#387 - AMA #83：肽类——评估一个快速发展的领域中的科学、安全与炒作

大家好。

Hey, everyone.

欢迎收听Drive播客的抢先版问答环节，也就是AMA。

Welcome to a sneak peek ask me anything or AMA episode of the Drive podcast.

我是你们的主持人，阿提亚。

I'm your host, Attia.

在本集短片的最后，我会告诉大家如何完整收听这些问答内容，以及我们为会员准备的其他大量权益。

At the end of this short episode, I'll explain how you can access the AMA episodes in full along with a ton of other membership benefits we've created.

你们现在也可以访问 peterattiamd.com/subscribe，了解更多详情。

Or you can learn more now by going to peterattiamd.com forward slash subscribe.

那么不多说了，下面带来今天这场问答环节的抢先版内容。

So without further delay, here's today's sneak peek of the Ask Me Anything episode.

欢迎来到问答环节。

Welcome to Ask Me Anything.

今天的AMA，我们来聊聊一个大家最常问、也最让人困惑的话题：多肽。

In today's AMA, we take on one of the most requested and most confusing topics we've ever covered: peptides.

多肽处在生物学合理性、临床潜力和过度商业化三者的交汇点上。

Peptides sit at the intersection of biological plausibility, clinical promise, and rampant commercialization.

它们常被宣传为前沿的再生疗法，号称能修复肌肉、延缓衰老，甚至改善外貌。

They're often marketed as cutting edge regenerative therapies for everything from muscle repair and longevity to cosmetic enhancements.

但事实上，多肽领域庞大混乱、监管薄弱，各种说法从有依据到完全无凭无据，混杂其中。

But the reality is that the peptide ecosystem is sprawling, poorly regulated and filled with claims that range from legitimate to completely ungrounded.

所以这期节目的目的，不是鼓吹多肽，也不是全盘否定，而是帮你建立一套评估它们的思路。

So the goal of this episode is not to promote peptides or dismiss them as a category, but to give you a framework for evaluating them.

因为你知道的，我们这儿特别喜欢搞框架。

Because as you know, we love us some frameworks over here.

我们会讲清楚多肽是什么，使用任何多肽或药物前该问哪些问题，以及如何判断科学证据的强弱、安全性如何，还有科学和营销炒作之间的区别。

We walk through what peptides are, what questions you should ask before putting any peptide or any drug into your body, and how to think about the strength of evidence, the safety profile, and the difference between science and marketing hype.

具体来说，我们会探讨为什么多肽在健康与抗衰老圈子里变得这么热门，FDA批准的多肽药物和生物黑客圈里常说的那些‘多肽’之间到底有什么不同。

So specifically we're going to discuss why peptides have become such a dominant topic in the wellness and longevity culture, the differences between FDA approved peptide therapeutics and peptides, which are what most people refer to with quotes in the biohacking world.

我们会提供一套评估任何多肽的框架：作用机制、预期效果、安全性、剂量，以及有没有其他替代方案。

A framework for evaluating any peptide, mechanism, intended effects, safety, dosing and alternatives.

接着我们会用这个框架，详细分析几个具体的例子。

And then we're going to run our framework through a handful of examples in detail.

SS-31，我们会聊聊它的背景、生物学机制，以及它被研究用于哪些病症。

SS-thirty one, talk about the background, the biology and the types of conditions it has been studied for.

黑色素皮质素-2，讲讲它的受体活性、常见的宣传说法，还有同一通路中已获FDA批准的药物。

Melanotan-two receptor activity, common claims, related FDA approved compounds in the same pathway.

CJC-1295，我们会探讨它如何影响生长激素信号，为什么它被用于人体研究，研究目标是什么，以及通常怎么确定剂量。

CJC-twelve 95, we'll talk about growth hormone signaling, why it has been studied in humans, what it's been studied for, and how dosing is typically approached.

当然少不了BPC-157，谈到这个话题，不提它就不完整。

Of course BPC 157, no discussion on the topic would be complete without that.

