Dr. Chris Palmer: Diet & Nutrition for Mental Health

I'm Andrew Huberman, and I'm a professor of neurobiology and ophthalmology at Stanford School of Medicine.

我是安德鲁·胡伯曼，斯坦福大学医学院神经生物学和眼科教授。

Today, my guest is Dr. Chris Palmer.

今天，我的客人是克里斯·帕尔默博士。

Dr. Chris Palmer is a medical doctor specializing in psychiatry at Harvard Medical School.

克里斯·帕尔默博士是哈佛医学院精神病学专业的医生。

He is the world expert in the relationship between metabolic disorders and psychiatric disorders.

他是代谢紊乱与精神疾病之间关系的世界专家。

He treats a variety of different conditions, including psychosis, including schizophrenia, as well as attention deficit hyperactivity disorder, obsessive compulsive disorder, anxiety disorders, and depression among others.

他治疗各种不同的疾病，包括精神病，包括精神分裂症，以及注意力缺陷多动障碍、强迫症、焦虑症和抑郁症等。

He is best known for understanding the relationship between how metabolism and these various disorders of the mind interact.

他最出名的是理解新陈代谢与这些不同的心理疾病之间相互作用的关系。

And indeed, today, he describes not only his own fascinating journey into the field of psychiatry but also his clinical and research experience using diet that is different forms of nutrition in order to treat various psychiatric disorders.

事实上，今天，他不仅描述了自己在精神病学领域的迷人旅程，还描述了他使用不同形式的营养饮食来治疗各种精神疾病的临床和研究经验。

He describes some remarkable case studies of individuals and groups of people who have achieved tremendous relief from the types of psychiatric disorders that I just mentioned a few moments ago, as well as new and emerging themes as to how metabolism and the mind interact to control things like obesity.

他描述了一些引人注目的案例研究，这些案例研究了我刚才提到的那些已经从我刚才提到的精神疾病类型中获得巨大缓解的个人和人群，以及关于新陈代谢和精神如何相互作用以控制肥胖等问题的新主题。

Indeed, he raises the hypothesis that perhaps obesity, in many cases, is the consequence of a brain dysfunction as opposed to the consequence of a metabolic dysfunction that then impacts the brain.

事实上，他提出了这样的假设：在许多情况下，肥胖可能是大脑功能障碍的结果，而不是影响大脑的代谢功能障碍的结果。

During today's episode, he shares with us his overriding hypotheses about the critical roles that mitochondrial function and dysfunction play in mental health and mental illness, and how various particular types of diets-- ranging from the ketogenic diet to modified ketogenic diet and even just slight adjustments in carbohydrate intake-- can be used in order to change mitochondrial function and bring relief for various psychiatric illnesses.

在今天的节目中，他与我们分享了他的首要假设，即线粒体功能和功能障碍在心理健康和精神疾病中发挥的关键作用，以及如何使用各种特定类型的饮食（从生酮饮食到改良生酮饮食，甚至只是碳水化合物摄入量的轻微调整）来改变线粒体功能并缓解各种精神疾病。

He also highlights the essential and important theme that various diet interventions, including the ketogenic diet, were not first developed for sake of weight loss but rather were developed as treatments for neurologic conditions, such as epilepsy.

他还强调了一个基本且重要的主题，即包括生酮饮食在内的各种饮食干预措施最初并不是为了减肥而开发的，而是为了治疗癫痫等神经系统疾病而开发的。

Today, he shares with us how the foods that we eat alone and in combination, and how fasting-- both intermittent fasting and more lengthy fasts-- can interact with the way that our brain functions to strongly control the way that we think, feel, and behave.

今天，他与我们分享了我们单独吃和组合吃的食物，以及禁食（间歇性禁食和长时间禁食）如何与我们的大脑功能相互作用，从而强烈控制我们的思维、感觉和行为方式。

What's wonderful is that Dr. Palmer not only explains the science and his clinical expertise, but also points to various actionable measures that people can take in order to improve their mental health.

精彩的是，帕尔默博士不仅解释了科学和他的临床专业知识，还指出了人们可以采取的各种可行措施，以改善他们的心理健康。

I'd like to mention that Dr. Palmer is also the author of a terrific new book.

我想提一下帕尔默博士也是一本很棒的新书的作者。

The title is Brain Energy: A Revolutionary Breakthrough in Understanding Mental Health and Improving Treatment for Anxiety, Depression, OCD, PTSD and More.

标题是《大脑能量：理解心理健康和改善焦虑、抑郁、强迫症、创伤后应激障碍等治疗的革命性突破》。

I've read the book, and it is a terrific read.

我读过这本书，读得很棒。

I came away from this book with a much evolved understanding of how the various psychiatric disorders that I just described, as well as ADHD, emerge in people.

读完这本书后，我对我刚才描述的各种精神疾病以及多动症是如何在人们身上出现的有了更深刻的理解。

And it has completely revised my understanding about the possible origins of various psychiatric disorders and the best ways to treat them, including both with medications but also with nutritional approaches.

它彻底改变了我对各种精神疾病的可能起源以及治疗这些疾病的最佳方法的理解，包括药物治疗和营养方法。

If you'd like to learn more about Dr. Palmer's work and the book, please go to chrispalmermd.com.

如果您想了解有关 Palmer 博士的工作和本书的更多信息，请访问 chrispalmermd.com。

We also provide links to the book and to his website in our show note captions.

我们还在节目注释中提供了该书及其网站的链接。

Before we begin, I'd like to emphasize that this podcast is separate from my teaching and research roles at Stanford.

在开始之前，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。

It is, however, part of my desire and effort to bring zero cost to consumer information about science and science-related tools for the general public.

然而，我的愿望和努力的一部分是为公众带来有关科学和科学相关工具的零成本消费者信息。

In keeping with that theme, I'd like to thank the sponsors of today's podcast.

为了与这个主题保持一致，我要感谢今天播客的赞助商。

Our first sponsor is Thesis.

我们的第一个赞助商是论文。

Thesis makes custom nootropics.

论文制作定制促智药。

And as I've said many times before on this podcast, I am not a fan of the word "nootropics" because it means smart drugs.

正如我之前在这个播客上多次说过的那样，我不喜欢“促智药”这个词，因为它意味着聪明的药物。

And frankly, there are no specific neural circuits in the brain or body for being, quote unquote, "smart."

坦率地说，大脑或身体中没有特定的神经回路可以“聪明”。

Thesis understands this.

论文明白这一点。

And they've developed custom nootropics that are designed to bring your brain and body into the state that's ideal for what you need to accomplish.

他们开发了定制的促智药，旨在使您的大脑和身体进入最适合您需要完成的任务的状态。

They use the highest quality ingredients, things like phosphatidylserine, alpha GPC, many ingredients that I've talked about before on this podcast and that I happen to use myself.

他们使用最优质的成分，例如磷脂酰丝氨酸、α GPC，以及我之前在这个播客上讨论过的许多成分，而且我自己也碰巧使用过。

I've been using Thesis for over a year now.

我已经使用论文一年多了。

And I can confidently say that their nootropics have been a game changer.

我可以自信地说，他们的促智药已经改变了游戏规则。

For me, I like their nootropic for clarity.

对我来说，我喜欢他们的促智药，因为它的清晰度。

I use that before cognitive work often.

我经常在认知工作之前使用它。

And I like their nootropic for energy, and I often use that before workouts-- in particular, workouts that are especially intense.

我喜欢它们的益智药来补充能量，我经常在锻炼前使用它——尤其是特别剧烈的锻炼。

To get your own personalized nootropic starter kit, go online to takethesis.com/huberman.

要获取您自己的个性化促智入门套件，请上网访问 takethesis.com/huberman。

Take their 3-minute quiz, and Thesis will send you four different formulas to try in your first month.

参加他们的 3 分钟测验，论文将向您发送四种不同的公式，供您在第一个月内尝试。

Again, that's takethesis.com/huberman.

同样，这是 takethesis.com/huberman。

And use the code Huberman at checkout to get 10% off your first box.

结帐时使用代码 Huberman 即可享受第一盒 10% 的折扣。

Today's episode is also brought to us by Eight Sleep.

今天的节目也是八觉给我们带来的。

Eight Sleep makes smart mattress covers with cooling, heating, and sleep tracking capacity.

August Sleep 生产具有冷却、加热和睡眠跟踪功能的智能床垫套。

I've talked many times on this podcast about the critical relationship between sleep and body temperature.

我在这个播客上多次谈到睡眠和体温之间的重要关系。

That is, in order to fall asleep and stay deeply asleep throughout the night, our body temperature needs to drop by about 1 to 3 degrees.

也就是说，为了入睡并整夜保持深度睡眠，我们的体温需要下降约1至3度。

And conversely, when we wake up in the morning, that is, in large part, because of our body heating up by 1 to 3 degrees.

而反之，当我们早上醒来的时候，也就是很大程度上，是因为我们的身体升温了1到3度。

Now, people have different core body temperatures.

现在，人们有不同的核心体温。

And they tend to run colder or hotter throughout the night.

而且它们往往会整个晚上变冷或变热。

Eight Sleep allows you to adjust the temperature of your sleeping environment so that you have the optimal temperature that gets you the best night's sleep.

八睡眠允许您调整睡眠环境的温度，以便您拥有最佳温度，让您获得最佳的夜间睡眠。

I started sleeping on an Eight Sleep mattress cover about eight months ago, and it has completely transformed my sleep.

大约八个月前，我开始睡在八睡眠床垫套上，它彻底改变了我的睡眠。

I sleep so much deeper.

我睡得更深了。

I wake up far less during the middle of the night, if at all.

我半夜醒来的次数要少得多（如果有的话）。

And I wake up feeling far better than I ever have even after the same amount of sleep.

即使睡眠时间相同，醒来后我的感觉也比以往任何时候都好得多。

If you want to try Eight Sleeping, you can go to eightsleep.com/huberman to save up to $400 off their sleep fit holiday bundle, which includes their new Pod 3 cover.

如果您想尝试“Eight Sleeping”，您可以访问 everysleep.com/huberman，在他们的 sleep fit 假日套餐中节省高达 400 美元，其中包括新的 Pod 3 罩。

Eight Sleep currently ships in the USA, Canada, United Kingdom, select countries in the EU, and Australia.

八睡眠目前在美国、加拿大、英国、欧盟部分国家和澳大利亚发货。

Again, that's eightsleep.com/huberman.

再说一遍，这是八睡眠.com/huberman。

Today's episode is also brought to us by ROKA.

今天的节目也是ROKA给我们带来的。

ROKA makes eyeglasses and sunglasses that are of the absolute highest quality.

ROKA 生产绝对最高品质的眼镜和太阳镜。

The company was founded by two All-American swimmers from Stanford.

该公司由两名来自斯坦福大学的全美游泳运动员创立。

And everything about ROKA eyeglasses and sunglasses were designed with performance in mind.

ROKA 眼镜和太阳镜的所有设计均以性能为考量。

I've spent a lifetime working on the biology, the visual system.

我一生都在研究生物学和视觉系统。

And I can tell you that your visual system has to contend with an enormous number of challenges in order for you to see clearly-- for instance, when you move from a sunny area to a shady area and back again, whether or not you're looking at something up close or often to the distance.

我可以告诉你，为了让你看清楚，你的视觉系统必须应对大量的挑战——例如，当你从阳光明媚的地方移动到阴暗的地方然后再回来时，无论你是在近距离看东西还是经常在远处看东西。

ROKA understands the biology of the visual system and has designed their eyeglasses and sunglasses accordingly so that you always see with perfect clarity.

ROKA 了解视觉系统的生物学原理，并相应地设计了眼镜和太阳镜，让您始终拥有完美的清晰度。

ROKA eyeglasses and sunglasses were initially designed for activities such as running and cycling.

ROKA 眼镜和太阳镜最初是为跑步和骑自行车等活动而设计的。

And indeed, they are very lightweight.

事实上，它们非常轻。

Most of the time I can't even remember that they're on my face.

大多数时候我什至不记得它们在我脸上。

They're so lightweight.

它们非常轻。

But the important thing to know about ROKA eyeglasses and sunglasses is that while they can be used during sports activities, they also have a terrific aesthetic.

但了解 ROKA 眼镜和太阳镜的重要一点是，虽然它们可以在体育活动中使用，但它们也具有出色的美感。

And they can be used just as well for wearing to work or out to dinner, et cetera.

它们也可以用于上班或外出就餐等场合。

If you'd like to try ROKA eyeglasses and sunglasses, you can go to ROKA-- that's roka.com, and enter the code Huberman to save 20% off on your first order.

如果您想尝试 ROKA 眼镜和太阳镜，您可以访问 ROKA（即 roka.com），并输入代码 Huberman 即可在首次订单时享受 20% 的折扣。

Again, that's ROKA, roka.com, and enter the code Huberman at checkout.

再次强调，这是 ROKA，roka.com，并在结帐时输入代码 Huberman。

And now, for my discussion with Dr. Chris Palmer.

现在，我与克里斯·帕尔默博士进行了讨论。

Chris, Dr. Palmer, thank you for being here.

克里斯，帕尔默博士，谢谢你们来到这里。

Most people have some idea what nutrition is.

大多数人都知道什么是营养。

Fewer people certainly know how closely those things can interact.

当然，很少有人知道这些事物之间的相互作用有多密切。

And I think everybody is familiar with the feeling of a food or the ingestion of a food making them feel good in the short term.

我认为每个人都熟悉食物的感觉或摄入食物让他们在短期内感觉良好。

When we eat a food that tastes delicious to us or that we associate with something nice, then we feel good mentally and physically.

当我们吃到美味的食物或与美好事物联系在一起的食物时，我们的精神和身体都会感觉良好。

Whereas, when we eat something that gives us food poisoning or maybe even something that just doesn't taste that great or that we associate with a bad experience, we feel less good in the short term.

然而，当我们吃了一些会导致食物中毒的东西，或者甚至是一些味道不太好或者让我们联想到不好的经历的东西时，我们在短期内会感觉不太好。

But I believe that very few people understand or are familiar with the fact that nutrition and our mental health interact in this very intimate, maybe even causal, way and that is something that occurs over long periods of time.

但我相信很少有人理解或熟悉这样一个事实：营养和我们的心理健康以这种非常亲密、甚至可能是因果的方式相互作用，而且这是长期发生的事情。

Meaning, what I ate yesterday or the day before, maybe even 10 years ago, could be impacting the way that my brain and body are making me feel now.

这意味着，我昨天或前天，甚至十年前吃的东西可能会影响我的大脑和身体现在的感觉。

So if you would, I'd love for you to just tell us about a little bit of the history, in particular, your history with exploring the relationship between nutrition and mental health.

因此，如果您愿意，我希望您能告诉我们一些历史，特别是您探索营养与心理健康之间关系的历史。

And then we can dive into some of the more particulars of ketogenic diets versus other diets, and some of the truly miraculous findings that you and others are coming up with based on real patients and real experiences of people who suffer and then find relief by altering their nutrition.

然后我们可以深入探讨生酮饮食与其他饮食相比的一些更多细节，以及您和其他人根据真实患者和遭受痛苦然后通过改变营养获得缓解的人们的真实经历得出的一些真正神奇的发现。

A series of events happened in my family.

我家里发生了一系列的事情。

My mother had a horrible kind of psychotic break, and all sorts of adverse childhood events for me.

我的母亲经历了一次可怕的精神崩溃，也给我带来了各种各样的童年不良事件。

She and I were actually homeless together for a while.

她和我实际上一起无家可归有一段时间了。

I went on to have subsequent depression, suicidality, all sorts of things.

随后我出现了抑郁症、自杀倾向以及各种各样的症状。

But somehow or another, I pulled myself together and got through medical school-- actually did quite well in medical school, got an award for being one of the top students, and then was doing my internship and residency at Harvard.

但不知何故，我振作起来并完成了医学院的学习——实际上在医学院表现得很好，作为最优秀的学生之一获得了奖项，然后在哈佛进行实习和住院医师实习。

And at that point in time, I was diagnosed with metabolic syndrome.

就在那时，我被诊断出患有代谢综合症。

So I had high blood pressure, horrible lipids, and pre-diabetes.

所以我患有高血压、可怕的血脂和糖尿病前期。

And I was doing everything right supposedly.

据说我所做的一切都是正确的。

I was on a low-fat diet, and I was exercising regularly.

我实行低脂饮食，并且经常锻炼身体。

And year after year, my doctor kept telling me diet and exercise.

年复一年，我的医生不断告诉我饮食和锻炼。

I kept asking him, what diet?

我一直问他，什么饮食​​？

What exercise?

什么运动？

I was doing everything he kept telling me to do.

我正在做他一直告诉我做的一切。

Everything was getting worse.

一切都变得更糟了。

My blood pressure kept going higher.

我的血压持续升高。

And at some point, he kind of said, you're going to have to go on medication.

他说，到了某个时候，你将不得不继续接受药物治疗。

I need to put you on something for your pre-diabetes, something for your cholesterol, and something for your blood pressure.

我需要给你服用治疗糖尿病前期的药物、治疗胆固醇的药物以及治疗血压的药物。

So three pills out of the gate.

所以三粒药丸就出炉了。

And I'm like, I'm only in my 20s.

我想，我才20多岁。

And as a physician, I knew what that meant.

作为一名医生，我知道这意味着什么。

I knew that I'm in my 20s, if I'm already on three meds for metabolic syndrome, I'm going to be screwed by the time I'm 40 or 50.

我知道我已经 20 多岁了，如果我已经服用三种治疗代谢综合征的药物，那么到 40 或 50 岁时我就会完蛋。

And I'm probably going to be having heart attacks.

我可能会心脏病发作。

And I'd heard through the rumor mill that the Atkins diet could somehow help people improve their cholesterol in pre-diabetes.

我从谣言中听说阿特金斯饮食可以以某种方式帮助人们改善糖尿病前期的胆固醇水平。

I actually didn't really believe it.

我其实不太相信。

I was highly skeptical.

我非常怀疑。

And I believed everything I was taught in medical school.

我相信我在医学院学到的一切。

Why would my professors lie to me?

为什么我的教授要对我撒谎？

They knew what they were talking about.

他们知道自己在说什么。

Low-fat diet was the thing to do.

低脂饮食是要做的事情。

And the Atkins diet was clearly dangerous and reckless.

阿特金斯饮食法显然是危险且鲁莽的。

But I had been trying the medical dogma for years, and it wasn't working for me.

但多年来我一直在尝试医学教条，但它对我不起作用。

And so for whatever reason, I decided this is going to be my last attempt at something different.

因此，无论出于何种原因，我决定这将是我最后一次尝试不同的东西。

And then I'll just bite the bullet and go on meds.

然后我就硬着头皮继续吃药。

So I tried the Atkins diet.

所以我尝试了阿特金斯饮食法。

I did my own special version of it.

我做了我自己的特殊版本。

I still avoided red meat because I was terrified of red meat.

我仍然避免吃红肉，因为我害怕红肉。

I tried to do a healthy version, which it's probably more like the South Beach diet.

我尝试做一个健康的版本，它可能更像南海滩饮食。

This was before the South Beach Diet was invented.

这是在南海滩饮食发明之前。

But within three months, my metabolic syndrome was completely gone.

但三个月内，我的代谢综合症完全消失了。

You mentioned OCD.

你提到了强迫症。

I actually am familiar with this.

我其实很熟悉这个。

As a kid, I had a low level kind of Tourette's grunt.

当我还是个孩子的时候，我有一种低水平的图雷特氏咕噜声。

And probably me, obsessive still to some extent-- although not full-blown clinically diagnosed OCD, so I can relate somewhat.

也许我，在某种程度上仍然有强迫症——尽管临床上还没有完全诊断出强迫症，所以我可以有一些联系。

If you're willing, what was the context of all that before and after this nutritional switch?

如果您愿意的话，请问这次营养转换前后发生的一切情况是什么？

So they would have looked at me and said, you're fine.

所以他们会看着我说，你很好。

But I wasn't.

但我不是。

I was actually on medications.

我实际上正在服用药物。

I was trying different medications, trying to figure out how to feel better, how to stop obsessing so much, how to not be so depressed.

我尝试了不同的药物，试图找出如何让自己感觉好一点，如何停止过度沉迷，如何不那么沮丧。

And I found that those medications, they actually came with more side effects for me than benefits.

我发现这些药物对我来说实际上带来的副作用多于益处。

I was on Prozac for a long time.

我服用百忧解很长时间了。

It totally messed up my sleep.

它完全扰乱了我的睡眠。

And then the psychiatrist was like, you need pills to help you sleep now.

然后精神科医生说，你现在需要药物来帮助你入睡。

And I'm-- I just-- I'm like, that doesn't-- that's not really resonating very well with me.

我——我只是——我想，这并没有引起我的共鸣。

And I'm now a psychiatrist.

我现在是一名精神科医生。

I'm in my psychiatry residency.

我正在做精神病学住院医师实习。

And I'm thinking, you know what?

我在想，你知道吗？

That's just not sitting well with me that you're going to prescribe more and more meds for all the side effects that you're causing.

我不同意你要开越来越多的药物来治疗你造成的所有副作用。

And yet at the same time, I wanted to feel better.

但与此同时，我想要感觉更好。

And I was learning chemical imbalances.

我正在学习化学失衡。

This is what we do to get rid of depression and OCD.

这就是我们为了摆脱抑郁和强迫症所做的事情。

You're supposed to take your pills.

你应该吃药。

And so I was taking my pills.

所以我正在服药。

I was in psychotherapy.

我当时正在接受心理治疗。

I had been in psychotherapy on and off for years.

多年来我断断续续地接受心理治疗。

I had received much more intensive treatment when I was younger.

我年轻时接受过更强化的治疗。

And that was essentially worthless for me.

这对我来说基本上毫无价值。

It actually probably just caused harm at the end of the day.

实际上，它最终可能只是造成了伤害。

And they were actually horrible.

他们实际上很可怕。

They were horrible.

他们太可怕了。

They did nothing beneficial for me.

他们没有做任何对我有利的事情。

I gave them a decent amount of time to work.

我给了他们足够的工作时间。

I really wanted to feel better.

我真的很想感觉好一点。

So at the time that I tried this diet, I certainly wasn't impaired in the same way.

所以当我尝试这种饮食时，我当然没有受到同样的损害。

I wasn't struggling that much.

我并没有那么挣扎。

But I was-- still have these low grade symptoms, was trying to feel better.

但我仍然有这些低度症状，正在努力让自己感觉好一些。

And the thing that was the most striking to me, after doing the diet for three months, was not the fact that my metabolic syndrome was gone.

经过三个月的节食后，最让我震惊的并不是我的代谢综合症消失了。

That was my goal, and it was a seemingly miraculous achievement because I got rid of everything with one dietary change.

这就是我的目标，这似乎是一个奇迹般的成就，因为我通过一次饮食改变就摆脱了一切。

But the thing that I noticed was dramatic improvement in my mood, energy, concentration, and sleep.

但我注意到我的情绪、精力、注意力和睡眠都得到了显着改善。

I-- for the first time in my life, I started waking up before my alarm went off and feeling rested.

我——这是我一生中第一次，在闹钟响起之前就醒来，并感到休息了。

That never happened to me before.

我以前从未发生过这种情况。

I was meticulous about planning when my alarm went off and how many times I could push the snooze button in order to be on time for wherever I needed to be, whether it was school or the hospital or whatever.

我仔细地计划了闹钟何时响起，以及我可以按下小睡按钮多少次，以便准时到达我需要去的任何地方，无论是学校还是医院还是其他什么地方。

I had it.

我有它。

I had this good system.

我有这么好的系统。

I was never late for anything.

我从来没有迟到过任何事情。

But that was shocking to me, that I felt so good.

但这让我很震惊，我感觉很好。

And one of the things that I've often said to people, prior to the diet, I always felt like there are two types of people in the world.

我经常对人们说的一件事是，在节食之前，我总觉得世界上有两种类型的人。

There are "haves" and "have-nots."

有“有”和“无”。

There are these happy, peppy people, who just are so positive, and they've got energy.

这些人快乐、充满活力，他们非常积极，而且充满活力。

And they have the saying, they like to work hard and play hard.

他们有句话说，他们喜欢努力工作，努力玩耍。

And I always understood working hard.

我一直明白努力工作。

I totally got that because I was a hard worker and I understood the value of hard work.

我完全明白这一点，因为我是一个努力工作的人，并且我了解努力工作的价值。

And you got to do something useful with yourself.

