Dr. Gary Steinberg: How to Improve Brain Health & Offset Neurodegeneration

This transcript version is not in its final form and will be updated.

该文字记录版本并非最终版本，将会更新。

Andrew Huberman:

安德鲁·休伯曼：

Welcome to the Huberman Lab podcast where we discuss science and science-based tools for everyday life.

欢迎来到休伯曼实验室播客，我们在这里讨论科学和基于科学的日常生活工具。

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。

My guest today is Dr. Gary Steinberg.

今天我的客人是加里·斯坦伯格博士。

Dr. Gary Steinberg is a medical doctor, PhD professor of neurosurgery, neurosciences, and neurology at Stanford University School of Medicine.

加里·斯坦伯格博士是一位医学博士，斯坦福大学医学院神经外科、神经科学和神经病学博士教授。

He's a world expert in what is called the cerebrovascular architecture of our brain, which is a scientific term explaining how blood flow to the brain supplies oxygen and critical nutrients to our neurons, our nerve cells, as well as playing a critical role in removing waste products from our brain in order for our brain to function normally.

他是大脑脑血管结构方面的世界专家，这是一个科学术语，解释了流向大脑的血液如何为我们的神经元、神经细胞提供氧气和关键营养物质，以及如何在清除大脑中的废物以使我们的大脑正常运作方面发挥关键作用。

During today's discussion, he explains in very clear terms, how blood flow to the brain occurs and how disruptions in blood flow in things like stroke and aneurysm impact brain functioning.

在今天的讨论中，他以非常清晰的方式解释了流向大脑的血液是如何发生的，以及中风和动脉瘤等情况下的血流中断如何影响大脑功能。

We also discuss concussions and TBI or traumatic brain injuries, which unfortunately are very common and what can be done to treat concussion and traumatic brain injury.

我们还讨论脑震荡和 TBI 或创伤性脑损伤，不幸的是，这很常见，以及如何治疗脑震荡和创伤性脑损伤。

Dr. Steinberg also shares with us recent findings from his laboratory and clinic revealing how stem cells can be used to recover function in the human brain and spinal cord after things like concussion, TBI, stroke and other disruptions to the cerebrovascular architecture, and he shares with us the science supported tools that is protocols that any of us can use to improve the health and functioning of our brains.

斯坦伯格博士还与我们分享了他的实验室和诊所的最新发现，揭示了如何利用干细胞在脑震荡、脑外伤、中风和其他脑血管结构破坏等事件后恢复人类大脑和脊髓的功能，他还与我们分享了科学支持的工具，这些工具是我们任何人都可以用来改善大脑健康和功能的协议。

So if you or somebody that you know has experienced concussion or traumatic brain injury, stroke, or aneurysm, today's discussion is sure to include vital information for you and for those fortunate enough to not have experienced those conditions.

因此，如果您或您认识的人经历过脑震荡或创伤性脑损伤、中风或动脉瘤，今天的讨论肯定会为您和那些没有经历过这些情况的幸运者提供重要信息。

Today's discussion will also review the latest science and protocols for improving brain health.

今天的讨论还将回顾改善大脑健康的最新科学和方案。

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 to the general public.

然而，我的愿望和努力的一部分是向公众提供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 Eight Sleep.

我们的第一个赞助商是八睡。

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

August Sleep 生产具有制冷、加热和睡眠跟踪功能的智能床垫套。

Now, I've spoken many times before on this podcast about the fact that sleep is the critical foundation for mental health, physical health and performance.

现在，我之前在这个播客上多次谈到过这样一个事实：睡眠是心理健康、身体健康和表现的重要基础。

Now, one of the key things to getting the best possible night's sleep is to control the temperature of your sleeping environment, and that's because in order to fall and stay deeply asleep, your body temperature actually needs to drop by about one to three degrees, and in order to wake up feeling refreshed and alert, your body temperature actually has to increase by about one to three degrees.

现在，获得最佳夜间睡眠的关键之一是控制睡眠环境的温度，这是因为为了入睡并保持深度睡眠，您的体温实际上需要下降约一到三度，而为了醒来时感到神清气爽和警觉，您的体温实际上必须升高约一到三度。

Eight Sleep mattress covers make it extremely easy to control the temperature of your sleeping environment and thereby to control your core body temperature so that you fall and stay deeply asleep and wake up feeling your absolute best.

八个睡眠床垫套让您可以非常轻松地控制睡眠环境的温度，从而控制您的核心体温，让您入睡并保持深度睡眠，醒来时感觉绝对最佳。

I've been sleeping on an eight sleep mattress cover for about three years now, and it has completely transformed the quality of my sleep for the better.

我已经睡在八人床床垫罩上大约三年了，它完全改善了我的睡眠质量。

Eight Sleep recently launched their newest generation of pod cover, the POD four Ultra.

八睡眠最近推出了他们最新一代的 Pod 套，POD 4 Ultra。

The Pod 4 Cover has improved cooling and heating capacity, higher fidelity sleep tracking technology, and the POD four cover has snoring detection that will automatically lift your head a few degrees to improve airflow and stop your snoring.

Pod 4 Cover 具有改进的冷却和加热能力、更高保真度的睡眠跟踪技术，并且 POD 4 Cover 具有打鼾检测功能，可自动将您的头部抬起几度，以改善气流并停止打鼾。

This is really important.

这真的很重要。

Snoring is associated with something called sleep apnea and sleep apnea is known to disrupt brain health and body health in a number of ways put differently.

打鼾与睡眠呼吸暂停有关，众所周知，睡眠呼吸暂停会以多种不同的方式破坏大脑健康和身体健康。

Being able to breathe clearly throughout the night is essential for not only feeling rested when you wake up, but also for brain health and body health.

能够整夜清晰呼吸不仅对于醒来时感到休息至关重要，而且对于大脑健康和身体健康也至关重要。

If you'd like to try an eight sleep mattress cover, you can go to eight sleep.com/Huberman to save $350 off their pod.

如果您想尝试 8 sleep 床垫套，您可以访问 8 sleep.com/Huberman，在他们的 pod 上可节省 350 美元。

4 Ultra eight sleep currently ships to the USA, Canada, UK select countries in the EU and Australia.

4 Ultra 8 sleep 目前运往美国、加拿大、英国、欧盟和澳大利亚的部分国家。

Again, that's eight sleep.com/Huberman.

同样，这是八点 sleep.com/Huberman。

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

今天的节目也是由乐家给我们带来的。

Roca makes eyeglasses and sunglasses that are the absolute highest quality.

乐家 (Roca) 生产的眼镜和太阳镜绝对是最高品质的。

Now, I've spent a lifetime working on the biology of the visual system, and I can tell you that your visual system has to contend with an enormous number of different challenges in order for you to be able to see clearly.

现在，我花了一生的时间研究视觉系统的生物学，我可以告诉你，你的视觉系统必须应对大量不同的挑战，才能让你看得清楚。

Roca understands this and has developed their eyeglasses and sunglasses so that regardless of the conditions you're in, you always see with the utmost clarity.

乐家 (Roca) 深知这一点，并开发了眼镜和太阳镜，以便无论您处于何种条件下，您始终都能看得最清楚。

Roca, eyeglasses and sunglasses were initially designed for use in sport, in particular things like running and cycling.

Roca、眼镜和太阳镜最初是为运动而设计的，特别是跑步和骑自行车等运动。

Now, as a consequence, Roca frames are extremely lightweight, so much so that most of the time you don't even remember that they're on your face.

因此，现在乐家镜架非常轻巧，以至于大多数时候您甚至不记得它们戴在脸上。

They're also designed so that they don't slip off if you get sweaty.

它们还经过精心设计，即使出汗也不会滑落。

Now, even though they were initially designed for performance in sport, they now have many different frames and styles, all of which can be used in sport, but also when out to dinner at work, essentially any time and in any setting.