它的由来、提出的机制，还有常被引用的动物和人体研究证据到底是什么情况。

The origin story, the proposed mechanisms, and the nature of the animal and human evidence that's often cited.

我们还会讨论专利在药物研发中的作用，以及背后的激励机制，为什么有些化合物能进入正式临床试验，有些却不能。

We're going talk about the role of patents and the incentives in drug development and why some compounds do or don't advance through formal clinical pipelines.

我们会把肽类物质的研究证据标准，和其他那些热度高但数据还不充分的干预手段做个对比。

We're going to compare peptide evidence standards to other widely discussed interventions that fall into high interest incomplete data categories.

我们来聊聊多肽是怎么生产和在灰色市场销售的，'仅供研究使用'这个标签到底是什么意思，第三方检测能评估哪些方面，又有哪些是它覆盖不到的；再讲讲口服多肽、消化过程中的分解、吸收的难题，以及从制药案例中我们了解到的信息；接着讨论要让多肽成为更广泛应用的疗法，还需要哪些条件；最后展望一下多肽疗法未来可能拓展的方向，以及目前哪些医学领域最有可能从中受益。

We're going talk about how peptides are manufactured and sold in the gray market and what the research use only designation actually means, what third party testing can evaluate and what it doesn't capture, talk about oral peptides, digestive breakdown, absorptive challenges, and what we know from pharmaceutical examples, talk about what needs to happen for peptides to become more broadly usable therapies, and where peptide therapeutics may expand in the future and what areas of medicine might be most actively and positively benefited right now.

彼得，欢迎来到又一次的问答环节。

Peter, welcome to another AMA.

你最近怎么样？

How are you doing?

我挺好的。

I'm

我这边也很好，老兄。

doing great, man.

你呢？

How are you?

我状态不错。

I'm doing good.

今天的问答环节，我们主要聊一聊多肽。

For today's AMA, we are gonna be talking about peptides.

肽这个话题，我们被问到的频率高得离谱。

So peptides are a topic that we get asked about an insane amount.

网上到处都是这方面的内容。

You see so much content on there.

就连今天翻邮件，我们都收到两封信，专门让我们讲讲肽。

Even today going through our email inbox, we had two emails asking us to talk about peptides.

这个话题我们一再遇到。

So it's a topic we see over and over.

这期节目的目的不是要鼓吹或否定肽，而是帮大家建立一个思考框架：到底什么是肽？

And our goal with this episode is not to promote, dismiss peptides overall, but just to give people a framework and how to think about them, which is what are peptides?

哪些科学依据扎实，哪些薄弱，或者根本不存在？

Where is the science solid, weak, or nonexistent?

该怎么判断别人做出的各种宣称？

And how to evaluate the claims that people make.

我们会围绕一套核心问题来展开，这些问题是适用于任何肽的，然后用它们来分析几种最受欢迎的肽，比如：我们是否清楚它的作用机制？

With this, we'll walk through a core set of questions that apply to any peptide and we'll apply it to a variety of peptides to kind of walk through some of the most popular ones, which is whether we know there's a mechanism of action.

关于安全性和剂量，我们了解多少？

What do we know about safety and dosing?

有没有证据表明它对人类有效？

Is there any evidence that it can be helpful in humans?

该怎么权衡风险和潜在益处？

How does someone compare the risks and the potential benefits?

有没有其他合法且获批准的替代方案？

And are there any other legitimate approved solutions that are available?

最后，我们还会放眼整个肽类产品的灰色市场，聊聊人们该怎么看待纯度、来源这些问题。

And then at the end, we'll also zoom out and talk about the gray market space for peptides, including how people should think about purity, sourcing, etcetera.

之后我们会进一步展望肽类的未来，看看需要哪些新证据，才能真正判断它们在哪些方面有希望。

And then we will truly end on the potential future of peptides and what we would need to know, what new information would have to come out to really understand where these could be promising.

