#364 – AMA第75期：饮食方式评估与实践——从生酮、纯肉、素食到地中海饮食等多种选择

大家好，欢迎来到《The Drive》播客的'问我任何事'(AMA)抢先看特别节目。我是主持人彼得·阿蒂亚。在这期简短节目最后，我会说明如何完整观看AMA剧集以及我们提供的众多会员福利。您也可以立即访问peterattiamd.com/subscribe了解更多信息。

Hey, everyone. Welcome to a sneak peek ask me anything or AMA episode of the drive podcast. I'm your host, Peter Attia. 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. Or you can learn more now by going to peterattiamd.com forward slash subscribe.

话不多说，以下是今天'问我任何事'第75期的抢先内容。欢迎来到AMA第75期。在今天的节目中，我们将深入探讨如何为自己选择饮食方案，而不是寻找'最佳饮食'。我首先列出了每个可持续饮食模式必须满足的五个不可妥协要素：能量平衡、代谢健康、充足蛋白质、微量营养素充足性以及长期坚持性。

So without further delay, here's today's sneak peek of the Ask Me Anything episode. Welcome to Ask Me Anything, AMA episode 75. In today's AMA, we're taking a closer look at how to choose a diet for yourself rather than which diet is the best of them all. I start by laying out the five non negotiables every sustainable eating pattern must hit. Energy balance, metabolic health, adequacy of protein, micronutrient sufficiency, and long term adherence.

接着我们引入一个简单评估框架：首先定义饮食规则，然后指出其优势和理想适用人群，最后揭示潜在缺陷以便必要时进行调整。基于这个框架，我将详细分析大家最常问及的四种饮食：生酮饮食、纯肉饮食、纯素饮食和地中海饮食，展示如何应用该框架。我们讨论为什么本期面向的是大多数感到困惑的人群，而非饮食狂热者，让每个人都能获得常识性指导路线。

From there, we introduce a simple rubric. First, define the diet's rules, then pinpoint its strengths and ideal users, and finally surface the potential pitfalls so you can make corrections when necessary. With that framework, I walk through the four diets you asked about most: ketogenic, carnivore, vegan, and Mediterranean, to show how to apply the framework. We discuss why I'm aiming this episode at the majority of people who feel confused, not the diet zealots, so everyone has a common sense roadmap. A deep dive into each of the five non negotiables for any diet and how missing even one can sink long term results.

对五种不可妥协要素进行深度解析，说明即使缺失其中一项也会影响长期效果。应用'定义优势/劣势'框架分析生酮、纯肉、纯素和地中海饮食，重点讨论代谢影响、微量营养素缺口和坚持难度。介绍实用的进展追踪方法：DEXA扫描、重要实验室指标（空腹胰岛素、糖化血红蛋白、连续血糖监测）以及需记录的症状指标，帮助判断饮食方案是否真正有效。

Applying the Define StrengthsWeaknesses rubric to keto, carnivore, vegan and Mediterranean diets, highlighting metabolic effects, micronutrient gaps and adherence hurdles. Practical ways to track progress, DEXA scans, important lab metrics like fasting insulin, hemoglobin A1c, CGMs and simple symptoms to log. So you know whether a diet is actually working. Why there's no single perfect diet and instead the best diet meets those five core needs and your current goals and how to iterate as life changes. If you're a subscriber and you want to watch the full video of this podcast, you can find it on the show notes page.

解释为什么不存在单一完美饮食，最佳饮食应满足五大核心需求并契合个人当前目标，以及如何随生活变化进行调整。如果您是订阅用户，可以在节目备注页面观看本期完整视频。

And if you're not a subscriber, you can watch the sneak peek of this video on our YouTube page. So without further delay, I hope you enjoy AMA seventy five.

彼得，欢迎再次来到'问我任何事'环节。您感觉如何？

Peter, welcome to another Ask Me Anything. How are feeling?

很荣幸再次做客。谢谢您的邀请。

I'm honored to be back. Thank you for having me.

你有没有想过干脆睡在播客工作室里，这样无论何时我们需要你录制内容，你都能随时准备好？

Do you ever think about just sleeping in the podcast studio so you can just be ready at any given moment if we need you to record something?

我觉得有时候我妻子可能会喜欢这个主意。

I think there are times when my wife would like that.

我们应该在工作室桌子另一边搭个帐篷。时不时地，你和孩子们就在工作室里露营。可能行得通。这主意不错。好吧。

We should just, on the other side of the table in the studio, just put a tent. And every now and then, you and the boys just camp in the studio. Could work. That could work. Alright.