现在，尽管它们最初是为运动性能而设计的，但现在它们有许多不同的框架和款式，所有这些都可以在运动中使用，而且也可以在外出工作晚餐时使用，基本上可以在任何时间和任何环境下使用。

If you'd like to try Roka glasses, you can go to Rocha, that's ROK a.com and enter the code Huberman to get 20% off.

如果您想尝试 Roka 眼镜，可以前往 Rocha，即 ROK a.com，输入代码 Huberman 即可享受 20% 的折扣。

Again, that's ROK a.com and enter the code Huberman to get 20% off.

同样，这是 ROK a.com，输入代码 Huberman 即可享受 20% 的折扣。

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

今天的节目也是爱乐压为我们带来的。

AeroPress is like a French press, but a French press that always brews the perfect cup of coffee, meaning no bitterness and excellent taste.

AeroPress 就像法压壶，但法压壶总能冲泡出一杯完美的咖啡，意味着没有苦味且味道极佳。

AeroPress achieves this because it uses a very short contact time between the hot water and the coffee, and that short contact time also means that you can brew an excellent cup of coffee very quickly.

AeroPress 之所以能够实现这一点，是因为它在热水和咖啡之间使用了非常短的接触时间，而短的接触时间也意味着您可以非常快速地冲泡一杯优质的咖啡。

The whole thing takes only about three minutes.

整个过程只需要大约三分钟。

I started using an AeroPress over 10 years ago and I learned about it from a guy named Alan Adler, who's a former Stanford engineer who's also an inventor.

我十多年前开始使用 AeroPress，是从一位名叫艾伦·阿德勒 (Alan Adler) 的人那里了解到的，他是前斯坦福大学工程师，也是一位发明家。

He developed things like the Arbi Frisbee.

他开发了 Arbi 飞盘之类的东西。

In any event, I'm a big fan of Adler inventions, and when I heard he developed a coffee maker beer press, I tried it and I found that indeed it makes the best possible tasting cup of coffee.

无论如何，我是阿德勒发明的忠实粉丝，当我听说他开发了咖啡机啤酒压榨机时，我尝试了它，发现它确实可以制作出味道最好的咖啡。

It's also extremely small and portable, so I started using it in the laboratory when I travel on the road and also at home, and I'm not alone in my love of the AeroPress coffee maker with over 55,005 star reviews, AeroPress is the best reviewed coffee press in the world.

它也非常小和便携，所以我开始在实验室旅行时和家里使用它，而且我并不是唯一喜欢爱乐压咖啡机的人，它拥有超过 55,005 颗星评价，爱乐压是世界上评价最好的咖啡机。

If you'd like to try AeroPress, you can go to aeropress.com/Huberman to get 20% off.

如果您想尝试 AeroPress，可以访问 aeropress.com/Huberman 享受 20% 的折扣。

AeroPress currently ships in the USA Canada and to over 60 other countries around the world.

目前，爱乐压 (AeroPress) 向美国、加拿大和全球其他 60 多个国家/地区发货。

Again, that's aeropress.com/Huberman.

同样，这是 aeropress.com/Huberman。

I usually mention this at the end of episodes, but if you're learning from and enjoying the Huberman Lab podcast, please click the subscribe button on YouTube, and if you listen to the podcast on Spotify or Apple, make sure you click the follow tab on Spotify and or Apple and on both Spotify and Apple.

我通常会在剧集结尾提到这一点，但如果您正在学习并享受 Huberman Lab 播客，请单击 YouTube 上的订阅按钮，如果您在 Spotify 或 Apple 上收听播客，请确保单击 Spotify 和/或 Apple 以及 Spotify 和 Apple 上的“关注”选项卡。

You can also leave us up to a five star review.

您还可以给我们留下五星级的评价。

And now for my discussion with Dr. Gary Steinberg, Dr. Gary Steinberg.

现在我与加里·斯坦伯格博士进行讨论，加里·斯坦伯格博士。

Welcome.

欢迎。

Gary Steinberg:

加里·斯坦伯格：

Thank you, Andrew.

谢谢你，安德鲁。

Pleasure to be here.

很高兴来到这里。

Andrew Huberman:

安德鲁·休伯曼：

I have a lot of questions.

我有很多问题。

I know people are interested in keeping their brains healthy and sadly things happen to the brain sometimes as a consequence of aging, sometimes as a consequence of certain activities.

我知道人们对保持大脑健康很感兴趣，但遗憾的是，大脑有时会因为衰老而发生一些事情，有时则是由于某些活动的结果。

Maybe you could just explain for us right off the bat, what is a stroke, what is an aneurysm, what is a hemorrhage?

也许你可以立即为我们解释一下，什么是中风，什么是动脉瘤，什么是出血？

Where do these terms overlap?

这些术语在哪里重叠？

How are they different?

它们有何不同？

Obviously, none of us want these things, and we will talk about ways to prevent them and your ways of treating them as well, of course.

显然，我们谁都不想要这些事情，当然，我们将讨论预防它们的方法以及您处理它们的方法。

But just to start off, maybe we can just lay down the nomenclature.

但首先，也许我们可以制定术语。

Gary Steinberg:

加里·斯坦伯格：

Sure.

当然。

So a stroke is like a heart attack of the brain.

因此，中风就像大脑的心脏病发作。

It involves disruption of blood flow to the brain, either in the form of a blocked vessel or less likely a hemorrhage.

它涉及到大脑的血流中断，要么表现为血管阻塞，要么表现为不太可能的出血。

About 87% of strokes are due to a clot either forming in the brain artery itself or forming closer to the heart, in the heart or in the carotid artery and dislodging and blocking blood flow to the brain.

大约 87% 的中风是由于脑动脉本身形成血栓或在靠近心脏、心脏或颈动脉中形成的血栓导致流向大脑的血液移位和阻塞。

About 13% are caused by a hemorrhage bursting of a blood vessel, and that results in lack of oxygen and glucose being delivered to the brain cells, and that ultimately causes death of tissue and disruption of bodily functions, neurologic function, that's what a stroke is.

大约 13% 是由血管出血破裂引起的，导致脑细胞缺乏氧气和葡萄糖，最终导致组织死亡和身体功能、神经功能破坏，这就是中风。

Andrew Huberman:

安德鲁·休伯曼：

How do we know if we have a clots residing in our body that could be dislodged?

我们如何知道体内是否有可以排出的血栓？

I know that some people when they fly, wear compression socks.

我知道有些人在飞行时会穿着压力袜。

I know that some people have genetic mutations that affect clotting.

我知道有些人有影响凝血的基因突变。

I'll raise my hand here and I'll do a disclosure.

我会在这里举手并进行披露。

I did some genetic testing.

我做了一些基因测试。

I am a heterozygote for factor five Leiden, which is a clotting factor.

我是莱顿因子五的杂合子，这是一种凝血因子。

Heterozygote folks means I have one mutant copy.

杂合子意味着我有一个突变体副本。

So fortunately I don't suffer from excessive bleeding or clotting, but there are lifestyle factors that can exacerbate an existing mutation like that.

幸运的是，我没有过度出血或凝血，但生活方式因素可能会加剧现有的突变。

People who are homozygous mutants for factor five leiden, of course at much greater risk for clotting and bleeding.

莱顿因子五纯合突变体的人当然有更大的凝血和出血风险。

So I just disclosed a lot.

所以我只是透露了很多。

Maybe you could comment on some of the clotting factors and lifestyle factors that impact clotting, but how would somebody know if they've got a clot that could potentially go to their brain?

也许您可以评论一些影响凝血的凝血因素和生活方式因素，但是人们如何知道他们是否有可能进入大脑的血栓？

Gary Steinberg:

加里·斯坦伯格：

Sure.

当然。

Well, you might not know.

嗯，你可能不知道。

In many cases, you don't know, and that's the problem.

在很多情况下，你不知道，这就是问题所在。

You can have a predisposition, as you say, to certain genes that are mutated or represented that predisposed to clots, and those clots can occur on the arterial side or the venous side.

