol or is it estriol or estrone and everything?

是的。

Yeah.

我的意思是，通常只测一种指标。

I mean, usually it's one marker.

这取决于使用的设备。

It depends on the device.

我想给正在收听的女性听众的建议是，一定要保持一致性。

The thing I would advise women who are listening is to be really consistent.

我们认为血液中第五天的FSH可能是最佳的检测指标，因为它的预期值非常稳定一致。

We think that day five FSH in the blood is probably your best test because again, you really consistently know what it should be.

所以在你的生育期，第五天——假设第一天是月经开始的日子——如果第五天的FSH水平检测，它确实应该是偏低的。

So when you're fertile, day five, so if day one is the day your period starts, if you have an FSH level on day five, it really should be low.

这正是我们观察她在进入围绝经期时数值上升的关键指标。

And that's the thing that we're watching to climb as she's entering perimenopause.

所以一旦这个数字达到10，我们基本上就能确定她开始进入这个阶段了。

So once that number is even hitting 10, we sort of know that she's now entering that zone.

显然，如果你观察一位处于更年期的女性，这个数值会迅速攀升至二十五、三十、五十等等。

And obviously if you look at a woman in menopause, that number is going to very quickly rise to twenty five, thirty, fifty, etcetera.

我能接着问个问题吗？

Can I ask you a follow-up?

可以，可以。

Yeah, yeah.

如果她们体内有避孕环，你们会怎么做？你们会参考AMH数值吗？

What do you do if they have an IUD and do you ever use like AMH numbers?

是的，我们会参考AMH数值。

Yeah, we do look at AMH.

它可能有一定帮助。

It can be somewhat helpful.

但确实，如果有避孕环完全阻止了排卵，判断会困难得多。

But yes, it's definitely harder if there's an IUD that's completely preventing that.

我这么问是因为实际情况中确实存在很大的变数。

I ask because it really is, There's so much variability happening.

作为一名研究者，我们既要捕捉实时翻译，也要注意到其中的变异性。

And as a researcher, we wanna capture that real time translation, but also the variability is there.

因此为了获得高质量的研究，我来这里的另一个动机就是临床联系。

And so to get some quality research my motivation for being here too is that clinical connection.

我们如何将临床实践转化为研究，反之亦然？

How do we take clinical practice and form research and vice versa?

这很好，我得看看我们第五天的数据。

So that's good, I'll have to look at our day five numbers.

当然，有些使用宫内节育器的女性仍会突破避孕效果来月经，但可能一年只有三次，所以你们要抓住那些时刻。

And of course some women with an IUD will still break through and have a period, but it might only be three times a year and so you just try to capture those moments.

太棒了。

That's great.

是的。

Yeah.

好的。

Okay.

那么回到

So going back to

我其实没有回答你的问题。

I didn't actually answer your question.

我们在这个领域做了大量研究，作为科学家，数据指引着我们。

We have looked a lot at this space and I'll tell you it wasn't as a scientist, the data leads us.

因此我们进行了一项初步研究，作为对部分天鹅研究的后续，采用了非常精密的新陈代谢测量方法，研究绝经前、围绝经期和绝经后的身体成分变化。

And so we did an initial study as a follow-up to some of the Swan studies using very sophisticated measurements of metabolism, body composition of what happens premenopause, perimenopause, and postmenopause.

我们反复观察到，在围绝经期会出现一些相当显著的变化，包括新陈代谢、肌肉体积、肌肉质量以及骨骼的变化，甚至代谢灵活性也会趋于在绝经后变得更为稳定。

Repeatedly, we're seeing in perimenopause, there are some pretty, I wanna say significant, but changes to metabolism, changes to muscle size, muscle quality, and bone, even metabolic flexibility that tend to be a bit more stable into post menopause.

所以我会回答你的问题，但我现在想先强调这一点。

And so I will get to your question, but I say that of it really now.

我们正深入探究围绝经期这个关键阶段，因为似乎这正是我们需要把握生活方式行为改变的黄金时期，以实现终身影响并延长健康寿命。

We are really diving into that perimenopause window because it seems that's where the time we really need to take advantage of lifestyle behavior changes to have this lifelong impact, improve health span.

这一阶段贯穿我们三十多岁后期至四十多岁乃至五十多岁，与我们的运动和营养息息相关。

It's coming in our late thirties to our forties to our fifties with our exercise and nutrition.

那么，对于女性来说，你会做出哪些具体的改变？

So what is a specific change you might make for a woman?

或许我们可以先以一位女性为例，她因为有三个六岁以下的孩子而忙得不可开交，所以运动量并不大。

So maybe let's take the first example, which is a woman who's actually not exercising that much because she's got three kids under six and she has her hands full.

当你忙于应付这些时，每天去健身房根本不在考虑范围内。

Going to the gym every day is not on the list when you're trying to manage that.