说到孩子们，快速更新下国际象棋进展。我们这周末搞了个小型内部象棋锦标赛。我和我最小的儿子一起打进了决赛。我当时打得特别疯狂，简直是在下闪电棋。而且这孩子最爱说垃圾话，所以特别有意思。

Speaking of the boys, quick chess update. We had a little chess tournament, in house chess tournament this weekend. I made it to the finals with the youngest, my youngest boy. And I was playing kind of a bananas game, kind of playing lights out chess. And this is the one that loves to trash talk, so it was awesome.

然后我犯了个愚蠢的错误。转眼间局势就逆转了。五步之后，我就被将死了。我当时就想，天啊，这就是为什么我对这个游戏又爱又恨。

And then I made this idiotic blunder. And in a second, the game changed. And five moves later, it's checkmate against me. And I was like, God, this is why I love and hate this game so much.

我特别喜欢你是从吹嘘自己打进了三人家庭象棋锦标赛的决赛开始的。

I do love that you started this by bragging about making it to the finals of an in house chess tournament, which composed of three people.

不。不。不。还有其他人呢。还有几个别的人

No. No. No. There were a few others. There were some other people

在锦标赛中。

in the tournament.

是的。是的。

Yeah. Yeah.

是的。我以为是你和两个都不到11岁的男孩。我当时想，炫耀自己进入了一个三人国际象棋锦标赛的决赛有点大胆，其中两个人甚至还不能开车呢。不过好吧。很高兴听到还有更多人参与。

Yeah. I thought it was you and the two boys both under 11. And I was like, it's kinda kind of audacious to brag about making it to the finals of a three person chess tournament, two of which can't even drive yet. But okay. That's good to hear there was more people involved.

更大的问题是，当你输掉那场比赛时，有没有棋子飞向空中？

The bigger question is, when you lost that game, did any pieces go flying through the air?

就发生过一次，尼克。就一次。我永远都忘不了这件事。

It happened one time, Nick. One time. I'll never live it down.

有一次在下国际象棋的时候

One time in during this chess

不。不。不。只发生过那一次。我通常不是一个会扔棋子的人。

No. No. No. It only happened that one time. I am not a chess piece thrower, ordinarily.

那是因为Tia妈妈态度坚决。

That's because mama Tia put her foot down.

确实如此。

That's true.

你让吉尔开始下国际象棋了吗？

Have you gotten Jill to start playing chess yet?

吉尔永远不可能下国际象棋。

Zero chance Jill will ever play chess.

我不知道。永远别说永远。你有时会做一些过去说过永远不会做的事情，所以你永远无法预料。就像这次AMA，它不仅涉及你最喜欢的宏观话题，还有你最爱的微观话题。这不仅聚焦营养学，还特别针对饮食方案——长期听众都知道这可能不是你最喜欢讨论的主题，但我认为这会非常精彩。

I don't know. Never say never. You sometimes do things that you said you never were gonna do in the past, so you kinda never know. I mean, much like this AMA, which is all on not only your favorite meta topic, but your favorite micro topic. Not only is this nutrition focused but it's diet specific focused which anyone who's listened to this for a while knows maybe not your favorite topic to cover but I think it's gonna be really good.

原因如下：我们收到大量关于饮食的问题，我认为这是因为网络上充斥着各种饮食信息。因此我们收集了这些问题，向听众征集疑问，整合归类后将以这样的形式展开。本次目标不是做营养学AMA（我们做过可附链接），而是更聚焦饮食方案，采用不鼓吹特定饮食流派、不参与阵营斗争的方式，务实分析利弊，帮助听众建立评估框架并应用到实际生活中。

Here's why. We get a ton of question on diets, and I think it's because there's so much information in the ether on diets. And so what we did is we gathered those questions, we went to the audience, asked for questions, combined them all, organized them and we're going to structure them in this way. The goal here is to not be a nutrition AMA which we've done before which we can link. It's much more to focus on diets and to do it in a way that doesn't really talk about everyone should follow this diet or this diet or this diet and not to kind of join the tribal battles that people see but instead really just take a pragmatic listen and really identify how can anyone listening to this understand the pros, cons, how to think about diets and put it into their own life.

我们旨在提供饮食方案评估框架，无论你坚持现有饮食方式或未来改变策略。为此我们将首先列出你认为所有饮食必须满足的五个核心要素——无论是纯素还是肉食主义，都应遵循哪些基本原则？然后通过框架评估每种饮食：其生效的核心要求是什么？优势包括最适合哪些人群？

In it, we want to give people a framework to evaluate a dietary approach whether you follow the same one now that you did years ago or you change in the future. To do that we'll start by laying out the five non negotiables that you think any diet must address. So no matter if it's vegan or carnivore, what are the approaches that they all should follow? And then we're going to evaluate each diet through a framework which is what are the core requirements for that diet to work? What are its strengths including who is it best suited for?

