#411 ‒ 问答 #90：坚定的信念，灵活地持有：彼得关于断食、生酮饮食、二甲双胍、雷帕霉素、全身MRI和运动的观点如何发生变化

嘿，大家好。

Hey, everyone.

欢迎收听《The Drive》播客的抢先预览版，也就是“问我任何问题”（AMA）特辑。

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.

在这集短节目的结尾，我会告诉大家如何完整获取AMA特辑，以及我们为会员准备的其他大量福利。

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.

或者你现在就可以去peterattiamd.com，在斜杠后面输入subscribe了解更多。

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

那么，话不多说，下面就是今天AMA特辑的抢先预览。

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

欢迎收听第90期“问我任何问题”特辑。

Welcome to Ask Me Anything episode number 90.

在今天的AMA中，我们回顾了《The Drive》前400期节目，继续探讨“坚定信念，但保持开放”这一主题。

In today's AMA, we're reflecting back on the first 400 episodes of The Drive with another episode of the, strong convictions loosely held theme.

那我们怎么处理这个问题呢？

So what do we do with this?

我们会回顾我在这个播客八年多里坚持的一些最重要的观点，然后通过问自己“数据把我们带到了哪里”来重新审视这些观点。

Well, we walk through some of the biggest positions I've taken across the eight plus years of this podcast, but then we revisit them by basically asking, where have the data taken us?

有什么变化吗？如果有的话，是什么？

What's changed, if anything?

当然，因此，我今天站在哪里？

And as a result of that, of course, where where am I today?

在这一集里，我们会讨论我对生酮饮食、作为长寿干预措施的延长禁食，以及Doctor TRCR框架的不断演变的看法。

In this episode, we're going to talk about my evolving views on ketogenic diets, extended fasting as a longevity intervention, and the Doctor TRCR framework.

为什么我停止服用二甲双胍来追求长寿，以及我对雷帕霉素、全身MRI和用于癌症筛查的液体活检的立场转变，包括为什么我认为全身MRI的数据质量实际上随着时间变差了而不是变好了，我的心肺训练方法和八二Zone 2框架如何改变，特别是对于训练时间有限的人，以及为什么我退出了大重量杠铃深蹲和硬拉，以及如何考虑力量训练中的风险管理。

Why I stopped taking metformin for longevity and my shifting position on rapamycin, whole body MRI and liquid biopsies for cancer screening, including why I think whole body MRI data quality has actually gotten worse over time and not better, how my approach to cardiorespiratory training and the eightytwenty Zone 2 framework has changed, especially for people with limited training time, and why I stepped away from heavy barbell squats and deadlifts, and how to think about risk management in strength training.

如果你是订阅者，想观看这期播客的完整视频，可以在节目笔记页面上找到。

If you're a subscriber and want to watch the full video of this podcast, you can find it on the show notes page.

如果你不是订阅者，可以在我们的YouTube页面上观看视频的预览片段。

If you're not a subscriber, you can watch a sneak peek of the video on our YouTube page.

话不多说，希望你们喜欢我们第400期特别节目，也就是第90期AMA。

Without further delight, I hope you enjoy our celebration of 400 episodes together with AMA number 90.

彼得，

Peter,

欢迎来到新一期播客。

welcome to another podcast.

你最近怎么样？

How are doing?

非常好。

Very good.

谢谢。

Thank you.

你呢？

You?

我也挺好的。

Doing good.

挺好的。

Doing good.

所以今天，我们庆祝第400期节目，差不多八年了。

So today, we are celebrating 400 episodes, about eight years.

我们最近刚过了这个里程碑，通常我们每隔一段时间就会做一期回顾反思的节目。

So we recently crossed this, and usually what we do is every now and then we'll look back at kind of a reflection episode.

过去，我们一直称这些为“坚定但开放的信念”。

In the past, we've always referred to them as strong convictions loosely held.

所以我觉得在我们开始讨论具体话题之前，你想不想先跟大家说说这个词对你来说是什么意思，你是从哪里听说的，以及为什么你觉得它这么重要？

And so I think as we start and before we get into specific topics, do you kinda wanna remind people about what that term means to you, where you heard about it, and why you think it's so important?

