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Dr. Peter Attia: Improve Vitality, Emotional & Physical Health & Lifespan | Huberman Lab Podcast

发布时间 2023-03-20 20:00:47    来源

摘要

In this episode, my guest is Peter Attia, M.D. He completed his medical and advanced training at Stanford University School of Medicine, Johns Hopkins School of Medicine and the National Institutes of Health (NIH). Dr. Attia is host of the health and medicine podcast, The Drive, and the author of a new book, “Outlive: The Science & Art of Longevity,” which examines disease prevention and healthy aging, including emotional health. He explains the leading causes of death worldwide and how to measure one’s risk of death and mitigate each risk factor. Dr. Attia shares how, in addition to blood-based markers of lipids and hormones, there are behavioral measures and interventions, and key aspects of emotional health (i.e., relationships, emotional stability, purpose, etc.) that fundamentally impact our physical health and longevity, and how to assess and adjust our emotional health. This episode is rich with actionable information related to disease screening and biomarker testing, nutritional, exercise, behavior and prescription-based tools that area useful to all people regardless of age, male or female, and that can significantly improve vitality, health and lifespan. #HubermanLab #Science #Science Thank you to our sponsors AG1 (Athletic Greens): https://athleticgreens.com/huberman Eight Sleep: https://eightsleep.com/huberman LMNT: https://drinklmnt.com/huberman HVMN: https://hvmn.com/huberman InsideTracker: https://www.insidetracker.com/huberman Supplements from Momentous https://www.livemomentous.com/huberman Huberman Lab Social & Website Instagram: https://www.instagram.com/hubermanlab Twitter: https://twitter.com/hubermanlab Facebook: https://www.facebook.com/hubermanlab LinkedIn: https://www.linkedin.com/in/andrew-huberman Website: https://hubermanlab.com Newsletter: https://hubermanlab.com/neural-network Dr. Peter Attia Website: https://peterattiamd.com The Peter Attia Drive Podcast: https://peterattiamd.com/podcast Newsletter: https://peterattiamd.com/newsletter Twitter: https://twitter.com/PeterAttiaMD Instagram: https://www.instagram.com/peterattiamd YouTube: https://www.youtube.com/c/PeterAttiaMD Facebook: https://www.facebook.com/peterattiamd Articles A Wandering Mind Is an Unhappy Mind: https://bit.ly/40ccfw8 Books Outlive: The Science & Art of Longevity book: https://peterattiamd.com/outlive The Road to Character: https://amzn.to/42nMx9H Other Resources Withings Blood Pressure Cuff: https://amzn.to/42pG3a7 Omron Blood Pressure Cuff: https://amzn.to/3LEnbyj Prenuvo Whole-Body MRI: https://www.prenuvo.com Biograph: https://www.biograph.com The Fentanyl Crisis and Why Everyone Should Be Paying Attention (The Drive podcast episode): https://peterattiamd.com/anthonyhipolito Timestamps 00:00:00 Dr. Peter Attia 00:03:22 Sponsors: Eight Sleep, LMNT, HVMN, Momentous 00:07:34 Lifespan vs. Healthspan 00:10:54 “4 Horseman of Death”, Diseases of Atherosclerosis 00:14:44 Tool: Hypertension & Stroke, Blood Pressure Testing 00:23:14 Preventing Atherosclerosis, Smoking & Vaping, Pollution 00:32:24 Sponsor: AG-1 (Athletic Greens) 00:33:29 Cholesterol, ApoB 00:42:21 Cholesterol Levels, LDL & ApoB Testing 00:49:29 ApoB Levels & Atherosclerosis, Causality 01:01:06 ApoB Reduction, Insulin Resistance, Statins, Ezetimibe, PCSK9 Inhibitors 01:12:30 Monitoring ApoB 01:17:12 Sponsor: InsideTracker 01:18:30 Reducing Blood Pressure, Exercise & Sleep 01:20:50 High Blood Pressure & Kidneys 01:23:11 Alcohol, Sleep & Disease Risk 01:31:21 Cancer & Cancer Risks: Genetics, Smoking & Obesity 01:39:47 Cancer Screening & Survival 01:44:17 Radiation Risks, CT & PET Scans 01:48:48 Environmental Carcinogens 01:52:11 Genetic & Whole-Body MRI Screening, Colonoscopy 01:58:47 Neurodegenerative Diseases, Alzheimer’s Disease, ApoE 02:08:08 Alzheimer’s Disease & Amyloid 02:13:58 Interventions for Brain Health, Traumatic Brain Injury (TBI) 02:21:26 Accidental Death, “Deaths of Despair”, Fentanyl Crisis 02:31:20 Fall Risk & Stability, 4 Pillars of Strength Training 02:41:05 Emotional Health 02:53:45 Mortality & Preserving Relationship Quality 03:02:20 Relationships vs. Outcomes, Deconstructing Emotions 03:09:34 Treatment Centers, Emotional Processing & Recovery 03:16:34 Tool: Inner Monologue & Anger, Redirecting Self-Talk 03:27:37 Zero-Cost Support, YouTube Feedback, Spotify & Apple Reviews, Sponsors, Momentous, Social Media, Neural Network Newsletter Title Card Photo Credit: Mike Blabac - https://www.blabacphoto.com Disclaimer: https://hubermanlab.com/disclaimer

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中英文字稿  

Welcome to the Huberman Lab podcast where we discuss science and science-based tools for everyday life. I'm Andrew Huberman and I'm a professor of neurobiology and Ophthalmology at Stanford School of Medicine. Today my guest is Dr. Peter Atia, his second time on the podcast. Dr. Peter Atia is a medical doctor who did his training at Stanford School of Medicine, Johns Hopkins School of Medicine, and the National Institutes of Health.
欢迎来到Huberman实验室的播客节目，我们将探讨科学和科学为日常生活带来的工具。我是Andrew Huberman，是斯坦福医学院神经生物学和眼科学的教授。今天，我的嘉宾是Peter Atia博士，这是他第二次出现在我们的节目中。Peter Atia博士是一名医学博士，在斯坦福医学院、约翰霍普金斯医学院和美国国立卫生研究院接受了培训。

He is a world expert in all things related to health span, vitality, and longevity. In this episode we focused on many topics, focusing mainly however, on health span and longevity and mental health. Health span and longevity of course relate to how long one lives and Dr. Atia goes systematically through the seven major causes of death worldwide, beginning with cardiovascular disease and cerebral vascular disease, also cancer, also accident related deaths, dementia, deaths of despair, and in every case, explains the three or four major levers that one can employ in order to offset, that is to prevent those major causes of death.
他是关于健康寿命、活力和长寿的全球专家。在本集中，我们涉及了许多话题，但主要关注了健康寿命、长寿和心理健康。 健康寿命和长寿当然与寿命有关，Atia博士系统地介绍了全球的七大死因，从心血管疾病和脑血管疾病开始，也包括癌症、意外死亡、痴呆、绝望死亡，而在每种情况下，解释了可以采用的三个或四个主要杠杆，以抵消，也就是预防这些主要死因。

What follows is an incredibly informative and actionable set of tools for anyone, male, female, young or old. He explains the behavioral, nutritional, supplementation based and prescription drug-based approaches that one can use in order to extend health span and longevity. Dr. Atia explains the key tests and markers that we should all pay attention to if our goal is to extend our health span and how to do so while maximizing our vitality.
接下来，我们将为所有人提供一组非常有价值且可操作的工具，无论男女、年长还是年轻。作者讲解了行为、营养、补充和处方药物方面的方法，可以用来延长健康寿命和寿命。Atia博士解释了我们应该关注的关键测试和标志，以及如何在最大化我们的活力的同时延长我们的健康寿命。

This is something that not a lot of people think about when they think about health span and longevity, but as Dr. Atia illustrates for us emotional health has everything to do with our physical health and vice versa, and he shares quite openly about his own experiences in pursuing ways to improve emotional health and thereby, health span, lifespan and vitality. Dr. Atia is quite open about his own experiences, exploring different practices to improve emotional health as ways not just to improve health span longevity and vitality, but of course also to derive the most meaning and satisfaction from life. Throughout today's discussion, we also discussed Dr. Atia's newly released book, which is entitled Outlive, The Science and Art of Longevity.
当人们谈到健康寿命和长寿时，很少有人会考虑情感健康的问题。但正如Atia博士向我们阐述的那样，情感健康与身体健康息息相关，相互影响。他也非常坦率地分享了自己探索改善情感健康的经历，以提高健康寿命、寿命和活力。Atia博士还讨论了他新近出版的书《Outlive, The Science and Art of Longevity》。通过今天的讨论，我们也了解到，探索不同的实践方式来改善情感健康，不仅可以提高健康寿命、寿命和活力，而且当然也可以从生活中获得最多的意义和满足感。

This is a phenomenal book. I've read it covered to cover it now three times. I have extensive notes written throughout and the book of course focuses on longevity and health span and also has an extensive section on emotional health. It gets quite detailed into Dr. Atia's personal experiences with emotional health and tools to improve emotional health that are very actionable for anybody to use. I think the best way for me to summarize my feelings about the book would simply be to read the back jacket quote, which I provided. So I read quote, finally, there is a modern thorough, clear and actionable manual for how to maximize our immediate and long-term health.
这是一本非常出色的书。我已经读了三遍，每一页都仔细看过，并且做了大量的笔记。这本书主要关注长寿和健康，还有一个涵盖情感健康的广泛部分。书中详细介绍了Atia博士的个人经验以及改善情感健康的工具，这些工具对于任何人都非常实用。我想总结我的感受最好的方式是读一下封底上的引文，我已经提供了。引文说：“终于，有了一个现代的、详尽、明确和可操作的指南，告诉我们如何最大程度地促进我们的即时和长期健康。”

Firmly grounded in data and real-life conditions, this is the most accurate and comprehensive health guide published to date. Outlive is not just informative, it is important. And indeed, Outlive is an important book. As is the discussion that Dr. Atia so graciously provided us in today's episode. Outlive is released on March 28th, 2023 and is available for pre-order prior to that date. You can find a link to where it sold in the show note captions.
这本健康指南是基于数据和真实生活状况建立的，是迄今为止最准确和全面的健康指南。 Outlive不仅提供了信息，而且非常重要。事实上，Outlive是一本重要的书。Dr. Atia在今天的节目中提供的讨论也是如此。Outlive将于2023年3月28日发布，并在此日期之前接受预订。您可以在节目注释标题中找到它的销售链接。

Before we begin, I'd like to emphasize that this podcast is separate from my teaching and research roles at Stanford. It is, however, part of my desire and effort to bring zero cost to consumer information about science and science-related tools to the general public. In keeping with that theme, I'd like to thank the sponsors of today's podcast. Our first sponsor is 8 Sleep.
在我们开始之前，我想强调一下，这个播客与我在斯坦福大学的教学和研究角色是分开的。然而，这是我渴望并努力为大众提供关于科学和科学相关工具的零成本信息的一部分。为了贯彻这一主题，我想感谢今天播客的赞助商。我们的第一个赞助商是 8 Sleep。

8 Sleep makes smart mattress covers with cooling, heating, and sleep tracking capacity. As I've talked about before on the Hubertman Lab podcast, there is a critical relationship between sleep and body temperature. That is, in order to fall asleep and stay deeply asleep, your body temperature needs to drop by about 1 to 3 degrees. And in order to wake up in the morning and feel alert, your body temperature needs to increase by about 1 to 3 degrees.
8睡眠推出了带有冷却、加热和睡眠跟踪能力的智能床垫套。就像我之前在Hubertman实验室播客中讲过的那样，睡眠与体温之间存在着关键的关系。也就是说，为了入睡并保持深度睡眠，你的体温需要下降约1至3度。而为了在早上醒来并感到清醒，你的体温需要增加约1至3度。

The problem with most people's sleeping environment is that even if you make the room cool, the actual environment that you sleep on, that is your mattress and underneath your covers, is hard to regulate in terms of temperature. With 8 Sleep, regulating the temperature of that sleeping environment becomes incredibly easy. In fact, you can change the temperature of that environment across the night, making it a little bit cooler at the beginning of the night. Even cooler still a few hours into your sleep, which really helps getting into very deep sleep. And then warming it as you approach morning so that you wake up feeling most alert.
大多数人睡眠环境的问题在于即使你让房间变凉爽，你睡觉的实际环境，也就是你的床垫和被子下面，很难调节温度。使用8 Sleep，调节睡眠环境的温度变得非常容易。实际上，你可以在夜间改变这个环境的温度，使它在晚上开始时变得稍微凉爽。在睡眠几个小时后，甚至更凉，这真的有助于进入非常深的睡眠。然后在接近早晨时加热，以便你清醒地醒来。

I've been sleeping on an 8 Sleep mattress cover for over a year now, and it has completely transformed my sleep. If you'd like to try 8 Sleep, you can go to 8sleep.com slash Hubertman to save up to $150 off their pod 3 cover. 8 Sleep currently ships in the USA, Canada, UK, select countries in the EU and Australia. Again, that's 8sleep.com slash Hubertman.
我已经睡在8 Sleep床垫上一年多了，它完全改变了我的睡眠。如果你想试试8 Sleep，你可以去8sleep.com/Hubertman，享受多达150美元的折扣。8 Sleep目前只在美国、加拿大、英国、欧盟部分国家和澳大利亚出货。再说一遍，就是8sleep.com/Hubertman。

Today's episode is also brought to us by Element. Element is an electrolyte drink that has everything you need and nothing you don't. That means plenty of salt, magnesium, and potassium and no sugar. The electrolytes, salt, magnesium, and potassium are critical for the function of all cells in particular neurons or nerve cells. And of course, proper hydration is critical for mental functioning and physical performance. To ensure that I stay hydrated, I consume one packet of Element in approximately 20 to 30 ounces of water every morning when I first wake up. And I will also consume one Element packet in about the same amount of water when I exercise or when I'm doing any kind of mental work, preparing for a podcast, writing grants, working on papers, and so forth. I find that allows me to maintain my focus and physical performance at levels that I just simply can't otherwise.
今天的节目由Element赞助。Element是一种电解质饮料，具有所需要的所有成分，没有不需要的成分。这意味着它含有足量的盐、镁和钾，但没有糖。电解质、盐、镁和钾对所有细胞特别是神经元或神经细胞的功能都至关重要。当然，适当的水分摄入对心理功能和身体表现非常关键。为了确保水分充足，我在早上醒来时会饮用一包Element，大约配合20至30盎司的水。同时，当我进行运动、进行任何形式的心理工作或是准备播客、写申请、工作论文等等时，我都会饮用一包Element，配合大约相同数量的水。我发现这样能够让我的注意力和身体表现保持在我平时无法达到的水平上。

Today's episode is also brought to us by HVMN ketone IQ. HVMN ketone IQ is a supplement that increases blood ketones. I want to be clear that I am not following a ketogenic diet. Most people fall into this category. They are not following a ketogenic diet. They are omnivores and they do eat carbohydrates. So their standard fuel source for the brain and body is not ketones. However, I found that by taking ketone IQ, which we know increases blood ketones, I can achieve much better focus for longer periods of time for any kind of cognitive work and much greater energy levels for exercise, especially if I'm going into that exercise fasted and find myself a little bit hungry when I start that exercise. And this is no surprise. As we know that ketones are the brain's and body's preferred fuel source, even if you're not following a ketogenic diet. So in other words, I and many other people are now starting to leverage endogenous ketones as a fuel source for the brain and body, and yet we are not following a ketogenic diet. And of course, if you are following a ketogenic diet, ketone IQ will further allow you to increase your blood ketones as a source of brain and body fuel. If you'd like to try ketone IQ, you can go to hvmn.com slash huberman to save 20% off your order. Again, that's hvmn.com slash huberman.
今天的节目也由HVMN ketone IQ赞助。HVMN ketone IQ是一种增加血酮的补充剂。我想澄清的是，我不是在遵循生酮饮食。大多数人都属于这个类别。他们没有遵循生酮饮食，他们是杂食动物，吃碳水化合物。因此，他们的大脑和身体的标准能量来源不是酮体。然而，我发现通过服用ketone IQ（我们知道可以增加血酮），我可以在任何认知工作中实现更好的长时间集中精力和更高的运动能量水平，特别是如果我在进行这种运动时处于禁食状态，开始时感到有些饥饿。这并不奇怪，因为我们知道，即使你不遵循生酮饮食，酮体也是大脑和身体的首选燃料。因此，换句话说，我和许多其他人现在开始利用内源性酮作为大脑和身体的燃料来源，但我们并没有遵循生酮饮食。当然，如果您正在遵循生酮饮食，ketone IQ将进一步让您增加血酮作为大脑和身体的燃料来源。如果您想尝试ketone IQ，您可以前往hvmn.com/huberman来节省20%的订单。

The Huberman Lab Podcast is now partnered with Momentous supplements. To find the supplements we discuss on the Huberman Lab Podcast, you can go to live momentous spelled o us live momentous.com slash huberman. And I should just mention that the library of those supplements is constantly expanding. Again, that's live momentous.com slash huberman.
Huberman实验室播客现在与Momentous Supplements合作。要找到我们在Huberman实验室播客中讨论的补品，您可以访问live momentous (拼写为“us”) .com / huberman。而且，我要提醒大家，这些补品的库存一直在扩展。再次强调，这是live momentous .com / huberman。

And now for my discussion with Dr. Peter Atia. Dr. Atia, Peter, welcome back. Thanks, man. Good to be back and sounding better this time. Looking forward to talking about a number of important topics with you that you cover in your book.
现在让我们来看看我与彼得·阿蒂亚博士的讨论。阿蒂亚博士，彼得，欢迎回来。谢谢，伙计。这次声音好多了。期待与你讨论你在书中涵盖的许多重要话题。 （意思是：在这段话中，演讲者欢迎特邀嘉宾彼得·阿蒂亚博士的到来，准备就绪讨论他的书中涉及的各种重要话题。）

But maybe we could start off by trying to set the frame for what people should be thinking about in terms of vitality and especially longevity. So I mean, I think you have to be mindful of how you define these terms. And I'm not going to suggest that the way I define them is the only way or necessarily the best way. But I think from a clinical perspective, it's the way that makes the most sense to me having thought about this for the better part of a decade. So it involves some bifurcation between lifespan and health span.
也许我们可以先试着为人们在生命力和特别是长寿方面应该思考的框架设定一些基础。我是说，我认为你必须谨慎地定义这些术语。我不会建议我所定义的方式是唯一的方式或者必然是最好的方式。但是我认为，从临床角度来看，它是我在思考这个问题的大部分时间里最有意义的方式。因此，它涉及到一些生命期和健康期之间的分叉。

Lifespan is very easy for people to understand. It is binary, you are alive or you are not alive. And clearly part of longevity is about how long you live. Now I think for a lot of people, that tends to be where the discussion ends. That tends to be the focus of it. It's sort of like longevity somehow implies living for 100 years, 120 years, something like to that extent. We talk a lot about maximum lifespan, even in laboratory experiments with mice, that's sort of one of the metrics that's discussed is what's maximum lifespan of the animals. But there's an equally, if not slightly, I think potentially more important part of longevity which is health span.
寿命对于人们来说非常容易理解， 它是二进制的，你活着或者不活了。显然，长寿的一部分与你的寿命有关。现在，我想对于许多人来说，这就是讨论的终点了。这往往是人们关注的焦点。这有点像长寿意味着活到100岁，120岁之类的。我们经常谈论最大寿命，即使在小鼠的实验室实验中，也会讨论其中的一个度量指标，比如动物的最大寿命是多少。但是，长寿同样也有一个同等重要，甚至更重要的方面，那就是健康寿命。

And health span is squishier and I think it requires some definition. Now the medical definition of health span is the period of time by which you are free from disability and disease. I find that to be a not particularly helpful definition. Because by that definition, you and I have the same health span today that we did 30 years ago. But I know you pretty well, you know me pretty well. 30 years ago we were twice the men we are now based on what we believe our health span is, right, in terms of our cognitive function, our physical performance and things like that. So, you know, I've clearly experienced the deterioration of my physical function. as I'm sure you have going back to when you were a teenager, late teenager, early 20s.
“健康寿命”这个概念不是很具体，需要做一些解释。按照医学定义，“健康寿命”指的是人在没有任何残疾和疾病的情况下可以活动的时间。但我认为这个定义并不是很有用，因为按照这个定义，和30年前相比，你和我现在的健康寿命是一样的。但事实上，我们早在30年前，根据我们对自己认为的健康寿命来看，我们比现在要健康两倍，包括认知能力、身体表现等等。所以，我和你都经历了身体能力的恶化，就像你还是十几岁时或二十岁初时所经历的一样。

And I think that needs to be captured somehow in health span. So the way I think of health span really is along these three dimensions, physical, cognitive and emotional. Again, not necessarily suggesting that that's the only way to do it. But I do think that clinically it makes the most sense. And so therefore, anything that really becomes a question of longevity has to address all of these issues. Lifespan, physical health beyond that of just straight up disability and disease, cognitive health, independent of and separate from pathology such as dementia, an emotional health, which of course is by far the most complicated of all of these because we have no biomarkers for it. We have no, you know, it's not like you can get a scan on somebody and determine the state of this.
我认为健康年龄需要以某种方式包括这三个维度：身体、认知和情感。我并不是在暗示这是唯一的方法，但我认为在临床上这是最有意义的。因此，任何与长寿有关的问题都必须涉及这些问题。寿命、不仅仅是残疾和疾病的身体健康、不同于像痴呆这样的病理学的认知健康、以及情感健康，这当然是最复杂的，因为我们没有可以用来确定其状态的生物标志物或者扫描技术。

But nevertheless, it's important right? And it dramatically factors into quality of life. So with all of that in mind, what are the major exit points for people along the lifespan route? So start with the binary one, dead or alive, right? I think most everyone who's healthy would like to be alive rather than dead. So what are the typical ways that people exit from alive to dead and how can people stay on the free way of life, so to speak?
但是，这很重要，对生活质量有极大的影响。因此，在这些情况下，人们在一生中的主要转折点是什么呢？我们可以从死亡或生存的二元性开始，对吧？我认为，大多数健康的人都想活着，而不是死去。那么人们从活着到死亡的典型方式是什么，人们如何保持在这条自由之路上呢？

So this is again a great analysis. We internally in our practice call this the death bar analysis. And it's a surprisingly trivial analysis that I'm just surprised the death bars aren't plastered front and center on every doctor's office. So if you simply just look at actuarial data, which are readily available through the CDC and do a little bit of data manipulation and analysis, you can pretty quickly realize what the horsemen of death are because there's largely speaking kind of four horsemen of death.
这是一篇很好的分析。在我们的实践中，我们称之为死亡棒分析。这实际上是一个非常简单的分析，我惊讶的是为什么死亡棒没有成为每个医生办公室前端的标志。因此，如果您仅仅查看已经公开发布的计量资料，并进行一些简单的数据处理和分析，您就可以很快地意识到死亡四骑士的存在，因为总体上，死亡的四骑士为主要原因。

The first and most consequential in terms of the numbers is the diseases of atherosclerosis. So that's cardiovascular disease being the lion's share of that, but also cerebrovascular disease. So anything that has to do with atherosclerosis rises to the top. Now that's true in the United States, but it's even more true outside of the United States. It's even more true globally.
在各种疾病中，动脉粥样硬化性疾病是最为普遍和影响数目最大的一种。其中心血管疾病占了大部分，但脑血管疾病也不容忽视。任何与动脉粥样硬化有关的疾病都居于榜首。这在美国是事实，但在美国之外甚至更为明显。这在全球范围内也是如此。

So in other words, when you look at the relative difference between the number one cause of death in the US and number two, which is cancer, the gap is actually smaller in the US than globally. Globally, it's enormous. We're talking about 18 to 19 million people a year that are dying of atherosclerotic cardiovascular disease in the world, whereas number two is cancer at about 11 million. How does the number change when you include cerebrovascular disease? Yeah, it adds a bit to it. cerebrovascular disease has, there's largely speaking, you can die sort of through embalic events, which are the majority of them.
换句话说，在美国，当你比较死亡原因排名第一的疾病与排名第二的癌症时，两者之间的差距实际上比在全球范围内更小。全球范围内，这个差距很大。全世界每年有大约18到19百万人死于动脉粥样硬化心血管疾病，而排名第二的是约有11百万人的癌症。如果包括脑血管疾病，这个数字会怎么样变化呢？是的，会增加一些。脑血管疾病主要可以通过栓塞性事件导致死亡，大多数是如此。

They just like for people at what embalic events are. Yeah, so taking a step back, what is the brain need more than anything? It needs blood flow. Anything that interrupts blood flow to the brain that results in ischemia is devastating. And it's devastating in a more readily apparent fashion than virtually any other organ.
他们喜欢在丧葬仪式等场合出现。是的，站在一个更高的角度看问题，大脑最需要的是什么？它需要血液流动。任何影响血流到达大脑并导致缺血的情况都会造成灾难性的后果。而且这种后果比其他器官更容易确定。

So one way that that can happen is if a clot or disruption of blood flow occurs through obstruction of blood flow. So that can occur through a clot. So for example, if a person has atrial fibrillation and a blood clot gets festering in the right atrium, and they happen to have a hole in between the atria of their hearts, called it Peyton Framon of Alley, and a clot goes from right to left. It can make its way up into the arterial circulation and happen that way where you include blood flow. The much more common way it occurs is the same way it occurs in the heart, which is you have plaque build up and that plaque becomes unstable, that plaque ruptures. And the rupture of that plaque results in an immediate attempt by the body to fix the problem, but in doing so, it walls off the artery, meaning the blood flow distal to that point so that, you know, now blood is acutely being robbed of that.
有一种可能是由于血流被阻塞或中断导致的栓子或血流障碍。这可能是由于一个血栓。例如，如果一个人患有心房颤动，并在右心房中存在一个正在腐烂的血栓，并且他们的心房之间有一个叫Peyton Framon of Alley的洞，血栓从右向左流动。它可以通过上行动脉循环向上移动，以此阻碍血流。它更常见的发生方式是与心脏发生相同，即心脏中会有斑块形成，这些斑块不稳定，斑块破裂。斑块破裂会导致身体立即尝试解决问题，但在这样做时，它会将动脉封闭，这意味着该点远端的血流被剥夺了。

However, there are other ways that people can have this problem. And so you have the whole hemorrhagic side of this. So you can have blood vessels that, you know, small blood vessels in the brain that will rupture as a result of high blood pressure, for example. So hypertension factors both into both sides of this equation, both in the heart and in the brain.
然而，人们出现这个问题的其他途径也存在。因此，你可能会遇到出血方面的问题。比如，由于高血压的原因，脑部的小血管可能会破裂。因此，高血压因素不仅涉及心脏问题，还涉及脑部问题。

The majority of these are embolic, however, so don't quote me on this exactly, but call it four or five to one strokes result from an embolic phenomenon as opposed to a hemorrhagic phenomenon, a bleeding phenomenon. I don't want to take us too far off on a tangent, but as long as we're here talking about bleeds versus clots, what are some of the major risks for bleeds? I mean, I know some people out there have genetic predispositions for being bleaters, as they're sometimes called, or clotters.
这些中大多数是由栓子引起的，但是不要完全引用我的话，但可以说四五分之一的中风是由栓子现象引起的，而不是由出血现象引起的。 我不想让我们太偏离话题，但既然我们在讨论出血与凝块的区别，那么出血的主要风险是什么？我的意思是，我知道有些人天生易出血，有时被称为“出血者”或“凝块者”。

So things like factor five, lighten mutations, which can be exacerbated in women, for instance, by taking certain oral contraceptives. I mean, and there's a huge list of people are interested in them. They can look up, you know, what are the factors controlling bleeding and predispositions to be in clotter. But for the typical person out there who feels healthy, but might do well to know whether or not they are predisposed to be a bleeder or a clotter, what sorts of things rise to the top of that list and that people might want to check into?
有些因素如因子五和轻型突变等，可能会在女性身上加重，比如说服用某些口服避孕药的女性。这个列表有很多人感兴趣，大家可以查一下，了解一下控制出血和易于凝血的因素。但对于通常感觉健康的人来说，他们可能需要知道自己是否容易出血或凝块，那么在这个列表中最重要的是哪些因素呢？人们可能想要深入了解这些。

Well, I mean, there might be sort of two different things going on in that question, but I think if your question is when we look at the subset of people who are at highest risk for hemorrhagic strokes, the far more germane question is not underlying coagulopathy. The far more germane question really comes down to blood pressure. Blood pressure would be the first second and the third driver of that. So hypertension is hands down the leading driver of hemorrhagic stroke phenomenon.
嗯，我的意思是，这个问题可能存在两个不同的事情，但是我认为，如果您的问题是在最高风险的人群中，我们应该观察的子集，那么更加相关的问题不是潜在的凝血功能障碍，而是血压。血压是第一、第二和第三个驱动因素。因此，高血压绝对是造成出血性中风现象的主因。

Okay. So I'll just briefly interrupt and ask, since sometimes your recommendations deviate from the standards that one would find online or in the typical doctor's office, at what point do you get concerned? Well, I actually find myself quite in line with the most recent available data on blood pressure. And this has been obviously the topic that's of high concern to any doctor who's taking care of patients, who even pays a fraction of attention to the available literature, which is that basically with each subsequent blood pressure trial, the data are becoming clearer and clearer that the more aggressively you manage blood pressure to be within the 120 over 80 range, the better.
好的，我稍微插句话问一下，有时候你的推荐与在线或典型医生诊所的标准不同，那么你会在什么时候感到担忧呢？ 其实，我发现自己非常符合最新的血压数据。对于任何照顾病人并留心可用文献的医生来说，这显然是一个非常关注的话题。基本上，在每一次血压实验中，数据都越来越清晰了，即越积极地控制血压在120/80的范围内，越好。

So there's a recent study that even looked at going from what used to be considered acceptable, which was 130 to 135 over 80 to 85. We used to basically say that's kind of the first level of hypertension. And we would say, well, do you really need to be better than that? And the answer turns out to be yes you do. If you want to reduce heart attacks and strokes, it's better to be 120 over 80 than 135 over 85.
最近有一项研究，甚至考虑了从过去普遍认为可接受的130到135超过80到85。我们曾经基本上说这是高血压的第一级，然后我们会问，您真的需要比这更好吗？结果证明是的，如果你想降低心脏病发作和中风的风险，比起135超过85，120超过80更好。

Now this is a whole other rabbit hole that we don't need to go down, but it's a total obsession of mine, which is how do you measure a person's blood pressure? I think this is potentially, I'd have to give it thought, but honestly, I could say top three under diagnosed fixable problems in the United States today and probably globally. In other words, there are too many people walking around with high blood pressure who don't know it.
现在这是另一个我们不需要深入探讨的话题，但它是我的一个全新的研究方向，它是如何衡量一个人的血压？我认为这可能是美国今天和全球范围内排名前三的被低估但可修复的问题之一。换句话说，有太多高血压的人不知道自己的健康状况。

And I think part of the problem is it's something that is mostly done in the doctor's office. And the readings that you get in the doctor's office can be often misleading. You've heard of this phenomenon of white coat hypertension.
我认为问题的一部分在于血压测量通常是在医生办公室进行的。而在医生办公室测量到的血压读数常常会有误导性。你可能听说过“白袍高血压”的现象。

So you go to the doctor, your blood pressure is virtually never measured correctly in the doctor's office. That cuff they put on and that squeeze bowl. Yeah. If you look at the rigor with which you need to measure a person's blood pressure, the right way to do it is the person has to be sitting like this for five minutes doing nothing.
所以，你去看医生，但是医生办公室里测量你的血压几乎从来都不正确。那个医生会戴上袖带，再弄那个气球。如果你看一下正确测量一个人血压的严谨程度，正确测量的方法是让这个人坐在那里什么也不做，坐五分钟。

Okay, folks. When you go to the doctors now, you don't let them take your blood pressure out of the gate, sitting for five minutes. And that doesn't include in the waiting room because if you walk on the way, you get up and walk over it, right? Okay. So make them stand there. Right. So you want to be sitting there like this.
各位，现在去看医生时，你们不要让他们在门口就帮你们量血压，要先坐五分钟。而且这五分钟并不包括在候诊室里的时间，因为你可能在路上走动，对吧？所以让他们在那里站着。对的。你要坐得像这样。 翻译：去看医生时，不要立即让医生在门口帮你量血压，应该先坐五分钟。这段时间不包括在候诊室内的时间，因为你在路上可能要走动。因此，让医生在你身边等待。你要以这种姿势坐着。

A manual cuff is better than an automated cuff, but not enough people use manual blood pressure. So a manual blood pressure means they put a cuff on you and they actually put a stethoscope on the brachial artery and they're using the human ear to listen, which believe or not, you would think a machine is better, but it's not.
手动血压器比自动血压器更好，但是使用手动测量血压的人不够多。所以手动测量血压意味着他们会给你戴上血压袖带，然后真的放上听诊器在肱动脉上听，相信或不相信，你会认为机器更好，但实际上，它并不是。

The machine can be misled by different sounds. No, I don't want to suggest that automated cuffs are useless. They're not, but when an automated cuff gives you an answer that is potentially suspect, always back it up with a manual. I'm pretty relentless about checking my blood pressure. And so I'll do side to side manual versus automated every day. And there's easily a 10 to 15 point difference between them.
这个机器可能会受到不同声音的干扰。不，我不是想说自动袖带是无用的。它们并非如此，但当自动袖带给出潜在可疑的答案时，一定要用手动袖带进行验证。我非常坚持检查我的血压。所以我每天都会对手动和自动进行比较，发现它们之间有10到15点的差异。

Maybe there's a silly question, but can people check their own blood pressure? Meaning manually? Yeah, just could it, could I get a comment on the mold and learn how to do it? Yeah, I think so. I mean, I can do it, but honestly, I usually have my wife do it. She's a nurse, but it's not rocket science.
也许这是一个愚蠢的问题，但人们可以自己检测血压吗？手动地？是的，可以，我能得到有关操作方法的评论并学会如何进行吗？是的，我想是可以的，虽然我自己也能做到，但说实话，通常我让我的妻子来操作，她是一名护士，但这并不是什么高深的科学。

Check blood pressure. I'm, I'm guarantee you, there's a great video on YouTube that explains the physiology of it, and if you're willing to splurge on a good enough stethoscope and cuff, like the cuff I have is really easy to use.
检测血压。我向您保证，在YouTube上有一个很棒的视频可以解释其生理学，如果您愿意花钱购买足够好的听诊器和袖带，就像我所使用的袖带非常易于使用。

Like it's, once you put it on, you know, it's in a single thing. I'm squeezing the bulb and looking at the pressure gauge while I've got the, you know, stethoscope on my artery. I mean, given the importance of blood pressure and this arterial sclerosis being at the top of the list of risks for dying, it seems to me it might be worth the expense.
一旦你穿上它，就会感觉到它只是一个单一的物品。当我用听诊器检查我的动脉时，我会挤压球并查看压力计。考虑到血压的重要性以及动脉硬化是导致死亡风险排名最高的因素之一，我认为这可能值得一些花费。

What's that typical range of cost for quality? I don't, it's not an or that's like I feel like my blood pressure cuff is 40 bucks. And the stethoscope is a couple hundred bucks if you're getting a good one. And you know, good automated cuff. There's, I have no affiliation with any of these companies.
在质量方面，典型费用范围是多少？我不确定，这并不是一个标准，就像我的血压袖带只要40美元，而如果你买一款好的听诊器，要花几百美元。另外，一个好的自动臂带也是要不少钱的。我与任何公司都没有任何关联。

I use a, I use two automated cuffs. One's called withings. The other one's made by a company called Omron OMRON. And they're both decent, but again, they tend to run high. And I have yet to find a credible explanation from cardiologists as to why everybody acknowledges that the manual one when done correctly is the answer.
我使用一个和两个自动血压计。其中一个叫做Withings，另一个是由一家名为Omron OMRON的公司生产的。它们都还不错，但是它们往往会显示高血压。我还没有找到来自心脏病专家的可靠解释，为什么每个人都认为正确使用手动血压计就是答案。

But I've heard wonky answers about why automated ones are sometimes incorrect. And again, it's just made me realize we're not checking blood pressure off enough on people. We're overly relying on blood pressures in the doctor's office, which are not being done correctly.
但是我听到了一些荒谬的答案，解释为什么自动血压计有时会有误。这让我意识到我们没有足够地测量人们的血压。我们过分依赖医生办公室的血压测量，但它们并不总是正确的。

So we basically have our patients do this relentlessly. So how often, let's say someone buys this because I think for $240, I mean, I realize that's prohibited for some people. But given the cost of some of the other things they're discussed on this and many other podcasts. I would just have people start with an automated cuff to begin with and just start with there.
所以基本上我们让我们的病人无休止地这样做。那么多久一次，比如有人购买这个，因为我想对于240美元，我知道对于一些人来说这是禁止的。但考虑到其他一些在这个和许多其他播客中讨论的东西的成本。我建议人们先从自动袖带开始，从那里开始。 意思是：建议病人购买自动血压计，并且不断重复测量血压，以获取准确的数据，建议病人先从自动血压计开始使用。虽然某些人可能会对价格产生顾虑，但考虑到其他一些医疗设备的价格，自动血压计还是很实惠的。

We generally have people do it for two weeks. You know, we give our patients a little spreadsheet that automatically calculates averages and stuff like that, tells them what to record and where. And we just say, look, for two weeks, we want to see two recordings a day. And, you know, do in morning and an afternoon slash PM recording twice a day for two weeks and let us see those numbers and we'll scrutinize them further. And if those numbers come in fine, let's revisit in a year.
我们一般让患者连续两周进行记录。我们会提供一个可以自动计算平均值等的小型电子表格给患者，告诉他们要记录哪些内容和位置。我们建议他们在这两周内进行早上和下午/晚上两次记录。让我们看看这些数字并对其进行深入分析。如果这些数字正常，我们将在一年后进行复查。

Well, a day ever come when a watch or a wristband can do this really well. So I hope so. I'm investigating it. I'm actually going to be trying one out in a couple of weeks with a company that I tried two years ago, two years ago when I tried it, I was not impressed.
会有一天，手表或手环能够真正做到这一点吗？我希望如此。我正在调查这个问题。实际上，我将在几周内与一家公司尝试一个手表，这家公司我在两年前试过，但当时的体验并不印象深刻。

So I kind of punted on it. The company, which I guess I'll not share the name of the company just yet, but they claim that it's significantly better. So I'm going to put it to the test again. And it's basically a continuous monitor. So it's a wrist device that about every 15 minutes throughout the course of the day, we'll check your blood pressure.
所以，我有点敷衍了。这个公司，我猜暂时不会透露公司名称，但他们声称这个设备明显更好。所以我准备再次测试一下。这基本上是一个持续监测器。所以它是一个手腕设备，每隔约15分钟就会在一天的时间内检测你的血压。