而且你必须为自己做一些有用的事情。

But I never understood who the hell wants to play hard, like who's got energy for that?

但我从来不明白谁到底想努力打球，谁有精力这么做？

Aren't you tired from working so hard?

你这么辛苦工作不累吗？

How on Earth do these people have energy to go and play hard?

这些人到底是怎么有精力去拼命玩耍呢？

And I assumed that they were just part of the "haves" in the world.

我认为他们只是世界上“富人”的一部分。

And they were just lucky and privileged.

他们只是幸运和特权。

They either had good genetics or maybe they had good childhoods or good parents or something-- something that I didn't have.

他们要么有良好的基因，要么有美好的童年，或者好的父母，或者其他一些我没有的东西。

And also, have been going through what sounds like a very long iterative process of trying to figure out what works and what doesn't work to finally arrive at a solution, and then make that the basis of much of the work that you're doing today for other people.

而且，我们一直在经历一个听起来非常漫长的迭代过程，试图找出什么有效，什么无效，最终找到解决方案，然后将其作为您今天为其他人所做的大部分工作的基础。

I think it's very important because I think many people share with you this notion that there are indeed two groups-- a happy group and then fated-to-be unhappy group.

我认为这非常重要，因为我认为很多人都与你们分享这样的观念：确实有两个群体——一个是快乐的群体，另一个是注定不快乐的群体。

And it speaks to the fact that-- your story, rather, speaks to the fact that what we see is not always what's going on internally with people and that this notion of there just being two groups-- the happy or the haves and the have-nots-- can't be the way that it works, and there are probably many more people suffering than we realize, and that there is an important need for tools to overcome that suffering.

它说明了这样一个事实——相反，你的故事说明了这样一个事实：我们所看到的并不总是人们内部发生的事情，这种只有两个群体——幸福的人或富人和穷人的观念不可能是这样的，而且可能有比我们意识到的更多的人，并且非常需要工具来克服这种痛苦。

So I really just hear you.

所以我真的只是听到你的声音。

Even early in our discussion, I just want to extend a genuine thanks because so much of what I hear from people is questions about health, and mental health, and physical health.

即使在我们讨论的早期，我也只想表达真诚的感谢，因为我从人们那里听到的很多问题都是关于健康、心理健康和身体健康的问题。

But that clearly point to the fact that many people are struggling to varying degrees.

但这清楚地表明，许多人都在不同程度地陷入困境。

And even the people who are in this category of great childhood and happiness could do far better for themselves and then also for other people.

即使是那些拥有美好童年和幸福的人也可以为自己和他人做得更好。

So thank you for that.

所以谢谢你。

I want to know.

我想知道。

At the point where you realized that nutrition can play a profound role in how you feel and operate in a large number of domains, you are still a student or a resident at that point?

当您意识到营养可以在许多领域对您的感受和运作方式发挥深远的作用时，您那时仍然是学生或居民吗？

They were like, how the hell are you doing that?

他们说，你到底是怎么做到的？

How are you resisting all of this food?

你如何抵抗所有这些食物？

And I said, I don't crave it anymore.

我说，我不再渴望它了。

I don't want it, I'm fine.

我不想这样，我很好。

I'm just-- I'm having turkey and green beans.

我只是——我正在吃火鸡和青豆。

And that's good enough for me.

这对我来说已经足够了。

So I got them to do the diet.

所以我让他们节食。

And they too noticed dramatic improvement in their moods, and energy, and sleep, and everything else.

他们也注意到自己的情绪、精力、睡眠和其他一切都得到了显着改善。

So within a few years, the primary thing I noticed is this powerful antidepressant effect.

所以几年之内，我首先注意到的是这种强大的抗抑郁作用。

And now, I'm an attending physician.

现在，我是一名主治医师。

I've got all these patients in my clinical practice with treatment resistant mental illness.

在我的临床实践中，所有这些患者都患有难治性精神疾病。

I'm in a tertiary care hospital.

我在三级甲等医院。

So I almost never get somebody off the street with their first episode of depression.

所以我几乎从来没有让第一次抑郁症发作的人离开街道。

Out of the gate, as part of my career, I get treatment resistant mental disorders.

作为我职业生涯的一部分，我一开始就患有难治性精神障碍。

So I get people who've already been to 6-plus psychiatrists, therapists.

所以我找的人已经看过六位以上的精神科医生、治疗师。

They've usually tried dozens of different medications.

他们通常尝试了数十种不同的药物。

They've been in decades of psychotherapy.

他们已经接受了几十年的心理治疗。

They've often had ECT and other things.

他们经常接受 ECT 和其他治疗。

And nothing's working.

但什么都不起作用。

And I'm thinking, well, we're kind of out of options for these other people.

我在想，好吧，对于其他人来说，我们别无选择。

And this diet is having this really powerful antidepressant effect.

这种饮食具有非常强大的抗抑郁作用。

I think I'm going to try it and just see if any of my patients are game to try it to see if it might help them.

我想我会尝试一下，看看我的病人是否愿意尝试一下，看看是否对他们有帮助。

Sure enough, it did.

果然，确实如此。

Didn't help everyone and not everybody was interested and/or able to do it.

并没有帮助每个人，也不是每个人都有兴趣和/或能够做到这一点。

But some of the ones who were able to do it ended up having a remarkable and powerful antidepressant effect.

但一些能够做到这一点的人最终产生了显着而强大的抗抑郁效果。

One woman actually became hypomanic within a month.

一名妇女实际上在一个月内变得轻躁狂。

And she had been depressed pretty much nonstop for over five years-- chronically depressed, suicidal, in and out of hospitals.

五年多来，她几乎一直处于抑郁状态——长期抑郁，有自杀倾向，进出医院。

And I saw her become hypomanic.

我看到她变得轻躁狂。

And I'm thinking, wow, this really is a powerful antidepressant effect.

我在想，哇，这确实是一种强大的抗抑郁作用。

This is amazing.

这太棒了。

This is like a medication but better because it actually is working for her.

这就像一种药物，但更好，因为它确实对她有效。

But I laid low at that point because, at that point, we didn't have many clinical trials of the safety or efficacy of the Atkins diet for even weight loss or diabetes, let alone any mental disorders.

但当时我保持低调，因为当时我们还没有进行很多关于阿特金斯饮食的安全性或有效性的临床试验，甚至没有对减肥或糖尿病进行临床试验，更不用说任何精神障碍了。

And so I really actually felt like I'm on the fringe here.

所以我真的感觉自己处于这里的边缘。

And this is not going to be met with praise by anyone.

这不会受到任何人的赞扬。

So I'm just going to lay low.

所以我要保持低调。

I'm going to offer it to patients.

我要把它提供给病人。

And I went along that way up until 2016.

我就这样一直走下去，直到 2016 年。

And what was involved in making sure that they adhered to that, maybe even some of the things you observed in terms of who was more willing to try this or not try this?

确保他们遵守这一点涉及什么，甚至可能是你观察到的一些事情，即谁更愿意尝试这个或不尝试这个？

Any observations or maybe even data?

有什么观察结果甚至数据吗？

At that time, probably, fasting wasn't as popular now.

那时，禁食可能还没有现在那么流行。

Thanks to the incredible work-- I think it's incredible, and he is a former colleague.

感谢令人难以置信的工作——我认为这令人难以置信，而且他是我以前的同事。

And I know there's a lot of controversy about fasting.

我知道关于禁食有很多争议。

But I think, for many people, fasting is a powerful tool.

但我认为，对于很多人来说，禁食是一个强大的工具。

For others, it's a less useful tool --of Satchin Panda and others.

对于其他人来说，它是一个不太有用的工具——Satchin Panda 和其他人。

But fasting certainly will limit your carbohydrate intake and get you into ketosis.

但禁食肯定会限制碳水化合物的摄入量并导致酮症。

Correct?

正确的？

So for some patients, it was actually quite easy to get into ketosis, especially overweight and obese patients.

所以对于一些患者来说，其实很容易陷入酮症，尤其是超重和肥胖的患者。

They have a lot of fat stores on their body and actually limiting carbohydrates usually results in high levels of ketosis for them.

他们体内储存了大量脂肪，实际上限制碳水化合物通常会导致他们的酮症水平较高。

The thing that completely upended everything that I knew as a psychiatrist, though, was when I helped a patient in 2016 lose weight.

然而，彻底颠覆我作为精神科医生所知道的一切的是，2016 年我帮助一位患者减肥。

So this was a patient, 33-year-old man with schizoaffective disorder.

这是一位 33 岁的男性，患有分裂情感障碍。

He had been my patient for eight years now.

他已经是我的病人八年了。

And I mean that with respect, of course.

当然，我的意思是尊重。

But oftentimes, people with schizophrenia can seem just like-- you don't even know how to interact with them because their world seems so altered because they have all these so-called positive symptoms-- hallucinations, and they're talking to people that no one else can see, et cetera.

但很多时候，精神分裂症患者看起来就像——你甚至不知道如何与他们互动，因为他们的世界似乎发生了很大的变化，因为他们有所有这些所谓的阳性症状——幻觉，他们正在与其他人看不到的人交谈，等等。

Is that schizoaffective?

这是分裂情感吗？

Thank you for that reminder.

谢谢你的提醒。

He was convinced that there were these powerful families, that they had technologies that could control his thoughts.

他确信有这些强大的家族，他们拥有可以控制他思想的技术。

They could broadcast his thoughts to other people.

他们可以将他的想法传播给其他人。

They were trying to hurt him.

他们试图伤害他。

They had targeted him for some reason.

他们出于某种原因瞄准了他。

He wasn't quite sure why.

他不太清楚为什么。

He had some suspicions and beliefs about maybe when he did this bad thing when he was 11 years old, that's why they decided to target him.

他有一些怀疑和信念，也许当他11岁时做了这件坏事时，这就是他们决定针对他的原因。

This man was tormented by his illness, tormented.

这个人被他的病折磨着，折磨着。

It ruined his life.

这毁了他的生活。

He had already tried 17 different medications, and none of them stopped his symptoms.

他已经尝试了 17 种不同的药物，但没有一种能缓解他的症状。

But they did cause him to gain a lot of weight.

但它们确实使他体重增加了很多。

So that's him.

这就是他。

He weighs 340 pounds.

他体重 340 磅。

And for whatever reason, he gets it in his head, I'm never going to get a girlfriend if I don't lose some weight.

不管出于什么原因，他脑子里一直在想，如果我不减肥，我就永远找不到女朋友。

He also recognizes, I'm never going to get a girlfriend because I'm a loser.

他还认识到，我永远不会找到女朋友，因为我是一个失败者。

I'm schizophrenic.

我是精神分裂症患者。

I live with my father.

我和父亲住在一起。

I have nothing going for me.

我没有什么适合我的。

But I could at least try to address one of these awful, horrible things about myself.

但我至少可以尝试解决关于我自己的这些可怕的事情之一。

And maybe I could lose some weight.

也许我可以减肥。

So he asked for my help.

所以他请求我的帮助。

For a variety of reasons, we ended up deciding to try the ketogenic diet.

由于种种原因，我们最终决定尝试生酮饮食。

Now, at this point, I have no anticipation that the ketogenic diet is going to do anything for his psychiatric symptoms because this man has schizoaffective disorder.

现在，在这一点上，我并不预期生酮饮食会对他的精神症状产生任何作用，因为这个人患有分裂情感障碍。

That's not depression.

那不是抑郁症。

Depression is very different.

抑郁症则非常不同。

They're totally different disorders.

它们是完全不同的疾病。

So he decides to give it a try.

所以他决定尝试一下。

Within two weeks, not only does he start losing weight, but I begin to notice this dramatic antidepressant effect.

两周之内，他不仅开始减肥，而且我开始注意到这种戏剧性的抗抑郁效果。

He's making better eye contact.

他的目光接触变得更好了。

He's smiling more.

他笑得更开心了

He's talking a lot more.

他话很多。

I'm thinking like, what's gotten into you?

我在想，你怎么了？

You're coming to life.

你即将复活。

Like you're-- I've never heard you talk this much.

就像你——我从来没有听你说过这么多话。

I've never seen you so excited or present or alive.

我从未见过你如此兴奋、如此活跃、如此活跃。

I haven't changed his meds at all.

我根本没有改变他的药物。

The thing that upended everything that I knew as a psychiatrist was six to eight weeks in, he spontaneously starts reporting, you know, those voices that I hear all the time?

六到八周后，这件事颠覆了我作为一名精神科医生的认知，他自发地开始报告，你知道，那些我一直听到的声音吗？

They're going away.

他们要走了。

And he says, you know how I always thought that there were all these families who were controlling my thoughts and out to get me, and they had targeted me?

他说，你知道我怎么一直认为所有这些家庭都在控制我的思想并出手抓捕我，他们瞄准了我？

And I'm thinking, oh, yeah.

我在想，哦，是的。

We've been talking about that for eight years.

我们已经讨论这个问题八年了。

We can talk about that again.

我们可以再讨论一下这个问题。

He says, you know what?

他说，你知道吗？

Now that I think about it, I don't think that's true.

现在想来，我不认为这是真的。

And now that I say it, it sounds kind of crazy.

现在我这么说，听起来有点疯狂。

It probably never was.

可能从来都不是。

I've probably had schizophrenia all along like everybody's been trying to tell me.

我可能一直患有精神分裂症，就像每个人都试图告诉我的那样。

And I think it's going away.

我认为它会消失。

That man went on-- he's now lost 160 pounds and kept it off to this day.

那个人继续说道——他现在已经减掉了 160 磅，并且一直保持到今天。

And that completely blew my mind as a psychiatrist.

作为一名精神科医生，这完全让我大吃一惊。

And I went on a scientific journey to understand what in the hell just happened.

我踏上了科学之旅，去了解到底发生了什么。

I'd like to take a quick break and acknowledge one of our sponsors, Athletic Greens.

我想稍微休息一下并感谢我们的赞助商之一，运动绿党。

Athletic Greens, now called AG1, is a vitamin mineral probiotic drink that covers all of your foundational nutritional needs.

Athletic Greens（现称为 AG1）是一种维生素矿物质益生菌饮料，可满足您的所有基本营养需求。

I've been taking Athletic Greens since 2012, so I'm delighted that they're sponsoring the podcast.

我自 2012 年以来一直在服用 Athletic Greens，所以我很高兴他们赞助这个播客。

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 me the probiotics that I need for gut health.

我开始服用运动绿色食品的原因以及我仍然每天服用一次或通常两次运动绿色食品的原因是它为我提供了肠道健康所需的益生菌。

Our gut is very important.

我们的直觉非常重要。

It's populated by gut 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.

它充满了肠道微生物群，它们与大脑、免疫系统以及我们身体的所有生物系统进行交流，对我们的近期和长期健康产生强烈影响。

And those probiotics in Athletic Greens are optimal and vital for microbiotic health.

Athletic Greens 中的益生菌对于微生物健康来说是最佳且至关重要的。

In addition, Athletic Greens contains a number of adaptogens, vitamins, and minerals that make sure that all of my foundational nutritional needs are met.

此外，运动绿叶蔬菜还含有多种适应原、维生素和矿物质，可确保满足我所有的基本营养需求。

And it tastes great.

而且味道好极了。

If you'd like to try Athletic Greens, you can go to athleticgreens.com/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, in the car, on the plane, et cetera.

如果您想尝试 Athletic Greens，您可以访问 Athletic Greens.com/huberman，他们会为您提供五个免费旅行包，让您在路上、车内、飞机上等场合轻松搭配 Athletic Greens。

And they'll give you a year supply of vitamin D3/K2.

他们将为您提供一年的维生素 D3/K2。

Again, that's athleticgreens.com/huberman to get the five free travel packs and the year supply of vitamin D3/K2.

再次强调，您可以访问 Athleticgreens.com/huberman 获取 5 个免费旅行包和全年维生素 D3/K2 供应量。

I have a couple of questions.

我有几个问题。

First of all, did he stay on any kind of antipsychotic or other medication?

首先，他是否继续服用任何抗精神病药物或其他药物？

If so, were the dosages adjusted, excuse me, while undergoing this remarkable transition?

如果是这样，请问，在经历这一非凡的转变时，剂量是否进行了调整？

Because as we know, it's not an either or medication or nutrition changes, it can be both.

因为正如我们所知，这不是药物或营养改变中的一个，它可以两者兼而有之。

And then the other question is one of adherence.

另一个问题是坚持。

I think about someone with schizoaffective disorder, who's suffering from all the sorts of things that you described.

我想到一个患有分裂情感障碍的人，他患有你所描述的各种事情。

How does somebody like that organize themselves in order to stay on a ketogenic diet?

像这样的人如何组织自己以保持生酮饮食？

And I say this with all the seriousness in the world.

我是非常严肃地说这句话的。

I think there are a lot of people who do not have schizotypal or schizoaffective disorder who have trouble, they claim, adhering to a ketogenic diet.

我认为有很多没有精神分裂症或分裂情感障碍的人声称，坚持生酮饮食会遇到麻烦。

It's not the easiest diet.

这不是最简单的饮食。

Certainly in its extreme form at first, it's not the easiest diet to stick to.

当然，在最初的极端形式下，它并不是最容易坚持的饮食方式。

So how did he do it?

那么他是怎么做到的呢？

That sounds like a remarkable individual.

这听起来像是一个了不起的人。

And I'd also like to just know your general thoughts about adherence to things when people are back on their heels mentally.

我还想知道当人们在精神上恢复正常时，您对坚持事物的总体想法。

How do they get motivated and stick to something?

他们如何获得动力并坚持做某事？

So the questions were, medication, yes or no?

所以问题是，药物治疗，是还是不是？

If yes, dosage adjusted, yes or no. And if people are suffering from depression or full-blown psychotic episodes, how does one ensure that they continue to adhere to a diet?

如果是，调整剂量，是或否。如果人们患有抑郁症或全面的精神病发作，如何确保他们继续坚持饮食？

Over the years, we have slowly but surely tried to taper him off his meds.

多年来，我们缓慢但坚定地尝试逐渐减少他的用药量。

He has been on meds for decades.

他已经服药数十年了。

He started medications when he was a young child.

当他还是个小孩子的时候，他就开始接受药物治疗。

His brain is as developed in response to all sorts of psychiatric medications.

他的大脑是对各种精神药物做出反应而发育的。

And it has not been easy to try to get him off.

想让他下车并不容易。

We continue to try to get him off medication.

我们继续努力让他停止服药。

And it's challenging and difficult.

这充满挑战和困难。

And I just want to say for any listeners, it is-- getting off your meds is very difficult and dangerous.

我只想对所有听众说，戒掉药物是非常困难和危险的。

And you need to do it with supervision, with a mental health professional or a prescriber because it is dangerous.

而且您需要在心理健康专家或处方医生的监督下进行，因为这是危险的。

When people reduce their meds too much, they can get wildly symptomatic.

当人们过度减少用药时，他们可能会出现严重的症状。

I had one patient, almost quit her job because she became convinced that, well, my life sucks, and it's all because of my boss.

我有一位病人，她差点辞去工作，因为她确信，我的生活一团糟，而这一切都是因为我的老板。

And I know that she's just a horrible human being.

我知道她只是一个可怕的人。

And she's abusing me.

她还虐待我。

And I was like, whoa, whoa, whoa.

我当时想，哇，哇，哇。

I think this is related to your medication change.

我认为这与您改变用药有关。

We got her back on her meds, within three days, she said, oh my god, I can't believe that happened.

三天之内，我们让她重新接受药物治疗，她说，天哪，我不敢相信会发生这样的事。

I almost quit my job.

我差点就辞职了。

And that would have been the most illogical and irrational decision I've ever made in my entire life.

这将是我一生中做过的最不合逻辑、最不合理的决定。

But somehow, it seemed so real just several days ago.

但不知怎的，几天前的事情却显得如此真实。

And now that I'm back on this medication-- and it doesn't mean that she needs the meds.

现在我重新开始服用这种药物，但这并不意味着她需要这些药物。

But it doesn't mean that he needs the meds.

但这并不意味着他需要药物。

It means that meds need to be adjusted very safely, and cautiously, and gradually.

这意味着需要非常安全、谨慎、逐步地调整药物。

So that's the medication piece.

这就是药物部分。

The adherence piece was not easy for him and for other patients.

对于他和其他患者来说，粘附片并不容易。

It is very rare that I have a patient who I can say, do the ketogenic diet.

我很少有一个病人可以说进行生酮饮食。

Come see me in 3 months, and let me know how it was going.

三个月后来见我，让我知道进展如何。

That almost never happens.

这几乎不会发生。

It has happened, I think, on two occasions.

我想，这种事已经发生过两次了。

So I knew whether he was compliant or not, which is so beneficial in doing clinical work and research on this diet.

这样我就知道他是否顺从，这对做这种饮食的临床工作和研究非常有帮助。

It's the only diet where within seconds, I can have an objective biomarker of compliance or noncompliance.

这是唯一一种在几秒钟内我就能获得依从性或不依从性的客观生物标志物的饮食。

And you and I both know that blood draws for neurotransmitter levels are complicated because you want to know what's in the brain and what's functional in the brain.

你和我都知道，抽血检测神经递质水平很复杂，因为你想知道大脑中有什么以及大脑中有什么功能。

And then we have to imagine that most people there prescribed drugs for any number of different psychiatric conditions are not giving blood every time they talk to their psychiatrist or psychologist.

然后我们必须想象，那里的大多数人为各种不同的精神疾病开出药物，但他们并不是每次与精神科医生或心理学家交谈时都献血。

No?

不？

They were off their routine.

他们打破了常规。

They forgot to brush their teeth-- because that's when they take their meds.

他们忘记刷牙——因为那是他们服药的时间。

And so because it was so late, they just crashed when they got home.

因为时间太晚了，他们回到家就摔倒了。

They forgot to take their meds.

他们忘记吃药了。

Happens all the time.

一直在发生。

If it's a medication that people take more than once a day, the noncompliance rates are much higher because it's just easy to forget.

如果人们每天服用一次以上的药物，那么不依从率就会高得多，因为它很容易忘记。

So it's not that people are willfully disobeying their doctors or anything else.

所以这并不是说人们故意不服从医生或其他任何事情。

It's just hard to remember to take meds consistently every day.

只是很难记住每天坚持服药。

So for instance, I've followed the-- I don't any longer.

举例来说，我已经遵循了——我不再遵循了。

But I've tried, in the past, the so-called cyclic ketogenic diet, where every third or fourth day, get some pasta, or rice, et cetera.

但我过去尝试过所谓的循环生酮饮食，每三四天吃一些面食或米饭等。

That was interesting as an experiment.

作为一个实验，这很有趣。

But to stay in ketosis, what sort of blood levels of ketones do you like to see in your patients?

但是为了保持酮症，您希望患者的血液酮水平达到什么样的水平？

What is the range that you think most people could aspire to?

您认为大多数人能够追求的范围是多少？

And lo and behold, we've got emerging data that suggests, that strongly suggests, it's also bad for mental health.

你瞧，我们得到的新数据表明，强烈表明，这对心理健康也有害。

Depression and anxiety are the most common mental disorders.

抑郁和焦虑是最常见的精神障碍。

And so we have the best data for those disorders.

因此我们拥有这些疾病的最佳数据。

But we actually have a lot of data with even bipolar disorder and schizophrenia that insulin resistance, in particular, and insulin signaling in the brain is impaired in people with chronic mental disorders kind of across the board-- all the way from chronic anxiety, depression, to bipolar, to schizophrenia, and even Alzheimer's disease.

但实际上，我们有大量关于双相情感障碍和精神分裂症的数据表明，慢性精神障碍患者的胰岛素抵抗，特别是大脑中的胰岛素信号受到全面损害——从慢性焦虑、抑郁，到双相情感障碍，到精神分裂症，甚至阿尔茨海默病。

We know that patients with all of those disorders have impaired glucose metabolism and that the insulin signaling system in the brain, which is different than insulin signaling in the periphery, seems to somehow possibly be playing a role.

我们知道，患有所有这些疾病的患者都存在葡萄糖代谢受损的情况，并且大脑中的胰岛素信号系统（与外周的胰岛素信号系统不同）似乎可能在某种程度上发挥了作用。

So to step back from that, so for some patients, I might just want to decrease glucose and insulin levels.

因此，退一步来说，对于某些患者来说，我可能只想降低血糖和胰岛素水平。

And I can do that by getting rid of sweets.

我可以通过戒掉糖果来做到这一点。

For other patients, like patients with schizoaffective disorder or schizophrenia or bipolar disorder, especially if it's chronic, if I'm using it as a brain treatment, then I do want a ketogenic diet.