这是我第一次从一个管理对冲基金的朋友那里听到的，显然这是从他的投资理念角度出发的，那就是你当然需要有坚定的信念，但因为你是在用真金白银去支持一个观点。

It's a term that I first heard from a friend who ran a hedge fund, and obviously this was through the lens of his investment thesis, which was that obviously needed strong convictions, but because you're putting real capital behind a thesis.

但这些信念必须保持开放，因为一旦出现新的信息或者相反的信息，你就得愿意放下自我，说，也许我错了，我需要怎么调整？

But those convictions had to be loosely held because the moment new information or contradictory information showed itself, you had to be willing to check your ego at the door, say, Maybe I was wrong, and how do I need to change things?

我一直觉得这其实是思考所有事情的一个很好的方式，尤其是在有实际信息参与的情况下。

I always thought that that frankly was a great view of how to think about everything, where there's actual information at play.

显然，医学和科学就是很好的例子。

Obviously, medicine and science are great examples of that.

我接触过很多非常非常优秀的科学家，他们都有一个共同点，就是不会死守某个特定的理论一定要是对的。

I've been around many really, really great scientists, and one of the characteristics they all have in common is they're not married to a particular thesis being right.

他们追求的是尽可能把事情做对，通过跟随数据来减少不确定性，不管数据把他们带到哪里。

They're married to getting things as right as possible and reducing uncertainty by following the data wherever those data take them.

我觉得重新审视我们的假设很重要。

I think it's important that we are revisiting our assumptions.

曾经有人问我，如果十年后你重写《超越寿命》这本书，你觉得会和三年前写的那本一样吗？

As someone asked me once, if you were to write Outlived ten years from now, do you think it would be the same book that you wrote three years ago?

我会说不会。

I would say no.

事实上，如果十年后这本书和当初写的时候一模一样，那才让人担心，因为那要么说明我的思维太僵化，要么说明科学没有任何进步。

In fact, that would be concerning if it were the same book in ten years as it was at the time it was written, because it would either suggest I'm too rigid in my thinking or science has made no progress.

我觉得这两种情况都挺让人头疼的。

I think both of those would be challenging.

对，差不多就是我们这期节目的思路。

Yeah, that's loosely how we, think about this episode.

彼得，当你审视自己的观点、思考方式以及它们如何演变时，这些通常源自哪里？

And, Peter, when you're kind of looking at your opinions and how you're thinking about things and how they evolved, where does that traditionally come from?

是什么触发你可能会改变观点或看待事物的方式？

What are the triggers that are causing you to potentially change your opinion or how you look at things?

我觉得这是多种因素共同作用的结果，显然包括文献中的新发现，但你知道，科学进步本质上就是缓慢而阶段性的。

I think it's a combination of, obviously, things that change in the literature, but, you know, scientific progress is, by its very nature, somewhat glacial and episodic.

它不是那种……

It's not like...

它不会一直以同样的速度前进。

It doesn't just progress at the same rate.

对我来说，其他学习的来源以及促使我改变可能曾经坚持的观点的因素，就是播客本身。

I think the other sources of learning for me and things that force me to change, maybe things I once held, would be the podcast itself.

大多数星期我都有机会和某个领域的专家坐下来交流，在准备讨论和进行讨论的过程中，我学到的东西常常会改变……

There's opportunity I get most weeks to sit down with someone who's far more of an expert in a subject matter than I am, and both in preparing for that discussion, having a discussion, I'm learning something that often changes...

我是说，这总会让我在思考方式上有所改变。

I mean, always changes something in how I think.

然后，当然，就像每位医生都希望的那样，我们的病人都是我们的老师。

Then obviously, have, as every doctor hopefully appreciates, all of our patients are kind of our teachers.

我们学到了很多，因为我们看到了病人在诊所里的实际情况。

We learn a lot because we're seeing what happens in a clinic with patients.

说实话，我们今天就要讨论其中一些事情。

We're going to talk about some of these things today, frankly.

基本上，我认为所有这些因素加在一起，无论是文献、与专家的对话，还是亲眼看到诊所里的实际情况。

Basically, I think all of these things taken together, whether it be literature, conversations with experts, and seeing actually happens in the clinic.

我觉得很多时候这些因素会不断汇聚，观点变化不大。

I think a lot of times these things continue to converge, and the views don't change much.

有时候，观点只是变得更加细致，你会开始考虑边缘情况和例外。

Other times, the view just gets more nuanced, and you start to carve out edge cases and exceptions.