但随着她进入围绝经期，你如何向她证明，除了那些常见的理由外，运动对她的健康至关重要，应该优先考虑？

But as she's becoming perimenopausal, how do you make the case to her that exercise should be prioritized for her health beyond the usual things that you would hear?

当然，锻炼对你有好处。

Like, of course, exercise is good for you.

但如果你能证明，尽管你很忙，现在正是开始或重新养成这个习惯的好时机，你会怎么做？

But how do you make the case if you can that actually, despite how busy you are, this is a great time to start this or re engage in this habit?

我想说的是，不仅仅是重新开始或养成这个习惯。

I mean, would follow it up of not just say re engage or start this habit.

开始永远不会太晚。

You're never too late old to start.

这将实实在在地影响你一生的健康。

And it will literally impact your health forever.

根据数据，我想说，并不需要每周150分钟的运动量。

And I would say, based on the data, it doesn't have to be a hundred and fifty minutes a week of exercise.

关键在于持之以恒。

It's really consistency.

这是有数据支持的。

So there's data.

我很想听听你的看法，但强度比运动量更重要，而坚持又比运动量更重要。

I would love to get your opinion on this, but intensity is more important than volume, and consistency is more important than volume.

所以真正要告诉她的是：我理解作为母亲的愧疚感，这些女性往往怀着照顾他人的强烈愿望，却忽略了自己。

And so really telling her that I know I struggle with mom guilt, and often these women are worried about taking care of everyone else with this desire to care for them.

有趣的是，父亲们很少会有这种愧疚感。

It's amazing how little dad guilt occurs in the

我正想问你，难道父亲们就没有愧疚感吗？

I mean, was gonna ask you, surely there's dad guilt, no?

这不一样。

It's not the same.

我认为事实是，我比以前无私多了，但真相是我妻子比我无私无数倍。

I think the truth of the matter is I'm way less selfish than I used to be, but the truth of the matter is my wife is infinitely more selfless.

嗯。

Mhmm.

我们天生就这样，不是吗？

We're wired that way, aren't we?

是啊。

Yeah.

有时我会感到内疚。

And I feel bad sometimes.

这要看情况。

It depends.

比如，如果我妻子正在备战马拉松，而我们中只有一人能去锻炼，那一定是她去。

Like, look, if my wife is in the middle of training for a marathon and only one of us can do our workout, it will be her.

但通常情况下，她总是会说，看，如果我们今天只有时间让一个人去做某件事

But ordinarily, she'll always be the one to say, look, if we only have time for one of us to do something today

她会主动承担。

She'll take it.

她会选择牺牲自己，让我去做。

She'll take the hit and let me do it.

我是说，再加上孩子们的因素。

I mean, you throw in the kids.

我有两个小男孩，他们会说，别走。

I have two little boys and they say, don't go.

比如，你为什么要去跑步？

Like, why are you going to run?

这也把他们牵扯进来了。

It's bringing them into it too.

我认为女性对此充满热情的另一个原因是，我们不仅有能力改变自己的健康寿命，还能影响后代。我总是和孩子们开玩笑说，你们见过其他妈妈在夺旗橄榄球或棒球场上这么拼命吗？

I think women the other reason I'm passionate about it is that we have the ability to not only change our health span, but also generations behind us of, hey, this is really important so that I can I always joke with my kids of like, do you see any other mom killing you on the flag football or the baseball?

这让我能够陪伴他们，跟上他们的步伐。

Like, it allows me to be out there and to keep up with them as well.

所以我将其与健康、长寿和生活质量联系起来。

So I tie it back into health and longevity and quality of life.

如果你想活得更健康更长久，现在就需要投入时间，最终这会帮助你成为更好的母亲、妻子等等。

If you want to live healthier longer, you need to put the time in now, and it will ultimately help you be a better mom, wife, etcetera.

祖母。

Grandmother.

没错。

Exactly.

是的。

Yeah.

对。

Yeah.

我想谈谈你提到的关于运动量和强度的问题。

I wanna touch on your point about volume and intensity.

我们对此进行了大量研究，根据文献解读，实际上在时间不受限的情况下，训练量才是最重要的。

We've been looking at this a lot and I'll tell you what our reading is of the literature is actually that with unlimited time volume matters the most.

当训练量下降时，训练强度就变得更为关键。

As volume goes down, intensity becomes more important.

换句话说，如果一个人每周只能锻炼150分钟，就必须优先考虑强度，因为这样的训练量不足以最大化体能提升。

In other words, if a person only has 150 a week to exercise, you have to prioritize intensity because you're not really getting enough volume to maximize conditioning.

如果有人愿意每周训练12小时（这显然很多），那么就可以依靠训练量来获得收益，此时高强度与低强度的比例就会大幅降低。

If a person is willing to train twelve hours per week, which is obviously a lot, then you have the luxury of relying on the volume for the benefits and the ratio of high intensity to low intensity is going be a lot shorter.

因此这是一个更为细致的观点，我认为这点经常被忽视。

And so this is a slightly more nuanced view that I think often gets communicated.