对于其他患者，例如患有分裂情感障碍或精神分裂症或双相情感障碍的患者，尤其是慢性患者，如果我将其用作大脑治疗，那么我确实需要生酮饮食。

And I usually want reasonably high levels of blood ketones.

我通常想要相当高水平的血酮。

Usually, for depression, I want to see at least greater than probably 0.8 minimal.

通常，对于抑郁症，我希望看到至少大于 0.8 的最小值。

For psychotic disorders and bipolar disorder, I usually want to see levels greater than 1.5.

对于精神障碍和双相情感障碍，我通常希望看到大于 1.5 的水平。

That's what I'm shooting for, if at all possible.

如果可能的话，这就是我拍摄的目的。

So yeah, I think that's what I'd go for.

所以是的，我想这就是我想要的。

You make very clear in your book-- and we'll go into this in more detail-- that avoiding insulin resistance, reversing insulin resistance, and essentially trying to reverse what earlier you described as this metabolic syndrome, which is a bunch of different things, is the target.

您在书中明确表示——我们将更详细地讨论这一点——避免胰岛素抵抗、逆转胰岛素抵抗，并从本质上试图扭转您之前描述的代谢综合征（这是一堆不同的东西）是目标。

And for some people, getting rid of highly processed foods and focusing mainly on nonprocessed or minimally processed foods will really help.

对于某些人来说，摆脱高度加工的食品并主要关注未加工或最低限度加工的食品确实会有帮助。

For others, going straight to the full-blown ketogenic diet will be of most benefit.

对于其他人来说，直接进行全面的生酮饮食将是最有益的。

I'd like to back up a little bit in history and get to something which I find incredibly interesting, which is epilepsy and the longstanding use of ketogenic diet and fasting to treat epilepsy.

我想回顾一下历史，谈谈我觉得非常有趣的事情，那就是癫痫症以及长期使用生酮饮食和禁食来治疗癫痫症。

And the reason I want to kind of rewind to that point in history is that, I think that for a lot of listeners and people out there who are familiar with how changing your diet or changing your exercise can positively impact sleep and weight and all these things, and it cascades into feeling better-- that makes perfect sense.

我想回顾历史上的这一点的原因是，我认为对于很多听众和熟悉改变饮食或改变锻炼方式如何对睡眠和体重以及所有这些因素产生积极影响的人来说，这会带来更好的感觉——这是完全有道理的。

But for a lot of the world still, the idea that changing or using nutrition as a dissection tool or as a treatment tool to understand and treat mental illness, is still a kind of heretical idea, that to them, it kind of falls in the, OK, well, that's like a woo science or something like that.

但对于世界上许多人来说，改变或使用营养作为解剖工具或作为理解和治疗精神疾病的治疗工具的想法仍然是一种异端思想，对他们来说，它有点落入，好吧，好吧，这就像宇科学或类似的东西。

Now, obviously you're a board-certified physician or psychiatrist at arguably one of the finest medical schools in the world, Harvard Medical School.

现在，显然您是哈佛医学院可以说是世界上最好的医学院之一的经过委员会认证的医生或精神病学家。

Even though I'm on the Stanford side, we acknowledge-- we acknowledge our East Coast--

尽管我站在斯坦福大学这边，但我们承认——我们承认我们的东海岸——

But for a lot of people out there, the notion of using diet, they immediately think, ah, well, that makes perfect sense.

但对于很多人来说，使用节食的概念，他们立即认为，啊，好吧，这是完全有道理的。

Or I think there's a category of people who think, well, yeah, didn't Atkins die of a heart attack?

或者我认为有一类人会想，嗯，是的，阿特金斯不是死于心脏病吗？

I hear that a lot.

我经常听到这样的说法。

That was crazy.

那太疯狂了。

People immediately discard the Atkins diet for that reason, which I do think is throwing the baby out with the bathwater.

由于这个原因，人们立即放弃了阿特金斯饮食法，我确实认为这是把婴儿和洗澡水一起倒掉了。

But it's an interesting thing nonetheless.

但这仍然是一件有趣的事情。

And then I think that the majority of people sit in the middle and just want to see science and medicine come up with treatments that work.

然后我认为大多数人都坐在中间，只是想看到科学和医学提出有效的治疗方法。

And I have to say, I'm very relieved to hear what you said earlier, which was-- you never said that people should come off their medication and just become-- go on a ketogenic diet and everything will be cured.

我不得不说，听到您之前所说的话，我感到非常欣慰，您从未说过人们应该停止用药，而只是进行生酮饮食，一切都会得到治愈。

You're certainly not saying that.

你当然不是这么说的。

So let's talk about epilepsy and how the ketogenic diet is not just used for epilepsy but is one of the oldest, if not the oldest, examples of the use of nutrition to treat a condition of the nervous system that can be incredibly debilitating, even deadly.

因此，让我们来谈谈癫痫症，以及生酮饮食如何不仅用于治疗癫痫症，而且是利用营养来治疗神经系统疾病的最古老（如果不是最古老的）例子之一，这种疾病可能会令人难以置信地衰弱，甚至致命。

But the thing that immediately got me credibility was I didn't focus on it as a diet.

但立即让我获得信任的是我并没有将其作为一种饮食方式。

I did a deep dive into the epilepsy literature.

我深入研究了癫痫文献。

So the ketogenic diet, unbeknownst to most people, was actually developed a hundred years ago, 1921, by a physician for one and only one purpose-- to treat epilepsy.

因此，大多数人不知道的生酮饮食实际上是一百年前（即 1921 年）由一位医生开发的，其目的只有一个：治疗癫痫。

It wasn't developed as a weight loss diet.

它并不是作为减肥饮食而开发的。

It wasn't developed as the diet that all human beings should follow.

它并不是作为所有人都应该遵循的饮食而开发的。

And the reason it was developed is because of this longstanding observation, since the time of Hippocrates, that fasting can stop seizures.

它之所以被开发出来，是因为自希波克拉底时代以来的长期观察，禁食可以阻止癫痫发作。

Now, fasting is not a healthy diet.

现在，禁食并不是一种健康的饮食。

Fasting is the process of no diet.

禁食是不节食的过程。

So we now understand a tremendous amount of science.

所以我们现在了解了大量的科学知识。

Most people think going without food is bad.

大多数人认为不吃东西是不好的。

And they equate it with starvation.

他们将其等同于饥饿。

But in fact, when we go without food, it causes tremendous shifts in metabolism-- both brain and body metabolism.

但事实上，当我们不吃东西时，它会导致新陈代谢——大脑和身体新陈代谢——发生巨大的变化。

And it puts the body into a mode of autophagy, and conservation of resources, and all sorts of things that are beneficial to human health.

它使人体进入自噬模式，节约资源，以及各种有益于人体健康的事情。

And this is why fasting has been used as a therapeutic intervention in almost every culture, in almost every religion for a millennia.

这就是为什么几千年来禁食在几乎所有文化、几乎所有宗教中都被用作治疗干预措施。

But for the most part, that was all thought to be religious folklore.

但在大多数情况下，这都被认为是宗教民间传说。

That was just crazy talk.

那只是疯狂的言论。

And those stupid people way back then thought God cured everything.

那时那些愚蠢的人认为上帝治愈了一切。

And so they fasted.

于是他们禁食了。

And they just assumed that they were getting better.

他们只是认为自己正在好转。

Well, in 1921, one physician used intermittent fasting on a child with seizures and found that, oh, Lo and behold, this religious folklore stuff has something to it.

1921 年，一位医生对一名癫痫发作的儿童进行了间歇性禁食，他发现，哦，瞧，这种宗教民间传说确实有其道理。

It actually worked.

它确实有效。

The problem with fasting is that you can only fast for so long before you starve to death.

禁食的问题在于，你只能禁食一段时间，然后才会饿死。

And that's not a very effective treatment.

这并不是一种非常有效的治疗方法。

The fasting can take a few days because it can take a few days to get ketosis.

禁食可能需要几天的时间，因为可能需要几天的时间才能出现酮症。

And then you can get some relief from chronic seizures.

然后您就可以从慢性癫痫发作中得到一些缓解。

But it's not a good long-term treatment because, again, people will starve to death.

但这并不是一个好的长期治疗方法，因为人们会再次饿死。

As soon as they start eating, seizures come back.

一旦他们开始进食，癫痫就会再次发作。

So it was actually Dr. Russell Wilder at the Mayo Clinic who developed the ketogenic diet with one and only one purpose.

所以实际上是梅奥诊所的拉塞尔·怀尔德博士开发了生酮饮食，其目的只有一个。

He wanted to see, can we mimic the fasting state, using this special diet, to see if it might stop seizures long-term?

他想看看，我们能否模仿禁食状态，使用这种特殊的饮食，看看是否可以长期阻止癫痫发作？

And lo and behold, it worked.

你瞧，它成功了。

Early results were extraordinarily positive.

早期结果非常积极。

50% of patients who use the ketogenic diet became seizure-free.

50% 使用生酮饮食的患者不再出现癫痫发作。

And another 35% had a 50% or greater reduction in their seizure frequency, so about 85% efficacy rate.

另外 35% 的患者癫痫发作频率减少了 50% 或更多，因此有效率约为 85%。

And there's no question, they work for a lot of people.

毫无疑问，它们为很多人工作。

That's great.

那太棒了。

And taking a pill is so much easier than doing this diet.

吃药比节食要容易得多。

So the diet pretty much fell out of favor.

因此，饮食几乎不再受欢迎。

And nobody was using it from the 1950s to about the '70s.

从 20 世纪 50 年代到 70 年代左右，没有人使用它。

But lo and behold, even to this day, people with epilepsy, about 30% don't respond to the current treatments that we have available.

但你瞧，即使到今天，仍有约 30% 的癫痫患者对我们现有的治疗方法没有反应。

30% will have treatment resistant epilepsy, which means they continue to have seizures no matter how many anticonvulsants they're taking, even if they've had brain surgery.

30% 的人患有难治性癫痫，这意味着无论他们服用多少抗惊厥药物，即使他们已经接受过脑部手术，他们仍会癫痫发作。

It just doesn't stop their seizures.

它只是不能阻止他们的癫痫发作。

And so in the 1970s, the ketogenic diet was resurrected at Johns Hopkins for these treatment-resistant cases.

因此，在 20 世纪 70 年代，约翰·霍普金斯大学针对这些难治性病例重新启用生酮饮食。

And lo and behold, it works-- not for all of them, but it works in-- about 1/3 become seizure-free.

你瞧，它有效——虽然不是对所有人都有效，但它有效——大约 1/3 的人不再癫痫发作。

And these are people who've tried everything and nothing's working.

这些人已经尝试了一切，但毫无效果。

So 1/3 become seizure-free.

因此，1/3 的患者不再癫痫发作。

Another third get a clinical benefit, meaning a 50% or greater reduction in their seizure frequency.

另外三分之一获得了临床益处，这意味着癫痫发作频率减少了 50% 或更多。

And the other third, it doesn't seem to work.

另外三分之一，似乎不起作用。

It's not always clear if that's because of noncompliance or if that's because the diet's just not working.

我们并不总是清楚这是因为不遵守规定还是因为饮食不起作用。

But about a third, a third, a third-- seizure freedom, reduction in seizures, or it just doesn't work.

但大约三分之一、三分之一、三分之一——癫痫发作自由，癫痫发作减少，或者根本不起作用。

And so the reality, the godsend for me is that we have decades of neuroscience research on the ketogenic diet and what it is doing to the brain.

因此，现实对我来说是天赐之物，我们对生酮饮食及其对大脑的影响进行了数十年的神经科学研究。

We know that the ketogenic diet is influencing neurotransmitter levels-- in particular, glutamate, GABA, adenosine.

我们知道生酮饮食正在影响神经递质水平，特别是谷氨酸、GABA、腺苷。

It changes calcium channel regulation and calcium levels, which is really important in the function of cells.

它改变钙通道调节和钙水平，这对细胞功能非常重要。

It changes gene expression.

它改变基因表达。

It reduces brain inflammation.

它可以减少大脑炎症。

It changes the gut microbiome.

它改变肠道微生物组。

Gut microbiome is a huge topic right now.

肠道微生物组现在是一个巨大的话题。

And there are some researchers who argue that is the primary benefit of the ketogenic diet-- it's changing the gut microbiome in beneficial ways.

有一些研究人员认为，这是生酮饮食的主要好处——它以有益的方式改变肠道微生物组。

So it's doing a lot of things.

所以它做了很多事情。

It obviously improves insulin resistance.

明显改善胰岛素抵抗。

It lowers glucose levels, lowers insulin levels, which improves insulin signaling.

它可以降低血糖水平，降低胰岛素水平，从而改善胰岛素信号传导。

The key for my research that I've outlined, the real magic, is that this diet stimulates two processes that relate to mitochondria.

我所概述的研究的关键，真正的魔力，是这种饮食刺激了与线粒体相关的两个过程。

It stimulates a process called mitophagy, which is getting rid of old and defective mitochondria, and replacing them with new ones.

它刺激一种称为线粒体自噬的过程，即去除旧的和有缺陷的线粒体，并用新的线粒体取代它们。

And it also stimulates a process called mitochondrial biogenesis, which means that after people have done the ketogenic diet for a while-- months or years-- many of their cells in their bodies and brains will have more mitochondria.

它还刺激了一种称为线粒体生物发生的过程，这意味着人们进行生酮饮食一段时间（几个月或几年）后，他们身体和大脑中的许多细胞将拥有更多的线粒体。

And those mitochondria will be healthier.

这些线粒体会更健康。

And I believe that is the reason the ketogenic diet is such a powerful treatment not only for epilepsy but also for people with chronic mental disorders.

我相信这就是生酮饮食不仅能有效治疗癫痫而且还能治疗慢性精神障碍患者的原因。

But for instance, typically if somebody is presenting with something that looks like Alzheimer's, dementia, they'll talk to a neurologist.

但举例来说，通常如果有人出现类似阿尔茨海默氏症、痴呆症的症状，他们就会去看神经科医生。

Whereas, if somebody is presenting with symptoms, like schizophrenia, bipolar, they'll talk to a psychiatrist.

然而，如果有人出现精神分裂症、双相情感障碍等症状，他们会去看精神科医生。

But if you wouldn't mind wearing a dual hat, could you just quickly list off some of the neurologic and psychiatric disorders for which ketogenic-- or let's just say-- nutrition changes have been shown to improve symptoms significantly.

但是，如果您不介意戴上双重帽子，您能否快速列出一些神经系统和精神疾病，对于这些疾病，生酮（或者我们只是说）营养改变已被证明可以显着改善症状。

And then maybe we can dive into a couple of these as well as get more deeply into these two very interesting aspects of mitochondrial function and repair and turnover.

然后也许我们可以深入研究其中的几个，并更深入地了解线粒体功能以及修复和周转的这两个非常有趣的方面。

We have a lot of mechanistic science papers by some of the leading neuroscientists and psychiatrists in the world-- and neurologists in the world kind of outlining, this is everything we know that the ketogenic diet is doing.

我们有很多世界上一些领先的神经科学家和精神病学家以及世界上的神经学家发表的机械科学论文，这些论文概述了，这就是我们所知道的生酮饮食所做的一切。

These are the problems in the brains of people with these chronic mental or neurological disorders.

这些是患有慢性精神或神经疾病的人大脑中的问题。

So we know that they should work.

所以我们知道它们应该起作用。

But the disorders range from chronic depression to-- we've got a trial underway for PTSD.

但这些疾病的范围从慢性抑郁症到——我们正在进行一项针对创伤后应激障碍的试验。

We've got one actually decent pilot trial from the National Institutes of Health for the ketogenic diet for alcohol use disorder, of all things.

我们从美国国立卫生研究院进行了一项非常不错的试点试验，用于治疗酒精使用障碍的生酮饮食。

And we can go into that a little more.

我们可以进一步讨论这一点。

We've got a couple of pilot trials of the ketogenic diet for Alzheimer's disease.

我们已经进行了几项生酮饮食治疗阿尔茨海默病的试点试验。

And those are randomized controlled trials.

这些是随机对照试验。

We've got case studies of the ketogenic diet for chronic depression, bipolar disorder, and schizophrenia.

我们有生酮饮食治疗慢性抑郁症、双相情感障碍和精神分裂症的案例研究。

The largest study that we've got in that mental health sphere is a pilot study of 31 patients admitted to a French hospital.

我们在心理健康领域进行的最大规模的研究是对法国一家医院收治的 31 名患者进行的试点研究。

28 of those patients were able to do the diet and stay on the diet.

其中 28 名患者能够进行节食并坚持节食。

So 10%, off the bat, noncompliant, couldn't do the diet.

因此，有 10% 的人一开始不遵守规定，无法进行节食。

So we need to include that.

所以我们需要将其包括在内。

But of the 28 patients who were able to do-- and these are 28 patients with treatment-resistant mental disorders, chronic depression, bipolar, and schizophrenia.

但在 28 名能够做到这一点的患者中，有 28 名患者患有难治性精神障碍、慢性抑郁症、双相情感障碍和精神分裂症。

Of the patients who were able to do the ketogenic diet, 100% had at least some improvement in symptoms.

在能够进行生酮饮食的患者中，100% 的症状至少有一些改善。

46% had remission of illness.

46% 的疾病得到缓解。

Remission of illness, that does not happen with current treatments.

目前的治疗无法实现疾病缓解。

And 64%, I think, were discharged on less medicine than they went into the hospital on.

我认为 64% 的人出院时服用的药物少于入院时服用的药物。

So it wasn't that the people were prescribing more medicine and that's why.

所以并不是人们开了更多的药，这就是原因。

They were being discharged on less medication.

他们出院时服用的药物较少。

We've got at least-- again, a lot of the hard core scientists are going to say, show us the randomized controlled trial with hundreds of patients.

我们至少——再次，许多核心科学家会说，向我们展示了数百名患者的随机对照试验。

And we've got five randomized controlled trials underway now, funded primarily through philanthropy.

我们现在正在进行五项随机对照试验，主要通过慈善事业资助。

I can tell you that-- we've talked about that one index patient.

我可以告诉你——我们已经讨论过那位指标患者。

But at this point, I have now treated dozens of patients.

但到目前为止，我已经治疗了数十名患者。

And I've heard from hundreds of patients who've been treated by other clinicians, researchers-- or I've just heard from patients from around the world-- who have shared stories of complete remission of long, chronic mental disorders-- like bipolar disorder and schizophrenia-- off of psychiatric meds.

我从数百名接受过其他临床医生、研究人员治疗的患者那里听说过，或者我刚刚从世界各地的患者那里听说过，他们分享了长期慢性精神障碍（如双相情感障碍和精神分裂症）在使用精神药物后完全缓解的故事。

Some of them-- not all of them, but some of them are able to get off all psychiatric meds and remain in remission.

他们中的一些人——不是全部，但其中一些人能够摆脱所有精神药物并保持缓解状态。

Again, I think I didn't say this before.

再说一次，我想我之前没有说过这一点。

But it's really important to mention.

但值得一提的是。

For people who might be unfamiliar with the mental health field and its connection with epilepsy, the reason that it's such an important connection is that we use epilepsy treatments in psychiatric patients every day in tens of millions of people.

对于那些可能不熟悉心理健康领域及其与癫痫的联系的人来说，这种联系之所以如此重要，是因为我们每天都在为数以千万计的精神病患者使用癫痫治疗。

So a lot of people don't know this, but I'll list off some names that a lot of your listeners may have heard of.

所以很多人不知道这一点，但我会列出一些很多听众可能听说过的名字。

And they probably know them as psychiatric drugs.

他们可能知道它们是精神药物。

But in fact, these are epilepsy drugs.

但事实上，这些都是治疗癫痫的药物。

Depakote, Tegretol, Lamictal, Topamax, Neurontin or gabapentin, Valium, Klonopin, Xanax-- those are all medications that stop seizures.

Depakote、Tegretol、Lamictal、Topamax、Neurontin 或加巴喷丁、安定、Klonopin、Xanax——这些都是阻止癫痫发作的药物。

And many of them were developed initially for seizures.

其中许多最初是为癫痫发作而开发的。

But we, in the mental health field, quickly steal them and start using them in tens of millions of people, even if they're off label.

但我们在心理健康领域很快就窃取了它们并开始在数以千万计的人身上使用它们，即使它们没有适应症。

So that means, we don't have research studies documenting that they're effective.

所以这意味着，我们没有研究证明它们是有效的。

But we go ahead and use them anyway because the reality is far too many patients aren't getting better with the FDA-approved treatments that we do have to offer.

但无论如何我们都会继续使用它们，因为现实是太多的患者在接受我们必须提供的 FDA 批准的治疗后并没有好转。

So psychiatrists are just winging it in some cases.

因此，在某些情况下，精神科医生只是即兴发挥。

And we're just throwing whatever we can at them and we absolutely include epilepsy treatments.

我们只是尽我们所能地帮助他们，而且我们绝对包括癫痫治疗。

So in many ways, using the ketogenic diet as a treatment for serious mental disorders, is nothing new at all.

因此，从很多方面来说，使用生酮饮食来治疗严重的精神障碍并不是什么新鲜事。

It's an established evidence-based treatment for epilepsy.

这是一种基于证据的癫痫治疗方法。

We use evidence-based treatments for epilepsy across the board for a wide range of mental disorders.

我们针对多种精神障碍全面使用基于证据的癫痫治疗方法。

And so in many ways, that's all I'm doing with the ketogenic diet.

所以从很多方面来说，这就是我在生酮饮食中所做的一切。

It just happens to be a diet.

这恰好是一种饮食。

‍

‍

And he made a really important point, which should have been obvious to me but wasn't until he said it, which was the psychiatrist has tools, just like the surgeon has tools.

他提出了一个非常重要的观点，这对我来说应该是显而易见的，但直到他说出来，精神科医生有工具，就像外科医生有工具一样。

But the tools are language and observing behavior.

但工具是语言和观察行为。

Those are the dissection tools for what's going on in someone's brain.

这些是剖析某人大脑中正在发生的事情的工具。

And then as a neuroscientist, I'm familiar with the neurotransmitters and neuromodulators.

作为一名神经科学家，我熟悉神经递质和神经调节剂。

And you mentioned that-- and there are these tools of altering brain chemistry, which are of the sorts of drugs you just listed off, or antidepressants, or antipsychotics, that fall into these major bins of adjusting dopamine or adjusting serotonin or some combination of dopamine, serotonin epinephrine, adenosine, and on, and on, and on.

你提到过，有一些改变大脑化学物质的工具，它们是你刚才列出的那种药物，或者抗抑郁药，或者抗精神病药，它们属于调节多巴胺或调节血清素或多巴胺、血清素肾上腺素、腺苷等的一些主要组合。

And it seems to me, it's an incredible field.

在我看来，这是一个令人难以置信的领域。

But that the field is still very much in its infancy that it wasn't about a hundred years ago that people were measuring bumps on the head as a way to diagnose phrenology, and that there's still so much to learn.

但这个领域仍处于起步阶段，大约一百年前人们才开始测量头部的肿块作为诊断颅相学的方法，而且还有很多东西需要学习。

And so when I hear you say, adjusting nutrition or putting people into a ketogenic state or even just eliminating highly processed foods, sugars, et cetera, taking care of metabolic syndrome, and then observing tremendous relief in clinical syndromes of-- or symptoms, rather, of psychiatric disorders, it makes perfect sense to me.

因此，当我听到你说，调整营养或让人们进入生酮状态，甚至只是消除高度加工的食品、糖等，照顾代谢综合症，然后观察到精神疾病的临床综合症或症状的巨大缓解时，这对我来说是完全有道理的。

It's yet another dissection tool.

这是另一个解剖工具。

And a tool for altering brain chemistry.

以及改变大脑化学物质的工具。

If I think about the landscape, the sort of sociology out there of-- again, there seem to be these bins, like a third of people saying, of course, diet, and exercise, and social connection, and limiting stress, that's the good stuff.

如果我想想外面的情况，那种社会学——再次，似乎有这些垃圾箱，就像三分之一的人说的那样，当然，饮食、锻炼、社会联系和限制压力，那是好东西。

That's the stuff that we really works.

这就是我们真正做的事情。

And then about a third of people are sort of unclear.

然后大约三分之一的人有点不清楚。

And then a third of people think, well, if it's not a prescription drug, then it just has no place in medicine.

然后三分之一的人认为，好吧，如果它不是处方药，那么它在医学上就没有地位。

And hopefully, that's changing.