正如您所说，您可能对某些突变或代表易形成血栓的基因有一种倾向，而这些血栓可能发生在动脉侧或静脉侧。

The arterial side is what generally causes a stroke, an ischemic stroke.

动脉侧通常是导致中风（缺血性中风）的原因。

On the venous side, you can sometimes have problems when you talk about flying, not moving your legs, developing clots in your legs, wearing compression boots.

在静脉方面，当您谈论飞行、腿部不动、腿部形成血栓、穿着压缩靴时，有时可能会出现问题。

That's on the venous side, and that can cause something like a deep vein thrombosis, which is not good.

那是在静脉侧，可能会导致深静脉血栓形成，这是不好的。

It can travel to the lung and cause a pulmonary embolus that generally on the venous side does not go to the brain.

它可以传播到肺部并导致肺栓塞，而肺栓塞通常在静脉侧不会进入大脑。

Andrew Huberman:

安德鲁·休伯曼：

Oh, good.

哦，很好。

In my case, that feels fortunate.

就我而言，这感觉很幸运。

Gary Steinberg:

加里·斯坦伯格：

Exactly.

正是如此。

You can develop some venous problems in the brain, which can cause a venous type stroke.

您的大脑可能会出现一些静脉问题，从而导致静脉型中风。

That's much less common, and the way that causes a stroke is not lack of blood flow being delivered to the brain, but by having a clot in an important vein, the blood can't get out of the brain.

这种情况不太常见，导致中风的原因并不是缺乏输送到大脑的血流，而是重要静脉中出现凝块，导致血液无法流出大脑。

It backs up and causes swelling or edema, but that's much less common.

它会积聚并导致肿胀或水肿，但这种情况不太常见。

Generally, we talk about strokes as being arterial in nature and either blockage of a blood vessel or bursting of a vessel.

一般来说，我们所说的中风本质上是动脉性的，或者是血管堵塞，或者是血管破裂。

Andrew Huberman:

安德鲁·休伯曼：

What are some things that impact clotting and or excessive bleeding?

哪些因素会影响凝血和/或过度出血？

My understanding is these factor five liden mutations are one example.

我的理解是，五因素莱登突变就是一个例子。

The other is let's say somebody takes, say a blood thinning agent like baby aspirin, or I told, and I'll have to check this, I'm sure people will say in the YouTube comments that if you take lots and lots of say fish oil or things like that, you can become more of a bleeder.

另一个是假设有人服用了血液稀释剂，比如婴儿阿司匹林，或者我告诉过，我必须检查一下，我相信人们会在 YouTube 评论中说，如果你服用了很多很多鱼油或类似的东西，你会变得更容易出血。

Some people out there are hemophiliacs.

有些人是血友病患者。

And then my understanding is also that certain forms of oral contraception for women can increase the rates of bleeding.

然后我的理解是，某些形式的女性口服避孕药会增加出血率。

So tell me if I'm wrong about any of those and if any of those things predispose people to more stroke or hemorrhage.

因此，请告诉我我对这些中的任何一个是否有误，以及这些中的任何一个是否会使人们更容易中风或出血。

Gary Steinberg:

加里·斯坦伯格：

Sure.

当然。

So different kinds of drugs thin the blood and they can predispose you to having a larger hemorrhage than you would if something bursts or if you fall and have some traumatic injury to your brain or anywhere in the body.

因此，不同种类的药物会稀释血液，它们可能会使您容易出现比物体破裂或跌倒并对大脑或身体任何部位造成外伤时更大的出血。

In general, they don't cause a hemorrhage because they're fairly safe, but if there's, as I say, some interruption to the body like a bruise, it would be a much worse type of bleed.

一般来说，它们不会引起出血，因为它们相当安全，但如果像我说的那样，对身体造成一些干扰，比如瘀伤，那将是一种更严重的出血类型。

So aspirin is a type of antiplatelet agent that thins the blood.

因此，阿司匹林是一种稀释血液的抗血小板药物。

There are many types of antiplatelet agents, and they're very, very useful for treating people who have a predisposition to develop clots because they thin the blood anticoagulants are another type.

抗血小板药物有很多类型，它们对于治疗容易形成血栓的人非常非常有用，因为它们可以稀释血液，而抗凝剂是另一种类型。

They're known as Coumadin, warfarin, Eliquis.

它们被称为 Coumadin、warfarin、Eliquis。

There's lots of new agents, and they're often taken orally or can be given intravenously.

有很多新药，它们通常是口服或静脉注射。

Heparin's another one.

肝素是另一种。

Again, they thin the blood, so they would put someone at somewhat increased risk for hemorrhage.

同样，它们会稀释血液，因此会使人出血的风险有所增加。

Then as far as oral contraceptives, if you go back to the 1970s when the oral contraceptives were first generation were coming out, it turns out and they were heavily estrogen dominated rather than progesterone, they did, and they still to some extent increase the risk of developing clots.

然后就口服避孕药而言，如果你回到 20 世纪 70 年代，当时第一代口服避孕药问世，事实证明，它们主要以雌激素而非黄体酮为主，而且它们仍然在一定程度上增加了形成血栓的风险。

So women back in the seventies who took oral contraceptives and smoked had a very, very high incidence of developing clots and ischemic strokes and clots elsewhere in the body.

因此，七十年代服用口服避孕药和吸烟的女性出现血栓、缺血性中风和身体其他部位血栓的几率非常非常高。

The newer generations are much safer in terms of developing clots, but for my patients, many of whom have had strokes or at risk for stroke, we recommend that the women do not take oral contraceptives that they use some other form IUD for instance, may have a little bit of progesterone, which is released locally, but it doesn't cause a large increase in estrogens or progesterone systemically.

新一代在形成血栓方面要安全得多，但对于我的患者来说，其中许多人患有中风或有中风风险，我们建议女性不要服用口服避孕药，她们使用其他形式的宫内节育器，例如，可能会有一点黄体酮，局部释放，但不会导致全身雌激素或黄体酮大幅增加。

So we still believe that the oral contraceptives increase the risk somewhat, not the way it did for first generation.

因此，我们仍然认为口服避孕药会在一定程度上增加风险，而不是像第一代那样。

And then there are other modifiable factors besides the genetic ones.

除了遗传因素之外，还有其他可改变的因素。

So smoking is a very high risk factor for developing clots, which can lead to strokes, heart attacks, peripheral vascular disease, high lipids is another, so when people have high bad cholesterol, LDL, it's recommended that if they can't reduce it with diet, that they take a statin.

因此，吸烟是形成血栓的一个非常高的风险因素，血栓可能导致中风、心脏病、周围血管疾病，高血脂是另一个因素，因此，当人们的坏胆固醇、低密度脂蛋白含量较高时，如果无法通过饮食来降低胆固醇，建议服用他汀类药物。

The statins are very, very effective in lowering the bad cholesterol, preventing strokes and heart attack.

他汀类药物在降低坏胆固醇、预防中风和心脏病方面非常非常有效。

Interestingly, the statins have also been shown to be highly beneficial for the blood vessel integrity, even if you don't have high LDL, so they have other beneficial properties.

有趣的是，即使您的低密度脂蛋白水平不高，他汀类药物也被证明对血管完整性非常有益，因此它们还有其他有益的特性。

So again, for my patients, I often recommend they take a statin even if they don't have high cholesterol.

因此，对于我的患者，我经常建议他们服用他汀类药物，即使他们的胆固醇水平不高。

Interesting.

有趣的。

And then hypertension is another risk factor for developing clots and arterial disease.

高血压是形成血栓和动脉疾病的另一个危险因素。

Andrew Huberman:

安德鲁·休伯曼：

When you say that smoking dramatically increases the risk of stroke, is that because of nicotine per se?

当您说吸烟会大大增加中风的风险时，这是因为尼古丁本身吗？

Is it the vasoconstriction and blood pressure elevation that comes from nicotine itself or is there something about smoking, maybe even vaping?