这与职业跑者或职业自行车选手每周训练25小时的情况形成鲜明对比。

And it's the difference between the professional runner or the professional cyclist who's out there twenty five hours a week training.

是的，他们80%的训练量确实会保持非常、非常低的强度。

And yes, 80% of their volume is going to be really, really low intensity.

但这与我们普通人无关。

But that's none of us.

所以，是的，我们确实需要优先考虑高强度训练。

And so, yeah, we do have to prioritize high intensity training.

我最近在做演讲时，有人问我，如果他们每周只有极少的几分钟训练时间，那训练计划应该怎么安排？

And I was giving a talk recently and someone said, If I only had and they gave some incredibly low number of minutes to train a week, what would it look like?

事实是，如果你想最大化训练效果，那训练内容大部分必须保持相当高的强度。

And the truth of the matter is, if you're trying to maximize the training effect, it's going to mostly have to be pretty high intensity.

但当然，如果只做高强度训练，你会面临两个风险：一是错过其他益处，二是无法打下坚实的基础。

But of course, you run the risk when it's just high intensity that A, you're missing some of the other benefits, but you're not building a strong base.

嗯。

Yeah.

我是说，这要回到我们关注的具体目标是什么。

Mean, think it would go back to what the outcome we're looking at.

我完全理解你的观点，我本身也是一名运动生理学家。

I definitely hear you and I'm an exercise physiologist.

我非常推崇训练量的重要性。

I love volume.

我要告诉你，几年前我刚进入这个领域时，还是一名耐力跑者。

I will tell you when I first started in this space several years ago, I was an endurance runner.

那时我认为必须训练到几乎走不动路，才开始真正关注高强度训练。

I thought we had to train until you, like, couldn't walk and really started looking at high intensity training.

回到你提到的那个有三个孩子的久坐女性案例，如果我们想提升最大摄氧量，训练量的确很重要，但通过高强度训练我们能更快看到改变，这正是当下有时所需要的。

And when we go back to that sedentary woman you mentioned with three kids, if we want improvements in v o two max, that volume does come into play, but we can get those changes more quickly with that high intensity, which is sometimes what we need now.

刚开始锻炼时，采用这种训练方式让我感觉没那么痛苦。

I don't feel as terrible when I go work out when I'm just starting.

另外有个有趣的数据是关于'运动零食'概念的，即短时间高强度训练。

And so the other thing is there's some fascinating data on exercise snacks, that higher intensity short periods of time.

你了解Scott Trape的研究吗？他长期追踪测量了一些顶尖耐力运动员的数据。

And then are you familiar with Scott Trape's work that shows he's measured and tracked some pretty elite endurance athletes over time.

仅仅增加训练量并不能保持肌肉体积和质量的完整性。

Just doing volume doesn't help maintain the integrity of the muscle size and quality.

确实如此。

It does.

它在促进毛细血管形成和血流方面非常有效。

It's very good at capitalization and blood flow.

你指的是耐力训练吗？

You're talking just endurance training?

是的。

Yeah.

我们还没讨论过抗阻训练，但训练量可能并非唯一途径。

We haven't talked about resistance training, but where volume is maybe not the only way.

所以我只想稍作调整，无论你是谁，一点强度训练都很重要。

So I would just tweak that a little bit of intensity is gonna matter no matter who you are.

但确实，根据我们的表现目标，有时确实需要更大的训练量。

But yes, depending on our performance goals, sometimes you do need more volume.

那么我们来聊聊如何安排训练计划，因为我认为这是更现实的场景。

So let's talk a little bit about how you might structure that because I think this is the more realistic scenario.

我觉得每周能有18小时训练时间的人很奢侈，我们可以讨论各训练强度区间的分配比例。

I think it's a luxury for the person who's got eighteen hours a week to train where we can talk about how much zone two, how much zone one, zone three and zone five.

但现在让我们来谈谈那位妈妈说，好吧，我每周总共要挤出三小时来训练。

But now let's talk about the mom who says, Okay, I'm gonna carve out three hours a week in total for training.

那将是我的抗阻训练，也将是我的耐力训练。

That's gonna be my resistance training, that's gonna be my endurance training.

首先，这三小时里你打算在健身房和跑步机上各分配多少时间？

First of all, how much of that three hours are you gonna wanna put in the weight room versus on the treadmill?

是的。

Yeah.

意思是，还是要回到目标上来，但如果是一个普通的中年女性，我绝对会优先考虑每周进行几天全身渐进式抗阻训练。

Mean, would come back to goals, but if it was just a general, let's say midlife woman, I would absolutely prioritize a few days a week of whole body progressive resistance training.

我们正在进行一项研究，并尝试将其压缩到两天内完成。

We're doing a study right now and have done where we try and get it into two days.

我们会进行一些强度稍高的渐进训练，然后安排两到三天进行有氧运动。

We do a little bit higher intensity progressive and then two to three days where you're doing aerobic exercise.