要聊的内容很多，涉及的方面也很广。

A lot to cover, a lot of different things to be said.

在开始之前，你有什么想让大家知道的吗？

Anything you want people to know before we get rolling?

没有。

No.

我觉得你都已经讲全了。

I think you've covered it.

最近半年，我被问得最多的议题，恐怕就是这个了。

I don't think there's a topic I get asked about more today and probably for the last six months than this topic.

我想补充一点，我们拖了这么久才做这场AMA，是因为想把它真正做好。

I would just add that the reason it has taken us so long to come out with this AMA is we wanted to do this justice.

我们这档播客什么事都追求极致，唯独对‘适度’例外。

We don't do anything in moderation on this podcast except for moderation.

这个标准必须得达到才行。

There's a bar that just had to be cleared.

希望接下来的内容，能让你觉得值回票价。

I hope we're about to clear it for you as a listener.

我其实有点不敢问，我们的研究团队为我准备这场内容花了多少时间。

And it just took I'm actually kind of afraid to ask how much time it took of our research team to help me get ready for this.

那我们直接切入正题吧。

So let's dive into it.

太好了。

Perfect.

我觉得我们得先说清楚什么是肽。

I think we got to start off with defining what are peptides.

说起来还挺有意思的。

By the way, it's funny.

上周末我老婆也问我这个问题。

My wife asked me this over the weekend.

我们一家人正吃着饭，她突然问了我一个关于肽的问题。

We were sitting there, she was asking me a peptide question and it was like we were having dinner with the whole family.

结果自然地，八岁和十一岁的孩子也跟着问：肽是什么？

And of course, naturally, the eight year old and the 11 year old are like, What are peptides?

所以我提前给他们解释了肽是什么，为的就是今天这场讨论。

And so, I'm explaining to them what peptides are in anticipation of this discussion.

你看，这没什么神奇的。

So look, there's nothing magical here.

在健康养生领域，人们总把肽说得像什么神奇新玩意儿，其实根本不是。

A peptide, it gets talked about in this health and wellness space like it's something magical or new, but it's not.

肽就是一串短链的氨基酸。

A peptide is a short chain of amino acids.

其实对于肽和蛋白质之间到底怎么区分，也没有一个明确的定义。

I don't think there's a real clear definition of what constitutes a peptide versus a protein.

但很明显，一旦氨基酸数量达到几千个，那肯定就是蛋白质了。

Clearly, once you're into the thousands of peptides, you're clearly talking about proteins.

我看过一些说法，说最多到60个、100个氨基酸左右，具体我也说不准。

I would say I've read definitions that would suggest up to 60, up to 100, I don't know.

但关键是，肽的结构很小。

But the point is it's pretty small.

所以，肽就是由相对较少的氨基酸连在一起形成的。

So, a short number, relatively short number of amino acids strung together forms a peptide.

顺便说一下，有时候肽特别短，就是一串直线排列的氨基酸，有时候则会形成更复杂的结构，比如环状之类的。

Now, by the way, sometimes it's so short that it's literally just a straight line of amino acids and other times they form more complex structures, they form rings and things like that.

这些其实都是身体自己天然产生的东西。

Again, these are things that the body naturally produces.

所以人体内自然会产生很多种肽。

So there are many peptides that are produced naturally.

它们承担着各种至关重要的功能。

They serve all sorts of essential functions.

它们作为信号分子、神经递质发挥作用。

They act as signaling molecules, neurotransmitters.

有的帮助运输分子，有的还能起到抗氧化的作用。

They act to facilitate the transport of molecules, they sometimes can act as antioxidants.

所以有些肽的名字你肯定听过。

So some of these peptides are going to sound really familiar.

比如大家常听说的内啡肽、胰岛素、GLP-1，这些其实都是肽类激素。

Some of the most important things that people have heard of like endorphins, insulin, GLP-one, these are all peptide hormones.

当然，这些物质中的一些也可以通过人工合成的方式制造出来。

Now, of course, some of these things can be produced synthetically.

