本集简介
双语字幕
仅展示文本字幕，不包含中文音频；想边听边看，请使用 Bayt 播客 App。
欢迎收听《你的大脑》播客，在这里我们探索一切事物的神经科学。
Welcome to Your Brain On, the podcast where we explore the neuroscience of everything.
我是艾莎·希尔扎伊医生。
I'm Doctor Aisha Shirzai.
今天我们要讨论化疗与大脑的关系。
Today we're talking about chemotherapy and the brain.
如果你或你爱的人经历过癌症治疗，你可能听说过化疗脑这个词。
If you or someone you love has gone through cancer treatment, you may have heard the term chemo brain.
这个短语用来描述许多患者在治疗期间或治疗后经历的健忘、思维迟缓和头脑昏沉等症状。
It's a phrase used to describe the memory lapses, slowed thinking, and mental fog that so many patients experience during or after treatment.
多年来，这种现象被轻描淡写地称为传闻轶事，或者被解释为压力所致。
And for years, it was brushed off, called anecdotal or explained away as stress.
但如今我们有了更深入的了解。
But today we know better.
大脑会受到癌症、化疗以及周围一切因素的影响。
The brain is affected by cancer, by chemotherapy and by everything that surrounds it.
恐惧、炎症、某些激素的紊乱、睡眠问题、身份认同危机等等。
The fear, the inflammation, the disruption of certain hormones, sleep, identity and more.
本期节目将探讨癌症治疗期间大脑的真实变化、科学研究的实际发现以及目前仍存在的认知空白。
This episode is about understanding what's really going on in the brain during cancer treatment, what the science actually tells us, and where it still falls short.
最重要的是，我们将了解患者如何能够获得改善。
And most importantly, how people can get better.
让我们从已知和未知的领域开始说起。
Let's start with what we know and we don't.
研究表明，约75%接受化疗的患者会出现某种形式的认知功能障碍。
Studies suggest that about seventy five percent of people undergoing chemotherapy experience some form of cognitive dysfunction.
其中约三分之一患者的这些变化会持续到治疗结束后，有时长达数月甚至数年。
For about a third, those changes last beyond treatment, sometimes for months or even years.
这些症状具体表现为什么样呢？
What does that actually look like?
表现为思维迟缓、注意力难以集中、语言提取困难、多任务处理障碍或短期记忆受损等症状。
It looks like slower processing, difficulty concentrating, having word finding difficulties, trouble with multitasking, or having difficulty with short term memory.
许多人形容这种感觉就像在泥沼中前行，思维模糊，情感迟钝，认知能力下降。
A lot of people describe it as feeling like they're moving through mud, mentally foggy, emotionally flat, and cognitively blunted.
‘化疗脑’这个术语暗示化疗是唯一原因。
The term chemo brain suggests that chemotherapy is the sole cause.
但事实比这更复杂。
But the truth is it's more complicated than that.
癌症相关认知障碍（CRCI）很可能是多因素导致的，这意味着涉及许多因素。
Cancer related cognitive impairment or CRCI is likely multifactorial, which means that there are so many factors involved.
癌症本身引发的炎症，加上手术影响、麻醉、放疗、以及影响内分泌系统的癌症类型导致的荷尔蒙变化，都起着重要作用。
Inflammation from the cancer itself, plus the impact of surgery, the anesthesia, the radiation, the hormonal changes for the kinds of cancers that impact the endocrine system all play a major role.
长期压力本身就会影响海马体和前额叶皮层。
Chronic stress in itself can impact the hippocampus and the prefrontal cortex.
睡眠经常被打断，无论是由于化疗本身还是癌症相关的疼痛。
Sleep is often disrupted, whether it's because of the chemotherapy itself or the pain related with cancer.
其他影响因素还包括营养、运动锻炼、情绪健康等等。
Other factors that play a role are nutrition, exercise and movement, emotional health, etcetera.
确实，有些研究表明化疗期间大脑会发生结构性变化。
And, yes, there are some studies that have shown structural changes in the brain during chemotherapy.
我们实际上有证据表明灰质体积减少，特别是在与记忆和注意力相关的特定区域。
We actually have evidence that the gray matter volume decreases especially in certain regions that are tied to memory and attention.
但需要明确的是，这些发现通常相当有限。
But let's be clear, these findings are often quite modest.
影像数据受限于样本量，这意味着尚未在大量人群中进行测试，研究设计参差不齐且随访期非常短。
Imaging data is limited by sample size which basically means that it hasn't been tested in a lot of people, The design is variable and the follow-up period is very short.
我们在这个领域没有海量信息，无法高度确信地说大脑会在化疗期间萎缩。
We don't have tremendous amount of information in this field and we can't say with a high degree of confidence that the brain shrinks during chemotherapy.
文献中更一致的发现是大脑各部分之间沟通方式的功能性变化，特别是在认知负荷下。
What is more consistent across the literature is functional change in how the different parts of the brain communicate, especially under cognitive load.
所有这些告诉我们的是：
What all of this tells us is this.
大脑正在压力下进行适应。
The brain is adapting under pressure.
这并不一定是受损，更恰当的说法是它在应对压力。
It's not necessarily damaged, but a more appropriate way to describe it is it's coping.
它正在对系统性压力做出反应。
It's responding to systemic stress.
我们从纵向研究中得知，许多这类变化会随时间推移而消退。
And we know from longitudinal studies that many of these changes resolve with time.
因此神经可塑性是真实存在的现象，恢复能力也是如此。
So neuroplasticity is a real phenomenon, and so is recovery.
本月早些时候，迪恩与乳腺癌外科医生、演讲者和作家莉兹·奥赖丹博士进行了交谈。
Earlier this month, Dean spoke with doctor Liz Oryordan, a breast cancer surgeon, a speaker, and an author.
而且她是亲身经历过乳腺癌的人——不是一次，而是三次。
And she's also someone who's lived through breast cancer not once, but three times.
作为医生和患者的双重身份，她带来了融合临床知识与深刻人文洞察的独特视角。
As both a doctor and a patient, she brings a perspective that bridges clinical knowledge with deep human insight.
她利用这段经历来教育、倡导并与世界各地的人们建立联系。
And she's used this experience to educate, advocate, and connect with people around the world.
她非常出色。
She's fantastic.
2024年，她因在乳腺癌宣传和患者护理方面的工作，被未来梦想慈善机构授予人道主义奖。
In 2024, she was awarded the humanitarian award from future dreams charity for her work in breast cancer awareness and patient care.
莉兹的声音之所以重要，不仅因为她所经历的一切，更因为她从中创造的价值。
Liz's voice matters not just because of what she's been through but because of what she's built from it.
我很想听你讲讲你的经历。
I would love for you to tell us about your journey.
好的，没问题。
Yeah, sure.
对于不认识我的听众们，我曾在英国担任乳腺外科顾问医师。
So for anyone listening who doesn't know me, I was a consultant breast surgeon in The UK.
我花了二十年时间努力成为最优秀的乳腺外科医生。
I'd spent twenty years training to be the best breast surgeon I could.
40岁那年，我在自己的乳房里发现了一个肿块。
And at the age of 40, I found a lump in my breast.
我之前有过几个囊肿。
I'd had a couple of cysts before.
我从未定期检查它们。
I never checked them regularly.
而且我认为大多数人，老实说，不会主动检查癌症，因为我们觉得这事永远不会发生在自己身上。
And I think most people, if we're honest, don't check ourselves for cancer because we think it's never gonna happen.
我的乳腺X光检查结果正常。
And my mammogram was normal.
我做了超声波扫描，结果显示有一个很大的肿瘤。
I had an ultrasound scan and that showed a large cancer.
在那一刻，我比普通患者懂得更多。
And in that minute, I knew far more than normal patients.
我知道我需要化疗。
I knew I need chemotherapy.
我知道我需要做乳房切除术。
I knew I need a mastectomy.
我很清楚自己活过十年的几率是多少，因为了解这些是我的本职工作。
I had a good idea what my chance of making it to ten years was because it's my job to know this.
就好像我大脑里的某个开关突然关闭了。
And it's like something in my brain just switched off.
我拒绝接受现实。
I'm in denial.
这种事不可能发生在我身上。
This isn't happening to me.
这一定是发生在别人身上的事。
It's happening to someone else.
这就是我接受治疗期间的心理状态。
And that's how I process through treatment.
我经历了全套治疗：化疗、乳房切除术，所有淋巴结都被清除了。
I had the full works, chemotherapy, mastectomy, all my loads out.
我还接受了放疗。
I had radiotherapy.
我被注射了激素阻断剂，大约花了一年时间才从这一切中恢复过来并重返工作。
I was put on hormone blockers and it took me about a year to recover from all of that and go back to work.
但遗憾的是，大约两年后的2018年，我的胸壁出现了局部复发，治疗带来的副作用使我无法继续手术。
But sadly, about two years later in 2018, I had a local recurrence on my chest wall and the side effects of the treatment for that meant that I couldn't operate anymore.
43岁时我被迫辞职，失去了工作。
I was forced to resign at the age of 43 and I had no job.
我没有爱好。
I had no hobbies.
我没有社会地位。
I had no status.
我不知道自己是谁。
I didn't know who I was.
我仍在为失去的一切而哀伤。
I'm still grieving for so much I'd lost.
几年前我的癌症第二次复发，失去一切让你真正认清自己、明白什么定义了你、以及你真正的目标是什么。
And I had a second recurrence a couple of years ago and losing everything makes you realize who you are and what defines you and what your real purpose is.
而我的使命是帮助人们和小动物以及鸟类。
And mine is to help people and small animals and birds.
我通过演讲、写作、制作播客和解释视频找到了继续实现这一目标的新方式，这让我成为了互联网上的志愿医生，但这份工作非常有意义。
And I kind of just found new ways to keep doing that by talking, by writing, by doing podcasts, by doing explainer videos and it's just led to this volunteer doctor for the internet, but it is so rewarding.