而且，希望其中两天能进行高强度训练。

And, hopefully, two of those might be high intensity.

这确实还是要回归到目标本身。

It really does come back to the goals.

他们是想减脂、增肌，还是单纯为了活动身体？

Are they trying to lose fat, gain muscle, just move?

但实际上，你需要结合一些持续性的抗阻训练和一些能提高心率的运动，而不仅仅是低到中等强度的活动。

But in reality, you need a blend of some resistance training consistently and some exercise that elevates your heart rate versus just low to moderate intensity.

在那个例子中，你会不会说，好吧，我们每周做两天四十五分钟的全天抗阻训练？

In that example, would you say, okay, we're gonna do two forty five minute whole body resistance days?

我连那点时间都没有。

I don't even have time for that.

假设三十分钟吧。

Let's say thirty minutes.

我们设计了一个方案，这不是唯一的方法，但为了时间效率，设定为30分钟，每组6到8次重复。

We've done a protocol, and this is not the only way, but just for time efficiency where it's thirty minutes, it's six to eight reps.

所以采用60%到80%的1RM（一次最大重量），每个动作之间休息30秒。

So 60 to eighty percent one RM, thirty seconds in between each exercise.

每组间隔两分钟，总共三十分钟，我们就完成了。

Two minutes in between, it's thirty minutes, we're done.

好的。

Okay.

这样每周只需要一小时。

That takes an hour a week.

那么剩下的两小时，比如在跑步机上跑步或骑健身车，你如何安排这些时间？

And then of the two hours that you're gonna be left for, say, running on a treadmill or being on an exercise bike, how do you structure those?

听起来你是在说其中三分之二的时间可能是高强度训练，三分之一是低强度。

It sounds like you're saying two thirds of that time might be high intensity, a third of it might be low intensity.

是的。

Yeah.

我是说，至少每周要有一天进行高强度间歇式训练。

I mean, I would say at a minimum one day a week of high intensity interval style training.

如果能安排两天，刚开始时效果会更好。

If you can get two in, it's gonna be a bigger bang for your buck as you're starting.

而且我认为单纯的活动本身就很有价值。

And I do think there's a lot of value of just movement.

所以也许在你时间稍充裕的那天，无论是散步还是进行低强度的骑车运动，我的意思是，自由地促进血液循环并提升心率

So maybe on that day where you have a little bit more time, whether you're walking or doing more of that low intensity riding a bike, I mean, the freedom to just get some blood flow and get that heart rate

上升。

up.

那么高强度训练日你又是如何安排的呢？

And how do you structure the high intensity days?

我是说，方法实在是太多了。

I mean, are so many different ways.

对我们来说，从非常健康的人到癌症患者都非常有效的方案是：10组一分钟运动，一分钟休息。

The protocol that's been very effective for us in very fit individuals down to cancer individuals is 10 sets of one minute on, one minute off.

那一分钟要达到90%到110%的什么水平？

With that one minute being anywhere from 90% to a 110% Of?

最大心率的水平。

Of max.

你如何解释超出最大值的110%？

How do you explain 110% of max?

我的建议是选择一个你无法坚持1分20秒的运动强度。

What I would do is say pick an intensity that you couldn't go for a minute and twenty.

选择一个让你在1分钟内感到非常吃力、需要休息的强度。

You pick an intensity that one minute is really hard and you need to take a break.

我们曾通过测量最大摄氧量(VO2 max)来精确计算，但我们也试过，简单来说就是让你做一分钟非常吃力的运动然后必须休息。

We've done it where you measure VO two max and very calculate it, but we've also done it where we just said, hey, go do something for a minute that's really hard and you need to take a break.

然后下一分钟你再重复一次。

And then that next minute you go again.

好的。

Okay.

换句话说，是的，大多数人不会测量最大摄氧量，但你会说大约在最大摄氧量的90%到110%之间。

So in other words, yeah, most people are not gonna have VO two max measured, but you would say anywhere from 90 to a 110 of VO two max.

或者我们也用最大心率作为参考。

Or of max heart rate we've used as well.

是的。

Yeah.

关于心率训练，我的问题在于任何如此短时间的训练中，心脏根本达不到最大心率。所以直到最后——我发现普通人在训练时，比如在间歇训练开始时，他们的心率已经降下来了。

My issue with heart rate training when it comes to anything that's that short is the heart never gets to max heart rate So until the very I find that the lay person when they're training, let's say at the beginning of the interval, their heart rate has come down.

虽然不会降太多，但假设降到每分钟100次，而他们的最大值是180次，当进行到30秒时，心率只有140次。

Now it won't come down that much, but let's say it comes down to 100 beats per minute and let's say their max is 180, when they're thirty seconds in, it's only 140.

对。

Yeah.

他们可能会看到这个然后稍微退缩，可能会有点困惑。

They might look at that and back off a little bit, they might be a bit confused.

所以他们可能会试图加速超过应有的程度。

So they might try to speed up more than they should.