而有时候，这确实会让你完全改变方向。

Then sometimes it actually causes you to change course completely.

显然，这就是我认为这一期节目的核心，也是为什么我个人觉得这种类型的节目特别有意思。

Obviously, that's what I think this episode's all about and what what makes this type of episode for me personally quite enjoyable.

我觉得我们开始的时候，最合理的起点就是每个人最喜欢的主题——营养。

I think as we start this, I think the topic that makes the most sense to start at, which is everyone's favorite, nutrition.

所以很早以前，你是生酮饮食的大力支持者。

So kind of very early on, way back in the day, you were a big proponent of the keto diet.

你也是早期采用和倡导延长禁食的人，认为这可能对长寿有潜在的好处。

You were also an early adopter and advocate for kind of extended fasting and what that could potentially do from a longevity perspective.

你现在对这些怎么看？你的观点有什么变化？

Where are you now on those things and how has your opinion changed?

嗯，我最初的想法，先从饮食说起，主要是受胰岛素肥胖模型的驱动。

Well, my original thinking, I'll start with the diet thing, was really driven by this insulin model of obesity.

代谢疾病当时是，现在显然仍然是，不仅是慢性病四大骑士之一，更是根本问题，对吧？

Metabolic disease was and obviously remains not just one of the four horsemen of chronic disease, but the foundational problem, right?

这是唯一一个，当代谢健康恶化时，你患其他所有慢性病的风险基本上都会上升的因素。

It's the one thing where as metabolic health gets worse, your risk of all other chronic diseases essentially goes up.

在我自己的营养实验过程中，限制碳水化合物确实对我很有好处。

In my own journey of nutritional experimentation, carbohydrate restriction was proving to be very beneficial.

当你一步步减少碳水摄入时，很快就会到达一个临界点，也就是通常所说的生酮饮食与否的分界线。

And as you stepwise move down the plank of carbohydrate restriction, you're going to pretty quickly find yourself at a place, which is generally a line in the sand of ketogenic diets or not.

因为到了一定程度，碳水摄入太低，大脑得不到足够的葡萄糖。

Because at some point, carbohydrate intake gets so low that you're not providing enough glucose for your brain.

但如果碳水还是有点高，高到身体无法切换到生酮状态，那大脑就得不到足够的补充能量，你就处在那种进退两难的痛苦境地。

But if it's still a little high and it's too high to allow your body to switch over into ketosis, then you're not getting enough supplemental energy for your brain, and you're in that kind of no man's land of hell.

我记得当时到了那个点，然后决定——那时我已经读了很多关于生酮饮食的资料，我就说，好吧，我要试试这个。

So I remember getting to that point and then deciding, I at that point had been reading a lot about ketogenic diets, and I said, Look, I'm going give this thing a shot.

所以，我的旅程就是从自己的体验开始的，而且体验非常正面。

So anyway, so my own journey starts with my own experience, which was very positive.

我知道外面有些人给我贴标签，说我反对生酮饮食什么的。

I know I get sort of labeled as someone who's anti keto diets and stuff like that by various people out there.

我觉得这真是最可笑的批评，因为我不仅坚持了三年生酮饮食，那可能是我感觉最好的时期。

I just find that to be the most comical critique of me because not only was I on a ketogenic diet for three years, it was probably the best I ever felt.

回想那三年，每一个方面对我来说都非常有益。

I look back at what those three years were like, and every element of it was very positive for me.

当然，我放弃它还有其他原因。

There are other reasons, obviously, I chose to abandon it.

不过，这让我更加确信，碳水化合物、胰岛素、高胰岛素血症、脂肪生成等等之间的关系，似乎是……

Nevertheless, it reinforced the model in my mind that the relationship between carbohydrates, insulin, hyperinsulinemia, lipogenesis, etcetera, was sort of...

这样一来，生酮饮食能解决这些问题就说得通了。

It all made sense that then a ketogenic diet would sort of fix these problems.

我觉得也有很多令人信服的动物和人类研究数据表明，血糖控制、胰岛素敏感性、肝脏内脏脂肪以及其他代谢指标都有改善。

I think there were also lots of compelling data with animals and humans showing the improvements in glycemic control, insulin sensitivity, liver visceral fat, etcetera, and other metabolic markers improving.