确实如此。
Absolutely.
我的意思是，我认为我一生都在从事研究工作。
I mean, I think I've done research all my life.
我曾在美国国立卫生研究院等杰出机构工作。
I worked at NIH and all these incredible institutions.
现在我担任查尔斯·德鲁大学和加州大学洛杉矶分校临床研究的执行主任。
And I'm right now executive director of clinical research at Charles Drew and UCLA.
说实话，我意识到我们正处于历史的关键时刻，传播科学变得比科学本身更重要。
I'll be honest, I recognize the moment we're in in history and communicating science becomes almost more important than the science.
是的。
Yeah.
所以我获得了分子肿瘤学博士学位，你变得非常擅长写长达200词的句子。
So I did a PhD in molecular oncology and you get very good at writing sentences that have 200 words.
这就是你教授想要的。
That's what your professor wants.
是的。
Yes.
当我患癌时，我开始为媒体撰稿，那时我意识到必须彻底改变我的表达方式。
And when I had cancer, I started writing for media, I realized I've gotta change my tone completely.
我没有接受过为普通大众写作的训练。
I'm not trained to write for the average general public.
他们说大众的平均阅读水平相当于七到九岁。
They say the general reading age is like a seven or nine years.
我不得不迅速学会如何解释概念。
And I had to learn really quickly how to explain concepts.
当时我在谈论放射治疗，一个朋友问：什么是放射治疗？
And I was talking about radiotherapy and a friend said, what's radiotherapy?
就像，哦，那些我觉得显而易见的事情。
It's like, oh, the stuff I think is obvious.
是的。
Yes.
对其他人来说仍是医学术语。
Is still medical jargon to other people.
我学会了用橙子和柠檬之类的东西，找到帮助人们理解的方法。
And I've learned to use things like oranges and lemons and find ways of helping people explain it.
因为我觉得我们的注意力都跟蜉蝣一样短暂，大多数人理解统计数据的能力都很差。
Because I think we've all got the attention span of a gnat and most people are terrible understanding statistics.
我们听到的是相对风险、吓人的头条风险，但花时间解释这对他们意味着什么，就能消除那种恐惧。
We hear the relative risk, the scary headline risk, but actually to take the time to explain what it means to them just takes that risk away.
但这不够吸引眼球，也卖不出报纸。
But it's not sexy and it doesn't sell newspapers.
这种简化并不是在降低水准。
And that simplification is not dumbing down.
我讨厌那种概念。
I hate that concept.
不。
No.
这并非居高临下地看待大众。
It's not like looking down at the population.
关键在于意识到对话中的情感与概念要素，以及如何将其与成千上万人产生联结。
It's about being cognizant about the emotional and the conceptual elements of the conversation and how it can get connected to a 10,000, 50,000 people.
而你做得非常出色。
And you do it so well.
你简直太棒了。
You're absolutely amazing.
话虽如此，这是一种非常普遍的病症。
Having said that, this is a very common condition.
癌症很常见，化疗也很常见，但关于它们的对话却远远不够。
Cancer is common, chemotherapy is common, yet conversations about it are lacking.
例如，在美国的非裔社区，结肠癌等疾病的发病率较低，但死亡率却更高。
For example, in African American communities here, colon cancer and others are lower frequency, but death rates are higher.
人们害怕接受检查评估。
People are afraid to get evaluated.
医生们不擅长沟通，反而让患者更加恐惧。
Physicians are not good at communicating, and so they make them even more afraid.
这就是你的工作职责，希望也是我们的共同目标——消除这种恐惧。
That is what your job is, and hopefully ours as well, to take away that fear.
是的，我们知道世界上有些文化不谈论癌症。
Yeah, we know there are cultures in the world that don't talk about cancer.
患上癌症是可耻的。
It's shameful to have it.
我们害怕它。
We're scared of it.
而我认为，作为一名医生，我说我不知道这个，也不知道那个，这才是真实的情况。
And I think by me being a doctor saying, I didn't know this and I didn't know that, and this is what it's really like.
根据与我交谈的人，我可以相对诚实地描述大多数人的真实感受。
Based on the people that talk to me, I can give a relatively honest opinion of what it's like for most people.
我的女性患者来见我时，当我说‘你得了乳腺癌’后，她们问的第一个问题总是‘我会掉头发吗？’
And the first thing my women would ask when they came to see me and I said, You've got breast cancer, is, Am I going to lose my hair?
我对化疗的副作用略知一二。
And I knew a little about the side effects of chemo.
我知道你会掉头发。
I knew you lost your hair.
我没想到是全身的毛发都要处理。
I didn't realise it was all the hair on your body.
巴西蜜蜡脱毛和腿部脱毛，你逃不掉了。
Brazilian and leg wax, here you come.
我就知道你会觉得有点不舒服。
I knew you'd feel a bit sick.
但这就是我的极限了，因为我不是肿瘤科医生。
But that was about my limit because I'm not an oncologist.
我没意识到我们所说的‘化疗脑’是真实存在的，而且可能是永久性的。
I didn't realise that chemo brain as we call it is real and can be permanent.
我想他们说这会导致大约百分之十的脑损伤。
I think they say it causes about ten percent brain damage.
然后当你进入更年期时，很难分辨是什么在影响它，但我的认知功能确实改变了。
And then when you get the menopause, it's hard to know what's confounding it, but my cognitive function changed.
我以前能快速解答密码纵横字谜和变位词。
I used to do cryptic crosswords and anagrams and solving really quickly.
现在我连变位词都看不出来，心算也做不了，还时常出现命名性失语。
Now I can't see an anagram and I can't do mental arithmetic and I still get nominal aphasia.
我会把手机叫成土豆，我知道它不是土豆，但就是想不起那个词。
I'll call my phone a potato and I know it's not a potato, but I can't find the word.
这确实真实存在。
And that's really real.
如果你从事高压工作，突然大脑不灵光了，这真的很困难。
And it's hard if you've got a high pressure job and suddenly your brain doesn't work.
这真的很痛苦。
It's it's miserable.
而且我接受的化疗剂量还算温和。
And I had quite a mild dose of chemo.
我当天就做完回家了，但那些因骨癌和白血病接受化疗的人，他们要在医院住上两三天。
I had it in a day and I was home, but people who had chemotherapy for bone cancers and leukemias, they're in hospital for two or three days.
化疗过程非常剧烈，但半年后你却记不清了。
It's really intense, but you can't remember it six months later.
这很了不起。
It's remarkable.
我是说，关于化疗脑的主要假说之一是炎症。
I mean, one of the leading hypotheses for chemo brain is inflammation.
有许多不同的途径，比如细胞因子穿过血脑屏障。
There are many different paths, cytokines crossing the blood brain barrier.
你能带我们了解一下当前关于化疗脑成因的科学理论吗？
Can you walk us through the current scientific theories about why chemo brain happens?
重申一下，目前我认为主要还是理论阶段。
Again, at this point, I think it's mostly theories.
这些理论尚未得到充分验证，尽管我们现在拥有一些非常先进的工具。
They haven't been fully validated, although we have some incredible tools now.
我们甚至可以通过PET扫描和配体来观察神经炎症，这在我看来非常酷，因为我认为炎症是影响整体健康的主要因素之一。
We can even with using PET scan and ligands, look at neuroinflammation, which to me is so cool because I think a major driver of health in general is inflammation.
如果我们能在分子层面通过配体追踪炎症，尤其是在大脑中，这简直太了不起了。
And if we can follow it at that molecular level with ligands, it's just remarkable, especially in the brain.
但目前还停留在理论阶段，我很想听听你的想法。
But at this point, stories, I would love to hear what your thoughts are.
我印象中从未见过有人明确解释过这种现象的成因。
I can't remember ever actually seeing someone who said, this is why it happens.
我个人认为，由于化疗会攻击所有生长分裂的细胞，而大脑细胞分裂速度很慢。
To me, I feel because chemo attacks every cell that's growing and dividing, the brain doesn't divide very quickly.
所以这种损伤需要时间积累，而且可能无法恢复，因为大脑可能无法复制或再生那些受损的神经。
So it takes a while for that damage to occur and it may not come back because the brain may not duplicate or regrow those nerves that were damaged.
由于化疗，这可能是其中一个作用机制。
Because of the chemotherapy, that could be one action.
我们知道炎症在全身都是个实际问题。
We know inflammation is a real problem everywhere.
再次强调，关键在于哪些药物能通过血脑屏障。
And again, it's what drugs can get through that blood brain barrier.
我们确实会使用化疗来治疗某些脑转移瘤。
And we give chemotherapy to treat some brain metastases.
具体观察我们造成了哪些损伤确实非常有趣。
It was really interesting to see exactly what damage are we doing.
虽然我们使用冷帽来阻止血液流向头皮，但我很想知道冷帽是否能减轻脑部炎症。
And I know we use the cold capping to stop the blood going to the scalp, but I'd love to know if cold capping reduces the inflammation in the brain.
是的，我们确实对多发性硬化症使用冷帽疗法。
Yeah, we do we use cold capping for MS.
是啊，这过程并不舒服。
Yeah, it's not pleasant.
你会经历大约四小时的冰淇淋头痛。
You have an ice cream headache for about four hours.
我没想到会发生这种情况。
I didn't realize it would happen.
是啊。
Yeah.
直到有个朋友过来告诉我，接受化疗时，你的大脑会受到影响。
And it was only when a friend came and said, right, when you get chemo, your brain's going to go.
你将无法做到这些。
You won't be able to do this.
我当时就震惊了，什么？
And I was like, what?
没人告诉过我。
Nobody told me.
我没想到影响会如此之大。
I didn't realize how big an impact it is.
是的。
Yeah.
功能性磁共振成像研究显示，前额叶皮层尤其会受到影响，这涉及到执行功能和注意力。
And the fMRI studies show that the prefrontal cortex especially is affected, which is executive function and some attention as well.