所以我一直认为你必须教会人们如何通过RPE（自觉用力程度）来应对这些强度。

So I've always felt like you have to be able to teach people how to RPE their way through those efforts.

当然，好在如果是骑车或在跑步机上，使用某种测功计时，功率或速度是固定的，这会迫使你保持这个强度。

Of course, the nice thing is on a bike or on a treadmill, if you're doing it on some sort of ergometer, the power or the speed are locked in and that forces you into the effort.

百分百同意。

A 100%.

我也认为间歇训练的目标，如果你在实验室环境下进行，即使不一定达到90%的强度，你仍然能看到效果。

I also think the goal of the interval style training if you're doing it, you know, in a lab is that you'll still see benefits even if you're not necessarily hitting that 90%.

可能只是需要的时间稍长一些，我们在家庭医疗诊所做过类似尝试，只提供一些指导，让他们不必非得在自行车或跑步机上进行。

It might just take a little bit longer and we've done this where we did some at home in a family med clinic and just said, here's some guidance so that they don't feel like they just have to do it on a bike or a treadmill.

他们开始体会到高强度运动的感觉。

They begin to feel what a high intensity feels like.

还因为RPE（自觉用力程度）和心率确实每天都在变化。

Also because RPE and heart rate does vary day by day.

你建议的是做一组休息一组，共十轮吗？

And you suggested one on, one off for 10 rounds?

最多十轮。

Up to 10.

有时我们从六轮开始。

Sometimes we start with six.

但确实，你会觉得一分钟内什么都能做到。

But yes, it just feels you can do anything for a minute.

现在有很多关于三十秒训练的科学依据，我们也研究过不同的方案，比如两分钟。

Now there's a lot of good science of doing thirty seconds, and we've looked at different protocols, two minutes.

但那种一分钟运动、一分钟休息的模式，你可以自己完成，而且通常非常可行。

But that one minute on, one minute off is something you could do on your own, and it tends to be very feasible.

当你告诉那位女士时，我们回到原点，实际上只需要十分钟的运动，总共二十分钟。

And when you tell that woman, we go back to of, it really takes ten minutes of work, twenty minutes total.

有时候当我说没时间锻炼或要送孩子去打棒球时，我很喜欢这样做。

And I love doing that sometimes when I say I don't have any time to exercise or I gotta get my kids to baseball.

也许今天只做六组间歇训练。

Maybe it's only six intervals today.

你完成训练后，不仅当场见效，还能在第二天持续产生效果。

You get it in, get it out, and you have a not only an effect there, but that lasting effect for the day after.

那么回到我们假设的这位女性案例，如果她愿意投入两小时进行有氧运动（因为你已经用一小时进行抗阻训练），考虑到包含热身和放松时间，假设每次训练耗时半小时，你会建议她做两次这样的训练吗？

So if you're going back to the case of our hypothetical woman here, if she's got two hours that she's willing to put into cardio because you've taken one hour on resistance training, would you do two of those since with warm up and cool down, let's just say each of those is half an hour.

所以现在你又多了一小时，总共两小时。

So now you're at two of those as another hour.

剩下的那一小时，你会安排一两天低强度训练吗？

For the remaining hour, would you prescribe one or two low intensity days?

是的。

Yeah.

这完全取决于你是否能单独抽出一整小时。

It all comes down to do you have a whole hour by itself?

随着年纪增长，我现在需要每天锻炼。

Now as I've aged, like, I need exercise every day.

否则我就会感觉不适。

Otherwise, I'm unwell.

所以三十分钟的运动更容易坚持，具体取决于强度。

So that thirty minutes, it's a bit more manageable to do and depending on intensity.

因此，我会拆分时间，确保大多数日子都能进行某种锻炼。

So, yes, I would split it up so that more days than not, we're doing some sort of exercise.

我还要补充一点，优先安排几天进行高强度训练，而非增加低强度训练日，这也有助于增加瘦体重，对中年人群很有帮助。

The other thing I'll add is prioritizing that high intensity training a couple days versus an added low intensity day, it does increase lean mass as well, which can be helpful for that midlife.

那么我们来谈谈女性可能带着哪些目标来参与训练。

So let's talk a little bit about some of the goals that women might be coming into this with.

那么我们先从这个问题开始：你是否会区分减重和身体成分的改变？

So let's start with, do you ever differentiate between weight loss and body composition?

我是说，它们基本上是一回事，对吧？

I mean, they're basically the same thing, aren't they?

这是我所热衷的事情之一，因为大多数女性都说我想减重。

It's one of the things I'm passionate about because most women say I wanna weigh less.

或者说我们被教导说，哦，我不想了解自己的体脂率，而实际上我们应该知道。

Or we were taught like, oh, I don't wanna know my body fat when in reality, like, we should know.

你需要进行测量，因为很多时候体重没有变化甚至增加了。

And you wanna measure so that a lot of times the weight doesn't change or goes up.

所以这一切都关乎身体成分。

And so it is all about body composition.