因为我们经常谈到的是，不同的饮食方式可能更适合不同的人群。那么这是为什么？接下来我们会探讨其弱点——如果有人要遵循某种饮食，可能会遇到哪些陷阱，如何解决以及如何避免？然后基于这个框架，我们将讨论被问及最多、讨论最广泛、最具代表性的四种饮食方式：生酮饮食、纯肉饮食、纯素饮食和地中海饮食。最后我们会给出实用的建议。

Because oftentimes we've talked is sometimes there's going to be different diets that are better for different people. So what is that and why is that? And then we'll look at its weaknesses which is if someone's going to follow a diet, what are some of the pitfalls and how can they be addressed and how can they avoid those? And then with that framework we'll cover four of the diets that are asked about us the most, seem to be talked about the most and paint the broadest picture which is keto, carnivore, vegan and Mediterranean. And we'll close with practical takeaways.

今天我们有很多关于饮食的话题要讨论。在开始之前，你还有什么想补充的吗？

So we got a lot of diet talk today. Anything you want to add before we roll into it?

我觉得这个开场很好。我补充两点不相关的看法。第一，你指出了我通常不太喜欢这个话题，原因在于它很容易演变成部落式的宗教争论，而不是科学讨论。而且往往会衍生出一种道德评判，我认为这根本不应该出现在这个领域。

I think that's a good setup. I'll add two unrelated comments. The first is, yeah, you pointed out how much I just generally don't enjoy this subject matter. And the reason for it is it tends to very quickly degrade into tribal religious discussions as opposed to scientific discussions. And there tends to be almost a morality that comes out of this, which I just frankly don't think belongs in the space.

但在许多听众和我们团队的劝说下，我还是勉强决定值得一做。这也引出了第二点：我是被拖着来做这个内容的，一开始非常抗拒。但我觉得我们团队的乔什·罗奇说得很对：彼得，你不是为极端人群做这个。你不是为各个饮食阵营中的极端主义者做的，也不是为那些坚信自己的饮食方式是唯一真理、认为不吃这种饮食的人都很糟糕的硬核信徒做的。

But at the convincing of many listeners and our team have reluctantly decided that it's worth doing. And I think that sort of feeds into the second point, which is I came into this kicking and screaming, not wanting to do it. But I think Josh Roche on our team did a great job of pointing out, Peter, you're not doing this for the extremes. You're not doing this for the extremists in each of these camps. You're not doing this for someone who is so hardcore in a dietary camp that they believe that their diet is the one true diet and anyone who doesn't eat that way is an awful human being.

你不是要说服那些人改变立场。你实际上是为了那87%感到困惑、处于中间地带、不知道该怎么办、尝试过但不确定是否合理的人群。这个定位对我很有帮助，因为我很容易关注到狂热分子。而所有领域的狂热分子都让我反感。但只要我记住我不是在和那些人对话，而是为几乎所有其他人——幸运的是这是大多数只想获得一些常识性框架来评估这些饮食策略的人。

You're not trying to talk that person off that perch. You're doing this for frankly the eighty seven percent of people who are confused, who are in the middle, who don't quite know what to do, who have tried this and they're not sure if it makes sense. I think that was a very helpful framing for me because it's very easy for me to focus on the fanatics. And the fanatics across all lenses really turn me off. But as long as I just keep in my mind that I'm not talking to those people, I'm here for virtually everybody else, which fortunately is the majority of people who just kind of want some common sense frameworks for how to evaluate these dietary strategies.

这么说来，我感觉好一些了。

So with that said, I feel a little bit better about it.

太好了。我想如果你赢了内部象棋锦标赛可能会感觉更好，但可能最好不要总想着肩上有筹码我们不在

That's great. I imagine you'd feel even better if you won that in house chess tournament, but it's probably always Don't good to have think a chip we're on your not

要再比一场，别以为我不会让那个七岁小孩吃尽苦头。

having a rematch and don't think I am not gonna put a world of hurt on that little seven year old.

下国际象棋。澄清一下。

In chess. Just to clarify.

顺便说一句，他整个周末都在家里到处走动，告诉所有人他是怎么把我打得落花流水的。我的意思是，你忍不住要笑。

By the way, he spent the rest of the weekend walking around the house telling everybody how he smoked my bags. I mean, you couldn't help but laugh.

你不得不笑。特别是因为听起来他确实做到了。

You have to. Especially because it sounds like he did.

他确实做到了。

He did.

听起来他简直把你玩弄于股掌之间。

Sounds like he just put you in his pocket.

确实。是的。我们可以聊上一整天。

Trust. Yep. We could talk about that all day.