你有没有注意到在执行功能、问题解决和注意力方面有具体到那种程度的影响？
Did you notice anything specific to that extent as far as your executive function and problem solving and attention?
有。
Yes.
大约六个月后我回去工作了。
So I went back to work after about six months.
那时我已经习惯了更年期带来的副作用，因为这些副作用会影响大脑功能。
And by that time I got used to the side effects of the menopause because that can change how your brain functions.
我不能接受激素替代疗法。
I can't have HRT.
但作为一名乳腺外科医生，我原本习惯在门诊连续接诊10位病人，然后坐下来写完所有病历。
But as a breast surgeon, I'd be used to seeing 10 people in the clinic, one after the other, then I'd sit down, I'd write all the notes.
我记不清刚刚看过的病人。
I couldn't remember the patient I'd just seen.
我记不起以前能做的事。
I could not remember the things that I used to do.
我不得不把所有事情都写下来。
I would have to write everything down.
我无法依赖大脑记住两三件事。
I couldn't rely on my brain to remember two or three things.
我再也不能同时处理多项任务了。
I could not multitask anymore.
而你却不明白为什么。
And you don't understand why.
你试图训练大脑让它好转，但现在我明白了，我需要把所有事情都写下来。
And you try and train your brain to get better, but I now learn, I need to write everything down.
我需要...这么说听起来很蠢，当有人说某件事时，我知道自己记不住。
And I need to be I sound like an idiot when someone says this, I'm not gonna remember that.
你能把它写下来发邮件给我吗？
Can you write it down and email it to me?
因为我的大脑已经不再那样运转了。
Because my brain doesn't work like that anymore.
这真的很艰难。
And it's really hard.
我仍然会做很多数独之类的游戏，只是为了尽量保持大脑活跃。
I still do a lot of Sudoku puzzles and things just to try and keep the brain active.
我认为确实有一些改善。
And I think there has been some improvement.
我觉得在重返工作的头六个月到一年里，你会明显注意到大脑仍在恢复中。
I think you just notice it in the first six months to a year when you go back to work and the brain is still recovering.
因为据说化疗后需要一年才能恢复，而且会让生理年龄增长十岁。
Because they say it takes you a year to recover from chemo and ages you biologically by ten years.
所以你的大脑无法像从前那样高效运转了。
So your brain isn't working as well as it would.
这也是需要记住的一点。
And that's something to remember as well.
我们对轻度认知障碍（MCI）患者（即痴呆前期）的认知活动进行了荟萃分析，对吧？
We did a meta analysis on cognitive activities in general in MCI patients, which is pre dementia, right?
我们发现，像数独这类活动确实很棒。
And what we saw was, yeah, things like Sudoku and all of those are great.
它们确实有效，甚至传统游戏也有帮助。
They work, even old fashioned games work.
更有效的是现实生活中的活动，比如艺术、音乐、舞蹈、课程学习和志愿服务这类。
The more effective thing is real life activities like art and music and dance and classes and volunteering and these kinds of things.
它们涉及多领域、多层次的大脑活动，还包含情感成分。
They are multi domain, multiple layers of brain, and also there's an emotional component to it.
那么，我们在现实生活中做哪些具有挑战性的事呢？
So, what do we do that's real life challenging?
所以，当我不再做外科医生后，我需要继续使用双手。
So, when I stopped being a surgeon, I needed to use my hands.
所以，我编织、钩针、缝纫，还自己做衣服。
So, I knit and I crochet and I sew and I make my own clothes.
我弹钢琴，你说得对。
I play the piano And you're right.
就是这些事情。
It's those things.
当你做这些时，大脑必须同时处理多件事情。
You do your brain is having to do several things at once.
没错。
Yes.
你能获得快乐。
You get the pleasure.
这有其意义所在。
There's a purpose to it.
我认为这确实非常有帮助。
And I think that's really really helped.
是否有证据表明化疗会加速痴呆症和阿尔茨海默病的发病？
Is there any evidence to show that having chemo brings forward the onset of dementia and Alzheimer's?
并没有强有力的证据——我是说我们看待数据的方式，是非常反对社交媒体那套的。
There isn't a strong I mean the way we look at data, which is very anti social media.
在社交媒体上，经常有篇基于30人样本的论文就敢宣称结论，简直就像在说...
So in social media there's a paper that's done on 30 people and then it's like oh
噢别提这个了！
Oh don't go there!
是啊，我告诉他们：你知道有400篇关于阿尔茨海默病的小鼠实验论文吗？没有一篇能转化到人类身上。
Yeah and I tell them you know that 400 papers showed results in mice when it came to Alzheimer's and none of them translated to humans.
实际上并没有确凿证据表明化疗会导致痴呆症。
There isn't actually strong evidence that chemotherapy leads to dementia.
我们有足够的数据，因为这并非罕见疾病，对吧？
There's enough data because this is not a rare disease, right?
美国有七百万人，全球五千五百万人患病。
Seven million Americans, fifty five million worldwide.
因此我们仍需持续关注这个问题。
So we will have to still keep looking at it.
但风险的本质在于，如果你制造了某种风险，那只会稍微降低一些阈值。
But the nature of risk is if you create some risk, that's going to just lower the threshold a bit.
但随后其他因素可能会占据主导。
But then other things can take over.
这就是它的本质。
That's the nature of it.
对你而言，可能是化疗的风险，但之后你开始弹钢琴并做了所有这些事。
For you, maybe the risk of chemotherapy, but then you started doing piano and started doing all of this.
我们知道认知活动的力量要强大得多。
We know that cognitive activity is that much more powerful.
是的。
Yeah.
我认为回到临床试验的话题，我们几乎需要教育公众，甚至从学龄前就开始灌输，告诉他们应该如何正确进行试验。
I think going back to trials, I think we almost need to educate the general public, even pre bunk at school age to say, this is how a trial should be done.
我们一开始就假设它不会起作用。
And we go into it assuming that it's not gonna work.
是的。
Yeah.
你必须想要证明它不会起作用。
And you must want to prove that it's not gonna work.
如果确实有效，那就太好了。
And if it does, that's great.
但那些用保健品做试验想治愈这个的人，他们希望它有效。
But the guys with their supplements creating trials to cure this, they want it to work.
他们花钱就是为了让它有效。
They're paying it for it to work.
这正是他们希望的结果。
That is the outcome they are hoping for.
这完全是不同的设定。
It's completely different setup.
我认为如果我们能帮助他们理解应该如何正确进行科学研究，以及为何不能只挑选有利数据而隐瞒底部的关键信息。
And I think if we could help them understand how proper science should be done and how you can't cherry pick the data and not tell people about that little bit at the bottom.
因为他们说，要驳斥、反驳无稽之谈需要多花上千倍的时间。
Because they say it takes a thousand percent more time to debunk, to contradict nonsense.
因为你必须去查证、找论文、做研究。
Because you have to go and prove and find the papers and do it.
他们只需要随口说一句：'嘿，香蕉会致癌'。
They just have to say, Hey, bananas cause cancer.
是啊，是啊。
Yeah, yeah.
所以我收到人们的请求，今天就有五封邮件说：'嘿，这里有五个谣言'。
So I get people, I've had five emails today saying, Hey, I've got five myths.
你能辟谣吗？
Can you debunk?
你有三天时间吗？
Have you got three days?
你能付钱让我做这件事吗？
Could you pay me to do that please?
是啊。
Yeah.
这真的很难。
It's really hard.
确实，确实如此。
It is, it is.
而且因为我们没有被愤怒冲昏头脑，我们不是在追求点击量和浏览量。
And because we're not raged by angry, we're not trying to get the clicks and the views.
这并不吸引人。
It's not sexy.
这并不刺激。
It's not exciting.
你无法在喧嚣中脱颖而出。
You don't cut through the noise.
不，但你知道吗？
No, but you know what?
我常说，我希望在学校里能用统计学和流行病学代替代数。
One of the things I say is I wish that in schools I would replace algebra with statistics and epidemiology.
是的。
Yes.
我是说，如果人们学习统计学及其本质，以及如何从流行病学角度将其应用于人群，世界将会不同。
I mean, if people learn statistics and the nature of statistics and then epidemiologically how it's translated to populations, the world will be different.
没错。
Exactly.
还有如何识别网络上的胡说八道。
And how to spot BS online.
对，对。
Yes, yes.
批判性思维。
Critical thinking.
那我们聊聊化疗这部分吧。
So let's talk about this chemotherapy part of it.
人们应该知道认知功能会受到影响。
People should know that cognition is going to be affected.
但这还不是故事的结局。
And that's not the end of this story.
不过这是故事的一部分。
But that's a part of this story.
确实如此。
It is.
而且我认为，如果你在化疗期间继续工作——因为很多人确实这样做，化疗方案有很多不同类型——你需要让员工知道你可能无法像以前那样快速完成任务或思维清晰。
And I think if you're carrying on working through chemotherapy, because many people do, there are many different types of chemotherapy regimens, you need to let your employees know that you might not be able to do things as quickly or think as clearly.
你可能需要放慢工作节奏，因为很多人负担不起化疗期间无法工作。
You may need to step down what you're doing because a lot of people can't afford to not work during chemo and they go into their job and suddenly my brain isn't working, do I do?
所以能够明确告知重要人物，
So being able to tell the important people that you might not be as quick as you used to be is really clear.
确实如此。
Absolutely.
另外我认为重要的是让人们知道，这可能不仅仅是化疗的问题。
The other thing I think is important for people to know that this might not be just chemotherapy.
女性受化疗脑影响的比例格外高。
So women are disproportionately affected with chemo brain.
部分原因是她们患上癌症的年龄，恰好也是更年期开始的年龄。
And part of that is because at the age that they come to this disease, which is cancer, it's also the same age as menopause.
我们的好友，
A great friend of ours, Doctor.
莫斯康尼博士，是一位研究女性脑健康与更年期的杰出科学家。
Moscone, who's a brilliant, brilliant scientist working on women's brain health and menopause.