因此，我们现在能够开发出基于肽的疗法，模拟人体自身产生的肽类物质。

So we're able to create peptide based therapies that can mimic the endogenous or body produced peptide.

所以，这里最重要的一种，毫无疑问就是胰岛素。

So again, I would say here the single most important of these would be insulin.

胰岛素大约一百年前被发现，当时人们已经清楚，患有一型糖尿病的人因为免疫系统攻击自身的胰岛β细胞，导致缺乏胰岛素，最终会死亡。

Insulin was discovered roughly one hundred years ago and it was clear that in a disease called type one diabetes that people who lacked insulin because their beta cells were being attacked by their immune system were going to die.

如果我们不能给他们补充某种形式的胰岛素——最初是通过从狗或猪身上提取——他们就会面临生命危险。

And if we couldn't give them some form of insulin, and initially that was done by taking insulin from dogs or pigs, that they were going to be in trouble.

但后来，一旦胰岛素可以人工合成，我们就有了能够挽救一型糖尿病患者生命的治疗方法。

But ultimately, of course, once insulin could be synthetically produced, you could create a therapy to save the life of somebody with type one diabetes.

最近，大家肯定对GLP-1类药物非常熟悉了。

More recently of course people will be very familiar with the GLP-1s.

我们会专门讲这个话题，因为在GLP-1领域，我们通常不是直接给患者使用完全相同的肽，这点稍后我们会再说明。

We're going to talk about that because in the GLP-one world we're not typically giving people the exact same peptide, but we'll come back to that.

总之，可能我说得有点多了，不过我们就先从这个定义开始吧。

So anyway, that's maybe more than you want to hear but we'll start with that as a definition.

让大家了解‘肽’这个词涵盖的分子种类确实很有帮助，但很多时候，当人们问起肽类补充剂时，他们指的往往不是胰岛素，甚至也不是GLP-1类物质。

It's good for people to hear how many different molecules the word peptides can cover but I think a lot of times when people are asking questions about peptide supplements, traditionally it seems like they're not always referring to insulin or even GLPs.

所以为了今天这场对话不至于拖上十八个小时，你最想让我们重点聊哪些肽类物质？你的核心目标是什么？

And so for the sake of this conversation today and not having eighteen hours to go over everything, what is your goal with the peptides you want to make sure we talk about today?

这其实挺有意思的。

Well, it's interesting.

我们待会儿会换一种方式来讨论这些物质。

We're going to actually talk about these a little differently.

今天我们不会谈胰岛素。

So we're definitely not going to talk about insulin today.

GLP-1我们会稍微提一下，但主要是从监管的角度来看。

We will talk a little bit about GLP-one but from a sort of regulatory standpoint.

从医学角度来说，肽通常指的是经FDA批准的治疗性分子，比如胰岛素或者GLP-1类药物。

In medical terms, would say a peptide broadly refers to an FDA approved therapeutic molecule, again like insulin or GLP-one drugs.

但我觉得，日常生活中提到的‘肽’，我们今天要聊的这种，更多是指那种属于生物黑客、流行科学、兄弟科学圈里的说法，指的是各种号称能延缓衰老、改善容貌、促进组织修复和提升表现的疗法。

But I think in the more colloquial sense, the word peptide, as we're going to talk about it today, is more of the biohacking, pop science, bro science connotation that refers to various therapeutics that are touted for various benefits often related to longevity and beauty and tissue healing recovery performance.

但这些产品根本没获得FDA批准，或者只是被超说明书使用来达到这些目的。

But they don't have an FDA approval at all or they're being just used off label for any of these purposes.

所以我们今天谈的肽，指的是那些通常通过注射方式使用、尽管缺乏科学或医学共识支持其效果，却依然流行起来的东西。

So when we're going to talk about peptides, we're going be talking about things that are generally administered via injection that have become popular despite a lack of scientific or medical consensus on their efficacy.

这些产品几乎都是通过灰色渠道获得的。

These are going to be things that are virtually all available through gray market means.