希望这种情况正在改变。

And certainly, the work that you're doing is going to be important in that transition that I think we will see.

当然，您所做的工作对于我认为我们将会看到的转型非常重要。

I'd like to talk about mitophagy and mitochondrial biogenesis.

我想谈谈线粒体自噬和线粒体生物发生。

I think most people learn that the mitochondria are the energy factories of cells and that indeed, they are.

我想大多数人都知道线粒体是细胞的能量工厂，而且确实如此。

As a neuroscientist, what I know about them is that they are present everywhere in neurons.

作为一名神经科学家，我对它们的了解是它们存在于神经元中的各处。

Not just in the so-called cell body, but you can find mitochondria in the furthest little bits of neurons.

不仅在所谓的细胞体中，你还可以在最远的神经元中找到线粒体。

And neurons can be quite big, very large.

神经元可能非常大。

In fact, meters long or more in some cases and some species, including us.

事实上，在某些情况下，某些物种（包括我们）的长度可达数米或更长。

Depending on how tall somebody is, could be many meters-- or several meters rather.

根据某人的身高，可能有几米——或者更确切地说是几米。

And that mitochondria do a lot of stuff besides just produce energy, because I think people hear "mitochondria," "energy," and they think, oh, so these patients felt better.

线粒体除了产生能量之外还有很多作用，因为我认为人们听到“线粒体”、“能量”，他们会想，哦，所以这些病人感觉好多了。

They lost weight.

他们体重减轻了。

They had more energy.

他们有更多的精力。

And then they're doing better.

然后他们做得更好。

But here we're talking about remission of auditory hallucinations, people feeling suicidal and then changing their diet and feeling like life is something they can deal with, and maybe even function extremely well, and et cetera.

但在这里我们谈论的是幻听的缓解，人们有自杀倾向，然后改变他们的饮食，感觉生活是他们可以应对的，甚至可能运转得非常好，等等。

So maybe we could just talk about mitochondria for a moment.

所以也许我们可以暂时谈谈线粒体。

And then talk about these two major effects.

然后说说这两个主要的影响。

What are some of the other things that mitochondria are important for in neurons and maybe other cells of the brain?

线粒体对于神经元甚至大脑的其他细胞还有哪些重要作用？

Because as an access point for all this, I think it would be great if people could learn a little mitochondrial biology.

因为作为这一切的切入点，我认为如果人们能够了解一点线粒体生物学那就太好了。

They take food and oxygen and turn it into ATP.

它们吸收食物和氧气并将其转化为 ATP。

And that's really important.

这真的很重要。

Yeah, we get that.

是的，我们明白了。

But they're just little batteries.

但它们只是小电池。

That's all they are.

这就是他们的全部。

And so one of the reasons that this work is so important it's because it combines cutting-edge research in the metabolic field in the aging field.

因此，这项工作如此重要的原因之一是它结合了衰老领域代谢领域的前沿研究。

And we can start to pair it with a mental health and neurological health field.

我们可以开始将其与心理健康和神经健康领域配对。

So mitochondria-- one scientist gave me this analogy.

线粒体——一位科学家给了我这个类比。

He said, if you think of the cell as a computer, a lot of people think of mitochondria as the power cord to that computer because they're providing the power.

他说，如果你把细胞想象成一台计算机，很多人就会把线粒体看作计算机的电源线，因为它们提供电力。

And they are, in fact, the power cord to that computer.

事实上，它们是该计算机的电源线。

But actually, their real function is the motherboard of that computer.

但实际上，它们的真正功能是该计算机的主板。

So mitochondria are directing in allocating resources throughout a cell.

因此，线粒体负责在整个细胞中分配资源。

That is their primary function.

这是他们的主要职能。

And then they happen to be powerhouses as well.

然后他们也恰好是强者。

And so to give some clear examples, mitochondria play a direct role in the production, and release, and regulation of some really key neurotransmitters, including serotonin, dopamine, glutamate, acetylcholine.

举一些明确的例子，线粒体在一些真正关键的神经递质（包括血清素、多巴胺、谷氨酸、乙酰胆碱）的产生、释放和调节中发挥着直接作用。

Those are pretty powerful neurotransmitters.

这些是非常强大的神经递质。

There have been some research studies that have actually found that mitochondria move along the membrane of the synapse to release batches of vesicles of neurotransmitters, and that if the mitochondria are removed from the synapse and researchers flood that cell with ATP, neurotransmitters usually are not getting released.

一些研究实际上发现，线粒体沿着突触膜移动，释放出一批批神经递质囊泡，如果将线粒体从突触中移除，并且研究人员向该细胞注入 ATP，神经递质通常不会被释放。

Mitochondria are doing other things.

线粒体正在做其他事情。

We don't entirely even understand what all they're doing or how they're doing it.

我们甚至不完全了解他们在做什么或他们是如何做的。

But they're doing other things than just providing the power.

但他们不仅仅提供电力，还做其他事情。

Another really important example is that mitochondria are actually the primary regulators of epigenetics.

另一个非常重要的例子是线粒体实际上是表观遗传学的主要调节因子。

If you look at any one factor-- so one study actually found that they're responsible for the expression of about 60% of the genes in a cell.

如果你观察任何一个因素——一项研究实际上发现它们负责细胞中大约 60% 的基因的表达。

And mitochondria do this through a lot of ways that have been known for years and sometimes decades.

线粒体通过许多多年来甚至数十年来为人所知的方式来做到这一点。

So mitochondria are directly related to the levels of reactive oxygen species in a cell.

因此线粒体与细胞中活性氧的水平直接相关。

They are managing calcium regulation in cells.

他们正在管理细胞中的钙调节。

And we know that those things play a role in epigenetic expression.

我们知道这些东西在表观遗传表达中发挥着作用。

We know the levels of ATP to ADP or AMP also play a role.

我们知道 ATP、ADP 或 AMP 的水平也会发挥作用。

And mitochondria are doing those things.

线粒体正在做这些事情。

But it turns out, mitochondria are actually doing much more sophisticated things than even those in terms of gene expression.

但事实证明，线粒体实际上正在做比基因表达方面更复杂的事情。

Mitochondria at least play a role in all of the aspects of the human stress response.

线粒体至少在人类应激反应的所有方面都发挥着作用。

So when humans are stressed, either physically or psychologically, there are several things that happen-- increased cortisol increased adrenaline, noradrenaline, inflammation, and gene expression-- in particular, in the hippocampus-- occur with the stress response.

因此，当人类在身体或心理上受到压力时，会发生一些事情——皮质醇增加，肾上腺素、去甲肾上腺素增加，炎症和基因表达——特别是在海马体中——与压力反应一起发生。

And one group of researchers actually genetically modified mitochondria in four different ways, and found that all of the stress response, all those four buckets of stress response were impacted in one way or another, implying that mitochondria are somehow playing a role in those.

一组研究人员实际上以四种不同的方式对线粒体进行了基因改造，并发现所有的压力反应，所有这四类压力反应都以这种或那种方式受到影响，这意味着线粒体在某种程度上发挥了作用。

In terms of their role in cortisol, we know that mitochondria actually have the enzyme required for the synthesis of steroid hormones.

就其在皮质醇中的作用而言，我们知道线粒体实际上具有合成类固醇激素所需的酶。

So that includes cortisol, estrogen, testosterone, and progesterone, some names that maybe everybody's heard of.

其中包括皮质醇、雌激素、睾酮和黄体酮，这些名字可能每个人都听说过。

so that means that if mitochondria are in short supply or dysfunctional, the production of those hormones may become dysregulated.

因此，这意味着如果线粒体供应不足或功能失调，这些激素的产生可能会失调。

Mitochondria play a direct role in inflammation.

线粒体在炎症中发挥直接作用。

And they turn the inflammatory system both on-- or they at least play a role in turning the inflammatory system both on and off.

它们会打开炎症系统——或者至少在打开和关闭炎症系统方面发挥作用。

I'm not going to be able to quote the exact study and author.

我无法引用确切的研究和作者。

But one paper in cell actually identified mitochondria as the key regulator in turning certain inflammatory cells off, and that when you inhibit mitochondrial function, those cells don't turn off, that mitochondrial levels of reactive oxygen species are a key signaling process to turn the inflammatory cell process off.

但《细胞》杂志上的一篇论文实际上确定线粒体是关闭某些炎症细胞的关键调节因子，当你抑制线粒体功能时，这些细胞不会关闭，线粒体活性氧水平是关闭炎症细胞过程的关键信号传导过程。

Another study found that macrophages-- so macrophages are an important immune cell that play a role in healing.

另一项研究发现巨噬细胞——巨噬细胞是一种重要的免疫细胞，在愈合中发挥作用。

So if you cut yourself, your body will get-- send inflammation that way and send immune cells that way to try to heal your skin.

因此，如果你割伤了自己，你的身体就会——以这种方式发送炎症，并以这种方式发送免疫细胞来尝试治愈你的皮肤。

And macrophages play an important role in that healing.

巨噬细胞在愈合过程中发挥着重要作用。

One group of researchers tried to figure out how do macrophages know to switch between the different phases of wound healing because the macrophages do different things in the different phases of wound healing.

一组研究人员试图弄清楚巨噬细胞如何知道在伤口愈合的不同阶段之间进行切换，因为巨噬细胞在伤口愈合的不同阶段会做不同的事情。

And the conclusion of all of their research was that it's mitochondria.

他们所有研究的结论是线粒体。

Mitochondria are sending the essential signals that change the state of the macrophages to induce these different phases of wound healing.

线粒体正在发送改变巨噬细胞状态的重要信号，以诱导伤口愈合的不同阶段。

So I've just talked about neurotransmitters, hormones, epigenetic expression, inflammation.

我刚才谈到了神经递质、激素、表观遗传表达、炎症。

For anybody familiar with the mental health field, they know these are some of the key variables that researchers have been struggling with for decades, trying to figure out how do these fit together.

对于任何熟悉心理健康领域的人来说，他们都知道这些是研究人员几十年来一直在努力解决的一些关键变量，试图弄清楚它们如何结合在一起。

We know that all of those buckets can be disrupted in people with mental disorders.

我们知道，精神障碍患者的所有这些能力都可能被打乱。

And our field has struggled to understand, but how do they fit together?

我们的领域一直很难理解，但它们如何结合在一起？

How can we make sense of this disruption?

我们如何理解这种破坏？

And I believe once you understand the science of mitochondria, you can actually connect all of the dots of the mental illness puzzle.

我相信，一旦您了解了线粒体科学，您实际上就可以将精神疾病难题的所有点联系起来。

I've long been a believer in getting regular blood work done for the simple reason that many of the factors that impact your immediate and long-term health can only be analyzed from a quality blood test.

长期以来，我一直坚信定期进行血液检查，原因很简单，影响您当前和长期健康的许多因素只能通过高质量的血液测试来分析。

The problem with a lot of blood and DNA tests out there, however, is that you get data back about metabolic factors, lipids, and hormones, and so forth.

然而，大量血液和 DNA 测试的问题在于，你会得到有关代谢因素、脂质和激素等的数据。

But you don't know what to do with those data.

但您不知道如何处理这些数据。

InsideTracker solves that problem and makes it very easy for you to understand what sorts of nutritional, behavioral, maybe even supplementation-based interventions you might want to take on in order to adjust the numbers of those metabolic factors, hormones, lipids, and other things that impact your immediate and long-term health to bring those numbers into the ranges that are appropriate and indeed optimal for you.

InsideTracker 解决了这个问题，让您很容易了解您可能需要采取哪些营养、行为、甚至基于补充剂的干预措施，以调整那些影响您当前和长期健康的代谢因素、激素、脂质和其他因素的数量，使这些数字达到适合您且实际上最适合您的范围。

If you'd like to try InsideTracker, you can visit insidetracker.com/huberman to get $200 off an ultimate plan or 34% off the entire site as a special Black Friday deal now through the end of November.

如果您想尝试 InsideTracker，您可以访问 insidetracker.com/huberman，享受终极计划 200 美元的折扣或整个网站 34% 的折扣，作为黑色星期五的特别优惠，从现在到 11 月底。

Again, that's insidetracker.com/huberman and use the code Huberman at checkout.

同样，这是 insidetracker.com/huberman，并在结帐时使用代码 Huberman。

Super interesting little subcellular goodies, these mitochondria are.

这些线粒体是超级有趣的亚细胞小东西。

I come from a field where people are often divided into lumpers and splitters.

在我所在的领域，人们经常被分为集大成者和分裂者。

And I'm somewhere in between.

我介于两者之间。

For those of you who don't know, lumpers are people that like to make things really simple-- lists of no more than three functions or dividing brain areas into no more than three.

对于那些不知道的人来说，笨蛋是那些喜欢让事情变得非常简单的人——列出不超过三个功能或将大脑区域划分为不超过三个。

Splitters are people that like to subdivide into a ton of detail.

分裂者是喜欢细分成大量细节的人。

There's a history of scientists being splitters in order to be able to name things after themselves because--

历史上科学家们为了能够以自己的名字命名事物而进行分裂，因为——

Maybe someday, what we call mitochondria will actually be two or three different little subcellular or organelles.

也许有一天，我们所说的线粒体实际上将是两个或三个不同的小亚细胞或细胞器。

There may be little bits in there that are controlling gene expression and little bits in there that are controlling neurotransmitter production.

那里可能有一些小部分控制着基因表达，还有一些小部分控制着神经递质的产生。

But at least for now, the name is mitochondria.

但至少现在，这个名字是线粒体。

And thank you, by the way, for illustrating some of the other things that they do because in the landscape of science education, oftentimes, people will think, OK, energy production.

顺便说一句，谢谢你说明他们所做的一些其他事情，因为在科学教育领域，人们常常会想，好吧，能源生产。

There'll be a picture or a cartoon of mitochondria flexing its muscles.

会有一张线粒体展示肌肉的图片或漫画。

People go, OK, energy, mitochondria, mighty mitochondria.

人们会说，好吧，能量，线粒体，强大的线粒体。

And then they'll think, oh, they're just sort of like a dumb jock portion of the cell.

然后他们会想，哦，他们就像牢房里的一个愚蠢的运动员。

They're not doing anything sophisticated.

他们没有做任何复杂的事情。

And everything you listed off is that they are doing many sophisticated intricate things within cells.

你列出的一切都是它们在细胞内做许多复杂的事情。

So I think how things are cartooned and discussed actually has an impact-- and not just on the general public, but on the medical field and on the science fields.

因此，我认为事物的卡通化和讨论方式实际上会产生影响——不仅对公众，而且对医学领域和科学领域。

Anyway, that's more science sociology.

不管怎样，这更科学社会学。

But now that everyone is well aware that mitochondria are doing a large number of very important things in a very regulated way, let's talk about mitophagy.

但现在大家都清楚线粒体正在以一种非常受监管的方式做大量非常重要的事情，让我们来谈谈线粒体自噬。

A few years ago, because a Nobel Prize was given for autophagy-- sometimes called autophagy.

几年前，因为自噬（有时称为自噬）获得了诺贝尔奖。

Look, people, you can say it either way.

听着，人们，你可以用任何一种方式说。

People will know hopefully what it means is more important, which is the gobbling up of one's own cells that are dead or injured.

人们希望知道这意味着什么更重要，那就是吞噬自己死亡或受伤的细胞。

And this idea of autophagy, of cells being eaten up within a system-- nervous system or other system-- has come up again and again.

这种自噬的想法，即细胞在系统（神经系统或其他系统）内被吞噬的想法一再出现。

I actually wasn't aware that mitophagy could be such an important lever.

事实上我并不知道线粒体自噬可能是一个如此重要的杠杆。

So tell us about mitophagy, which I have to presume is the, intentional or not, gobbling up of mitochondria, presumably to replace them with newer healthier mitochondria.

那么请告诉我们有关线粒体自噬的信息，我必须推测线粒体自噬是有意或无意地吞噬线粒体，大概是用更新的、更健康的线粒体取代它们。

Is that right?

是这样吗？

Mitochondria actually are playing a role in autophagy itself.

线粒体实际上在自噬本身中发挥着作用。

And this makes sense because one of-- so the global picture of autophagy is stimulated by fasting states or fasting-mimicking states.

这是有道理的，因为其中之一是自噬的整体情况是由禁食状态或模仿禁食状态刺激的。

So when your body senses that you don't have enough food, it actually hunkers down and starts to recycle dead old parts in this kind of carefully orchestrated way.

因此，当你的身体感觉到你没有足够的食物时，它实际上会蹲下并开始以这种精心策划的方式回收死去的旧部分。

And it takes them to lysosomes.

它将它们带到溶酶体。

They get degraded.

他们变得退化了。

And then those degradation products get used for either energy or to build new things.

然后这些降解产物被用于能源或建造新事物。

Autophagy is always occurring at a low level.

自噬始终以低水平发生。

But you can really hyperstimulate the process through fasting, calorie restriction, fasting-mimicking diets, other things.

但你确实可以通过禁食、限制热量、模仿禁食饮食或其他方式来过度刺激这个过程。

And this is why fasting and calorie restriction is so kind of such hot topics in the medical field now.

这就是为什么禁食和热量限制现在成为医学领域的热门话题。

It's because they've been shown to induce longevity.

这是因为它们已被证明可以延长寿命。

And we think it's probably through that process that you're stimulating the body to kind of become lean and conservative in terms of its allocation of resources.

我们认为，通过这个过程，你可能会刺激身体在资源分配方面变得精简和保守。

And the body doesn't just destroy the healthiest tissue along with the old dead stuff.

身体不仅会破坏最健康的组织以及旧的死亡物质。

It has these processes that identify the old and defective parts first.

它具有首先识别旧零件和有缺陷零件的流程。

And they go first.

他们先走。

And that's what's beautiful about the whole thing.

这就是整件事的美妙之处。

And that's why fasting is so important.

这就是为什么禁食如此重要。

So mitophagy we know plays a really important role because-- so there's this term called mitochondrial dysfunction, which some researchers are actually wanting to get rid of and move away from because, as you just said, mitochondria do so many different things.

所以我们知道线粒体自噬起着非常重要的作用，因为——所以有一个叫做线粒体功能障碍的术语，一些研究人员实际上想要摆脱并远离它，因为正如你刚才所说，线粒体做了很多不同的事情。

And different mitochondria even within the same cell may very well be specializing in different tasks.

即使在同一细胞内，不同的线粒体也很可能专门从事不同的任务。

And mitochondria from one cell to another are sometimes doing very different things, like not all mitochondria can produce cortisol.

从一个细胞到另一个细胞的线粒体有时会做非常不同的事情，比如并非所有线粒体都能产生皮质醇。

That's specific to specific cells where those genes are getting turned on.

这是特定于那些基因被打开的特定细胞的。

So it's not like all mitochondria are producing cortisol.

所以并不是所有的线粒体都会产生皮质醇。

Just the ones in your adrenal gland, for instance, are producing cortisol.

例如，只有肾上腺中的细胞才会产生皮质醇。

But there is this term "mitochondrial dysfunction." And it has long been known, for decades, that mitochondrial dysfunction is associated with everything that ails us essentially.

但有一个术语“线粒体功能障碍”。几十年来，人们早已知道线粒体功能障碍与我们本质上的一切疾病有关。

So in the 1950s, we had a theory of aging that was based on reactive oxygen species.

因此，在 20 世纪 50 年代，我们提出了一种基于活性氧的衰老理论。

And that's where all the inflammation is bad for you comes from.

这就是所有对你有害的炎症的来源。

So researchers used the antioxidants to see if, well, maybe if we can stop, somehow tame these reactive oxygen species, we'll improve health outcomes.

因此，研究人员使用抗氧化剂来看看，好吧，也许如果我们能够停止，以某种方式驯服这些活性氧，我们是否会改善健康状况。

Doesn't seem to work.

似乎不起作用。

By the 1970s, our understanding of mitochondria and their role in the production of reactive oxygen species expanded.

到了 20 世纪 70 年代，我们对线粒体及其在活性氧产生中的作用的了解不断扩大。

And that led to the mitochondrial theory of aging.

这导致了线粒体衰老理论。

So in the 1970s, we had this mitochondrial theory of aging, based primarily and exclusively on reactive oxygen species.

因此，在 20 世纪 70 年代，我们有了这种线粒体衰老理论，该理论主要且完全基于活性氧。

Fast forward a couple of decades, that was disproven because we now reactive oxygen species aren't all bad.

快进几十年，这一点被证明是错误的，因为我们现在的活性氧并不都是坏的。

They actually serve a signaling process.

它们实际上服务于信号传递过程。

They're a normal part of human functioning and cellular function.

它们是人类功能和细胞功能的正常组成部分。

So they're not all bad.

所以他们并不都是坏人。

But we still know high levels of reactive oxygen species are bad for you.

但我们仍然知道高水平的活性氧对您有害。

Fast forward to just, I think, maybe last year, with this expanded role of all of the different things mitochondria are doing.

快进到，我想，也许是去年，线粒体所做的所有不同事情的作用都在扩大。

So David Sinclair published a paper in one of the cell journals, I think, saying that, oh, mitochondria are actually the unifying link of everything that we know about aging.

因此，我认为大卫·辛克莱在一份细胞期刊上发表了一篇论文，他说，哦，线粒体实际上是我们所知道的有关衰老的一切的统一纽带。

Mitochondria are the cause-- or defective mitochondria or defective mitochondrial function, mitochondrial dysfunction, is possibly the unifying cause of aging and all of the aging related disorders.

线粒体是原因——或者有缺陷的线粒体或有缺陷的线粒体功能、线粒体功能障碍，可能是衰老和所有与衰老相关的疾病的统一原因。

So mitophagy is trying to address all that.

因此，线粒体自噬正试图解决这一切。

It's trying to say, OK, this is bad.

它试图说，好吧，这很糟糕。

We don't want defective mitochondria and how can we get rid of old ones or defective ones and replace them with new ones.

我们不想要有缺陷的线粒体，我们如何才能摆脱旧的或有缺陷的线粒体并用新的线粒体替代它们。

And I think the most powerful signal and tool that we have right now is, in fact, related to diet.

我认为我们现在拥有的最有力的信号和工具实际上与饮食有关。

It's calorie restriction.

这是卡路里限制。

That is the oldest, truest, kind of best-proven way to prevent aging in a wide variety of animal species-- fasting and intermittent fasting.

这是最古老、最真实、最有效的预防多种动物衰老的方法——禁食和间歇性禁食。

And again, you can only do those things for so long.

再说一次，你只能做这些事情这么长时间。

And then fasting-mimicking diets can also stimulate this process of mitophagy.

模仿禁食的饮食也可以刺激线粒体自噬过程。

And if various diets, including ketogenic diet, including fasting, reducing sugar intake, et cetera, can assist in mitochondrial function and mitophagy-- and that's at least one of the levers by which diet can positively impact mental health and physical health, can we conclude that there's something special about low blood glucose in the brain?

如果各种饮食，包括生酮饮食，包括禁食、减少糖摄入量等，都可以帮助线粒体功能和线粒体自噬——而这至少是饮食可以积极影响心理健康和身体健康的杠杆之一，那么我们是否可以得出结论，大脑中的低血糖有什么特别之处？

The sort of common pathway of all of those things-- fasting, ketogenesis-- for some people, maybe they-- maybe some people have great insulin management, so just removing sweets, refined sugars, brings down their blood glucose level substantially.

所有这些事情的共同途径——禁食、生酮——对于某些人来说，也许他们——也许有些人有很好的胰岛素管理，所以只要去掉甜食、精制糖，就能大幅降低他们的血糖水平。

They don't need to go on a ketogenic diet in order to relieve a low level depression or something like that.

他们不需要通过生酮饮食来缓解轻度抑郁症或类似症状。

Seems like the common theme here is that glucose levels in the brain need to be reduced, which for me, is surprising because neurons love glucose.

似乎这里的共同主题是大脑中的葡萄糖水平需要降低，这对我来说是令人惊讶的，因为神经元喜欢葡萄糖。

There are some really nice studies.

有一些非常好的研究。

One that I can think of recently that was published in Neuron, if you just look at the tuning of a neuron, how well a neuron in the brain represents some visual image in the environment in terms-- here, we can just generalize and say, more action potentials, more electrical signals from the neuron generally correlates with better high fidelity representation.

我能想到最近发表在《神经元》上的一篇文章，如果你只看神经元的调整，大脑中的神经元如何很好地表示环境中的一些视觉图像——在这里，我们可以概括地说，更多的动作电位、来自神经元的更多电信号通常与更好的高保真度表示相关。

It's sort of if everyone's time someone says, shout, and then someone shouts, the neuron is the one responding to the order.