我们知道更年期会影响大脑功能，尤其是随着我们对此了解得越来越多。
Menopause, we know is going to affect the brain, especially as we're beginning to learn more and more.
所以这是另一个影响因素。
So that's another element.
第三个因素是压力。
And the third element is stress.
我们知道压力本身会导致海马体萎缩。
We know that stress itself shrinks the hippocampus.
所以你必须意识到这可能不仅仅是化疗的问题。
So you have to figure out that it might not be just chemotherapy.
可能是需要应对的压力问题。
It might be stress to address stress.
可能是睡眠不足，那就解决睡眠问题。
It might be lack of sleep, so address sleep.
可能是更年期导致的。
It might be menopause.
每当讨论大脑变化、更年期和痴呆症时，我就非常担忧，因为我们还没有掌握全部证据。
I get very worried when kind of talk about the brain changes and the menopause and dementia, because I think we don't have all the evidence yet.
我们尚不确定确切原因，因为痴呆症主要发生在老年女性身上。
We don't know for definite because dementia mainly happens in women as they get older.
这真的是更年期导致的，还是男性身上也在发生同样的情况？
Is it really the menopause or is it the same thing that's happening in men?
我患有一种对雌激素敏感的癌症，像80%的乳腺癌患者一样，这种癌症对雌激素敏感。
So I've had a cancer that's sensitive to estrogen, like eighty percent of the women with breast cancer, it's sensitive to oestrogen.
这意味着为了防止复发，我们会将你的雌激素水平降至比更年期女性更低，而且你不能接受激素替代疗法。
That means to stop it coming back, we reduce your oestrogen levels to lower than a menopausal woman, and you cannot have HRT.
我认为化疗是多因素作用的，再加上你承受着'天啊我得癌症了，而且可能会复发'的心理压力。
I think chemo is multifactorial, plus you've got the stress of, Oh my God, I've got cancer, and my cancer could come back.
当你明知会有多难受时，却不得不强迫自己回来接受第二、第三甚至第四次化疗周期。
It's having to drag yourself back for the second and the third and the fourth cycle when you know how crap you're going to feel.
牵涉的因素太多了。
So much involved.
确实如此。
Absolutely.
关于错误信息的问题，最近一位拥有大量粉丝的人发布视频称，女性经历更年期时，大脑实际上是在自我蚕食。
When it comes to the misinformation, recently a person with a large following came up with a video that says that, when women go through menopause, the brain is actually eating itself.
哦，我知道。
Oh, I know.
这简直是胡扯。
It's nonsense.
然后阿伊莎发布视频说这完全是胡说八道。
And then Ayesha put out a video saying this is absolute nonsense.
数据在哪里？
Where's the data?
在准备方面，约90%的癌症幸存者表示他们对治疗带来的心理健康和认知影响毫无准备。
On the side of preparation, about ninety percent of cancer survivors say they were unprepared for the mental health and cognitive effects of the treatment.
如果让你重写每位患者在化疗前都会收到的说明，关于大脑健康、记忆力和心理韧性方面你会补充什么内容？
If you could rewrite the pre chemo briefing every patient gets, what would you add about brain health, memory and mental resilience?
你会建议他们如何准备？
How would you have them prepare?
所以现在是以医生的身份告诉你，我会确保宣传单上包含哪些内容。
So there's me as a doctor speaking, telling you what I would make sure is on that leaflet.
但作为病人的我会说，我可能根本不会看它，因为回家时我已经一团糟，根本不会去看。
But me as a patient would say, I probably wouldn't read it because I go home in a mess and I wouldn't look.
你会收到一长串副作用清单，比如会导致你不孕不育。
And you get a long, long list of all the side effects and it's like, you're made infertile.
它可能会要了你的命。
It could kill you.
你可能出现肺部血栓，可能感染致命，可能指甲脱落，可能头发掉光。
You could get clots in your lungs, you could get an infection that could kill you, you could lose your nails, you can lose your hair.
这只是一长串令人不适的清单。
There's a long, long list of just unpleasantness.
要告诉患者化疗可能影响思维清晰度和记忆力，在化疗反应严重的几周里无法集中注意力——这很正常。
Telling patients chemo can affect how you think clearly and how you remember and during your bad chemo weeks you won't be able to concentrate on anything and that's normal.
还要给他们提供可看的东西。
And give them things to look at.
比如可以这样——我就很喜欢拼图。
So maybe just, I love jigsaws.
你可以拼上几块拼图，心想，这就是胜利。
You can put in a couple of pieces of a jigsaw and think, that's a win.
当我连《老友记》重播都看不进去时，今天也算有所成就。
I've achieved something today when I can't watch a rerun of Friends.
然后告诉他们化疗结束后，大脑会开始恢复，给他们建议并告知这种情况可能发生。
And then tell them when chemo is finished, your brain will start to improve, giving them advice and telling them this can happen.
还要记得找化疗护士，因为每个疗程她们都会陪着你。
And then always getting the chemo nurses because they spend time with you every cycle.
她们会检查所有副作用的情况。
They're checking about all the side effects.
也许我们需要问：你的大脑功能怎么样？
Maybe we need to say, how's your brain function?
不，我们无法改变它。
No, we can't change it.
我们无法让它好转，但了解这些可能有用。
We can't make it better, but it may be useful to know.
这完全说得通。
That absolutely makes sense.
真正的事实是，认知恢复不仅仅是恢复到正常状态。
The real fact is that recognizing that cognitive recovery is not just about getting back to normal.
所以我认为癌症之后就没有所谓的正常了。
So I would say there is no normal after cancer.
我们都在谈论新常态，但实际上没有什么常态可言。
We all talk about the new normal and nothing is normal.
这是一种全新的不同状态。
It's a new different.
这是你人生的新阶段。
It's a new stage in your life.
你可能永远无法像以前那样清晰地思考了。
And you may never be able to think as clearly as you did.
你认为这种新状态——既然你已经经历过癌症并幸存下来——是否是一种更丰富的状态？
And do you think that this new state, given that you've been through cancer and have survived, is a richer state?
我认为这取决于具体情况。
I think it depends.
我现在的生活比十年前更快乐、更坚强。
My life is happier and stronger now than I was ten years ago.
我被迫做出了改变。
I've been forced to change.
我被迫认识到什么才是重要的。
I've been forced to realize what's important.
重要的是创造回忆，并找到新的生活方式和存在方式。
It's the memories that you make and find new ways of living and being.
事实上，工作之外还有生活。
And actually, there is life outside of work.
我被迫改变，变成了一个完全不同的人。
I've been forced to change and become a completely different person.
化疗前的莉兹绝不会在网上谈论自己的性生活，也不会站在2000人面前的舞台上，更不会写出五本书。
Pre chemo Liz would not have talked about her sex life online or stood on stage in front of 2,000 people or written five books.
展开剩余字幕（还有 305 条）
我最新出版的书名为《抗癌路线图》。
My latest book is called The Cancer Roadmap.
这本书的创作源于我在Instagram上揭露了一对素食网红发布的视频，他们声称某播客嘉宾告诉他们蘑菇能治愈癌症。
And it came about when I debunked a video on Instagram by two vegan influencers who said a podcast guest told them mushrooms could cure cancer.
后来出版社找到我说：‘女性健康领域存在太多错误信息。’
And the publishers came to me and said, There is so much misinformation in women's health.
‘你愿意写一本关于癌症的书吗？’
Would you write a book about cancer?
我当时想：‘好吧，我可以试试。’
And I thought, Okay, I can do that.
根据我的经验，我认为如果癌症就是你的世界末日——对于一个患有转移性癌症且有两个孩子的年轻女性来说，这确实就是世界末日。
From my experience, I think if cancer is the end of your world and for a young woman with metastatic cancer and two kids, it is the end of the world.
她们往往会陷入一种状态，不再照顾自己。
They kind of go into a, they don't look after themselves.
这种压力不断累积，焦虑和抑郁也随之加剧。
That stress builds, the anxiety, the depression builds.
他们吃不好、不锻炼、也不睡觉。
They don't eat well, they don't exercise, they don't sleep.
那种恐惧会吞噬一切，导致他们往往恢复不佳。
And that fear becomes all consuming and they tend not to do as well.
但如果你能找到——不是积极因素——而是找到其他事情来转移注意力。
But if you can find not a positive, but find something different to distract you.
好吧，事情已经发生了。
Well, okay, this has happened.
我花了两年时间才达到这种心境。
And it took me two years to get to this space.
我无法改变这个事实。
I can't change it.
别再纠结自己可能三年内就会死去，而是问：好吧，今天我能做些什么？
Stop fighting the fact that you might be dead in three years and say, well, okay, what can I do today?
并尝试寻找新的方式，在忙碌中发现快乐。
And trying to find new ways to find the joy to occupy yourself.
它可以是一份礼物。
It can be a gift.
如果你愿意接受，它能开启许多扇门。
It can open so many doors if you're ready to accept them.
但并非每个人都如此幸运，也并非每个人都有我这样的感受。
But not everybody is lucky and not everybody feels as I did.
我认为这真的非常个人化。
I think it's really, really personal.
所以当你看到像我这样的人说'生活多美好'时，
So, when you see people like me going, Hey, life is wonderful.
我非常清楚自己也需要展示那些艰难的日子。
I'm very aware that I need to show the tough days.
那些我哭泣、痛苦、恐惧的日子，因为这就是过山车般的人生。
The days when I'm crying and I'm miserable and I'm scared because it's a roller coaster.
希望你在高处的时间能比低谷时更多。
Hopefully you'll spend more time on the up than you do on the low.
这是一次精彩的对话。
This was a fantastic conversation.
我很喜欢她描述的那种思维迷雾，以及在化疗和癌症期间经历的情感麻木，那种自我认知的转变，当你的大脑不再感觉像是自己的那一刻。
I love how she described the mental fog, but also the emotional flattening that is experienced during chemotherapy and cancer, that shift in self perception, the moment when your brain is no longer feeling like yours.