但很多女性并不理解这一点。

But a lot of women don't understand that.

你会如何建议一位来找你并表示想减肥的女性？这其实是大多数人的普遍诉求。

How would you counsel a woman that came to you and said, want to lose weight, which would be the common statement for anyone.

不仅女性如此，男性也一样，每个人都会说‘我想减肥’。

This is not this is men, this Everybody is says, I wanna lose weight.

是的。

Yes.

他们真正的意思是，我想减掉的是

What they really mean is, I wanna lose The

体脂。

stat.

没错。

Yes.

所以我们会进行一些测量，采用相当全面的方法，无论是DEXA扫描、多频生物电阻抗分析，还是家用体脂秤。

So we would do some sort of measurement, and we do a pretty comprehensive, whether it be a DEXA scan or a multi frequency bioelectrical impedance or an at home scale.

它们各有不同，但大多数在追踪变化方面做得相当不错。

They're all different, but most of them do a pretty good job with tracking changes.

我会根据那个数字计算理想体重。

And what I would do is based on that number calculate ideal weight.

由此，它告诉我们，好吧。

And from that, it tells us, okay.

这是我们的脂肪和肌肉比例，但根据我的健康目标或体重目标，这是我的理想脂肪和肌肉比例。

Here's our percent fat and our muscle, but here's my goal percent fat and muscle based on my health goals or my weight goals.

很多时候人们会想，哦，我要回到高中时的状态。

A lot of times people think, Oh, I went away what I did in high school.

但实际上，他们需要为此减掉肌肉。

But in reality, they'd have to lose muscle for that.

因此，给他们一个更具体的脂肪比例目标，以此来指导我们的体重目标。

And so giving them more of a target percent fat with that to inform our weight goal.

你是如何确定理想体脂率的？

And how do you make a determination of what the ideal body fat percent is?

我的意思是，根据设备不同，很多时候可以使用NHANES的数据。

I mean, depending on the device, lot of times you can use NHANES.

实际上在第五十百分位左右，我们会看到很多心脏代谢变化。

Really around the fiftieth percentile, we see a lot of cardiometabolic changes.

所以采用较低的百分比，我会根据个人情况参考一些标准数据。

So using a lower percentage, there's normative data that I would use based on the individual.

但你具体会以哪个百分位为准呢？

But to what percentile do you bank?

降到第五十百分位数？

Down to the fiftieth percentile?

哦，不。

Oh, no.

不是的。

No.

通常我们希望降到第二十五百分位数或更低。

Usually we want it down to like the twenty fifth percentile and lower.

是的。

Yeah.

第五十百分位是你需要避开的。

Fiftieth is what you wanna stay away from.

明白。

Yep.

懂了。

Got it.

如果一位女性走进来，身高五英尺六英寸，大约平均身高，体重一百五十磅，这些数据目前还说明不了什么。

If a woman came in and she was five foot six, probably the average height, and one hundred and fifty pounds, which tells us nothing yet.

但现在你给她做了个DEXA扫描，显示体脂率30%。

But now you do a DEXA scan and she is 30% body fat.

我猜这大概接近NHANES数据的第五十百分位。

My guess is that's probably about the fiftieth percentile of NHANES.

她多大年纪？

How old is she?

40岁。

40.

是的。

Yeah.

我会说这个数值稍微偏低一些。

I would say that it's a little bit lower.

可能还行。

Probably Okay.

第三十百分位

Thirtieth

如果她说，听着，我想减掉20磅。

if she said, look, I want to lose 20 pounds.

我想从100...我刚才说多少来着？

I want to go from a 100 what did I say?

一百，对。

Hundred Yeah.

我想减到130磅。

I want to be one hundred and thirty pounds.

那么你会如何建议她呢？

So how would you then advise her?

我们会测量她的身体成分，看看她的骨骼重量、肌肉组织以及脂肪含量，还有脂肪分布的位置。

So we would measure her body composition, see what her bone weighs, what her lean soft tissue or muscle and her fat, also where she stores her fat.

然后我们就能了解她的食物摄入量。

And then we would understand how much food she's consuming.

对于一个典型的40岁女性，假设她是两个孩子的母亲，她的脂肪分布通常会是什么模式？

And a typical 40 year old woman, let's say she's a mother of two, what would be the typical pattern of fat storage on her?

这个问题很棘手，因为情况已经发生了变化。

So most often, this is tricky because it's changed.

我的意思是，大多数女性脂肪会储存在臀部，但随着年龄增长，腹部区域的脂肪会增多。

I mean, most women store it in their hips, but as we age, we store more in our abdominal region.

这并不总是内脏脂肪，但这是很多讨论的焦点，也是我们测量它的原因。

And so it's not always visceral fat, but that is a lot of the conversation and why we measure it.

许多女性开始在内脏区域储存更多脂肪，主要是在器官周围而非臀部，这会增加心脏代谢疾病的风险。

A lot of women then begin to store more in their visceral region, kind of on their organs versus their hips, which comes with an increase in cardiometabolic disease.