To me, this would be, honestly, probably more important. You know, you know how much emphasis I place on CGM as a great thing to be able to test. The test glucose monitor. Right. I would argue this would be more important. When the day comes that we can continuously assess people's blood pressure, it would be an integral part of a person's health checkup once a year is due two weeks of continuous blood pressure monitoring.
对我来说，说实话，这可能更重要。你知道我有多重视连续血糖监测作为一种很好的测试方法。测试血糖监测仪。对，我认为这更重要。当我们能够持续评估人们的血压时，这将成为每年一次的健康检查的重要组成部分，需要连续两周的血压监测。

Right now to do that, which I've done as well, is so cumbersome that it borders on absurd. You actually have to wear a blood pressure cuff that is attached to a clumsy device that goes through the whole insufflation exercise every 15 minutes, including while you're sleeping. You know, it provides some insight, but it's so disruptive that it's not what we really want. What we, the dream would be like a patch that you could put, I don't know, over your chest that can somehow impute changes in blood flow or something like that and regulate. But we'll see, you know, between optical sensors and things like that, I hope that we're getting closer to having something.
现在要做到这一点，就像我也做了一样，很繁琐，几乎到了荒谬的地步。你必须戴上一种连接着笨重设备的血压袖带，每隔15分钟完成一次整个充气过程，包括你睡觉时。你知道，这提供了一些见解，但是它太破坏生活了，这不是我们真正想要的。我们希望的是一种可以放在胸部上的贴片，它可以以某种方式描绘出血液流动的变化或类似的东西，并进行调节。但是我们会看到的，你知道，通过光学传感器等技术，我希望我们正在接近拥有这样的东西。

So I don't want to stroke. I don't want to bleed in the brain. I don't want to clot. As long as we're at this number one on the list, our two-verse chlorosis being the number one killer, what are the major ways to prevent it? Yes. So there's three big ones that stand out, you know, top and center, and then there's kind of a fourth one that I think is the foundational piece.
所以我不想中风。我不想大脑出血。我不想血栓。既然我们在慢性缺氧这个最致命疾病的排行榜上排名第一，那么防止它的主要途径是什么呢？是的。所以有三个重要的方法突出在前，还有一个我认为是基础的部分。

So the three big ones we've talked about one blood pressure. So if your blood pressure is 120 over 80 or better, that's important. The second is not smoking. So it turns out that smoking and blood pressure are both devastating for arteries, but for different reasons, right? So smoking is devastating from a chemical perspective. So it's completely irritating to the endothelium. So the endothelium, as you know, is the single cell lining that is the innermost part of the arterial and arterial wall.
所以我们谈论了三个重要因素，其中第一是血压。如果你的血压是120/80或更好，那就很重要。第二个因素是不吸烟。因为吸烟和高血压都对动脉造成毁灭性影响，但原因是不同的。吸烟会对内皮细胞层造成严重损伤，使内皮细胞层变得非常刺激。内皮细胞层是动脉和动脉壁最内层的单层细胞。

So this is a pretty special organ. Again, it's a bit naive, but understandable that people just think of arteries as tubes. They're much more complicated than that. They have many layers to them. But this particular layer is unusually important. It has an outsized importance because it is the one that's in contact with the lumenol side, right, where the blood is flowing in the tube, and anything that injures that has significant consequences. So smoking is irritating to that in a chemical way, and blood pressure is irritating to that in a mechanical way. So those two things, basically, you just want to... That's the low hanging fruit in my world, right? You just don't want to have those things causing irritation to the endothelium because that renders you now susceptible to the third factor, which is apobaring lipoproteins.
这是非常特别的器官。虽然有点单纯，但人们通常只认为动脉是管子，这也是可以理解的。实际上，它们比那要复杂得多。动脉有许多层。但是其中一层非常重要。它的重要性超过其它层，因为它是与内皮细胞接触的层，血液在管子里流动，任何对它的损伤都会产生重大的影响。吸烟会在化学上刺激它，而血压则会在机械上刺激它。所以，这两个因素基本上，你只需…… 在我的世界里，那是低果实，你只需避免这些因素刺激内皮细胞，否则你就容易受到第三个因素的影响，那是载脂蛋白B。

I want to talk about apob in depth, but as long as don't smoke is the second recommendation on the list, can we better define smoking and what's being smoked? So assume nicotine for... What about cannabis? And what about vaping of nicotine and cannabis because vaping has become so much more common? Yeah. It's a great question, and it's sadly something we don't have a great answer for.
我想深入探讨一下apob，但是只要不吸烟就是清单上的第二个建议，我们能否更好地定义吸烟和被吸的物质？所以假设烟草中的尼古丁是...那大麻呢？以及尼古丁和大麻的电子烟怎么样？因为电子烟已经变得如此普遍了。是的。这是一个很好的问题，可悲的是我们还没有一个很好的答案。

So I can certainly tell you that there's no reason to believe that smoking cannabis is somehow better than smoking cigarettes. But the dose seems to be significantly lower. In other words, let's consider a person who smokes a pack a day for 20 years. We call that a 20-pack year smoker. Someone who smokes two packs a day for 15 years is a 30-pack year smoker. That's a person who's dramatically increased their risk of many cancers, including lung cancer and also their risk of cardiovascular and cerebral-vascular disease.
我可以肯定地告诉你，没有理由相信吸食大麻比吸烟更好。但是吸食剂量似乎要低得多。换句话说，让我们考虑一个每天吸一包烟，吸了20年的人。我们称之为20包年烟民。一个每天吸两包烟，吸了15年的人是30包年烟民。这个人明显增加了很多癌症的风险，包括肺癌以及心血管和脑血管疾病的风险。

Again, I'm not a THC guy, so I can't necessarily speak for the habits of people that are smoking marijuana. I can't imagine they're smoking that much. Probably not. Yeah. So while on a joint to cigarette basis, they're probably equivalent in terms of harm. I don't know. Let's say a person smokes a joint a day. That would be like smoking a cigarette a day. That's a 20th of a pack.
再说一遍，我不是一个吸食THC的人，因此我不能代表那些吸食大麻的人的习惯发表意见。我想他们不会吸得那么多。也许不会。那么，在以一根大麻卷烟和一包香烟为基础的情况下，它们在危害方面可能是相等的。我不知道。假设一个人每天吸一支大麻卷烟。那就相当于每天吸一支香烟。也就是20支烟的1/20。

Again, I don't want to say that there's no downside to that, but it's probably significantly less. I don't think the risk fully tracks. I think the same is probably true for vaping. I want to be clear, I don't think vaping is a good idea. The last time I looked at the data on this, it was surprisingly sparse, but to me, the only advantage I could see to vaping was if it was the only way a person would stop smoking. I looked at it as it was definitely the lesser of two evils, but by far the better scenario was not to do any of these things. If nicotine is what you're after, there are better ways to get nicotine, for example, through lozenges and gum and things like that. You shouldn't be turning to those things to do it, but if gum is here and cigarettes are here, vaping was probably here, but boy, I don't know.
我并不是说这种做法没有缺点，但它可能显著减少了风险。我认为风险并不完全影响到这种做法。我认为吸电子烟的情况也可能是如此。让我清楚一点，我认为吸电子烟不是一个好主意。上一次我看到相关数据时，我很惊讶数据非常匮乏，但对我而言，除非是电子烟是唯一一种使人戒烟的方法，否则我看到的唯一好处是电子烟绝对是两者中风险较小的那一个，但是远远不如两者都不做好。如果您需要尼古丁，有更好的方法来获得尼古丁，例如通过含片和口香糖等等。您不应该轻易依赖这些物质，但如果口香糖和香烟分别在这里，吸电子烟可能处于这里，但我并不确定。

For those listening, Peter spaced his hands far apart for gum and smoking, and put vaping about a third of the way from gum toward smoking. In other words, vaping isn't good for you, but it's not as bad as smoking. That would be my, that would be my, I mean, do you have a, you've probably looked into this as well?
对于那些在听的人来说，彼得用手分开了咀嚼口香糖和吸烟间的距离，并将电子烟的距离放在离咀嚼口香糖大约三分之一的位置。换句话说，电子烟对你身体不利，但它不像吸烟那么糟糕。那就是我的看法，我意思是，你是否也研究过这个问题？

We did an episode on nicotine. I did an episode on cannabis and the discussion around cannabis gets a little contentious for reasons that aren't important. If we have funny people, the moment someone starts to confront cannabis as a potential health harm, people say it's not as nearly as bad as alcohol, which is a crazy argument, right?
我们做了一期节目关于尼古丁。我也做了一期关于大麻的节目，但由于一些无关紧要的原因，关于大麻的讨论会有些争议。如果我们有幽默的人，当有人开始把大麻作为潜在的健康危害去讨论时，人们会说，它远没有酒精那么糟糕，这是一个疯狂的观点，对吧？

Getting hit by a boss isn't nearly as bad as getting hit by a motorcycle in most cases, but sometimes, you know, so that's just kind of silly. And clearly cannabis has medical applications. Clearly. And then it becomes an issue of the ratio of THC to CBD, pure CBD forms actually being quite effective for the treatment of certain forms of epilepsy. So it's called Charlotte's Web, that's actually what it's called.
在大多数情况下，被老板打击不会像被摩托车撞击那样严重，但有时候可能会是这样，这有点荒谬。显然，大麻具有医疗应用，这是显而易见的。然后问题就变成了THC和CBD的比例，纯CBD的形式实际上非常有效，可以治疗某些形式的癫痫。所以它被称为夏洛特的网，实际上就是这个名字。

Very high THC containing cannabis clearly predisposes, especially young males, to later onset psychosis. Those data are starting to become clear, clear enough to me anyway that people ought to be aware of them, at least, and maybe make decisions on the basis of those.
含有极高THC的大麻显然会让人更容易患上晚发型精神病，尤其是年轻男性。这些数据越来越明显，对于我们来说，人们应该意识到这一点，至少在做出决定时应该参考这些数据。

When it comes to the smoking versus vaping, it's just very, very apparent that the chemical constituents of the vape and what people are inhaling are terrible for people and are loaded with carcinogens and a bunch of other stuff, many of which cross the blood brain barrier. So that's what worries me the most. No, obviously I'm not a clinician, but anytime I hear about small molecules, you know, these small, energetic molecules getting across the blood, being buried and then being maintained in neurons for many, many years, I worry because the experiment is ongoing mostly in young people.
当涉及到吸烟和电子烟的问题时，很明显电子烟的化学成分对人们的危害非常大，其中含有致癌物质和大量其他物质，其中许多物质都会穿过血脑屏障。这是我最担心的问题。虽然我不是临床医生，但每当我听到小分子这个词时，我就会担心这些小而有能量的分子穿过血脑屏障并在神经元中长期存在的实验大多数是在年轻人中进行的。

Anyway, without going too far down that track, I think if people can avoid smoking and vaping, they should. And as you mentioned, there are other delivery devices for nicotine and cannabis, tinctures and patches and gums and things that edibles that if people choose to use those substances in the hospital. I think sometimes people would benefit to imagine what the surface area of the lung is. Right, if you took the alveolar air sacs of the lungs and spread them out, you would easily cover a tennis court. Remarkable. So just think about anytime you inhale something, you are exposing, your body is so adept at absorbing it.
不过，不深入讨论这个问题，我认为如果人们能够避免吸烟和电子烟，他们就应该这么做。正如你提到的，还有其他的尼古丁和大麻递送设备，如酊剂、贴片、口香糖和食品等，如果人们选择在医院使用这些物质。有时候，人们可以想象下肺表面积的大小。如果你将肺泡分散开来，你可以轻松地覆盖一个网球场。非常惊人。所以只要想想每次吸入时，你的身体是如此擅长吸收这些物质。

I mean, we have this unbelievable system for gas exchange that was designed for gas exchange and anytime you're putting something else in that wake, you're doing a really good job of getting it into your body. So be mindful of what that is. And that applies to pollution too. I mean, the PM 2.5 data is pretty good. I think once you, so particulates that are less than 2.5 microns are getting straight into the body, which is like a great argument for avoiding air pollution.
我的意思是，我们有这个不可思议的气体交换系统，是专门用于气体交换的，每当把其他东西引入其中时，就会很好地将其引入身体。所以要注意这是什么。这也适用于污染。我的意思是，PM 2.5数据还不错。我认为，小于2.5微米的颗粒物会直接进入身体，这是避免空气污染的好理由。

Right, I mean, I always find it funny not to get off on this tangent, but to me, the most compelling arguments around cleaner energy have nothing to do with greenhouse gases. They have to do with air pollution. I promise you, more people are dying from the particulate matters in air that result from burning coal than are ever going to die from the CO2 emissions that result from that.
嗯，我的意思是，我始终觉得有趣的不是走神，而是对我来说，关于清洁能源最有说服力的论点与温室气体无关，而是与空气污染有关。我向你保证，比起二氧化碳排放带来的影响，更多的人死于燃烧煤炭所产生的颗粒物污染。

And I would argue that's going to be two orders of magnitude. It's not even in the same zip code. It makes sense during the fires, which seem to follow me because when I was in Northern California, there were a bunch of fires and we were constantly looking, wake up in the morning, everything was covered with ash.
我认为这将是两个数量级的差距。它甚至不在同一个邮政编码范围内。在火灾期间这是有道理的，因为似乎跟着我来，当我在北加州的时候，有一堆火灾，我们总是在不停地寻找，早上醒来，一切都被灰烬覆盖了。

My dog was having trouble breathing. I was having trouble breathing. Everyone was suffering. But there are websites that one can go. You can just look at air pollution. And we tend to only do this during fires. And then, you know, when I'm in Southern California, there tend to be fires here. So, you know, it's correlation, not causation. But for sure, I didn't set those fires, folks.
我的狗呼吸有困难，我也有呼吸困难，每个人都遭受折磨。不过现在有一些网站，可以查看空气污染情况。通常我们只在火灾期间使用这些网站。而且当我在南加州的时候，这里经常有火灾。所以这只是相关性，而不是因果关系。但是可以肯定的是，我没有引起那些火灾。

But it's clear that it disrupts your breathing for a very long period of time. But it's the long tail of that that we're really talking about here. The very small particulate that we know firefighters, for instance, and certain industrial workers can end up with that stuff embedded in their brain tissue for extremely long periods. It's just not good.
很明显，它会长时间地影响你的呼吸。但我们真正关注的是它的长尾。我们知道消防员和某些工业工人可能会得到微小颗粒物，这些物质可能会嵌入他们脑组织中，并持续很长时间。这对健康不利。

You make a really interesting point about the call for cleaner energy. We run that one up to Washington, or settle some of the debates about climate change just by getting straight to it. Right, right. I feel like just bypass all the garbage that's being spewed back and forth and just, and basically get to the issue at hand, right?
你提到了对于清洁能源的呼吁真的很有意思。我们可以把这个问题提交给华盛顿，或者直接解决关于气候变化的争议。是的，我感觉我们应该跳过所有那些被来回吐槽的东西，直接到达面对的问题。

Yeah. Just make it better for people to not die from the direct consequence.
是的。要让人们更容易不死于直接后果。

I'd like to take a quick break and acknowledge one of our sponsors, Athletic Greens.
我想稍作休息，感谢我们的赞助商Athletic Greens。

Athletic Greens, now called. AG1, is a vitamin mineral probiotic drink that covers all of your foundational nutritional needs.
Athletic Greens现在叫AG1，是一种维生素矿物质益生菌饮料，可以满足你所有的基本营养需求。

I've been taking Athletic Greens since 2012, so I'm delighted that they're sponsoring the podcast.
自2012年以来，我一直在使用Athletic Greens，所以我很高兴他们赞助这个播客节目。

The reason I started taking Athletic Greens and the reason I still take Athletic Greens once or usually twice a day is that it gets to be the probiotics that I need for gut health.
我开始服用Athletic Greens的原因，也是我仍然每天服用一次或通常两次的原因是因为它提供了我需要维持肠道健康所需的益生菌。

Our gut is very important. It's populated by microbiota that communicate with the brain, the immune system, and basically all the biological systems of our body to strongly impact our immediate and long-term health.
我们的肠道非常重要。它们由微生物群落组成，与大脑、免疫系统和基本上我们身体的所有生物系统进行交流，从而强烈影响我们的即时和长期健康。

And those probiotics and Athletic Greens are optimal and vital for microbiotic health.
那些益生菌和Athletic Greens对于肠道微生态健康的优化和维护至关重要。

In addition, Athletic Greens contains a number of adaptogens, vitamins, and minerals that make sure that all of my foundational nutritional needs are met, and it tastes great.
此外，Athletic Greens 包含一些适应性元素、维生素和矿物质，确保了我的营养基础需求全部满足，而且口感极佳。

If you'd like to try Athletic Greens, you can go to AthleticGreens.com slash Huberman, and they'll give you five free travel packs that make it really easy to mix up Athletic Greens while you're on the road and the car on the plane, et cetera.
如果您想尝试Athletic Greens，可以访问AthleticGreens.com/huberman，他们将赠送您五个免费的旅行包，让您在旅途中轻松混合Athletic Greens，无论是在车上还是飞机上等。

They'll give you a year supply of Vitamin D3K2, again, that's AthleticGreens.com slash Huberman to get the five free travel packs and the year supply of Vitamin D3K2.
他们将为你提供一年的维生素D3K2供应，再次强调，访问AthleticGreens.com slash Huberman以获取免费的五个旅行包和一年的维生素D3K2供应。

So trying to avoid a serious, such a difficult word to say, especially for a neuroscientist, arterial sclerosis.
避免动脉硬化，这是一个很难说的术语，尤其对于神经科学家来说。

Did I get right? Well, it's athero, which is easier because yeah. Atherosclerosis. Oh, there.
我说的对吗？嗯，是动脉硬化，因为它比较容易理解。动脉粥样硬化。哦，就是这个。

Yeah, but you can like more complicated for myself. Typical of me.
是啊，但我喜欢让自己有更复杂的感觉。这很像我自己的典型表现。

Okay. And so blood pressure keeping it 128, 120 over 80 or better.
好的。所以保持血压在128，120/80或更好的水平。 意思是保持血压在128，120/80或更佳的范围内。

Don't smoke. Let's just throw and don't vape. Sure. I'm going to just plant my flag on. Just don't vape. There are other ways to get those things in your system if you really want to get nicotine or cannabis in your system.
不要吸烟，让我们扔掉并且不要电子烟。当然，我只是要坚定地立场不使用电子烟。只是不要使用电子烟，如果你真的想让尼古丁或大麻进入你的体内，还有其他的方法。

Apobee. What's the story with apobee?
Apobee是什么意思？简单说，它是一个代表着旅游、探险和美食的创新品牌。Apobee提供各种各样的产品和服务，包括旅游景点的推荐、私人导游服务、特色美食推荐等等，以帮助人们更好地探索和享受一个地方的文化和美食。总之，Apobee是为那些想要深入了解并享受不同文化和美食的人打造的品牌。

Okay. So to explain this, you have to tolerate a little bit of chemistry.
好的，为了解释这个问题，您必须容忍一点化学。 意思是，这个问题需要一些化学知识来解释。

So everybody's heard of cholesterol and I certainly devote quite a bit of time in the book to explaining this because it is so important.
每个人都听说过胆固醇，我在这本书中花了相当多的时间解释这一点，因为它非常重要。

And it's definitely one of those areas where I initially received a lot of pushback from the editor.
这绝对是我最初遭到编辑者强烈反对的领域之一。 意思是：作者最初在这个领域遭遇了一些编辑的反对。

And there was a thought that, hey, this is a bit more technical than it needs to be. But I think that sometimes you do need to resort to longer dissertations to dispel mythology.
有一个想法是，嘿，这可能比必须的技术含量更高。但是我认为，有时候你需要使用更长的论文来消除神话。

So cholesterol is a lipid. It is a molecule that the body synthesizes.
所以胆固醇是一种脂质。它是身体自我合成的分子。

It is a molecule that is essential for life.
这是一种对生命至关重要的分子。

So if you cannot synthesize cholesterol, you can't live.
因此，如果你无法合成胆固醇，就无法生存。

You'll die in utero. So there are rare genetic conditions that prevent the successful synthesis of cholesterol, embryos that have those mutations do not survive.
你将在子宫中死亡。因此，有些罕见的遗传病可以防止胆固醇成功合成，拥有这些突变的胚胎无法存活。

Okay. So why do we need this stuff?
好的，那么我们为什么需要这个东西呢？意思是：为什么我们需要这个东西？

So we need this stuff primarily for two reasons.
我们之所以需要这些东西，主要有两个原因。

First, it makes up a very important structural component of cell membranes.
首先，它构成细胞膜的非常重要的结构组成部分。 简单说明： "它" 指代某个物质，它是细胞膜的重要组成部分。

So as you know, a cell is a sphere.
你知道的，一个细胞是一个球形体。

We look at them and think they're circles, but they're spheres and they're fluid, right?
我们看着它们觉得它们是圆形，但实际上它们是球体，而且是液体的，对吗？

They aren't just like little perfect, you know, big bowling balls or, you know, balloons.
它们不是像完美的小保龄球或气球那样的东西。

They actually morph and shape and move in these paths.
它们实际上会变形、改变形状并沿着这些路径移动。

And this is what allows cells to be next to each other and all the sorts of things.
这就是让细胞能够相邻并发挥各种功能的原因。

They also have channels across all of them.
它们还在所有频道上都有信号。

And those channels are held in place by, among other things, cholesterol and phospholipids.
这些通道的保持是由胆固醇和磷脂等物质维持的。

The second thing that makes cholesterol so important, it is the precursor to some of the most important hormones in our body.
胆固醇之所以如此重要的第二个原因是，它是我们身体中一些最重要激素的前体。

So our sex hormones, testosterone, estrogen, progesterone, in addition to glucocorticoids.
因此，我们的性激素，睾酮、雌激素、孕激素，以及糖皮质激素。这些激素对我们的身体具有重要作用。

If you look at them, it's really funny.
如果你看着他们，那真的很有趣。

You know, people, if you're looking at, if you Google, like, give me the structure of these things, you're kind of like, wow, they're all basically the same.
你知道吗，如果你想了解一些东西的结构，比如使用谷歌搜索，你会发现它们基本上都是一样的。

They all look really similar and they're all pretty much just templates of cholesterol.
它们看起来非常相似，几乎可以被视为胆固醇的模板。

So understandably, when it's something that's that important, the body would leave nothing to chance.
可以理解的是，当一件事情如此重要时，身体不会留下任何风险。

We make all of our own cholesterol.
我们自己制造全部胆固醇。 这句话的意思是，胆固醇是人体内部制造的一种物质，而不是从外部摄入的。因此，我们的身体需要适量的胆固醇来保持正常的身体功能。过多或过少的摄入会对健康产生负面影响。需要注意的是，某些食物中含有胆固醇，但在适量摄入的情况下，这些食物并不会对身体造成伤害。

The cholesterol that you eat in food, largely irrelevant.
你从食物中摄取的胆固醇，大多数都不重要。 意思是，从食物中摄取的胆固醇对身体的影响并不是很大。

It's a sterified cholesterol.
这是一种酯化的胆固醇。意思是这种胆固醇被酯化处理，不易溶于水。

So it means it has an ester side chain.
这意味着它具有一个酯侧链。

It's too bulky to absorb in the gut. So most cholesterol that you eat in food just goes out your GI tract.
它太笨重了，无法在肠道中被吸收。因此，你在食物中摄入的大部分胆固醇只是通过你的消化道排出。

Okay, so we have this super important molecule that every cell in the body makes, but there's a bit of a problem.
好的，我们有一个非常重要的分子，每个细胞在身体里都能制造它，但是有一个小问题。

There's actually two problems.
实际上有两个问题。

The first problem is, not every cell can make as much as it needs all the time.
第一个问题是，不是每个细胞都能一直制造其所需的足够数量。 简单易懂翻译：第一问题是，有些细胞不能时时刻刻制造足够数量的东西。

So you have this demand problem.
那么，你遇到了需求问题。意思是你的需求无法得到满足。

So for example, if you're sick, you're going to need to make far more glucocorticoids.
例如，如果你生病了，你需要制造更多的糖皮质激素。

Your body's response is going to be to ramp up cortisol production, to mobilize fuel and do a whole bunch of other things.
你的身体反应就是要增加皮质醇的产生，动员燃料和做很多其他事情。

And certain cells, like the adrenal glands, are going to be called on to rise to a higher level of performance.
某些细胞，如肾上腺，将被要求提高其表现水平。

And they're not going to be able to make enough cortisol. So they're going to have to borrow or take cholesterol from other cells in the body. In fact, one of the things we used to notice in the ICU, I never knew why it was happening. I now know. Because the few times I would accidentally order the wrong set of labs on a patient in the ICU and also order like a lipid test or something, you would always notice their cholesterol levels were dropping. You know, serum cholesterol levels. And I now realize why? Because they were basically just funneling cholesterol to the adrenals to make more of the cortisol that they needed to combat whatever they were in the ICU for, which is usually the most severe form of stress the body is under.
他们不会产生足够的皮质醇。所以他们将不得不从身体中的其他细胞借用或取走胆固醇。实际上，我们在重症监护室曾经注意到的一件事情，我以前不知道发生了什么。现在我知道了。因为我有几次不小心给ICU中的患者订错了化验单，并同时订了脂质测试之类的东西，你会发现他们的胆固醇水平正在下降。你知道，血清胆固醇水平。现在我明白为什么了，因为他们基本上只是将胆固醇导向肾上腺，以制造更多他们需要对抗ICU中所患的任何病情所需的皮质醇，这通常是身体所承受的最严重的压力形式。

So you have to be able to transport this stuff. And then the second problem is, as you know, cholesterol being a lipid is not water soluble. So the most dominant highway in the body is the circulatory system. We can use the lymphatic system and things like that. But for the most part, we use our circulatory system as the highway to move stuff around. And the highway is made up of water. Which is what is the liquid component of your blood is water. And therefore, things that are water soluble move easily. So glucose, sodium, electrolytes, all of those things are dissolvable in water. And therefore, they don't need a carrier. You just dissolve them in the water and they can go.
因此，你必须能够运输这些东西。然后第二个问题是，胆固醇作为脂质不溶于水。因此，人体中最主要的载体是循环系统。我们可以使用淋巴系统等其他方法。但大部分还是使用循环系统作为运输工具。而这个工具是由水构成的。你的血液中的液体成分就是水。因此，那些可以溶于水的东西容易传输。如葡萄糖、钠、电解质等，它们都可以在水中溶解，不需要携带者。

So that's why your liver can make glucose that your brain can easily get. And there doesn't need to be a carrier or an intermediary or anything like that. But unfortunately, with cholesterol being a lipid, we can't do that. Just as water and oil don't mix, cholesterol and plasma don't mix. So the body had to come up with a trick. And the trick was designing a vehicle that was water-soluble on the outside and fat-soluble on the inside. That you could bury the cholesterol inside along with triglycerides. And on the outside, it was covered in protein, which is water-soluble.
因此，这就是为什么你的肝脏能够制造葡萄糖，并让你的大脑轻易地获取。而且，这不需要任何携带者或中介物等。但不幸的是，由于胆固醇是一种脂类，我们无法直接用这种方式进行处理。就像水和油不能混合一样，胆固醇和血浆也不能混合。因此，身体不得不想出一个办法。这个技巧就是设计出一个外部水溶性、内部脂溶性的载体，你可以把胆固醇和甘油三酸脂一起包裹在里面。在外部，它被蛋白质包裹，蛋白质是水溶性的。

And that's the thing that moves around. And that thing is called a lipoprotein. And as its name suggests, it's part lipid, part protein, lipid on the inside protein on the outside. And those lipoproteins come largely in two different families. So one family comes from a lineage called APOB. So the APOB family, which is short for APO lipoprotein B100, is a family that is derived from the liver. And each of those lipoproteins has one and only one APO lipoprotein B100 on it. We shorten it and just call it APOB because we don't really worry about APO lipoprotein B48, which is a sat attached to chylomicrons that are responsible for fat absorption in the gut.
这个游动的东西被称之为脂蛋白。脂蛋白的名称已经表明，它是由脂肪和蛋白质组成的，在内部是脂肪，在外部是蛋白质。这些脂蛋白主要分为两个不同的家族。其中一家族来自APOB谱系，缩写为APO脂蛋白B100的家族来源于肝脏，每个脂蛋白上仅有一个APO脂蛋白B100。我们将其缩写为APOB，因为我们不太关心附着在乳糜微粒上吸收脂肪的饱和脂肪酸APO脂蛋白B48。

And every short lived, they don't really factor into atherosclerosis. So we're going to just, for the purists out there, there's an APOB48. We're not going to talk about it. So when I say APOB, what I'm talking about is a protein that wraps around a subset of these lipoproteins. There's another family of lipoproteins called APOA, or APO lipoprotein A. This is a much more complicated family. And I'm not going to talk about it here because we would take an hour to just explain how the APO lipoprotein A family works. But I'll give the punchline is there are many APO lipoprotein A's. There's variable numbers of APOAs on those proteins.
每一个短暂存在的脂蛋白都不是与动脉粥样硬化相关的因素。所以，对于纯粹主义者来说，我们不会谈论APOB48。因此，当我提到APOB时，我指的是包裹在这些脂蛋白子集周围的一种蛋白质。还有另一族脂蛋白叫做APOA，或APO脂蛋白A。这是一个更为复杂的家族。我在这里不会讨论它，因为我们需要一个小时来解释APO脂蛋白A家族的工作原理。但我会给出结论，它们有许多不同的APO脂蛋白A，这些蛋白质上的APOA数目是可变的。

And they are all part of a family called high density lipoproteins. Back to the APOB guys, they are of the low density lipoprotein lineage. So you've heard the term LDL and HDL. What is it referring to? It's basically referring to the relative concentrations of protein and lipids in the lipoproteins and not surprisingly based on their names. The HDLs are higher density, more protein less lipid. The LDLs, low density lipoproteins and VLDLs, very low density lipoproteins and IDLs, intermediate density lipoproteins are all lower density, which means more lipid to protein. There are different sizes. There's a whole bunch of other things going on.
它们全部属于一类名为高密度脂蛋白的家族。回到APOB这群人，他们属于低密度脂蛋白的谱系。你已经听过LDL和HDL这个术语。它指的基本上是脂质蛋白中蛋白质和脂质相对浓度的差别，这不足为奇基于它们的名字。HDL的密度更高，蛋白质较多，脂质较少。LDL、VLDL和IDL都是低密度脂蛋白，意味着更多的脂肪而不是蛋白质。它们有不同的尺寸和其他特征。

Most important fact in all of this is that the APOBs are arthrogenic. So what we're about to talk about next is perpetuated by lipoproteins that have an APOB on them. So everything in the story right now is just about how do you get cholesterol around the body? And these proteins that have lipid in the middle. So let's just take APOB, for example, many, many billions of them floating around in our body, even in the healthiest of people. And they're being shuttled to tissues that need them like the adrenals, muscle, heart, etc.
最重要的事实是APOB具有关节发病性。所以下面我们要讨论的一切都与携带APOB的脂蛋白有关。目前故事中的一切都是关于如何将胆固醇运输到身体各部位的问题，以及这些在中间具有脂质的蛋白质。我们以APOB为例，即使在最健康的人身上，也有数十亿个这样的蛋白质漂浮在体内，它们被输送到需要它们的组织中，如肾上腺、肌肉、心脏等。

Paragraph 1: What sets the demand for these things? So for instance, could somebody have relatively high LDL, maybe even higher than sort of high end of chart or even above high end APOB, but there's some sort of metabolic demand or they're weight training a lot or they're running marathons. And so they need a lot of LDL. The reason I ask this is because it's so easy for the uninformed person, which I include myself in that group, to just sit here, oh LDL bad, cholesterol bad, APOB bad, when in fact you very graciously spelled out the fact that these things actually perform a functional role in the healthy body.
这些东西的需求是由什么决定的？比如说，一个人可能会拥有相对较高的低密度脂蛋白（LDL），甚至高于图表上的高点，甚至高于高端的载脂蛋白B（APOB），但是他们身体内存在一些代谢需求，或者他们进行了很多重量训练或长跑。因此，他们需要大量的LDL。我问这个问题的原因是因为对于那些不了解胆固醇、LDL或APOB的人来说，他们很容易就会认为这些东西不好，但是你非常友善地解释了这些在健康体内的功能作用。

Paragraph 2: So before we get into why they are can be bad, why would you want a low density like proprtine, what is that doing for somebody? And is there any circumstance where the way people are exercising or thinking or not sleeping or sleeping too much that a higher level actually reflects a healthy metabolic need? We don't have any evidence of that to date. All of the functions that I described can be done by the HDL. So the high density like proprtines, the APOA's can do all of it. So APOB and low density like proprtines are just they're just the necessary.
在我们讨论为什么低密度蛋白质如蛋白这样的物质有害之前，为什么你会想要低密度蛋白质呢？这对某些人有什么作用？是否有任何情况，人们的运动方式、思维方式、睡眠不足或睡眠过多的情况下，较高水平实际上反映了健康代谢需求?迄今为止，我们没有任何证据。我所描述的所有功能都可以由高密度脂蛋白完成。所以类似蛋白质的高密度物质，如APOA，都可以完成所有功能。因此，APOB和类似蛋白质的低密度物质只是必需的。

Paragraph 3: We don't, I mean, we don't understand why we have a mandarin. This is the part that's really interesting to me. Most species do not even have APOB. And as a result of that, most species are chemically incapable of atherosclerosis. So if someone could zero out their APOB and their LDL, we assume they would function just fine. We know they would because we have certain people who walk around with genetic mutations that render them that way. Wow.
我们不明白为什么我们会有柑橘。这是我最感兴趣的地方。大多数物种甚至没有APOB。因此，大多数物种在化学上无法患上动脉硬化。因此，如果某人能将其APOB和LDL降至零，我们认为他们会正常运转。我们知道这一点，因为有些人具有遗传突变，使他们达到这种状态。哇。

Paragraph 4: Furthermore, we also know that there's a bit of a myth out there that cholesterol, the cholesterol you measure in your blood is essential for brain health, for example. That's an understandable thing, right? You can speak to this very eloquently the role of cholesterol in the brain. Yeah, I wrote down when I was a postdoc at Stanford, so I always went out. I was born at Stanford, trained at Stanford, where is that probably diet? Stanford, hopefully a long time. You'll tell me how long.
另外，我们还知道有一个谣传，即你血液中测量到的胆固醇对于大脑健康至关重要。这是可以理解的，对吧？你可以非常流利地谈论胆固醇在大脑中的作用。是的，我在斯坦福大学攻读博士后时写了这些，所以我总是提到这个。我是在斯坦福出生的，接受的训练也是在斯坦福，这可能与我的饮食有关。希望能在斯坦福待很长时间，你可以告诉我待多长时间。

Paragraph 5: Well, we're going to do the Charlie Munger thing and make sure that you never go back to Stanford so that like you can't die there. There exactly. We cured already. When I was a postdoc, I worked with a guy named Ben Barras, who I know, you know, probably as a different person than for reasons that people can look up Ben's name. Anyway, incredible scientist. But there was someone in his lab that discovered that cholesterol is a critical component of the synaptogenesis process, the formation of connections between neurons and the developing brain.
我们将采取查理·蒙格的方法，确保您永远不会回到斯坦福，以便您不会在那里去世。这样就解决了。当我当博士后研究员时，我和一位名叫本·巴拉斯的人一起工作，他是一位令人难以置信的科学家。但是他的实验室中有个人发现，胆固醇是突触发生过程中的关键组成部分，即神经元之间的连接和发展大脑的过程。

Paragraph 6: Then they went on to lead to the discovery of things like thrombospondons being important for synaptogenesis, et cetera. But cholesterol sits central in the brain development mechanisms. You want cholesterol around for brain development. In fact, I think very low fat diets and very low cholesterol diets during early development can really impair brain development as I understand.
接着，人们发现像血小板衍生生长因子等物质对突触形成非常重要。但胆固醇在脑发育机制中是至关重要的。你需要让胆固醇存在于脑发育过程中。事实上，我认为在早期发育阶段过于低脂肪和低胆固醇的饮食可能会严重影响脑发育。

Paragraph 7: Yeah, it's not entirely clear why. But here's what we know. When you're born, your serum cholesterol levels are very low. So children, infants and children, have very low levels of cholesterol. They would have, and I should explain one thing that's important. They're not myelinated yet. Right? The myelin, of course, the sheathing around neuronal axons, which accelerates the propagation of nerve signals in which is deficient in things like multiple sclerosis, is essentially fat, made up of phospholipid and requires cholesterol for synthesis.
是的，为什么不太清楚。但是这是我们所知道的。当你出生时，你的血清胆固醇水平非常低。所以婴儿和儿童的胆固醇水平非常低。他们会有，我应该解释一件重要的事情。他们的髓鞘还没有形成。髓鞘，当然是围绕神经轴突的覆盖物，加速了神经信号的传导，而这种覆盖物在多发性硬化等情况下缺乏，基本上是脂肪，由磷脂组成，需要胆固醇来合成。

Paragraph 8: But young children are not very well myelin. I mean, the spinal cord is myelin. You know, spinal tract are myelin. So this is what's interesting, right? We would all agree that cholesterol is more important to infants and children than to anybody else. Right? It would be the most important substrate for CNS development. And yet, infants and children have virtually unmeasurable levels of cholesterol. It really starts to take off in your teenage years. Right? So cholesterol basically serum cholesterol levels rise, basically monotonically throughout life. Women get a big bump at menopause, so it really goes up for them.
但是幼儿的髓鞘不是很好。我是说，脊髓就是髓鞘。你知道，脊髓束都是髓鞘。所以这很有趣，对吧？我们都同意，胆固醇对婴儿和儿童的发育比对其他任何人都更重要。对于中枢神经系统的发育来说，胆固醇是最重要的物质。然而，婴儿和儿童的胆固醇水平几乎是不可测量的。它真正开始在青少年时期起飞。基本上，血清胆固醇水平会随着寿命的延长而单调上升。女性在更年期时会出现一个大的增长，所以她们的胆固醇水平会真正上升。

Paragraph 1: But what's interesting is how is it? How do we reconcile the fact that infants and children have really low levels of serum cholesterol yet clearly undergo CNS maturation without any problems? And it basically comes down to the following.
但有趣的是它是如何做到的？我们如何调和婴儿和儿童血清胆固醇水平明显较低，却没有任何问题地进行中枢神经系统成熟？这基本上归结为以下几点。

Paragraph 2: What you measure in the serum is but a fraction of the total body pool of cholesterol. So we get a little bit of the light under the, you know, the, you know, the street lamp under the trunk under the trunk of the street lamp. Just because we're looking there, we tend to think that that's what we're seeing. But if you took the entire circulatory pool of cholesterol, it's about 10% of your total body cholesterol. It's a tiny fraction of it. So it's what we measure, because that's all we have access to, but it really represents virtually none of it.
在血清中测量到的胆固醇仅是总体胆固醇储备的一小部分。就像我们在街灯底部找光，因为我们只看到那里，我们便认为那就是我们所看到的。但是，如果你考虑整个循环的胆固醇池，它仅占你总体胆固醇的约10％。这只是其中的一小部分。虽然这是我们所能测量到的，但实际上它几乎不代表总体胆固醇的数量。