我们也会解释一下，这到底意味着什么，以及为什么非得走这条路。

And again, we're going to talk about what that actually means and why that's necessary.

所谓‘非得’，就是说为什么你只能通过这种方式买到这些东西。

By necessary, I mean why that's the means by which you would acquire these things.

它们的销售在技术上并不违法，但商家会打着‘仅供研究使用’的旗号——我特别强调这个措辞——明确说不用于人体，可谁都心知肚明，实际上就是有人在用。

In which their sale isn't technically illegal, but by marketing them for research use only, and I'm being very clear in that language, they're not approved for human use but everybody understands that they are indeed being used by people.

是的。

Yeah.

既然这么多肽类物质属于灰色市场产品，也没有获得FDA批准，你建议人们该怎么看待它们，怎么判断它们是否真的有用呢？

And given that a lot of these are gray market, not FDA approved peptides, How do you recommend people start to think about them and start to evaluate the potential of whether they can be helpful or not?

我觉得我们应该从疗效和安全性两个方面全面讨论这个问题。

I think we want to talk about this across the entire spectrum of efficacy and safety.

但我不觉得我们该去问‘肽类有没有用’这种笼统的问题。

But I don't think we want to even entertain the question, do peptides work as a category?

答案很明显：它们确实有用。

The answer is obviously they do.

我们不妨看看GLP-1激动剂、胰岛素，甚至像HCG这样可能还属于肽类的长效蛋白，它们的临床效果都是有明确证据的。

Again, we'll point to GLP-one agonists, insulin and even longer proteins that are probably on the verge of still being peptides like HCG that are clearly clinically efficacious.

所以，我认为真正该做的是以客观中立的态度，逐一评估每种肽类是否有足够的科学依据支持其安全性和实际效果，看看它的监管状态如何，再问一句：它有没有理由在现实中使用？

So, I think what we want to really do is take an unbiased approach and evaluate whether any given peptide has enough evidence for its safety and its actual efficacy, examine the regulatory structure of it and ask the question, is there a justification for real world use?

而且我觉得，这种评估方式在分析这些未受监管的肽类时特别有用，这也是我们今天要重点讨论的部分。

And again, I think this is most helpful when evaluating things through the lens of these unregulated peptides and that's really where we're going to focus today.

我想，这正是我们这个播客能为这个话题带来的独特价值。

That's the value I think we can bring in this podcast to this discussion.

所以，不管你是不是经过FDA批准，只要是往身体里放的东西，都该问同样的问题。

So, again, whether you're FDA approved or not, I think you should always be asking the same question of anything you put in your body.

咱们先退一步，别急着从肽类这个角度去想。

Let's just take a few steps back and not even think about the lens of a peptide.

不管用什么药，都该问这些问题，而且答案应该直接影响你的决定。

If you're going to put any drug in your body, you should be asking these questions and the answers to these questions should be kind of informing your decision making.

第一个问题是：有没有明确的作用机制？

So the first question is, is there a viable mechanism of action?

关于这一点，当然有很专业的分析方法。

There's very technical ways to think about this.

我不关心那种模糊的说法，比如‘它能提升能量’之类的。

I'm not interested in vague theories like, oh, it boosts energy production.

这根本算不上作用机制。

That's not a mechanism of action.

我们真正想知道的是：有没有一套清晰、合乎逻辑的机制步骤，能合理地导致预期的效果？

What we want to know is do we have a defined course of mechanistic steps that might logically lead to an intended effect?

这一点非常重要。

So this is very important.

事实上，FDA批准的药物中，那些作用机制尚不明确的占比非常小。

In fact, the list of drugs that are approved by the FDA for which we don't have a mechanism of action is very small.

据估计，不超过所有获批药物的3%。

It's estimated to be no more than 3% of total drugs that are approved.

这还包括非处方药。

And this includes over the counter drugs.

如果一种药物或补充剂没有明确的作用机制，你就该保持高度怀疑。

If there's no mechanism of action, you should be very skeptical of a drug or supplement.