我真的很高兴她也谈到了哪些方法有所帮助。
And I'm really glad that she also talked about what helped.
那些日常习惯、生活结构、放下内疚感。
The routines, the structure, the letting go of guilt.
所有这些都极其重要。
All of that is incredibly important.
而且，她还强调了从试图恢复到以前状态转变为学会如何以全新方式前进的转变。
And also, she highlighted the shift from trying to bounce back to learning how to move forward fully and differently.
听她讲述时，我深刻意识到我们很少讨论康复的这个部分——认知层面的恢复和情感重建，以及身份认同的转变。
Listening to her struck me how little we talk about this part of the recovery, the cognitive piece and the emotional reintegration part of it, the identity shift.
这让我们有请下一位嘉宾。
Which brings us to our next guest.
妮可·安德鲁斯是一位肿瘤营养师，她与治疗期间、治疗后以及过渡期的患者密切合作。
Nicole Andrews is an oncology dietitian who works with patients in the thick of it, during treatment, after treatment, and in the in between.
她的工作不仅关乎重建体力，还通过饮食、教育以及消除围绕癌症康复（尤其是营养方面）的恐惧心理，帮助患者恢复认知清晰度和情绪稳定性，她在患者护理方面做得非常出色。
Her work is about rebuilding not just physical strength but cognitive clarity and emotional grounding through food, through education, and through dismantling the fear based that surrounds cancer recovery and nutrition specifically, she's doing an amazing job with her patients.
她与我探讨了营养、运动和认知康复三者如何相互交织。
She and I spoke about how nutrition, exercise, and cognitive healing intersect.
她还分享了她临床实践中的观察，以及我们如何帮助人们不仅生存下来，更能重新找回自我。
She also discussed what she sees in her practice and how we can support people not to just survive, but to feel like themselves again.
以下是我们的对话内容。
Here's our conversation.
非常荣幸能与您交谈。
It's such a pleasure speaking with you.
公共卫生已转向社交媒体，这既是好事也可能非常危险。
Public health has moved to social media, which is a good thing and it can also be a very dangerous thing.
而您是一名注册营养师。
And you're a registered dietitian.
你肩负着巨大的责任，而营养学领域存在。
You have such a huge responsibility, and there's a lot of misinformation in the field of nutrition.
让我们来谈谈 about how you respond to someone who basically says, eat this food.
Let's talk about how you respond to someone who basically says, eat this food.
它可能是像西兰花这样的食物，或者某种补充剂，声称如果你正在经历癌症，它会让你感觉更好，甚至逆转癌症或预防癌症。
It could be something like broccoli or let's say a kind of a supplement, and it's going to make you feel better if you're going through cancer, either reverse your cancer or prevent cancer.
那么，当谈到营养与癌症这个话题时，你通常会和人们进行怎样的对话呢？
Like, what is your general conversation to people when it comes to the idea of nutrition and cancer?
是的。
Yeah.
好的。
Okay.
首先，非常感谢邀请我参加这次对话。
First of all, thank you so much for having me on.
确实，当面对癌症诊断时很重要的一点是，我们要向癌症幸存者传递正确的信息，而这些信息他们往往无法获得。因为社交媒体虽然有其积极的一面，比如有你和我这样致力于传播正确信息的人，特别是像我这样专注于癌症幸存者营养的人，但同时也充斥着大量错误信息。
And, yeah, when it comes to a cancer diagnosis, it's really important that we're sharing the right information to cancer survivors, which they don't get, which is because social media, while it has amazing people like you and myself, especially, you know, me talking about nutrition for cancer survivors, it has a lot of misinformation.
错误的营养信息确实会给他们带来很多困扰和问题。
There's so many things that really are hard on them and go wrong for them with nutrition when it's the wrong information.
这可能导致许多并发症。
So it can cause a lot of complications.
而当你获得正确的营养支持时。
Now, you get the right nutritional support.
这正是我在社交媒体上所做的。
That's definitely what I do on my social media.
它能彻底扭转局面。
It can turn everything around.
他们能找回自我的感觉。
They can feel like themselves.
他们能够滋养和保护自己的身体、大脑健康等各方面。
They can nourish and protect their bodies, their brain health, and all that.
但这可能具有挑战性，因为癌症幸存者可能并不擅长判断该听取谁的建议，或谁对营养学的观点正确与否。
But it can be challenging because cancer survivors, they may not be experts in figuring out who's the right person or not to listen to or who's right or wrong about nutrition.
因此我认为最重要的是，像你我这样拥有专业资质的人，我们在某个领域工作多年，积累了丰富经验。
So I think it's really important just first off, people who are credentialed like you and I who have worked in an area and a space that we have experience with for many years.
当有人说'嘿，就吃这个食物'时，
When somebody is like, Hey, this one food.
事情根本不是这样运作的。
So that's not how it works.
从来不存在一种你错过的万能饮食、神奇食物或补充剂。
There's never one diet, one food, one supplement that you had missed.
这种说法完全不正确。
That's just not true.
我们的身体非常复杂。
Our bodies are complex.
在营养方面，你的身体每天都需要碳水化合物、蛋白质和脂肪，年复一年，永远如此。
And when it comes to nutrition, your body needs carbs, protein, and fat every day for years, forever.
根本不存在什么神奇食物。
There's not one magical food.
所以当他们说'嘿，这种补充剂'时，那肯定是标题党。
So it's gonna be clickbait if they're like, Hey, this one supplement.
嘿，这种食物。
Hey, this one food.
嘿，这种蔬菜。
Hey, this one veggie.
那绝对是标题党。
That's gonna be clickbait.
现在他们说'嘿，我喜欢这种食物'。
Now, they're saying, Hey, I love this food.
比如作为癌症营养师的我个人很喜欢树莓，而且一杯树莓就富含营养。
For example, like me as a cancer dietitian, I love raspberries personally, but also they just pack in so much nutrition in just one cup.
所以我可能会说树莓很棒，但它不是超级食物。
So I might talk about how raspberries are great, but it is not a super food.
没有哪种单一食物或饮食能神奇地让癌症消失，或者确保癌症永不复发。
There's no one food, one diet that is gonna magically make cancer disappear or that's gonna magically make it so cancer never comes back.
现在有一些我们可以采用的饮食模式，还有很多我们可以添加的绝佳食物，这些都会产生巨大影响。
Now there's eating patterns that we can do, and there's a lot of amazing foods we can add in that will make a huge impact.
但这是我们需要注意的一个问题。
But that's one thing we gotta look out for.
在健康、营养和癌症方面，从来没有什么神奇的东西。
There's never this one magical thing when it comes to health or nutrition and cancer.
这是一系列因素的集合，我们需要简化这些因素，使其变得现实且易于实施。
It's a collection of things, and it's simplifying those and making it realistic and easy for them to implement.
这就是他们取得成果的方式。
That's how they get results.
当他们说某样东西、某种补充剂时，这就是一个危险信号，我会选择避开。
When they say one thing, one supplement, red flag, I'd run the other way.
我真的很感谢你这么说。
I really appreciate you saying that.
我认为让我感到安慰的是，这种说法不仅适用于癌症幸存者，也适用于所有其他健康相关问题。
I think one thing that gives me solace is that this kind of language is it's applicable for cancer survivors, but it's also applicable for all other health related issues as well.
说真的，同样的饮食模式对心脏健康有益，对大脑健康有益，对胃肠道健康有益，对生殖健康也有益。
Fake goodness, the same dietary pattern that is good for heart health is good for brain health, is good for GI health, is good for reproductive health.
所以在饮食模式上没有太多巨大的差异。
So there's not a lot of huge differences in the dietary pattern.
作为一名科学家，我研究不同的饮食模式。
And as a scientist, I study different dietary patterns.
我很高兴我们已经从推荐特定营养素或特定补充剂转向了在公共卫生信息传递方面，告诉人们以饮食模式的形式摄入多种不同的食物。
And I'm glad that we've shifted from recommending a particular nutrient or a particular supplement to telling when it comes to general public health messaging, it's telling people to eat a variety of different things in a form of a dietary pattern.
是的。
Yes.
对于癌症幸存者来说，这种饮食模式具体是什么样的？
What does that dietary pattern look like for cancer survivors?
对。
Yeah.
实际上，我们主要关注的是以植物为主的饮食。
So really, what we're looking at is mostly plant based.
如果你想的话，可以选择纯素食或素食，但这是个人选择。
You could go vegan or vegetarian if you want, but that's a personal choice.
当真正谈到降低癌症风险时，只有两种食物你确实需要避免，它们与增加癌症风险的人类数据有强烈关联。
When it truly comes to reducing risk of cancer, there's only two foods you really want to eliminate that have been tied in with strong human data to increase cancer risk.
一种是酒精，另一种是加工肉类。
One would be alcohol, and then two would be processed meats.
这些包括预煮肉类或深度加工的食品，比如培根、香肠、熟食肉类等，它们会特别增加结直肠癌的风险。
And those will include your precooked meats or heavily processed, so bacon, sausages, deli meats, things like that, those are going to increase risk of colorectal cancer specifically.
而酒精则会增加七种不同癌症的风险。
And then the alcohol is going increase risk of seven different cancers.
其中包括结肠癌、肝癌、口腔癌、喉癌等。
Some of those colon cancer, liver, mouth, throat.
所以只有这两种是需要避免的。
So those are the only two.
所以当人们情绪激动地说'哦，不能喝无糖可乐'，或者'哦，不能吃麸质'，或者'哦，糖'，这些说法其实并不准确。
So when everyone comes in hot with, Oh, no diet Coke, or, Oh, no gluten, or, Oh, sugar, are just not it's not true.
对所有人来说，了解食物研究一直在进行且科学家们不断发布更新非常重要。
It's really important for everyone to know that foods are studied all the time, and scientists are releasing updates.