Paragraph 3: I do want to say something because you mentioned LDL. I want to tie this back to the reader, right? Or the listener rather. Um, APOB refers to the lipoprotein, the singular lipoprotein wrapped around an LDL particle.
我想说一些关于你提到的低密度脂蛋白LDL的事情。我想把它与读者或听众联系起来。APOB指的是包裹在LDL粒子周围的单一脂蛋白。

Paragraph 4: So if you happen to be lucky enough that your doctor measures an APOB level, it's a blood test. It says APOB X number of milligrams per desoleter. That's measuring the concentration of that protein. It is a direct measurement of the concentration of LDL and VLDL particles.
因此，如果你足够幸运，你的医生可以测量你的APOB水平，这是一种血液检测。它会显示每毫升血液中APOB的毫克数。这是测量该蛋白质浓度的直接方法。这也是测量低密度脂蛋白和极低密度脂蛋白颗粒浓度的一种方式。

Paragraph 5: When you have a blood test that says LDL, it usually doesn't say LDL. It usually says LDL C or LDL cholesterol, because LDL is not a laboratory measurement. LDL cholesterol is a laboratory measurement. And it's just taking the total number of LDL particles, breaking them apart and measuring how much cholesterol is in them. So LDL C measures the total concentration of cholesterol in the LDLs.
当你做了一项显示LDL的血液检测时，它通常不会只显示LDL。它通常会显示LDL C或LDL胆固醇，因为LDL本身并不能被实验室测量。LDL胆固醇是一种实验室测量。它只是将所有LDL粒子分解并测量它们中含有多少胆固醇。因此，LDL C测量了LDL中胆固醇的总浓度。

Paragraph 6: APOB measures the number of them. And they're different, but one of them is far superior at predicting risk in its APOB. The number of particles is much more predictive of risk than the amount of cholesterol contained within them.
APOB衡量其中的数量。而它们各不相同，但其中一种在预测风险方面比其他更为出色，这就是其APOB。比起颗粒内所含胆固醇的数量，颗粒数量更能有效地预测风险。

Paragraph 7: Fascinating. First time I've understood HEL LDL and these lipoproteins in a way that makes sense. So thank you. I'm sure others feel the same way. What APOB level is your red flag cut off? I actually had my APOB measured recently and I'm definitely above the high end. We'll be discussing this over dinner.
很有意思。这是我第一次以一种让我感到有意义的方式理解了HEL LDL和这些脂蛋白。所以谢谢你。我相信其他人也有同样的感受。你的红旗截止点是什么APOB水平？我最近检测了我的APOB，肯定高出了高端水平。我们将在晚餐时讨论这个问题。

Paragraph 8: And just to tie this back, I hope that's a stake dinner and that should be fine given in the fact that dietary cholesterol has no direct link to APOB. That's true, but dietary saturated fat does. Which is not to say we're not going to have a stake. Not necessarily one of the fatier cuts, although probably will be for me. So what's the high end that you high end flag? At what point do you start saying we need to do something and then we'll talk about what people can do?
我希望这是一个牛排晚餐，因为饮食中的胆固醇并没有直接与APOB相连，所以这应该是没问题的。但是，饮食中的饱和脂肪却有其直接影响。这并不是说我们不会吃牛排，只是可能不会选择脂肪含量更高的部位，虽然我可能会选。那么，何时会有高端需求？在什么时候开始认为我们需要采取行动，然后我们会谈什么样的人们可以采取行动？

Paragraph 9: Yeah, so this is a complicated question because it depends on so many factors. The first factor it depends on is what is your objective? And I do pose this question directly to a patient. So I say, look, we've got this disease. That's the number one cause of death. Now you can die with it or you can die from it. That's those are your choices. Statistically speaking, more people will die from it than anything else. But if you live long enough, we will all die with it to some extent. So if you're me and I come from a family history, as you know, I write about this in the book, where basically every man in my family except one has died of atherosclerosis and they have all done so very prematurely.
这是一个相当复杂的问题，因为它取决于许多因素。第一个因素取决于你的目标是什么？我直接问病人这个问题。所以我会说，看，我们有这个疾病，这是死亡率最高的原因。你可以死于它，也可以死于其他原因。从统计上来说，更多的人会死于它，而不是其他疾病。但是如果你足够长寿，我们都会在某种程度上患有这种疾病。如果你像我一样，我来自一个家族，就像你们所知道的，在我家族中，除了一个人，每个男人都死于动脉粥样硬化，而且都很早就去世了。

Paragraph 10: My dad lost brothers in their 40s and 50s. By some miracle, my dad is still alive at 86, but I think that's in large part because he at least had the good sense to listen to doctors and take medication to lower his cholesterol and blood pressure. If your objective is to not die from heart disease and only to die with it, then you want apoby as low as possible. Now how low you go depends on when you start because one way to think about this is it's an area under the curve problem. The longer you wait to start doing something about this, the more aggressively you need to do something about it.
我的父亲失去了40岁和50岁的兄弟。通过一些奇迹，我的父亲现在还活着，他至少有足够的智慧听从医生的建议，并服用降低胆固醇和血压的药物。如果您的目标是不死于心脏疾病，只是带着它去死，那么您希望apoB尽可能低。现在，您的下降幅度取决于何时开始，因为这是一个曲线下面积问题。您等待开始做出反应的时间越长，就越需要积极采取行动。

Paragraph 11: I think a better way to think about this though is to go back to what we talked about with smoking. So would you agree that smoking is causally related to lung cancer? Yes. So just to be clear Andrew, you do not think that it's just an association that smokers get more lung cancer. No, I do not. In other words, you believe that smoking causes lung cancer then. Yes.
我认为更好的理解方式是回归到我们之前谈到的吸烟问题。你同意吸烟与肺癌之间存在因果关系吗？是的。所以，安德鲁，你不认为吸烟只是与吸烟者更容易得肺癌的关联而已，是吗？不，我不认为。换句话说，你相信吸烟会导致肺癌，是吗？是的。

Paragraph 12: Okay. There are a number of mechanisms in between. I mean, somebody who really wanted to drill into the logic, they could say, okay, it's not actually the smoking. It's a, you know, some disruption of the endothelial cell lining that, you know, the smoking triggers that, that triggers that. I assume so. And I agree with you, by the way. I think the data are very clear. A very relief to hear.
好的。中间有许多机制。我的意思是，真正想要深入逻辑的人可能会说，其实不是吸烟的原因，而是某些损害内皮细胞屏障的因素，吸烟只是触发了这些因素。我认为你是这个意思吧？我也同意你的看法。数据非常清楚，这听上去非常令人宽慰。

Paragraph 1: Yeah.
是的。

Paragraph 2: But I'm going someplace very important here because if there's one topic that doesn't get enough attention in medicine, it's causality. And causality is an obsession of mine.
但我在这里提到的是一个非常重要的话题，因为在医学领域，很少有人关注因果关系。而因果关系是我的一种迷恋。

Paragraph 3: Like most of the day on some level, I sit around thinking about causality. And I think the hardest part about studying medicine with respect to human beings is how difficult it is to infer causality for most things that we do.
在某种程度上，我像大多数人一样，坐着思考因果关系。我认为，关于人体，研究医学最困难的部分就是大多数事情都难以推断其因果关系。

Paragraph 4: So if you believe that smoking is causally related to lung cancer, then smoking cessation reduces the probability of lung cancer. That is a, that is a logical equivalency. There can be no debate about that.
因此，如果您认为吸烟与肺癌有因果关系，那么戒烟会降低患肺癌的概率。这是一种逻辑等价性，这一点是无法争辩的。

Paragraph 5: What if I said to you, Andrew, this is going to be our new philosophy around smoking cessation? You're going to, I'm going to, I'm going to, you the czar of smoking cessation. So if people pick up smoking, no problem. We're going to let them smoke. But we're going to assess their risk for lung cancer using a model that predicts when their 10 year risk of lung cancer gets above a certain level, we're going to recommend that they stop smoking.
如果我告诉你，安德鲁，我们将采取这种新的戒烟理念，你会怎样？你，我，我，你将成为戒烟的沙皇。所以，如果有人开始吸烟，没关系。我们会使用预测模型来评估他们患上肺癌的风险，当他们未来10年患上肺癌的风险达到一定水平时，我们会建议他们戒烟。

Paragraph 6: So we're going to look at their age, their sex, their family history, some biomarkers that might help us. We're going to even do scans of their lungs. And once we think they cross a threshold where their risk of lung cancer is high enough, let's just say it's 25%. Boom, you make them stop. You tell them it's time to stop.
所以我们将研究他们的年龄、性别、家族病史和一些可能有助于我们了解的生物标志物，甚至还会对他们的肺进行扫描。一旦我们认为他们的肺癌风险超过了一个阈值，比如说25%，那么就停止吸烟。告诉他们现在是停止的时候了。

Paragraph 7: Is that a logical approach to treating smoking and lung cancer or would it be better to say, even that we know cigarettes are causally related to this, how about you never start smoking? And the minute you do, we pull the cigarette out of your mouth and explain to you that you're doing something that is causally related.
这种治疗烟草与肺癌的方法是否合乎逻辑，还是我们最好说，即使我们知道香烟与肺癌之间存在因果关系，你最好从未开始抽烟？而且，一旦你开始了，我们立即拿走香烟，告诉你这是有因果关系的行为。

Paragraph 8: Of course, it would be the latter, not the former. It would be idiotic to suggest that we endorse smoking until you cross a certain threshold. Well, this now becomes the germane question.
当然，应该选择后者，而非前者。暗示我们赞成抽烟直到达到一定的标准是愚蠢的。那么现在，这就成为了关键问题。

Paragraph 9: There is no ambiguity that APOB is causally related to atherosclerosis. How can I tell you that? I can tell you that looking at all of the clinical trial literature, all of the epidemiologic literature, and perhaps even most importantly, the Mendelian randomizations. All of these things tell us because by the way... Mendelian randomizations, meaning genetic mutants, humans out there that make very little APOB or obsessed with the magic.
毫无疑问，APOB与动脉粥样硬化有因果关系。我是如何知道的呢？我可以告诉你们，通过观察所有的临床试验文献、流行病学文献，甚至也包括最重要的门德尔随机化研究。所有这些都是表明这一点的依据……也就是门德尔随机化研究，也就是基因突变，这些人体内产生的APOB非常少或者有强烈追求的“魔法”。

Paragraph 10: And very, very, very... Exactly. And say if you make very little, you aren't going to die as quickly in your life as if you make too much. That's right. So, Mendelian randomization is such an elegant tool where you basically let genes do the randomization.
非常、非常、非常...准确地说，如果你的收入很少，你的寿命不会像收入过高时那样短。没错。所以，孟德尔随机化是一种非常优雅的工具，你基本上让基因进行随机化。

Paragraph 11: And as you said, there is a gradation of LDL concentration or APOB concentration that occurs from insanely low to insanely high. And this is a wildly polygenic, polymorphic set of conditions. And we can look at the outcomes of those people based on the random sorting of those genes. And there's no ambiguity. LDL is causally related. LDL cholesterol or APOB, causally related to atherosclerosis.
正如你所说，低密度脂蛋白或APOB浓度存在从极低到极高的层次差别。而且，这是一组极具多基因型、多态性的情况。我们可以根据这些基因的随机分配来观察这些人的结果。结果是毫无歧义的，低密度脂蛋白或APOB与动脉粥样硬化之间存在因果关系。

Paragraph 12: Well, if that's true, and I haven't seen a credible argument that it's not, there are people who argue that it's not, by the way, but they just don't have credibility in their arguments. And you have to say that what we're doing in medicine today is very backwards.
如果这是真的，我还没有看到有充分说服力的反驳意见，尽管有人持不同观点，但他们的论点缺乏可信度。不得不说，我们今天在医学上所做的事情非常落后。

Paragraph 13: Because what we're doing in medicine today is the following. We're saying, I'm coming at this in a long way, but your question is so important that I want to answer it this way.
因为我们今天在医疗方面所做的正是这样。我们说，我用了比较长的方式来回答你的问题，但是你的问题非常重要。

Paragraph 14: We're answering your question today as follows. We're saying, Andrew, let's do a 10-year risk calculation of your risk of MACE. MACE stands for major adverse cardiac event. It is the metric we use in medicine.
今天我们要回答你的问题。我们建议，安德鲁，让我们做一个10年的风险计算，来评估您发生主要心脏不良事件（MACE）的风险。MACE是医学上使用的指标。

Paragraph 15: So, a major adverse cardiac event is a heart attack, stroke, or death, basically, resulting from these things. And we have calculators that are pretty good at predicting your 10-year event risk. They'll look at your cholesterol levels, your blood pressure. They'll ask if you smoke. They'll ask some family history questions, and they'll spit out a number.
因此，重大的不良心脏事件是指心脏病发作、中风或死亡，这些都是由这些因素引起的。我们有一些相当好的计算器可以预测您未来十年的心脏病发作风险。他们会检查您的胆固醇水平、血压、是否吸烟、家族病史等因素，然后输出一个数字。

Paragraph 16: Now we should do yours after the fact. And I don't know if we did it for a person who says, you're in your mid-40s, it would probably spit out less than 5% risk for a major adverse cardiac event in the next 10 years. In fact, the models don't even work if age is below 40. So the first time I went to do one of these tests when I was in my mid-30s, I couldn't do it. The algorithm breaks.
现在我们应该在事后来做你的心脏风险评估。我不知道如果我们为一个人做这个测试，他说你已经四十多岁了，那么这个测试可能会显示未来十年内心脏不良事件的风险低于5%。事实上，如果年龄低于40岁，这个模型甚至无法使用。因此，当我三十多岁时第一次去做这个测试时，我无法完成，模型就会出问题。

Paragraph 17: That's sort of like, you know, it just doesn't work. So, the implication there is, if your MACE risk is less than 5%, the thinking is you do not need to treat LDL or APOB. I argue that that makes absolutely no sense.
这有点像，你知道的，这只是行不通。因此，这意味着，如果你的MACE风险低于5％，则认为你不需要治疗LDL或APOB。我认为这完全没有意义。

Paragraph 18: It's just as idiotic as the analogy I used around smoking. If a risk is causal and it is modifiable, it should be modified regardless of the risk tale, in duration.
这与我之前用于吸烟的比喻一样愚蠢。如果一个风险是因果关系而可修改的，无论风险故事有多长，都应该加以修改。

Paragraph 1: So then the question becomes to what level? And again, the earlier you start, the less aggressive you need to be, the less damage that's there already.
那么问题就变成了什么程度？同样地，您越早开始，就越不需要过于激进，已经存在的损害也就越小。

Paragraph 2: So for example, we do CT-Angio-Grams on our patients. If the CT-Angio-Gram shows no evidence of calcification, no evidence of soft plaque, that means grossly their coronary arteries are still normal, histologically they're probably not because nobody probably makes it to our age with histologically perfect coronary arteries.
举个例子，我们为病人做CT-冠状动脉造影。如果CT-冠状动脉造影没有显示钙化的迹象，也没有软斑块，那么从表面上看，他们的冠状动脉仍然是正常的；从组织的角度来看，可能不是这样，因为在我们这个年龄段，很少有人的冠状动脉是组织学上完美的。

Paragraph 3: We might be satisfied with a person's APOB being at the fifth percentile of the population, which would be about 60 milligrams per deciliter. But if we have any other factors, meaning we're starting later in life, or a person already has gross evidence of disease, calcification, soft plaque, family history is significant, any other risk factors are present.
我们可能会满意一个人的APOB只在人口的第五百分位数，大约是每分升60毫克。但是如果我们有其他因素，这意味着我们从晚年开始，或者一个人已经有明显的疾病迹象，如钙化，软斑块，家族病史显著，其他任何风险因素存在。

Paragraph 4: I mean, we'll treat APOB to 30 to 40 milligrams per deciliter, which is probably the first percentile. And if somebody's sitting up in the say low 130s, what kind of flag does that raise for you? And I realize it's highly contextual, age, etc. No, no, it's a huge red flag.
我是说，我们会将APOB治疗到每分升30到40毫克，这可能是第一个百分位。如果有人的数值在低130的范围内，那会引起什么警示？我知道这高度依赖于上下文和年龄等因素。不，不，这是一个巨大的警示信号。

Paragraph 5: And just because something is causal doesn't mean you're guaranteed to get it. There are smokers who don't get lung cancer. So there's going to be somebody listening to this who says, my grandmother's 95 years old, she's her cholesterol is sky high and she's alive and well. And I will say, absolutely, there are a lot of people walking around that way.
即使一件事情是因果关系，也不意味着你一定会得到它。有些吸烟者不会得肺癌。所以有人听到这个会说，我的祖母95岁，她的胆固醇很高，但她仍然健康。我会说，确实，有很多人这样走在路上。

Paragraph 6: Just as there are a lot of smokers walking around who don't get lung cancer, you can't impute these things on an individual basis. You basically have to ask the question, how do I make the best judgment about an individual from heterogeneous population data and based on what are causal and non-causal inferences around risk?
就像很多吸烟者没有得肺癌一样，你不能仅仅通过个体来推断这些问题。你基本上必须问自己一个问题，如何从异质人群数据中做出对个体的最佳判断，基于哪些是因果和非因果的风险推断？

Paragraph 7: So to me, if a person has very high APOB and they do not want to be treated for it, then the best we would do is say, let's at least establish that there are no other risk factors present and let's at least do the most investigation we can around the existing damage. And if that person has a perfect CT-NGogram, I'm going to push less hard than if they have a devastating NGogram.
所以对我来说，如果一个人的APOB指数非常高，但他们不想接受治疗，那么我们最好的做法就是，至少要确认没有其他风险因素存在，并尽可能对现有的伤害进行最深入的调查。如果那个人拥有完美的CT-NGogram，我会比面对灾难性的NGogram时少施加压力。

Paragraph 8: And by the way, devastating in my book is just any amount of calcification or soft plaque. Anything that shows up grossly that you can see on a CT scan means that you've got a decade plus of really bad histology building up to it. This issue of causality, I think, now becomes very clear as to why that is so crucial.
顺便说一下，在我的看法中，任何钙化量或软斑块都是灾难性的。任何在CT扫描中明显可见的东西都意味着你已经有十年以上的糟糕组织学累积在它上面。这个因果关系问题，我认为，现在变得非常清楚，为什么它非常重要。

Paragraph 9: And really appreciate the way you spell that out. So let's say somebody's APOB is, you know, 80, 100, let's say 130, for example, what sorts of things can they do to reduce that number? Is this always going to be prescription medication? And if so, what are the more common forms of prescription medication that work best? What are their side of effect profiles and so on?
非常感谢您详细解释清楚。假设某人的 APOB 值为 80、100 或 130，他们可以做哪些事情来降低这个值呢？这种情况下是否总是需要处方药物？如果需要，最常见的药物种类是哪些？它们的副作用有哪些等等？

Paragraph 10: So yeah, usually once you want to start getting down into the 30 to 60 range, you're going to require pharmacotherapy. But you know, usually we want to see how far we can get with nutrition. So fixing insulin resistance in an insulin resistant person will bring this down, right?
所以通常情况下，如果想将血糖控制在30到60的范围内，就需要使用药物治疗。但通常情况下，我们希望先尝试通过饮食来调节血糖水平。在存在胰岛素抵抗的人身上，解决胰岛素抵抗问题可以降低血糖。

Paragraph 11: So one of the hallmarks of insulin resistance is elevated triglycerides. We haven't talked about triglycerides, but they warrant some attention because I mentioned it earlier, but one of the other things that the Lypo proteins carry is triglycerides. So they're carrying fat and cholesterol. And if you recall, APOB represents the number of particles. So the purpose of them is to be carrying around mostly cholesterol.
因此，胰岛素抵抗的一个标志是高三酰甘油。我们还没有讨论过三酰甘油，但需要注意，因为我之前提到过。Lypo蛋白质承载的另一种物质是三酰甘油。它们承载着脂肪和胆固醇。如果你还记得，APOB代表颗粒数。因此，它们的目的在于主要承载胆固醇。

Paragraph 12: But if you have a high amount of triglyceride, you're basically using up cargo space on the ships. And so you need more ships. So if a person has elevated triglycerides, and I consider anything over 100 to be elevated, even the most laboratory tests would consider normal to be up to 150 milligrams per deciliter, we would want to fix their insulin resistance, bring the trig's way down.
如果你的甘油三酯含量很高，那么你基本上是在船上占用货物空间。所以你需要更多的船只。因此，如果一个人的甘油三酯偏高，我认为高于100毫克/分升就属于偏高，即使在大多数实验室测试中，正常范围也被认为是高达150毫克/分升，我们需要解决他们的胰岛素抵抗问题，将甘油三酯减低。

Paragraph 13: I would want to see trig no more than two times the HDL cholesterol. So if the HDL cholesterol is 60 milligrams per deciliter, I consider 120 to be through the roof high. And ideally, we want trig's at or below HDL cholesterol. Tricks being triglycerides.
我希望三酰甘油的值不要超过高密度脂蛋白胆固醇的两倍。因此，如果高密度脂蛋白胆固醇为60毫克/分升，我认为120毫克/分升的三酰甘油值过高。理想情况下，我们希望三酰甘油值等于或低于高密度脂蛋白胆固醇。这里的“tricks”是指三酰甘油。

Paragraph 14: So that's the big, big, trig dietary fat. No, actually, it's most easily accomplished through carbohydrate restriction. And triglycerides in some ways are kind of an integral of carbohydrate consumption. Any energy restriction will get it for you, but it's most sensitive to restriction of even under eucooloric conditions, carbohydrate restriction will lower triglycerides.
那么这就是大大小小的三酰甘油脂肪。实际上，最容易通过限制碳水化合物来实现。在某些方面，三酰甘油是碳水化合物消耗的一个整体指标。任何能量限制都会给你带来它，但是在等热量条件下，限制碳水化合物会最敏感地降低三酰甘油的水平。

Paragraph 15: So again, energy restriction would be kind of first order of business, but within that carbohydrate restriction will probably get you there quicker. So you just want to take the low hanging fruit off the table. And where does exercise come play a role?
因此，再次强调，限制能量摄入将是首要的任务，但在此基础上，限制碳水化合物的摄入可能会更快地帮助你达成目标。所以你只需摘掉那些容易实现的目标。那么运动又起到了什么作用呢？

Minimal role for improving insulin sensitivity. No, no, no, I'm sorry for improving lipids in general. Yeah, it can, but it can improve. It can improve. absolutely. Especially combinations of resistance training and cardiovascular exercise. Correct.
最小化对改善胰岛素敏感性的作用。对改善脂质总体而言，不是，不是，不是，抱歉。是的，它可以，但它可以改善。它可以改善。尤其是抗阻训练和心血管运动的组合。正确。

Yeah. So once it comes down to pharmacotherapy, you basically have several classes of drug. So the most obvious and the one that most people are aware of are called statins. So statins work both directly and indirectly on the problem. So directly they work by targeting an enzyme very high in the synthetic pathway of cholesterol production.
是的，一旦谈论到药物治疗，你基本上有几种类别的药物。最明显和大多数人知道的是被称为他汀类药物。他汀类药物可以直接和间接地作用在问题上。直接作用是通过靶向胆固醇合成途径中一个非常高的酵素来工作。

An enzyme is called HMG CoA reductase. And I think it's the second committed step. I might, I can be wrong on that. It's, I don't think it's the first committed step, but you, that, that enzyme gets targeted kind of ubiquitously throughout the body. And in response to that, the liver senses a reduction in the body's pool of cholesterol.
一种酶被称为HMG CoA还原酶。我认为这是第二个关键步骤，但我可能错了。我不认为它是第一个关键步骤，但这种酶在身体中得到广泛的靶向。相应地，肝脏感知到身体胆固醇池的减少。

And the liver really tries to regulate this. So the liver in response to that increases its expression of LDL receptors. So the liver itself has LDL receptors on its surface. And as the body's pool of cholesterol goes down, the liver senses this reduction and says I want to bring more cholesterol in. More LDL receptors go up and more APOB particles are coming out of circulation.
肝脏真的在试图调节这个过程。因此，为了应对这一过程，肝脏增加了其LDL受体的表达。肝脏自身表面上有LDL受体。随着身体内胆固醇储备的降低，肝脏感知到了这种降低，于是说：我想要带更多的胆固醇进来。越来越多的LDL受体表达，越来越多的APOB颗粒从血液循环中被排除。

So that's really the dominant way that they work. And in fact, that's kind of the dominant way that all of these drugs work. So another class of drug is called azetimib. It works by blocking, or we could get as technical as you want on this. It's called the Neiman Pixi one-like one, transporter in the entero site.
这就是它们起作用的主要方式。实际上，所有这些药物的主要方式都是如此。另一类药物被称为阿泽替米布。它的作用是通过阻止或阻碍某种名为"Neiman Pixi one-like one"的转运蛋白在肠道内细胞内的作用。

I like to explain this. I borrow this explanation from Tom Day spring. But the entero site is obviously the luminal gut side cell that is responsible for absorption of cholesterol. Remember I said earlier, most of the cholesterol you eat, you don't absorb. The reason you can't absorb it is an esterified cholesterol molecule cannot come in the Neiman Pixi one-like one, transporter. It's physically too large.
我喜欢解释这个问题。我借鉴了Tom Day Spring的解释。但是，肠道中的肠道细胞明显是负责吸收胆固醇的。还记得我之前说的吗？你吃的大部分胆固醇都无法被吸收。这是因为酯化胆固醇分子不能通过Neiman Pixi一样的转运蛋白进入细胞中。这个分子太大了。

But the cholesterol that you synthesize, which once it makes its way back to the liver, is secreted in bile down the intestine. That is un-esterefied and readily fits into that transporter. So I kind of describe that guy as the ticket taker at the bar. He lets everybody in as long as they fit through the door.
但你身体中合成的胆固醇，一旦返回肝脏，就会通过胆汁分泌到肠道中。它没有酯化，很容易适合这种转运蛋白。所以我把这个蛋白比喻为酒吧门口的验票员。只要符合门的尺寸限制，他就让每个人进来。

There's a checkpoint inside the bar that basically says, do we have too much cholesterol if so spit it out? And there's another door that acts more like the bouncer. And he's called the ATP binding cassette G5G8, and he spits excess cholesterol out. If that system is working fine, everything is great. But in a lot of people that ATP binding cassette doesn't work very well, and it can't properly regulate the total body pool of cholesterol. So there's a drug called a zetamib that simply blocks the ticket taker.
这个酒吧里面有一个检查站，基本上它是在询问我们的胆固醇是否过多，如果是的话就吐出它来吧？还有另一个门，起到保镖的作用。它被称为ATP结合盒G5G8，可以把多余的胆固醇吐出去。如果这个系统工作得很好，一切都很好。但是，在很多人身上，ATP结合盒不能很好地工作，不能适当地调节胆固醇的总体储备。因此，有一种药物叫做齐他米布，它只是阻止了检票员的作用。

Are there side effects to statins in a zetamib? Zetamib has virtually no side effects. You can think of it as a drug that's acting outside the body. It's sort of acting on a turn-style door in your gut. I have seen one patient get loose stools from it that became enough of an issue that we discontinued it.
在使用Zetamib的情况下，他汀类药物会有副作用吗？Zetamib几乎没有副作用。你可以把它想象成一种在身体外发挥作用的药物。它在你的肠道中作用于一个旋转式门。我曾经看到一个患者因为使用这种药物导致腹泻问题，所以我们停止了使用。

I would say that when zetamib is combined with a statin, which is very commonly done, it's not unheard of. I can't give you a number, but it could be as high as 10% that you see an elevation in transaminases, which are enzymes that are made by the liver in response to some irritation. So this is where I think it's unclear what the clinical significance of that is.
我认为当zetamib与他汀类药物结合使用时，这种情况很常见，很少会出现意外的情况。虽然我无法给出具体数字，但可能会有高达10%的患者出现转氨酶升高，这是肝脏对一些刺激产生的酶。因此，我认为目前仍不清楚这种现象的临床意义。

We tend to abort the strategy in the presence of elevated transaminases. Even though the literature says you don't need to, our view is we have other options. Why would we tolerate any inflammation if you don't need to? Statins do have side effects. So 5% of people genuinely and legitimately get a muscle soreness that can be debilitating. It could feel like the worst workout you've ever had.
我们倾向于在转氨酶升高时放弃这一策略。尽管文献称你不需要这样做，但我们的观点是我们有其他选择。如果不需要，为什么要容忍任何炎症呢？他汀类药物确实有副作用。所以有5%的人真正合法地出现肌肉酸痛，可能会对他们产生极大的影响。这可能感觉像你曾经做过的最艰苦的锻炼。

Imagine you hadn't lifted weights in six months and then you came over and I made you do the most brutal workout of your life. You would feel the next day. Every time I come over to, well, I work out often, but every time I come over to your house, you put me through the most brutal workout I've ever been through. I think you and Cam Haynes are the two people who've managed to put me through workouts that kept me sore for at least two weeks after each visit.
想象一下，如果你六个月没有举过重量，然后我让你做了一次生命中最艰苦的锻炼，第二天你会感到身体很痛。每次我过来，我经常锻炼，但每次我来到你的家，你总是让我经历过去最残酷的锻炼。我认为你和卡姆·海因斯是唯二让我经历过每次访问后至少两周肌肉疼痛的人。

So that soreness, that imagine you would have that persisting. Five percent of people get that response from a statin. And obviously that's just none. It's a non-do. There's a narrower subset of people that do get brain fog and do experience brain fog from statins. And we don't really understand the why there.
那种疼痛感会一直存在，想象一下您会有多难受。百分之五的人会对他汀药物产生这种反应，显然这是不可接受的。还有一个更狭窄的人群会因为他汀药物产生脑雾，而我们对此没有真正的了解。

We have some theories as to why maybe they're getting too much of a reduction in central cholesterol synthesis. Again, it's a subjective finding, but given that we have so many tools in the toolkit, we don't have to tolerate side effects with these drugs anymore.
我们有一些理论，认为可能是因为他们的中心胆固醇合成减少过多，导致这种情况。尽管这是一个主观的发现，但由于我们有这么多的工具，我们不必再容忍这些药物的副作用了。

There was a day when you had somebody who just had a heart attack and they're basically looking down the barrel of being on a statin for the rest of their life and they were like two of them and they had tons of side effects and it didn't matter. Today, while there are probably nine statins out there, there were really only four that we even use and at least two of them have such a low side effect profile.
曾经有一天，你接待了一个刚经历心脏病发作的人，他们基本上面临着终身用他汀类药物的困扰，而且他们必须使用其中的两种药物，这些药物有很多副作用，但是这并不重要。如今，虽然市面上可能有九种他汀药物，但实际上我们只用其中的四种，其中至少有两种的副作用极低。

They're not as potent, but they have a, I mean, potent is a bit of the potent is the wrong word. They don't have the same effect, but they're very potent because you're at least one of them you're taking at such a low dose that we've got lots of statin options.
它们不如强效，但是我想说，强效可能是不合适的字眼。它们的效果不同，但它们仍然非常有效，因为你至少在其中一种药物上都是以低剂量服用的，我们有许多他汀类药物选择。

The third side effect of statins, which again, not common, but can't be ignored is insulin resistance.
他的意思是:他重要副作用不常见，但不能忽略的是他会引起胰岛素抵抗。

So it really, and this is one of the, I think one of the benefits of at least having periodic CGM tracking is we'll see this. We had a patient who happened to be wearing CGM in general and then we started him on 10 milligrams of Resuva statin, which is probably the workhorse statin right now.
因此，我认为进行定期连续血糖监测的好处之一就是我们会看到这个情况。我们有一个正在经常穿戴连续血糖监测仪的患者，然后我们开始给他服用10毫克的Resuva他汀，这可能是目前最常用的他汀药物。

That's generic nerve for crest or, and he pings us like a couple of weeks later and he's like, man, my glucose is like 10 points up consistently from where it has normally been.
这是一般性的神经问题，可能是冠状动脉有问题，然后几周后他联系我们说，我的血糖水平比正常值高10个点，一直如此。

One hum then hot, we troubleshoot it a few things. After two months, we're like, let's just stop the crest or and see if that fixes it and it immediately fixed it. So there was, you know, we reintroduced the crest or and it happened again. So there was no doubt in my mind that, you know, we're very low doubt in my mind that crest or was responsible for that.
当时我们听到嗡嗡声，就排查了几个可能的问题。过了两个月，我们想，不如停掉压缩器，看看是否能解决问题，结果问题迅速得到了解决。随后我们重新使用压缩器，问题就又出现了。所以我很确定，压缩器是造成这个问题的原因。

And again, you could say, well, maybe that's not that clinically significant, but I would argue, why bother? I have other choices. So those are your two big ones.
再次重申，你可能说，嗯，这可能并不在临床上有意义，但我认为，为什么要麻烦呢？我有其他选择。这就是你的两个主要选择。

The next one that is really the big one are PCS K9 inhibitors. So, you know, gosh, coming up about 20 years ago, maybe a woman named Helen Hobbes made a discovery of a group of people that had a disease called familial hypercholestrolemia.
下一个真正重要的研究方向是PCS K9抑制剂。大约20年前，一个名叫Helen Hobbes的女士发现了一组人患有家族性高胆固醇血症。

So FH or familial hypercholestrolemia is a very genetic heterogeneous condition going back to that Mendelian randomization study.
FH或遗传性高胆固醇血症是一种非常遗传异质性的疾病，这可以追溯到门迪尔随机化研究。

These are the people on the far end that show us how high lipid levels cause atherosclerosis. So these people have very high cholesterol levels.
这些人位于远端，他们向我们展示了高脂血症如何引起动脉粥样硬化。因此，这些人具有非常高的胆固醇水平。

Typically, north of 300 milligrams per desoleter, their LDL cholesterol alone is by definition at least 190 milligrams per desoleter, very high incidence of atherosclerosis in these people, along with other sort of injuries.
通常情况下，每分贝尔特（单位）的低密度脂蛋白胆固醇水平超过300毫克时，这些人的LDL胆固醇水平至少190毫克/分贝尔特，严重增加他们患动脉粥样硬化和其他损伤的风险。

Like they have so much cholesterol, they accumulate it in their tendons, in their eyes. It's a really devastating condition, if not managed correctly. And she discovered this mutation in a gene for PCS K9 that codes for a protein that degrades LDL receptors. So these people had hyperfunctioning PCS K9 genes. So their genes were just chopping down all the LDL receptors in the liver. So these people weren't clearing LDL.
就像他们体内的胆固醇很高一样，他们的腱和眼睛中堆积了胆固醇。如果没有正确处理，这是一种非常破坏性的状况。她发现了一种PCS K9基因的突变，该基因编码降解LDL受体的蛋白质。因此，这些人的PCS K9基因过度活跃。因此，他们的基因只是在肝脏中砍下所有的LDL受体。因此，这些人无法清除LDL。

About five years later, another subset of the population were discovered that were the exact opposite. These people had hypofunctioning PCS K9. They had virtually unmeasurable. These people had LDL cholesterol levels of 10 to 20 milligrams per desoleter. And not surprisingly, they had no heart disease.
大约五年后，另一部分人群被发现具有完全相反的特征。这些人的PCS K9功能较弱，其含量不可测量。这些人的低密度脂蛋白胆固醇水平为每分升10至20毫克。并且毫不奇怪的是，他们没有心脏病。

So that led to the development of a couple of amazing drugs that are now used. So I take one of these drugs. I've been taking one of these drugs for, I don't know, I probably started in 2015.
因此，这促使研发出了几种令人惊叹的药物现在已经被使用。所以我服用其中一种药物。我大概是从2015年开始服用这种药物的。

So it's an injectable drug. I take it every two weeks and it's called a PCS K9 inhibitor. So the drug blocks the protein. And therefore gives me more LDL receptors. Yangs more apobiotic circulation.
这是一种可以注射的药物，叫做PCS K9抑制剂。我每两周注射一次，它可以阻塞蛋白质的作用，从而增加我的LDL受体，提高我的apo蛋白循环。

Interesting. When we were talking about side effects, I was thinking, are there any short term benefits? So I guess we'd call this positive side effects. But let's think of it more directly in line with the underlying biology. Let's say my apob is mid-range to high, let's say, 80 to 100.
有趣。我们谈论副作用时，我在想是否有任何短期的好处？所以我猜我们可以称其为积极的副作用。但是让我们更直接地考虑底层的生物学。如果我的apoB在中高水平，比如80到100，我们该怎么说呢？

And I improve my insulin resistance through nutrition, but we decide it doesn't go down so much. So we're going to continue to try and knock this number down. And I take any number of different drugs to reduce it. Do I immediately start to feel better? Nope.
通过饮食改善胰岛素抵抗情况，但我们决定数字下降不太明显。所以我们会继续努力把这个数字降下来。我还服用各种药物减少胰岛素抵抗情况。是否会立即感觉好转？不是的。

So there's no... Okay. And I think that's an important point because of the causality issue that we were talking about earlier. Because a lot of people are walking around out there feeling fine. Their apobie might be a bit high. They either know it or don't know it.
所以没有……好的。我认为这是一个重要的观点，因为我们之前谈到的因果关系问题。因为许多人走在外面感觉良好，但他们的apoB可能有点高，他们可能知道或不知道。

But they think, well, I'm feeling fine. And you gave a very rational argument earlier as to why because of the causality involved, it makes far more sense to intervene. Yeah, we don't want to rely on feeling when it comes to atherosclerosis.
但是他们认为，嗯，我感觉很好。之前你提出了一个非常合理的论点，指出由于因果关系的作用，更合理的做法是进行干预。是的，当涉及到动脉硬化时，我们不想依靠我们的感觉。

Just to put some perspective on this. When I was in medical school, we had a... And I think I even write about this in the book. We had a pathology lecture where the professor stands up there and he says, what is the most common presentation of a heart attack? And you know, a keener first-year med students hands-shoot straight up. Chest pain. Nope. That's not the most common. Oh, shoulder pain. Aren't radiating down the left arm. No, nausea. Shortness of breath. No, no, no, no. We rattled this off for a few minutes and he goes, death.
仅仅为了让大家了解一下。当我还在医学院时，我们有...... 我想我在书里甚至写了关于这个的事情。我们有一节病理学课，教授站起来问，“心脏病发作最常见的表现是什么？”你知道的，一个卖力的一年级医学生的手立刻拍了起来。胸痛。不，那不是最常见的症状。哦，肩膀疼痛，不会向左臂放射。不，恶心。呼吸急促。不，不，不，不。我们连续说了几分钟，他说，死亡。

The single most common presentation for a myocardial infarction is death. More peep. Now I would say today, that was 25 years ago. Today it's probably not the most common because advanced cardiac life support is so much better, but it's still strikingly common. So... Well, you could say that the best predictor of a heart attack is still a heart attack. Well, I mean, not saying that the best underlying predictor. Yeah.
心肌梗死最常见的表现是死亡。我现在要说，那是25年前的情况，现在可能不是最常见的了，因为先进的心脏生命支持技术更好了，但仍然相当普遍。所以...你可以说，心脏病发作的最好预测因素仍然是心脏病。我是说，并不是最好的潜在预测因素。