是尼古丁本身引起的血管收缩和血压升高，还是与吸烟甚至电子烟有关？

I don't know that the contaminants, the other chemicals in cigarettes or vape chemicals that increases the stroke risk, or is it nicotine itself?

我不知道污染物、香烟或电子烟中的其他化学物质会增加中风风险，还是尼古丁本身？

Gary Steinberg:

加里·斯坦伯格：

It's not just nicotine.

这不仅仅是尼古丁。

Nicotine is one of the factors, but it's the other products that are produced by smoking that can have an effect.

尼古丁是其中一个因素，但吸烟产生的其他产物也会产生影响。

Andrew Huberman:

安德鲁·休伯曼：

So given that so many fewer, at least Americans, and I think worldwide people are smoking less, are we seeing less stroke?

因此，考虑到吸烟人数减少了很多，至少是美国人，而且我认为全世界的人吸烟人数都减少了，我们中风的情况是否有所减少？

Gary Steinberg:

加里·斯坦伯格：

Yes.

是的。

The instance of stroke is actually decreasing.

中风的发生率实际上正在减少。

It may be in part due to decreased smoking, but it also is in part due to other modifiable factors.

部分原因可能是吸烟减少，但也有部分原因是其他可改变的因素。

So hypertension is much better treated now than it used to be.

因此，现在高血压的治疗比以前好得多。

People take better care of themselves in terms of other lifestyle factors, so people exercise more, there's a lower incidence in some subgroups of obesity.

人们在其他生活方式因素方面会更好地照顾自己，因此人们锻炼得更多，某些亚组的肥胖发生率较低。

Those are the risk factors also for developing strokes as well as heart attack.

这些也是发生中风和心脏病的危险因素。

Andrew Huberman:

安德鲁·休伯曼：

What is the relationship between heart health and brain health as it relates to stroke?

心脏健康和大脑健康与中风有何关系？

I would imagine that anything that's good for our heart is probably good for our brain, given the enormous amounts of blood and glucose that the brain requires to function normally.

我想任何对我们的心脏有益的东西都可能对我们的大脑有益，因为大脑需要大量的血液和葡萄糖才能正常运作。

Gary Steinberg:

加里·斯坦伯格：

Yeah, it's a good point.

是的，这是一个好点。

In general, the things that are good for the heart are good for the brain.

一般来说，对心脏有益的东西对大脑也有好处。

There are differences between the heart and the brain, but they both depend very much on blood flow.

心脏和大脑之间存在差异，但它们都非常依赖于血流。

The brain's unique though because the brain represents only 2% of the body weight, yet it draws 15% of the total blood flow, and remarkably it consumes 20% of the body's oxygen.

大脑的独特之处在于，大脑仅占体重的 2%，但却吸收了总血流量的 15%，而且值得注意的是，它消耗了身体 20% 的氧气。

Amazing.

惊人的。

So the brain, I still think the brain is the most important organ, not the heart, not the kidneys, but I'm biased.

所以大脑，我仍然认为大脑是最重要的器官，不是心脏，不是肾脏，但我有偏见。

Of course.

当然。

Andrew Huberman:

安德鲁·休伯曼：

Yeah.

是的。

You've spent some time in the landscape of the brain.

你已经在大脑的景观中度过了一段时间。

Yeah.

是的。

It is clear that of all the tissues in the body, if you had to pick one tissue to remove one cubic millimeter of that tissue, that your brain and probably the neural retina would be your least favorite choice, just given the deficits that can result.

很明显，在身体的所有组织中，如果你必须选择一种组织来去除该组织的一立方毫米，那么你的大脑和神经视网膜可能是你最不喜欢的选择，只是考虑到可能导致的缺陷。

Gary Steinberg:

加里·斯坦伯格：

Right.

对。

And of course, the brain also is what makes us human.

当然，大脑也是我们成为人类的原因。

Andrew Huberman:

安德鲁·休伯曼：

Right.

对。

Speaking of which, if we take a little departure into neurosurgery itself, specialty of all the years of doing brain surgery,

说到这里，如果我们稍微偏离一下神经外科本身，多年来进行脑外科手术的专业，

Can you recall maybe one of the most incredible moments or days that allowed for some insight into how the brain works by virtue of, let's say, stimulating a given brain area or removing a given brain area or something of that sort?

您能否回忆起最令人难以置信的时刻或日子之一，通过刺激特定的大脑区域或移除特定的大脑区域或类似的东西，可以深入了解大脑的工作原理？

I ask this because so very few of us will ever have the opportunity to do what you do, and if I were here talking to an astronaut, and by the way, I consider neurosurgeons the astronauts of neuroscience, if I were sitting here with an astronaut, I'd say, tell me something interesting about being in space that I wouldn't know from looking at pictures or videos of it.

我问这个问题是因为我们中很少有人有机会做你所做的事情，如果我在这里与一位宇航员交谈，顺便说一句，我认为神经外科医生是神经科学的宇航员，如果我和一位宇航员坐在这里，我会说，告诉我一些关于在太空中的有趣的事情，我通过观看照片或视频无法知道这些有趣的事情。

What is an example of maybe one of the more profound insight stimulating moments from doing

举个例子，也许是从做事中激发出更深刻的洞察力的时刻之一

Gary Steinberg:

加里·斯坦伯格：

Brain surgery?

脑部手术？

Yeah, I mean, every patient is different, so I'm always learning, and that's why I still enjoy it, that it's a challenge and you have to think quickly.

是的，我的意思是，每个病人都是不同的，所以我总是在学习，这就是为什么我仍然喜欢它，这是一个挑战，你必须快速思考。

It's not simply mechanical, but for instance, a couple weeks ago I had a patient who had a vascular malformation, which was located, we thought right in her speech area.

这不仅仅是机械问题，例如，几周前，我有一位患有血管畸形的患者，我们认为该血管畸形位于她的言语区域。

So in order to operate safely first, we did what's called a functional MR scan before surgery, and that gives us some idea of where the speech area is.

因此，为了首先安全地进行手术，我们在手术前进行了所谓的功能性核磁共振扫描，这让我们对言语区域的位置有了一些了解。

We can map it out on an MR scan, and the way it's mapped out is we have the patient awake talk to us when they do the scan, and because there's a coupling between blood flow and the neuronal activity when the speech area, the language area is stimulated by talking, there's increased blood flow to that area, and we can see that on an MR scan.

我们可以在 MR 扫描上绘制出来，绘制的方式是让患者在扫描时保持清醒，与我们交谈，因为当言语区域、语言区域受到说话刺激时，血流和神经元活动之间存在耦合，流向该区域的血流量增加，我们可以在 MR 扫描中看到这一点。

That's how the MR scan works.

这就是 MR 扫描的工作原理。

So we have some idea that this was very close, if not in the speech area, but the most accurate way of determining that is to operate on the patient with her awake.

所以我们有一些想法，即使不是在言语区域，这也非常接近，但确定这一点的最准确方法是在患者清醒的情况下对她进行手术。

So what we did was we sedate the patient.

所以我们所做的就是给病人注射镇静剂。

We don't put a tube down and induce general anesthesia.

我们不会放置管子并进行全身麻醉。

We numb up the scalp, we take off a piece of bone after cutting the scalp open, the membrane covering the brain called the dura, and then we allow the patient to wake up more from the sedation.

我们麻醉头皮，切开头皮后取下一块骨头，覆盖大脑的膜称为硬脑膜，然后让患者从镇静中清醒过来。

And then what I did on this particular patient was to use a tiny stimulator, a little probe, and I can stimulate areas of her cortex with her awake and see if the stimulation impairs her ability to speak or understand language.

然后我对这个特定的病人所做的就是使用一个微型刺激器，一个小探针，我可以在她清醒的情况下刺激她的皮质区域，看看刺激是否会损害她说话或理解语言的能力。

And quite surprisingly, there was no activity in the corridor that I chose.