那么对于这位女性，我们假设她的内脏脂肪实际上很低。

So in the case of this woman, let's assume that her visceral fat is actually quite low.

再假设她代谢状况相当健康，虽然你们未必测量过，但假设她做过其他血液检测且代谢健康，而且这些脂肪主要是皮下脂肪，无论是堆积在臀部还是腹部，，但不在内脏周围。

And let's assume that she's also metabolically quite healthy, even though you haven't necessarily measured that, but let's just say she's had some other blood tests and she's metabolically healthy and that this is just mostly subcutaneous fat, whether it be on her hips or on her abdomen, but it's not inside.

那很好。

That's great.

但说实话，我们都希望看起来更好。

But let's be honest, we all want to look better.

她大概会说，'我想减掉20磅'。

She sort of says, Look, I want be 20 pounds lighter.

顺便说，如果她想锻炼，膝盖少承受20磅的重量会轻松很多。

And by the way, if she wants to exercise, it's great to carry 20 less pounds around on the knees.

对。

Right.

嗯，我通常会说20磅可能太多了。

Well, I would usually say that 20 pounds is probably too much.

根据历史测量数据，如果她身高五尺六寸、体重一百五十磅，我们可能更倾向于减10磅。

Based on historical measurement, we're probably looking at more of a 10 pound if she's a hundred and fifty, five six.

根据那个骨架，一百四十磅可能更合理，然后会包括一些后续测量。

Hundred and forty pounds based on that skeleton is probably more reasonable, and then it would include some follow-up measurements.

所以我们正在进行一个项目，许多女性不一定要减重，而是用肌肉替代脂肪。

So we're doing a project right now where many women are not necessarily losing weight, but they're replacing fat with muscle.

这又回到了营养策略的问题上。

Again, that comes back to some nutritional strategies.

所以我想问题是，我们如何帮助她减重？

And so I guess the question is how do we get her to lose weight?

需要结合低热量摄入，即轻微的热量赤字，同时了解她的饮食情况。

There's a blend of hypocaloric intake, so we need a slight calorie deficit to understand what she's eating.

我们在中年阶段尚未充分讨论的是，不仅仅是减少食物摄入，还需增加如纤维这类能增强饱腹感的食物，以及足够的蛋白质和复合碳水化合物。

A conversation that we're not having in this midlife is it's not just taking out food, it's adding in foods like fiber that help with satiety, enough protein, and complex carbohydrates.

所以需要平衡锻炼和适当的热量赤字。

So it's balancing that with her workout and having some of a calorie deficit.

现在，很多女性或任何人，但我们讨论的是这个假设案例，许多处于150磅这种情况的女性，使用GLP-1受体激动剂可以轻松减到130磅。

Now, a lot of women or anyone for that matter, but we're talking about this hypothetical case, a lot of women in this situation of being one hundred and fifty could easily get to one hundred and thirty with a GLP-one agonist.

假设有位女士说，我要服用这种GLP-1激动剂，因为我要减到130磅。

So let's just say a woman says, I'm going to take this GLP-one agonist because I'm going to weigh one hundred and thirty pounds.

你会采取什么策略来确保：在总共减掉的20磅体重中，肌肉流失不超过5磅，这样就有15磅是脂肪？

What are the strategies you're going to employ to figure out a way to say, Look, I want Of the 20 pounds that you're going to net lose, I'd like to make sure that no more than five of them are muscle and therefore 15 of them are fat.

顺便说一句，这对身体成分会是巨大的改善，对吧？

Which by the way would be an enormous improvement in body composition, right?

她的体脂率会从35%降到20%或22%左右。

She would go from being 35% body fat to 20% body fat or 22% body fat or something like that.

那么在这两方面——营养和训练上，你会采取什么样的策略呢？

So what kind of strategies would you employ there both in terms of nutrition and in terms of her training?

在这些情况下，通常在那个生命阶段，我们知道我们的肌肉质量也在发生变化。

In those cases, in general, in that life space, we know that our muscle quality is also changing.

这更加凸显了抗阻训练的必要性。

It just emphasizes the need for resistance training.

具体实施方式多种多样，但我绝对会优先考虑抗阻训练，以帮助维持瘦体重并改善肌肉质量。

And there's a lot of different ways to do that, but I would absolutely prioritize resistance training to help to maintain that lean mass and improve the muscle quality.

此外必须讨论蛋白质摄入问题，特别是要考虑到全天氨基酸的持续供应。

And then protein has to be a conversation, particularly thinking about maintaining amino acids over the day.

因此需要规律进食，通常目标是每天均匀分配摄入约30克蛋白质。

So consistently feeding, usually the goal is around 30 grams of protein evenly spaced throughout the day.

我们还研究了运动前后补充必需氨基酸的效果，这对优化瘦体重维持很有帮助。

We've also done some work with essential amino acids around exercise, which really helps optimize that maintenance of lean mass.