就像我说的，我确实更加确信这一点。

As I said, I certainly reinforced that.

现在，不同的是什么呢？

Now, here's what's different.

我放弃生酮饮食，主要是因为我对饮食限制感到厌倦了。

I abandoned the ketogenic diet basically because I was just tired of being that restrictive in my eating.

我是说，我在生酮状态上非常严格。

I mean, was very strict in my ketosis.

我觉得在这个过程中我还记录了前所未有的数据量。

I think I also logged unprecedented amounts of data during this process.

我想在三年的时间里，我早晨空腹的平均β-羟基丁酸水平在1.8到2毫摩尔之间，差不多这个范围。

I think over a three year period of time, my average morning fasting beta hydroxybutyrate level was 1.8 to two millimoles, something in that range.

我不是那种轻度生酮的人。

I wasn't a light ketosis guy.

当然，白天的时候这个数值会更高，取决于我吃了什么，因为我主要吃脂肪。

Then of course it would get much higher during the day depending on what I was eating because I was mostly eating fat.

放弃生酮饮食和我对生酮饮食的看法无关，直到今天，我仍然认为它是一种有效的饮食。

Abandoning the ketogenic diet was independent of my views of the ketogenic diet, and to this day I still view it as an effective diet.

改变的是我对它为什么有效的看法。

What has changed is my belief as to why it works.

你看，我以前认为这种饮食是通过抑制胰岛素来起作用的。

You see, I used to believe that the diet worked through insulin suppression.

但今天，我不这么认为了。

But today, I don't think that's the case.

今天，我认为这种饮食法之所以有效，和许多限制性饮食法一样，是因为它更容易控制能量摄入。

Today, I think the diet works for the same reason many restrictive diets work, which is it makes it easier to control energy intake.

即使你不需要刻意去想这件事——说实话，我从来就没刻意想过。

Even if you don't have to think about it deliberately, which to be clear, I never did.

当然，我在生酮饮食期间并没有减掉多少体重，因为之前通过限制碳水化合物，我已经减掉了大部分想减的重量。

Of course, I wasn't losing much weight on a ketogenic diet because I had already lost most of the weight I was trying to lose just from carbohydrate restriction.

但当我看到那些在生酮饮食上取得成功的人时，他们常常说感觉非常饱足。

But when I see people who are successful on ketogenic diets, they often report that they feel quite satiated.

我觉得这和他们吃的食物种类有关，这些食物比碳水化合物更能让人有饱腹感。

I think that has to do with the type of foods that they're consuming, which satiate them more than carbohydrates.

我还认为，当你氧化脂肪酸时，这本身就在内源性提供燃料，这显然发生在减重期间。

I also believe there's something to be said for when you are oxidizing fatty acids that in and of itself is providing fuel endogenously, which is happening obviously during a period of weight loss.

这是一个微妙但值得提出的观点，因为它反映了我观点的转变：代谢功能障碍、内脏脂肪堆积、异位脂肪堆积、胰岛素敏感性下降——所有这些都是能量失衡的结果，而高胰岛素血症只是伴随而来的现象。

It's a subtle point, but it's worth making because it does reflect a change in my viewpoint, which is that the metabolic dysfunction, the visceral fat accumulation, the ectopic fat accumulation, the insulin sensitivity deteriorating, All of these things are the result of the energy imbalance, and hyperinsulinemia is along for the ride.

但如果你神奇地解决了高胰岛素血症，却没有解决能量失衡的问题，这些问题还是不会得到解决。

But if you magically address the hyperinsulinemia without addressing the energy imbalance, you're not going to fix these problems.

最简单的验证方法就是观察一个正在生酮饮食的人，他因为某种原因仍然处于能量失衡状态。

The easiest way to see that is to watch a person who's on a ketogenic diet, who for whatever reason is still in energy imbalance.

他们的胰岛素水平确实会降低，但他们不会减肥，甚至可能增重。

They're still going to have lower levels of insulin, but they're not going to lose weight and they could even gain weight.

如果你能量失衡，即使采用生酮饮食也可能增重。

You could gain weight on a ketogenic diet if you're out of energy balance.

这就是我对这个问题的主要看法。

That's sort of the long and short of my views on that.