令人惊讶的是，我选择的走廊里没有任何活动。

Sometimes when we see an area that is involved with speech that's eloquent, we have to choose a different pathway to get to the underlying vascular problem.

有时，当我们看到某个区域涉及雄辩的演讲时，我们必须选择不同的途径来解决潜在的血管问题。

And so that's what we did in this case, and she talked to us the entire case.

这就是我们在这个案例中所做的，她向我们讲述了整个案例。

She told us about her daughter who was very involved in debate and all of her successes while we were operating, while I was taking out this vascular malformation under 20 magnification with very special instruments.

她向我们讲述了她女儿的故事，她非常热衷于辩论，以及她在我们手术期间所取得的所有成功，而我则用非常特殊的仪器在 20 倍放大倍数下取出了这个血管畸形。

I use a laser now, which has a diameter of the fiber optic cable.

我现在使用激光，其直径与光纤电缆相同。

The laser tip is 0.5 millimeters.

激光尖端为 0.5 毫米。

So that I think is the generalist way.

所以我认为这是通才的方式。

Other times I've been surprised about brain function is operating deep in the brain.

其他时候，我对大脑深处的大脑功能运作感到惊讶。

There's a part of the brain called the brainstem, which you know well, it's a small area that connects the thalamus.

大脑的一部分叫做脑干，你很清楚，它是连接丘脑的一个小区域。

Those are the signals coming from the cortex go through the thalamus to get down to the face, arm and leg to move the muscles, and all the sensory information, which comes from the arms and the legs and face goes through the brainstem, up to the thalamus and then to the cortex.

这些来自皮质的信号通过丘脑到达面部、手臂和腿部以移动肌肉，所有来自手臂、腿部和面部的感觉信息通过脑干，到达丘脑，然后到达皮质。

In this area, although it's very small, are contained very closely packed fiber tracts and nuclei.

该区域虽然很小，但包含非常紧密的纤维束和细胞核。

Those are the cell bodies, very important neurons.

这些是细胞体，非常重要的神经元。

And when I trained back in the eighties, we never operated in that area because we couldn't do it safely.

当我在八十年代训练时，我们从未在该地区进行过操作，因为我们无法安全地进行操作。

With developments in computer technology and imaging and anesthesia, we can now find safe corridors to get into the brainstem, and sometimes we stimulate for other pathways, not language, but other pathways.

随着计算机技术、成像和麻醉的发展，我们现在可以找到进入脑干的安全通道，有时我们会刺激其他通路，不是语言，而是其他通路。

And I'm continually amazed this last week I took out two vascular malformations, and they're not big.

我一直很惊讶上周我取出了两个血管畸形，而且它们并不大。

I mean, they measure between eight millimeters and a centimeter, but they can wreak havoc in the brainstem because it's such high price real estate, and these had bled, but I found a safe car to go through.

我的意思是，它们的尺寸在八毫米到一厘米之间，但它们会对脑干造成严重破坏，因为这是如此昂贵的房地产，而且这些已经流血了，但我找到了一辆安全的车可以通过。

I took it out, and I'm amazed that you hardly set the patients back in some cases because in the past we would've clobbered the patients doing that.

我把它拿出来，令我惊讶的是，在某些情况下，你几乎没有让病人退缩，因为在过去，我们这样做会痛打病人。

Andrew Huberman:

安德鲁·休伯曼：

Amazing.

太棒了。

Yeah, it's remarkable to me how much can be done now with imaging.

是的，对我来说，现在成像技术可以做很多事情，这对我来说是很了不起的。

So visualizing the brain and being able to target a specific location.

因此，可视化大脑并能够瞄准特定位置。

And you mentioned fiber to optic cables.

您提到了光纤到光缆。

I've also heard of things like the gamma knife and lasers.

我还听说过伽玛刀和激光之类的东西。

So how much of neurosurgery nowadays is actually burrowing down through the brain to a given location to stimulate or remove tissue versus using these laser or fiber optic approaches to of triangulate and get to something without having to basically drill down through the brain?

那么，现在有多少神经外科实际上是在大脑中挖掘到给定位置以刺激或去除组织，而不是使用这些激光或光纤方法进行三角测量并基本上不需要深入大脑就可以得到某些东西呢？

Gary Steinberg:

加里·斯坦伯格：

Right.

对。

Neurosurgery is becoming much less invasive, and this is something that I really tried to push when I was chair of the department for 25 years at Stanford.

神经外科的侵入性正在变得越来越小，这是我在斯坦福大学担任系主任 25 年时真正努力推动的事情。

So minimally invasive techniques include operating through the vessels, right?

那么微创技术包括通过血管进行手术，对吧？

So now I don't do this myself, but my colleagues, some of whom are neurosurgeons, some are interventional radiologists.

所以现在我自己不做这件事，但我的同事们，其中一些是神经外科医生，一些是介入放射科医生。

They can go through the groin in the femoral artery or through the radial artery.

它们可以通过股动脉或桡动脉穿过腹股沟。

They can thread a catheter backwards into the brain from the groin.

他们可以将导管从腹股沟向后穿入大脑。

They can go up into the aorta, then up into the carotid artery.

它们可以向上进入主动脉，然后向上进入颈动脉。

From there, they can go up into the brain arteries, the middle cerebral artery, and they can treat some of the hemorrhagic problems like aneurysms by deploying thrombogenic coils there or new devices, they can pull clots out.

从那里，他们可以进入脑动脉，大脑中动脉，他们可以通过在那里部署血栓形成线圈或新装置来治疗一些出血问题，例如动脉瘤，他们可以将血栓拉出来。

If there's an acute stroke from a clot in an artery in the brain, it's really quite impressive.

如果大脑动脉中的血栓导致急性中风，那真是令人印象深刻。

Then we and others have developed techniques to use focus radiation on the brain, and that's called radiosurgery.

然后我们和其他人开发了对大脑使用聚焦辐射的技术，这就是所谓的放射外科手术。

So examples of that are gamma knife.

伽玛刀就是这样的例子。

CyberKnife was invented at Stanford by one of my colleagues actually, and this uses beams of radiation.

实际上，射波刀是我的一位同事在斯坦福大学发明的，它使用的是辐射束。

Gamma knife uses a cobalt source, multiple sources of cobalt.

伽玛刀使用一个钴源，多个钴源。

The CyberKnife uses X-rays.

Cyber​​Knife 使用 X 射线。

When I started, I was very involved with using cyclotron generated heavy particles like helium and proton, and they can be focused.

当我开始时，我非常热衷于使用回旋加速器产生氦和质子等重粒子，并且它们可以被聚焦。

And the advantage of this is you don't have to open the skull.

这样做的好处是你不必打开头骨。

You focus it on a very small area, and you can eliminate vascular malformations called arteriovenous malformations tumors.

你把它集中在一个非常小的区域，你就可以消除称为动静脉畸形肿瘤的血管畸形。

You can even use it for some pain conditions like trigeminal neuralgia.

您甚至可以将它用于治疗某些疼痛状况，例如三叉神经痛。

It's not risk-free because even though radiation doesn't require opening the skull, it still is a form of energy that's damaging.

它并非没有风险，因为即使辐射不需要打开头骨，它仍然是一种具有破坏性的能量形式。

That's how it works.

这就是它的工作原理。

It causes for the AVMs, it gradually clots off the blood vessels, but it's much easier and much safer than some of the invasive techniques that we use.

它会导致 AVM 逐渐凝结血管，但它比我们使用的一些侵入性技术更容易、更安全。

We operate now through tiny openings.

我们现在通过微小的开口进行操作。

Even when we do open surgery, when I trained, we used to shave the whole head.

即使我们做开放手术，当我训练时，我们也会剃掉整个头部。

We would open a huge area of the skull.

我们会打开头骨的一大片区域。

Now we operate through tiny, very small areas.

现在我们在非常小的区域开展业务。

When I take out vascular malformations in the brainstem, for instance, I sometimes operate through openings in the side of the brainstem that are two to three millimeters.