科学家们正在研究例如零卡路里甜味剂等物质。
Scientists are looking at, for example, zero calorie sweeteners.
这些已经被研究了几十年又几十年。
Those have been looked over for decades and decades.
所以不存在什么隐藏的东西，科学家们也没有隐瞒任何事实。
So there's no hidden thing like hiding, and scientists aren't hiding anything either.
他们实际上在识别真正增加或降低癌症风险因素方面做得很好。
They're actually doing a great job of figuring out what really increases cancer risk or decreases it.
所以我们不必成为素食主义者，但确实需要增加植物性食物的摄入。
So we don't have to go vegan or vegetarian, but we do need to add in more plant foods.
如果你想降低患癌风险，就必须思考其中的因果关系。
So if you want to reduce risk of cancer, you have to think about what happens.
癌症究竟是如何发生的呢？
How does cancer come about?
源于受损的细胞和受损的DNA。
Comes from a damaged cell, damaged DNA.
那么通过饮食，你能做些什么来帮助这些细胞得到保护或修复DNA呢？
So what can you do with food to help those cells basically be protected or repair that DNA?
你需要多吃植物性食物，因为植物含有特定的维生素、矿物质、抗氧化剂和植物化学物质，它们要么守护细胞免受损伤，要么修复损伤——毕竟人体细胞每天都会因正常生理活动而受损。
You eat more plant foods because plants contain certain vitamins and minerals, antioxidants and phytochemicals that either guard and protect your cells from being damaged, or maybe they're damaged because our cells do get damaged daily just from being a person.
但某些特定的植物性食物能够修复这种损伤。
But those certain plant foods will repair it.
比如当你吃橙子、草莓或任何你喜欢的食物时，也许你特别喜欢苹果。
So like when you eat an orange or a strawberry or whatever your favorite food is, maybe you, you know, love apples.
你正在享用这些食物。
You're eating that.
它们会在体内循环，起到保护或修复的作用。
It's going around protecting or repairing yourselves.
这非常神奇，也非常美妙。
And it's pretty amazing, pretty beautiful.
我要指出，植物性食物包括水果、蔬菜、豆类、坚果、种子以及全谷物。
I do want to point out plant foods include fruits and veggies, beans, legumes, nuts, seeds, and then whole grains.
很多人都在妖魔化谷物，除非你患有乳糜泻。
A lot of people are demonizing grains unless you have celiac disease.
你可以也应该摄入谷物。
You can have grains and you should.
这些食物将帮助你降低患癌症的风险。
So those foods are going to help you to reduce risk of cancer.
此外，为了在癌症治疗期间及之后滋养身体，适量摄入低脂乳制品和瘦肉蛋白是可以的，我们应多选择那些富含单不饱和及多不饱和脂肪、饱和脂肪含量较低的有益心脏健康的脂肪。
Now, addition to that, to nourish your body through cancer treatment and beyond, it's okay to have lean dairy, it's okay to have lean proteins, we want to choose more of those heart healthy fats that are going to be lower in saturated fat, more of those mono and polyunsaturated fats.
适量摄入糖分也是可以的。
It's okay to have sugar moderation.
没人建议采用高糖饮食。
No one is saying to have a high sugar diet.
但吃块饼干、去约会吃冰淇淋、在节日咖啡或生日蛋糕里加点甜味剂，这些都是正常的，不会促使癌症生长。
But to have a cookie or go on an ice cream date or have a little sweetener in your holiday coffee or birthday cake, these things are normal and they're not gonna make your cancer grow.
如果你戒掉它们，也不会让你的癌症消失。
If you pull them out, it's not gonna make your cancer vanish.
所以在真正降低癌症风险方面，适量摄入糖分是可以的，但它不应该是你饮食的全部。
So when it comes to really reducing cancer risk, it's okay to have the sugar in there, but it's not supposed to be your whole diet.
你的饮食大部分应该是那些植物性食物和瘦肉蛋白。
A lot of your diet is supposed to be those plant foods and lean proteins.
这就是我为了降低患癌风险而采用的饮食方式。
So that's how I eat to reduce my risk of cancer.
这也是我在社交媒体上分享的内容，同样也是我对所有客户的建议，无论他们是在癌症治疗期间还是之后。
And that's what I say on my social media, but that's also really what I tell all my clients whether they're during or after cancer treatment.
我非常赞同。
I love it.
非常感谢你的分享。
Thank you so much for sharing that.
这与其他病症的研究证据也完全吻合。
That's exactly what the evidence shows for other conditions as well.
关于有机食品与非有机食品的概念，以及整个转基因问题，存在大量错误信息。
There's a lot of misinformation surrounding the concept of eating organic versus inorganic and the whole GMO issue as well.
在神经学领域，我们知道接触杀虫剂——比如那些因职业风险在田间工作并接触这些化学物质的人——可能会增加患帕金森病的风险。
In the realm of neurology, we know that exposure to pesticides, like people who actually have an occupational hazard that work in the field and they're exposed to these chemicals could potentially have a higher risk of developing Parkinson's disease.
但除此之外，我们确实没有证据表明传统种植的水果和蔬菜本身会增加任何脑部疾病的风险。
But beyond that, we really don't have any evidence of conventionally grown fruits and vegetables increase the risk of any brain diseases per se.
我知道在癌症领域，这方面也存在许多错误信息。
And I know that in the realm of cancer, there's a lot of misinformation around that.
你对此有何看法？你是如何与患者和客户讨论这个问题的？
What are your thoughts about that, and how do you talk to your patients and clients about it?
是的。
Yeah.
其实你不需要购买有机食品，或者任何类型的有机食品。
So you don't need to buy organic, and that's one thing or any type of organic food.
这是癌症幸存者被告知的一件事。
That's one thing cancer survivors are told.
他们中有很多人会告诉我，这现在是我预算中很大的一部分。
And a lot of them will share with me, this is really a big part of my budget now.
或者他们干脆就不买了。
Or they're skipping out.
比如，他们原本可能会买些蓝莓，这能显著降低癌症风险并支持肠道健康，非常重要。
Like, maybe they would have picked up some blueberries, which would totally reduce their cancer risk and support their gut health, which is huge.
但因为不是有机的，他们就觉得自己不能买。
But they weren't organic, so they feel like they can't.
或者有机蓝莓要8美元，他们觉得这又占预算的很大一部分。
Or the organic blueberries are $8 and they feel like, again, like that's such a huge part of their budget.
所以真正重要的是要与农民和食品科学家交流，全面审视这些问题。
So it's really important to look at talking with farmers and food scientists and looking at all this.
有机食品并不会更好地降低你的癌症风险。
So organics is not going to reduce your risk cancer better.
就营养成分而言，传统种植的蓝莓与有机蓝莓是完全相同的。
Conventional blueberries, when it comes to the nutrient profile, is going be exactly the same for organic or conventional.
冷冻食品也是一样的道理，明白吗？
Same with frozen, okay?
这是个好消息，因为这样我们就能多吃些水果蔬菜，这才是真正有助于降低患癌风险的做法。
And this is good news because then we can go out and have more fruits and veggies, which is what will help you reduce cancer risk.
说到农药残留，两者的含量都会在安全范围内。
When we look at pesticides, they're both going to be at safe levels.
虽然采用不同的耕作方式，但两者都是安全的。
They're going use different type of farming patterns, but they're both going to be safe.
这很大程度上只是营销手段罢了。
It's really just a lot of marketing.
这只是不同的耕作方式。
It's a different way of farming.
并不代表营养更优越。
It's not nutrient superior.
谈到转基因作物，我们得感谢科学家和农民，因为他们的工作让作物变得更耐旱，甚至可能减少农药使用量。
When it comes to GMOs, we've got to say thank you to the scientists and farmers because what they've done with GMOs is they changed around crops that are more drought tolerant or may even need less pesticides.
他们正在研究如何让食物更易于种植，这样我们既能享用又能负担得起。
They're looking at foods to make it in a way that's easier to grow so we can enjoy them and afford them.
所以实际上转基因食品并不多。
So there's not really a lot of GMOs.
我认为对癌症幸存者和所有人来说，真正重要的是要明白，他们甚至会因为人们对转基因的恐惧而给本无转基因版本的产品贴上‘非转基因’标签。
And I think what's really important for cancer survivors and everyone to understand is they'll even label things because people are so afraid of GMOs, having a non GMO, but they won't even have a counterpart.
例如，像橙子或树莓会被标注为非转基因。
So for example, like oranges or raspberries will be labeled non GMO.
但实际上根本不存在转基因的橙子或树莓。
But there are no GMOs that are oranges or raspberries.
所以这完全是危言耸听。
So there's so much fear mongering.
这些公司现在给产品添加了各种我们根本不需要的标识。
These companies are now putting all these things on products that we don't even need to have.
转基因食品是安全的。
GMOs are safe.
你不需要购买有机食品。
You do not need to buy organic.
我只希望你能多吃水果蔬菜，要知道它们上面的农药残留量微乎其微。
I just need you to have more fruits and veggies and know that pesticide residual on either of them is so low.
首先，两者都会使用农药。
First of they both use pesticides.
但如果你想达到今天菠菜的安全摄入上限，得吃掉800袋菠菜——根本没人会这么做。
But if you wanna reach this safe limit of maybe like spinach today, you'd have to eat 800 bags of spinach and nobody's doing that.
所以关键是要明白这不会对你造成任何伤害。
So it's just so important to know it's not gonna cause you any harm.
残留量处于非常安全的水平。
It's at very safe levels.
监管非常严格。
It's watched so close.
报告制度也非常严密。
It's reported on so close.
如果你想真正降低患癌风险，就需要在预算范围内多吃你愿意吃的水果蔬菜。
And that if you really wanna reduce your risk of cancer, I need you having more fruits and veggies that fit in your budget and that you wanna eat.
说得太棒了。
Beautiful.