And actually, this hits home when I was a postdoc. I was living in San Francisco and I'll never forget this. Taking my coffee out on my porch in the morning. This is right near the UCSF Parnassus campus. And this guy's walking down the street. He's probably about my age. And I said, hello. And he said, hello. He walked a few more steps and boom. He just hit the concrete and died right in front of me. It took a minute or two to know that he was truly dead.
实际上，当我还是一名博士后时，这件事对我影响很大。当时我住在旧金山，永远不会忘记这件事。我早上拿着咖啡走到阳台上，正好在UCSF帕纳西斯校园附近。这个人从街上走过来，大概和我同龄。我招呼他，他也回应了我。然后他走了几步，突然就倒在了地上，当场死亡。花了一两分钟才确定他真正死亡了。

I'll never forget it because that's a... Yes, for a long time. You know, it's an event, right? And I followed up on this because it's family, you know, the whole thing because they wanted a report and no cocaine in a system, no prior history of any kind of health issues. But he was just strolling along and just boom, as if he'd been hit by a bus. Yeah.
我永远不会忘记这件事，因为那是一个……很长一段时间。你知道，这是一个事件，对吧？我后来进行了跟进，因为那是我们家人，整件事他们都想要一个报告，确保他没有吸食可卡因，也没有任何健康问题的先前历史。但是他只是在漫步，然后猛地像被一辆公交车撞到了一样倒下了。是啊。

And it's, I mean, again, this is just one of those things where we're going to... He's been a lot of time talking about things that feel good and feel bad when you change them, right? Like you take a person who's not sleeping well, but who thinks they're sleeping well and you ask them for a leap of faith, which is, hey, give me a month to help you sleep really well. Yeah, you're going to feel better. You might not know it now because you don't know how bad you're sleeping now.
这个说法就像我们要做的事情之一…他花了很多时间谈论改变会让人感觉好或不好的事情，比如，你遇到一个睡眠不好但自认为睡得好的人，你可以让他冒险试试，让我帮你好好地睡上一个月。是的，你会感觉更好的，现在你可能还不知道自己的睡眠有多糟糕。

You've become acclimated to this. But this is not one of those domains. You know, exercise, nutrition, sleep, all those things, when you do those things better, you feel better. But, you know, I don't want to over promise on this. You're not going to feel better in the moment when you fix your lipids, but you'll feel better when you don't have a heart attack.
你已经适应了这种状态。但这不是属于那些领域的一种。你知道的，锻炼，营养，睡眠，所有这些东西，当你做得更好时，你会感觉更好。但是，我不想对此过于承诺。当你调整你的脂质时，你不会立刻感觉更好，但当你不再患心脏病时，你会感觉更好。

So by all this logic, everybody should get their APOB measured. How early in life should people do that? Starting in their 20s, in their 30s? Certainly if you have a family history that is of any concern. Like if I could live my life over again, knowing, if I knew everything, you know, then that I know today, yeah, I would have had mine measured in my 20s.
因此，按照这种逻辑，每个人都应该检测他们的APOB。人们应该何时开始进行检测呢？20多岁还是30多岁？如果有家族病史需要关注，当然应该及早检测。如果我能重新开始我的生活，知道我今天所知道的一切，那么我会在20多岁时测试我的APOB。

You know, I didn't, I didn't get my APOB measured for the first time, probably till I was in my 40s because, you know, that's, well, yeah, maybe late 30s, early 40s, right? I had my first calcium scan when I was 35 and I had to beg boros steel to get it done because everyone was like, why does a 35 real going to do this? But I, something, I just felt something was wrong given my family history. And I'm glad I did, you know, I'm glad I did that because I learned something that, that completely changed the direction of my life.
你知道吗，我直到我40多岁才第一次测量了我的APOB水平，可能是在晚30岁或早40岁时，因为你知道的，这是很少被关注的指标。我第一次做钙化扫描是在35岁，我不得不恳求医生去做这个检查，因为每个人都问我为什么一个35岁的人需要这样做？但是，基于我的家族史，我有一种感觉是有些不对劲的。我很高兴我这么做了，因为我学到了一个东西，它完全改变了我的生活方向。

Okay, I know my APOB numbers and it, I might be that guy who's up in the, you know, above 100. So I'm going to get this treated. That's a promise to myself.
好的，我知道我的APOB指数可能超过了100，所以我会治疗它的。这是我对自己的承诺。

I'd like to just take a brief moment and thank one of our podcast sponsors, which is Inside Tracker. Inside Tracker is a personalized nutrition platform that analyzes data from your blood and DNA to help you better understand your body and help you reach your health goals. A long been a believer in getting regular blood work done for the simple reason that blood work is the only way that you can monitor the markers such as hormone markers, lipids, metabolic factors, etc.
我想花一点时间感谢我们播客的赞助商之一——Inside Tracker。Inside Tracker是一款个性化营养平台，它会分析你的血液和DNA数据，帮助你更好地了解自己的身体，并帮助你实现健康目标。长期以来，我一直相信定期进行血液检查的重要性。血液检查是唯一一种可以监测荷尔蒙标记、脂质、代谢因子等指标的方式。

The impact your immediate and long term health. One major challenge with blood work, however, is that most of the time it does not come back with any information about what to do in order to move the values for hormones, metabolic factors, lipids, etc. into the ranges that you want with Inside Tracker, changing those values becomes very straight forward because it has a personalized dashboard that you can use to address the nutrition-based, behavior-based, supplement-based approaches that you can use in order to move those values into the ranges that are optimal for you, your vitality and your longevity.
您的短期和长期健康会受到影响。然而，血液检查的一个主要难题是大多数时候它并没有返回任何关于如何使荷尔蒙、代谢因子、脂质等数值进入您所期望的范围的信息。但有了Inside Tracker，改变这些数值就变得非常简单，因为它拥有一个个性化的仪表板，您可以使用它来针对基于营养、行为和补品的方法，以使这些数值进入对您的活力和长寿最优的范围。

Inside Tracker now includes a measurement of APO-Lipoprotein B, so called APOB in their ultimate plan. APOB is a key marker of cardiovascular health and therefore there's extreme value to knowing your APOB levels. If you'd like to try Inside Tracker, you can go to Inside Tracker.com slash Huberman to get 20% off any of Inside Tracker's plans. Again, that's Inside Tracker.com slash Huberman to get 20% off.
Inside Tracker现在在他们的最终计划中包括了APO-Lipoprotein B的测量，也称为APOB。APOB是心血管健康的关键指标，因此了解您的APOB水平具有极高的价值。如果您想尝试Inside Tracker，您可以前往Inside Tracker.com/Hunerman获取Inside Tracker任何计划的8折优惠。再次提醒您，这是Inside Tracker.com/Hunerman以获取8折优惠。

We covered the three major risk factors, which were blood pressure, keeping that in check, don't smoke, and APOB. We've now talked about the things to adjust APOB levels. We did not really talk about things to adjust blood pressure. I'm assuming exercise sits as one of the forms- Exercise, news-risk. Yeah, weight management is a huge one here. You take a person who's blood, and this is one of those things where we don't immediately jump on the pharmacotherapy train with blood pressure because here there are side effects sometimes. You do have to worry about overshooting. You don't really have to worry about overshooting a person's lipids.
我们已经介绍了三个主要的风险因素，分别是血压（保持正常）、不吸烟以及 APOB （调整水平）。现在我们已经讨论了调整 APOB 水平的方法，但实际上我们没有真正讨论如何调整血压水平。我认为运动是其中一种方法，还有权衡风险的因素。是的，管理体重也是这方面的一个重要因素。你要知道，血压调整不同于血脂调整，因为有时候药物治疗会有副作用，还需要担心突然反弹的问题。而对于血脂水平，你不必担心过量的问题。

We do back off if we overshoot, but it doesn't cause a symptom. There's not a short-term immediate risk from doing that. If you overshoot somebody's blood pressure medication, you trade one problem for another problem. They become light-headed when they get up to pee at night. They fall and bang their head. That's a devastated consequence, totally unacceptable. Our goal is to see how much we can lower blood pressure without medication before we turn to medication. Let's be clear, the meds today are so much better than they used to be. Again, there was a day when the side effects of these medicines were miserable. That's simply not the case today.
我们会避免超过限度，但这不会导致任何症状。短期内没有即时风险。如果你超了某人的血压药，你就把一个问题换成了另一个问题。他们会感到头晕，起夜排尿时摔倒并撞到头。这是一个毁灭性的后果，完全不能接受。我们的目标是在使用药物之前尽可能降低血压。让我们明确，今天的药物比以前好多了。以前这些药物的副作用很糟糕。但今天情况完全不同了。

Asinhibitors, NGitensin receptor blockers, these things are very well tolerated, especially the ARBs. Almost anybody can be on these things. If we could get a person to lose 10 pounds and exercise every day, we see great effects with zone two stuff, the low-intensity cardio. Your recommendation there, I know you talk about this in the book, but I've thrown out numbers about 150 to 180 minutes per week, you go a bit higher. We go 180 to 250 to 240. I'd like to see three to four hours a week of zone two. That's an important piece and sleep is an important piece. Get the sleep right, get the exercise right. If you're overnourished, let's correct that problem. If all of that doesn't work, and by the way, that works a lot of the time. That works most of the time. If that doesn't work, then we've got pharmacotherapy.
抑制剂和血管紧张素受体拮抗剂非常易于耐受，特别是ARBs。几乎任何人都可以使用这些药物。如果我们能让一个人减轻10磅并每天锻炼，我们可以看到区域二的低强度有氧运动带来的良好影响。我知道你在书中谈论了这个问题，但是我提出了每周150到180分钟的数字，你可以更高一些。我们建议每周锻炼时间为180至250至240小时。每周进行三到四小时的区域二运动是很重要的，而睡眠也很重要。如果您有过度营养的问题，请纠正这个问题。如果所有这些都不起作用，那么我们就去试试药物治疗。这通常是有效的。

There is still a true phenomenon of essential hypertension, which is in individuals for whom all the fixable stuff has been fixed and they still have high blood pressure. We still have to medicate those folks. By the way, there's something that I want to mention here that doesn't get much attention, but it's so important, which is the effective high blood pressure on the kidney and also the brain itself. We've talked about the brain, we've talked about the heart, but the kidney doesn't get enough attention. The kidney is a remarkable organ.
还有一个真正的本质性高血压现象，即对于已经修复了所有可修复的问题仍然有高血压的个人。我们还需要为这些人服用药物。顺便提一下，这里有一些很重要的内容很少得到注意，那就是高血压对肾脏和大脑本身的影响。我们已经谈过了大脑和心脏，但肾脏没有得到足够的关注。肾脏是一个非常出色的器官。

I think if you're really in this game of trying to live longer. If you think, hey, maybe we'll live 80, 85 years, but if we start doing all of these other things and really optimizing our behaviors, that could be 95. You have to start thinking about the capacity of the kidney. Once the glomerular filtration rate falls below a certain level, you have to be very careful with how you live your life. Unfortunately, this is one of those things that is another mistake that's made in modern medicine, which is we don't pay enough attention to how to measure kidney function correctly. We rely very heavily on something called creatinine, as opposed to looking at another biomarker called cystatin C, which is far more accurate.
我认为，如果你真的打算尝试延长寿命，如果你认为，也许我们可以活到80岁、85岁，但如果我们开始做这些其他的事情，并优化我们的行为，也许可以活到95岁。你必须开始考虑肾脏的容量。一旦肾小球滤过率低于一定水平，你就必须非常小心地生活。不幸的是，这是现代医学中另一个错误，我们没有足够重视如何正确测量肾功能。我们非常依赖肌酸酐等一些东西，而不是看另一个叫做半胱氨酸蛋白C的生物标志物，这是更准确的。

We also tolerate too low of a kidney function for a person's age. We might look at someone who's 50, whose kidney function is at 65%, and say, you're totally fine, because it's true that at 65%, there is no problem. But you're not thinking, well, if this person has to live another 40 years, and this continues to go down, they're going to potentially be staring down the barrel of needing dialysis the last five years of their life. Again, you don't want to die with compromised kidney function, but never from compromised kidney function.
我们还容忍一个人年龄对应的肾功能过低。比如，我们可能看到一个50岁的人，其肾功能为65%，然后说这个人完全没问题，因为确实在65%这个水平下没问题。但是你并没有考虑到，如果这个人还要再活40年，而这个水平不断下降，那么他最后五年可能需要依靠透析生存。我们不想在妥协了肾功能的情况下去世，但更不想因为肾功能丧失而结束生命。

The hazard ratio of all-cause mortality associated with compromised kidney function is even greater than that of heart disease. Once you cross that threshold, I mean, lights out. Once you are needing dialysis, your risk of death is higher than that of someone with high blood pressure, smoking, even someone who has cancer. The kidney is so sensitive to blood pressure. This is a tiny organ that on every pump of your heart is getting 20 to 25% of your blood. So just imagine how sensitive and susceptible it is to elevated blood pressure.
所有死亡原因与受损肾功能相关的风险比心脏病甚至更高。一旦你跨过那个界限，我指的是，灯灭了。一旦你需要透析，你的死亡风险比高血压、吸烟甚至癌症的人更高。肾脏对血压非常敏感。这是一个微小的器官，每次心跳都会得到20到25%的血液。所以，想象一下，它对高血压有多么敏感和容易受到影响。

We've covered quite a bit, so just to finish up on the APOB thing. If you get tested and you're in the red zone or yellow zone, what do you do? Dietary intervention can actually have quite meaningful effects on APOB. What do you suppose could move APOB?
我们已经讲了很多内容，现在就来结束APOB的讨论。如果你接受了检测，发现APOB处于警戒区或中等区，那么你该怎么做呢？实际上，饮食干预可以对APOB产生相当显著的影响。你认为有什么因素会影响APOB吗？

Well, trans fats, so getting those out would help.
嗯，反式脂肪能引起健康问题，把它们排除在外可以有所帮助。

What about saturated fat?
饱和脂肪酸怎么样呢？这是询问饱和脂肪酸对健康的影响。

Saturated fats seem to have modest effect on APOB. So my guess is that the folks who are butter-coffee people who are consuming large amounts of saturated fat are probably not the people who are going to see the biggest effect or the most rapid effect on APOB. Again, omega-3 fat, we see a meaningful effect there.
饱和脂肪似乎对 APOB 的影响有限。因此我猜测，那些喜欢喝牛油咖啡、摄入大量饱和脂肪的人可能不会看到 APOB 效果最显著或最快的人。相反，我们可以看到 omega-3 脂肪的显著影响。

Fiber can have an effect there.
光纤可以在这方面产生影响。意思是说，光纤可以对某个特定的事物、领域或场景产生影响。例如，光纤可以提高网络速度、改善通信质量等等。

The thing that's interesting in the lipidology literature is the lowering of fast carbs, so refined carbs, the lowering of all forms of sugar. They have a really profound effect on APOB, which is interesting.
在脂质学文献中有趣的事情是降低快速碳水化合物，即精制碳水化合物，降低所有形式的糖。它们对APOB有非常深远的影响，这很有趣。

And then exercise and dietary changes like not consuming too much red meat.
然后进行运动和饮食改变，例如不过多摄入红肉。 这句话意思是，除了运动以外，改变饮食也是重要的，特别是要减少对红肉的摄入量。

No one likes to talk about red meat, but yeah, the amount of red meat that people eat in the United States and the Western world is just insane. Few corners of avoiding the major killer, Arthurus Chlerosis.
没有人喜欢谈论红肉，但是，美国和西方世界人们吃红肉的数量实在太多了。很少有人能避免主要杀手——动脉硬化。

Let's talk about cancer. Nobody wants cancer. Everybody seems to know somebody who has had or has died of cancer and probably no surprise given that it's number two on the list. What are the numbers and what can people do to offset cancer? Of course, there are a huge number of different types of cancer.
让我们谈谈癌症。没有人愿意得癌症。似乎每个人都认识有人曾经患过癌症或者已经去世，这不足为奇，因为癌症是全球第二大致死原因。癌症的发病率是多少？人们可以采取哪些措施来抵消癌症的风险？当然，癌症有许多不同类型。

Inside of this conversation, I just want to earmark that might be good to have a conversation about alcohol, which we didn't talk about in the last discussion. But if alcohol is involved or is a risk factor rather for cardiovascular disease or cerebral vascular disease, now would probably be the time to mention it. Yeah.
在这次谈话中，我想要强调一下，也许谈论一下酒精问题可能是很有意义的，上一次我们没有讨论到这个话题。但如果酒精是心血管疾病或脑血管疾病的危险因素，现在可能是提及它的时候了。是的。

This has been looked at in a number of ways. If you look at top line epidemiology and you've heard of these things called the French Paradox, which is, oh, come on, like they eat all of this fatty stuff and drink all this wine and they have a slightly lower risk of cardiovascular disease, you just have to throw that stuff out the window because there's so many confounders there that it's kind of useless epidemiology. If you really look at the data clearly and there was actually a really elegant analysis that included some genetic studies that came out in JAMA about a year ago, it's actually pretty clear that there is no dose of ethanol that is healthy.
这个问题已经以多种方式被研究过了。如果你从流行病学的高层面来看并听过所谓的法国悖论，也就是他们吃了很多高脂肪的东西，喝大量的葡萄酒，但心血管疾病的风险稍微降低了一些，那么你应该把这些东西直接丢掉，因为里面有太多混杂因素，这种流行病学并没有什么用处。如果你真正据数据分析，实际上有一个非常优雅的研究包括了一些基因研究在内，在一年前发表在JAMA上，它告诉我们一个非常明确的结论，那就是不存在任何饮酒剂量是健康的。

Okay, so there's no J-curve. So it used to be kind of this literature that said there's a J-curve associated with ethanol. So meaning at total abstinence, there's a slightly higher risk of death than if you're drinking one drink a day and then if you go beyond one drink a day, the rate of death starts to climb. The problem with that analysis, so there's just been a lot of consternation around that. But the problem with those analyses are multiple, but the most important of these are that the abstainers have a reason for abstaining typically. And those reasons can't be extracted statistically from these analyses. So I'll leave it at that without, I mean, I've written many blog posts about this if people are really interested.
好的，所以没有J型曲线。以前有一些文献说乙醇会引起J型曲线，也就是说在完全戒酒时，死亡风险会略微高于每天饮用一杯，如果超过每天饮用一杯，死亡率就会开始上升。但这种分析存在多重问题，其中最重要的是禁酒者通常有戒酒的理由，这些原因无法从这些分析中统计提取。如果人们真的感兴趣，我写了很多关于这个问题的博客文章，但我先在这里说到这里。

They can go and talk about that. I also do talk about this a little bit in the book, by the way. But the short answer is there is no dose of ethanol that is healthy. I would argue that it's not a straight line of risk, but it probably goes, I think from zero to one, there's probably no measurable harm for most people, one per day or one per week, probably one per day, up to one per day. It's probably very difficult to discern the harm, but I'm going to put a caveat on that that I'll come back to.
他们可以去谈论那个问题。顺便说一下，我在书中也稍微谈到了这个问题。但简短回答是，没有一种乙醇的剂量是健康的。我会认为这不是一个直线的风险，但是可能从零到一，对大多数人来说可能没有明显的伤害，每天一杯或每周一杯，可能是每天一杯，但很难确定伤害的程度，但是我会在此加上一个警告，稍后会回来解释。

And then I think the risk starts to climb pretty steeply after that. And I think it climbs non-linearly after that. That is my reading of the literature. Okay. So then how do you decide if you're going to have up to one drink a day? And by the way, that's not the same as seven a week because that doesn't mean seven in a day, right? Which we know is really detrimental, right?
然后我想在那之后风险会急剧上升。而且我认为风险在此之后变得非线性。这是我对文献的理解。那么你如何决定是否每天喝一杯酒呢？顺便说一句，每周一杯酒并不等于一天七杯，对吧？ 我们知道那样对健康非常有害。

Especially for the brain, right? But also the cascades that result from disrupted sleep, not just for that one night, but multiple nights. Yeah. The literature I've seen on alcohol, you know, that the most, now again, this is an emerging literature because what you're describing is exactly right. But people are now some more conservative folks are starting to place it at two drinks per week, total, beyond which you start running into issues, especially for women in terms of breast cancer risk, which is something we can circle back.
特别是大脑方面，对吧？但是也是由于睡眠不足引起的连锁反应，不仅仅是一夜，还有多个晚上。是的。我看到有关酒精的文献，你知道的，现在最多的是，再次说明一下，这是新兴的文献，因为你所描述的情况是完全正确的。但是现在有些更加保守的人开始把它定位在每周两杯饮酒总量之外，否则你就会遇到问题，特别是对于女性来说，涉及到乳腺癌的风险问题，这是我们可以回过头来谈谈的。

Yeah. I mean, look, my view is if you can not drink at all, you're better off not drinking at all. People always say to me, well, Peter, what's your view on this? And my view is I do drink. I'll go weeks at a time without having a drink. I haven't had a drink, you know, I've had one drink since I saw you last a couple weeks ago because I've been sick. So I'm thinking, well, gosh, like the deck is stacked against me right now. Why would I do anything to stack it more? But my philosophy, which is half tongue and cheek, but it's true, is like, I just don't drink that alcohol. You know, I sort of, my wife saw me do this the other day. We opened up a bottle of wine and it was a very expensive bottle of wine. And I took a sip and I was like, yeah, I just dumped my glass. I was like, I don't know, just doesn't taste right to me. And it tasted fine to her. So I don't think it was that the wine had spoiled. It was just, I didn't like the taste of it enough to justify drinking it. I was like, I don't feel like drinking it. Yeah.
是的。我的观点是，如果你能不喝酒，最好就不喝。人们经常问我，Peter，你对此有什么看法？我的观点是我喝酒，有时会连续几周不喝。自从几周前见到你后，我只喝了一杯酒，因为我病了。所以我在想，哎呀，现在我的情况已经很不利了，为什么要再做更劣的选择呢？但我的哲学（虽然有点耍嘴皮子），但是真的就是我就是不喝那种含酒精的饮料。有一天，我妻子看到我这么做，我们开了一瓶很贵的红酒，我喝了一口，然后我就把酒倒了。我说，“我不知道，这味道对我来说不太对劲。”对我妻子来说，酒还是好喝的。所以我想这不是因为红酒变质了，只是因为我不喜欢它的味道，不喜欢喝它而已。

I've fortunate that there were times in like, you know, certainly college and portions of graduate school and I drank, but I've never really enjoyed the taste or experience of alcohol. So I, all the alcohol in the plane could disappear. I wouldn't even notice, but I'll have one every once in a while. I'm sort of of that mindset. But great to hear that zero is better than any because I think everyone agrees on that.
我很幸运，在我生命中有一些时刻，比如大学和研究生阶段的某些时期，我尝试过喝酒，但我从来没有真正享受酒的口感或体验。所以，如果飞机上的所有酒都消失了，我甚至都不会注意。但是偶尔我也会喝一杯。我就是这种心态。但是听到零酒精比任何酒都好，我很高兴，因为我认为每个人都同意这一点。

So it doesn't appear that alcohol can be directly linked to cardiovascular disease and cerebral vascular disease. Although, well, these indirect effects are insulin, yeah, insulin sensitivity. And suicide. I think the impact of sleep on cardiovascular cerebral vascular disease is profound.
因此，似乎无法直接将酒精与心血管疾病和脑血管疾病联系起来。然而，这些间接影响是胰岛素敏感性和自杀。我认为睡眠对心血管和脑血管疾病的影响是深远的。

And I do think that the impact of ethanol on sleep is underappreciated. Yeah. And here I think we should do a nod to Matt Walker, the great Matt Walker because, you know, 10 years ago, if someone had a conversation about sleep and how critical it is and how not getting enough quality sleep is dangerous. People would have just kind of shake their heads and say, what's the evidence for that? But I think Matt really deserves most of the credit for alerting people to these issues around not getting enough sleep. It's just remarkable what's happened in the last decade, thanks to Matt. And while we're on that topic, we have the other next horseman of death, the neurodegenerative disease is, I think those were also heavily impacted, especially on the dementia side by ethanol.
我认为乙醇对睡眠的影响被人们低估了。是的，在这里，我认为我们应该向伟大的马特·沃克致敬，因为，你知道的，如果10年前有人谈论睡眠，以及它对健康的重要性，以及不足够的高质量睡眠会有危险，人们可能只会摇摇头说这有什么证据吗？但我认为马特真正应该得到警示人们关于不足够睡眠问题的信任与认可。过去十年，由于马特的贡献，令人惊讶的是发生了什么。而在我们谈论这个话题时，我们还有其他的“死亡骑士”——神经退行性疾病，我认为这些疾病也受到了乙醇的严重影响，特别是在痴呆症方面。

So again, I want to be careful when I say this stuff, right? I don't believe in fear-mongering. Okay. I just said a moment ago, I'll say it again. I drink alcohol and I'm going to continue to drink alcohol. But I think that one has to make the trade-offs, which is like, if I really do love the taste of certain Spanish wines, I really do love the taste of certain tequila, certain mescals, and I really do love the taste of certain weird esoteric Belgian beers. And it really does give me pleasure to consume those things in the same way it gives me pleasure to consume certain foods that are quite vapid, right?
再次强调，我说这些话时要小心谨慎，我不相信恐吓战术。我刚才说过了，我会再说一遍，我喝酒，我会继续喝酒。但我认为我们必须做出权衡，就像我真的喜欢某些西班牙葡萄酒的口味，真的喜欢某些龙舌兰酒、某些梅斯卡尔酒的口味，真的喜欢某些奇怪的比利时啤酒的口味。像我喜欢消费某些毫无意义的食物一样，它们确实给我带来愉悦。

You know, there's no upside in consuming a brownie that my kid just made, except for the fact that my kid just made it, and it's fun to eat the brownie with them, right? So, you know, we come back to this thing about, like, longevity is also about health span. And part of health span is quality of life. And, you know, I write about this in the book that I think there is a day when my approach to this was purely an engineering approach, which was, we are going to optimize every molecule of my being for this. And if you go so far down that rabbit hole that the quality of your life deteriorates, what's the point?
你知道，吃我孩子刚刚做的布朗尼没有好处，除了它是我孩子做的，和他们一起吃布朗尼很有趣吧？所以，你知道，我们回到这件事情上，即长寿也与健康期有关。而健康期的一部分是生活质量。你知道，我在书中写到过这一点，我认为有一天我的方法纯粹是一种工程方法，即我们要使我的每个分子最优化。但是，如果你深入探究到生活质量下降的程度，那还有什么意义呢？

So, that's why I think for somebody like you, who says, like, you could take all the alcohol at the face of you that I wouldn't even notice, then that's a great reason not to bother drinking. I wouldn't put myself at the opposite end of that spectrum, but I'm probably further to the spectrum, you know, where, yeah, if you told me I could never drink alcohol again, I would be fine with it, but I'd be giving something up that I enjoy. But at the same time, I know if I have two drinks with dinner, my sleep sucks, and therefore, that's just a threshold, I rarely, rarely cross. I certainly have my vices. Alcohol just doesn't happen to be one of them.
因此，我认为像您这样的人，说您可以喝很多酒，我甚至都不会注意到，这就是不必要喝酒的好理由。我不会把自己放在相反的地位上，但我可能更倾向于谨慎，您知道，如果您告诉我我再也不能喝酒了，我会觉得没事，但我会失去一些我喜欢的东西。但同时，我知道如果我晚餐喝两杯酒，我的睡眠很差，因此，这就是一个门槛，我很少凌驾于此。我当然有我的恶习，但酒并不是其中之一。

What about cancer? Again, nobody wants cancer. We've all known people have died of cancer or have had cancer. What can be done to reduce one's risk of cancer? Well, you asked earlier about the numbers. Let's throw some numbers out there, right? So globally, we're talking about 11, 12 million deaths per year, about half the number of AACVD, still a staggering number.
癌症怎么样呢？再说一遍，没有人想要得癌症。我们都知道有人因为癌症去世或患有癌症。有什么办法可以降低患癌症的风险呢？嗯，你之前问到了数字。让我们来说一些数字，对吧？全球每年死亡人数约为1100万到1200万，大约是心脑血管疾病死亡人数的一半，仍然是一个惊人的数字。

At the individual level, put it this way, somewhere between one and three and one in four chance, anyone listening to this or watching this is going to get cancer in their lifetime. But what's the probability they will die from that cancer? About one in six chance of dying. Okay. So is it true that every male gets prostate cancer?
在个人层面上，我们可以这样说，你们中间有一到四分之一的几率在一生中得到癌症。那么得癌症后死亡的概率是多少呢？死亡的概率大约是六分之一。好的。那么每个男性都得前列腺癌是真的吗？

In other words, every man will die with prostate cancer and some will die from it. You and I have prostate cancer right now. Thank you for informing. Yes. Hopefully, we will not die of it. We should not die of it. Prostate cancer, colon cancer are cancers that no one should ever die from because they're so easy to screen for. They are so easy to treat when they are in their infancy that it's totally unacceptable that people are dying from this.
换句话说，每个男性最终都会患上前列腺癌，一些人可能会因此死亡。你和我现在就患有前列腺癌。感谢您告知。是的，希望我们不会死于它。我们不应该死于它。前列腺癌、结肠癌是从未应该因此死亡的癌症，因为它们非常容易进行筛查。只要在早期治疗，它们就非常容易治疗，人们死于这种疾病是完全不可接受的。

There are other cancers for which I can't really say that. Breast cancer, much more complicated. Pancreatic cancer, much more complicated. Gleobustomy multiformy, much more complicated. So as you said a second ago, cancer is not a disease. It is a category of diseases. It's not just that each organ is different and breast differs from pancreatic. It's that within breast cancer, ERPR positive, her two new positive is a totally different disease from the triple negative. breast cancers. Those with raccomutations or non-raccomutations. Even putting that aside, just looking at the hormone profile of the individual breast cancers, they're totally different diseases. So it's not just that breast cancer is different from prostate cancer. It's that all breast cancers are quite different. Maybe I should frame the question a little differently than given the vast number of different types of cancers and categories. Well, no, no, no. Your question is still a fair one. I just wanted to throw that caveat out there.
有其他癌症我无法这样说。乳腺癌更加复杂，胰腺癌更加复杂，化生性胶质母细胞瘤更加复杂。正如你刚才所说，癌症不是一种疾病，而是一类疾病。不仅仅是每个器官都不同，乳腺癌不同于胰腺癌，而是在乳腺癌中，ER/PR阳性、Her2/neu阳性与三阴性相比，它们是完全不同的疾病。有具有RAC突变或非RAC突变的乳腺癌。即使把这些都放在一边，单纯从个体乳腺癌的激素特征来看，它们仍然是完全不同的疾病。所以不仅仅是乳腺癌与前列腺癌不同，所有的乳腺癌也都非常不同。也许我应该用一个不同的方式来提出这个问题，考虑到不同类型和类别的癌症数量如此之多。那么，不，不，不，你的问题仍然是公平的。我只是想再次强调一下这个注意事项。

So now to your question, okay, so what do we know? It turns out that we can very comfortably speak to several things. One is the role that genes play. So maybe I'll just spend one second on a gene 101 thing for the viewer.
现在回答你的问题，我们知道什么呢？事实证明，我们能够很舒适地谈论几件事情。其中一个是基因所起的作用。因此，也许我能够花一点时间为观众讲解一下基因101的内容。

We want to differentiate between what are called germline mutations and somatic mutations. So your germline and my germline are set. When we were born, our germline mutations, any mutations we have in germline genes are inherited from our parents. It's a non-negotiable. You got those things. So question one is how much of cancer results from those types of genetic mutations? And the answer is very little, less than 5%. So very, you know, you mentioned one moment ago, Braca.
我们希望区分所谓的生殖细胞突变和体细胞突变。因此，你的生殖细胞和我的生殖细胞已经确定。当我们出生时，我们从父母那里继承了任何生殖细胞基因的突变。这是不可谈判的。这些东西已经属于你了。所以问题一是：癌症有多少是由于这些类型的遗传突变引起的？答案是非常少，不到5%。因此，你说的布拉卡刚刚被提到。

Okay, so mutations in Braca are germline mutations. A woman will get a Braca mutation from one of her parents and we will often have a sense of that just from the family history. You know, when mom and sister and grandmother had breast cancer, you've got a breast cancer gene. Now it might be Braca. It might be another gene that's not Braca. But there's no ambiguity. And we test for these genes, mostly just for insurance purposes, frankly, but there's no ambiguity that that was a germline transmission of a gene that is driving cancer. But 95% of cancers are not arising from germline mutations.
好的，Braca基因突变是生殖系突变。女性会从父母中的一方获得Braca基因突变，通常从家族史中可以得知。你知道，当母亲、姐妹和祖母患有乳腺癌时，你有一个乳腺癌基因。现在可能是Braca基因，也可能是其他不是Braca的基因。但没有任何歧义。我们进行这些基因的测试，主要是为了保险目的，但是肯定是来自生殖系基因突变，驱动着癌症的产生。但是95%的癌症并非由生殖系突变引起。

They are arising from somatic mutations or acquired mutations. So the question then becomes what is driving somatic mutation? And the two clearest indications of drivers of somatic mutation are smoking and obesity. Smoking we've talked about. Let's put that aside for a moment.
它们是由躯体突变或获得性突变引起的。因此，问题就变成了是什么推动了躯体变异？而导致躯体变异的两个最明显的驱动因素是吸烟和肥胖。吸烟我们已经讨论过了。让我们暂且把它放在一边。

I'm so surprised about obesity. I don't know why I'm surprised, but I've never heard this. I'm probably just naive to the literature. Yeah. So obesity is now the second most prevalent environmental driver of cancer. Now I will argue and I think I argue this in the book, hopefully pretty convincingly. I don't think it's obesity per se. I think obesity is just a masquerading proxy. What is obesity? It's a disease that is being found by the body mass index.
我对肥胖问题感到非常惊讶。我不知道为什么会这么惊讶，但是我以前从未听说过这个问题。可能是因为我对这方面的文献比较天真。是的。所以现在肥胖已经成为癌症环境影响的第二大因素了。现在我想争论的是，我认为我在书中争论过，而且应该相当有说服力。我认为它并不是肥胖本身导致的问题，而是肥胖成为了一个掩盖的代理因素。那什么是肥胖？它是通过身体质量指数来确定的一种疾病。

Well first of all, I don't think I'm obese, but I'm way overweight on BMI. You probably are too. So let's just ignore it. I'm clinically diagnosable as obese. Are you? Oh no, well, well clinically, maybe as a BMI over 30. I don't think you're probably there. No, but if I measure my weight by height, my BMI is probably 27 or 28. Okay, it's been a little while since I've checked. I can only know body fat percentages and things like that.
首先，我认为我不是肥胖的，但我的BMI指数过高。你可能也一样。所以我们就忽略它吧。我在临床上被诊断为肥胖。你呢？噢，也许在BMI超过30时，临床上可能如此。我认为你可能还没到那里。但是，如果我按身高测量我的体重，我的BMI指数可能是27或28。好的，我很久没检查了。我只知道身体脂肪百分比之类的东西。

So basically, BMI is a far from perfect proxy, but at the population level, it's what we use. I wish we would get off it, by the way. I think it's really crap because it doesn't take into account lean versus non-leaf issue. I think we could get better data if we looked at waist to height ratio. That's a way better metric. So this is just a quick test for everybody. Because I'm going to argue your BMI is less relevant to me than your eye color. But if your waist circumference is more than 50% of your height, you should be concerned.
基本上，身体质量指数（BMI）并不是完美的代理指标，但在人口层面上，它是我们所使用的。顺便说一句，我希望我们能够不再使用它。我认为它非常糟糕，因为它没有考虑到瘦体重与非瘦体重之间的区别。如果我们看腰围与身高比例，我认为我们可以获得更好的数据。所以这只是给大家的一个快速测试。因为我要说，对我来说，你的BMI比你的眼睛颜色不那么重要。但如果你的腰围超过了你身高的50％，你应该担心。

Okay, well then I'm okay. Yeah, you're fine by that metric, right? Yeah, that's important. So if you're a six feet tall, your waist better be under 36 inches. And if it's over, I would argue that's the definition of obesity, not your BMI being over 30. So back to this issue, because we're using such a crude measurement, it basically is catching a whole bunch of stuff, but the question is what's driving it?
好的，那么我没问题。是的，按照那个标准，你没问题，对吧？是的，那很重要。所以如果你身高六英尺，你的腰围最好控制在36英寸以下。如果超过，我认为这就是肥胖的定义，而不是BMI超过30。所以回到这个问题上，因为我们使用的是非常粗略的衡量方法，它基本上捕捉了很多东西，但问题是是什么在驱动它？

And I think if you really look at the physiology of cancer, I don't think it's obesity. I think it's two things that come with obesity. Insulin resistance, which is two thirds to three quarters of obese individuals are insulin resistant and inflammation. And I think those two things, with the inflammation and the immune dysfunction, with the insulin resistance and the hyperbasically tonic growth stimulus that's coming, that's what's driving cancer.
我认为如果你真正关注癌症的生理学，我不认为它是肥胖引起的。我认为它是与肥胖相关的两个因素：胰岛素抵抗和炎症。我认为这两个因素，连同炎症和免疫功能障碍，胰岛素抵抗和高度活跃的生长刺激，是导致癌症的原因。

So again, is it because a person is storing extra fat, you know, and their love handles that that's driving. the risk of cancer? No, that's, those are just two things that are coming along for the ride. So beyond those two things, and along with certain, there are also certain environmental toxins we absolutely know are doing this, right?
那么，是因为人体储存额外脂肪，比如爱 handles，才会增加患癌症的风险吗？不，这些只是同时存在的两个因素。除了这两个因素外，还有一些肯定会导致这种风险的环境毒素。

So we understand that people who have exposure to asbestos have a much higher risk of certain types of lung cancers and things like that. But for the most part, those are our big risks. Beyond that, we talk about alcohol in certain cases, absolutely. Alcohol is a carcinogen. It's the dose part still isn't clear to me. I don't know, is one drink a day moving the needle much on cancer risk per se? It's not clear. And it might depend on those genetic predispositions.
我们知道接触石棉的人患上某些肺癌等疾病的风险要高得多，但大部分情况下，这些就是我们需要担心的主要风险了。除此之外，我们也会在某些情况下谈论饮酒，因为酒精是一种致癌物。但是饮酒对癌症风险的影响仍不清楚，一个人每天喝一杯酒是否会显著提高他本身患癌症的风险也不确定，具体情况可能因人而异，可能取决于遗传倾向性。

Yes. So, yeah, if step one is don't get cancer, you have no control over your genes. You have control over smoking. You have control over insulin sensitivity. I wish I could sit here and tell you that there is a proven anti-cancer diet or that if you do x amount of exercise per week, you're going to not get cancer. We just don't have a fraction of the control over cancer that we have with cardiovascular disease. We don't understand the disease well enough.
是的。所以，如果第一步是不要得癌症，你无法控制你的基因。但你可以控制你的吸烟习惯和胰岛素敏感度。我希望我可以告诉你有一个已被证明对抗癌症有效的饮食或者如果你每周做x量的运动，你就不会得癌症。但我们对癌症的控制能力远不如心血管疾病。我们对癌症的认识还不够深入。