例如，当我切除脑干中的血管畸形时，有时我会通过脑干侧面两到三毫米的开口进行手术。

Wow.

哇。

Another form of non-invasive treatment that neurosurgeons use is called focused ultrasound.

神经外科医生使用的另一种非侵入性治疗称为聚焦超声。

Again, you don't have to open the skull.

再说一次，你不必打开头骨。

It focuses sound waves on areas of the brain.

它将声波聚焦在大脑区域。

We're using that to treat essential tremor or Parkinson's disease.

我们用它来治疗特发性震颤或帕金森病。

It's starting to be used for treating tumors.

它开始用于治疗肿瘤。

So these are all advances that were not present when I trained.

所以这些都是我训练时不存在的进步。

Another way of treating minimally invasive, although it still requires a hole in the head, is to put in an electrode and stimulate the brain.

另一种微创治疗方法是放入电极并刺激大脑，尽管它仍然需要在头部打一个洞。

So that was first used for treating Parkinson's disease very effective for medically intractable Parkinson's.

因此，它首先用于治疗帕金森病，对医学上难以治愈的帕金森病非常有效。

It's used to treat chronic pain.

它用于治疗慢性疼痛。

Recently it was shown to be beneficial for epilepsy.

最近，它被证明对癫痫有益。

In fact, the two major trials, prospective randomized trials that were done were led by physicians neurologists at Stanford and showed the benefit of stimulation of the brain to treat a very difficult epilepsy.

事实上，这两项主要试验，即前瞻性随机试验，是由斯坦福大学的神经科医生领导的，显示了刺激大脑对于治疗非常困难的癫痫症的好处。

So this I think is going to be the future is more and more minimally invasive.

所以我认为未来会越来越微创。

In fact, we're using some of these techniques to even treat psychiatric disorders like depression, obsessive compulsive behavior.

事实上，我们甚至正在使用其中一些技术来治疗抑郁症、强迫行为等精神疾病。

Andrew Huberman:

安德鲁·休伯曼：

Incredible.

难以置信。

I should have asked this earlier, but TIAs transient ischemic attacks.

我应该早点问这个问题，但 TIA 是短暂性脑缺血发作。

I think most people assume or know that the symptoms of stroke include sudden weakness, maybe hemi paralysis of the face, confusion, slurring of the words.

我想大多数人都认为或知道中风的症状包括突然虚弱，可能是半边脸瘫痪、意识混乱、言语含糊不清。

Of course, these symptoms can be the consequence of other things as well.

当然，这些症状也可能是其他原因造成的。

What are some of the symptoms of transient ischemic attacks, and is there anything that people can take for transient ischemic attacks?

短暂性脑缺血发作有哪些症状？人们可以服用什么药物来治疗短暂性脑缺血发作？

And I of course would love for you to inform us what a transient ischemic attack is.

我当然希望您能告诉我们什么是短暂性脑缺血发作。

Gary Steinberg:

加里·斯坦伯格：

Right.

对。

So a transient ischemic attack or TIA is a reversible stroke.

因此，短暂性脑缺血发作或 TIA 是一种可逆性中风。

It results in a temporary loss of function such as inability to move partial paralysis or complete paralysis, but then it resolves inability to speak visual problems, double vision, blurred vision, loss of vision.

它会导致暂时的功能丧失，例如无法移动，部分瘫痪或完全瘫痪，但随后它可以解决无法说话的视觉问题、复视、视力模糊、视力丧失。

It can cause slurred speech or difficulty understanding language imbalance problems, walking, even cognitive problems.

它会导致言语不清或理解困难、语言不平衡问题、行走问题，甚至认知问题。

So it can vary depending on what part of the brain it affects.

因此，它可能会根据它影响大脑的哪个部分而有所不同。

In the past, it was defined as a neurologic deficit due to lack of blood flow that lasted less than 24 hours.

过去，它被定义为由于持续不到 24 小时的血流不足而导致的神经功能缺损。

But now that we have such sophisticated imaging like MR Scan, some of these patients who have a, what would've been considered a TIA before lasting minutes or up to 24 hours on MR scan have been shown to have a little stroke.

但现在我们有了像 MR 扫描这样复杂的成像技术，其中一些在 MR 扫描持续几分钟或长达 24 小时之前被认为是 TIA 的患者已被证明患有轻微中风。

So now the definition is a little different.

所以现在的定义有点不同。

If you do an MR scan and it shows a new abnormality, a new stroke, then it's called a stroke rather than a TIA.

如果您进行 MR 扫描并显示新的异常，即新的中风，那么它被称为中风而不是 TIA。

So there's a little overlap there, but it's a temporary loss of neurologic function due to lack of blood flow or in some cases a hemorrhage.

所以那里有一点重叠，但这是由于缺乏血流或在某些情况下出血而导致的神经功能暂时丧失。

Andrew Huberman:

安德鲁·休伯曼：

My understanding is that people can also have strokes in their spinal cord because spinal cord tissue is after all central nervous system tissue.

我的理解是，人们的脊髓也可能发生中风，因为脊髓组织毕竟是中枢神经系统组织。

I think most people don't realize this, but the tail end of the brain, the brain stem, as we were talking about before, essentially extends down the spinal column, sort of like a long tail down to the base of the pelvis really.

我想大多数人都没有意识到这一点，但大脑的尾端，即脑干，正如我们之前讨论的那样，本质上沿着脊柱延伸，有点像一条长尾巴，一直延伸到骨盆的底部。

So we call it the spinal cord, but it's all brain.

所以我们称之为脊髓，但它都是大脑。

It's contiguous with the brain.

它与大脑相连。

So how often do you observe spinal strokes and what are some of the symptoms of spinal stroke?

那么您多久观察一次脊髓中风以及脊髓中风的一些症状是什么？

Gary Steinberg:

加里·斯坦伯格：

Yeah, it's much less common than a stroke involving the brain, probably because there's less tissue involved.

是的，它比涉及大脑的中风要少得多，可能是因为涉及的组织较少。

The spinal cord is supplied by an anterior spinal artery that's an artery on this side, and by two,

脊髓由脊髓前动脉（这一侧的动脉）供血，并且由两条，

Andrew Huberman:

安德鲁·休伯曼：

So for those listening, sorry, it would be the, sorry, on the stomach side of the body,

所以对于那些听的人来说，抱歉，这将是，抱歉，在身体的胃侧，

Gary Steinberg:

加里·斯坦伯格：

And it's supplied by two arteries posterior spinal on the backside.

它由背面的两根脊髓后动脉供血。

So if there's an interruption to blood flow in any of those arteries, it can cause death of tissue in the spinal cord, and that would result in a neurologic deficit depending on where it is.

因此，如果任何动脉中的血流中断，都可能导致脊髓中的组织死亡，这将导致神经功能缺损，具体取决于其所在位置。

So if it occurred on the stomach side, that whole artery which supplies the two thirds of the spinal cord on the stomach side, and it involved both sides of the spinal cord, it would cause paralysis of both legs and a partial sensory deficit would cause loss of pain and temperature.

所以如果发生在胃侧，供应胃侧三分之二脊髓的整条动脉，涉及到两侧脊髓，就会导致双腿瘫痪，局部感觉缺失，就会导致疼痛和体温的丧失。

That's where those pathways are.

那就是那些路径所在的地方。

If the problem was on the backside of the cord, it would cause a problem potentially with a light touch sensation in the legs if it was below the cervical region.

如果问题出在绳索的背面，如果绳索位于颈部以下，则可能会导致腿部出现轻微的触觉问题。

And problems with what's called proprioception, that's the ability to recognize where your position of your joints is.

还有所谓的本体感觉的问题，即识别关节位置的能力。

So it depends on where it is.

所以这取决于它在哪里。

Some of the vascular problems I deal with actually do involve the spinal cord, and you can develop other problems there.