我们会把这个留给我们还需要设立的七岁圆桌会议。好的。那么也许在开始之前，我们简单提到过，我们最近做了一个营养问答环节。我们会附上链接。你是否想大致介绍一下你对营养和饮食的不同思考方式。

We'll save that for the seven year old roundtable we still need to set up. Alright. So maybe before we start, we've kind of mentioned quickly, we did a nutrition AMA somewhat recently. We'll link to it. Do you just kind of wanna walk through how you think about nutrition and diets a little differently.

是的。那个营养问答环节是在12月发布的，我认为它涵盖了一些宏观问题。有没有最佳饮食？营养对健康结果的影响与运动相比如何？维持身体和肌肉增长实际需要多少蛋白质？

Yeah. So the Nutrition AMA, was released, I think it was December, it covered the big picture questions. Is there a best diet? How does nutrition compare to exercise for health outcomes? How much protein do you actually need for maintenance versus muscle growth?

但它并没有深入探讨，我认为大多数人思考的方式，即个体化的饮食方法。过去我曾说过，人们应该选择一种能够坚持并且满足一系列不可妥协的生理状态和需求的饮食方式。但具体该如何实施？老实说，我们还没有讨论过这一点。而且坦白说，人们应该注意什么？

But it didn't really delve into, I think, the way most people think about it, is individual dietary approaches. Now in the past I've said, Look, people should pick a diet that they can stick to and it meets a certain list of non negotiable physiologic states and needs. But how to exactly go about doing that? We haven't talked about that, frankly. And frankly, what should people watch out for?

你如何做出决定并知道它是否适合你？感谢收听今天《The Drive》的抢先版问答节目。如果你有兴趣收听这个问答环节的完整版本，你需要成为高级会员。对我来说，在不依赖付费广告的情况下提供所有这些内容极其重要。为此，我们的工作完全依靠会员的支持才得以实现。

How do you make a decision and know if it's the right choice for you? Thank you for listening to today's sneak peek AMA episode of The Drive. If you're interested in hearing the complete version of this AMA, you'll want to become a premium member. It's extremely important to me to provide all of this content without relying on paid ads. To do this, our work is made entirely possible by our members.

作为回报，我们提供独家会员专属内容和福利，远超免费内容。因此，如果你想将你在这个领域的知识提升到新的水平，我们的目标是确保会员获得的回报远超过订阅价格。高级会员享有几项福利。首先，全面的播客节目笔记，详细记录了每期节目中讨论的每个主题、论文、人物和事物。而且据说，没有谁的节目笔记能比得上我们的。

And in return, we offer exclusive member only content and benefits above and beyond what is available for free. 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. Premium membership includes several benefits. First, comprehensive podcast show notes that detail every topic, paper, person, and thing that we discuss in each episode. And the word on the street is nobody's show notes rival ours.

其次，每月的“问我任何事”或问答环节。这些节目包含对订阅者问题的详细回答，通常聚焦于单一主题，旨在为会员特别感兴趣的话题提供高度的清晰度和细节。当然，你还可以获取这些节目的笔记。第三，接收我们的高级通讯，这是由我们专注的研究分析团队精心编写的。这份通讯涵盖了与长寿相关的广泛主题，并提供比免费周刊更多的细节。

Second, monthly ask me anything or AMA episodes. 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. You'll also get access to the show notes for these episodes, of course. Third, delivery of our premium newsletter, which is put together by our dedicated team of research analysts. This newsletter covers a wide range of topics related to longevity and provides much more detail than our free weekly newsletter.

第四，访问我们的私人播客源，让你可以收听每一期节目，包括问答环节，但省去了你现在在常规播客源中听到的这段介绍。第五，Qualys，一个额外的会员专属播客，我们将其作为精彩集锦，精选自《The Drive》以往节目中的最佳片段。这是回顾以往节目的好方法，无需回去逐一收听。最后，还有其他沿途增加的福利。如果你想了解更多并享受这些会员专属福利，可以前往 peterateamd.com/subscribe。

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. 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. This is a great way to catch up on previous episodes without having to go back and listen to each one of them. And finally, other benefits that are added along the way. If you want to learn more and access these member only benefits, you can head over to peterateamd.com slash subscribe.

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You can also find me on YouTube, Instagram, and Twitter, all with the handle Peter Atia MD. You can also leave us review on Apple Podcasts or whatever podcast player you use. This podcast is for general informational purposes only and does not constitute the practice of medicine, nursing, or other professional health care services, including the giving of medical advice. No doctor patient relationship is formed. The use of this information and the materials linked to this podcast is at the user's own risk.

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The content on this podcast is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Users should not disregard or delay in obtaining medical advice from any medical condition they have, and they should seek the assistance of their health care professionals for any such conditions. Finally, I take all conflicts of interest very seriously. For all of my disclosures and the companies I invest in or advise, please visit peterateamd.com slash about where I keep an up to date and active list of all disclosures.