所有观察性研究都表明，水果蔬菜、全谷物、豆类、坚果和种子等可能让我们更健康的食物，其关联性都是在传统种植的蔬果上验证的。
And all of the observational studies that have showed the association between consumption of foods like fruits and vegetables, whole grains, legumes, nuts, and seeds, all the wonderful foods that could potentially make us healthy, They were tested on conventionally grown vegetables and fruits.
这些研究用的都不是有机品种。
They were not the organic type.
实际上我们拥有数十年的数据证明，遵循这种食用传统种植农产品的饮食模式，确实能让人感觉更好、更健康。
So we actually have decades of data showing that when you follow that dietary pattern of eating conventionally grown produce, you actually feel better and you're healthier.
非常感谢你详细解释这一点。
So thank you so much for elaborating on that.
我想请教你作为注册营养师，对正在接受化疗的患者采取的具体方法，以及他们的一些常见问题。
I'd love to pick your brain on your approach as a registered dietitian with your patients who are going through chemotherapy specifically and some of their complaints.
因为我是神经科医生，经常接到关于化疗脑（虽然这不是ICD-9编码）的咨询，本质上就是有些人在化疗期间经历的认知障碍问题。
Because I'm a neurologist, I always get consultations about, brain fog because it's not an ICD-nine code, but essentially the cognitive impairment that some people experience going through chemotherapy.
这需要进行大量的神经学检查。
And that requires a lot of neurological workup.
我们要确保进行影像学检查和一些记忆测试等等。
We want to make sure that we get some imaging and do some memory testing, so on and so forth.
我总是会把病人转诊给注册营养师。
And I always send my patients to a registered dietitian.
请告诉我们，对于在座的可爱观众们，这具体包含哪些内容？
Tell us for for our lovely audience here, what does that entail?
你如何帮助那些因化疗而出现疲劳或精力不足症状的患者？
How do you work with someone who comes in with, say, example, fatigue or low energy when they're going through chemotherapy?
在营养方面，他们需要注意哪些事项？
What are some of the things that they need to be aware of as far as nutrition is concerned?
是的。
Yeah.
我们马上可以从几个不同方面来看这个问题。
So there's a few different things that we can kind of look at right away.
首先请注意，对于许多癌症幸存者因不同治疗方式出现的精力不足或脑雾症状，你不该自责。
So first off, please note that you can't blame yourself for that low energy or brain fog that a lot of different cancer survivors are getting it with different modalities.
可能有些人还在接受化疗。
Maybe some are even on chemo.
这只是诊断结果，是癌症存在的表现。
It's just the diagnosis, the cancer being present.
但我想鼓励大家，情况会好转，而且有很多可以采取的措施。
But I want to encourage everyone that it will get better, and there are things that you can do.
在你接受癌症治疗期间，从确诊到获得无癌检查结果的过程中，你的身体会逐渐康复。
And that as you go through cancer treatment or go through from having a diagnosis to getting your clean scans, your body is going to be healing.
我曾与数十位癌症幸存者合作，他们的脑雾症状确实会改善。
I've worked with dozens, I mean, of cancer survivors where the brain fog, it gets better.
精力也会恢复。
The energy, it comes back.
只是需要一些时间。
It just takes some time.
所以你必须记住，对于脑雾症状，用健脑食物滋养大脑非常重要，其中之一就是碳水化合物。
So you have to remember that for brain fog, it's so important that you're nourishing your brain with those brain foods, and one of those is carbohydrates.
碳水化合物包括各种水果、谷物，以及除奶酪外的所有乳制品。
So carbohydrates are going to land any fruits, grains, all dairy except for cheese.
我们不能完全戒掉碳水化合物。
We cannot take out the carbs.
你的大脑需要它们。
Your brain needs that.
其他更健康的脂肪选择也会支持大脑健康。
Other healthier fat choices are also going to support brain health.
因此选择亚麻籽、核桃等抗炎脂肪，这些能真正滋养你的大脑。
So choosing anti inflammatory fats like flaxseed, walnuts, those are going to really nourish your brain.
所以需要记住的一点是：我们既不能完全戒掉脂肪，也不能完全戒掉碳水化合物。
So that's one thing to keep in mind is we don't want to be taking out all the fats and taking out all the carbs.
另一个影响大脑健康的因素是决策疲劳。
Another thing for your brain health is the decision fatigue.
你脑海里充斥着太多事情。
There's so many things going through your mind.
癌症幸存者要面对太多事情：你的治疗、预约、未来、应对措施、与家人沟通。
So many things to cancer survivor, your treatments, your appointments, your future, coping, talking to your family.
我是说，哇哦。
I mean, woah.
你不仅可能因治疗和癌症本身而身体疲惫，现在还承受着这种精神负担。
Not only may you be physically tired because what's going on with the treatments and cancer present, but now you have this mental load.
所以真正要努力减轻这种精神负担，尽管这可能非常具有挑战性。
So really working on reducing that mental load, which can be very challenging.
但你必须获得支持，比如你的医生、营养师和家人。
But you have to have support, like your physician, like your dietitian, your family.
好的。
All right.
所以，要减少决策疲劳并坚持锻炼。
So, getting that decision fatigue down and exercise.
运动对于改善血液循环、获得更好的治疗效果至关重要，同时也能极大地呵护你的器官，包括大脑。
Exercise is so important to improve circulation, to have better treatment outcomes, but to just really take care of your organs so much, including your brain.
因此，运动将会变得极其重要。
So the exercise is what's gonna be so important.
我想确保这一点讲得清楚明白。
And I wanna make sure it's clear.
我并不是说要每天去健身房锻炼两小时。
I'm not saying go to the gym every day for two hours.
我说的只是绕着街区散步这样的活动。
I'm talking about like just walking around the block.
曾有位客户，她连走到邮箱再返回都做不到。
Had one client, she couldn't even walk to her mailbox and back.
我们设定了小目标，这些属于行为改变的阶段性目标。
We made small goals, and these are like behavior change goals.
你从练习走到邮箱开始，等这个目标达成后，就绕着邮箱走一圈，等这个也做到了，你就能步行一英里了。
You start walking to your mailbox when you get that down, then you do a loop around your mailbox, then you get that down, then you're walking a mile.
因此作为癌症幸存者，我们需要重新将运动纳入生活，以支持大脑健康，真正提升你的精力。
So with exercise, we need to incorporate it back in as a cancer survivor to support your brain health to improve your energy truly.
这很难，因为癌症幸存者会说：'我太累了，所以我不去运动'。
It's hard because cancer survivors will be like, I'm so tired, so I'm not gonna go exercise.
而我会说：'但如果你运动，反而会感觉不那么疲惫'。
And I'm like, but if you exercise, you're gonna feel less tired.
但关键在于，我们并不是要求你做两小时运动。
But the thing is, though, we're not asking you to do two hours.
我们只是希望你开始行动。
We're asking you just to start.
而监督问责——这正是我在项目中要做的事，确保你对自己负责。
And accountability, that's what I do inside my programs to hold you accountable.
这并不意味着你不能休息，但当真正要提升精力、改善大脑健康时，休息已不再是建议方案。
And it doesn't mean that you can't rest, but that's no longer the recommendation when it comes to really improving energy, helping with your brain health.
你不该在经历癌症治疗后永远处于休息状态。
You don't want to go through cancer treatments and always be resting.
你真的应该继续保持运动和锻炼。
You really want to continue to move and exercise.
我甚至会让癌症患者在治疗期间也进行一些肌肉训练。
I'll even have cancer survivors build some muscle during treatments.
这是完全可能的。
It's possible.
但我想让你明白，我们不是要求你做到所有事情。
But I think I want you to know it's not doing everything.
如果你现在完全不运动，正在听我们说话，心里想着'好吧，那我明天就去跑个五英里'。
If you're not exercising at all and you're listening to us right now and you're thinking, Okay, I guess tomorrow I'll go out and run five miles.
你要知道，我们不是这个意思。
You know, that's not what we're saying.
我们只是希望你散步十分钟。
We want you to walk ten minutes.
如果感觉良好，我们再逐步增加运动量。
And if that goes good, let's build on that.
所以对大脑健康而言，关键是重新摄入碳水化合物。
So for brain health, it's adding back in the carbs.
就是运动。
It's exercising.
就是建立支持系统来减轻你的精神负担。
It's getting a support system to reduce your mental load.
这些是主要事项。
Those are the main things.
我经常看到癌症幸存者戒掉碳水和谷物，这正是我们需要重新引入的东西。
I just see so often cancer survivors cutting out carbs and grains, and that's just something we got to bring back.
说得太棒了。
Beautifully stated.
是的，要知道碳水化合物——尤其是葡萄糖——是脑细胞最重要的燃料。
Yeah, know carbohydrates and specifically glucose is the most important fuel for brain cells.
听到某些网红建议人们在癌症治疗或化疗期间尝试生酮饮食之类的方案，这真的让我很不安。
And it really disturbs me to hear some of these influencers suggesting people start something like the ketogenic diet during cancer therapy or chemotherapy.
这真的会搞乱很多事情，他们的能量水平、卡路里摄入量，当然还有你提到的，他们大脑的燃料。
That just messes up so many things, their energy levels, their calorie intake, and, of course, like you said, the fuel for their brain.
所以我真的很感谢你说碳水化合物，这对我来说简直是天籁之音。
So I really appreciate that you said carbohydrates sounds music to my ears.
把它们带回来。
Get them back.
是啊。
Yeah.
生酮饮食不是我们想要的。
Keto is not we don't wanna be doing that.
请不要采用生酮饮食。
Please don't do the keto diet.
那只是一时流行的风潮。
That's a fad.
完全同意。
Absolutely.
我对注册营养师怀有极大的热爱与敬意。
I have tremendous love and respect for a registered dietitian.
我这么说不仅仅是因为你在我面前，而是真心觉得这是你的专业领域。
I'm not just saying that because you're in front of me, but I truly feel that this is your field.
你接受过这方面的专业训练。
You've been trained to do that.