So we don't understand kind of the initiation process and the propagation process. And we have to rely much more on screening. Are there good whole body screens for cancer? In other words, can I walk into a tube or a cylinder rather and get screened for the presence of tumors, any and everywhere in the body outside the brain? Because the brain is a little harder to get to, right?
因此，我们不理解癌症发病过程和传播过程。而我们必须更多地依靠筛查。是否存在适用于癌症的全身筛查方法？换句话说，我是否可以走进一个管道或圆柱体中，进行全身筛查以检测身体任何部位（除了大脑外）的肿瘤存在？因为大脑有点难以到达，对吧？

Believe it or not, the brain is actually pretty easy to screen for. Because so fatty and floating and water. Well, and also the head, when you put the head into an MRI scanner, there's no movement. It's the least motion artifact is in the brain. So when you use something called diffusion weighted imaging with background subtraction in an MRI, a technology that was actually pioneered in the brain for stroke identification, it's also really good at looking for tumors as well.
信不信由你，大脑其实非常容易筛查。因为大脑含脂肪较多、漂浮在水中，而且头在进行MRI扫描时没有运动。大脑是最少受运动伪影影响的部位。因此，当使用MRI中的扩散加权成像技术进行背景减除时，就可以用来筛查肿瘤，而这项技术实际上是用于中风识别方面的脑部研究的先驱。

So let me make the argument for why screening matters. So this is again, kind of an area where I go far down a rabbit hole in a way that I think traditional medicine would argue against. So my argument for screening is an argument at the individual level and it goes as follows. To my knowledge, there is not a single example of a cancer that is more effectively treated when the burden of cancer cells in the body is higher than when it is lower.
让我为筛查的重要性辩护。这可能是一个领域，我在这方面的看法与传统医学不同。我认为个人水平的筛查是有必要的。我的论点是，据我所知，没有一个癌症例子表明体内的癌细胞负担越高，治疗就越有效。反之，癌细胞负担越低，治疗就越有效。

So the two examples I think I talk about in the book are colon cancer and breast cancer. So when you take an individual with stage four colon cancer, that means that the cancer has left the colon and is now outside of the colon. So it's usually in the liver at a minimum, potentially in the lungs or in the brain. That person's five year survival is very low, their 10 year survival is zero. We will treat them with a very aggressive regimen of multiple drugs. And again, you'll get a five year survival of maybe 10 to 20% and by 10 years nobody's alive.
在书中，我想讨论的两个例子是结肠癌和乳腺癌。当你面对一个患有第四阶段结肠癌的患者时，这意味着癌细胞已经离开了结肠并且扩散到了身体其他部位，通常最少会扩散到肝脏，可能也会扩散到肺部或大脑。这个人的五年生存率非常低，十年生存率为零。我们会使用非常强力的多种药物组合治疗。即使治疗成功，五年生存率可能只有10%到20%，而到了十年后也没有人幸存。

If you take a person with stage three colon cancer, so the colon cancer is big and it's even in the lymph nodes around the colon, but at least grossly you can't see colon cancer cell. You can't see those cells in the liver. Microscopically, of course, we know they're there because if you don't treat those patients, they still die of colon cancer, but you whack them with the same chemo regimen that you were going to give the metastatic patients. 80% of those people are alive in five years. So night and day difference in survival.
如果你接到一个第三期结肠癌的患者，也就是说该结肠癌很大，甚至在结肠周围的淋巴结中，但至少在肉眼上你看不到结肠癌细胞。你在肝脏中也看不到这些细胞。当然，从显微镜的角度来看，我们知道它们存在，因为如果你不治疗这些患者，他们仍会死于结肠癌，但是你可以使用相同的化疗方案来治疗那些转移性患者。其中80％在五年内仍然存活。这是生存率上的巨大差异。

What's the difference? When the person with metastatic cancer, you're treating a person with hundreds of billions of cells in the adjuvant setting, which is what we call it, we call it adjuvant when you treat people who have only microscopic disease, you're treating billions of cells. The same is true with breast cancer. So we have the clinical trial data to put them side by side. So rule number one is don't get cancer. Rule number two is catch cancer as early as possible if you're going to get it.
这段话想表达什么？ 这段话主要是说在治疗癌症时，癌症的早期发现和治疗非常重要。治疗晚期肿瘤的患者需要对数十亿个细胞进行治疗，而治疗早期病例时只需要对数亿个细胞进行治疗。通过临床试验数据的对比可以证明这一点。因此，预防癌症和早期发现癌症是非常重要的。

This brings us to your question of how do you screen for it? We basically screen, the first line of screening is imaging, is sort of visualization. So you have cancers that occur outside the body that you can look at directly. So skin cancer, you can look directly at the skin. Asophageal gastric colon cancer, those are outside the body, right? Mouth to anus embryologically is outside the body. So you can put a scope in and you can look directly at the cancer.
这就引出了你关于如何筛查它的问题。我们的筛查方式主要是通过影像进行可视化。因此，你可以直接查看身体外部发生的癌症。例如，皮肤癌可以直接查看皮肤。食管、胃、结肠癌也是身体外部发生的癌症，对吧？从口到肛门在胚胎学上也是身体外部的。因此，你可以将内窥镜放入体内直接观察癌症。

But for all other cancers that are inside the body, yeah, you have to rely on some sort of imaging modality. Although now we're starting to look at things called liquid biopsy. So blood tests that are looking for cell-free DNA and the cell-free DNA gives us a sense of based on the epigenetic signature and what you're looking at. Hey, is there a cancer in the body? And if so, what tissue is potentially coming from based on these epigenetic signatures?
但对于其他在体内的所有癌症，你必须依靠某种成像技术。虽然现在我们开始研究称为液体活检的东西。血液测试寻找细胞自由DNA，而细胞自由DNA基于表观遗传学标记并根据你所看到的东西，让我们感觉到身体中是否有癌症？如果是这样，基于这些表观遗传标记，可能来自哪些组织？

So the problem with relying on any one modality is a problem of sensitivity and specificity optimization. Now with MRI scanners, which are in some ways the best way to do this because they don't have radiation. So you don't want to be incurring damage as you do this. The irony of doing a whole body CT scan, screening for cancer is your whole body CT scan would be close to 30 to 50 milliseverance of radiation. It's staggering some of radiation.
因此，依靠单一的诊断方式存在灵敏度和特异性优化的问题。MRI扫描器在某些方面是最好的方式，因为它们不会产生辐射。因此，在进行这种诊断时不要导致身体受损。正在进行全身CT扫描以筛查癌症的讽刺是，您的全身CT扫描将接受近30至50毫西弗（milisievert）的辐射。这是令人惊讶的辐射水平。

So does that mean that people should, sorry to pull you off this, but I was going to ask about this anyway, avoiding going through the whole body scanner at the airport. Noise, so low, so low. Yeah, going through a whole body scanner at the airport or even getting a dexoscan. I mean, these are trivial amounts of radiation. What about flying? You hear that pilots get more cancer at the scan. If you're a pilot who's flying over the North Pole back and forth and back and forth, you're probably getting five to 10 milliseverts a year. The NRC suggests that nobody should get more than 50 milliseverts a year.
那是否意味着人们应该尽量避免在机场通过全身扫描器呢？噪音很小，确实很小。是的，在机场里通过全身扫描器，甚至进行dexoscan，所受的辐射量都很微不足道。但是坐飞机呢？听说飞行员在通过扫描器时患癌症的比例更高。如果你是一名飞行员，反复地在北极来回飞行，那么你每年可能会接受五到十毫西弗的辐射。美国核能委员会建议每年不应超过五十毫西弗的辐射。

So you and I both travel a fair amount, but typical travel for the busy person. Let's say two round trip flights of more than two hours per month and an international trip every three months. Probably still less than a millisever to year. Living at sea level, one millisever to year, living at a mile elevation. If you live in Denver, you're at two milliseberts a year. I have to ask standing in front of the microwave. I'm just, yeah, we've got friends. They ask and with or without testes on the counter. That's an inside joke that unfortunately, unfortunately deserves no description and Peter's not referring to me.
所以你和我都经常旅行，但对于忙碌的人来说是典型的旅行方式。假设每月两次超过两个小时的往返航班，每三个月一次国际旅行。可能仍然少于每年一毫西弗。生活在海平面上，每年一毫西弗，如果你生活在一英里高的地方，在丹佛，你每年有两毫西弗。我不得不站在微波炉前面问一下。是的，我们有朋友。他们问有没有在柜台上的睾丸进行测试。这是一个内部玩笑，不幸的是，它没有什么描述，彼得并不是指我。

But people worry about other sources of radiation. So it doesn't sound like the microwave has been certain. What are the other major sources of radiation? I mean, outside of sort of nuclear stuff, where things go exactly wrong. Yeah, you live near a plant or there's been a, yeah, there's been a, it's mostly, it's mostly at the hands of medical professionals, right? It's the CT scanner and the PET scanner are hands down, the biggest source of radiation.
但人们担心其他放射源。因此，微波炉似乎并不是肯定的放射源。除了核能事故外，还有哪些主要的放射源？我的意思是，除了核能事故外，那些事情恰恰出了差错。是的，你住在一个工厂附近，或者发生了......主要是医疗专业人员的行为，是吗？CT扫描和PET扫描无疑是最大的放射源。

What about the X-rays of the dentist when they go very low? But they scurry behind the wall, but they're under the lead blanket. They're very low, relatively speaking. The fluoroscopy is very high. They tend to try to cover up all of you that, so for example, if they were doing a florescopic study of your kidney because you had a stone or if you were getting an injection into, you know, if they were doing a florescopic guided injection of one of your discs in your neck, that would be a locally pretty high dose, but they're going to cover the hell out of you elsewhere.
牙医的X射线仪的辐射很低，但他们会躲在墙后面，而且在铅毯下面，相对而言，是非常低的。荧光透视的辐射非常高，他们往往试图对您进行全面的保护。例如，如果他们正在对您的肾脏进行荧光透视研究，因为您有结石，或者如果他们正在对您颈椎的一个盘进行荧光透视引导注射，那将是局部相当高剂量，但他们会在其他部位全力保护您。

And again, if you get one of these things that's not the end of the world, but boy, I wouldn't want to be getting one a month and back to the point about screening, you know, a chest abdomen pelvis CT scan is probably, I mean, look, there's probably a scanner out there now that's moving fast enough that it's much lower, but I'll give you an example. Okay. Remember how I talked about we do CT angiograms on all of our patients for coronary artery disease? And off the shelf scanner for this is 20 milli-seed radiation. Okay. So calibrate me because 40% of your annual allotment.
再次提醒，如果你得了这些病症不是世界末日，但是我可不想每个月都得这个病。关于筛查，进行胸部、腹部和骨盆的 CT 扫描可能是最好的办法。当然，现在可能已经有速度更快、辐射更低的扫描仪了，但是我给你举个例子吧。你还记得我们如何对所有患者进行冠状动脉疾病 CT 血管造影吗？目前市面上的扫描仪辐射量为 20 毫西弗，这相当于你年度辐射总量的 40%左右，请您参考。

Oh, wow. So the medical practitioners really are the major culprits here. That's right. So what we say is, and I think most doctors are now realizing this is, no, no, it behooves you to pay a little bit more to go to a really good place that can do that scan for two milli-seedverts, meaning they have a much faster CT scanner, much better software and they're better engineers. So they have better engineering that they can do on the scanner to get that done. So, so if someone listening to this, here's my take, do not get a CT scan or any imaging study without asking, how much radiation am I seeing?
哦，哇。所以医疗从业者确实是这里的主要罪犯。没错。所以我们要说的是，我认为大多数医生现在已经意识到这一点，你最好花一点钱去一个能以2毫秒的辐射量进行扫描的真正好的地方，这意味着他们拥有更快的CT扫描仪、更好的软件以及更好的工程师。因此，他们可以在扫描仪上进行更好的工程设计以完成任务。所以，如果有人在听时，这是我的建议，请务必在进行CT扫描或任何影像学研究之前问一下，我看到了多少辐射量？

And if a person can't tell you how many milli-seedverts of radiation you're being exposed to, then just say, I'm going to wait a minute until somebody can tell me that. I realize. And keep in mind, 50, if you know, if 50 is the most you should ever be exposed to in a year, there better be a damn good reason why I'm going to get 25 in a day. Now there are some people who have to do this. If you're a cancer patient and they're scanning you as a part of your treatment, I mean, you have to pick and choose between those two opportunities. So I don't want to, I don't want to create some fear mongering where, oh my god, if you hit 50 in a year, your hose, no, it's just, I wouldn't want to hit 50 a year every year for my whole life. And I certainly wouldn't want to be hitting hundreds a year for any period of time. I think we're just trying to raise awareness and also calibrate people to, you know, what the sources are and so they make, can make good choices, not to place them into his chronic state of fear, or even a acute state of fear. So for that reason, we prefer MRI scanners because there is no radiation.
如果某人无法告诉你受到多少毫西弗的辐射暴露，那么就说，我会等一会儿，直到有人告诉我。我明白。并且要记住，如果50是你在一年内应该暴露的最多的量，那么如果我一天暴露了25，就必须有一个非常好的理由。现在有些人是必须这样做的。如果你是癌症患者，他们正在通过扫描来治疗你，那么你必须在这两个机会中进行选择。所以我不想制造恐惧，哦，我的天啊，如果你在一年内达到了50，你就完了，不，我只是不想每年一年地达到50，更不想在任何时间段内达到数百个。我想我们只是试图提高人们的意识，并校准他们的认知，以便他们做出好的选择，而不是使他们处于慢性恐惧状态，甚至是急性恐惧状态。因此，出于这个原因，我们更喜欢MRI扫描仪，因为没有辐射。

I realize this might sound like a specialized circumstance, but I'll just start off with my own, which is when I was a graduate student, I worked with fixatives, paraformaldehyde, paraformaldehyde, excuse me, gluteraldehyde. We know that these are mutagens. They mutate cells, not good. You do some molecular biology in the lab, you use DNA and tercolating, die those little bands and gels.
我意识到这可能听起来像是一个专门的情况，但我只是先从我自己的经历开始说起。当我还是研究生的时候，我使用了一些固定剂，比如聚甲醛和戊二醛。我们知道这些物质是致突变剂。它们会改变细胞，对人体不利。在实验室里进行分子生物学研究时，我们会使用DNA和热敏感染剂，用来染色分离细胞和蛋白。

The reason they label is because they get between the DNA, not good to get into your own DNA. And that's a very specialized circumstance. I also injected triturative radioactyl proling into the animals and things of that sort. Again, very specialized. And yet, most people, I think, will be exposed to pesticides. They'll put stuff on their lawn or they'll have paint thinners and things of that sort.
它们被标为有害是因为它们会进入 DNA 中间，这会对你自己的 DNA 造成不良影响，这是一个非常特殊的情况。我也注射过被碾磨过的放射性探针到动物和其他物体中，同样都是非常特殊的情况。然而，大多数人，我认为，会接触到农药。他们会往草坪上撒东西，或者使用稀释剂和其他类似物品。

Is there any sense of what the average, if one can, average risk is incurred in terms of carcinogens just through interaction with weed killers, paint thinner, detergents around the house that we now know, there's some major lawsuits that have been successful against the manufacturers of these things. What is the real cancer risk created by having those kinds of solvents and pesticides and things around? I don't think I know, truthfully. I think it's very complicated to calculate such things when their ubiquity is so high. So one argument is, look, it's kind of baked into the baseline prevalence of cancer today because these things are so ubiquitous.
在我们现在所知的杀虫剂、稀释剂和家庭清洁剂的接触过程中，有没有一种平均风险存在，如果有的话，这种平均风险指的是患癌风险。我们知道，有一些对这些产品的制造商提起的重要诉讼取得了成功。那么，这些有害溶剂和农药带来的真正癌症风险是多少呢？实话实说，我觉得我不知道。这种东西的普遍性如此之高，所以计算起来非常复杂。因此，有一种观点是：看，这种东西现在已经如此普遍，基线癌症患病率已经融入其中。

Yeah, it's best dose. In California, for whatever reason, it seems that there's in its best dose warning on pretty much every building. If you look carefully enough, except maybe the one's built in the last five years. I don't think I've ever worked in a building where the elevator was updated in terms of the inspection. It was almost like 10 years back. You always see it while you're in the elevator. No one seems to worry about those or where there was not in its best dose warning or a lead warning. It seems like it's just kind of everywhere and they're noting it in these little flags.
是的，这是最佳剂量。在加利福尼亚州，不管出于什么原因，几乎每栋建筑物上都有最佳剂量警告标识，如果你仔细观察的话，除了可能最近五年新建的建筑。我觉得我从来没有在一个电梯检查更新的大楼工作过。那几乎是十年前的事情了。你总是在电梯里看到这个警告标识。似乎没有人关注没有最佳剂量或铅警告的地方。这种情况似乎随处可见，它们用这些小旗标记着。

I don't walk around worried about it. I don't lose sleep over it. But it sounds like a real risk or else they wouldn't bother, right? Clearly they're just trying to cover their legal masks. Yeah, it might go more CYA than anything at this point. I don't know how much of a risk asbestos poses when it's not being agitated. In other words, I don't know that the asbestos in the ceiling, four layers up is really a problem. But if they had to come in here and rip this ceiling apart, I don't know that I want to be in here either.
我不会担心这个问题，也不会因此失眠。但听起来这真的是个风险，否则他们就不会费心操心了，对吧？显然，他们只是试图掩盖他们的法律责任。现在看来，这可能只是一种“自我保护”。当它不受干扰时，我不知道石棉有多大的风险。换句话说，我不知道天花板上四层的石棉是否真的是问题。但如果他们必须撕毁这个天花板，我也不知道我是否想留在这里。

It was post 9-11 a lot of the work they're selling the World Trade Center pits because that's what was left. Sadly, we're developed cancers, probably from exposure to those kinds of things. I mean, I would argue it's also the fuel, just the unbelievable amount of pollution, micro pollution that was in the air following those things. I mean, that's devastating stuff. So, yeah, those are fortunately the outlier events that are dramatic. But again, my focus is basically, look, I could hermetically seal myself somewhere in the world, maybe, and maybe that would reduce my risk by 1%. But I'm going to focus my energy on what I control, because that's really hard for me to control.
在911事件之后，他们大部分的工作都是销售世贸中心遗址上的东西，因为那是唯一剩下的。可悲的是，我们发展出了癌症，很可能是因为暴露在这些物质中导致的。我的意思是，我认为这也与燃料有关，是由于随之而来的不可思议的大量污染，微小污染物在空气中。这真是毁灭性的东西。所以，是的，这些是幸运情况中的异常事件，但是我的焦点基本上是，我可以在世界的某个地方密封自己，也许可以将我的风险降低1％。但是我会专注于我自己能够控制的事情，因为那真的很难控制。

I like focusing my things on, I like focusing my energy on things I can control. What I can control is the timing and frequency of my screening. That's, I can't control my genes anymore. They are what they are. I got whatever predisposing cancer genes I'm going to get. I might be lucky in this regard and that I seem to get all these horrible heart disease genes and maybe not as much. But you can also argue, I got, there are cancer bad genes in me that we don't really know about because everybody was dying of heart disease so young. But boy, am I going to control the screening thing?
我喜欢把注意力集中在我能控制的事情上，更喜欢把精力聚焦在那些我能掌控的事情上。我能掌控的是筛查的时间和频率。我的基因已经无法控制了，它们就是它们的样子。我可能会很幸运，没有患上那些可怕的心脏病基因，但也有可能有患癌症的基因，只是因为大家很年轻就死于心脏病，我们还不太了解这些基因。但是，我一定会掌控好筛查的事情。

What source of genetic screening do you recommend to your patients? Because there are a lot of them. There's 23 of me. There's whole genome sequencing in place available now in a variety of formats. This is actually one of the questions our research team is working on as we speak. So, we're trying to decide, so we do genetic screening for certain things like ApoE, it was a gene we want to know in everybody. For its role in neurodegenerative disease. Correct. Specifically, in Alzheimer's disease.
你向你的病人推荐哪种基因筛查来源呢？因为现在有许多这样的来源。有23andMe，现在也有全基因组测序可供选择。我们的研究团队正在探讨这个问题。所以我们正在努力决定，我们要进行基因筛查以确定某些特定物质，比如ApoE基因，这是我们希望了解所有人的基因，因为它与神经退行性疾病有关。确切地说是与阿尔茨海默病有关。

We are selectively using cancer screening in some patients. But in our practice, it's less important because we're generally so aggressive anyway that it turns out to be a little bit moot. We don't learn a lot in the genetic screening that's changing our screening practices because we're so thorough in our family history and we're so aggressive in everybody regardless of family history. But I think there's a place for these things, for example, if you're looking for reimbursement on certain tests, give an example.
在一些患者身上，我们有选择地使用癌症筛查。但在我们的实践中，这不是很重要，因为我们通常非常积极，所以这变得有点无意义。我们在基因筛查方面没有得到很多的学习，因为我们对家族史非常仔细，而且在所有人中都非常积极，不论家族史如何。但我认为这些事情有其适用的地方，例如，如果你正在寻找某些测试的报销。

So colon cancer historically was not covered by a colonoscopy screening for colon cancer, it was not covered until you were 50. That's been bumped to 45. We still think everybody should be screened no later than 40. No, I haven't had one, so I suppose I should. Yeah. I'm 50 and I've had three already. So again, why? Because colon cancer is not just the third leading cause of cancer death, it's 100% preventable.
肠癌历史上并不被列入肠镜筛查的范畴，只有在50岁才开始被纳入筛查范畴，但现在已经提前到了45岁。我们仍然认为每个人都应该在40岁之前进行筛查。我自己还没有接受过筛查，所以我想我应该尽快去做。我今年50岁了，已经做了三次筛查。因为肠癌不仅是导致癌症死亡的第三大原因，更重要的是它是可以百分之百预防的。

Why? Because every colon cancer comes from a polyp. And every polyp can be seen on a colonoscopy. So there's simply no reason to not know that. And that has to be weighed against the cost of the colonoscopy, both the financial cost and the risks, which are very low but not zero. There's a risk that comes from electrolyte abnormalities and hypertension from the bowel prep. There's a risk from the sedation. And there's obviously a risk of bleeding or perforation that comes from the colonoscopy itself. Again, in a generally healthy person, those risks are so low that they're almost difficult to quantify as evidenced by a recent New England Journal of Medicine paper that was a very anti-colonoscopy paper, which I won't get into because it's probably a little bit of attention.
为什么呢？因为每个结肠癌都来自肠息肉。而每个肠息肉都可以在结肠镜检查中看到。所以没有理由不知道这个。而这需要权衡结肠镜检查的成本，包括金钱成本和风险，风险非常低，但并非零。从肠准备中的电解质异常和高血压会带来风险。从镇静剂中也会有风险。而显然，结肠镜检查本身也会有出血或穿孔的风险。再次强调，对于一般健康的人来说，这些风险非常小，难以定量化，这在最近发表的《新英格兰医学杂志》上有所体现，那是一篇非常反感结肠镜检查的文章，我不会详细介绍，因为这可能会吸引一些不必要的关注。

But what's interesting is despite being a very anti-colonoscopy paper, this paper does a better job demonstrating the safety of colonoscopy than anything else. It just was an oddly designed experiment. So the biggest challenge with aggressive screening posture is the specificity problem, which is when you stack more and more modalities around these things, you're going to start finding things that aren't cancer. So MRI has a very high sensitivity in English.
但有趣的是，尽管这篇论文非常反对结肠镜检，但它比其他任何东西都更好地证明了结肠镜检的安全性。只不过这是一个奇怪设计的实验。因此，积极筛查的最大挑战是特异性问题，当你在这些事情周围堆叠更多的模态时，你将开始发现并非都是癌症。因此，MRI在英语中具有非常高的敏感性。

That just means if a cancer is present and MRI is very likely to see it, but it has a very low specificity, which means in English, it will see a bunch of things and think they are cancer when they are not. And it's most troubled by glandular tissue. The glandular tissue is the Achilles heel of MRI. And therefore when you use, as we do, whole body MRI for cancer screening, we tell our patients going in, it's like a 25% chance we're going to find something that is not cancer, but will require us to do further investigation. If you're not cool with that, which is totally fine, we probably shouldn't do this.
这意味着如果肿瘤存在，MRI很有可能检测到它，但其特异性非常低，这意味着它会检测到很多东西，认为它们是癌症，但实际上它们并不是。而且，它最困扰的是腺组织。腺组织是MRI的软肋。因此，当我们使用全身MRI进行癌症筛查时，我们会告诉我们的患者，有25％的机会我们会发现一些并非癌症，但需要进一步调查。如果您不满意这样的结果，这是完全可以理解的，我们可能就不应该这样做。

And again, most people are okay with that, but it helps to set that expectation going in that you're going to probably be chasing your tail, looking at some stupid thyroid nodule that is absolutely nothing. I mean, I can't tell you how many useless thyroid nodules we've had to get ultrasounds on that prove to be absolutely nothing. And you have to follow them for a couple of years to make sure they're nothing. What is the typical cost of a whole body MRI?
再次强调，大多数人都可以接受这个事实，但最好在开始时就设定这样的期望，即你可能会不停地追踪某些毫无意义的甲状腺结节。我的意思是，我们必须进行多少次无用的甲状腺结节超声检查才能证明它们毫无意义，让我无法统计。而且你还必须跟随它们几年，确保它们是无害的。全身MRI的 typi cal成本是多少？ 意思是：在进行医学检查时，有些检查可能会浪费时间和金钱，比如甲状腺结节的检查经常是不必要的。全身MRI的典型成本取决于地区和提供服务的医疗机构。

And so for people who are not your patients, how would they go about getting those? Because I think most people's general practitioner is not going to script that out for them. Correct. I don't know the short answer because I don't know how many different places are doing it. I can tell you that we use a couple of different facilities and I should disclose that I'm a founder of one of them. But we use a scanner that probably we send our patients to anywhere they want to go, but within a certain company that we like that's not a company I have an affiliation with. I believe they're charging about $2,500.
那么对于不是你的病人的人来说，他们该如何获得这些资料呢？因为我认为大多数人的家庭医生不会为他们提供这些资料。没错。我不知道简短的答案，因为我不知道有多少不同的地方在提供这项服务。我可以告诉你，我们使用了几个不同的设施，我应该披露我是它们之一的创始人。但我们使用的扫描仪可能会被我们的病人送到任何他们想去的地方，但在我们喜欢的某个公司内，该公司不是我所属的公司。我相信他们收费约为2500美元。

Since you don't have an affiliation, can you mention that? Because for instance, you are not my physician, sadly, for me and luckily for you. But I'd love to get a whole body MRI. So where can I, what is this company?
由于您没有所属机构，您能在提及时说明吗？例如，您不是我的医生，对我来说很遗憾，但对您来说很幸运。但我想进行全身MRI检查，那么这个公司在哪里？它是什么公司？

So the company that makes the MRI that we're using right now is called Pranuvo. I interviewed the chief technology officer and the head radiologist of that company on one of my podcasts. It's a super interesting technology based out of Vancouver. And for a long time, that was the only scanner in the world. So I had my first scan back in 2015. I went up to Vancouver to get it done. Probably had my first two up there. We've now opened locations all over the country, so they've got one in the Bay Area. They probably got one here in LA. I know they have one in Dallas. So they've got them all over the place.
现在我们正在使用的MRI生产公司名为Pranuvo。我曾经在我的播客中采访过该公司的首席技术官和主任放射科医师，这是一项总部位于温哥华的非常有趣的科技。很长一段时间以来，这是世界上唯一的扫描仪。我第一次进行扫描是在2015年，我去温哥华进行了两次扫描。现在我们公司已经在全国开设了多个地点，所以他们在湾区，洛杉矶可能也有一个，我知道他们在达拉斯有一个。所以他们在各个地方都有这样的设备。

Great. And then the company that I'm affiliated with is a different type of company that does all sorts of diagnostics. But among them is we have a Pranuvo scanner in that company. That company is called Biograph and that's in the Bay Area. Biograph. Biograph. Spelled as one.
太好了。我所涉及的公司是一家不同类型的公司，做各种各样的诊断。但其中之一是我们在这家公司拥有一个Pranuvo扫描仪。这家公司叫做Biograph，位于湾区。Biograph，全拼为一。

Well, that's very helpful in terms of understanding the general risk and ways to offset cancer to the extent that one can. And certainly what the what the consideration should be. Number three on the list of ways to die. We should just title this ways to die. Or we should title this how not to die too early.
嗯，这对于理解普遍风险以及抵消癌症的方法非常有帮助，以尽可能的程度。并且当然应该考虑的因素。在死亡方式列表中排名第三。我们应该把它命名为死亡方式。或者我们也应该把它命名为如何避免过早死亡。

Neurodegenerative disease. This is an area I'm somewhat familiar with, not because of my own experience, thankfully, but because of my relationship to the neuroscience community. And last time I checked, I was told that everyone experiences some age-related cognitive decline.
神经退行性疾病。这是我有些熟悉的领域，不是因为自己的经历，幸运的是，而是因为我与神经科学界的关系。上次我查过，被告知每个人都会经历一些与年龄有关的认知能力衰退。

So we all get less proficient at focus memory, complex context dependent tasks, switching all that stuff as we get older. And it's the slope of that line that really can be controlled to some extent. And that Alzheimer's dementia represents just a steep acceleration downward acceleration of all of that. That was what I was told. I'm guessing that even though I reside in the not kind of, but I'm residing in that community, that some of that is being revised, especially with respect to the underlying causes of Alzheimer's, because there's a lot of controversy even scandal around this whole APP, APOB, amaloid plaque, tingle, stuff, which is the stuff of textbooks, biomedical students and neuroscience students.
随着年龄的增长，我们都会变得对焦点记忆、复杂背景下的任务和切换任务变得更慢。但是，这个坡度可以在一定程度上得到控制。而老年痴呆症代表了全部这些要素的急剧加速下降，这是我听到的解释。尽管我属于其中的一部分群体，但我猜测，由于老年痴呆症的潜在原因存在很多争议，甚至丑闻，特别是涉及到APP、APOB、淀粉样斑块等一些医学和神经科学学科中的文本书籍和知识点。

What is the story with neurodegenerative disease Alzheimer's in particular? How can we offset it? And perhaps as importantly, how can we all slow our own cognitive decline irrespective of whether or not we get what is called Alzheimer's dementia?
关于神经退行性疾病阿尔茨海默病，情况如何？我们如何抵消它？而且同样重要的是，无论我们是否患有所谓的阿尔茨海默痴呆，我们如何减缓自己的认知下降？

So Alzheimer's disease is both the most prevalent form of dementia and the most prevalent neurodegenerative disease. So it occupies that unique spot. We're talking about roughly six million people in the United States have Alzheimer's disease. That's one in... Let's see. I mean... About 2% of the total... Total population. But that doesn't include those with mild cognitive impairment or pre-dimension or other forms of dementia. And of course, the right metric is not what percent of the population, which of course includes children, things like that. It's a more function of age. Yeah.
阿尔茨海默病是最常见的痴呆症和最常见的神经退行性疾病，因此其具有独特的地位。在美国，大约有六百万人患有阿尔茨海默病，占总人口约2％。但这并不包括那些有轻度认知障碍、痴呆前期或其他类型痴呆症的人。当然，正确的度量标准不是人口占比，因为这当然包括儿童等人群，而是更与年龄有关。

But is age the major risk factor for having Alzheimer's? Lately, we say with glaucoma, that disease I'm much more familiar with because my lab worked on it for many years. The biggest risk factor for getting glaucoma is age. The greatest risk factor for cardiovascular disease is age. The greatest risk factor for cancer is age. We tend to not spend a lot of time talking about that because it's not a modifiable risk. So we tend to focus on modifiable risk factors.
但是年龄是患上阿尔茨海默症的主要风险因素吗？最近，我们说青光眼，这是一种我非常熟悉的疾病，因为我的实验室研究它多年。患上青光眼的最大风险因素是年龄。心血管疾病最大的风险因素是年龄。癌症的最大风险因素是年龄。我们倾向于不花太多时间谈论这一点，因为它不是可修改的风险因素。因此，我们倾向于关注可修改的风险因素。

So what else can we tell you just to give you kind of lay of the land?
那么我们还能告诉您些什么，来为您展示一下整体情景呢？

So the second most prevalent neurodegenerative disease would probably be Louis body dementia followed by Parkinson's disease. Although the rate of growth of Parkinson's disease is the highest. So I think we'd probably be most, you know, those three diseases we want to really be paying a lot of attention to.
因此，第二大常见的神经退行性疾病可能是路易体痴呆症，紧随其后的是帕金森病。尽管帕金森病的增长率最高。因此，我认为我们应该非常重视这三种疾病。

As you know, there are a lot of other neurodegenerative diseases. Every one of these things is devastating. Like multiple sclerosis, ALS, Huntington disease. These are awful, awful diseases. There are also other kinds of dementia. Seller dementia is not Alzheimer's dementia, but it produces comparable symptoms. Each of these things, by the way, are slightly different. Louis body is a dementia. It's a demanding disease, but it also has a movement component. So it sort of sits on a spectrum that's sort of, you know, loosely halfway between Alzheimer's disease and Parkinson's disease.
正如您所知，还有许多其他神经退行性疾病。每一个都是毁灭性的，例如多发性硬化症、肌萎缩侧索硬化症、亨廷顿病。这些都是可怕的疾病。还有其他类型的痴呆症。轻度认知障碍并不是阿尔茨海默病，但它会产生类似的症状。顺便说一下，每种病都略有不同。路易体痴呆症就是一种痴呆症，它是一种具有运动成分的艰难疾病。因此，它在阿尔茨海默病和帕金森病之间的谱系上大致处于中间地带。

We talked obviously about age being the number one risk factor. Kind of not that interesting because can't do anything about it. So the real goal is as we age, what are we doing to reduce risk?
很明显，我们谈论的是年龄是最重要的风险因素。但这并不是很有趣，因为我们无法做任何改变。因此，真正的目标是随着年龄增长，我们正在采取什么措施来降低风险？

Well, let's start with an important gene. The gene that everybody's heard of certainly came up a lot on the limitless special where Chris Hemsworth was, you know, made the decision to reveal something that none of us expected when we started that whole series, which was that he ended up being homozygous for the ApoE4 isoform.
好的，我们从一个重要的基因开始说起。这个基因肯定在无极限特别节目中被频繁提及，当克里斯·海姆斯沃斯被告知他的结果时，我们都没有想到他最终是纯合子型的ApoE4亚型。

Maybe folks understand we have two copies of every gene. So for gene X, you have copy that you got from your mom and copy that you got from your dad. And the ApoE gene is kind of a unique gene and that it really, it has three different isoforms that are all considered normal. None of them are mutations. So you have the E2 isoform, the E3 isoform and the E4 isoform. The E4 isoform is the OG isoform. That's the one that we have historically had as far back as we can go. We actually think the E4 isoform offered a lot of advantages back in the day. It's a bit of a pro-inflammatory isoform and it certainly offered protection against infections, especially parasitic infections in the CNS, which would have been a really important thing to select for 200,000 years ago.
可能很多人都知道，我们的每个基因都有两个副本。例如，基因X有一个来自妈妈的副本和一个来自爸爸的副本。而ApoE基因是一种独特的基因，因为它有三种不同的亚型，而且都被认为是正常的，没有突变。你有E2亚型、E3亚型和E4亚型。E4亚型是最原始的亚型。我们认为在远古时期，E4亚型提供了很多优势。它是一种促炎症的亚型，可以有效地防御感染，特别是中枢神经系统的寄生虫感染，这在20万年前一定是非常重要的选择。

Kind of parasites get into the CNS. Me of blood, brain, barrier, thick skull. I mean, I'm not calling, I'm not talking about you, you have a thick skull, but I mean, it just seems like parasites and other tissues would be an issue because what we're talking about here is brain disease. Yeah, yeah. Anyway, well, it also could have predicted them. It probably offered some protection outside of the brain as well.
有一种寄生虫会进入中枢神经系统。这些寄生虫包括血液中的、脑组织中的、血脑屏障以及厚颅骨。我不是在说你，你的颅骨很厚，但是似乎寄生虫和其他组织会成为问题，因为我们讨论的是大脑疾病。嗯，它也可能会提供一些保护，不仅限于大脑的外部。

Anyway, the E3 isoform, I think showed up, I think 50,000 years ago, and the E2 isoform showed up very recently about 10,000 years ago. Now today, we realize that there's a clear stratification of risk when it comes to Alzheimer's disease that tracks with those isoforms.
无论如何，我认为E3亚型出现在大约50,000年前，而E2亚型则是在最近的约10,000年前出现的。现在，我们意识到患阿尔茨海默病时存在明显的风险层次分化，这与这些亚型相关。

So because you have two copies, you basically have six combinations of how you can combine those genes. You could be 223, 24333, 3444. The prevalence of them is basically as follows. Three three is now the most common, three is the most common. So double three is 55 ish percent of the population. The next most common is the three four, which is about 25 percent of the population. And then after that, most things are kind of a rounding error. So two threes and two fours would be the next most common. Four fours are very rare, and two twos are the rarest of them all.
因为你有两份基因副本，所以你基本上有六种组合方式。你可以是223、24333、3444。它们的普遍性如下：333现在是最常见的，3是最常见的。所以双333是人口的约55%。其次最常见的是三四，约占人口的25%。其它大部分组合方式只是舍入误差。两份3和两份4是其次最常见。四个4非常少见，两个2是所有中最为罕见的。

Two twos are less than 1 percent. Four fours are about 1 to 2 percent. Very important point here is that the E4 genes are not deterministic. So they're highly associated with the risk, but they're not deterministic. There are at least three deterministic genes in Alzheimer's disease. One is called PSEN1. Another one is called PSEN2 and another one is called APP. Those genes collectively make up about 1 percent of cases of people with Alzheimer's disease. So they're fortunately very rare genes, but sadly they are deterministic. Meaning if you have those genes, you do get Alzheimer's disease.
两个二比1％还少。四个四约为1至2％。这里非常重要的一点是E4基因不是决定性的。因此它们与风险密切相关，但它们不是决定性的。在阿尔茨海默病中至少有三个决定性基因。一个叫PSEN1，另一个叫PSEN2，还有一个叫APP。这些基因共占患有阿尔茨海默病人的1％左右。所以它们是非常罕见的基因，但可悲的是它们是决定性的。意味着如果你有这些基因，你会患上阿尔茨海默病。

And what's perhaps most devastating about those genes is how early the onset is of the disease. These are people that are usually getting Alzheimer's disease in their fifties. So we do have a patient in our practice. Actually, she's spoken about this very openly, whose mom had one of these genes. And she got Alzheimer's disease in her early fifties was, I think she might have made it into her sixties before she died. So, you know, absolutely devastating consequences here.
这些基因最可怕的可能在于这种疾病的早发情况。这些患者通常在五十多岁时便患上阿尔茨海默病，这是一个非常早的起病年龄。我们诊所里有一个患者，她的母亲就携带这种基因。她在五十多岁时得了阿尔茨海默病，最后大概在六十多岁时去世。这些情况可以说是毁灭性的后果。