所有处方药和合法销售的非处方药中，不到3%的作用机制我们还不清楚。

This is everything that you get a prescription for and everything that is sold legally over the counter, less than 3% of these, we don't understand the mechanism of action.

当然，也有一些有趣的例子。

Now, are some interesting examples.

比如，泰诺就是一个例外。

So, Tylenol is an exception.

你可能不信，但我们其实并不清楚泰诺是怎么起作用的。

Believe it or not, we don't actually know how Tylenol works.

我们也不知道锂是如何发挥作用的。

We don't know how lithium works.

我们最近刚发过一期通讯，讨论过锂可能对认知有好处，但具体情况还不清楚。

You know, we did a newsletter on this somewhat recently talking about lithium for potential cognitive benefits.

我们真不知道它到底是怎么起效的。

We don't actually know how it works.

有人猜过几种可能，但都没确凿证据。

There's some speculation but we don't know.

像沐舒坦这类药，我们其实也不清楚它的作用机制。

Something like Mucinex, we don't really know how that works.

确实存在一些例外，但数量极少。

So there are exceptions out there but they're very rare.

你还要问一个问题：这种药物对健康人群的长期影响，我们到底了解多少？

Another question you should be asking is what do we know about the downstream effects of this in healthy individuals?

这正是我们想要的效果。

That is the intended effect.

换句话说，我们想知道这种药在健康人群或目标患者群体中的实际效果如何。

So this is another way of saying what is the efficacy of this drug, in particular in healthy humans or in the patient population that we're interested in addressing this in.

当然，另一个问题是，我们对它的安全性了解多少？

Of course, another question is, what do we know about safety?

通常得先从动物实验开始，但最终还是要弄清楚它在人体内的安全性如何。

And that usually means starting in animals, but eventually you have to figure out what the safety looks like in humans.

而这当然也取决于剂量和使用方式。

And of course that's also a function of dose and usage pattern.

那这些因素该怎么综合起来看呢？

How do you put these things together?

那你怎么权衡药物可能带来的副作用风险和它预期的益处呢？

Well, how do you then weigh the potential risks of the potential side effects with the intended benefits of the drug?

比如抗生素这种药。

Take something like an antibiotic.

抗生素的副作用很多。

Antibiotics have lots of side effects.

有些甚至可能非常严重。

Some of them can be really quite devastating.

但我们也知道，它们带来的预期后续效果非常重要。

But we also know that they have really important intended downstream effects.

因此，没人会建议你随便乱用抗生素。

As such, nobody would ever suggest you just take antibiotics willy nilly.

为了防范房间里可能存在的细菌就吃抗生素，这完全说不通。

That would not make sense to ward off any potential bacteria in the room.

我们只会在不使用抗生素的风险足够高的情况下才使用它。

Rather, we reserve them for when the risk of not taking the antibiotic is high enough.

另一个我们总该问的问题是，有没有合法获批的替代方案？

Another question I think we always want to be asking is are there legitimate approved alternatives available?

这其实跟多肽的问题直接相关。

This is actually specific to the peptide question.

因为一旦你开始讨论那些灰色市场的产品，又没法核实成分的合法性，你就得问问自己：如果我要用这个，是不是至少该考虑一下有FDA批准、风险和收益差不多的替代品？

Because again, once you start to talk about things that are gray market where you have no way of scrutinizing the legitimacy of a compound, you have to ask yourself, well if I'm going to take this, should I be at least considering something that is FDA approved that might have the same risk and benefit profile?

等你把这些问题都想清楚了，就能把任何一种肽类物质归到相应的类别里。

Once you answer all of these questions, you can put any one of these peptides into basically a group of buckets.

你了解我的，我一向喜欢用框架来梳理问题。

You know me, I love my frameworks.

这是我们整理出的一个框架，我觉得任何肽类都可以套进去分析。

So this is kind of a framework that we've come up with that I think you could put any peptide into.