我处理的一些血管问题实际上确实涉及脊髓，并且那里可能会出现其他问题。

For instance, you can have a direct connection between a abnormal artery and a vein in the spinal cord, which doesn't cause a typical stroke by blocking blood flow, but it causes more of that venous problem we discussed where there's so much blood going directly from the artery to the vein, bypassing the capillaries that the veins become engorged, the blood can't get out of the spinal cord and the spinal cord becomes congested, and patients can present with problems walking or sensory problems.

例如，异常动脉和脊髓中的静脉之间可能存在直接连接，这不会通过阻塞血流而导致典型的中风，但它会导致更多我们讨论过的静脉问题，即有大量血液直接从动脉流向静脉，绕过毛细血管，导致静脉充血，血液无法流出脊髓，脊髓变得充血，患者可能会出现行走问题或感觉问题。

If the spinal cord is involved in the cervical region up high, then the arms could be involved as well.

如果脊髓累及颈部高位区域，那么手臂也可能累及。

Andrew Huberman:

安德鲁·休伯曼：

I see.

我明白了。

I should have asked this earlier, but is there any relationship between alcohol intake and the propensity for stroke or hemorrhage or any of these other

我应该早点问这个问题，但是酒精摄入量与中风或出血或任何其他疾病的倾向之间有任何关系吗？

Gary Steinberg:

加里·斯坦伯格：

Things?

东西？

Yeah, that's a good question.

是的，这是一个好问题。

Yes, there is.

是的，有。

The people who indulge or overindulge are at risk for developing stroke problems.

沉迷或过度沉迷的人有患中风问题的风险。

So it's another contributory factor which can promote problems with the blood vessels, clots, but also hemorrhage, so it can make the blood vessels more fragile.

因此，它是另一个促成因素，可以促进血管、血栓和出血问题，因此它可以使血管更加脆弱。

Another factor I see commonly in patients who develop aneurysms, those are blisters on the blood vessels in the brain, and they're like little balloons, and as they enlarge, they rupture just like a balloon can burst.

我在患有动脉瘤的患者中经常看到的另一个因素是大脑血管上的水泡，它们就像小气球，当它们扩大时，它们就会像气球一样破裂。

Some of the patients I see are not just smokers, but indulge in other drugs.

我接诊的一些患者不仅是吸烟者，还沉迷于其他药物。

So cocaine, methamphetamines markedly increase the risk of developing these aneurysms or developing hemorrhage, bursting of a blood vessel.

因此，可卡因、甲基苯丙胺会显着增加发生动脉瘤或出血、血管破裂的风险。

Andrew Huberman:

安德鲁·休伯曼：

And is that because those drugs tend to increase blood pressure during their use, it's

因为这些药物在使用过程中会导致血压升高，所以

Gary Steinberg:

加里·斯坦伯格：

Because they damage the vessels and they also cause hypertension?

因为它们会损害血管并且还会导致高血压？

Yes.

是的。

It's both factors.

这是两个因素。

So when I operate on these patients and looking at the vessels, they are, they're ragged, they're very thin, they're not normal vessels.

因此，当我对这些患者进行手术并观察血管时，它们是破烂的、非常薄的，它们不是正常的血管。

They lack structural integrity.

它们缺乏结构完整性。

So it contributes to the development of poor vessel integrity and drugs like cocaine and methamphetamine can jack the blood pressure up and that could cause a hemorrhage in these problematic vessels.

因此，它会导致血管完整性不良，而可卡因和甲基苯丙胺等药物会导致血压升高，并可能导致这些有问题的血管出血。

Yes.

是的。

Andrew Huberman:

安德鲁·休伯曼：

So it sounds like the message is clear, avoid cocaine use, avoid methamphetamine use, and avoid excessive alcohol intake if you want to avoid stroke.

因此，听起来信息很明确，如果你想避免中风，请避免使用可卡因，避免使用甲基苯丙胺，并避免过量饮酒。

Gary Steinberg:

加里·斯坦伯格：

Right.

对。

And throw smoking in there too.

还把烟也扔在那里。

Andrew Huberman:

安德鲁·休伯曼：

It's interesting because for a lot of years there was so much discussion about red wine being good for heart health.

这很有趣，因为多年来人们一直在讨论红酒有益于心脏健康。

Now it's debated the moment I say that people will send a bunch of studies that say yes.

现在，当我说人们会发送大量研究表明是的时候，就会引起争论。

My stance on the more recent data is that if you had to pick, you'd drink less or not drink as opposed to drink.

我对最新数据的立场是，如果你必须选择，你会少喝或不喝，而不是喝酒。

But I'm curious what your take is on this.

但我很好奇你对此有何看法。

Gary Steinberg:

加里·斯坦伯格：

Well, this is interesting, and I'm always quite amazed at the way people change their behavior based on one study that comes out, even if it's a good study.

嗯，这很有趣，我总是对人们根据一项研究而改变行为的方式感到惊讶，即使这是一项很好的研究。

So yes, it used to be considered beneficial if you drank red wine and then for a while study showed any wine was beneficial in moderation.

所以，是的，过去人们认为喝红酒是有益的，但一段时间的研究表明，适量饮用任何葡萄酒都是有益的。

And that used to be two drinks a day for men, one drink a day for women, and in the latest studies, which have been surfacing this year suggests no alcohol is good.

过去，男性每天喝两杯，女性每天喝一杯，而今年公布的最新研究表明，没有酒精是好的。

But next year it may be that we're back to, oh, wine is the best thing you can do for in moderation for your brain and heart health.

但明年我们可能会回到这样的观点：哦，为了大脑和心脏健康，适量饮酒是最好的选择。

So yeah,

所以是的，

Andrew Huberman:

安德鲁·休伯曼：

It's tricky.

这很棘手。

My read of the data and here, I mean the data across multiple, certainly not every study, but multiple studies is that zero to two drinks per week seems to be the range that everyone agrees is safe, at least for non-alcoholic adults.

我读到的数据在这里，我指的是多项研究的数据，当然不是每项研究，但多项研究表明，每周饮酒零到两杯似乎是每个人都认为安全的范围，至少对于不酗酒的成年人来说是这样。

And then once you get out past two drinks per week is when it gets into the gray zone where some people say it's good, some people say it's neutral, some people say it's bad, but that once you get up past four or five servings of alcohol per week, it's pretty clear to me it's not a good situation.

一旦你每周喝超过两杯酒，就会进入灰色地带，有些人说它很好，有些人说它是中性的，有些人说它不好，但一旦你每周喝超过四到五杯酒，我就很清楚这不是一个好情况。

Gary Steinberg:

加里·斯坦伯格：

Well, that was the prevailing theory until this year, and I don't know if you've kept up, but in the past few months there have been several articles published saying, no, alcohol is good.

嗯，这是今年之前流行的理论，我不知道你是否跟上，但在过去的几个月里，已经发表了几篇文章说，不，酒精是好的。

But then you have to balance that against the fact that alcohol for many people tends to relieve stress.

但你必须权衡这一点，因为酒精对许多人来说往往可以缓解压力。

So if you're relieving, stress may be it counteracts any adverse effects.

因此，如果您正在缓解压力，压力可能会抵消任何不利影响。

So complicated issue, but my theory is moderation is the key to life and happiness also we know promotes longevity.

问题如此复杂，但我的理论是节制是生活的关键，我们也知道幸福可以延长寿命。

Andrew Huberman:

安德鲁·休伯曼：

Absolutely.

绝对的。

I agree with you.

我同意你的看法。

I'm not heavy handed about the alcohol thing.

我对酒精的事情并不严厉。

I always just say, do as you wish, but know what you're doing.

我总是说，做你想做的事，但要知道你在做什么。

And I think many people who heard our podcast episode about alcohol who stopped drinking alcohol or who elected to drink less did so I'm told because they really didn't enjoy it that much to begin with.

我认为很多听过我们关于酒精的播客节目的人都停止饮酒或选择少喝酒，因为他们一开始就不太喜欢喝酒。

So it more or less gave them permission to drink less.