Why do people with Alzheimer's die? Because I know about the hippocampal degeneration, hippocampus, of course, being an area of the brain important for learning and memory. But is their brain stem degeneration? Do they lose breathing centers or cardiovascular control? No, usually what happens is it's sort of failure to thrive, aspiration, things like that. Yeah.
为什么患有阿尔茨海默症的人会死亡？因为我了解海马体退化，海马体是大脑中重要的学习和记忆区域。但他们的脑干是否有退化？他们是否失去了呼吸中枢或心血管控制？通常不是这样，他们的死因是身体衰竭，误吸等原因。

So it's usually they just stop eating or they can't control secretions. They aspirate. They get an ammonia. Or they really lose the ability to even sense like pain in their body. And therefore, like they'll get an ulcer and they don't realize it and it'll become cellulitic and they'll develop a horrible infection and response to it. I see. So it's a body vulnerability.
通常情况下，老年人会停止进食或无法控制分泌物，这会导致吸入物质并感染氨滴。或者，他们会失去身体中疼痛的感觉。因此，他们可能会患上溃疡，但并不会意识到，最终导致发生细胞化和严重的感染。所以，这是身体上的脆弱性问题。

The reason I ask is everyone's a while at news report will come out based on a legitimate case study where they'll do a scan on some person and discover that they're missing literally half their cerebral cortex, like huge chunks of brain. And they're functioning relatively normally. And so here we're talking about a neurodegenerative disease. Relatively, it's widespread, but there are a few hot spots, of course, in the brain that degenerate more profoundly than others and the people dying.
我问的原因是，偶尔会听到一些新闻报道，基于一些准确的案例研究，他们会对某些人进行扫描，发现他们真的缺失了一半的大脑皮层，就好像大脑的一大块都消失了一样，但他们的功能相对正常。所以这里我们谈论的是一种神经退行性疾病。相对来说，它是很普遍的，但肯定有一些热点，比其他区域更严重退化，人们也会因此死去。

So that makes sense. It extends to lack of peripheral awareness or control and then some acute injury or infection. Got it. You mentioned earlier some of the controversy, right? So what are we talking about here?
这很有道理。它延伸到缺乏周边意识或控制，然后可能出现急性损伤或感染。明白了。你之前提到了一些争议，对吧？那么我们在这里讨论的是什么？

Well, it's, and I do write about this at length in the chapter on Alzheimer's disease because I think this is a very important point, right? Which is the index case for Alzheimer's disease. There's always an index case, right? There's the quote-unquote patient zero. The index case was a woman who, you know, a hundred years later, we realized had an APP mutation. I was, these are APP or PSCN1, but she had one of these deterministic genes that led to a very early onset of disease, which by the way, without which we may not have come up with the diagnosis because had she just got Alzheimer's disease in her 70s, it would have just been referred to as senility, which is, you know, was not interesting enough to pay attention to.
好的，这是一个非常重要的观点，我在关于阿尔茨海默病的章节中详细阐述了这个观点。阿尔茨海默病的指数病例非常重要。每个疾病都有一个指数病例，就像"患者零号"一样。这位女士是指数病例，我们一百年后才意识到她拥有一个APP变异基因。她拥有这些确定性基因之一，导致了疾病的早期发生。如果没有这个基因，我们可能想不到这个疾病的诊断，因为如果她在70岁时患上阿尔茨海默病，这只会被称为老年痴呆，这并没有足够的吸引力来引起注意。

But I think it probably set the field on the path towards an over-emphasis on emaloid beta. And it's not really clear how important emaloid is, which is not to say it's not important. It is important. And there's no ambiguity that emaloid is responsible for the changes that we see in the brain. But it's not crystal clear because there are lots of autopsies that are done on people that are completely healthy and have died with no cognitive impairment and they're chock full of emaloid.
但我认为这可能会导致过度强调阿尔茨海默病的β淀粉样蛋白。而目前我们并不清楚β淀粉样蛋白的重要性，这并不是说它不重要，事实上它是重要的。我们没有置疑的是β淀粉样蛋白负责导致我们在大脑中看到的变化。但是并不是非常明确，因为有很多尸检的结果显示一些人即使完全健康，在死亡时也没有认知障碍，但大脑内仍积聚了很多β淀粉样蛋白。

So what we don't fully understand is exactly what does removing amyloid do. The other thing that complicates the story is there has been no shortage of drugs that target amyloid that have seemed unsuccessful. And just to clarify, when you say amyloid, you mean people have died with their brains, examined in autopsies, and see that there are tons of so-called amyloid plaques. Different than arterial plaques, of course, but within the brain, so that the two hallmarks of Alzheimer's, histopathologically would be plaques and tangles.
我们还不完全理解清楚去除淀粉样蛋白的具体作用。另外一个使情况复杂的因素是已经有不少针对淀粉样蛋白的药物似乎都没有取得成功。当谈到淀粉样蛋白时，我们指的是人们死后进行尸检时，在他们的大脑中发现了大量所谓的淀粉样斑块，这是不同于动脉斑块的。因此，阿尔茨海默病的两个病理特征将被归类为斑块和缠结。

And even that now is, of course, coming under question. But for, that's what we teach every neuroscience. Yeah. Graduate students, that's what we teach every undergraduate. It's also what we teach every medical student, and not just at Stanford, but everywhere.
如今，即使这个观点也受到了质疑。然而，这是我们教授神经科学的基础。我们教授研究生，我们教授本科生。我们也教授每一个医学生，不仅在斯坦福，而是全球普遍如此。

So I have heard that the link between APP and whether or not one develops genes for a relay to APP, and whether or not it's cleaved at one side or another, which is what you were describing and risk for Alzheimer's. Yeah. So it's basically a question. It's a cleaved question, right? So, people with the APP mutation, I think, have one extra cleavage site. They result in one extra cleaved of amyloid, and then it misfolds. And the misfolding is what the plaque is that's being created. It also then predisposes them to the neurofibulatory tangles. And again, but all this is under question now, right?
据我所听，APP与是否会产生中继基因以及是否会在某一侧断裂之间存在联系，这就是您所描述的关于阿尔茨海默病风险的问题。是啊。因此，这基本上是一个问题。这是一个断裂性的问题，对吗？所以，我认为患有APP基因突变的人会有一个额外的断裂位点。他们会产生一个额外的淀粉样蛋白断裂，然后它会误折叠。这种误折叠就是正在被创建的斑块。它还会让他们更容易患神经纤维缠结。但是现在所有这些都存在疑问，对吗？

Well, I mean, this is what I was told. And when I look, it sounds like there were some early, there were some papers early in the chain of discovery and the research in Alzheimer's that were either wrong because they were falsified, intentionally falsified. There was intentionally falsified paper on one particular amyloid variant. And that clearly set the field back a decade because a lot of people went down that rabbit hole based on deliberately falsified data. Then what happened to that guy? I'm going to assume I don't know why I assume it was the guy, but what happened to that guy? Yeah. It's a good question.
嗯，我的意思是，这是我听到的。当我仔细看的时候，似乎在阿尔兹海默症的发现和研究早期，有一些文章是错误的，因为它们被故意伪造了。有一篇特定的淀粉样变异体的论文是被故意伪造的。这显然使领域倒退了十年，因为很多人根据故意伪造的数据陷入了那个兔子洞。那个人后来怎么了呢？我想不出为什么，但我认为这是个好问题。

I think I wrote one piece about it when it happened. I actually reached out to the person who broke the story because I wanted to have them on my podcast. And I forget why he didn't do it. I forget why he wouldn't commit to it or something like that. I thought it was a little odd because I thought this would be a great way to talk about this. I do not know what came of that scandal. In other words, I haven't paid attention to it for probably nine months. So I don't know, obviously the paper has probably been recalled, but I don't know what disciplinary action was taken.
当发生这件事情时，我写了一篇关于它的文章。实际上，我联系了那个报道此事的人，因为我想邀请他参加我的播客节目。我忘记他为什么没有参加，或者为什么他不能承诺参加。我认为这有点奇怪，因为我认为这是一个谈论这件事情的好方法。我不知道那个丑闻的结果是什么。换句话说，我大概已经九个月没有关注过它了。所以我不知道该报纸是否被召回了，或者是否采取了何种纪律行动。

The field is, I don't know. I don't want to speak like I'm in the field because I'm not. So I don't want to be careful what I say, but I think the field is probably in a bit of a crisis because there's been so many bets placed on anti-Maloid therapies and M.A.L.O.D. biomarkers and M.A.L.O.D. everything. And we just haven't seen efficacy, right? So contrast that with cardiovascular disease where you have this APOB biomarker, you understand the pathophysiology of how it works, you have drugs that target it.
这个领域，我不太确定。我不想像在领域里一样说话，因为我不是领域内的人。所以我不得不小心说话，但我认为这个领域可能陷入了一些危机，因为已经有很多押注，注重反-M.A.L.O.D.治疗和M.A.L.O.D生物标记以及M.A.L.O.D.每个方面。但我们还没有看到疗效，对吧？所以与心血管疾病相比，你有这个APOB生物标志物，你了解它的病理生理学如何工作，你有针对它的药物。

So you have a biomarker. So you give somebody a drug that lowers APOB, you can measure APOB. That's a really important and obvious thing to be able to do. And then you have clinical outcomes, which is, oh, when you take a bunch of people in primary prevention, it takes this long before you see an effect. In secondary prevention, it only takes this long to see an effect, right? Different risk stratifications, all these different things. We don't have any of that for Alzheimer's disease. But we do use, there are now serum M.A.L.O.D. biomarkers that we use. And we do track these in our highest risk patients, but only because we believe, and I don't know if we're right, by the way, that lower is better. And therefore, if we make these changes to you, and your serum M.A.L.O.D. levels come down, that that tells us something about what's happening in your brain that's favorable.
所以你有了一种生物标记。例如你给某人用一种降低APOB的药物，你可以测量APOB。这是一个非常重要且显而易见的能力。然后你有临床结果，比如，当你在初级预防中使用大量人群，需要很长时间才能看到效果。对于次级预防，只需要较短的时间就可以看到效果。我们没有任何关于阿尔茨海默病的这些信息。但是现在我们使用了血清M.A.L.O.D.生物标记，而且我们只在最高风险的患者中追踪这些标记，这是因为我们相信，虽然我不知道我们是否正确，即越低越好。因此，如果我们对您进行这些更改，并且您的血清M.A.L.O.D.水平下降，那么这告诉我们一些有利于脑部发生的变化。

But I mean, I would hate to represent that we are practicing nearly the level of precision medicine there that we are in cardiovascular medicine. When it comes to Alzheimer's disease, maybe take a step back. When it comes to brain health, I think there are a handful of things that seem unequivocally true. And there's a lot of stuff that is signal to noise ratio that's really low.
我的意思是，我不想让大家误认为我们在阿尔茨海默病方面的精准医疗水平已经和心血管医学一样了。当涉及到阿尔茨海默病时，也许应该退后一步。当涉及到大脑健康时，我认为有一些事情是毋庸置疑的。而且有很多的信噪比真的很低。

So the unequivocally true things for brain health are sleep matters. Another unequivocally true thing for brain health is that lower LDL cholesterol and APOB is better than higher. Another thing that is unequivocally true is not having type 2 diabetes matters. So having really green ins— Yeah, by insulin sensitive. The insulin sensitive matters. Sleeping adequately matters. Having lower lipids matters. Those three things are clear and the fourth one that is unequivocally clear is exercise matters.
因此，对于大脑健康来说，确凿无疑的事情就是睡眠很重要。另一个确凿无疑的事情是，低LDL胆固醇和APOB比高的更好。还有一件确凿无疑的事情就是，不患2型糖尿病很重要。所以要拥有良好的胰岛素敏感度，足够的睡眠和低的血脂是很重要的。这三件事情是清楚的，第四件确凿无疑的是锻炼很重要。

More specific form of exercise. So I tried to answer this question on a recent AMA that I did because the answer is more is always better. But if you—if I tried to have one of our analysts look at it through the lens of, if you could only exercise three hours a week, what would be the highest use case and our interpretation of the literature was if you could only spend three hours a week exercising, you'd be best off doing one hour of low intensity cardio, one hour of strength, and one hour of interval training. So if someone said like, I only want the minimum effective dose, you're going to get a pretty good bang for your buck doing that.
这是关于具体的锻炼方式的问题。在我最近的AMA中，我尝试回答这个问题，因为答案是越多越好。但是，如果我们从这样的角度看待它——你只能每周锻炼三个小时，那么什么锻炼方式最有效呢？我们解读文献后发现，如果你只能花三个小时锻炼，最好的方式是进行一小时的低强度有氧运动、一小时的力量训练和一小时的间歇训练。所以，如果有人想要最小有效量，这样锻炼是非常实惠的。

But I would argue if your brain really matters to you, do more. One hour of interval training is no joke. No. Because you're going to spread that out over probably at least two workouts. But under those four things are basically the only thing where there's no ambiguity about the benefit. What about head hits? Don't hit your head. Seems almost assuredly true, in a susceptible individual for sure. So I put that, yeah, maybe we could include that as well.
但是我认为如果你真的很在乎你的大脑，那就要多加努力。一个小时的间歇训练不是开玩笑的。不，因为你可能需要至少两次锻炼才能完成。但是在这四个方面，基本上唯一没有关于益处的歧义。那头撞呢？不要碰头。对于容易受感染的个人来说，这几乎可以肯定。所以我认为，是的，也许我们可以把这个包括在内。

Well, I just mentioned, you know, one of the things I've been learning recently is I know you boxed for a number of years. When you were younger, I boxed a little bit, hit my head a number of times, skateboarding. But you know, we think about sport injuries is the major cause of head injuries. But then I've got colleagues that are at the end of the day. Car accidents, bike accidents. I've got so many colleagues. and children of colleagues growing up in around campus that were hit by cars on Woodside Road, or you know, a mere small object surrounded by, you know, three was a carway. Three thousand pounds or something like that more. You know, it's unbelievable that the number of head injuries and then construction sites because those ridiculous little hard hats which don't protect against anything except, I don't know, maybe wind blown hair, they basically predispose, the whole situation predispose people to head injuries. Very common on construction sites and then saying nothing of military, et cetera.
嗯，我刚才提到，你知道，我最近学习的一件事是，你曾经拳击过好几年。当你年轻的时候，我也曾经打过一点拳击，滑板时撞了几次头。但是，我们认为运动损伤是头部损伤的主要原因。但是，我有同事在一天结束时会发生交通事故、自行车事故。我有很多同事和他们孩子在校园周围成长的，他们被车撞到了Woodside Road上，或者只是被围绕在三个行车道之间的一个微小物体撞到。三千磅以上。你知道的，惊人的是头部损伤的数量，还有建筑工地，因为那些毫无用处的小硬帽除了保护不了任何东西，我不知道，也许只有防止风吹乱头发，整个情况使人们更容易受到头部损伤。在建筑工地上非常常见，更不用说军队等等。

So I think that I was told that the best thing to do if you get a head injury is to not get another one. In other words, if you can stop doing the activity that leads to more head injury. Yeah, the other thing that I think is emerging and I hope it is studied rigorously is the use of hyperbaric oxygen immediately following a TBI, traumatic buried injury. Reach out to Dom Dagestino a little while ago to kind of, because he knows a lot about this lit to say, hey, is there anything out there that's really kind of turnkey convincing and he said, not yet, they're still doing it, right? So I would do this.
所以，我认为如果你受到头部伤害，最好的方法是不再受到另一次伤害。换句话说，如果你能停止导致更多头部伤害的活动，就停止它。是的，我认为还有一件事正在兴起，我希望它能经过严格的研究，那就是在颅脑损伤后立即使用高氧气压。我不久前联系了Dom Dagestino，因为他对这方面知识很多，问他是否有什么可行的方法，他说还没有，他们还在研究中。所以我会这样做。

If I was in a car accident tomorrow and sustained a concussion and by the way, I'm not a proponent of hyperbaric oxygen. So we have an internal white paper that we wrote inside quite recently where I examined, when I say I examined, the analyst team examined and I pushed back and reviewed and I came away very kind of bearish on hyperbaric oxygen. I don't think it's harmful, but I think all of the claims are nonsense. Teal of mere extension is totally irrelevant. And if you actually look at the studies, the worst done studies I've ever seen in my life, I'm sure you've seen some of these where it's like, you put these people on a hyperbaric chamber and then watch them do cognitive tasks after and they're so much better. Well, the fine print is, they don't even have placebo groups here.
如果明天我在一次车祸中受伤而患上了脑震荡，顺便说一句，我不是高压氧的支持者。我们内部最近撰写的一份白皮书，我在其中进行了研究，当我说我进行了研究时，是分析团队进行了研究，我反驳并审查，最终得出了非常悲观的结论，即高压氧是无意义的。我不认为它有害，但我认为所有的声明都是胡说八道。纯粹的扩展青黄不接。实际上，如果你看看研究，你会发现这些是我见过的最糟糕的研究，我相信你也看到过其中一些，比如把这些人放在高压氧室里，在完成认知任务后他们表现得更好了。那么细节上来看，这些实验连安慰剂组都没有。

Like, can you imagine doing a study without a placebo group or your placebo group doesn't go into a sham chamber? Yeah, I mean one of the big problems of the proliferation of all these pay to play journals, meaning journals that will basically publish a paper with minimal or poor peer review because they charge in order to publish and then offer free access. You know, free access sounds great, but when it's paid to play type journals, there's been a huge proliferation of papers, most of which you find on Twitter, in which the study design is beyond that. They get like a ninth grader who woke up late for school and was partying all weekend to design a better study than most of these studies.
你能想象在没有安慰剂组或者安慰剂组没有进入虚假空间的情况下进行的研究吗？是的，我的意思是，所有这些收费出版文章的出现，也就是一些基本上只通过最少或低质量同行评议就会发表文章并提供免费访问的期刊的出版，是一个重大问题。免费访问听起来很好，但当它是这种付费出版的类型时，会出现大量的文章，其中大多数都可以在Twitter上找到，而研究设计超出了范围。他们找到一个像初中学生一样在周末狂欢之后迟到的人来设计一个比大多数这些研究更好的研究。

Yeah, and there's some excellent studies out there as well, of course, presumably and eventually on hyperbaric chamber two. So I'm not picking on hyperbaric chamber per se, but the proliferation of truly terrible science that's published in peer review journals is just overwhelming. Yeah, it's insane. And all of that is to say, I think there are places where hyperbaric oxygen makes sense. Clearly in wound healing, it does. It's a miracle treatment for wound healing. And I would absolutely use hyperbaric oxygen if I suffered a concussion. But beyond that, I think it's pretty tough to make the case.
是的，当然也有一些优秀的研究，预计和最终推广使用高压氧舱二的研究也会到来。所以我并不是要挑剔高压氧舱本身，但是在同行评审期刊上发表的真正糟糕的科学研究却是令人不堪重负。是的，这简直太疯狂了。 总之，我的意思是，我认为高压氧治疗在某些情况下是有意义的。在伤口愈合方面，它确实起作用。它是治疗伤口愈合的神奇方法。如果我有脑震荡，我绝对会使用高压氧舱。但除此之外，我认为很难提出其他有效的使用案例。

Where do people go for that? I mean, their clinics, their clinics, you basically go to. And protocols have to be very precise. I mean, you're big. This isn't something to cowboy at home. No, no, no, no, no. You have to go into a real chamber. I think the TBI protocol that's most commonly used is, God, I want to say it's pretty intense. It's like five, 60 minute sessions a week at two atmospheres. Oh, boy, like it's no joke. So from a cost and time perspective, it's enormous. And in the time and cost are reasons why I think when I see people doing hyperbaric oxygen just because they think it's going to help them live longer, I'm like, dude, you know what you could do with five hours a week plus the commuting time that you put into that? Like, put that into exercise and I promise you you'll get a bigger benefit than you're getting out of hyperbaric oxygen.
人们是到哪里进行氧气高压治疗的？我的意思是，他们的诊所，你只能去他们的诊所。而且治疗方案必须非常精确。这是一件大事，不能在家自己实验。你必须去一个真正的氧气高压舱。我认为最常用的颅脑外伤治疗方案是五个60分钟的治疗，每周两个大气压。哇哦，这是一件非常严肃的事情。从成本和时间的角度来看，这是极其昂贵的。时间和成本是我认为当我看到人们进行氧气高压治疗只是因为他们认为这可以帮助他们活得更长久时，我会说“鸟事啦，你知道你每周5小时的时间再加上通勤的时间，你可以做些其他运动，我保证你会得到比氧气高压治疗更大的好处”。

But there's a lot of other stuff that I just think is maybe helpful. There's tons of supplements that I think about when it comes to brain health, you know, what about Theracumin, what about magnesium with L3 and A, the transporter, what about methylated vitamins that lower home assisting, what about EPA and DHA? And we've gone through all of the literature on that stuff and many of these things we still are recommending through a kind of basically like the potential benefits outweigh the potential costs.
但是还有很多其他的东西，我认为可能会有所帮助。当谈到大脑健康时，有很多补充剂是我考虑的，比如Theracumin、含有L3和A转运蛋白的镁、能降低家庭助理的甲基化维生素以及EPA和DHA。我们已经研究了所有相关的文献，许多这些东西我们仍然推荐，基本上是潜在的好处大于潜在的代价。

But the evidence is really unimpressive for most of those other interventions. So when you think about the big four or big five, if you include not getting head injury, everything else is probably a rounding error compared to those big ones. We just for sake of Theranus, we can just list off those four again, exercise, exercise, sleep, insulin sensitivity and lipid management.
但是对于大多数其他干预措施，证据确实不令人印象深刻。因此，当你考虑到那四个或五个大问题时，如果你包括不受头部损伤，其他一切可能与那些大问题相比都是微不足道的。仅仅为了塞伦诺斯，我们可以再列举一下那四个——运动、睡眠、胰岛素敏感性和脂质管理。

Well, along the lines of head injuries, we should probably move to the next category of how not to die as to avoid accidental death, how common is accidental death? And what are these accidental deaths? Because we are separating this out from automotive death. Was this people falling while hiking, selfies going bad? What are we talking about here? I'm not chuckling because I like it. It seems like there's a near infinite ways to die accidentally.
好吧，关于头部受伤的话题，我们应该转向下一个话题，即如何避免意外死亡，意外死亡有多常见？又包括哪些方式？我们要把它与交通事故死亡区分开来。是指人们在徒步旅行中跌倒，自拍出现问题吗？我们在谈论什么？我不是因为喜欢这个话题而大笑。似乎有无数种意外死亡的方式。

So I think there's two ways to kind of look at this. And so here I kind of merge two categories. So I would call it that overlap in the way that they're characterized by the CDC, but I would sort of, we'll talk about them separately and bring them together.
我认为有两种看待这个问题的方式。在这里，我将两个类别合并起来，称为它们在CDC中都有的重叠部分，在讨论中会分别讨论并将它们组合在一起。

So if you talk about true accidental deaths, automotive and falls and overdoses are the three. That's basically what it comes down to. So when our death bar analysis, we kind of list all this stuff out. In fact, I think that's actually one of the figures in the book is I have the accidental death figure that we've put together where we've adjusted by population.
因此，如果你谈论真正意义上的意外死亡，汽车事故、跌落和药物过量是三种类型。基本上就是这样。所以在我们的死亡条形图分析中，我们列出了所有这些东西。实际上，我认为书中的一个图表就是我们整理出来的意外死亡数据，已经按人口调整过了。

And you'll see a couple of things. If you look at it in absolute terms, it's basically a pretty constant. So regardless of what decade of life you're in, once you're above 20 accidental deaths are a pretty sizable number of deaths. Now car accidents seem to be pretty constant throughout life. Little more common if you're under 60 than over 60, but they never go away. I was told that in teenage and boys and in boys in their early 20s, alcohol induced automotive fatalities, play some of this in an astronomical risk. Is that just not true? It's not true anymore compared to overdoses.
你会看到几个事情。如果你以绝对值来看，这基本上是一个相当恒定的数目。所以，不管你在人生的哪个十年，一旦超过20岁，意外死亡的数字就是相当多的。现在，车祸似乎在整个人生过程中都是相当不变的。如果你还没有60岁，它可能比60岁以上要多一点，但它永远不会消失。有人告诉我，在少年和20多岁的男孩中，由饮酒引起的汽车死亡风险极高。这是不是真的？与过量药物相比，这不再是真的了。

Is that because young people now aren't getting their driver's licenses or all sort of that? It's also because we're seeing such an uptick in the deaths that come from fentanyl. So fentanyl related deaths have basically squashed all other deaths below 65 on the accidental front. Really? Oh, it's not even close. Because of the number of different substances that fentanyl is being woven into.
这是因为现在的年轻人不再去考取驾照或者其他原因吗？另一方面，我们看到由芬太尼引起的死亡人数急剧上升。事实上，芬太尼相关的死亡人数已经压倒了65岁以下的其他意外死亡原因。真的吗？是的，这甚至还不够。因为芬太尼被纳入了许多不同的物质中。

Winding its way into everything. So all counterfeit drugs, all illicit drugs. And look, most of the time you're not getting a lethal dose. So it's, you know, but you're getting lethal doses so often now that, well, I did a little analysis actually the other day when I looked at how are deaths of despair increasing over the last five years?
它渗透到了所有东西中。所有假药、非法药品。而且，大多数情况下你并没有服用致命剂量的药物。但现在你越来越频繁地服用了致命剂量，我最近进行了一些分析，看看自从过去五年来绝望死亡数量增加了多少？

So what did I define as a death of despair? Suicide? Alcohol-related death or overdose? Accidental overdose. We differentiate that from suicide where suicide is obviously deliberate and accidental is not. So if you just look at those three things. So accidental overdoses, suicides, and alcohol use or alcohol-related death, not including driving. By the way, this is like cirrhosis of the liver that comes from that number is going up at almost 20% per year since 2019.
那么，我将“绝望死亡”定义为什么呢？自杀？与酒精相关的死亡或过量？意外过量。我们区分自杀和意外过量，自杀是明显有目的的，而意外过量不是。所以，如果仅看这三种情况：意外过量、自杀以及与酒精使用或酒精相关的死亡（不包括驾车）。顺便说一句，这就像来自肝硬化的情况，自2019年以来，这个数字每年增长近20%。

So I couldn't get 20, 22 numbers yet. But the time I did this analysis, which was last week, the 2021 numbers was about 210,000 Americans. Goodness. Up from 180,000 in 2020 up from like 150,000 in 2019. So is this, and that is driven almost entirely by fentanyl use. So I'm trying to get a sense of how this would happen. While back there was an article in the New York Times that some photographs of people that died of fentanyl overdose, they said they went out to buy cocaine and died of it. And I thought to myself, this is a really kind of odd sociobiological phenomenon, right?
我还没有获得20或22的数字。但是当我进行这个分析的时候，也就是上周，2021年美国的数字已经达到了大约210,000人。天啊！比2020年的180,000人还要多，比2019年的150,000人更多。几乎完全是由芬太尼导致的。所以我想知道这是怎么发生的。前段时间，纽约时报上有一篇文章，关于那些因芬太尼过量而死亡的人的照片，他们说他们外出购买可卡因，结果因此而死。我想，这是一个非常奇怪的社会生物现象，对吧？

Because I mean, here they're not demonizing these cocaine users. I mean, they went out to buy cocaine, right? This is not a, I know cocaine has one narrow clinical use as a prescription drug, but in general, when people buy cocaine, they're, they're going to go parting with it or using it to work longer hours or something like that. So the whole nature of the article was a bit strange to me, but it clearly pointed the fact that people are using cocaine. Okay, that's no surprise.
因为我想说的是，他们并没有妖魔化这些可卡因使用者。我的意思是，他们出去买可卡因，对吧？我知道可卡因作为处方药有一种狭窄的临床用途，但通常人们购买可卡因时，是为了用于派对或者加班等等。所以，这篇文章的整个性质对我来说有点奇怪，但它明确地指出了人们正在使用可卡因。好吧，这并不奇怪。

But people are going out and buying cocaine. They're presumably buying volume. They're presumably buying. Yeah, this is where it's really killing kids. I mean, it's. it's, it's, it's, it's, it's, it's, it's, it's, it's, it's, it's, it's online. This is a person. I mean, the reason I'm so, so baffled by this is let me contextualize what I, what I've said so far about this question. I was surprised that the Times would write a paper about the tragedy of cocaine users dying of fentanyl. And I think they did it to highlight this fentanyl problem because people have been using cocaine for a long time. And typically those are not the members of the population that were really focused on. That's the mid 80s, the so-called cocaine and crack a epidemic.
人们正在购买可卡因，他们可能在购买大量。这可能是在网上购买。这是在危害孩子。我非常困惑，我想解释我之前说过的话。我对《时代》会发表有关可卡因用户死于芬太尼的悲剧的文章感到惊讶。我认为他们这样做是为了突出芬太尼问题，因为人们已经使用可卡因很长时间了。通常来说，这些人并不是我们关注的人群，那是上世纪80年代的所谓可卡因和瘤胃流行病时期。

So basically, it tells me that people, like you said, illicit drugs, so cocaine, but also, you know, what other sources of drugs have been buying. So the majority of people are dying from fentanyl poisoning. And I had a guy on my podcast recently in Anthony Hippolito. And if anybody's interested in this topic, they really need to go listen to that. So I have to watch the YouTube version of this and your podcasts are excellent.
基本上吧，它告诉我人们，比如你说的，会使用非法毒品，比如可卡因，但也会购买其他来源的毒品。所以，大部分人死于芬太尼中毒。最近我有一个叫安东尼·希波利托的人来参加我的播客节目，如果有人对这个话题感兴趣，他们真的需要去听一下。所以我必须看这个视频的YouTube版本，你的播客节目真的很棒。

So if you're interested in this, and I think everyone should be interested in this. If you have a child or know somebody who has a child, you just got to get this podcast into their hands because it's the most important public service announcement I'll probably ever do in terms of saving more lives potentially.
如果你对此感兴趣，我认为每个人都应该对此感兴趣。如果你有孩子或认识有孩子的人，你必须让他们听这个播客，因为这可能是我在拯救更多生命方面做的最重要的公共服务宣传。

Where the majority of this is making its way into the accidental poisonings is through illicit counterfeit pills. So it's when kids are out there buying, you know, oxy, they want oxy. Well, they can't get real oxy, right? Because they're not going to go to a doctor and get real oxy. So they're going to buy it through, you know, Snapchat, right? They're going to buy it through some drug dealer that they're finding on social media. They're buying sleeping pills. They're buying all sorts of counterfeit stuff like Adderall. Any of these things are being laced with fentanyl.
大多数毒品意外中毒的情况是因为非法仿冒药丸的原因。当孩子们购买像奥克西这样的药物时，他们想要真正的奥克西。然而，他们无法获得真正的奥克西，因为他们不会去医生那里获得真正的奥克西。所以他们通过Snapchat等社交媒体渠道购买仿冒药物。他们购买安眠药。他们购买类似阿德拉尔这样的仿冒药品。所有这些药物都被掺入芬太尼。

Adderall. Absolutely. Well, I assumed the fentanyl. And again, the reasons are it's insanely cheap to use synthetic fentanyl. And secondly, and again, but the effects of fentanyl are nothing like the effects of Adderall. So cocaine doesn't make sense for that reason. Cocaine doesn't make sense either. Yep. And yet it's still showing up in cocaine. Again, I don't think that's the dominant place it's showing up. I would, I would guess that the dominant place it's showing up is in counterfeit opioids. So any opioid, barbituate, any sedative, the present.
安非他明（Adderall）。完全正确。我认为是芬太尼。原因是使用合成芬太尼的成本非常便宜。其次，芬太尼的作用与安非他明完全不同。因此，可卡因也不合理。可卡因也没有意义。是的，但是它仍然出现在可卡因中。我认为不是出现最多的地方。我猜想出现最多的地方是在仿制阿片剂中。因此，任何阿片类药物、巴比图类药物、镇静剂都可能存在芬太尼。

Yeah, but let me tell you what I'm telling my daughter, right? Because this is, to me, it's a front line problem. I have a 14 year old daughter. I'm like, listen, I don't care which friend of yours it is. I don't care how much she's amazing. If she tells you to try this sleeping pill because she took it the night before and it was really helpful or this will help you study better or this will help you do anything, I'm like, just come to us. We got a better pill for you. Right. Like in other words, you can't trust anything because you don't know where she got it. She has the best of intentions. I'm sure when she's given it to you. And by the way, she probably took it the night before and was just fine. But the people who are making these pills are not exactly up to GMP standards. So you just have no idea which pill is getting what dose of fentanyl.
是的，但我告诉你我对女儿说的话，因为这对我来说是一个前线问题。我的女儿14岁了。我说，听着，无论是哪个朋友告诉你要尝试这种安眠药，因为她前一晚吃过，感觉真的很有帮助，或者这能帮你更好地学习或做其他事情，我说，只需要来找我们就好了。我们有更好的药。换句话说，你不能相信任何东西，因为你不知道她从哪里得到的。她的出发点肯定是好的，当她给你吃的时候。顺便说一下，她可能前一晚吃了，感觉不错。但是制造这些药品的人并不完全符合GMP标准。所以你根本不知道哪种药物在得到什么剂量的芬太尼。

One thing that Anthony Hippolytto told me that I simply couldn't believe I had to ask him six times was that some of these pills have like one milligram of fentanyl in them. Now I made the point on the podcast that 100 milligrams of fentanyl for most people is a hit like they've like I've had fentanyl before. I've been in the hospital and I've had fentanyl. 100 milligrams is like, wow, that is such a trip. Why are people dying from one milligram intake? Respiratory inhibition. You can't breathe. That shuts the brain stem off.
安东尼·希波里托告诉我一件事，我简直不敢相信，我不得不问他六次：有些药片里含有1毫克芬太尼。在播客中，我强调了对于大多数人来说100毫克芬太尼是一次使用量，就像我之前在医院里使用过芬太尼一样。100毫克是一种非常致幻的体验。为什么人们会因为1毫克摄入量而死亡呢？呼吸抑制。你无法呼吸，这会使脑干关掉。

Well, I don't think we can highlight this enough. You know, adults are dying, kids are dying. I met someone earlier this week who told me her 35 year old son died of an accidental fentanyl over this and he wasn't at least by her description a drug addict or anything of that sort. Yeah, we're talking about a different game now, right? So it's like these are kids that have anxiety. These are kids that are sort of addressing another issue with these pills. And that's why I think this whole concept of deaths of despair is a really important one.
嗯，我觉得我们不能够强调这个问题太多。你知道，成年人和孩子们都在死去。本周早些时候我遇到了一个人，她告诉我她35岁的儿子因吸入了意外的芬太尼而死亡，但根据她的描述，他并不是一个毒品成瘾者或类似的人。是的，我们现在正在讨论另一种情况吧？所以这些孩子们有焦虑症。这些孩子通过这些药片解决另一个问题。这就是为什么我认为绝望死亡的概念是非常重要的一个概念。

But back to your question, what do accidental deaths primarily amount to for the aging population? Again, it is so clear that it is fall related. This is where once you hit 60, 65, the risk of a fall that results either immediately in death, you know, you hit your head and die, going back to like cerebral hemorrhage, or it is the straw that basically leads you down the path to death within the next 12 months is astonishingly high. It's so high that it's sort of hard to wrap your head around. But if you're over 65 and you fall and break your femur or hip, so you either crack the femoral neck or the femur itself, your 12 month mortality, the probability you will be dead in 12 months after that break, if you're 65 or older, depending on the study is about 15 to 30%.
回到你的问题，对于老年人群而言，意外死亡主要指什么？同样的，很明显这与跌倒有关。一旦你到了60岁、65岁，跌倒导致立即死亡的风险就变得很高，你知道，你撞到头而死，或者会导致脑出血，或者成为导致你在接下来的12个月内死亡的导火索。这样的风险非常高，以至于难以置信。但如果你已经超过65岁并且跌倒导致股骨或髋部骨折，无论是股骨颈骨折还是股骨本身的骨折，你在那次骨折后12个月内死亡的概率，根据不同的研究，大概在15%到30%之间。

Wow. Wow. So in terms of offsetting the probability of falls, you talked a little bit about this before, but you and I have talked a little bit about this before, but maybe we could go a little bit deeper. People's ability to jump and land seems to be highly correlated with one's ability to not fall or at least fall and control the fall in a way that leads to no or less severe injury.
哇，你之前讲过如何降低跌倒概率，但我们也曾讨论过这个问题，或许我们可以再深入探讨一下。人们跳跃和着陆的能力似乎与他们不跌倒或至少能够控制跌倒、避免或减少伤害的能力密切相关。

Yeah. So Andy Galpin talked about this on your path. He talked about it on my podcast. What is the hallmark of aging on the muscle? It is atrophy of the type two muscle fiber. That's the hallmark. Fast twitch, fast twitch muscle fiber. So if you want to understand what looks different in 50 year old Peter versus 18 year old Peter, it's not my type one fibers. It's my type two fibers. It's my fast twitch fibers. It's my explosive fibers. When I was 18 years old, I could vertical jump over 30 inches. Today, I'm lucky if I can vertical jump 24 inches. And when I'm 60, boy, it's like my goal is to be able to vertical jump 20 inches when I'm 60. And I don't know if I'm going to be able to do it. I've seen some videos of some 80 year old sprinters that are pretty impressive and certainly 80 year old gymnasts that are impressive. I have not seen very many videos of 80 year olds dunking basketballs for instance.
嗯，Andy Galpin在你的路上谈到了这个问题。他在我的播客中也谈到了这个问题。肌肉老化的标志是什么？它是二型肌纤维的萎缩。这就是标志。快速收缩型肌纤维。因此，如果你想了解50岁的彼得和18岁的彼得有什么不同，那不是我的一型纤维。而是我的二型纤维。这是我的快速收缩型纤维。这是我的爆发纤维。当我18岁时，我可以垂直跳跃超过30英寸。今天，我很幸运如果我能垂直跳跃24英寸。当我60岁时，我的目标是能够在垂直跳跃20英寸。我不知道我能否做到这一点。我看过一些80岁短跑运动员和一些非常出色的80岁体操运动员的视频。但我很少看到有80岁老人扣篮的视频。

Yeah. It's who are not taller than 635 inches. So when we lose, you know, so again, if you just think about size, strength, speed, we lose speed first. We lose speed, then strength. And the last thing you lose is size. So again, size is agnostic to fiber, right? You could have big type one fibers and still have lots of size. They're not going to be that strong and they're certainly not going to be fast. So what I mean, look, we could go through, we could spend hours on this particular topic. But I think the most important thing that people need to understand is you cannot age well if you are not doing the type of training that is there to strengthen and delay or minimize the hypertrophy of your type two fibers.
没错。我们指的是身高不超过635英寸的人。所以当我们失去时，你知道，如果只考虑大小、力量和速度，我们先失去速度。我们失去速度，然后是力量。最后失去的是大小。所以，大小与纤维类型无关，对吧？你可能有很多一型肌纤维，仍然有很大的尺寸。它们不会很强，当然也不会很快。所以我的意思是，我们可以花数小时来探讨这个特定的主题。但我认为人们需要明白的最重要的事情是，如果你没有进行加强和延迟或最小化二型肌纤维的肥大的那种训练，你就不能健康地老化。