一共分成四个类别。

And there's four buckets.

第一类是，你认真梳理过之后，如果诚实面对，根本找不到使用它的合理理由。

So bucket one will be you've gone through this line of inquiry and you really can't make a compelling case for it if you're being honest.

当然，如果你不诚实，随便什么东西你都能编出一堆理由。

You can be dishonest and come up with compelling cases for anything.

但如果你真的保持理性、诚实，那这种肽根本就没有使用价值。

But if you're being honest, intellectually honest, there would be no use case for this peptide.

这些是那些根本没有可行作用机制的东西，要么完全没有数据，要么只有理论上的推测，甚至已有数据明确反驳了它们。

So these would be things for which you have no viable mechanism of action, you just don't have data or there's some theoretical mechanism or there's existing data that actually refute it.

在人体上完全没有数据，甚至可能已经有负面的人体试验结果。

You don't have any data in humans or you might even have negative data in humans.

对于这类肽类物质，还要注意它们总是不断改变宣称的益处。

Another thing to look for with these peptides is when you get a lot of shifting goal posts for the alleged benefits.

它们一开始吹嘘一套功效，过几年又推出另一套，再过一阵子又换一套，一直在编新故事。

These are peptides where they tout one set of benefits and then they, a couple of years later, come out with a new set of benefits and then a new set of benefits and they're just kind of making up a new story all the time.

然后就是第二类肽，也就是第二组。

Then you have your bucket two peptides.

这类肽的作用机制是成立的，但从未进入临床试验，或者即使做过人体试验，后来也被放弃了。

Here you have a viable mechanism, but the compound has never entered clinical trials or if it did enter human clinical trials, it was abandoned.

制药公司根本没兴趣继续推进。

There's no real continued interest from pharma.

接下来我们会举一些具体的例子。

So we're going to talk about some examples there.

第三类肽具有明确的作用机制。

Your bucket three peptides have a viable mechanism of action.

它们甚至可能正在开展人体临床试验。

They might even be currently in human clinical trials.

它们可能已经获批用于其他适应症，而不是当前大众所宣称的用途。

They might even be approved for indications other than those that are intended in the general use population.

你确实有安全性和有效性数据，只是不一定针对你关心的人群或适应症，但目前还没有正式获批用于当前流行的用途。

You do have safety and efficacy data, though not necessarily in the population you're interested in or for the indication you're interested in, but they don't have an approved version that exists for the current popular use.

我们会逐一举例说明这几种情况。

We're going to talk about examples in all of these.

最后是第四类，这些基本上是盗用的FDA批准药物或激素。

Finally, the fourth bucket, these are basically peptides that are stolen FDA approved drugs or hormones.

它们本质上是被当作已获批药物的完全复制品来销售，却打着‘仅限科研用途’的旗号非法售卖。

So, they're basically peptides that are being sold that are being touted as exact replicas of approved drugs, but they're being sold illegally via research purposes only.

我们会详细分析几个典型案例，一方面是因为这些肽非常流行，所以我们才特意选了它们。

So we're going to talk through a handful of examples in a lot of detail to sort of A, cover those peptides because these are very popular ones, that's why we've chosen them.

但同时，我们也想帮你理清思路，让你在自己探索这条路的时候有个方向。

But also to kind of lay out the thinking that we'd like you to do as you embark on this journey yourself.

我提一下，节目笔记里我们会整理一个数据库，里面大概有二十种其他肽类物质，都是我们自己做过分析的，具体有多少我都数不清了。

I'll point out that in the show notes, we're also going to include kind of a database we've put together of, I would say, oh, I don't even know, I've lost track, maybe 20 other peptides that we've come up with our own point of view on.

明白了。

Okay.

那我们先从哪些开始讲呢？

So what are the ones we're going to start on?

我们会深入聊聊这四种：SS-31、Melanotan-2、CJC-1295 和 BPC-157。

We're going to kind of go a little deep into the following: SS-thirty one, melanotan-two, CJC-twelve ninety five, and BPC-one hundred fifty seven.