请告诉我们为什么人们需要请求医生与注册营养师沟通——因为甚至在某些医疗中心，许多肿瘤科医生可能都不知道有营养师可以为患者提供化疗期间的饮食指导，帮助他们维持充满活力的生活，保持认知敏锐。
Tell us why people need to ask their physicians to speak with a registered dietitian because a lot of even oncologists at some centers, they might not be aware that there is an RD that can speak with their patients about how to eat during their chemotherapy and live a vital life, a cognitively vibrant life.
为什么人们主动要求与注册营养师沟通或进行咨询如此重要？
Why is it important for people to ask to speak with a registered dietitian or get a consultation with them?
这就是我从事这份工作的意义所在。
This is why I do what I do.
因此至关重要的是，一旦确诊癌症（甚至在此之前）就要联系营养师，确保摄入全面营养以保持最佳状态。因为首要目标是——你的癌症中心可能有也可能没有营养师。
So it is imperative that as soon as you're diagnosed with cancer, even before that, to reach out to a dietitian to make sure you're hitting all the right nutrients to feel your best because the whole goal, first off, your cancer center may or may not have a dietitian.
根据所有文献记载，为了获得最佳治疗效果：减轻副作用严重程度、改善脑雾症状、保持精力充沛、在治疗期间维持瘦体重（即保住肌肉）——这些都取决于营养支持。
So in order for you to have the best treatment outcomes based on all the literature, reduce severity of side effects, improve that brain fog, keep your energy up, preserve lean body mass, meaning hold on to that muscle during treatment, comes from nutrition.
您的营养师将能够帮助您或我作为您的营养师提供正确的营养指导。
Your dietitian will be able to help you or me as your dietitian with the proper nutrition.
您不希望等到开始体重下降或感觉不适时才行动，因为那时要补充缺失的营养或恢复精力会更加困难。
You do not want to wait until you start losing weight or you start not feeling so great because it's harder to get back those certain nutrients you're missing or that energy back when you've waited.
因此，如果您想以完整剂量接受所有治疗（这正是我们期望的，因为这样才能获得干净的扫描结果），就必须在营养方面非常积极主动。
So really, if you want to attend all treatments at full doses, which is exactly what we want because that's how you're going to get clean scans, you want to make sure to be very proactive about nutrition.
目标绝不是‘我就随便吃，等到感觉糟糕了再说’。
The goal is not, I'm just going to wing it or eat whatever until I feel bad.
因为一旦你因这些副作用开始感到不适，可能就很难重获那种精力或肌肉了。
Because once you start feeling bad based on those side effects, it could be hard to regain that energy or that muscle.
目标是确保你摄入足够的热量和蛋白质，因为你很可能处于高代谢状态，意味着仅癌症的存在就会让你燃烧更多热量。
The goal is you're eating well enough, enough calories and protein because it's very possible that you are hypermetabolic, meaning you're burning so many more calories just from cancer being present.
你的蛋白质需求有时甚至会翻倍，因为当你患有癌症并接受治疗时，加上日常身体运转，所以需要大量蛋白质。
Your protein sometimes can even double because your body when you have cancer present and cancer treatment plus just your day to day body running, you need tons of protein.
所以当你提前做好这些准备，你会感觉像平常一样，不会有严重的副作用，能够顺利接受癌症治疗并感觉相当良好。
So when you get all these things ahead, you feel like yourself, you don't have a severe side effect, and you can go through cancer treatments and actually feel pretty good.
这应该是常态。
That should be the normal.
通过正确的营养摄入是可以实现的。
And it can be with the right nutrition.
我不认为被诊断出癌症、正在接受治疗就意味着一切都注定是悲惨的。
I don't believe that you're diagnosed with cancer, you're going through treatment, it's all doom and gloom.
如果你获得了正确的营养支持，你就能在治疗期间保持自我感觉良好，并在治疗之余继续正常生活。
If you get the right nutrition in, you can get to your treatments and still feel like you and still do your life around those treatments.
所以，营养确实对让你保持自我感觉良好并完成所有治疗产生最大的影响。
So, yeah, that's just nutrition makes the biggest impact of you just feeling like yourself and attending all treatments.
然后我认为另一个因素是恐惧。
And then I think the other part of it is that the fear.
事实上，很大比例的癌症幸存者在接受癌症治疗后，会产生如此多的食物恐惧，导致饮食失调。
So a very large percentage of cancer survivors actually, they go through cancer treatment, have so many food fears that it creates disordered eating.
这对许多幸存者来说完全不公平且出乎意料。
And that's completely not fair and unexpected by so many survivors.
当你作为营养师与我交谈时，我们会澄清这些疑虑，这样你就不会害怕糖分、不会恐惧麸质，消除这些不必要的食物恐惧，因为那同样不公平，而且这些恐惧可能在治疗结束后仍持续存在。
When you talk to me as your dietitian, we clear that up so you don't fear the sugars, you don't fear the gluten, you don't have these unnecessary food fears because that's not fair either, and that can linger even after treatments are done.
因此要提前应对那些散布恐惧的信息，让你与食物之间也能建立健康愉快的关系。
So it's getting ahead of all the fear monging information out there so you have a healthy, happy relationship with food as well.
我很感激妮可的这番对话。
I'm grateful for Nicole for that conversation.
如果你经历过癌症治疗，正苦于难以集中注意力、记忆力减退或感觉找不回自我，希望今天听到的内容能让你感到真实、被认同或有所帮助。
If you've been through cancer treatment and you're struggling to focus, to remember, or to feel like yourself again, I hope you heard something today that felt true or validating or useful.
化疗脑是真实存在的，但并非永久性的。
Chemo brain is real, but it's not forever.
而且不仅仅是化疗导致的。
And it's not just chemo.
你的大脑承受了一切——从炎症变化到失眠，再到癌症生存期间的创伤。
It's everything your brain has been carrying from inflammatory changes to insomnia to the trauma of survival during cancer.
相关科学认知仍在不断发展中。
The science is still evolving.
当然，我们需要更完善的研究、更具包容性的数据以及更长期的跟踪调查。
Of course, we need better studies, more inclusive data, and longer follow-up.
但我们已经知道的是：
But what we already know is this.
大脑具有适应性。
The brain is adaptable.
神经可塑性是存在的，它确实会对身体、情感、营养和认知方面的支持做出积极反应。
Neuroplasticity is possible, and it does respond to support to physical, emotional, nutritional, and cognitive support.
无论是莉兹在迷失后重新找回自我，还是妮可引导患者摆脱恐惧获得营养，这些故事都提醒我们：康复之路虽非直线，但希望始终存在。
Whether it's Liz finding her footing again after feeling lost or Nicole guiding patients towards nourishment without fear, these stories remind us that recovery isn't linear, but it is very likely.
如果你正在经历化疗脑症状，以下是需要了解的重点摘要：
If you're someone experiencing chemo brain, here's a summary of what you need to know.
首要之事是务必与你的主治医生沟通这个问题。
First and foremost, make sure you speak with your physician about it.
通过一些血液检测，这可能是可逆的症状。
It may be a condition that is reversible with some blood tests.
询问检查维生素B12、维生素D、甲状腺功能、铁含量等项目，这些都可能加重认知负担。
Ask about checking your vitamin b twelve, vitamin d, thyroid functions, iron levels, anything that could be adding to the cognitive load.
这些都是可检测的，在某些情况下是可治疗的。
These are all testable and in some cases treatable.
进行任何温和运动，无论是散步、轻柔活动、太极、瑜伽、普拉提，任何能促进血液循环并支持大脑可塑性的活动。
Engage in any kind of gentle movement, whether it's walking or gently moving, tai chi, yoga, pilates, anything that improves your blood flow and supports brain plasticity.
良好营养极其重要，如果有条件，尝试与注册营养师沟通，帮助你在这一关键时期制定饮食计划。
Good nutrition is incredibly important and if you have the resources, see if you can get a conversation going with a registered dietitian to help you create a program during this important time.
但总的来说，尽量摄入复合碳水化合物、欧米伽3脂肪酸、色彩丰富的水果蔬菜，这些能为大脑提供燃料，确保在压力时期获得所需营养。
But generally speaking, try to consume complex carbohydrates, omega three fatty acids, colorful fruits and vegetables that fuel the brain and make sure that it gives it the nutrients it needs at the time of stress.
保持规律睡眠非常重要。
Getting a consistent sleep is very important.
如果有失眠或其他问题，请咨询医生甚至睡眠专家，了解如何改善夜间睡眠质量。
And if you have insomnia or other issues, please speak with your physician or even a sleep specialist to see what other things you can do to get a good night's sleep.
这对记忆力和修复过程有极大帮助。
Helps with your memory and the repair process tremendously.
管理压力至关重要，你可以通过心理治疗或正念练习来实现，这能保护大脑的不同区域并提升专注力。
Managing stress is so important and you can do that with therapy or mindfulness exercises, and it protects the different parts of the brain and improves your focus and attention.
同样重要的是自我关怀，原谅自己，在这段艰难时期给自己一些宽容。
And just as important is self compassion, forgiving yourself, giving yourself some slack during this difficult time.
化疗脑并非失败。
Chemo brain is not a failure.
这是你的大脑在极端压力下竭尽全力的表现。
It's your brain doing its best under extreme stress.
所以你需要善待它。
So you need to be kind to it.
我们感谢演讲嘉宾为我们分享他们的时间和经历。
We're grateful for our speakers for spending their time and experiences with us.
本期《化疗中的大脑》到此结束，我是主持人医生。
This has been your Brain on Chemotherapy and I have been your host, Doctor.
艾莎·希尔扎伊。
Aisha Shirzai.
非常感谢您的收听，希望您和我们一样喜欢本期节目。
Thank you so much for listening and I hope that you enjoyed this episode as much as we did.
关于 Bayt 播客
Bayt 提供中文+原文双语音频和字幕，帮助你打破语言障碍，轻松听懂全球优质播客。