那你建议每天摄入多少量呢？

And what would you target per day?

如果她目前150磅，你会建议每天摄入150克蛋白质吗？

If she's at one hundred and fifty, would you target 150 grams of protein a day?

是的。

Yeah.

我是说，通常你会用目标体重来作为参考标准。

I mean, usually you use the goal weight to identify.

但没错，我会建议130到150克蛋白质，它的热效应更高。

But yes, I would say 130 to 150 grams of protein, it has a higher thermic effect.

这是相当激进的减脂、减重方案。

That's a pretty aggressive fat loss, weight loss.

所以是的，如果能达到150克，那会是个不错的目标。

So yes, if we could get to 150, that would be a good goal.

嗯。

Yeah.

我提出这个是因为我认为我们必须接受很多人将会使用这些药物的事实。

And the reason I bring this up is I think that we just have to accept that many people are going to use these drugs.

它们的耐受性正在变得越来越好。

They're becoming more and more tolerable.

Mounjaro或tirzepatide的耐受性明显优于semaglutide。

Mounjaro or tirzepatide is significantly easier to tolerate than semaglutide.

我只是想确保那些正在消瘦的人们能够明白，嘿，事情不必如此。

And what I just want to make sure is that all the people that are out there wasting away have the insight into, hey, it doesn't have to be this way.

我仍然可以服用这种药物，仍然可以减肥，但也需要采取一些刻意的措施来确保不对我的骨骼肌产生负面影响。

I can still take this drug, I can still lose weight, but I also have to do something kind of deliberate to make sure I don't have a negative impact on my skeletal muscle.

我认为这一点非常重要，我的意思是，大多数男性和女性，尤其是女性，真的希望体重更轻。

Which I think is such an important point that, I mean, most men and women, but most women really wanna weigh less.

但肌肉的流失会对我们的长期健康产生巨大影响。

But the loss of muscle can have a dramatic impact on our health long term.

我们刚开始研究这些GLP-1药物，探讨合适的剂量，或者通过调整剂量、结合抗阻训练和高蛋白饮食是否能改善身体感受。

And we're just starting some of this work with these GLP-1s of what is the right amount or can we alter the dose or help us feel better if we add things like resistance training and higher levels of protein?

在蛋白质方面有充分的科学依据，因为它们会影响食欲。

And there is good science on the protein side of things because they impact appetite.

研究重点仍然集中在营养素上。

It's still focusing on the nutrients.

这实际上与我们关于营养时机的研究工作密切相关。

And that really ties into some of our work with nutrient timing.

如果你正在使用GLP-1类药物并打算锻炼，你绝对需要考虑在运动前后补充氨基酸，以最大化锻炼效果。

If you are then on a GLP one and going to exercise, you absolutely wanna think about having amino acids before and or after to really maximize the effect of the workout.

是的。

Yeah.

实际上，我昨天还在和某人聊她使用司美格鲁肽和替尔泽肽的经历。

I was talking with someone yesterday actually about her experience on both semaglutide and tirzepatide.

这非常有趣，因为她说没有人跟她谈过——我想这也是大多数人的经历——没有人向她解释过，当你服用这些药物时，你不仅仅是减少日常饮食量。

It was just very interesting because she said that nobody had talked to her about, and I think this is most people's experience, nobody explained to her that when you're on one of these drugs, you don't just go about your day eating less.

实际上你需要制定一种新的饮食方案，这种方案当然要降低卡路里，但必须大幅提高质量以弥补总能量的减少。

You actually have to create a new diet that of course is lower in calories but has to be much higher in quality to compensate for the reduction in total energy.

换句话说，正是你所说的那样。

In other words, exactly what you're saying.

但有趣的是，她直到自己发现这一点之前都不知道。

But it was interesting that she didn't know that until she figured it out herself.

这当然让我想知道有多少人没有得到正确指导来使用这种药物。

And it of course makes me wonder how many people are not being counseled correctly to be able to use this drug.

这是一种很棒的药物。

It's a great drug.

它是一个神奇的工具。

It's an amazing tool.

但随之而来的是一种责任——暂且这么说吧——你必须对能量构成做出直接且非常审慎的改变，当然还有训练方面的调整。

But it comes with a responsibility, for lack of a better word, which is you're going have to make these direct and very deliberate changes in the energy composition and then obviously around the training.

大多数人也没有测量身体成分。

Most people are also not measuring body composition.

所以你根本不知道自己在减掉什么类型的体重。

And so you really don't know what type of weight you're losing.

而我们观察到肌肉和骨骼的加速流失。

And we see this accelerated loss of muscle and bone.

你对骨密度下降的原因有什么理论？

What's your theory on why the bone densities are going down?

嗯，我的第二点是取决于用药人群，如果我们观察年轻群体，无论是否使用这些药物都会看到这种情况。

Well, was my second point is depending on who's taking these drugs, if we're looking at a younger population, we're seeing with and without these drugs.