就好像每个人都有时间有人说、喊叫，然后有人喊叫，神经元就是对命令做出反应的人。

And these neurons just, when there's high glucose, they are faithful representatives of what's out there in the world.

当葡萄糖含量很高时，这些神经元就忠实地代表了外面的世界。

But then when you fast an animal, they become less faithful representatives of what's out there.

但当你给动物禁食时，它们就不再那么忠实地代表外面的事物了。

And yet when I've done intermittent fasting, and I do a kind of modified version of it, my mental clarity is far better than when I've had a big bowl of pasta-- probably for other reasons related to serotonin and tryptophan.

然而，当我进行间歇性禁食并对其进行某种修改后，我的思维清晰度远比我吃一大碗意大利面时要好——可能是由于与血清素和色氨酸有关的其他原因。

So I think for the typical listener out there, I have to imagine, it's got to be a little confusing.

所以我认为对于典型的听众来说，我必须想象，这一定有点令人困惑。

We hear neurons love glucose.

我们听说神经元喜欢葡萄糖。

They live on glucose.

他们以葡萄糖为生。

And here, we're saying, let's deprive them of some glucose.

在这里，我们要说的是，让我们剥夺他们的一些葡萄糖。

Or let's just bring glucose levels down.

或者让我们降低血糖水平。

Or let's switch the fuel source of the brain from glucose to ketones.

或者让我们将大脑的燃料来源从葡萄糖改为酮。

And now the brain really works the way it's supposed to.

现在大脑真的按照它应该的方式工作了。

So this raises a little bit of just so story question, like why would it be the case that neurons love glucose, and yet if there's too much glucose around, they become sick?

因此，这提出了一些故事性的问题，比如为什么神经元喜欢葡萄糖，但如果周围葡萄糖过多，它们就会生病？

And of course, with any why-would-it-be story, as I would say, I wasn't consulted at the design phase.

当然，正如我所说，对于任何“为什么会这样”的故事，在设计阶段都没有征求我的意见。

And I'm going to presume that you weren't consulted the design--

我假设你没有咨询过设计——

The idea that diet can impact mental health and physical health-- yes, absolutely-- by way of mitochondria-- at least in part, great.

饮食可以通过线粒体影响心理健康和身体健康——是的，绝对如此——至少部分地，这个想法很棒。

But then neurons love glucose.

但神经元喜欢葡萄糖。

So what's going on?

那么到底是怎么回事呢？

Or what do you think is going on?

或者你认为发生了什么？

And it appears to be a metabolic role, which in my mind, implies that the mitochondria in those astrocytes are probably playing a key role because we know mitochondria play a key role in sensing glucose levels.

它似乎是一种代谢作用，在我看来，这意味着这些星形胶质细胞中的线粒体可能发挥着关键作用，因为我们知道线粒体在感知葡萄糖水平方面发挥着关键作用。

They play a key role in the release of insulin from the pancreas.

它们在胰腺释放胰岛素方面发挥着关键作用。

But mitochondria in the brain is also playing a role in kind of balancing how much glucose is around.

但大脑中的线粒体也在平衡周围葡萄糖含量方面发挥着一定作用。

And so it's a difficult question because I think in some cases, high glucose levels are actually a symptom of metabolic dysfunction somewhere in the body or brain.

所以这是一个很难回答的问题，因为我认为在某些情况下，高血糖水平实际上是身体或大脑某处代谢功能障碍的症状。

And when I think about, well, what does that mean?

当我思考时，这意味着什么？

In my mind, most of the evidence currently is pointing to mitochondrial dysfunction somewhere in the body or brain.

在我看来，目前大多数证据都指向身体或大脑某个部位的线粒体功能障碍。

That is the most likely cause of that dysregulation of glucose levels.

这是血糖水平失调的最可能原因。

But we know that if you consume massive amounts of junk food, sugar, and other things, that you can get dysregulation of glucose levels.

但我们知道，如果您食用大量垃圾食品、糖和其他东西，您可能会出现血糖水平失调。

The conundrum, though, is that that's not a universal response.

然而，难题在于这并不是普遍的反应。

But I do eat carbohydrates.

但我确实吃碳水化合物。

I eat starches typically at night.

我通常在晚上吃淀粉类食物。

But I tend to do some very hard training at some point during the day.

但我倾向于在白天的某个时候进行一些非常艰苦的训练。

So I imagine I have some glycogen to repack.

所以我想我有一些糖原需要重新包装。

OK.

好的。

That's me.

这就是我。

I only mentioned that because I'm not in ketosis as far as I know.

我只是提到这一点，因为据我所知，我没有处于酮症状态。

I haven't-- unless you brought the strips, I haven't done the blood glucose test today.

我没有——除非你带了试纸，否则我今天还没有做血糖测试。

So what about the typical person who's an omnivore eating some rice, some pasta, pasta salads, people that are eating not junk food massive amounts of sugar but have blood glucose that's in kind of moderate range?

那么，那些吃一些米饭、一些面食、面食沙拉的典型杂食动物，那些不吃垃圾食品、大量糖但血糖处于中等范围的人呢？

Do you think-- and here, feel free to speculate.

你认为——在这里，请随意推测。

Do you think that those people might feel far better-- or even a little bit better-- if they were in a lower glucose state?

您是否认为这些人如果处于较低的血糖状态，可能会感觉好得多，甚至好一点？

And I ask this because I think there are a lot of people out there who suffer from full-blown depression.

我问这个问题是因为我认为有很多人患有全面的抑郁症。

But there are also a lot of people who suffer from moodiness and feeling not so great, subclinical depression.

但也有很多人患有情绪低落、感觉不那么严重的亚临床抑郁症。

Just because the ketogenic diet is an effective treatment, does not imply that the cause of the problem was eating carbohydrates.

仅仅因为生酮饮食是一种有效的治疗方法，并不意味着问题的原因是吃碳水化合物。

And I think that's a really important distinction.

我认为这是一个非常重要的区别。

There are many people who disagree with me on that.

在这一点上有很多人不同意我的观点。

There's no doubt about it.

毫无疑问。

And everybody's heard people say, sugar is the cause of everything that ails you.

每个人都听人说过，糖是一切不适的根源。

Or carbs are the cause of everything that ails you.

或者碳水化合物是导致你一切不适的原因。

If everybody does a low carb diet or a ketogenic diet-- and then they go to, so it must be sugar that was the cause.

如果每个人都进行低碳水化合物饮食或生酮饮食，然后他们都会这样做，那么原因一定是糖。

I don't see it as clearly black and white as that.

我不认为它是那么清晰的黑白。

Calorie restriction, ketogenic diet, carbohydrate restriction are inducing metabolic changes in the brain and body.

热量限制、生酮饮食、碳水化合物限制正在引起大脑和身体的代谢变化。

And regardless of what the person was eating, they are inducing metabolic changes that can be really beneficial to brain health.

无论人们吃什么，它们都会引起代谢变化，这对大脑健康确实有益。

So let me just give a clear black and white example of this.

让我举一个清晰的黑白例子来说明这一点。

And then I can speak to the broader topic that you brought up about just the general population.

然后我可以谈谈您提出的关于一般人群的更广泛的话题。

The easy example of the ketogenic diet being an effective intervention for somebody who was not following a bad diet is an infant with epilepsy.

生酮饮食对于没有遵循不良饮食习惯的人来说是一种有效的干预措施，一个简单的例子就是患有癫痫的婴儿。

There are lots of infants who have uncontrollable seizures.

有很多婴儿患有无法控制的癫痫发作。

They are drinking breast milk.

他们正在喝母乳。

To the best of our knowledge, that is the primary, most beneficial food source an infant could be consuming.

据我们所知，这是婴儿可以食用的主要、最有益的食物来源。

Now, some might say, well, maybe the mother is-- whatever, I don't buy that.

现在，有些人可能会说，好吧，也许母亲是——无论如何，我不相信这一点。

The mother's breast milk is, in fact, the optimal food source for that infant.

事实上，母亲的母乳是婴儿的最佳食物来源。

And yet that infant is still seizing.

然而那个婴儿仍在癫痫发作。

If we put that infant on a ketogenic diet, a lot of those infants seizures will stop.

如果我们让婴儿接受生酮饮食，很多婴儿的癫痫发作就会停止。

It doesn't mean that the cause of the infant seizures was a bad diet.

这并不意味着婴儿癫痫发作的原因是不良饮食。

But it means that dietary intervention can change brain metabolism and improve symptoms in that person.

但这意味着饮食干预可以改变大脑新陈代谢并改善该人的症状。

So going to your broader question about adults, modern-day, the real answer is-- there was just this conference in London, the Royal College of obesity medicine or something like that.

因此，对于现代成年人更广泛的问题，真正的答案是——伦敦皇家肥胖医学学院或类似的地方刚刚举行了一次会议。

That's not the name.

不是这个名字。

But it's something along those lines.

但事情就是这样的。

The conclusion of that conference that invited the greatest minds in obesity medicine, the overarching conclusion of that conference was we don't know what causes obesity.

那次会议的结论邀请了肥胖医学领域最伟大的思想家，该会议的总体结论是我们不知道导致肥胖的原因。

It's really important that we sit with that.

我们必须坐下来接受这一点，这一点非常重要。

We don't know what causes obesity.

我们不知道是什么原因导致肥胖。

And if you look at the diet, it was terrible.

如果你看看饮食，那就很糟糕了。

It was mostly-- yes, there was a lot of excessive amounts of drinking and cigarette smoking.

主要是——是的，有很多过量饮酒和吸烟。

But the diets were terrible.

但饮食很糟糕。

It was pre-packaged foods.

那是预包装食品。

It was frozen dinners.

这是冷冻晚餐。

That really came to prominence in the '70s and '80s.

这在 70 年代和 80 年代真正变得突出。

But even in the '50s and, from what I've been reading, even in the '30s and '40s, people were not eating grass-fed meat and Brazil nuts with a little bit of broccoli rabe on the side.

但即使在 50 年代，从我读到的内容来看，即使在 30 年代和 40 年代，人们也不会吃草饲肉和巴西坚果，配上一点西兰花拉贝。

That's not the typical intake.

这不是典型的摄入量。

So something out there-- or maybe multiple things-- are at play to increase obesity.

因此，有某种因素——或者可能有多种因素——在增加肥胖。

So that is either our food, environmental toxins, stress levels, poor sleep, not getting adequate sunlight, whatever you want to speculate on, all of the above, all of those things are known to impair mitochondrial function.

因此，要么是我们的食物、环境毒素、压力水平、睡眠质量不佳、没有获得足够的阳光，无论你想推测什么，所有这些，所有这些都会损害线粒体功能。

And if parts of your brain that regulate metabolism and that regulate eating behaviors are not metabolically healthy, it means that they will not stop you from eating.

如果你大脑中负责调节新陈代谢和饮食行为的部分代谢不健康，那就意味着它们不会阻止你吃东西。

Or it means that your metabolism will not rise to the challenge of 10 donuts, because some people can eat 10 donuts and go on staying thin and healthy.

或者这意味着你的新陈代谢不会上升到10个甜甜圈的挑战，因为有些人可以吃10个甜甜圈并继续保持苗条和健康。

Nowadays, that's dramatically altered.

如今，情况发生了巨大变化。

The landscape is dramatically altered in the other direction.

另一个方向的景观发生了巨大的变化。

It is rare when I encounter one of those can-eat-anything type people.

我很少遇到那种什么都能吃的人。

I know one, he's actually an employee at Stanford.

我认识一个人，他实际上是斯坦福大学的一名员工。

He's in our media team at Stanford.

他是我们斯坦福大学媒体团队的成员。

And this guy, when I take him to lunch, it's like-- he's in his early 70s, and he can eat.

这个家伙，当我带他去吃午饭时，他就好像——他已经 70 岁出头了，而且还能吃东西。

And he's incredibly lean.

而且他非常瘦。

He exercises a little bit.

他稍微锻炼一下。

But he's one of these mutants that just can eat, and eat, and eat, and he's lean and he's vital, and he's-- it's wild.

但他是这些变种人之一，只会吃、吃、吃，他很瘦，他很有活力，而且他——很狂野。

And he's an expensive lunch.

而且他的午餐很贵。

My understanding is that-- well, as everyone knows, we inherit DNA.

我的理解是——众所周知，我们遗传了 DNA。

We get genes from both of our parents.

我们从父母双方获得基因。

And they mix.

他们混合在一起。

Although there are incredible data from Catherine Dulac's lab at Harvard and others showing that we actually have entire regions of our brain that carry neurons that are of purely of mom's or of dad's DNA, depending on the brain region.

尽管来自哈佛大学凯瑟琳·杜拉克实验室和其他实验室的令人难以置信的数据表明，我们大脑的整个区域实际上都携带着纯粹来自母亲或父亲 DNA 的神经元，具体取决于大脑区域。

This is a wild finding.

这是一个疯狂的发现。

But it's accurate.

但它是准确的。

And this has actually been known about in terms of heritability of disease, et cetera.

事实上，人们已经从疾病的遗传性等方面了解了这一点。

Maternal DNA, DNA from mom, genes from our mother-- not to place blame on mothers at all.

母性 DNA，来自母亲的 DNA，来自我们母亲的基因——根本不应该责怪母亲。

My understanding is that the mitochondrial DNA come exclusively through the maternal side.

我的理解是线粒体 DNA 完全来自母体。

Is that true?

这是真的吗？

So that is what you're inheriting from your mom.

这就是你从你妈妈那里继承的。

It's the mitochondria and those 36 genes for the most part.

大部分是线粒体和那 36 个基因。

But the majority of proteins that make up mitochondria, over, I think, 1,300 genes that make up mitochondria are actually encoded in the nuclear DNA.

但构成线粒体的大多数蛋白质，我认为超过 1,300 个构成线粒体的基因实际上是在核 DNA 中编码的。

And so you inherit a copy from both your mother and your father.

所以你从你的母亲和你的父亲那里继承了一份副本。

So the majority of people who have mitochondrial defects or rare mitochondrial diseases actually could inherit them from either mom or dad because it can be a defect in the nuclear genes that code for proteins that make up mitochondria.

因此，大多数患有线粒体缺陷或罕见线粒体疾病的人实际上可以从父母那里继承这些疾病，因为这可能是编码构成线粒体的蛋白质的核基因的缺陷。

The much bigger issue when-- so when I talk about mitochondrial dysfunction being a primary driver of mental illness, metabolic illness, it's not that people inherit a defective mitochondrion or mitochondria from mom, and then that just ruins their life forever.

更大的问题是——所以当我谈到线粒体功能障碍是精神疾病、代谢疾病的主要驱动因素时，并不是人们从母亲那里遗传了有缺陷的线粒体或线粒体，然后这就永远毁了他们的生活。

That's actually not the way it works.

实际上并不是这样的。

The beautiful thing about this theory is that it connects all of the risk factors that we already know play a role in mental health but also metabolic health.

这个理论的美妙之处在于，它连接了我们已知的所有在心理健康和代谢健康中发挥作用的风险因素。

Sleep disruption impairs mitochondria and mitochondrial function.

睡眠中断会损害线粒体和线粒体功能。

Stress, high levels of stress and trauma, impair mitochondrial function.

压力、高水平的压力和创伤会损害线粒体功能。

Drug and alcohol use, alcohol, tobacco definitely-- in terms of the smoke-- and marijuana-- THC, in particular-- all impair mitochondrial function.

吸毒和酗酒、酒精、烟草（就烟雾而言）和大麻（尤其是四氢大麻酚）都会损害线粒体功能。

Because when they remove CB1 receptors in animal models, these changes don't happen.

因为当他们去除动物模型中的 CB1 受体时，这些变化就不会发生。

So the CB1 receptors-- we've got some large studies of adolescents who use a lot of marijuana.

因此，CB1 受体——我们对大量吸食大麻的青少年进行了一些大型研究。

And the areas where the mitochondria have the greatest number of CB1 receptors are areas of their brains that actually are atrophied or shrunk compared to normal healthy controls.

与正常健康对照组相比，线粒体中 CB1 受体数量最多的区域实际上是萎缩或缩小的大脑区域。

So that means their brain tissue is aging prematurely.

这意味着他们的脑组织正在过早老化。

It's shrinking prematurely.

它过早地萎缩了。

But the CB1 receptors on mitochondria also seem to play a role in the memory impairment that can be induced from THC.

但线粒体上的 CB1 受体似乎也在 THC 引起的记忆障碍中发挥着作用。

And they also play a role in the kind of lack of motivation, the behavioral amotivational state from THC.

它们还在缺乏动力、THC 导致的行为无动力状态中发挥了作用。

Now, again, for people who want to chillax, that's what they're looking for.

现在，对于那些想要放松的人来说，这就是他们所寻找的。

They don't want to remember anything.

他们不想记住任何事情。

They don't want to think.

他们不想去想。

They want to be spaced out.

他们想要保持一定的距离。

They want to relax.

他们想要放松。

That's great.

那太棒了。

But it's important that they know that they're actually harming the mitochondria in their brain cells.

但重要的是，他们知道自己实际上正在损害脑细胞中的线粒体。

And that although there's always an opportunity to repair mitochondria and always an opportunity to stimulate mitochondrial biogenesis, so you can get it back, but if you keep doing it chronically, you're probably not helping your overall mental or metabolic health.

尽管总有机会修复线粒体，也总有机会刺激线粒体生物发生，这样你就可以恢复线粒体，但如果你长期这样做，你可能不会帮助你的整体心理或代谢健康。

But it is clear that, at least to me, based on the data that regardless of what people have read about red wine, that not drinking any alcohol is going to be healthier than drinking alcohol, and that the thresholds for alcohol ingestion before people start to negatively impact their health is about one or two per week.

但很明显，至少对我来说，根据数据，无论人们对红酒有什么了解，不喝酒都会比喝酒更健康，而且人们开始对健康产生负面影响之前的酒精摄入阈值约为每周一到两次。

And then THC, because of the very high concentrations of THC that are present in a lot of products now-- vaping and smoking THC and even edibles-- that it can be problematic.

然后是四氢大麻酚，因为现在很多产品（电子烟和吸食四氢大麻酚，甚至食品）中都含有非常高浓度的四氢大麻酚，这可能会带来问题。

You mentioned adolescents that predisposition, and brain atrophy, psychosis, et cetera.

你提到青少年有这种倾向，还有脑萎缩、精神病等等。

In any case, because you mentioned alcohol because it is a commonly used substance, I heard you give a talk in which-- I think I have this right-- in which alcohol can disrupt the way that the brain uses fuels of all kinds, which may disrupt one's response to alcohol, make alcohol seem more rewarding to those that drink alcohol.

无论如何，因为你提到酒精是因为它是一种常用的物质，所以我听到你在演讲中——我想我有这个权利——其中酒精可以扰乱大脑使用各种燃料的方式，这可能会扰乱一个人对酒精的反应，使酒精对那些喝酒的人来说似乎更有价值。

So drinking alcohol makes alcohol more rewarding to the brains of alcohol drinkers, but that it also might alter glucose metabolism, that basically alcohol is not good for our brains.

因此，饮酒会使酒精对饮酒者的大脑产生更大的好处，但它也可能会改变葡萄糖代谢，基本上酒精对我们的大脑没有好处。

Do I have that correct?

我说的对吗？

So she's been hot on this trail for many, many years.

所以她多年来一直热衷于这条道路。

And as you said, it turns out that the reward pathways, in particular, are metabolically compromised in alcoholics.

正如你所说，事实证明，酗酒者的奖励途径尤其受到代谢损害。

And the metabolic compromise essentially, in a nutshell, means they aren't getting enough fuel from glucose.

简而言之，代谢妥协本质上意味着他们无法从葡萄糖中获得足够的燃料。

The interesting thing is that when people drink alcohol, your liver converts alcohol into a molecule called acetate.

有趣的是，当人们喝酒时，肝脏会将酒精转化为一种叫做乙酸盐的分子。

That acetate travels up to the brain and fuels brain cells, in particular, some of these reward pathway cells more than others.

醋酸盐到达大脑并为脑细胞提供能量，特别是其中一些奖励通路细胞比其他细胞更多。

And so chronic alcoholics have this chronic deprivation of energy in these cells.

因此，慢性酗酒者的这些细胞中的能量会长期被剥夺。

And so Nora Volkow and other researchers at the National Institutes of Health did a study in which they set out to see if we can change this brain metabolic problem in alcoholics.

因此，诺拉·沃尔科夫（Nora Volkow）和美国国立卫生研究院的其他研究人员进行了一项研究，他们试图看看我们是否可以改变酗酒者的这种大脑代谢问题。

Will that affect clinical symptoms of alcoholism?

这会影响酒精中毒的临床症状吗？

And will it do anything?

它会做任何事情吗？

It's clinically useful.

临床上很有用。

And so they actually did a pilot randomized controlled trial, admitted alcoholics to a detox unit.

因此，他们实际上进行了一项随机对照试验，将酗酒者接纳到戒毒所。

Half of the patients got a ketogenic diet.

一半的患者接受生酮饮食。

The other half got the standard American diet.

另一半则吃标准的美国饮食。

And then everybody else, all of them got the same detox protocol.

然后其他人都接受了相同的排毒方案。

The patients who got the ketogenic diet required fewer benzodiazepines for their detox.

接受生酮饮食的患者排毒所需的苯二氮卓类药物较少。

Despite that, they had fewer withdrawal symptoms from the alcohol.

尽管如此，他们的酒精戒断症状较少。

They reported fewer cravings for alcohol.

他们报告说对酒精的渴望减少了。

And the researchers did brain scans, which showed improved brain metabolism in these key areas that they were looking at.

研究人员进行了脑部扫描，结果显示他们正在研究的这些关键区域的大脑新陈代谢有所改善。

And their brains showed reduced levels of neuroinflammation, which was also something they were really interested in.

他们的大脑显示神经炎症水平降低，这也是他们真正感兴趣的事情。

And so that one study says to us that even though most people would think alcoholism has nothing to do with diet, alcohol is just drinking too much.

因此，一项研究告诉我们，尽管大多数人认为酗酒与饮食无关，但酒精只是喝得太多。

It's a matter of willpower.

这是意志力的问题。

Or it's somebody who's addictive.

或者是一个上瘾的人。

They've got an addictive personality, and it's that simple.

他们有一种令人上瘾的个性，就这么简单。

You come out of the womb with an addictive personality.

你从子宫里出来就具有令人上瘾的个性。

And those people are novelty seekers, and they're impulsive.

这些人都是新奇的追求者，而且很冲动。

And they have no patience.

而且他们没有耐心。

They have no discipline.

他们没有纪律。

They can't sustain any kind of rewarding experience.

他们无法维持任何有益的经历。

It's that if we can correct the brain metabolic defects from chronic alcohol use, we might be able to help people be sober and give them a fighting chance.

如果我们能够纠正长期饮酒造成的大脑代谢缺陷，我们也许能够帮助人们保持清醒，并给他们一个奋斗的机会。

Or give them an edge up or pull a lever that we can use in their favor, for their benefit.

或者给他们一个优势，或者拉动一个杠杆，我们可以利用这些杠杆来对他们有利，为他们谋取利益。

There's one caution to all of this research that I really do want to highlight.

对于所有这些研究，我确实想强调一个警告。

And so now, I'm going to get hate mail from all the keto community.

所以现在，我将收到来自所有酮社区的仇恨邮件。

This is a fairly easy study to do.

这是一项相当容易完成的研究。

So I'm hoping somebody will do this study soon.

所以我希望有人很快就能进行这项研究。

But they instead put rats half of them on a standard diet and half of them on a ketogenic diet.

但他们却让一半的老鼠吃标准饮食，另一半吃生酮饮食。

And then they exposed them to the exact same amount of alcohol.

然后他们让他们接触完全相同量的酒精。

The rats who were on the ketogenic diet had a five-fold increase in blood alcohol levels.

接受生酮饮食的老鼠血液中的酒精含量增加了五倍。

Five-fold increase.

增长五倍。

And yes, that's what the researchers are pursuing.

是的，这就是研究人员正在追求的目标。

And that's what I'm saying with the following caveat-- that if you relapse while on a ketogenic diet, you better not drink the same amount of alcohol that you think you can drink.

这就是我要说的，但需要注意的是——如果你在生酮饮食期间复发，你最好不要喝你认为可以喝的同样量的酒精。

If you go to a ketogenic diet, please don't drive with the same two drinks because it means your blood alcohol level-- if it models anything that we found in the rat study-- your blood alcohol levels may be five times higher than they would normally be.