因此，我觉得这让我对人们减少能量摄入时采用的策略或方法，变得不那么教条了，真的，宽容了很多。

As a result, I think it's made me less, I mean, much less dogmatic about the strategy or the tactics that a person employs when it comes to reducing, you know, energy intake.

当病人需要减少摄入时，我真的没有特别强烈的偏好。

I really don't have a strong preference when a patient is at a point where they need to reduce intake.

只要满足几个基本原则就行，而这些原则我们之前已经讨论了很多。

Once a few principles are met, and we've obviously talked a lot about those things.

我非常坚持让人们摄入足够的蛋白质，至少每公斤体重1.4克。

I really am pretty adamant about people maintaining the the right amount of protein, and at a minimum, I want them hitting 1.4 grams per kilogram of body weight.

但如果他们能通过生酮饮食、低脂饮食或主要是鱼素饮食达到这个目标，对我来说，真的不像以前那么重要了。

But if they can accomplish that on a ketogenic diet, on a low fat diet, on a mostly pescatarian diet, I mean, again, it just doesn't really matter as much to me as it once did.

所以，是的，我觉得这可能是关于我以前在营养学上固执己见的一个重要点。

So, yeah, I think that's that's probably a a big point around, the the sort of my previous dogmatism around nutrition.

现在来看延长禁食，你想谈谈你最初的动机是什么，以及你现在的想法吗？

And now looking at extended fasting, do you wanna talk about kind of what was your initial motivation there and where you're thinking as a bulb?

我觉得这有点类似。

I mean, I think it's sort of similar.

再说，我的很多想法都是从内心开始的，对吧，我在做某件事，并试图在个人层面上突破极限。

Again, a lot of things with me begin from a place internally, right, where I'm doing something and I'm trying to push the boundaries of it personally.

所以，在...

So for an...

大约三年的时间里，我每季度进行一次禁食，每次持续7到10天。

About a three year period of time, I was doing a quarterly fast, and it would be anywhere from seven to ten days once a quarter.

然后在季度的另外两个月里，我会做一次三天的断食。

And then on the other two months of the quarter, I would do a three day fast.

我这么做的逻辑是什么呢？

And what was my logic for this?

说实话，我不是为了减肥。

I mean, to be clear, I was not trying to lose weight.

我的体重当时非常合理。

I was at a weight that was perfectly reasonable.

但我特别着迷于一个想法，就是通过足够的营养剥夺，我们可以促进足够的自噬，从而带来真正的健康益处。

But I was really fascinated by this idea that with enough nutrient deprivation, we could promote enough autophagy that it would have real health benefits.

提醒大家一下什么是自噬，自噬就是细胞分解并回收旧的细胞内蛋白质和结构的过程。

Just to remind folks what autophagy is, autophagy is the process by which cells break down and recycle old intracellular proteins and structures.

这个名字‘自噬’字面意思就是细胞在吃自己。

The name auto self phagy eating is literally cells that are kind of eating themselves.

这是一个非常重要的过程，显然在进化中保存了很久，因为当营养匮乏时，身体必须基本上重复利用和回收东西。

This is a very important process, obviously long, long conserved in evolution because when nutrients are scarce, the body has to basically reuse and recycle things.

那么，这样做的好处当然是什么呢？当身体需要再利用和回收东西时，它会怎么做呢？

Now, the benefit of this of course is that what is the body going to do when it needs to reuse and recycle things?

它不会从最好的东西开始。

It's not going to start with the best stuff.

它会从最差的东西开始。

It's going to start with the worst stuff.

如果你有细胞正在走向衰老，如果你有细胞正在产生突变，那么想法是，嘿，我们就从这些开始。

If you have cells that are heading towards senescence, if you have cells that are developing mutations, the thinking goes, Hey, that's where we're going to start.

这些就是我们要清除并回收其组成成分的细胞。

Those are the cells we're going to get rid of and recycle for their constitutive components.

再说一次，在临床前模型中，长时间禁食确实能做到这一点。

Again, in preclinical models, extended fasting clearly does this.

毫无疑问，长时间禁食会促进自噬。

There's little doubt that extended fasting promotes autophagy.

顺便说一句，尼克，我已经几年没看这方面的文献了，所以也许我说的，会有人说，不，彼得。

As a little aside, Nick, and I haven't looked at the literature on this in a couple of years, so maybe what I'm saying, someone will say, No, Peter.