为什么选这四个？

Why did we pick those four?

因为它们特别热门。

They're incredibly popular.

这几种是我被问得最多的，不管是病人、朋友，还是其他人。

They're probably the ones I get asked about the most from patients, friends, anybody.

我们的目标是用刚才提出的这些问题来评估这些物质。

And our goal is to evaluate them through the lens of these questions we just laid out.

它们有哪些临床宣称？

What are the clinical claims?

有什么证据支持？

What's the evidence?

有哪些潜在风险？

What are the risks?

实际使用中需要注意哪些问题，等等。

What are the practical considerations, etcetera?

希望这个框架能帮你们评估其他任何肽类物质，包括我们后面会提到的那些。

So hopefully this gives you sort of a framework to evaluate any other peptide, including the ones that we will cover later on.

接下来我们会聊聊这些灰色市场的肽类，以及它们受到哪些监管约束之类的问题。

We're then going to talk about these questions, the gray market peptides, and talk about how these things are subject to some regulatory oversight, etcetera.

咱们直接开始吧。

Let's just dive into it.

咱们开始吧。

Let's do it.

我们先看第一个，SS-31。

Let's start with the first one, SS-thirty one.

首先，我们有没有已知的、切实可行的作用机制？

Let's start with the question, is there a viable mechanism of action that we know for it?

感谢收听今天《The Drive》AMA预览节目。

Thank you for listening to today's sneak peek AMA episode of The Drive.

如果你想听完整版的这次AMA，建议成为高级会员。

If you're interested in hearing the complete version of this AMA, you'll want to become a premium member.

对我来说，最重要的是不依赖付费广告就能提供这些内容。

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

这一切能实现，完全依靠会员的支持。

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

作为回报，我们会为会员提供独家内容和额外权益，这些都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.

所以，如果你想更深入地了解这个领域，我们的目标就是让会员获得远超订阅费用的价值。

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.

付费会员享有几项专属权益。

Premium membership includes several benefits.

首先是详尽的播客文字稿，涵盖每一集讨论过的所有主题、论文、人物和相关资讯。

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

圈子里的人都说，没人能比得上我们的文字稿。

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

其次是每月一次的问答专场，也就是AMA节目。

Second, monthly ask me anything or AMA episodes.

这些节目是对会员提问的详细回应，通常围绕一个主题展开，旨在为会员特别关心的内容提供清晰而深入的解析。

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，你也能获得这些节目的文字稿。

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

第三，你会收到我们由专业研究团队精心制作的高级通讯简报。

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

这份通讯涵盖长寿领域的广泛主题，内容比我们免费的周报详尽得多。

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

第四，你可以访问我们的私有播客源，获取所有剧集，包括那些不含你现在所听这类介绍的AMA内容，这些不会出现在你的常规播客源里。

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另一档播客，精选《The Drive》过往各期中最精彩的部分，相当于一个精华合集。

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.

这是快速回顾以往剧集的好方法，不用一集一集地重新听。

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，我们还会不断添加其他会员专属福利。

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

如果你想了解更多并享受这些会员专属权益，可以前往 peterattiamd.com/subscribe。

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

你也可以在YouTube、Instagram和Twitter上关注我，账号都是PeterAttiaMD。

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

你还可以在Apple Podcasts，或者你用的任何播客平台给我们留个评价。

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

本播客的内容仅用于一般性信息参考，不构成任何医疗、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.

听众与主播之间不构成医患关系。

No doctor patient relationship is formed.

使用本播客中的信息及所链接的资料，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.

本播客的内容不能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.

如果您有任何健康问题，请勿忽视或拖延寻求专业医疗意见，应及时咨询您的医护人员。

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

我非常重视所有潜在的利益冲突。

Finally, I take all conflicts of interest very seriously.

关于我的所有披露事项，包括我投资或提供咨询的公司，请访问 peterattiamd.com/about，那里会持续更新完整的披露清单。

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