So everything matters, right? You have to be doing your zone two. You have to be doing, you know, all of these other things. But some component of your training needs to be stressing the type two fibers. You have to be doing strength training that taxes those fibers. You have to be doing reactivity training. You have to be doing explosive training. And ideally some training that involves jumping and landing. Well jumping is a very big part of it. And landing is a very big part of another one of what I kind of think of as my four pillars of strength training.
这一切都很重要，不是吗？你必须保持在第二区域的训练状态。除此之外，还需要强化二型肌纤维的某些训练方式。你需要进行强度训练以增强这些肌纤维的负荷能力。你需要进行反应性训练，爆发力训练，以及涉及跳跃和着陆的训练。其中跳跃是其中一个非常重要的训练部分，着陆是我认为训练强度的四大支柱之一。

So one of the pillars of strength training is eccentric strength, which is brakes. So you know, you're going to hurt yourself ten times more likely. I'm making that number up by the way. I don't know if it's ten times, but experientially it seems to be you are ten times more likely to hurt yourself stepping off something than stepping on to something, right? Stepping down versus stepping up. Because when you step up onto something, you are concentrically controlling the muscle. When you step down, you have to apply the brakes. And that's where most people falter much harder to walk downhill than uphill. uphill is taxing your cardiovascular system, but if you slow down enough, you're fine.
力量训练的支柱之一就是离心力量，也就是刹车。你知道的，你受伤的可能性会增加十倍。顺便说一下，我不知道这个数字是不是十倍，但从经验上看，似乎你跨下东西比跨上东西更容易受伤，对吧？跨上去时，你是在浓缩控制肌肉。而当你跨下去时，你需要刹车。这就是大多数人比走上坡路要困难得多的原因。上坡路会对你的心血管系统产生压力，但如果你放慢步伐，就没关系了。

But a lot of people don't have the ability to slow themselves down when they're walking downhill. And so when an older person steps off a curb and can't fully stop themselves, and that results in a fall. So you know, I like doing things like a broad jump. Broad jumps have fun little tests that I like to do every once in a while.
但是很多人在走下坡路时没有减速的能力。因此，当老年人踏下人行道时无法完全停住，就会导致摔倒。所以，我喜欢做广跳。广跳有有趣的小测试，我偶尔也喜欢做一下。

I always want to make sure I can broad jump six feet. That's kind of my arbitrary number that I've chosen. And the reason is on the takeoff, that's a very explosive movement. But the landing is just as important. If I can't stick that landing, it means I don't have the brakes. So those are kind of some of the tests I want to be able to do to make sure that I'm utilizing that system.
我一直希望能够跳远6英尺，这是我选择的一个随意数值。原因在于起跳时需要爆炸性的动作，但着陆同样重要。如果我不能稳住着陆，就意味着我没有刹车。因此，为了确保我正在利用这个系统，这些都是我想要做的一些测试。

Because I do think, you know, look, I've watched my mom, my mom fell, gosh, probably been about four months ago, just fell in a typical way that people fall. By the way, it could have happened to anybody. It's not like, you know, my mom walks around and moves around just fine. But in this particular day, she just tripped on an uneven stone and fell and landed and broke her hand.
因为我认为，在我看来，我看到了我的妈妈，大概是四个月前，她摔倒了，像大多数人一样。顺便说一句，任何人都可能会发生这种情况，不是因为我妈妈走路和移动都很好。但在这个特定的日子里，她只是在不平坦的石头上绊了一下，摔倒并摔伤手。

And she really, lucky she didn't break her hip. And I told her that, because my mom was, you know, probably in her mid 70s. And I said, look, you know, if that was your femur, I'd give you a 30% chance of dying in the next year. I mean, it's just an un, those are such difficult to recover from injuries. Because first of all, you're dealing with the immobility of, you know, the hospitalization and immobility that follows that.
她很幸运没有摔断髋部。我告诉她，因为我的妈妈当时大概已经70多岁了。我说，如果那是你的股骨，你有30%的几率在接下来的一年里死亡。我是说这些伤势非常难康复。因为首先，你要应对住院和随之而来的活动能力受限。

And the amount of muscle loss that occurs could easily be, you know, four or five pounds of lean tissue lost that for most people at age becomes almost impossible to get back. And that says nothing about sort of the acute causes of death, like a fat embolism that results from a broken femur, a blood clot from laying in bed. Those things are also catastrophic. But what happens is a lot of these patients just never get back to the same level of mobility.
这里说的是肌肉的流失量很容易达到四到五磅，这些流失的都是精瘦组织，对大多数年龄较大的人来说，几乎不可能再把这些肌肉恢复回来。并且这还不包括一些急性死亡原因，比如说因断腿骨导致脂肪栓塞，或者因卧床不起而引起的血栓等等。这些事情都是灾难性的。而且这些病人经常会有的状况是，他们的身体移动能力无法恢复到原来的水平。

And you know, now I think in many ways we're kind of pivoting from what kills you to what ruins your quality of life. And we've spent so much time talking about what kills you. But I think you might as well be dead in some ways if you can't do the things you want to do. And if playing with your grandkids or gardening or playing golf or going for a walk with your spouse or think of any of the things that we all do today and take for granted, if you can't do those things, I don't know, you sort of lose the reason to be around.
你知道，在很多方面，我们现在正在从致命的东西转向破坏你生活质量的事情。我们已经花了很多时间讨论什么是致命的。但是，如果你不能做你想要做的事情，有些方面你可能就像死了一样。如果不能和孙子玩、园艺、打高尔夫或和配偶散步或其他我们每个人今天都做而且视为理所当然的事情，如果你不能做这些事情，我觉得你会失去存在的理由。

And oftentimes the inability to do those things is associated with pain that, you know, which is psychologically and obviously physiologically so distressing. You mentioned the four pillars of health. Maybe just list those off for people lifting.
常常无法做这些事情与痛苦相关，这种痛苦在心理和生理上都是如此令人痛苦。你提到了健康的四个支柱。也许可以为那些举重运动员列出这些支柱。

Though, well, the four pillars of longevity through physical. Oh, yeah, sort of the exercise pieces of them. Yes. So strength, stability, aerobic efficiency and aerobic peak output. I guess aerobic peak would be so. So Vio2 max and zone two. That's in my analogy.
嗯，其实身体长寿的四个支柱是通过体育锻炼。对，这四个支柱就是强度、稳定性、有氧效率和有氧峰值输出。我猜有氧峰值输出就是Vio2 max和第二区间。这就是我的比喻意思。

That's the your zone two is the how wide the base of your pyramid is and your Vio2 max is how tall the peak of the pyramid is. So the best pyramid has a wide base and a high peak. So you could have a reasonably wide base and a shallow peak. If you just did zone two training, you're, you know, you're going to get a reasonable peak, but it's not going to be that high.
你的第二训练区是金字塔底部的宽度，你的最大呼氧量是金字塔顶部的高度。因此，最好的金字塔有宽阔的底部和高耸的尖顶。因此，你可以有一个相对较宽的底部和较浅的尖顶。如果你仅仅进行第二训练区的训练，你会获得一个相对合理的高峰，但它不会太高。

You have to do some of that specific training. If you just focus on high intensity, you might drive up that Vio2 max, but you're actually going to have a relatively wide, narrow aerobic base. So you think about just maximizing the area of that triangle, widest, tallest, stability and strength. And of course, encompasses everything we're talking about in terms of reactivity.
你需要进行专门的训练。如果你只关注高强度的训练，可能会提升你的最大氧耗量，但你的有氧基础却相对较窄。因此，你应该考虑最大化三角形的面积，即最宽、最高、最稳和最强的部分。当然，这也包括我们在讨论中提到的反应性方面。

You know, I dedicate a chapter in the book to this concept because it is so foreign to most people. And for understandable reasons, it's just, it's not sexy. It's not, it's the hardest one to train. It's the hardest one to understand, but it's so important because it's the thing that I think differentiates people who age well and people who don't age well.
你知道吗，我在书中专门为这个概念写了一章，因为这对大多数人来说都是很陌生的。而且出于可以理解的原因，这个概念并不是很有吸引力。它是最难训练的，也是最难理解的，但它非常重要，因为我认为这就是区分老化得好和老化得不好的人的关键。

And I should perhaps throw in there. Please correct me if I'm wrong. But also most of the machines that are in typical commercial gyms that allow people who are not very experienced to start doing some resistance training don't really tap into the stability factor terribly much. So while there's value to leg extensions and leg curls and, you know, chest presses and shoulder presses that don't with machines, certainly for a number of reasons and can often be safer than free weights, especially for people who are approaching it at a later time or new to the whole thing.
我觉得我还需要补充一点，如果我说错了请指出。大多数商业健身房中的器械帮助那些没有太多经验的人开始进行一些抗阻训练时并没有很好地考虑到稳定性因素。虽然腿举和腿弯举、卧推和肩推等机器器械训练对于许多原因来说确实有价值，并且通常比使用自由重量更安全，特别是对于接近晚期或完全新手的人来说，但这些器械训练并没有很好地考虑到稳定性因素。

They don't really lend themselves to real life stability, walking down, as you mentioned, walking down stairs in the absence of a handrail or movements in kind of odd planes, you know, having to step aside to avoid a bicycle at an angle as opposed to just moving, you know, linearly. Yeah. And by the way, a lot of things that don't involve machines still don't give you that, right? Having a deadlift, you have to be stable to lift a heavy weight like you would a dead lift without hurting yourself.
它们并不太适合实际生活中的稳定性。比如你之前提到的走楼梯，如果没有扶手的话，有些姿势或动作非常奇特。还有些情况下不得不斜着走来躲避自行车，而不是直线前进。 同时，即使是不涉及机械设备的许多事情也不会给你带来稳定性。比如举重，你必须始终保持稳定，才能像做硬拉那样举起一块重物而不会受伤。

That requires an unbelievable capacity to harness intra-abdominal pressure and to be connected, you know, but if you're giving a lift 500 pounds off the ground, you're stable. But that still doesn't prepare you for what you just described. So stability is multifaceted and it involves doing a lot of things.
这需要非凡的能力来利用腹腔内压力并保持稳定，但如果你要在空中举起500磅的物体，你就是稳定的。但这仍然无法让你为你刚刚描述的事情做好准备。因此，稳定性是多方面的，涉及到很多事情。

You know, today, for example, I finished my, today was a cardio zone two day. So I did my cardio zone two and I, you know, had it extra 10 minutes before I needed to kind of get moving. And so all I did was step up for 10 minutes. I just did single leg, very slow step up and insanely slow step downs off a box in a gym. So two second up, four second down, two second up, four second down with, you know, and I would do them with Ipsilateral loads, Contralateral loads, all sorts of different things. And you know, basically that's just a stability game for me. It's like I'm building that concentric strength in a movement where it's easy to cheat, but can I do it without cheating?
例如，今天我完成了我的有氧运动区2，我在需要出门前多做了10分钟，我只是踩台阶，单腿慢慢的踩上去，再从舞台上慢慢下来，动作非常缓慢，上2秒，下4秒，上2秒，下4秒，并且我会用同侧重量和对侧重量进行练习，做各种不同的变化。对我来说，这只是稳定性训练，我要在一个容易作弊的运动中建立起同心肌力量，但我能在不作弊的情况下完成吗？

It's terrific and it's terrific that you cover all of that in the book in addition to these other topics. So several times during our conversation today, you alluded to quality of life. And one of my favorite segments in your book, indeed, the segment in your book that I believe could be its own entire book of tremendous value, is the section on emotional health.
这太棒了，你在书中涵盖了所有这些话题，除此之外，你的书还让我感到惊喜。今天在我们的谈话中，你多次提到了生活质量。我最喜欢的书中部分之一，实际上，我相信，这部分内容可以成为一本非常有价值的书，就是关于情感健康的部分。

If you could just share with us a bit of what inspired you to include that section, was this, for instance, based on communication with your patients, to what extent it was based on your own life experience. And then maybe we can drill a little bit deeper into what's contained in those chapters and what really constitutes emotional health.
如果您能与我们分享一些灵感，解释一下为什么您要包括那个章节，比如说这有没有基于您与患者的沟通，还有多少是根据您自己的生活经验。然后，也许我们可以深入探讨一下这些章节中包含的内容，以及什么才是真正的情绪健康。

Well, I mean, I think that that chapter of the book, which is a pretty long chapter, it's the final chapter as well, is certainly different from all of the others in that there is no confusion about expertise, right? I think in the other chapters, I at least try to come across as having some knowledge on the subject matter, and I'm writing them most often as, you know, quote unquote, the doctor, right?
我认为，这本书的最后一章非常与众不同，也是最长的一章。这一章与其它章节不同的地方在于，它没有关于专业知识的混淆。在其他章节中，我至少想让自己显得对主题有一些了解，通常我写作时会以“医生”的身份出现。

Whereas I think that last chapter is much more about an experiential side of my knowledge acquisition. And therefore, really, it comes across more as a patient. And I think you're right. I think that's a chapter that initially was resisted by all other parties involved in the book.
我认为最后一章更多地涉及我的知识获取经验方面。因此，实际上，它更像是一位有耐心的读者。你说得对，其他书中的有关方面一开始都反对这一章。

So my co-author, my editor, everybody else sort of felt like, this is interesting, but it's a separate topic. If you want to write about this, you should write another book about it. But it doesn't really belong in this book. I disagreed for two reasons, and ultimately, I guess my opinion prevailed.
我的合作者、编辑和其他人都觉得这很有趣，但这是一个单独的主题。如果你想写这方面的内容，应该再写一本书。但这并不适合放在这本书中。我有两个不同的看法，最终我想我的意见占了上风。

The first is, I didn't want to write another book. So it just, that, you know, not including this in this book to then write about another book was not something I was interested in doing. But I think more importantly, I do think that this book is about much more than how long you live.
第一点是，我不想再写一本书了。所以，你知道的，不把这个写进这本书里，然后写另一本书，这不是我感兴趣的事情。但更重要的是，我认为这本书远不止于你活多长时间。

And while we have talked about, and we'll talk about in the book, that is, you know, how cognitive and physical health are just as germane to quality of life as they are to length of life. This other piece of emotional health, you know, it's potentially the most important of them all. It's also the hardest to define, but without it, none of this other stuff matters, right? So there's, you know, infinite lifespan. If, if, if, if you're miserable means nothing.
我们在书中已经谈到过，并且还会谈到，即认知和身体健康与寿命的长度一样重要，也与生命质量相关。然而，情感健康是生活质量中最重要的部分，也是最难定义的部分。如果没有情感健康，其他的健康也就没有任何意义了。因此，即使生命可以无限延续，如果你感到痛苦，那也完全无意义。

Maybe worse. It's, that would be a curse, right? You could argue, how could you punish somebody the most, allow them to live forever and be miserable? Is there a, yeah, there's a Greek god, Tathonus. Tathonus, yeah. He was granted immortality. It's a bit different. He was granted immortality, but without a health span, basically. So he aged forever. Dreadful, yeah. And this would be dreadful too, right?
也许更糟糕。那会成为一种诅咒，对吗？你可以说，你怎么能折磨某个人最狠？让他们永远活着，一直痛苦着？对，有一个希腊神，塔索诺斯。塔索诺斯，对。他被赋予了不死之身。但这有点不同。他被赋予了不死之身，但没有健康的寿命，基本上就是永远老化。可怕，对吧？这种情况也将是可怕的，是吧？

And I feel like, why did I need to write about this? Well, I think that, you know, this is probably my greatest struggle, I think. You know, way at the outset of the podcast, you asked me kind of like, what are the obstacles to longevity? And that got us down a path of some very black and white things.
我觉得为什么我需要写这件事呢？我认为这可能是我最大的挑战。在播客开始的时候，你问我什么是长寿的障碍，这让我们进入了一些非常明显的问题。

But when I look at a patient, I create a dashboard. And the dashboard is what are all the things that are a threat to every component of your longevity, both lifespan and health span? We talked about a bunch of those things. So how, what is, what is your risk for atherosclerosis and what are we doing about it? What is your risk for cancer? What are we doing about it? What is your risk for neurodegeneration? What are we doing about it? What is your risk for accidental death? What are we doing about it? What is your risk for physical decline? What are we doing about it? And one of those things is, what is your risk of emotional health or poor emotional health and what are we doing about it?
当我看待一个病人时，我会创建一个仪表盘。这个仪表盘包括：哪些因素可能威胁你的健康和寿命的每个组成部分？我们谈论了一堆这样的因素。那么，你得动脉粥样硬化的风险如何？我们做了什么来应对它？你得癌症的风险如何？我们做了什么来应对它？你得神经退行性疾病的风险如何？我们做了什么来应对它？你的意外死亡的风险如何？我们做了什么来应对它？你身体衰败的风险如何？我们做了什么来应对它？其中一项因素是，你有多大的情感压力或心理健康问题的风险？我们做了什么来应对它？

So when I do that exercise for me, which I do, I mean, I have that spreadsheet laid out for me and I know where my factors line up. And interestingly, despite my family history being horrible for atherosclerosis, it's like sixth on my list. Because I mean, basically I intervened early, I have a clear understanding of the pathophysiology and I'm doing everything to the maximum. So I'm actually very confident I will die with and not from atherosclerosis. But the top thing on my list is actually emotional health. That's the one that is the hardest for me to manage. And it's the easiest to get out of balance and it creates the most pain in my life.
当我进行这项为我量身定制的运动时，我会使用一张电子表格，以便我了解我的因素如何排列。尽管我家族遗传中动脉硬化的历史非常糟糕，但是在我的列表中，它排名第六。这是因为我早期进行了干预，对病理生理学有清晰的了解，并尽可能地采取了所有措施。因此，我非常有信心我会在没有被动脉硬化的情况下离世。但是在我的列表中，最重要的事情实际上是情感健康。这是我最难以管理的项目，也是最容易失衡的项目，也给我生活中带来了最多的痛苦。

So that's a long answer to why I felt this needed to be in here. Well, in the book, you go into very honest detail about some of your journeys through and challenges with emotional health and paths to overcoming those. Maybe we'll get into those a bit. But before we do, how should we define emotional health? This to me seems like one of the most difficult areas to calibrate oneself. Even just measuring emotion is tricky.
这就是我为什么觉得这个需要在这里的长篇回答。在书中，你详细地谈到了你在情感健康方面的旅程、挑战和克服之路。或许我们可以稍微谈谈这些。但在此之前，我们应该如何定义情感健康呢？在我看来，这似乎是最难校准自己的领域之一。即使是衡量情感也很棘手。

Language is the dissection tool for psychologist psychiatrist and indeed for all of us. How are you doing today? Great or miserable or depressed? I mean, it means such different things to different people. Obviously, suicide being the far end of, we presume, misery. There are instances of manic suicide, but depressive misery. But setting that aside, how should we evaluate, think about and communicate emotional health to ourselves and to the relevant people that could potentially help us?
语言是心理学家、精神科医生和我们所有人的解剖工具。你今天过得怎么样？是大好还是悲惨或沮丧？我是说，这对不同的人意义不同。显然，我们认为自杀是极端的不幸。虽然有些是疯狂的自杀，但是大多数都是抑郁的痛苦。但抛开这些不说，我们应该如何评估、思考和向那些可能帮助我们的相关人员传达自己的情绪健康状况？

Yeah, we're right. It's very difficult. And so much of what goes into this book is about things that are much easier to quantify. I could sit here and talk for days about all the ways we quantify from the histologic to the gross of each of these diseases, genetically all of these other things. With emotional health, it's far more vague. And I don't even attempt to come up with a definition, right? I can tell you things that make up components of it. So connectivity with others just seems to be an inescapable part of this. So the ability to maintain healthy relationships and attachments to other people. Having, by the way, these are no particular order. Having a sense of purpose, being able to regulate your emotions, experiencing fulfillment, experiencing satisfaction. All of these things matter.
是的，我们说得对。这很困难。这本书的很多内容都是关于更容易量化的事情。我可以坐在这里，讲述我们如何从组织学到每种疾病的宏观特征，基因等方面进行量化。但是情感健康要模糊得多。我甚至不尝试给出一个定义，对吧？我可以告诉你构成情感健康的组成部分。所以，与他人的联结似乎是不可避免的一部分。能够保持健康的关系和与他人的联系。顺便说一下，这些并没有特定的顺序。拥有目标感，能够调节情绪，经历成就感，满足感等等，所有这些都很重要。

And I think that for many of us, if we're taking an honest appraisal of ourselves, we'll notice that we have deficits in these areas. Being present, by the way, that's something that may have been less of an issue 100 years ago than it is today. So I think for certainly for me, being present is very difficult. It's not my default state. I don't know that it's the default state for most people truthfully. But I'm very often predisposed with thoughts about the future. Occasionally, thoughts about the past, but it's much more often kind of thoughts about the future. And planning and thinking about what I need to do. And what do I want to do next? And never really being satisfied with anything that's happening in the moment. So I have to work hard to kind of overcome those things. And I'm sure you can appreciate this. But when you are present, you generally hear in a much better frame of mind.
我认为，对我们许多人来说，如果我们诚实地评估自己，我们会发现我们在这些方面存在不足。存在于此刻，顺便说一下，这可能在100年前比现在不是那么大的问题。所以，我想对我来说，居于当下非常困难。这不是我的默认状态。我并不确定这是大多数人的默认状态。但我经常会对未来思考。偶尔会想到过去，但更多的是未来的想法。规划和思考我需要做什么和下一步要做什么。从来没有真正满足当前发生的任何事情。所以我必须努力去克服这些事情。我相信你能理解这一点。但当你在当下时，你通常会以更好的心态去听。

Yeah, there's an interesting study. I think it was initially published by Dan Gilbert's lab, one of these long-term happiness studies. It was published in Science Magazine that pinged people for their level of happiness, unhappiness, presence, or lack of presence, multiple times throughout the day. This was in the early years of smartphones.
是的，有一个有趣的研究。我认为这最初是由丹·吉尔伯特的实验室发表的，这是其中一项长期幸福研究。该研究发表在《科学》杂志上，通过多次评估人们在一天中的幸福、不幸、存在或缺席程度。而当时正值智能手机的早期阶段。

So this is around 2010, 2011. So the technology wasn't as good as this now, but it was good enough to do this in a very large number of people. I forget how many, but it's certainly more than 10,000. And that number is stating it intentionally low. And what they found was regardless of whether or not people were doing something they enjoyed or not, boring to them or not, the degree of presence to what they were doing was a stronger predictor of their happiness in that moment.
这是在2010年或2011年左右。当时的技术并没有像现在这样好，但是它已经足够好了，可以应用在非常多的人身上。我不记得是多少人了，但肯定超过一万。并且这个数字是故意说得低一些的。他们发现无论人们是否喜欢做某件事情，不论这件事情是否令他们感到无聊，他们对所做事情的专注程度是判断当时幸福感的更强有力的预测因素。

And overall, then was anything else. And also a fairly rare feature for most people. So it seems like it's something that we do need to work at, perhaps nowadays, as you point out more than we perhaps had to do in our ancestral past.
总的来说，这是别的事情都没有的一个功能，对大多数人来说也相当罕见。因此，似乎这是我们需要努力发展的东西，也许现在比我们祖先时期更需要，正如你指出的那样。

I'm a little bit surprised that you say that you find it hard to be present, because you strike me as somebody that is not just willing, but as a strong, almost reflex toward, you know, observing the contour or something and then really drilling into it and really getting to the guts of most everything that interests you.
我有点惊讶你说你发现自己难以专注当下，因为你给我留下的印象是一个不仅愿意，而且几乎是一种强烈的本能，去观察某件事物的轮廓，然后深入研究，探究吸引你的几乎所有事情的核心。

So you strike me as somebody who's very present. And I guess maybe this gets back to this. But they're not mutually exclusive, right?
你给我一种非常专注的感觉。我想这可能和之前说的有关。但它们并不是互相排斥的对吧？

I mean, I think so for example, I'll notice that sometimes if I'm playing with my kids, especially my boys, because they're younger, right? And playing with them is really being in their world. Like if I'm with my daughter, we can be doing things that are kind of mutually, like, you know, we'll do things together that I would probably do by myself or she would do by herself.
我的意思是，比如说，有时候我会注意到，如果我和我的孩子一起玩耍，尤其是我的男孩们，因为他们比较年轻，对于我来说，与他们一起玩是真正进入他们的世界。如果我和我的女儿在一起，我们可能会做一些相互参与的事情，比如说我自己可能会去做，或者她自己可能会去做的事情。

But with my boys, it's generally doing something I wouldn't otherwise be doing. And if I'm paying attention to it, I'm constantly amazed at how after five minutes of searching through a bin for just the right Lego piece that we want to do to build this one little thing, like my mind will start thinking about something else.
但是跟我的孩子们在一起时，通常是做我平常不会做的事情。如果我留心，我总是惊讶于在搜索一堆LEGO积木片五分钟后，我们会找到恰当的那一块，然后就能用来建造我们想要的小东西，此时我的思维会开始想其他事情。

Like, oh my god, like I got to go, I didn't email that dude back and I got to do this and I got to do this and I got to do this and I got to do this. And I just get into that, I got to do, I got to do, I got to do. That's like dude, you've only been here for five minutes.
哎呀我的天啊，我得走了，我还没回那个家伙的邮件，还有这个事情要做，那个事情也要做，还有这个和那个也都要做。我就陷进去了，只想着这个要做，那个也要做，这样那样都要做。这简直是太夸张了，你才来了五分钟。

Why don't you just find the Lego piece that you need to finish building that thing over there that is this beautiful moment that you're not going to have many of right? There's a very finite number of these moments you're going to have. So you want to save her every one of them.
为什么你不直接找到你需要的乐高积木，完成那边正在建造的东西呢，这是你不会再有很多次的美好时刻。你能拥有这样的时刻是非常有限的，因此你要珍惜每一个。

So again, I don't think I'm alone in that. I think a lot of parents, for example, can relate to that and that's literally just one of many different things. And by the way, I wouldn't have said that that was my greatest challenge either. But it's something that requires, I think, deliberate attention.
因此，我认为我不是唯一一个有这种情况的人。例如，很多家长都能理解这种情况，这只是许多不同事情中的一个。顺带一提，我也不认为这是我最大的挑战。但是，我认为这需要刻意关注。

What you're alluding to is a challenge with holding a single time perception or perception of time. One of the most remarkable things to me about the human brain is our ability to be present or think about the past or the future or the present in the future. And we can occupy different timings.
你所暗示的是关于我们无法保持单一的时间感知或时间观念的挑战。对我来说，人类大脑最令人惊异的一点是我们能够在当下或想到过去或未来或只存在于未来的当下。我们能够占据不同的时间。

And in a recent non-recorded conversation of ours, you showed me something that I've seen before. But for some reason, this time it had a profound impact on me, which is that you have a chart of the number of weeks that you're going to live and you mark them off one week at a time.
最近我们有一次未记录的对话，你向我展示了一个我之前见过的东西。但出于某种原因，这一次它对我产生了深远的影响，就是你有一张图表，记录了你将要活多少周，并且每隔一周划掉一个。

We were talking about this in the context of major life decisions. And it illustrates the fact that we need such a chart that we can't really move through our day being present to the beauty of working on a Lego with our kid while also paying attention to the fact that, wow, this is week number, whatever.
我们是在谈论做出重大人生决策时需要这样一个图表。这也证明了我们需要这样一个图表的事实，我们不能仅仅专注于和孩子一起玩乐高的美好时光，同时也要留意今天是第几个星期。

You know, 600 in the, you know, X number of weeks of one's life so that that ability to contract and dilate our time perception is marvelous. But it's also a double-edged sword because it's what takes us out of what's meaningful in the moment.
你知道，在一个人的生命中，有X个星期，其中有600个星期是可以收缩和扩展我们的时间感知能力的，这是非常神奇的。但同时也是一把双刃剑，因为这使我们无法专注于当前的意义所在。

One sort of has to wonder then whether or not our challenges in being present, you know, I guess the psychoanalyst, maybe we need to, or psychiatrist, maybe we need to ask our Paul Conti, who you know, and I know, and respect greatly.
我们必须思考的一个问题是，我们是否面对在当下存在的挑战，我猜想可以请一位心理分析师或者精神科医生Paul Conti提供帮助，毕竟我们对他非常尊重。

Whether or not this is some subconscious refusal of our own mortality or something, right, that if we were to really contemplate our mortality on a regular basis, not just when we're marking off the weeks of the poster, we wouldn't be able to be present because it's kind of overwhelming.
无论是否有一种潜意识的拒绝面对死亡的因素，如果我们真的经常思考自己的死亡，而不仅仅在标记海报上的星期时，我们可能就无法保持当下的状态，因为这种思考会让人感到压倒性。

Paragraph 1: I don't know. I mean, I feel like the literature says that people who spend more time contemplating their own mortality are actually more at peace. Kind of a little bit of the exposure therapy idea. And so, so I'm not sure it's an unhealthy thing to be aware of your mortality. I suspect it's helpful in as much as you accept it, right, and you feel like you have some agency over parts of it, right?
我不知道。我的意思是，我感觉文献上说，花更多时间思考自己的死亡，实际上会更加平静，有点像曝露疗法的概念。因此，我不确定意识到自己的死亡是否是不健康的。我猜想，只要你接受了它，并且感觉你可以掌握其中的一部分，这会有所帮助，对吧？

Paragraph 2: I don't think I have nearly enough agency over the length of my life. I think I've got five to 10 years at wiggle room that I can extract. If I do, if I do all of the things that I've written about in that book, I bet I can stretch my life out 10 to 15 years at the maximum. Call it 10 over what would have happened if I didn't do those things. Maybe it's more, but, but, you know, that depends on what we're comparing it to, right, from being reasonable to maybe being a little bit, you know, hyper functioning. Maybe it's 10 years.
我觉得我对自己的一生长度没有足够的掌控力。我认为我最多能挽救五到十年的时间。如果我按照书中写的方式去做，我相信最多可以延长我十到十五年的寿命。相比不做这些事情，可以多活十年。或者更多，但这要看我们将其与何种情况相比较，可能有点夸张。总之，可能是十年左右。

Paragraph 3: But where I know I have a much greater agency is on is in quality. And for me, now a big part of that is in terms of quality of relationships. I think that's a big thing. And I think for most people that's that's that's what I hope this chapter does is it is it sort of allows more people to kind of take an appraisal of that and ask that question, which is before it's too late. Am I living my life more for my resume virtues or from my eulogy virtues to borrow from David Brooks's work, the road to character, which I I talk about as being kind of one of the many aha moments that I had during this journey.
我知道我在质量方面有更大的主导权，尤其是人际关系的质量。我认为这非常重要，而且我希望更多人能够思考这个问题，在还没有为时已晚的时候，问问自己：我是为了简历上的成就还是为了留给后人的美德而生活的呢？这是我在这个旅程中得到的很多“惊艳时刻”之一，借用了大卫·布鲁克斯《品格之路》中的术语。我希望本章可以帮助更多人认识到这一点。

Paragraph 4: Yeah, and there again, thank you. You recommended the road to character. To me, I do an annual solo wilderness trip and I listen to it during the drive to that trip and on that trip. And it's a it's a it's a it's a truly important book for everyone to listen to. It's really quite quite impressive.
是的，再次感谢你。你向我推荐了这本《性格之路》。我每年都会独自前往荒野旅行，在路上和旅途中都会听这本书。这是对每个人来说都非常重要的一本书。它真的非常震撼人心。

Paragraph 5: What are the things that you do on a regular, but let's say on a daily basis to try and enforce, forgive the word, but enforce emotional well being and health in terms of relationships. Because as you point out, it's not reflexive for everybody. And that doesn't make them bad people. I think it does have to do with this challenge in balancing expectations of work and other things.
你日常生活中有哪些事情是为了维持情感健康和有助于关系的，尽管可能需要使用一些强制的手段。因为就像你所强调的那样，这对于每个人来说都不是本能的。这并不意味着他们是坏人。我认为这涉及到在工作和其他事物的期望之间取得平衡的挑战。

Paragraph 6: And for some people, a more inherent selfishness. And for some people, they aren't selfish enough. I know plenty of people are running around trying to serve everybody and then their health is crashing or their mental health is crashing. So it can cut any which way or always what what sorts of practices do you incorporate or just even thoughts within your own mind?
对于某些人来说，他们更本性自私。对于某些人来说，他们的自私程度不够。我知道很多人一直在忙着为每个人提供服务，结果他们的健康或心理健康崩溃了。因此，反面的情况也可能存在。你是如何在自己的思想中融入这些练习或想法的呢？

Paragraph 7: Do you use charts and lists? I mean, you're very regimented about your workouts building grip strength, eccentric zone to eccentric training zone to et cetera. Why wouldn't we also script out the things to pay attention to each morning and day as a list of to do's.
你是否使用图表和清单？我的意思是，你在锻炼方面非常有规律，包括增强握力、从离心区锻炼到离心锻炼区等等。那么为什么我们不把每天早上和白天需要注意的事情编排成一个待办事项清单呢？

Paragraph 8: Well, I have done those things, right? So so certainly, you know, and I write about in the book, I've gone away a couple of times, right? So I in 2017 I spent two weeks at a facility in Kentucky in 2020. I spent three weeks at a facility in Arizona. And on the back end of that facility, three years ago, when I got out, I mean, I had I had a very clear list of daily things I needed to do.
那么，我确实已经做了那些事情，对吧？我在书中也写到了。我曾经离开家几次，在2017年我在肯塔基州的一家机构呆了两个星期，在2020年我在亚利桑那州的一家机构呆了三个星期。在三年前从那个机构回来的时候，我有一个非常明确的每日工作清单。

Paragraph 9: And so so at that point for about six months following getting out of that stint of rehab, I mean, I was. I mean, God, the list of behaviors I was doing every single day. I mean, twice a day standing in front of the mirror, reading my list of affirmations, writing in my journal every single day. I had therapy every single day. I mean, all of that stuff was highly regimented.
因此，在退出戒毒所的六个月里，我一直在做着一堆事情。天哪，我每天都要两次站在镜子前面，读我的正面清单，每天写日记，每天都有治疗。所有这些事情都非常规矩。

Paragraph 10: You know, today I would say there's no one single behavior that is quote unquote mandated as part of my recovery. But perhaps the most important thing that does come up every day is being mindful of and acting on as quickly as possible every time I do something damaging to a relationship.
你知道，今天我会说，并没有一个被认为是我康复所必须的行为。但也许最重要的事情是，每天都要意识到并尽可能快地采取行动，每当我做出有损于关系的行为时。

Paragraph 11: So I would say that like if you compare formula one, one of my favorites worked by far if you compare formula one 40 years ago to formula one today, the difference is not in the number of accidents that takes place. The difference is in a fatality of those accidents. There are just as many if not more accidents in formula one today. The difference is nobody dies in those accidents. The cars are so much safer. They're engineered first for safety, second for performance.
如果你比较一下40年前的F1和现在的F1，那我要说，我的最爱F1，在发生事故的数量方面没有什么不同。不同之处在于事故中的死亡率。今天的F1发生的事故数量与过去相比并没有减少。区别在于现在没有人在事故中死亡，因为赛车更加安全了。赛车首先是安全的，其次是性能。

Paragraph 1: It used to be the reverse. And that's why there was a day when every second or third weekend a driver was killed. It's catastrophic to imagine what took place between the mid 60s and about the mid 80s and formula one.
过去的情况恰好相反。正因如此，曾经有一天，每隔第二或第三个周末就会有一名车手遇害。想象上世纪60年代中期到80年代中期的一段时期，在一级方程式赛车中发生的事情是灾难性的。

Paragraph 2: And similarly, I would say that the frequency with which I have an interaction with a person who matters to me that is not the best interaction it could be is only slightly less than what it was five years ago. The difference is the severity of that is much lower and more importantly and most importantly, the length of time between when I screw up and when I make amends is infinitely shorter.
类似地，我想说，和我重要的人之间出现不太理想的交流的频率几乎与五年前相同。不同的是，这种情况的严重程度要轻得多，最重要的是，我犯错到向其赔礼道歉的时间间隔短得多，甚至可以说无限缩短。

Paragraph 3: Right went from being I would never make amends to if I'm a dick to my wife. I usually am trying to rectify it within a few minutes or at most a couple of hours. And so it's really you know one thing I learned throughout this journey was. If you hold yourself up to this goal of I have to be perfect, I have to be the perfect dad, I have to be the perfect husband, I have to be the perfect friend you're going to set yourself up for failure because you know you're not going to be perfect.
转变从我从不会道歉到现在如果我对我的妻子很差，我通常会竭尽所能在几分钟或最多几个小时内去改正。因此，我真正学到的一件事是，如果你把自己的标准定为“我必须完美，我必须成为完美的父亲，我必须成为完美的丈夫，我必须成为完美的朋友”，那么你将注定会失败，因为你知道你不可能完美。

Paragraph 4: But if instead you can say what I'm going to be perfect about is repairing damage when I cause it. That's what matters you know the other day I yelled at my son for something is a while ago actually before I lost my voice so you know I don't know he was just doing something and he was wrong you know like it was like he did something I told him 150 times not to do.
但是，如果你能说我要做到完美的是在我造成损害后修复它。这才是重要的，你知道的，前几天我因为一件事情向我的儿子吼叫了，其实是在我失声之前很久，所以我不知道他做了什么，但一定是错了，就像是他做了我已经反复告诉他不要做的150件事中的其中一件。

Paragraph 5: And I yelled at him and punished him like you know but I was way too harsh like because basically I basically the first 27 times he did it I didn't respond and then when I finally did it's like I blew a gasket right. But what I realized is yeah I you could say well maybe it hurts a child to do that but I think it hurts them way less if you can immediately go and repair and say hey buddy.
我朝他大喊大叫，惩罚他，就像你们知道的那样，但我实际上太过严厉了，因为最初他做了27次，我没有反应，最后我终于反应了就像我爆发了一样。但我意识到的是，你可以说这样做可能会伤害孩子，但如果你能立即修复并说“嘿，伙计”，那么伤害会少得多。

Paragraph 6: Daddy was a little harsh in that I'm sorry I didn't mean to yell at you like that but what you did is wrong and you're not going to get to go out and play right now as a result of it but I love you very much and I want us to do better I want you to do better and not doing this thing and I want to do better and not yelling at you when you do this thing so it's not it's not rocket science right but.
这段话表达了爸爸对孩子的行为感到不满，但同时也表达了他对孩子的爱和希望。爸爸认为孩子做错了事，因此不能让孩子出去玩。爸爸希望孩子以后不再犯同样的错误，他自己也希望自己不再对孩子大声喊叫。虽然这看起来不是难事，但父母和孩子之间的相处需要更多的耐心和努力。