如果您采用生酮饮食，请不要在开车时喝同样的两种饮料，因为这意味着您的血液酒精水平 - 如果它模拟了我们在大鼠研究中发现的任何情况 - 您的血液酒精水平可能比正常情况高五倍。

And that means you are really wasted.

这意味着你真的被浪费了。

And you're probably not safe to be driving.

而且您开车可能不安全。

I hear this again about mitochondria, about blood glucose, you mentioned astrocytes.

我再次听到有关线粒体、血糖、星形胶质细胞的消息。

And for those of you-- that earlier astrocytes are a non-neuron cell type in the brain, a glial cell type that my postdoc advisor was known for popularizing the modern science of glia, which include astrocytes.

对于你们来说，早期的星形胶质细胞是大脑中的一种非神经元细胞类型，是一种神经胶质细胞类型，我的博士后导师因普及神经胶质细胞的现代科学而闻名，其中包括星形胶质细胞。

And I'd be remiss if I didn't say that they are considered the cells that hold everything together in the brain and are kind of passive observers.

如果我不说它们被认为是将大脑中的一切结合在一起的细胞并且是一种被动的观察者，那我就失职了。

But they do many things actively.

但他们积极地做很多事情。

I think now people appreciate the astrocytes at least as important as the neurons.

我认为现在人们对星形胶质细胞的重视至少与神经元一样重要。

And certainly, for disease, they are often implicated in warding off of disease, et cetera.

当然，对于疾病来说，它们通常与预防疾病等有关。

Everything that you're telling me about the fact that the brain can regulate things that are happening in the body, metabolism, et cetera, organ health, obesity, et cetera, to me, as a neuroscientist, that's not surprising.

你告诉我的关于大脑可以调节体内发生的事情、新陈代谢等、器官健康、肥胖等的事实，对我来说，作为一名神经科学家，这并不奇怪。

All of it just screams hypothalamus, hypothalamus, hypothalamus because here, you're telling me, it's regulating these basal functions like metabolism.

所有这些都让下丘脑尖叫，下丘脑，下丘脑，因为在这里，你告诉我，它正在调节新陈代谢等基础功能。

It's regulating how much we crave things.

它调节着我们对事物的渴望程度。

And of course, hypothalamus is involved in motivation and craving.

当然，下丘脑与动机和渴望有关。

There are other areas, too-- other areas of the brain, too, of course.

当然，还有其他区域——大脑的其他区域。

But I would imagine that someone ought to or has mapped out where the receptors for all this business are in the brain.

但我认为有人应该或已经绘制出所有这些业务的受体在大脑中的位置。

And I guess that raises the question of, when one goes on a ketogenic or low blood glucose diet or fast, has anyone observed changes in the brain?

我想这提出了一个问题，当一个人进行生酮或低血糖饮食或禁食时，是否有人观察到大脑发生变化？

Has anyone had neuroimaging of humans and their brains under conditions of ingesting one diet or another, whether or not they're psychiatric-- suffering from a psychiatric disorder or not?

有没有人在摄入一种或另一种饮食的情况下对人类及其大脑进行过神经影像学检查，无论他们是否患有精神疾病——是否患有精神疾病？

I would think that's where the gold is.

我想这就是黄金所在。

And that's because we know that-- again, a common finding in patients with Alzheimer's disease is this glucose hypometabolism, some people are attributing it to insulin signaling impairment.

这是因为我们知道，阿尔茨海默病患者的一个常见发现是葡萄糖代谢低下，有些人将其归因于胰岛素信号传导损伤。

And so some people are calling it type III diabetes.

所以有些人称之为 III 型糖尿病。

At the end of the day, I think the clearest signal that we have is that cells aren't getting enough energy from glucose as a fuel source.

归根结底，我认为我们得到的最清晰的信号是细胞没有从葡萄糖作为燃料来源获得足够的能量。

That is something that I think I can confidently say that's backed by numerous research studies.

我想我可以自信地说这是有大量研究支持的。

There's debate in the research field about whether that's a primary driver of the illness.

研究领域对于这是否是该疾病的主要驱动因素存在争议。

I happen to believe it is.

我碰巧相信是这样。

And if you ask the question, well, why would cells not be getting enough fuel from glucose?

如果你问这个问题，那么，为什么细胞不能从葡萄糖中获得足够的燃料？

You have to focus on mitochondria because they're the ones producing the fuel from that glucose.

你必须关注线粒体，因为它们是利用葡萄糖产生燃料的线粒体。

So you somehow you have to implicate mitochondria in that process one way or another.

所以你必须以某种方式将线粒体牵涉到这一过程中。

Others will say, no, that's just a side effect of whatever's causing Alzheimer's disease.

其他人会说，不，这只是导致阿尔茨海默氏病的副作用。

So Stephen Cunnane has done studies where he even gives ketone supplements.

因此斯蒂芬·坎纳恩（Stephen Cunnane）进行了研究，他甚至提供酮补充剂。

But in the last year or so, I've started using liquid ketone esters.

但在去年左右，我开始使用液体酮酯。

And I do eat some carbohydrates each day, usually in proportion to how much high intensity exercise I'm doing.

我每天确实会吃一些碳水化合物，通常与我进行的高强度运动量成正比。

Those liquid ketone esters, for me-- at least subjectively-- I feel greatly increase my energy levels and my ability to focus mentally.

那些液体酮酯，对我来说——至少主观上——我觉得极大地提高了我的能量水平和集中精神的能力。

And they improve my sleep.

它们改善了我的睡眠。

This is my observation tracking some data but just, again, subjectively.

这是我跟踪一些数据的观察结果，但同样是主观的。

So in this example, are you talking about people taking ketone esters or ketone salts on a backdrop of a ketogenic diet or on the backdrop of a more typical diet?

因此，在这个例子中，您是在谈论人们在生酮饮食的背景下还是在更典型的饮食的背景下服用酮酯或酮盐？

And simply reducing carbohydrate consumption at breakfast and lunch resulted in cognitive improvement in a statistically significant way in some of those subjects.

仅仅减少早餐和午餐的碳水化合物摄入量就可以使其中一些受试者的认知能力得到显着改善。

Limiting carbohydrates most of the time during the day, for me, has been a game changer in terms of maintaining alertness, et cetera.

对我来说，一天中大部分时间限制碳水化合物的摄入，在保持警觉性等方面已经改变了游戏规则。

I'm not aware that I have age-related cognitive decline.

我不知道我患有与年龄相关的认知能力下降。

But then again, I would-- people around me may argue otherwise.

但话又说回来，我周围的人可能会反对。

But this is very interesting, I think, in the context of everything we've been talking about because could it be that supplementing with liquid ketones or prescribing liquid ketones to people who are challenged with mood disorders-- or things of that sort-- could be beneficial, even if they are not willing or able to adhere to a ketogenic diet?

但这非常有趣，我认为，就我们一直在谈论的一切而言，因为补充液体酮或给患有情绪障碍或类似疾病的人开液体酮可能是有益的，即使他们不愿意或无法坚持生酮饮食？

The bigger reason for my feeling confident in saying that is that we've had ketone salts and esters available for over a decade now.

我之所以有信心这么说，更大的原因是我们已经有酮盐和酯可供使用十多年了。

We have tens of thousands of children and adolescents who are following a strict, ridiculously strict, ketogenic diet to control their epilepsy.

我们有数以万计的儿童和青少年正在遵循严格的、严格得可笑的生酮饮食来控制癫痫。

Those kids would love to be off the ketogenic diet.

这些孩子希望摆脱生酮饮食。

Their parents would love to have them off the ketogenic diet.

他们的父母希望他们摆脱生酮饮食。

I do know some patients with bipolar disorder and even schizophrenia who are doing extraordinarily well on a ketogenic diet.

我确实认识一些患有双相情感障碍甚至精神分裂症的患者，他们在生酮饮食中表现得非常好。

They have tried to switch off the ketogenic diet using exogenous ketones.

他们尝试使用外源酮来关闭生酮饮食。

Their symptoms came back.

他们的症状又回来了。

And so they found that it just wasn't effective.

所以他们发现这并没有什么效果。

Now, again, those are anecdotes.

现在，再说一遍，这些都是轶事。

My scientific speculation about why is because the ketogenic diet is actually not necessarily about ketones themselves.

我对原因的科学推测是因为生酮饮食实际上不一定与酮本身有关。

Ketones are one of a multifaceted story there.

酮是一个多​​方面的故事之一。

And so when people do a ketogenic diet, they're also improving-- they're lowering glucose levels.

因此，当人们进行生酮饮食时，他们的情况也在改善——他们降低了血糖水平。

They're improving insulin signaling.

他们正在改善胰岛素信号传导。

They're ramping up mitochondrial biogenesis, in particular, in the liver because mitochondria actually make ketones.

他们正在加速线粒体的生物发生，特别是在肝脏中，因为线粒体实际上会产生酮。

That's where they're made.

那就是它们的制造地。

And they're primarily made in the liver mitochondria.

它们主要是在肝脏线粒体中产生的。

So when somebody is on in a fasting state or on a ketogenic diet, their liver mitochondria go through the roof because they're being called to action.

因此，当某人处于禁食状态或生酮饮食时，他们的肝脏线粒体就会兴奋起来，因为他们被要求采取行动。

It's like, hey, body's in starvation mode.

就像，嘿，身体处于饥饿模式。

Get to work.

开始工作吧。

And so the mitochondria-- the cell senses we need more mitochondria to process fat to turn it into ketones so that those ketones can get up to the brain and keep the brain fueled, because fatty acids can't fuel the brain.

因此，线粒体——细胞感觉到我们需要更多的线粒体来处理脂肪，将其转化为酮，这样这些酮就可以到达大脑并为大脑提供燃料，因为脂肪酸不能为大脑提供燃料。

Only ketones can.

只有酮可以。

Now, so my sense is that-- and the gut microbiome changes and everything, the changes in hormones-- so if you're eating a lot of donuts and drinking a bottle of ketones, the donuts are going to prevent your body from lowering glucose levels.

现在，我的感觉是——肠道微生物组和一切，激素的变化——所以如果你吃了很多甜甜圈并喝了一瓶酮，甜甜圈会阻止你的身体降低血糖水平。

You're still going to have the high glucose levels from the donuts.

甜甜圈中的葡萄糖水平仍然很高。

You're still going to probably have the impaired insulin signaling.

您的胰岛素信号传导可能仍会受损。

You're probably still going to possibly have some inflammation from the inflammatory effects of that food.

您可能仍然会因该食物的炎症作用而出现一些炎症。

And so just drinking ketones alone won't be enough.

所以仅仅喝酮是不够的。

I think for people who are metabolically healthy, I'll include you in that, I think ketones can play a really beneficial role, no doubt.

我认为对于代谢健康的人来说，我会把你也包括在内，我认为酮类可以发挥真正有益的作用，毫无疑问。

I think exogenous ketones may, in fact, proven valuable in clinical use for patients who maybe can't follow a super strict ketogenic diet but maybe could do a low carb diet.

我认为外源性酮实际上可能在临床使用中被证明对那些可能无法遵循超严格生酮饮食但可能可以进行低碳水化合物饮食的患者有价值。

And then given the research that's happening with alcohol use disorder, I could imagine a situation-- here's the million dollar tip to whoever wants to go out and get this, if it actually turns out to be true.

然后考虑到正在对酒精使用障碍进行的研究，我可以想象一种情况——如果事实证明这是真的，那么对于任何想出去得到这个的人来说，这是一百万美元的小费。

I could imagine a scenario where we use exogenous ketones with alcoholics.

我可以想象这样一个场景：我们与酗酒者一起使用外源性酮。

And that every time they have a severe craving for alcohol, they drink ketones instead.

每当他们非常想喝酒时，他们就会喝酮。

I might have an alcoholic drink every once in a while.

我可能偶尔会喝点酒精饮料。

I just don't ever crave it.

我只是从来不渴望它。

I just do it every maybe-- I think 2020 was the last time I had a drink of alcohol.

我只是偶尔这么做——我想 2020 年是我最后一次喝酒。

So obviously, I'm not a good representative example.

显然，我不是一个很好的代表性例子。

But the ketones taste good to me.

但酮对我来说味道很好。

And they obviously don't get you drunk.

而且它们显然不会让你喝醉。

They do seem to flick on my alertness pretty quickly.

他们似乎很快就提高了我的警觉性。

My understanding is that they are the brain's preferred fuel source.

我的理解是它们是大脑首选的燃料来源。

Meaning, they are going to be the first fuels used by the brain when there's a buffet of fuels available.

这意味着，当有大量可用的燃料时，它们将成为大脑首先使用的燃料。

If there's glucose in my bloodstream, there's circulating liquid ketones, the ketones would be used first or preferentially.

如果我的血液中有葡萄糖，有循环液体酮，那么酮将被首先或优先使用。

Is that true?

这是真的吗？

So there are some areas that require glucose.

所以有一些领域需要葡萄糖。

And that's probably the reason we have gluconeogenesis to keep the body going and keep the brain going no matter what.

这可能就是我们无论如何都要通过糖异生来保持身体和大脑运转的原因。

But when ketones are available, especially if ketones are high, the way I think about it is not that ketones are the preferred fuel source and glucose goes to the wayside.

但是当酮可用时，特别是当酮含量很高时，我的想法并不是酮是首选的燃料来源，而葡萄糖就被抛在了一边。

But the way I think about it is that you have a range of cells with varying degrees of metabolic health.

但我的想法是，一系列细胞具有不同程度的代谢健康状况。

And some of those cells are going to be extraordinarily healthy with appropriate healthy abundant mitochondria.

其中一些细胞将非常健康，具有适当健康、丰富的线粒体。

And those cells are probably going to continue to use glucose as a fuel source.

这些细胞可能会继续使用葡萄糖作为燃料来源。

But if ketones happen to be there, sure, they'll use that, too.

但如果酮体恰好存在的话，当然，他们也会使用它。

Why not?

为什么不呢？

But the real money is metabolically compromised tissues, whether it's brain cells or other tissues that-- we're talking about the brain.

但真正的钱是代谢受损的组织，无论是脑细胞还是其他组织——我们谈论的是大脑。

So if you've got metabolically compromised brain cells-- because it's not across the board.

因此，如果你的脑细胞代谢受损——因为这并不是全面的。

Like with Alzheimer's brain scans, there are specific regions that are more metabolically compromised than others.

与阿尔茨海默氏症的大脑扫描一样，某些特定区域的代谢受损程度比其他区域更严重。

And that's why we see patterns of atrophy in specific brain regions.

这就是为什么我们在特定的大脑区域看到萎缩模式。

It's because those regions are dysfunctional metabolically for whatever reason.

这是因为无论出于何种原因，这些区域的代谢功能失调。

And we can get into why that might be.

我们可以探究其中的原因。

But my sense is that if you've got a metabolically compromised cell, that cell is sending out a distress signal.

但我的感觉是，如果你的细胞代谢受损，那么该细胞就会发出求救信号。

That cell is calling resources from the body, like feed me.

那个细胞正在从身体调用资源，比如喂我。

Give me something.

给我一些东西。

And if it can't use glucose effectively, it is going to suck up those ketones and then start running on all cylinders or closer to it.

如果它不能有效地利用葡萄糖，它就会吸收这些酮，然后开始在所有气缸或接近它的气缸上运行。

And that process is so critical because what it means is that if that cell was barely getting by on 60% of its real ATP requirement, it means that it doesn't have enough energy for maintenance and repair functions.

这个过程非常关键，因为它意味着如果该细胞勉强满足其实际 ATP 需求的 60%，则意味着它没有足够的能量来维持和修复功能。

As soon as you give that cell a hundred percent energy or close to it, even if you get it up to 90% of its preferred energy amount, it can start to repair itself.

一旦你给该细胞提供 100% 或接近的能量，即使你给它的能量达到其首选能量的 90%，它也可以开始自我修复。

That's the beauty of the human body in living organisms, is that they have a priority list of what they're going to do.

这就是人体在生物体中的美妙之处，就在于它们有一个要做的事情的优先级列表。

If that cell senses that there are defective molecules, defective proteins in this cell that need to be replaced, once it gets enough fuel, it will start repairing itself and doing that work.

如果该细胞感觉到该细胞中存在有缺陷的分子、有缺陷的蛋白质需要更换，一旦它获得足够的燃料，它将开始自我修复并完成这项工作。

And many people have relatives that suffer from Alzheimer's or other forms of dementia.

许多人的亲戚患有阿尔茨海默氏症或其他形式的痴呆症。

I've heard that the ketogenic diet and diets like it can be very effective for helping to offset some of the symptoms of Alzheimer's and age-related cognitive decline.

我听说生酮饮食和类似的饮食可以非常有效地帮助抵消阿尔茨海默氏症和与年龄相关的认知能力下降的一些症状。

In fact, I even have a friend I won't out by institution, who's the chair of Cardiology, who contacted me, of all people, asking whether or not I was aware of any studies or whether or not I knew of anybody who had benefited from ketogenic diet for Alzheimer's.

事实上，我什至有一个我不愿公开的朋友，他是心脏病学的主席，他在所有人中联系了我，询问我是否知道任何研究，或者我是否知道有人从生酮饮食中受益于阿尔茨海默氏症。

And I thought, well, why don't you ask one of your colleagues in neurology?

我想，好吧，你为什么不问问你的一位神经病学同事呢？

But his response was really interesting.

但他的回应真的很有趣。

He said there are many books out there for the general public.

他说，有很多书可供公众阅读。

There are a lot of online discussions about this.

网上对此有很多讨论。

There are a lot of assertions about this, and some animal studies.

关于这一点有很多断言，还有一些动物研究。

Again, these are his words.

再说一遍，这是他的话。

There are very few, if any, controlled clinical trials exploring the role of the ketogenic diet for the treatment or reversal of Alzheimer's and age-related cognitive decline.

很少有对照临床试验探索生酮饮食在治疗或逆转阿尔茨海默病和与年龄相关的认知能力下降方面的作用。

I'm hoping that statement was incorrect or soon will be incorrect-- because those trials are ongoing-- but he said, yeah, the people are most popular for telling us about the important role and positive role of being in ketosis for Alzheimer's, for some reason, they just won't do a clinical trial.

我希望这种说法是错误的，或者很快就会错误——因为这些试验正在进行中——但他说，是的，人们最喜欢告诉我们酮症对阿尔茨海默病的重要作用和积极作用，出于某种原因，他们只是不会进行临床试验。

And that's been frustrating to the community.

这让社区感到沮丧。

So this is a very educated, very accomplished person who's a physician of heart medicine as opposed to something else related to the brain.

所以这是一个受过良好教育、非常有成就的人，他是一名心脏病医生，而不是其他与大脑相关的医生。

But what is the story there.

但那里有什么故事呢。

And for goodness' sake, why aren't there clinical trials on ketogenic diet and Alzheimer's?

天哪，为什么没有生酮饮食和阿尔茨海默氏症的临床试验呢？

I don't expect you to be responsible for that fact.

我不希望你对这个事实负责。

But goodness, I would think this would be the obvious thing for NIH.

但天哪，我认为这对于 NIH 来说是显而易见的事情。

I'm on study section but not for these sorts of experiments.

我在研究部分，但不是为了这类实验。

Why isn't money just avalanching into this area based on all the anecdotal evidence that people are talking about?

为什么根据人们谈论的所有轶事证据，资金没有大量涌入这一领域？

And that trial actually found that when patients were in ketosis, they had statistically significant improvement in activities of daily living and quality of life.

该试验实际上发现，当患者处于酮症状态时，他们的日常生活活动和生活质量有统计学上的显着改善。

And they did have improvement in cognitive function.

他们的认知功能确实有所改善。

But it didn't reach statistical significance, that improvement did not.

但它并没有达到统计显着性，这种改善也没有。

We've got other trials.

我们还有其他试验。

We've got several animal models showing that the ketogenic diet can improve biomarkers of Alzheimer's disease in Alzheimer's models.

我们的几个动物模型表明，生酮饮食可以改善阿尔茨海默病模型中阿尔茨海默病的生物标志物。

So it can reduce plaques and tangles, can even improve cognitive impairment in animal models.

因此它可以减少斑块和缠结，甚至可以改善动物模型的认知障碍。

And we've got a couple of other small pilot trials of ketogenic diet in humans, showing that it improves biomarkers compared to, say, the low fat diet or the American Heart Association diet.

我们还对人类进行了一些其他小型生酮饮食试点试验，结果表明，与低脂饮食或美国心脏协会饮食相比，它可以改善生物标志物。

So we've got those.

所以我们已经有了这些。

I think one of the biggest challenges that I'll just share openly-- and this is-- I'm somebody who's pretty passionate about this research.

我认为我将公开分享的最大挑战之一是——我是一个对这项研究非常热情的人。

And I believe it has a lot of potential.

我相信它有很大的潜力。

But Johns Hopkins' researchers attempted to do exactly this kind of a study, Alzheimer's patients' ketogenic diet versus the, I think, American Academy of Aging-- or something like that-- diet, is the controlled diet.

但约翰·霍普金斯大学的研究人员试图进行此类研究，阿尔茨海默病患者的生酮饮食与我认为美国老龄化学会（或类似的饮食）的饮食对比，即控制饮食。

And then grants are evaluated in a very small, because of the size of the federal budget for research, a very small percentage.

然后，由于联邦研究预算的规模，拨款的评估比例非常小，比例非常小。

Usually, about 10% of these studies are funded.

通常，这些研究中约 10% 会得到资助。

The rest generally don't end up happening.

其余的通常不会发生。

That is very informative.

这是非常有用的。

What you just described is very informative because now it makes sense to me.

你刚才描述的内容非常丰富，因为现在对我来说很有意义。

There's no conspiracy.

没有阴谋。

It's not big pharma, I don't think, is trying to suppress trials of ketogenic diets on Alzheimer's because I would imagine the first thing that pharma would want to do is to see that study done.

我不认为大型制药公司试图抑制生酮饮食对阿尔茨海默氏症的试验，因为我想制药公司想做的第一件事就是完成这项研究。

So they didn't have to.

所以他们没必要这么做。

And then the moment it was done, if it showed a positive effect, they'd probably want to isolate the molecule and wrap it up in something that people would take, right?

然后，一旦完成，如果它显示出积极的效果，他们可能会想要分离该分子并将其包裹在人们会服用的东西中，对吗？

That is very interesting.

这很有趣。

And it's kind of amazing, given our discussion of earlier, which is that you had a patient that was having schizophrenic symptoms who managed to stay on this diet.

考虑到我们之前的讨论，这有点令人惊讶，即你有一位患有精神分裂症症状的患者，他设法坚持这种饮食。

So is there something special about Alzheimer's patients and people with age-related cognitive decline?

那么，阿尔茨海默病患者和与年龄相关的认知能力下降的人有什么特别之处吗？

Presumably, they're very dependent on others to cook for them and shop for them.

据推测，他们非常依赖别人为他们做饭和购物。

I think that this is almost perfect controlled environment for getting this study done.

我认为这对于完成这项研究来说几乎是完美的受控环境。

In the pilot trial that I described to you, they actually got, I think, over 90% compliance with the different dietary interventions.

在我向您描述的试点试验中，我认为他们实际上对不同饮食干预措施的依从性超过 90%。

So some of it is going to be dependent on the research group.

所以其中一些将取决于研究小组。

And does the research group understand that this is not-- it's not like prescribing a pill.

研究小组是否明白这并不像开药丸那样。

Here, take this pill.

来，服下这颗药丸。

And take it every day and come back in three weeks.

每天服用，三周后回来。

And even then, we don't know for sure that the patient took the pill every day.

即便如此，我们也不能确定患者是否每天都服用药物。

We just assume they took the pill every day.

我们只是假设他们每天都吃药。

And studies say they probably didn't.

研究表明他们可能没有。

So I think when we think about a dietary intervention, we need to think about more intensive support and education.

因此，我认为当我们考虑饮食干预时，我们需要考虑更深入的支持和教育。

And that support could be a health and wellness coach.

这种支持可能是健康教练。

It could be a dietician.

可能是营养师。

It could be education of the family.

可能是家庭教育。

It might even be providing them with dietary meals.

它甚至可能为他们提供膳食。

That maybe for six months, we actually provide them with ketogenic meals-- once a week, put them in your freezer.

也许在六个月的时间里，我们实际上为他们提供生酮餐——每周一次，把它们放进冰箱里。

Microwave them when needed-- to make this diet as easy and doable as possible.