彼得。

Peter.

我们其实看了某某的研究。

We actually look at so and so's study.

当时不太清楚需要禁食多少天才能进入高水平的自噬，因为自噬不是数字式的，而是模拟式的。

It wasn't really clear how many days of fasting were necessary to get into high autophagy, because autophagy is not digital, it's analog.

不是说没有自噬，然后跨过一个阈值，就像开关一样突然就有了自噬。

It's not like you have no autophagy and then you cross a threshold and now you have autophagy in a digital switch.

它是逐渐上升的，有点像生酮。

It sort of ramps up, kind of like ketosis.

在生酮方面，我们有一个使用的阈值。

Now in ketosis, we have a threshold we use.

大约在静息或禁食状态下，介于零点五到一毫摩尔之间。

It's about somewhere between zero point five and one millimole resting or fasting.

在自噬方面，我们甚至没有一个测量单位来做这个。

We don't even have a unit of measure in autophagy to do that.

但是和这方面的专家聊过之后，再看看临床前的数据，大概三天左右似乎才能真正把自噬水平提升到比运动或其他方式更高的程度。

But having spoken with the experts on this subject matter and looking at preclinical data, somewhere around three days seemed to be where you could really sort of juice autophagy levels beyond what you would get from exercise or other things like that.

好的。

Okay.

那问题就来了，彼得，那你为什么现在不这么做了呢？

Then the question becomes, well, why aren't you doing that still, Peter?

再说，我觉得原因有好几个，但最大的变化可能是证据，还有成本。

And again, I think there were several reasons for that, but I think what changed most was kind of the evidence, but also the cost.

感谢收听今天的《The Drive》AMA抢先看。

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

如果你想听完整的AMA版本，可以成为我们的高级会员。

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

对我来说，提供所有这些内容而不依赖付费广告非常重要。

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

要做到这一点，我们的工作完全靠会员的支持。

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

作为回报，我们提供会员专属内容和福利，远超免费内容。

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

所以，如果你想把对这个领域的了解提升到新高度，我们的目标就是确保会员得到的回报远超订阅价格。

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

高级会员包含多项福利。

Premium membership includes several benefits.

首先，全面的播客节目笔记，详细记录我们每集讨论的每个话题、论文、人物和事物。

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

据说，没有谁的节目笔记能比得上我们的。

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

其次，每月一次的“问我任何问题”（AMA）节目。

Second, monthly Ask Me Anything or AMA episodes.

这些节目包含对订阅者问题的详细回答，通常聚焦单一主题，旨在为会员特别感兴趣的话题提供大量清晰和详细的说明。

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，你也能获取这些节目的节目笔记。

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

第三，我们会发送高级会员通讯，这是由我们专门的研究分析师团队精心制作的。

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

这份通讯涵盖了许多与长寿相关的主题，比我们免费的每周通讯要详细得多。

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人播客订阅源，这样你就能收听每一集，包括AMA，而且没有你现在正在听的这段介绍。

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，这是我们制作的另一个会员专属播客，它精选了《The Drive》往期节目中的最佳片段，作为精彩集锦。

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.

这是回顾往期节目的好方法，不用再回去一集一集地听了。

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

最后，还有其他一些福利会陆续加入。

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福利，可以访问peterattiamd.com/subscribe。

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

你也可以在YouTube、Instagram和Twitter上找到我，账号都是Peter Attia, MD。

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

你也可以在Apple播客或你用的任何播客播放器上给我们留个评论。

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

本播客仅供一般信息参考，不构成医学、护理或其他专业医疗服务的实践，包括提供医疗建议。

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

不构成医患关系。

No doctor patient relationship is formed.

使用本播客中的信息和相关链接，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.

本播客内容不旨在替代专业医疗建议、诊断或治疗。

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

用户不应忽视或延迟就任何医疗状况寻求医疗建议，如有此类状况，应寻求医疗专业人员的帮助。

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

最后，我非常重视所有利益冲突。关于我的所有披露以及我投资或提供咨询的公司，请访问peterattiamd.com/about，我在那里保持一份最新且活跃的披露清单。

Finally, I take all conflicts of interest very seriously For all of my disclosures and the companies I invest in or advise, please visit peterattiamd.com forward slash about where I keep an up to date and active list of all disclosures.