Paragraph 7: I just think I used to live my life in a way where all I did was break shit and never fix it so you're living in a house where everything is broken whereas now I still break things but now I clean up the mess and oh like all of a sudden the house is better. What is your process for when there's a need for repair but you feel that it wasn't you it was somebody else's error or potential error so you very humbly express how you go about repairing your errors but what about situations where a loved one coworker you feel screwed up.
我觉得以前过着的生活方式就是总是把东西搞坏了，然后从来不去修理。像是你住在一个什么都坏掉了的房子里，而现在虽然我还是会把东西弄坏，但是现在我会把弄坏的东西整理干净，突然，房子就变得更好了。当你发现需要维修的时候，但你觉得这不是你的错，而是别人的错或有可能是他们的错的时候，你是怎么处理的？你很谦虚地表达你修复错误的过程，但是如果这种情况发生在你爱的人或同事身上，你将如何处理呢？

Paragraph 8: Or wronged you right as many people do we all do from time to time feel this way do you approach them and try and repair the situation because there's a little bit less or far less control when you know then the situation you described and by the way the situation you describe everything is a perfect one because I think we all screw up and so the answer to this second question is sort of the answer to the first which is if everyone did what you were doing the world would be truly a far better place but not everyone's doing what you're doing so if somebody if you feel wronged assuming that wrong was it you know wasn't that the social pathically motivated what is your process for going about repairing a relationship fracture like that again it's assumes that this is a relationship that matters right so in every interaction you're you're only really able to optimize around one thing and you have to decide is this one thing that I'm optimizing around the relationship or is it the outcome.
有没有人曾经欺负过你，就像许多人经常做的那样，我们有时都会感到这样，你会去接近他们试图修复这种情况，因为你知道在你描述的那种情况下，情况会变得更少或者完全不能控制，顺便说一下，你描述的情况都是完美的，因为我认为我们都会犯错，所以对于第二个问题的答案也就是对于第一个问题的答案，如果每个人都像你一样做，这个世界将会变得更好，但并不是每个人都能像你一样去做，所以如果你感觉被冤枉了，假设这个原因不是出于社交心理动机，你采取的修复关系的方法是什么，这意味着这是一个重要的关系，所以在每一次交互中，你只能最优化一个问题，你必须决定我要最优化的这个问题是关系还是结果。

Paragraph 9: There are other things to optimize around but you understand that those are different and maybe you could elaborate on that a little bit I think I get it but I but fleshed out of it if I'm at the if I'm at the market and I'm trying if I'm trying to buy a new car and I'm sitting there talking to the car salesman that's a relationship that's an interaction now I want to buy this car for as little as possible and he wants to sell a car for as much as possible well in that interaction my relationship with him means nothing let's assume I don't know this is a good thing.
还有其他需要优化的事情，但你明白那些是不同的，也许你可以详细说明一下。我知道这点，但我需要更深入的了解，假如我在市场上想买一辆新车，我和销售员的关系就是一个互动，我希望以尽可能低的价格买到这辆车，而他希望以尽可能高的价格卖出车，那么在这种互动中，我的关系对他来说毫无用处，我们假设我不知道这是一件好事。

Paragraph 10: Let's assume I don't know this guy and he's not like my best friend. I'm optimizing everything around the outcome so everything I do in negotiating and in interacting with him personally is based on getting the best outcome for me. It's very selfish right nothing wrong with that by the way he's doing the same but exactly but now for example pretend that you are the car salesman you're one of my closest friends and it's your dealership like it's your money like it's you know you can't sell this thing to you.
假设我不认识这个人，他也不是我的好朋友。我正在优化一切以达到最好的结果，所以我在谈判和个人交往中所做的一切都是为了获得最好的结果。这很自私，但没有错，顺便说一句，他也在做同样的事情。现在举个例子，假设你是卖汽车的销售员，你是我最亲密的朋友之一，这是你的经销商，这是你的钱，你不能将这个东西卖给你。

Paragraph 1: I don't want you to do that because I want you to be able to make money and similarly like you care about. me and you don't want me to overpay for this so now we're negotiating and we're both trying to optimize for an outcome but there are relationship also matters. It's a very different negotiation at that point and so I think I always try to ask myself this question when I'm having some interpersonal conflict which is what am I optimizing for?
我不希望你这么做，因为我希望你能够赚钱，就像你关心我一样，你也不希望我为此多付钱，所以现在我们在谈判，我们都试图达成最佳结果，但关系也很重要。在这个时候，谈判是非常不同的，所以我认为当我面临一些人际矛盾时，我总是试着问自己这个问题，我想要达到什么目标？

Paragraph 2: So if I'm having a quarrel with my wife I have to remind myself that the outcome is the objective or outcome is not necessarily the top priority. Being right all the time which is my default state it's just to be a bull in a china shop it's to be authoritarian instead of authoritative and that doesn't work if the relationship matters.
所以，如果我和妻子吵架，我必须提醒自己结果不一定是最重要的目标。总是想要证明自己的正确并非最重要的，这只会像是一个大象闯进瓷器店，变得专横而非权威，对于关系的维护没有任何帮助。

Paragraph 3: So to answer your question the first thing I'm going to ask myself if I'm trying if I feel slighted is what is the nature of the relationship is it even worth trying to do something about this and presumably you're asking the question because the lens is yes this is someone who you you care about more than in just a transactional way.
所以，回答你的问题，如果我尝试去弥补一些感觉被冒犯了的事情，我首先会问自己的是，这个关系的本质是什么？是否值得尝试去解决这个问题？而且大概你问这个问题的原因是因为你很在意这个人，不仅仅是一种交易关系。

Paragraph 4: You know usually what I've realized is I can't try to approach the situation without fully understanding myself and that takes a while so generally and this is where you know I still one to two times a week I'm still working with a therapist I have to kind of try to figure it out on my own and then usually bounce it off a therapist and say well I think this is why I'm upset about this.
我意识到一般来说，如果我没有完全理解自己，就不能尝试处理这种情况，而这需要一段时间。因此，通常我一周要跟治疗师见一到两次，尝试自己摸索出问题的根源，然后再跟治疗师讨论，说出我认为自己为什么会为此不安。

Paragraph 5: I think that when this person did this or said this I felt this first of all am I am I correcting what I felt because remember sometimes you might at least for me this was the case I would just feel anger in response to every interaction. But what I didn't realize was that anger was really just another emotion that was super imposed on top of hurt or super imposed on top of fear or super imposed on top of shame or super imposed on top of something else but I didn't know how to articulate any of those other emotions so the only thing I could really articulate was anger.
我认为当这个人做了这件事或说了这句话时，我首先感觉到了这个情绪，我正在纠正我所感受到的情绪。记住，有时候至少对于我来说，我会对每次互动都感到愤怒。但我没有意识到愤怒实际上只是一种被强加在伤害、恐惧、羞耻或其他情感之上的情绪，但我不知道如何表达这些其他的情感，所以唯一能表达的就只有愤怒。

Paragraph 6: So if anger is the only thing I know and anger is the only response I see it's not very helpful it's not very insightful so that's that's a big part of it is being able to deconstruct what I'm feeling what I really feel is loss or what I really feel is abandonment right now and that sometimes takes a while to figure out at least for me like I'm still. You know I'm only a few years into this journey and maybe other people figured these things out when they were in their 20s and so they're veterans they can do this more more naturally but that step one if I don't really understand what's going on I can't even begin to try to approach this person to say this is how I feel.
所以如果愤怒是我唯一知道的，愤怒是我唯一的反应，这并没有什么帮助，也没有什么洞见，因此很重要的一点是能够分解我所感受到的情绪，我真正感受到的是失去还是被遗弃，有时需要很长时间才能弄清楚，至少对于我来说是这样的，因为我只是在这个旅程中的几年时间里，也许其他人在他们20多岁就弄清楚了这些事情，所以他们是老手，更加自然地做到了这一点，但这是第一步，如果我真的不了解发生了什么，我甚至无法开始尝试接近这个人并说出我的感受。

Paragraph 7: This is you know how do you feel and what are we optimizing for in this interaction. I certainly know you are not alone in this sense of the process and it takes a lot of time and on a case by case basis can take a lot of time to figure out you know exactly what one is feeling I think it really goes back to the the core sense of language as a way to sort one's feelings it was actually your other because we mentioned Paul Conti who is one of your Stanford medical school classmates but another previous guest on this podcast who was also one of your medical school classmates Dr. Carl Dicerol right psychiatrist and bio engineer of phenomenal stature and doing amazing things in the world who said you know most of the time we have no idea how other people feel even though we think we do and most of the time we don't even know how we feel I mean our ability to really do this is a great thing.
这是你知道你的感觉，以及我们在这种互动中要优化的内容。我知道你在这个过程中并不孤单，需要花费很多时间，而且每个案例都需要花费很多时间去了解自己的感受。我认为这实际上是回归到语言作为了解自己感觉方式的核心，正如我们之前提到过的保罗·康蒂，他是你在斯坦福医学院的同学之一，但是另一位以前在这个播客中出现过的嘉宾，也是你在医学院的同学之一，艾伦·卡尔·狄塞罗尔博士，他是一位身材高大的精神病学家和生物工程师，在世界范围内做出了惊人的成就，他说我们大多数时候都不知道其他人的感受，尽管我们认为我们知道，而且我们大多数时候甚至不知道我们自己的感受。我们真正做到这一点的能力是一件好事。

Paragraph 8: I mean our ability to really know what we're really feeling is terrible and yet we recognize the the broad the broad bins I'm pissed off super happy I'm relaxed I'm tired I mean just think about how course that that language is for that we're all the nuance and all the underlying things conscious and subconscious that could be driving an emotional state it's really it's really quite unbelievable yeah I'm beyond the valence that with you know positive versus negative that was about.
我是说我们真正了解自己情感的能力很差，但我们意识到我们感受的大致分类，例如生气、非常开心、放松、疲惫等等。想想看，这种语言是多么的简单粗暴，我们却错过了所有细微差别和潜在意识和无意识中驱动情感状态的因素，这真的非常不可思议。我已经超出了简单的正面与负面的区分了。

Paragraph 9: The extent of my emotional language until you know somewhere recently. Well strikes me you come a very long way maybe you could share with us a little bit about what you learned on these what you called retreats or I mean in the book chapter you describe deliberately going off to a treatment center.
直到最近，我的情感表达能力受限。我想知道，你已经走了很长的路，能否跟我们分享一下你在这些所谓的“撤退”中学到了什么呢？在书中的某一章节中，你描述了有意前往治疗中心的情况。

Paragraph 10: Multiple treatment centers over time to really drill into this process of understanding oneself better and how one's current state of emotional processing and emotional stability are influencing relationships and the key importance of that. What was there any kind of overriding theme for you for instance could you trace back to specific events or themes of childhood that made a lot of it makes sense or is it far more nuance than that.
随着时间的推移，多个治疗中心可以真正深入研究自我认知的过程，以及当前情感处理和情感稳定状态如何影响关系，以及其关键重要性。例如，是否存在一种主导主题，您可以追溯到童年时期的特定事件或主题，让其中很多事情变得有意义，还是更为微妙而复杂。

Paragraph 1: Well you know the first thing I would say is I wish I could tell you that this was a very deliberate and wonderful choice that I just decided I'm going to go on a little you know self healing journey but unfortunately that was not the case in both cases in 2017 and in 2020. I've heard I was as close to having no choice in the matter as one can have so both of these experiences represented total rock bottom moments in my life so these would have been the two lowest points in my life for different reasons but but they were nevertheless the two absolute low points in my life and I would say you know in the first instance I.
希望我能告诉你，这是一个非常谨慎和美妙的选择，我决定去走一段自我疗愈之旅。不幸的是，在2017年和2020年，这不是我所做的决定。我必须说，在这两种经历中，我几乎没有选择的余地，因此它们都代表了我人生中的低谷时刻。以不同的原因，它们是我生命中两个最低谷的时刻。在第一种情况下，我...

Paragraph 2: I guess I could have chosen not to go but I would have lost everything that mattered in my life at that point and I had you know our good friend Paul Conti basically telling me that I needed to do this that I really needed to do this in the second situation though completely different circumstances you might think how can one person in just a span of three years find themselves in a situation where they. Almost without having any choice in the matter have to go away to a place where you're you're basically blocked up without a phone for you know three weeks and you're doing 12 to 13 hours of therapy a day so nothing about this was was something I wanted to do nothing about this was pleasant.
我想我本可以选择不去，但那样我会失去我生命中最重要的一切。我们的好朋友保罗·孔蒂告诉我我需要这样做，我真的需要这样做。第二种情况完全不同，你可能会想，一个人在短短三年内怎么会陷入这种境地，不得不去一个没有手机，被关了三个星期，在那里每天要进行12到13个小时的治疗。这件事并不是我想做的，也不是令人愉快的事情。

Paragraph 3: I would describe these is the most difficult things I've ever done in my life bar none and I've done some difficult things in my life but they've always been physically difficult I love doing physically difficult things but this was emotionally the equivalent of for me climbing K to and swimming the English channel in the same month you know something that just I could you couldn't fathom. So so with that said yes I learned a lot and I learned that.
我认为这是我人生中最困难的事情之一，毫无疑问。虽然我做过一些困难的事情，但它们通常是身体上的困难。我喜欢做身体上的困难事情，但这次是在情感上的挑战上，对我来说相当于在同一个月攀登K2和游过英吉利海峡，你知道这是无法想象的事情。所以说，是的，我学到了很多，我学到了……

Paragraph 4: People like me can be overly analytical and. That that hyper analytical nature can lead you astray when you think that your intellect is giving you a fact based explanation for a set of circumstances and you rationalize them away well this happened to me when I was a kid but you know like I get it and it's not really a problem and as a result of that you know. It's it's it's these are actually some positive things that came out of that experience and and I think the real aha moment in my journey which occurred on a day that I remember very well was the day I finally dropped that I dropped that.
像我这样的人可能会过度分析，这种过度分析的性质会让你误入歧途，当你认为你的智力为一系列情况提供了基于事实的解释，然后你为之合理化，这种事情在我还是个孩子的时候发生过，但你知道像这样的事情并不是真正的问题，作为结果，这些实际上是我经历的一些积极的事情，我认为我旅程中真正的“啊哈”时刻发生在我记得非常清楚的一天，那是我终于放下了这一点。

Paragraph 5: That rationalization and I allowed myself to experience what a child would experience in that moment and then understood what the implications are for a child going through these things and I think that was that was really the first time in my life I ever accepted emotionally something that I had intellectually always said. It doesn't really matter. I mean it's just you know that's just life and those things happen and lots of worse things happen to lots of people and that's okay and I think it's not that once I emotionally accepted this I became a victim it wasn't at all it just finally allowed me to realize oh I can let that go now like I don't have to I don't have to be a slave to the adaptations that came from that I can I can surrender.
我和理性的自己允许自己去感受像一个孩子一样的体验，然后理解了孩子们经历这些事情的含义，我认为这真是我生命中第一次情感上接受了我一直以来理智上所说的东西。那并不重要。我的意思是，这只是生活中的一件小事，很多人经历了更糟糕的事情，这没关系。我认为，一旦我在情感上接受了这一点，我并不是成了一个受害者，而是终于让我意识到我可以放下了——我不必再受那些来自那些经历造成的适应方式的束缚，我可以投降了。

Paragraph 6: It's beautiful and and inspiring to me I think that yeah there's this incredible ability that human brain has to script a story and to compare to other people circumstances and as you say you know rationalize what are essentially emotional traumas. Or physical traumas from the perspective of the adult but if I know one thing for sure and make it very clear I'm not a clinician but is that the brain doesn't discard of any circuitry we repurpose the same circuitry we used as children as adults and so the ability to go back to that and to and to parse it but as you as you point out not from a from an intellectual standpoint standpoint but from an emotional standpoint. Seems to be the really hard work.
对我而言，这是美丽而鼓舞人心的。我认为人类大脑具有惊人的能力，能够编写故事，并将其与他人的情况进行比较，并像你所说的那样，从成年人的角度理性地对待从情感或身体上导致的创伤。但我可以肯定且明确地指出，我不是一名临床医生，大脑不会丢弃任何电路，我们将同样作为孩子所使用的电路重新利用为成年人。回到那时的能力，并从情感而非理智的角度通过这些体验是非常艰难的。

Paragraph 7: Do you do that on a regular basis? No not not at all it's been done a handful of times it's been exhausting it's it's very difficult it's it's it's it's I don't know if this is the right word I would almost describe it as emotionally violent and it's it's not something I need to revisit often truthfully I think that yeah it's it's it's been done a finite number of times and I think I've captured so much so much value from it that there are lots of other things I continue to do I mean I you know I I use a system called dialectical behavioral therapy that is a regular part of the therapy that I do but I don't have to go back to my childhood I don't have to go back to uncovering and right and I'm uncovering and and re exploring a lot of that stuff.
你经常这样做吗？不，完全不是，只做过几次，非常累人，非常困难，我不知道这是否是正确的词语，我几乎可以将其描述为情感上的暴力，这不是我需要经常重新访问的事情。说实话，我认为它只做过有限次数了，我从中获取了很多价值，所以我继续做很多其他事情，比如使用我们称作辩证行为疗法的系统。我不必返回到我的童年时期，不必揭开、重提那些事情。

Paragraph 1: I I've I've learned the lessons and now it's really about practicing the skills I know I know what I want now and I know you talk about plasticity I'll share one example which I know I wrote about in the book but just for for folks listening that you'll appreciate.
第一段： 我已经学到了一些教训，现在重点是要练习我所知道的技能。我知道自己想要什么，你曾谈到过可塑性，我会分享一个例子，虽然我在书中写过，但是对于倾听的人来说，你会很欣赏的。

Paragraph 2: So I you know just one of the one of the hallmarks of my existence has always been you know just a an insane amount of. anger and rage it's it's been there as long as I've known so I don't have a conscious memory of not having rage right so earliest memories of life when I'm five years old I have rage like you can't believe and it's it's a problem all my life so as a teenager if I go more than two weeks without punching a hole in the wall of our house it's a miracle I mean I am so good at drywall you can't believe how good I am for all the stuff I have to repair around our house like I'm breaking windows I'm breaking it just doesn't like I just and so in a way and of course I rationalized how much boxing saved my life because I had this amazing outlet for my rage right if you basically exercise six hours a day I'm hitting punching bags and people all day long and it's just a beautiful outlet that keeps me out of jail.
我的存在之一，一直都充满了愤怒和怒火，这已经伴随我很久了。我没有意识到没有愤怒的记忆，甚至在我五岁的时候，我就已经有了令人难以置信的愤怒了。这一直是我生命中的问题。作为一个青少年，如果我超过两周没有打破我们房子墙上的洞，那简直是个奇迹。我非常擅长修补石膏板，因为我不断需要修理我们房子里的东西，比如我打破窗户，打破门等等。当然，我也为自己理性化，说拳击救了我的命，因为它是我发泄愤怒的绝佳方式。每天锻炼六个小时，打击沙包和人，这是一种美妙的出口，让我远离监狱。

Paragraph 3: and a big part of that rage was inward right so it's it's it's not rocket science to be a person who has that much hatred for everyone has an enormous amount for themselves and so one of the things I didn't realize was happening was what my inner monologue was because as you can appreciate your inner monologue is so frequent and ubiquitous and present that it's easy to almost forget that it's there I mean that's the that's the that's the sort of dangerous part about it right is kind of the you know the David Foster Wallace this is water thing the fish are swimming through water the water is everywhere they don't even realize they're in water you don't unrealize you don't realize the subconscious stream of thoughts that constantly flow but eventually I became aware of just what that self-talk was.
这股愤怒的的大部分来源在心灵深处，因此一个极度憎恨每个人的人往往也同样地对自己充满恶感。我意识不到的一个问题就是自己心里的自我对话，因为你知道的，自我对话是如此频繁和无处不在，以至于很容易忘记它的存在。这就是它危险的地方——就像David Foster Wallace所说的，“这是水”，鱼儿游水在水中，水无处不在，它们甚至没有意识到自己身处水中。你没有意识到潜意识中不断流动的思维之流，但最终我意识到了这种自我对话的本质。

Paragraph 4: and it is it was no longer the case it was the angriest the most violent self-talk you can imagine I mean it was like there is no mistake that I could make that was anything other than my perfect perfect standard that didn't result in what I would call my inner Bobby Knight going ballistic so it just didn't matter like it it's it's it's it's it's it sounds silly under it didn't matter if I didn't perfectly cook a steak if I didn't perfectly nail something I was doing if if I didn't do anything that was perfect at what I described as match grade perfect I mean I would want to beat myself to a pulp and I would scream at myself.
以前的情况已经不再是这样了，我的内心对自己进行的自我谈话变得非常生气和暴力，你无法想象。我的标准是完美的，如果我犯了任何错误，我的内心就像是在爆炸。所以，这些事情就不再重要了，例如，如果我没有完美地煮牛排，如果我没有完美地完成某件事情，如果我做任何事情都不符合我所说的完全匹配的标准，我会想要自殴，并对自己大喊大叫。

Paragraph 5: it just it's again it's hard to describe and I hope that most people listening to this don't understand what that feels like well it became very clear that that had to change because when you are when you hate yourself that much by definition you are going to be an insufferable prick to everybody else like because you're just that's going to spill into how you interact with the world so I you know was working with a therapist who was one of the people who was sending me to this place in Arizona and basically it became clear that you know they they they they proposed that I could shed this trait if I was willing to do certain amount of work and I was like there's no chance like I'm 47 years old this is the only way I've ever interacted with myself.
这很难描述，我希望听到这个的大多数人都不理解那种感觉，因为当你自己讨厌自己的时候，你就会成为一个让其他人难以忍受的人，因为你的内在情绪会影响你与世界的互动。我当时正在和一个心理医生一起工作，他是将我送到亚利桑那州那个地方的人之一，基本上，我们意识到有必要改变这种状况，而他们提出了如果我愿意付出一定的努力，可以改变这种特质。但我当时已经47岁了，这是我与自己互动的唯一方式，我不相信我可以改变。

Paragraph 6: how in the world could this be undone and take another 40 years to undo this and they're like no no here's this exercise you're going to do so the exercise was every single time I did something where I would have that self talk I would have to immediately stop myself and pretend that it wasn't me that just did that but it was one of my closest friends and instead I would audibly speak to that person there's nobody else there but speak to that person as though they are the one that made the mistake and I were to I was to record that on my phone.
这句话的意思是，作者不知道如何才能解决这个问题，并且需要再等40年才能解决。但是治疗师告诉他们一种方法，那就是每次他有负面自我评价的想法，就立即中止，并假装这不是他自己，而是他最亲密的朋友犯了这个错误，然后对这个朋友说话，即使没有人在场。为了掌握这个方法，他们还要在手机上进行录音。

Paragraph 1: So I'm out there shooting my bow and arrow and I don't get a bullseye instead of screaming at myself I have to say oh imagine it's my buddy J.R. who just missed that shot what would I say to him pick up the phone or you can't get a phone and say of course something different and of course what I would say in that situation was much kinder I mean infinitely kinder like from saying it to my closest friend
所以我在那里用弓箭射击，却没有射中靶心。但我不会对自己喊叫，而是要想象一下是我的朋友J.R.未能命中该怎么办，我会对他说些什么？我会拿起电话或者说些不同的话。当然，在那种情况下，我会说些更加友好、无限温和的话，就像对待自己最亲密的朋友一样。

Paragraph 2: I'm going to say it in a very kind way and I had to take a copy of that audio and text it to my therapist oh wow yeah talk about can you imagine I was all on board this practice until you mentioned that at which point and I trust my therapist to a very deep level but I thought wow that that's a that's a mountain well this you know this poor person got a lot of text messages a lot of audio files but here's the part that just blows my mind
第二段： 我会以一种温和的方式说出。我不得不复制那个音频并将其发送给我的治疗师。哇，你可以想象一下，我一直支持这种做法，直到你提到这点，那时我非常信任我的治疗师，但是我想，哇，这是一座大山。这个可怜的人收到了许多文本消息和音频文件，但这部分让我惊讶。

Paragraph 3: it only took I don't know I can't remember exactly I have to go back to look at my journals I took about four months to get rid of Bobby night like you know again we. had kind of a mental model for what this looked like which was Bobby night was the chairman of the board he sat in the boardroom and nobody else got to talk and for those that don't know Bobby night had a terrible temper yeah the worst right this is the guy that was throwing chairs across the basketball court level 11 yeah out of 10 and and all of a sudden like we got to the point where Bobby night is not even in the board room anymore in fact I as I say this today like I don't really remember what he sounded like it's amazing to me and I've had some really amazing opportunities to bring him back
第三段：我不知道具体花了多长时间，我记不得了，我得去看我的日记。大概用了四个月的时间，我们成功摆脱了Bobby Night。我们对此有一个心理模型，就是Bobby Night是董事会主席，他坐在会议室里，其他人都不能发言。对于不了解Bobby Night的人来说，他非常暴躁，是最糟糕的人，他曾经在篮球场上扔过椅子，可怕程度达到了10分之11。但是突然之间，我们成功将Bobby Night从董事会中排除，事实上，今天我说这句话时，我已经不太记得他的声音了，这对我来说很奇妙。我有了一些非常棒的机会可以请他回来。

Paragraph 4: like it's not like I'm making fewer mistakes right it's not like I'm better today than I was three years ago at all the things that I do I'm not I'm actually probably worse in many regards but the difference is you know I can communicate with myself I think I can say this I think I can say lovingly right and and maybe not as lovingly as some people can I still think I'm probably maybe just a little higher standard with myself than maybe I need to be at times but but I'm just not beating myself up like I used to and I think by extension I'm beating other people up a lot less
这并不意味着我犯错的次数更少，今天在我所做的事情上比三年前更出色，实际上在许多方面我可能更差。然而，区别在于，我可以与自己沟通，我认为我可以以爱的方式说这些话，或许没有某些人那么有爱心，但我认为我对自己的要求可能比需要的高了一点，但是我现在不再像过去那样自责，我认为这样反过来，我打击别人的程度也会减轻。

Paragraph 5: well I don't know the extent to which your internal narrative reflects the narrative that others have about you but first of all I want to thank you for sharing what you just shared I think as a practical step it it first of all it's one I've never heard of before but certainly represents this incredible phenomenon of neuroplasticity because four months sounds like a bit of time and yet you were 47 years old that's 47 years of accumulated just absolutely berating self-talk is what it sounds like but something that people can can think about for their own purposes and their own challenges also you know
我不确定你内心的故事与外界对你的评价是否一致，但首先我要感谢你刚才的分享，我认为这是一个实用的步骤，我从未听说过它，但它代表着神经可塑性这个不可思议的现象。尽管四个月听起来不算长，但你已经47岁了，这代表了47年累计的自我贬低的对话。但这也是一个人们可以考虑应用于自己的目标和挑战的事情。

Paragraph 6: I've read the book twice now and love it as I put in my endorsement of it I think it's not just informative but it's indeed important because it centers on so many of the key actionable items related to by health span and life span vitality longevity whatever people want to call these things that are essential but also this section on emotional health was absolutely profound for me it inspired a huge number of changes and the book as a whole represents a very important contribution to everybody and their numerous points and I would say every chapter is applicable to everybody and there are very few books out there like that so I want to thank you for that and especially for including the section on emotional health and especially for sharing what you did today
我已经读了这本书两次，非常喜欢它，正如我在推荐书中所说，我认为它不仅提供了有用的信息，而且非常重要，因为它涵盖了许多与健康期望寿命和生命活力长寿（无论人们愿意如何命名）相关的关键可操作项目。此外，关于情感健康的部分对我来说是非常深刻的，它激发了我许多的改变，整本书代表了对每个人而言非常重要的贡献，我想说每一章都适用于每个人，几乎没有其他像这样的书籍，所以我要感谢你，特别是要感谢你包括情感健康的部分，并且特别感谢你分享今天的内容。

Paragraph 1: Hi everybody welcome to today's episode of the Huberman Lab podcast as promised this is the follow up to my episode with dr. Peter atia last week we discussed his new book which is coming out on March 28th 2023 entitled Outlive.
大家好，欢迎收听本期Huberman实验室播客，正如之前我所承诺的，这是上周与Peter Atia博士一起录制的节目的后续内容。我们讨论了他的新书《Outlive》，该书将于2023年3月28日出版。

Paragraph 2: The science and art of longevity in today's episode we're going to discuss the emotional health components of optimizing your life your health your relationships your work and much much more I really enjoyed this conversation with Peter it was a different side of him maybe a more vulnerable side and I think you will all enjoy it as well as always please check out the sponsors at the beginning and throughout today's episode that's the best way to support this podcast and keep it zero cost.
本期节目将讨论长寿的科学与艺术，着重讨论优化生活、健康、人际关系、工作等方面的情感健康因素。我很喜欢与彼得的对话，他展现了不同的一面，或许是更脆弱的一面，我相信大家也会喜欢。像往常一样，请注意本期节目一开始和中途的赞助商，这是支持这个播客并保持零成本的最佳方式。

Paragraph 3: There are no ads in the middle of the episode you'll hear me discuss more about those sponsors but we don't stop in the middle of the episode for ads unlike many podcasts also if you're finding value from these conversations please subscribe to our YouTube channel and the podcast on both Apple podcast and Spotify that's the best way to support us if you really like the podcast on Apple and Spotify you can leave us up to a five star review if you'd like please put in the comment section if you're enjoying the episode now or the podcast in general maybe mention some of your favorite episodes the guests that you enjoy and so on that will help us grow and also help us improve the feedback is always much appreciated.
第三段：在这集节目中没有广告，但我会在谈到赞助商。我们不会在中途插播广告，不像很多播客。如果您觉得这些对话有价值，请订阅我们的YouTube频道和同时在Apple Podcast和Spotify 上收听我们的播客。这是支持我们的最好方式。如果你真的喜欢在Apple和Spotify上收听播客，你可以给我们留下五星评价。如果您喜欢本期节目或整个播客，请在评论中说明，并提到您最喜欢的几集、嘉宾等等。这将有助于我们成长和提高。感谢您的反馈。

Paragraph 4: I hope you enjoy this conversation with Dr. Peter atia and the discussion of optimizing emotional health and the various components of it be sure to check out his new book Outlive the Science and Art of Longevity coming out on March 28th 2023 and without further ado please enjoy my conversation with Dr. Peter atia.
希望您喜欢本次与彼得·阿蒂亚博士的对话以及关于优化情感健康及其各个组成部分的讨论。请务必关注他的新书《超越寿命：长寿的科学与艺术》，该书将于2023年3月28日出版。那么，不再拖延，请欣赏我与彼得·阿蒂亚博士的对话。

Paragraph 5: Yeah I think the emotional health piece is one that I'm just starting to scratch the surface on I'm 50 years old and I'm realizing how brutally inept I am at this part of my life and so while I don't have anything meaningful or insightful to share it sounds like you may so what what are the most important pieces of the pers-the emotional health puzzle.
是的，我认为情感健康方面的问题是我才刚刚开始涉足的领域。我已经50岁了，我意识到我在生活的这个方面非常无能，所以虽然我没有什么有意义或深刻的东西可以分享，但是听起来好像你有，那么什么是情感健康谜题中最重要的部分呢？

Paragraph 6: It's such an important area that you're focusing on now and I think it's really brave to be able to talk about this because what we're seeing now is that more and more people are looking at the science behind emotional wellness the one thing that I really want to start with is the concept of vulnerability I think our culture looks at vulnerability as a weakness but it's actually a tremendous strength because it creates authenticity you can't have a great relationship without vulnerability and so in how we deal with our emotional situations that's a tremendous component of it.
你现在关注的内容非常重要，我认为你能够谈论这个是非常勇敢的。现在我们看到越来越多人开始关注情感健康的科学，我想首先讲的是脆弱性的概念。我认为我们的文化认为脆弱性是一种弱点，但实际上它是一种巨大的力量，因为它创造了真实性。没有脆弱性，你就无法拥有良好的关系，因此在处理我们的情感问题时，这是一个很重要的组成部分。

Paragraph 7: Because I think it doesn't just take a bit of vulnerability but a ton of vulnerability and humility to be able to share what you just shared and my only request or wish is that you also hopefully internalize the tremendous gift that you're giving everybody through coming on podcasts like this doing your own podcasts writing the book you know I look out on the landscape of front facing public facing health out there and you sit not alone but in a unique stance as the medical doctor that I do believe that people trust the very most because of the fact that you have that intense rigor your to I wouldn't say your desire your absolute obsession with measurement and precision many of the things that a moment ago you were pointing to as potentially you know hazards for your emotional life but that serve all of us the general public so preciously and so with just incalculable value.
我认为，分享你刚刚分享的事情不仅需要一点点脆弱，而是需要大量的脆弱和谦逊。我唯一的请求或愿望是，你也希望通过像这样的播客内化你所赠予每个人的巨大礼物，创作你自己的播客，写作书籍。我看着公众面前的医疗健康领域，你不是孤单的，但你拥有独特的立场，因为你是医生，我相信人们最信任你，因为你具有强大的严谨性，你对测量和精确度的绝对追求，在刚才你指出可能成为你情感生活危险因素的许多事情中，这些都为我们普通公众服务，如此珍贵，并且具有不可估量的价值。

Paragraph 8: So I hope that internalizes as well maybe it will even weave into yourself talk maybe I need to send you a script every day but in all seriousness I also want to thank you for taking the time today and even though it's a personal thing I really want to thank you for your being an amazing colleague to me in the podcast space in the health and medicine space whatever that is and also just in an incredible friend you've been a tremendous source of support and guidance in every one of the domains that we talked about today and many more and again I just want to say that this emotional health component I agree with you I think it's not just vital I think it's the most vital of all of them so you've just made numerous important contributions and I just want to thank you for sharing that you clearly put everything you have into everything you do thank you Peter.
我希望这些话语能够内化，甚至能够融入你的自我对话中。也许我需要每天给你发送一份剧本，但我也想认真地感谢你今天花费的时间。尽管这是个个人的事情，但我真的要感谢你在播客空间、健康与医学空间，以及在生活中是一个了不起的同事和朋友。你一直是我在我们今天谈到的各个领域以及更多领域中的支持和指导力量。再次强调一下，情感健康组成部分的重要性我同意你的看法，不仅是至关重要的，我认为它是所有组成部分中最为重要的。你做出了多个重要的贡献，我想感谢你的分享。你显然将自己所拥有的一切都投入到了你所做的一切中。谢谢你，Peter。

Paragraph 9: Thank you I really appreciate you making the time for us to sit down and talk in a long form way which I enjoy and yeah it's an it's an it's an honor and it means a lot to me that you have read it twice and that you've appreciated it and and and praise praise it as you have thank you thank you once again for joining me for today's discussion with Dr. Peter atia I hope you learned as much and enjoy the conversation as much as I did check out Dr. atia's new book which is releasing on March 28th 2023 entitled Outlive the Science and Art of Longevity if you're learning from and or enjoying this podcast please subscribe to our YouTube channel that's a terrific zero cost way to support us in addition please subscribe to the podcast on both Apple and Spotify and on both Apple and Spotify you can also leave us up to a five star review if you have questions for us or comments about the podcast or topics you'd like me to cover or guests that you'd like me to include on the Hubertman Lab podcast please put those in the comment section on YouTube.
非常感谢您抽出时间坐下来与我们长时间地交谈，我真的很喜欢这种方式。您已经阅读了我的作品两次，并且给予了赞扬，这对我来说意义重大，我感到非常荣幸。再次感谢您参加今天与Peter博士的讨论，希望您像我一样学到了很多东西，并且很享受这个对话。请关注Peter博士的新书《长寿的科学与艺术》（Outlive the Science and Art of Longevity），计划在2023年3月28日发行。如果您正在从这个播客中学习或者享受，请订阅我们的YouTube频道，这是一个绝佳的支持方式，完全免费。此外，请在苹果和Spotify上订阅我们的播客，并且在这两个平台上，您也可以留下五星好评。如果您有关于播客的问题或者评论，或者您希望我涵盖的话题或者包括的嘉宾，请在YouTube的评论区发表。

Paragraph 10: I do read all the comments in addition please check out the sponsors mentioned at the beginning and throughout today's episode that's the best way to support this podcast on various episodes of the Hubertman Lab podcast we discuss supplements while supplements aren't necessary for everybody many people derived tremendous benefit from them for things like improving sleep supporting hormones improving focus and so on the Hubertman Lab podcast is proud to have partnered with momentous supplements if you'd like to see the supplements discussed on the Hubertman Lab podcast you can go to live momentous spelled OUS live momentous dot com slash Hubertman.
第10段： 我会阅读所有的评论，请您还要关注今天的节目中提到的赞助商，这是支持这个播客的最佳方式。在Hubertman Lab播客的许多集中，我们讨论了补品。虽然补品并不是所有人都必须使用的，但是对于改善睡眠、支持荷尔蒙、改善注意力等等，许多人从中获得了巨大的好处。Hubertman Lab播客很自豪地与momentous supplements合作，如果您想查看在Hubertman Lab播客中讨论过的补品信息，您可以访问live momentous spelled OUS live momentous dot com slash Hubertman。

Paragraph 11: If you're not already following me on social media it's Hubertman Lab on Instagram Twitter Facebook and LinkedIn and at all of those places I cover science and science based tools some of which overlap with the contents of the Hubertman Lab podcast but much of which is distinct from the content covered on the Hubertman Lab podcast again it's Hubertman Lab on all social media platforms if you haven't already subscribed to the Hubertman Lab podcast neural network newsletter it's a monthly newsletter that includes free toolkits things like toolkit for sleep how to enhance the quality and duration of your sleep toolkit for focus tool kit for neuroplasticity toolkit for deliberate cold exposure heat exposure and summaries of podcast episodes all of those toolkits can be found by going to Hubertman Lab dot com go to the menu scroll down to newsletter and simply give us your email we do not share your email with anybody and again the newsletters and toolkits or completely zero cost and you will also find some PDF examples of previous toolkits again that's Hubertman Lab dot com.
如果您还没有在社交媒体上关注我，可以在Instagram、Twitter、Facebook和LinkedIn上搜索Hubertman Lab，我会在这些平台上涉及科学和基于科学的工具。其中一些与Hubertman Lab播客的内容重叠，但大部分是与播客中涉及的内容不同的。如果您还没有订阅Hubertman Lab播客的神经网络新闻通讯，可以到Hubertman Lab dot com网站上订阅。神经网络新闻通讯是一个月度的通讯，包括免费工具包，例如有关睡眠、如何增强睡眠质量和持续时间的工具包、专注工具包、神经可塑性工具包、冷热刻意暴露的工具包以及播客集锦。这些工具包可通过访问Hubertman Lab dot com网站的菜单并向我们提供您的电子邮件地址来找到，我们不会与任何人分享您的电子邮件地址。通讯和工具包都是完全免费的，您还可以找到以前工具包的一些PDF示例。再次强调，这是Hubertman Lab dot com网站。

Paragraph 12: Thank you once again for joining me for today's discussion with Dr. Peter itia and last but certainly not least thank you for your interest in science.
再次感谢您加入今天与彼得医生的讨论，还要特别感谢您对科学的兴趣。