需要时用微波炉加热——使这种饮食尽可能简单可行。

Because if we can get people to do the diet, if we can get them through the first couple of months, most people can learn how to do this diet.

因为如果我们能让人们进行这种饮食，如果我们能让他们度过最初的几个月，那么大多数人都可以学会如何进行这种饮食。

More importantly-- I didn't mention this before.

更重要的是——我之前没有提到过这一点。

But the number one reason I am so successful at getting patients to stay on this diet for years, is because of the consequences to them when they go off of it.

但我如此成功地让患者坚持这种饮食多年的首要原因是，当他们停止这种饮食时会给他们带来后果。

That is the reason I can get schizophrenic patients and bipolar patients to do this diet, whereas other people can't get an everyday human being to do it for weight loss because the weight loss patient doesn't experience devastating tormenting symptoms when they break the diet.

这就是为什么我可以让精神分裂症患者和双相情感障碍患者采用这种饮食方式，而其他人却无法让普通人采用这种饮食方式来减肥，因为减肥患者在打破这种饮食方式时不会经历毁灭性的折磨症状。

Oftentimes, they are rewarded.

很多时候，他们会得到奖励。

They eat something they really enjoy.

他们吃他们真正喜欢的东西。

And they get a little bit of a dopamine rush from it.

他们从中得到了一点多巴胺的刺激。

And they're off to the races.

他们要去参加比赛了。

They're like, I'm going to-- oh, I've already cheated.

他们就像，我要——哦，我已经作弊了。

I'll cheat again.

我又来骗人了

I'll get back on it someday.

有一天我会回来的。

And they never get around to it.

他们从来没有抽出时间去做这件事。

My patients, when they go off the diet, they start hallucinating within 48-- or 24, 48 hours.

我的病人，当他们停止节食时，他们会在 48 或 24、48 小时内开始产生幻觉。

And they quickly realize that was a really stupid thing to do.

他们很快意识到这是一件非常愚蠢的事情。

That piece of cake was not at all worth the torment that I'm experiencing now.

那小菜一碟根本不值得我现在所受的折磨。

So they get back on the diet.

所以他们重新开始节食。

I suspect with Alzheimer's disease, we might notice something similar.

我怀疑对于阿尔茨海默病，我们可能会注意到类似的情况。

Some of these people have very mild symptoms.

其中一些人的症状非常轻微。

So maybe they won't have that kind of a reinforcement, negative reinforcing kind of experience.

所以也许他们不会有那种强化、负面强化的经历。

But I think some of them will.

但我认为其中一些会的。

Some of them recognize that they are impaired cognitively.

他们中的一些人认识到自己的认知能力受到损害。

And if this diet could help them remember better, if this diet could help them function better-- and again, that's what the pilot trial showed, is activities of daily living.

如果这种饮食可以帮助他们更好地记忆，如果这种饮食可以帮助他们更好地发挥作用——试点试验表明，日常生活活动就是如此。

That means these people are able to go to the bathroom on their own.

这意味着这些人可以自己去洗手间。

They're able to get themselves dressed.

他们能够自己穿衣服。

Whereas, they needed help with those things before.

然而，他们以前需要帮助来处理这些事情。

Those are actually really important things to both the patient and the caregiver.

这些对于患者和护理人员来说实际上都是非常重要的事情。

And if they go off the diet and then quickly revert into a more symptomatic state, that might be reinforcing enough for them to figure out a way to do the diet on their own.

如果他们停止节食，然后很快恢复到症状更明显的状态，这可能足以让他们找到一种自己节食的方法。

And if we think about, if this really is an effective intervention-- and yes, we need longer trials, larger trials, all of that, because there are plenty of stories in the medical field where pilot trials looked really spectacular and promising.

如果我们想一想，这是否真的是一种有效的干预措施——是的，我们需要更长的试验、更大的试验，所有这些，因为在医学领域有很多故事，试点试验看起来非常壮观和有希望。

And then larger trials just failed to show the benefits.

然后更大规模的试验却未能显示出其好处。

I believe, based on all the science of metabolism, mitochondria, glucose hypometabolism, all of that, I believe the science makes this an obvious treatment that has real potential.

我相信，基于所有关于新陈代谢、线粒体、葡萄糖代谢低下的科学，我相信科学使这成为一种具有真正潜力的明显治疗方法。

So people will call me biased.

所以人们会说我有偏见。

That's fine.

没关系。

I've got my bias.

我有我的偏见。

But bias based on observation-- here, I should mention that most of what we know about human memory was sparked by one patient, a famous HM, who I think was living in Harvard Medical, in one of the hospitals around.

但基于观察的偏见——在这里，我应该提到，我们对人类记忆的了解大部分是由一位患者引起的，一位著名的HM，我认为他住在哈佛医学院，在附近的一家医院里。

There are many hospitals on Longwood Campus.

朗伍德校区有许多医院。

But one patient, the reason we associate the hippocampus with memory is because we knew that HM's the hippocampus was intentionally damaged for epilepsy treatment.

但一位患者，我们之所以将海马体与记忆联系起来，是因为我们知道HM的海马体是为了癫痫治疗而被故意破坏的。

So this idea that everything has to be a randomized clinical trial, to me, is crazy.

因此，对我来说，一切都必须是随机临床试验的想法是疯狂的。

Of course, that's a gold standard.

当然，这是黄金标准。

And it's essential.

这是必要的。

But there's so much information in textbooks, medical textbooks in particular, that are gleaned from single-patient case studies or from three-patient neurostimulation in the brain or something of that sort.

但是教科书，特别是医学教科书中有很多信息，这些信息是从单个患者的案例研究或三个患者的大脑神经刺激或类似的东西中收集的。

So to me, I'm still perplexed as to why there's this insistence on only one form of evidence.

所以对我来说，我仍然很困惑为什么坚持只使用一种形式的证据。

Clearly, what you're doing, the important work that you're doing clinically, and in the research side, and in public communication, is assisting this.

显然，您正在做的事情，您在临床、研究方面以及公共传播方面所做的重要工作正在对此提供帮助。

I have a question about-- or more of a statement/question about the ketogenic diet.

我有一个关于生酮饮食的问题，或者更多的是关于生酮饮食的陈述/问题。

Based on everything that we've talked about, seems to me that the ketogenic diet for weight loss is a very interesting aspect of the diet as is intermittent fasting for weight loss even though it might just be by way of caloric restriction that occurs with fasting.

基于我们所讨论的一切，在我看来，生酮减肥饮食是饮食中一个非常有趣的方面，就像间歇性禁食减肥一样，尽管它可能只是通过禁食时发生的热量限制。

But then in some ways, the effects of the ketogenic diet on weight loss are a bit of a decoy for most people.

但从某些方面来说，生酮饮食对减肥的影响对大多数人来说有点像诱饵。

That's where their mind goes.

这就是他们的想法。

This person lost X amount of weight.

此人体重减轻了 X 倍。

Maybe that made them feel better.

也许这让他们感觉好多了。

Maybe that actually made them underweight.

也许这实际上使他们体重不足。

I think you've talked about it.

我想你已经谈过了。

For some people, it can actually bring them under weight.

对于某些人来说，它实际上会使他们体重减轻。

I'm glad that we got the chance to dive into the description of ketogenic diet for epilepsy because it really is a medical intervention that has a side effect of weight loss or could be used to treat obesity and induce weight loss.

我很高兴我们有机会深入研究生酮饮食治疗癫痫的描述，因为它确实是一种具有减肥副作用的医疗干预措施，或者可以用于治疗肥胖和诱导减肥。

But it's really about far more than that.

但它的意义远不止于此。

And that raises a question for me, which is-- we've been talking about the ketogenic diet as one thing.

这给我提出了一个问题，那就是——我们一直在谈论生酮饮食。

But I've heard you discuss this before, where just as a physician will prescribe different dosage ranges of a given drug, you can prescribe different dosage ranges of a nutritional plan, a diet.

但我以前听你讨论过这个问题，就像医生会开出特定药物的不同剂量范围一样，你也可以开出不同剂​​量范围的营养计划、饮食。

It's not one thing.

这不是一回事。

It's not necessarily zero carbohydrates or 100 grams or 50 grams.

它不一定是零碳水化合物或 100 克或 50 克。

It depends on the patient and a lot of other factors.

这取决于患者和许多其他因素。

I've heard you list off various things classic keto.

我听说你列出了各种经典的酮类食物。

Maybe you could just briefly tell us what that typically is, because I think most people think it means eating a lot of meat and not carbohydrates.

也许你可以简单地告诉我们这通常是什么，因为我认为大多数人认为这意味着吃大量的肉而不是碳水化合物。

But it might not be that.

但事实可能并非如此。

Fasting and then some of the other-- you mentioned Atkins earlier.

禁食，然后是其他一些——你之前提到过阿特金斯。

We don't have to go into each of these in detail.

我们不必详细讨论其中的每一个。

And I know in your book, you talk about not just the science and clinical background but also some actionable steps that people could consider.

我知道在你的书中，你不仅谈论了科学和临床背景，还谈论了人们可以考虑的一些可行步骤。

So they can refer there for more detail.

所以他们可以参考那里了解更多详细信息。

But for somebody who, let's say, is depressed-- they've had some rounds of depression.

但对于那些抑郁的人来说，他们已经经历过几轮抑郁了。

Maybe they're on antidepressants, maybe not-- and they want to try something like this.

也许他们正在服用抗抑郁药，也许没有——他们想尝试这样的事情。

Obviously, this has to be done in concert with a physician observing all this.

显然，这必须在医生观察这一切的情况下完成。

But what is the typical thing that you probe with first?

但您首先探索的典型事物是什么？

Just like with a drug, you might probe with 20 milligrams of a drug.

就像药物一样，您可能会用 20 毫克药物进行探测。

What's your typical initial dietary intervention probe?

您典型的初始饮食干预探索是什么？

Terrible languaging, I realize.

我意识到，语言很糟糕。

And I'm criticizing myself for that.

我为此批评自己。

But I think people get the idea.

但我认为人们明白了。

So if somebody-- and I want to point out.

因此，如果有人——我想指出。

You mentioned the all-meat version of this diet, which is often referred to as the carnivore diet.

您提到了这种饮食的全肉版本，通常被称为肉食动物饮食。

But there are vegetarian and vegan versions of the ketogenic diet.

但生酮饮食有素食和纯素食版本。

So in my mind, this is not at all about the diet wars of animal-sourced versus plant-sourced foods.

所以在我看来，这根本不是动物源食品与植物源食品的饮食战争。

It's about inducing a state of ketosis, which is mimicking the fasting state.

这是为了诱导酮症状态，模仿禁食状态。

That is what it's about.

这就是它的意义所在。

And you can do that by not eating anything, by fasting and/or intermittent fasting.

你可以通过不吃任何东西、禁食和/或间歇性禁食来做到这一点。

And you get your results.

然后你就得到了你的结果。

So no diet is a ketogenic diet.

所以没有饮食是生酮饮食。

So it's not about the foods or the types of foods that you're eating.

因此，这与您所吃的食物或食物类型无关。

It's about inducing a state of ketosis.

这是为了诱导酮症状态。

The first variable I'm going to look at when I recommend this or prescribe this is the person's current weight.

当我推荐这个或开这个处方时，我要考虑的第一个变量是这个人的当前体重。

If somebody is obese versus somebody who's thin, I'm going to use different dietary strategies for those two situations.

如果有人肥胖而有人瘦，我将针对这两种情况使用不同的饮食策略。

In the obese patient, they have tons of fat stores on their body already.

对于肥胖患者来说，他们的体内已经储存了大量的脂肪。

Usually, it is a goal of theirs to tap into some of those.

通常，他们的目标是利用其中的一些。

And they'd like to lose some weight if they're going to try a ketogenic diet for brain health anyway.

如果他们无论如何都想尝试生酮饮食来保持大脑健康，他们就想减肥。

And so I'm going to use that.

所以我将使用它。

So that person, really, the diet is carbohydrate restriction.

所以那个人的饮食实际上是限制碳水化合物。

And that usually is a sufficient intervention.

这通常是足够的干预。

So if you can kind of get through a couple of weeks without sweet things, your cravings for those will go down.

因此，如果你能坚持几个星期不吃甜食，你对甜食的渴望就会下降。

And it'll make the diet easier and a little more sustainable.

它将使饮食变得更容易、更可持续。

But let's say you can have your artificial sweeteners, if that's what you really want.

但假设您可以使用人工甜味剂，如果您确实想要的话。

So I'm going to say less than 20 grams of carbs a day for those people.

所以我建议这些人每天摄入的碳水化合物少于 20 克。

They can have all the protein they want.

他们可以获得他们想要的所有蛋白质。

They can have vegetables.

他们可以吃蔬菜。

And they can have all the fat they want.

他们可以拥有他们想要的所有脂肪。

But I'm not going to push fat on those people.

但我不会把脂肪强加给那些人。

I'm not going to tell them, eat a lot of fat, at the same time because I want to use the fat on their body as the fat source, at least early on.

我不会告诉他们，同时吃很多脂肪，因为我想用他们身上的脂肪作为脂肪来源，至少在早期。

The more controversial thing are things like coconut oil or coconut cream, which the American Heart Association might say is not a healthy fat, I kind of disagree with that and don't think it's unhealthy at all actually.

更有争议的是像椰子油或椰子奶油这样的东西，美国心脏协会可能会说它们不是健康的脂肪，我有点不同意这一点，而且实际上并不认为它是不健康的。

And when you look at the epidemiological studies of saturated fat causing heart disease or causing adverse outcomes, at best, maybe increases your risk 10% to 15%-- at best.

当您查看关于饱和脂肪导致心脏病或不良后果的流行病学研究时，您的风险充其量可能会增加 10% 至 15%。

I have nothing against the actual fish.

我对真正的鱼没有任何异议。

But that's just me.

但这只是我。

But obviously, people have-- I say this because people have different preferences, right?

但显然，人们——我这么说是因为人们有不同的偏好，对吧？

The thin person is going to need to eat a lot of fat because they don't have a lot of fat stores on their body.

瘦人需要摄入大量脂肪，因为他们体内没有大量脂肪储存。

And if I want them in ketosis, clinical ketosis, I'm going to have to feed them fat.

如果我想让他们处于酮症，临床酮症，我就必须给他们喂脂肪。

So that's the person that I'm going to say, make sure you get in avocados, olive oil, butter, maybe heavy cream.

所以这就是我要说的，一定要吃牛油果、橄榄油、黄油，也许还有浓奶油。

So heavy cream is delicious.

所以浓奶油很好吃。

It's a delicious way to get your fats in.

这是吸收脂肪的美味方法。

I have one patient who just drinks it straight, to just try to get it in.

我有一位病人直接喝它，只是想把它喝进去。

So you can whip that up.

所以你可以把它搞起来。

You can freeze it.

你可以把它冷冻起来。

It turns into ice cream.

它变成了冰淇淋。

You can add vanilla.

你可以添加香草。

You can add cocoa powder.

您可以添加可可粉。

You can add all sorts of things.

你可以添加各种各样的东西。

And you're off to the races with shakes, and ice cream, and mousse, and all sorts of things that you can have.

然后你就可以带着奶昔、冰淇淋、慕斯以及各种你可以拥有的东西去参加比赛了。

With any of these patients, the beauty of this diet is I have objective biomarkers.

对于这些患者中的任何一个，这种饮食的优点在于我有客观的生物标志物。

I'm going to have them measuring ketones.

我要让他们测量酮。

And I'm going to adjust the diet based on their state of ketosis and/or the clinical benefits that I'm looking for.

我将根据他们的酮症状态和/或我正在寻找的临床益处来调整饮食。

If it's an average person, who is not currently under psychiatric care, not taking prescription medicines but is saying, I'm burned out.

如果是一个普通人，目前没有接受精神科护理，没有服用处方药，但会说，我已经精疲力竭了。

I'm exhausted.

我累极了。

I want some of that brain energy that Andrew Huberman is talking about.

我想要一些安德鲁·休伯曼所说的大脑能量。

He talks about feeling good.

他谈到感觉良好。

I want some of that.

我想要一些。

I'm probably actually going to recommend the protocol you describe, which is, let's see if we can just carb restrict for a while and see if that produces clinical benefit.

我实际上可能会推荐您描述的方案，也就是说，让我们看看我们是否可以限制碳水化合物一段时间，看看是否会产生临床益处。

I have one-- he's not even a patient, just somebody who read my book.

我有一个——他甚至不是病人，只是读过我的书的人。

I didn't tell him anything.

我什么也没告诉他。

And he came away from it saying-- he was ready to start an antidepressant for his anxiety.

结束后他说——他准备开始服用抗抑郁药来治疗他的焦虑。

He had chronic anxiety, was trying meditation, was trying all sorts of things.

他患有慢性焦虑症，正在尝试冥想，正在尝试各种各样的事情。

Nothing-- those things weren't enough.

什么都没有——这些还不够。

He was ready to go on prescription medicine.

他准备继续服用处方药。

He read an early copy of the book.

他读过这本书的早期版本。

He took it upon himself without consulting with me to restrict carbohydrates alone.

他在没有与我协商的情况下自行决定单独限制碳水化合物的摄入。

He did not go ketogenic.

他没有生酮。

He is a vegetarian.

他是素食主义者。

He restricted carbs.

他限制碳水化合物。

Within three weeks, said, I don't need prescription medicine.

说，三周内，我不需要处方药。

I can't believe how much better I feel.

我不敢相信我感觉好多了。

And all I did was cut out some of the high carb foods in my diet.

我所做的就是减少饮食中的一些高碳水化合物食物。

So I think for some people, it can be that simple.

所以我认为对于某些人来说，事情可能就是这么简单。

For people with serious mental disorders, if they are chronically depressed, if they're on lots of prescription meds, if they're disabled by their symptoms, and certainly, if you're bipolar or have schizophrenia or something, those are the people I really do want them to work with a medical professional because meds may need to be adjusted.

对于患有严重精神障碍的人来说，如果他们长期抑郁，如果他们服用大量处方药，如果他们因症状而残疾，当然，如果你患有双相情感障碍或患有精神分裂症或其他疾病，我真的希望他们与医疗专业人员一起工作，因为药物可能需要调整。

They need a real shot at this diet.

他们需要真正尝试一下这种饮食。

It's not like weight loss.

这不像减肥。

Weight loss, everybody wings it.

减肥，人人都有。

And either you're successful or you aren't.

你要么成功，要么不成功。

You look on the internet or you read a book or you do-- even the colleague that you mentioned, he's probably just reading-- who knows whether it's credible information or not-- and just winging it, and seeing whether it works or not.

你上网查一下，或者读一本书，或者你这样做——甚至你提到的同事，他可能只是在读——谁知道这些信息是否可信——然后即兴发挥，看看它是否有效。

For people with serious mental disorders, I want you to treat it like you have epilepsy because you do have a serious brain disorder.

对于患有严重精神障碍的人，我希望你像对待癫痫症一样对待它，因为你确实患有严重的脑部疾病。

It's impairing your ability to function in the world.

它正在损害你在世界上运作的能力。

It's impairing your health and happiness.

它正在损害你的健康和幸福。

You deserve a competent medical treatment.

您应该得到有效的医疗治疗。

And we have that.

我们有这个。

We have a hundred-year evidence-based.

我们有一百年的证据为基础。

We've got dieticians who know this like the back of their hand.

我们的营养师对此了如指掌。

They can monitor your level of ketosis.

他们可以监测您的酮症水平。

They can help look for vitamin and nutrient deficiencies that can be a consequence of the diet, and make sure that you're not developing those.

它们可以帮助寻找可能因饮食而导致的维生素和营养缺乏症，并确保您不会出现这些情况。

They can help tweak the diet if needed.

如果需要，他们可以帮助调整饮食。

They can give you ideas if you're getting bored with eggs every morning.

如果您每天早上对鸡蛋感到厌倦，他们可以给您一些建议。

They can give you ideas for what else you might have.

他们可以为您提供有关您可能还有什么的想法。

And if you're using it to treat a serious disorder, I think you need serious help.

如果你用它来治疗严重的疾病，我认为你需要认真的帮助。

So eat keto but eat between the hours of, whatever, 11:00 AM and 8:00 PM or something like that.

所以，吃酮类食物要在上午 11:00 到晚上 8:00 之类的时间之间吃。

That's the first question.

这是第一个问题。

And sometimes I will ask him to do either intermittent fasting or even a three or four day water fast.

有时我会要求他间歇性禁食，甚至三四天清水禁食。

And it is shocking.

这令人震惊。

When he does a three or four day water fast, the first day or two, he feels like crap.

当他进行三四天的清水断食时，第一天或第二天，他感觉很糟糕。

I'll just say up front, don't do it if you've got an important meeting or business trip or anything.

我只是预先说一下，如果您有重要会议或商务旅行或其他任何事情，请不要这样做。

Don't be--

别是——

And he said, I feel great.

他说，我感觉很棒。

I want to keep going.

我想继续下去。

I can't believe that I'm not hungry.

我不敢相信我不饿。

But I am not hungry at all.

但我一点也不饿。

I don't miss food at all.

我一点也不想念食物。

And at seven days, I kind of cut the cord.

第七天，我就切断了电源线。

I was like, no, no. We're done.

我当时想，不，不。我们完成了。

But I'm very interested in the neural side of it.

但我对它的神经方面非常感兴趣。

And it does seem that the fasted state can start to take on its own rewarding properties, where people get dopamine release not from eating, as most everyone does, but from abstaining from food.

禁食状态似乎确实可以开始发挥其自身的有益作用，人们不再像大多数人那样通过进食来释放多巴胺，而是通过戒断食物来释放多巴胺。

Now, this can be pathologic in the sort of example of anorexia nervosa, which is we both know as the most deadly psychiatric illness.

现在，这可能是病理性的，例如神经性厌食症，我们都知道这是最致命的精神疾病。

But for non-anoxerics, I think it's interesting to note that eventually not eating can have its own rewarding properties to it that aren't just related to weight loss.

但对于非厌氧症患者来说，我认为有趣的是，最终不吃东西可以有其自身的有益特性，而不仅仅是与减肥有关。

But in the short-term, feeling-- in other words, feeling really good by way of abstaining from eating.

但在短期内，感觉——换句话说，通过戒食感觉真的很好。

Hypomania, for better or worse, is something every human being probably craves.

轻躁狂，无论好坏，可能是每个人都渴望的。

So it is feeling extraordinarily good.

所以感觉特别好。

It's getting by on less sleep.

睡眠越来越少了。

But you don't need to sleep.

但你不需要睡觉。

Who needs sleep?

谁需要睡眠？

I've got things to do.

我还有事要做。

My brain is running on all cylinders.

我的大脑正在全速运转。

I feel so creative.

我感觉很有创意啊

There have been lots of famous people through the ages who have been bipolar, probably bipolar.

古往今来，有很多名人都患有躁郁症，很可能是躁郁症。

And some of their most productive periods of time, whether it's art or creating scientific models or what-have-you, were probably during hypomanic episodes.

他们最富有成效的一些时期，无论是艺术还是创建科学模型或其他什么，都可能是在轻躁狂发作期间。

And I always recommend behavioral tools first, then exercise, viewing sunlight, et cetera, at appropriate times, avoiding late night artificial light exposure, et cetera, and occasionally, for people who are doing all that and still struggle with sleep, supplementation.

我总是首先推荐行为工具，然后在适当的时间锻炼、观察阳光等，避免深夜人造光照射等，偶尔，对于那些做了所有这些但仍然难以入睡的人，补充营养。

One of the things that I've seen some data on is that for people who are following a low carbohydrate diet, that inositol, in particular, can be helpful for getting into sleep probably because it's a bit of an-- has a bit of an anti-anxiety effect.

我看到的一些数据之一是，对于遵循低碳水化合物饮食的人来说，肌醇尤其有助于入睡，可能是因为它有一点抗焦虑作用。

But presumably, there are other things out there, too.

但想必，还有其他事情存在。

The magnesiums will generally do that.

镁通常可以做到这一点。

A hot bath will do that, too, for that matter.

就此而言，洗个热水澡也能达到这个目的。

But what you're talking about is people who are going, what, a day and a half without sleep?

但你说的是那些一天半不睡觉的人？

Or they're just two hours of sleep a night?

或者他们每晚只睡两个小时？

And he was actually waking up at 4:00 AM, going for 10 to 20 mile runs most days.

事实上，他在凌晨 4:00 起床，大部分时间都会跑步 10 到 20 英里。

He finally stopped the ketogenic diet after about six months because he said, I can't maintain my weight.

大约六个月后，他终于停止了生酮饮食，因为他说，我无法维持体重。

I'm losing too much weight.

我减肥太多了。

So what does somebody do in that case?

那么在这种情况下有人会做什么呢？

So I don't know that I've ever been hypomanic.

所以我不知道我曾经有过轻躁狂。

But as I mentioned earlier, unless I've done a very high intensity workout early in the day and I need to replenish carbohydrates, I typically eat meat, fruit, and vegetables throughout the day-- minimum amounts of fruit but some.

但正如我之前提到的，除非我在当天早些时候进行了非常高强度的锻炼并且需要补充碳水化合物，否则我通常会全天吃肉、水果和蔬菜——水果的量最少，但也有一些。

And then at night, I switch over to mainly carbohydrate.

然后到了晚上，我主要吃碳水化合物。

It really helps me sleep.

它确实有助于我睡眠。

It replenishes glycogen stores.

它补充糖原储存。

I sleep really well, wake up the next morning, repeat.

我睡得很好，第二天早上醒来，重复。

And of course, this goes against a lot of the dogma that, oh, you're not supposed to eat carbohydrates late in the day and .

当然，这违背了很多教条，即，哦，你不应该在一天晚些时候吃碳水化合物，而且……。

This is what works for me.

这对我有用。

And so I do it.

所以我就这么做了。

For somebody like this mental health professional, who is hypomanic, would going off the ketogenic diet entirely be the best idea?

对于像这位心理健康专业人士这样的轻度躁狂的人来说，完全停止生酮饮食是最好的主意吗？

Or could it be that adjusting when they eat their carbohydrates would be advantageous in order to make sure that they felt alert and great during the day?

或者，调整他们吃碳水化合物的时间是否有利于确保他们在白天感到警觉和良好？

Maybe not hypomanic but then could have a four to eight-hour a night sleep as opposed to a two to four hours a night, which is really very little sleep.

也许不是轻躁狂，但每晚可以睡四到八个小时，而不是每晚睡两到四个小时，这实际上是很少的睡眠。

Let's start with behavioral measures first.

让我们首先从行为测量开始。

And the first intervention is education.

第一个干预措施是教育。

You need at least six hours of sleep a night.

您每晚至少需要六个小时的睡眠。

Period, end of story.

期间，故事结束。

That's non-negotiable.

这是没有商量余地的。

If you're not getting at least six hours of sleep a night, we need to consider this a problem.

如果您每晚睡眠时间不足六个小时，我们需要考虑这是一个问题。

So figure out a way to get 6 hours of sleep.

因此，想办法获得 6 小时的睡眠。

For some people, that's enough, just the education.

对于某些人来说，只要接受教育就足够了。

They don't get out of bed at 3:00 AM.

他们凌晨 3:00 不会起床。

It might take them an hour to fall back to sleep.

他们可能需要一个小时才能重新入睡。

They fall back to sleep.

他们又睡着了。

For most people, if you can get three nights of decent sleep in a row, the hypomania goes away.

对于大多数人来说，如果你能连续三个晚上获得良好的睡眠，轻躁狂就会消失。

That is the way to extinguish it.

这就是消灭它的方法。

And then they still go on feeling a high from it.

然后他们仍然会继续感到兴奋。

They feel great.

他们感觉很棒。

Their brain feels good in terms of memory, concentration, motivation, all of those things.

他们的大脑在记忆力、注意力、动力等方面感觉良好。

But they're not hypomanic anymore.

但他们不再轻躁狂了。

And then I might use supplements, melatonin, others that you mentioned, magnesium is a big one.

然后我可能会使用补充剂，褪黑激素，你提到的其他补充剂，镁是一个很大的补充。

And for some, I will recommend exactly what you're doing-- eat some carbohydrates in the evening before you're going to bed.

对于某些人，我会准确地推荐您正在做的事情——晚上睡觉前吃一些碳水化合物。

Either have them at dinner and then wait a few hours before you're going to go to bed or have them right before you're going to go to bed, just to try to calm your body down and get it going.

要么在晚餐时吃，然后等几个小时再上床睡觉，要么在临睡前吃，只是为了让你的身体平静下来，让身体运转起来。

When I'm using this as a clinical intervention, especially with patients with serious mental illness, I actually want them in a state of ketosis long-term.

当我将其用作临床干预时，尤其是对于患有严重精神疾病的患者，我实际上希望他们长期处于酮症状态。

So I'm not going to do the carbohydrate intervention.

所以我不会进行碳水化合物干预。

I'm going to try all the other ones.

我要尝试所有其他的。

But if they still can't sleep even with supplements, over the counter supplements, then I'm probably going to go with prescription, sleeping medicines, as a temporary stopgap to try to get them three to seven days of decent sleep.

但如果他们即使服用补充剂、非处方补充剂仍然无法入睡，那么我可能会服用处方安眠药，作为临时的权宜之计，试图让他们获得三到七天的良好睡眠。

That usually breaks the hypomanic cycle.

这通常会打破轻躁狂的循环。

And then they stay on the ketogenic diet because it ends up resulting in all of these other improvements that I've described.

然后他们继续坚持生酮饮食，因为它最终会带来我所描述的所有其他改善。

Their illness can sometimes go in to full remission.

他们的疾病有时可以完全缓解。

So as long as it's somebody without a history of addiction, I'm going to use a benzodiazepine or either commonly called the Z medicines for sleep-- zolpidem or Ambien or something like that.

因此，只要是没有成瘾史的人，我就会使用苯二氮卓类药物或通常称为 Z 的睡眠药物——唑吡坦或安必恩或类似药物。

We're looking for three to seven days of decent sleep.

我们正在寻找三到七天的良好睡眠。

And then we're going to try to get them off that medicine.

然后我们将尝试让他们摆脱这种药物。

And usually, people are off to the races and can sustain it well.

通常情况下，人们都会去参加比赛并且能够很好地维持下去。

How is that impacted by this?

这是如何受到影响的？

How does the menstrual cycle impact its efficacy, et cetera?

月经周期如何影响其功效等？

Carbohydrates and caloric restriction have been implicated in different interactions-- are known to interact with the endocrine system.

碳水化合物和热量限制与不同的相互作用有关——已知它们与内分泌系统相互作用。

So what do you do if you have a patient who is depressed or could have psychotic symptoms-- but let's go with depression because that's probably a bit more familiar to most people-- and then they're on a low carbohydrate or full ketogenic diet, but their menstrual cycles cease.

那么，如果你有一个患有抑郁症或可能有精神病症状的病人——但我们就抑郁症吧，因为这可能对大多数人来说更熟悉一些——然后他们接受低碳水化合物或全生酮饮食，但他们的月经周期停止了，你该怎么办？

How do you deal with those adjustments?

您如何应对这些调整？

And I guess we could expand this conversation and say, what about male fertility also?

我想我们可以扩展这个话题并问，男性的生育能力又如何呢？

Because some caloric diets seem to-- my understanding is that submaintenance caloric diets, so weight loss diets, will improve testosterone-estrogen ratios in males that are obese.

因为一些热量饮食似乎——我的理解是，维持热量饮食，即减肥饮食，将改善肥胖男性的睾酮-雌激素比率。

But for someone that's not obese, to go on a sub-caloric diet, that it can start to impair testosterone levels and-- probably not render them infertile but certainly adjust that whole axis.

但对于不肥胖的人来说，进行低热量饮食可能会开始损害睾丸激素水平，并且可能不会使他们不孕，但肯定会调整整个轴线。

So what about interactions between ketosis, diets, et cetera, and the endocrine system?

那么酮症、饮食等与内分泌系统之间的相互作用又如何呢？

So the first general observation that I'll make-- I know so many couples, husbands and wives, boyfriends and girlfriends, heterosexual couples, who have tried the ketogenic diet to lose weight together--

因此，我要做出的第一个一般性观察——我认识很多夫妇、丈夫和妻子、男朋友和女朋友、异性恋夫妇，他们一起尝试过生酮饮食来减肥——

And I think in those cases, it probably does relate to hormones.

我认为在这些情况下，它可能确实与激素有关。

I'm aware of animal models, of mice-- in particular, ketogenic diet in mouse models.

我了解小鼠的动物模型，特别是小鼠模型中的生酮饮食。

One researcher shared with me, the thing that was striking is that the female mice never got pregnant on the ketogenic diet.

一位研究人员与我分享，令人惊讶的是雌性小鼠在生酮饮食中从未怀孕。

Whereas, the mice on the standard diet were just having babies right and left.

而采用标准饮食的小鼠则只是左右产卵。

And it was just shocking, the difference.

差异令人震惊。

On the surface, it makes sense.

从表面上看，这是有道理的。

The ketogenic diet is mimicking the fasting state.

生酮饮食模仿禁食状态。

Women who are trying to reproduce should not be fasting.

想要生育的女性不应该禁食。

If your body is in a fasting state, it probably does not want to expend resources, metabolic resources, calories, nutrients, and other things, to creating a baby because your very life is being threatened by, quote unquote, "fasting" or starvation.

如果你的身体处于禁食状态，它可能不想消耗资源、代谢资源、卡路里、营养素和其他东西来创造婴儿，因为你的生命正受到“禁食”或饥饿的威胁。

That even though the ketogenic diet is a sustainable, nonstarvation diet, we're really using that diet to trick the body into thinking that it is in a fasting or starvation state.

尽管生酮饮食是一种可持续的非饥饿饮食，但我们实际上是在利用这种饮食来欺骗身体，使其认为自己处于禁食或饥饿状态。

And so just from a kind of evolutionary stance, it makes sense that women's bodies may actually have significant changes in hormonal status to prevent pregnancy because a woman should not be having a baby when she's starving to death.

因此，仅从进化的角度来看，女性身体的荷尔蒙状态实际上可能会发生显着变化以防止怀孕，这是有道理的，因为女性在饿死时不应该生孩子。

I know of examples of women who are the opposite, though, who have benefited dramatically and tremendously from the ketogenic diet, have put schizophrenia, bipolar disorder into full remission.

然而，我知道一些女性的例子却恰恰相反，她们从生酮饮食中获益匪浅，使精神分裂症、双相情感障碍得到完全缓解。

And I do actually know of one case, at least one case.

我确实知道一个案例，至少一个案例。

A woman, infertile, she and her husband had been trying for three years, no pregnancy.

一名女子，不孕不育，她和丈夫尝试了三年，仍未怀孕。

She went keto.

她去吃酮。

Within four months, she was pregnant.

四个月后，她怀孕了。

How do I make sense of that?

我该如何理解这一点？

I don't know.

我不知道。

And unfortunately, I don't think we really have good control data on what does the ketogenic diet do to male hormonal systems, what does the ketogenic diet do to female hormonal systems.

不幸的是，我认为我们对于生酮饮食对男性荷尔蒙系统有何影响，以及生酮饮食对女性荷尔蒙系统有何影响确实没有良好的控制数据。

But clearly, I think changes are happening.

但显然，我认为变化正在发生。

I don't have a way to predict it, at least.

至少我没有办法预测它。

If somebody else has great insights, I welcome them.

如果其他人有很好的见解，我欢迎他们。

But I haven't seen them published.

但我还没有看到它们出版。

It also calls to mind the important public service announcement that because of these bidirectional effects that you described, please don't use fasting or the ketogenic diet as a reliable form of contraception.

它还让人想起重要的公共服务公告，由于您所描述的这些双向影响，请不要使用禁食或生酮饮食作为可靠的避孕方式。

And these are the semaglutide drugs that are involved in-- they tap into these glucagon related GLP-1 pathways.

这些是索马鲁肽药物，它们利用这些胰高血糖素相关的 GLP-1 途径。

And it is a story that we've talked about a little bit on the podcast before.

我们之前在播客上谈过这个故事。

But many people, I imagine, probably haven't heard that conversation.

但我想很多人可能没有听过那次谈话。

I would simply like to know what you think about these drugs.

我只是想知道您对这些药物的看法。

They obviously adjust the way that glucose and insulin are managing energy, both in the body and the brain, and can produce weight loss.

它们显然调整了葡萄糖和胰岛素在身体和大脑中管理能量的方式，并且可以减轻体重。

So that to me, when I look at the data, it's impressive.

所以对我来说，当我查看这些数据时，它令人印象深刻。

But a good logical shift in diet and exercise could achieve similar weight loss.

但饮食和锻炼的良好逻辑转变可以实现类似的减肥效果。

But a lot of people just won't do that.

但很多人就是不会这么做。

So the question I have is, what are your thoughts on semaglutide and other GLP-- I think I might have said GLT before, excuse me-- GLP-1 related compounds?

所以我的问题是，您对索马鲁肽和其他 GLP 有何看法——我想我之前可能已经说过 GLT，请问——GLP-1 相关化合物？

And do you ever prescribe these in conjunction with these dietary shifts?

您是否曾将这些处方与这些饮食变化结合起来？

Because it seems to me, they would fall right in with the catalog of other approaches that you have available.

因为在我看来，它们正好符合您可用的其他方法的目录。

We have to figure out what on Earth is happening, and what can we do about it.

我们必须弄清楚地球上正在发生什么，以及我们能做些什么。

These medications, in early studies, are highly effective over a year or two.

在早期研究中，这些药物在一两年内非常有效。

That's promising.

这是有希望的。

I am worried, though, that we're not attacking the root cause of obesity.

但我担心我们没有解决肥胖的根本原因。

If the root cause of obesity ends up being some kind of poisoning of the metabolic machinery in the brain or body-- and I would argue that probably relates to mitochondrial health and mitochondrial function-- I have every reason to believe that taking a medication that helps you lose weight may not be addressing that problem.

如果肥胖的根本原因最终是大脑或身体代谢机制的某种中毒——我认为这可能与线粒体健康和线粒体功能有关——我完全有理由相信服用有助于减肥的药物可能无法解决这个问题。

And therefore, may not be addressing all of the negative health consequences of what we call obesity.

因此，可能无法解决我们所说的肥胖对健康造成的所有负面影响。

So obesity, in it of itself, we know that excess fat can become inflammatory and can cause problems, in and of itself.

因此，肥胖本身，我们知道多余的脂肪本身会引起炎症并引起问题。

But I actually see obesity as a symptom.

但我实际上将肥胖视为一种症状。

I see obesity as a symptom of metabolic derangement in the body or brain.

我认为肥胖是身体或大脑代谢紊乱的症状。

And that is why people become obese.

这就是人们变得肥胖的原因。

And that if we're really going to get anywhere, we need to identify what is causing that metabolic derangement.

如果我们真的想要取得进展，我们需要找出导致新陈代谢紊乱的原因。

Using a symptomatic treatment like a GLP-1 medication, to the best of my knowledge, is not addressing that core problem.

据我所知，使用 GLP-1 药物等对症治疗并不能解决这个核心问题。

And we're just ignoring it.

而我们只是忽略了它。

Maybe I'll be wrong.

也许我会错的。

And maybe these will be the wonder drug that saved the human species, and everybody will be thin and healthy forever and ever.

也许这些将成为拯救人类的灵丹妙药，每个人都将永远保持苗条和健康。

I'm not hopeful, because we've never-- we've had so many promising drugs come along.

我不抱希望，因为我们从来没有出现过这么多有前途的药物。

Fen-Phen, Dexedrine, and other things, we've had so many promising drugs.

Fen-Phen、Dexedrine 和其他药物，我们有很多有前途的药物。

And at the end of the day, when you try to muck with human metabolism using a single processed molecule, manmade, I can't think of even one example where it's been great for large numbers of people.

归根结底，当你试图使用一种经过加工的人造分子来破坏人类的新陈代谢时，我什至想不出一个对大量人来说有好处的例子。

Certainly, manufacturing insulin is life-saving for people with type 1 diabetes.

当然，生产胰岛素对于 1 型糖尿病患者来说可以挽救生命。

So that would be an example.

这就是一个例子。

But giving massive doses of insulin to people with type 2 diabetes, actually is a downward spiral.

但给 2 型糖尿病患者注射大剂量的胰岛素实际上是一种恶性循环。

I would much rather see people with type 2 diabetes control their diabetes through diet and lifestyle.

我更愿意看到 2 型糖尿病患者通过饮食和生活方式来控制糖尿病。

And that might be a ketogenic diet, or a low carb diet, or exercise or good sleep, or all of the other thing.

这可能是生酮饮食，或低碳水化合物饮食，或锻炼或良好的睡眠，或所有其他的东西。

All of it.

所有这一切。

I'd much rather see that because when people try to control their type 2 diabetes with a molecule, even though it's a natural molecule insulin, we know that thats results in really poor health consequences, results in higher rates of cardiovascular disease, higher rates of mental disorders, higher rates of premature mortality.

我更愿意看到这一点，因为当人们试图用一种分子来控制他们的 2 型糖尿病时，即使它是一种天然分子胰岛素，我们知道这会导致非常糟糕的健康后果，导致更高的心血管疾病发生率、更高的精神障碍发生率、更高的过早死亡率。

Do I think GLP-1 molecules are going to be different?

我认为 GLP-1 分子会有所不同吗？

No. I don't have any reason to think they are going to be.

不，我没有任何理由认为他们会这样。

So that would be my two cents, but we'll see.

所以这就是我的两分钱，但我们拭目以待。

Time will tell.

时间会证明一切。

There are drugs that certainly can help alleviate symptoms in some individuals.

有些药物确实可以帮助缓解某些人的症状。

But that lifestyle and in the case of your work-- in particular, in the discussion today-- diet and, the ketogenic diet, in particular, it's clear, can have incredible effects, miraculous effects, in some individuals.

但是，就你的工作而言，特别是在今天的讨论中，这种生活方式和饮食，尤其是生酮饮食，很明显，可以对某些人产生令人难以置信的效果，神奇的效果。

And positive effects in others that might not be of the same magnitude but nonetheless are extremely important, so on behalf of myself, and the listeners, and and certainly, just on behalf of everybody out there-- because everyone does need to be concerned about mental health issues, whether or not they have them and in their family themselves.

对其他人的积极影响可能不那么重要，但仍然极其重要，所以我代表我自己和听众，当然也代表所有人——因为每个人确实需要关心心理健康问题，无论他们自己和家人是否有心理健康问题。

Or otherwise, because they impact everybody.

或者说，因为它们影响着每个人。

Just really want to thank you for viewing the work that you're doing because it really is pioneering.

只是真的想感谢您观看您正在做的工作，因为它确实是开创性的。

And it's brave.

而且很勇敢。

And I can see now, based on our discussion, why it would work.

根据我们的讨论，我现在可以明白为什么它会起作用。

You've given us a lot of hints into the underlying mechanisms that suggest as to why it would work.

您已经向我们提供了很多有关其运作原理的潜在机制的提示。

And you're going to given us examples as to how it has worked in patients that you've worked with.

您将向我们提供一些例子，说明它如何在您治疗过的患者身上发挥作用。

And this field is expanding fast.

而且这个领域正在快速扩张。

I think this is an area of psychiatry and medicine in general.

我认为这是精神病学和医学的一个领域。

Meaning, behavioral, nutritional interventions, that is expanding very fast.

意思是，行为、营养干预措施正在迅速扩大。

So thank you for being brave and for taking this on, and doing it in such a structured way, and for communicating it here today.

因此，感谢您勇敢地承担起这件事，以如此结构化的方式进行，并今天在这里进行交流。

And with the general public, through your book, and your online presence.

并通过你的书和你的在线形象与公众接触。

We will certainly point people in the direction of those valuable resources.

我们一定会为人们指明这些宝贵资源的方向。

Thanks so much.

非常感谢。

Once again, if you're interested in his work or his new book, Brain Energy, I encourage you to go to his website.

再次，如果您对他的作品或他的新书《Brain Energy》感兴趣，我鼓励您访问他的网站。

That's chrispalmermd.com.

那是 chrispalmermd.com。

You can also find the book Brain Energy by Chris Palmer on Amazon and other sites where books are sold.

您还可以在亚马逊和其他书籍销售网站上找到克里斯·帕尔默 (Chris Palmer) 所著的《Brain Energy》一书。

And we provide links to the book and to Dr. Palmer's website in the show note captions.

我们在节目注释标题中提供了本书和帕尔默博士网站的链接。

If you're learning from and/or enjoying this podcast, please subscribe to our YouTube channel.

如果您正在学习和/或喜欢此播客，请订阅我们的 YouTube 频道。

That's a terrific zero cost way to support us.

这是支持我们的绝佳零成本方式。

In addition, please subscribe to the podcast on Spotify and on Apple.

此外，请订阅 Spotify 和 Apple 上的播客。

And on both Spotify and Apple, you can leave us up to a five star review.

在 Spotify 和 Apple 上，您都可以给我们留下五星级的评价。

If you have questions or suggestions about topics and guests you'd like me to include on the Huberman Lab podcast, please put those in the comments section on YouTube.

如果您对希望我在 Huberman Lab 播客中包含的主题和嘉宾有疑问或建议，请在 YouTube 的评论部分中提出。

I do read all the comments.

我确实阅读了所有评论。

In addition, please check out the sponsors mentioned at the beginning of today's episode.

另外，请查看今天节目开头提到的赞助商。

That's the best way to support this podcast.

这是支持这个播客的最佳方式。

During today's episode, we did not discuss supplements.

在今天的节目中，我们没有讨论补充剂。

But on many previous episodes of the Huberman Lab podcast, we do discuss supplements because while supplements aren't necessary for everybody, many people derive tremendous benefit from them for things like enhancing sleep, and focus, and hormone augmentation, and so forth.

但在休伯曼实验室播客的许多之前的节目中，我们确实讨论了补充剂，因为虽然补充剂并不是每个人都需要的，但许多人从它们中获得了巨大的好处，例如增强睡眠、集中注意力和增强激素等等。

The Huberman Lab podcast has partnered with Momentous Supplements because they are of the very highest quality.

Huberman Lab 播客与 Momentous Supplements 合作，因为它们具有最高的质量。

And they ship internationally.

他们在国际范围内运送。

And in addition to that, they have single-ingredient formulations that allow you to devise the supplement regimen that's most effective and most cost effective for you.

除此之外，他们还提供单一成分配方，让您能够设计出对您来说最有效且最具成本效益的补充方案。

If you'd like to see the supplements discussed on the Huberman Lab podcast, please go to LiveMomentous.com/Huberman.

如果您想查看 Huberman Lab 播客上讨论的补充剂，请访问 LiveMomentous.com/Huberman。

The Huberman Lab also has a zero cost newsletter that you can access.

胡伯曼实验室还有一份零成本时事通讯可供您访问。

It includes summaries of podcast episodes as well as summaries of various protocols for mental health, physical health, and performance.

它包括播客剧集的摘要以及心理健康、身体健康和表现的各种协议的摘要。

You can sign up for the newsletter by going to hubermanlab.com.

您可以访问 hubermanlab.com 订阅新闻通讯。

Go into the menu and look for the Neural Network Newsletter sign-up.

进入菜单并查找神经网络通讯注册。

You just provide your email.

您只需提供您的电子邮件即可。

And I assure you we do not share your email with anybody.

我向您保证，我们不会与任何人分享您的电子邮件。

And again, it's completely zero cost.

再说一遍，它完全是零成本。

Again, go to hubermanlab.com and sign up for the Neural Network Newsletter.

再次访问 hubermanlab.com 并订阅神经网络通讯。

And if you're not already following us on social media, we are Huberman Lab on Instagram, Huberman Lab Lab on Twitter, and Huberman Lab on Facebook.

如果您还没有在社交媒体上关注我们，我们是 Instagram 上的 Huberman Lab、Twitter 上的 Huberman Lab 和 Facebook 上的 Huberman Lab。

And at all of those sites, I provide science and science-related tools for mental health, physical health, and performance.

在所有这些网站上，我都提供有关心理健康、身体健康和表现的科学和与科学相关的工具。

Some of which overlap with information covered on the Huberman Lab podcast.

其中一些与 Huberman 实验室播客中涵盖的信息重叠。

But often which is distinct from information covered on the Huberman Lab podcast.

但通常这与休伯曼实验室播客中涵盖的信息不同。

So again, that's Huberman Lab on Instagram, Twitter, and Facebook.

再说一次，这就是 Instagram、Twitter 和 Facebook 上的 Huberman Lab。

Once again, thank you for joining me for today's discussion with Dr. Chris Palmer.

再次感谢您参加今天与克里斯·帕尔默博士的讨论。

And last, but certainly not least, thank you for your interest in science.

最后但同样重要的是，感谢您对科学的兴趣。