所以这或多或少允许他们少喝酒。

Not that they needed it, but they took it anyway.

并不是说他们需要它，但他们还是拿走了它。

I think it's a really interesting area, as you mentioned, probably lowers stress.

我认为这是一个非常有趣的领域，正如您提到的，可能会减轻压力。

It probably also disrupts patterns of sleep and the gut microbiome.

它可能还会扰乱睡眠模式和肠道微生物组。

So you can't escape in biology, there's always some modulatory influence on something else.

所以在生物学中你无法逃脱，总有一些对其他事物的调节影响。

Gary Steinberg:

加里·斯坦伯格：

Exactly.

正是如此。

Andrew Huberman:

安德鲁·休伯曼：

I'd like to take a brief break and acknowledge our sponsor AG one by now.

我想稍微休息一下，现在向我们的赞助商 AG 致谢。

Most of you have heard me tell my story about how I've been taking AG one once or twice a day every day since 2012, and that's true.

你们中的大多数人都听过我讲述自 2012 年以来我如何每天服用一到两次 AG 的故事，这是事实。

I started taking AG one and I still take ag one once or twice a day because it gives me vitamins and minerals that I might not be getting enough of from whole foods that I eat as well as adaptogens and micronutrients.

我开始服用 AG One，现在仍然每天服用一到两次，因为它为我提供了维生素和矿物质，而我可能无法从我吃的天然食物中获取足够的维生素和矿物质，以及适应原和微量营养素。

And those adaptogens and micronutrients are really critical because even though I strive to eat most of my foods from unprocessed or minimally processed whole foods, it's often hard to do so, especially when I'm traveling and especially when I'm busy.

这些适应原和微量营养素非常重要，因为尽管我努力吃未加工或最低限度加工的天然食品中的大部分食物，但通常很难做到这一点，尤其是当我在旅行时，尤其是当我很忙时。

So by drinking a packet of ag one in the morning, and oftentimes also again in the afternoon or evening, I'm ensuring that I'm getting everything I need.

因此，通过早上喝一包，并且经常在下午或晚上再喝一次，我可以确保我得到了我需要的一切。

I'm covering all of my foundational nutritional needs, and I like so many other people that take AG one regularly just report feeling better.

我满足了我所有的基本营养需求，而且我和很多其他定期服用 AG 的人一样，只是报告感觉更好了。

And that shouldn't be surprising because it supports gut health.

这并不奇怪，因为它支持肠道健康。

And of course gut health supports immune system health and brain health, and it's supporting a ton of different cellular and organ processes that all interact with one another.

当然，肠道健康支持免疫系统健康和大脑健康，并且支持大量相互相互作用的不同细胞和器官过程。

So while certain supplements are really directed towards one specific outcome, like sleeping better or being more alert, AG one really is foundational nutritional support.

因此，虽然某些补充剂确实针对一种特定的结果，例如睡得更好或更加警觉，但 AG 确实是基础营养支持。

It's really designed to support all of the systems of your brain and body that relate to mental health and physical health.

它的真正目的是支持与心理健康和身体健康相关的大脑和身体的所有系统。

If you'd like to try AG one, you can go to drink ag one.com/Huberman to claim a special offer.

如果您想尝试 AG one，可以前往 Drink ag one.com/Huberman 申请特别优惠。

They'll give you five free travel packs with your order plus a year's supply of vitamin D three K two.

您订购后，他们将赠送您 5 个免费旅行包，外加一年的维生素 D 3 K 2 供应。

Again, that's drink ag one.com/Huberman.

再说一次，那是饮料 ag one.com/Huberman。

Speaking of lifestyle factors, anytime we hear about traumatic brain injury or concussion, people immediately seem to think about football.

说到生活方式因素，每当我们听到脑外伤或脑震荡时，人们似乎都会立即想到足球。

But I'm told by colleagues of ours in neurosurgery at Stanford and in Neuroengineering that most head injuries are not from football.

但斯坦福大学神经外科和神经工程系的同事告诉我，大多数头部受伤并不是由足球造成的。

They're not even from sport, they're from construction work accidents, they're from car accidents.

它们甚至不是来自体育运动，它们来自建筑工事事故，它们来自车祸。

What is your take on somebody, let's say God forbid, gets rear-ended in a car accident, maybe gets whiplash, maybe they're feeling a little off, maybe they have a minor concussion, maybe there was some movement of the brain that wasn't good.

你对某人的看法是什么，假设上帝保佑，在一场车祸中被追尾，也许受到鞭打，也许他们感觉有点不对劲，也许他们有轻微脑震荡，也许大脑有一些不好的运动。

What's the going consensus on how to deal with that sleep more, but then they tell you not to sleep excessively.

关于如何应对多睡的问题目前有什么共识，但他们告诉你不要睡得太多。

Should people take blood thinning agents?

人们应该服用血液稀释剂吗？

I mean obviously avoid alcohol or certainly don't get another head injury anytime soon, but what do we know about TBI and concussion that can help people move through that period in the weeks and months afterwards where it's really scary?

我的意思是显然要避免饮酒，或者肯定不会很快再次遭受头部受伤，但是我们对创伤性脑损伤和脑震荡了解多少，可以帮助人们在几周和几个月后度过那段真正可怕的时期？

If you've ever had a hard head hit and they go, they might scan you, they might not see a bleed, but it's kind of scary when you feel a little bit off because you've been hitting in the head.

如果你的头部曾遭受过重击，他们会去检查你，他们可能看不到流血，但当你因为头部受到撞击而感到有点不舒服时，那就有点可怕了。

Gary Steinberg:

加里·斯坦伯格：

Yeah, it's a great question.

是的，这是一个很好的问题。

And there's a lot of interesting concussion.

还有很多有趣的震荡。

Now, I got very involved in this back in the nineties.

现在，我在九十年代就非常参与其中。

I was the 49 ERs neurosurgeon for a decade from 1990 to 2000.

从 1990 年到 2000 年的十年间，我担任了 49 名急诊室的神经外科医生。

Andrew Huberman:

安德鲁·休伯曼：

How are they doing in that point?

他们在这一点上做得怎么样？

I remember the dynasty of the eighties or the nineties are good.

我记得八十年代或者九十年代的王朝都不错。

Gary Steinberg:

加里·斯坦伯格：

Oh, they were in super goal contention.

哦，他们正在争夺超级进球。

In fact, I took care of Steve Young.

事实上，我照顾了史蒂夫·杨。

Andrew Huberman:

安德鲁·休伯曼：

Yeah, he's a local

是的，他是当地人

Gary Steinberg:

加里·斯坦伯格：

Guy.

盖伊。

Yeah, Steve's a great guy.

是的，史蒂夫是个好人。

And Steve, a really smart guy.

史蒂夫，一个非常聪明的人。

In fact, he has a law degree from Brigham Young.

事实上，他拥有杨百翰大学的法律学位。

Steve was quarterback then and they were in Super Bowl contention, and Steve had had some concussions and I actually sent him back to play when he recovered.

史蒂夫当时是四分卫，他们正在争夺超级碗，史蒂夫受到了一些脑震荡，当他康复后，我实际上让他回去打球。

So you can examine someone and get a decent idea of how they were recovering from a concussion.

因此，您可以对某人进行检查，并了解他们从脑震荡中恢复的情况。

Steve unfortunately had a bad concussion at one point, and he ended up retiring, which was the smartest thing I think for him in the end.

不幸的是，史蒂夫一度遭受了严重脑震荡，他最终退役了，我认为这对他来说是最明智的事情。

And he's become very involved with studying concussions and trying to figure out better ways to diagnose them, prevent the sequelae for football players, including changes in equipment and in tackling and that kind of thing.

他非常热衷于研究脑震荡，并试图找出更好的方法来诊断脑震荡，防止足球运动员留下后遗症，包括改变设备和铲球之类的事情。

But concussion is, we've learned a lot since the 1990s.

但自 20 世纪 90 年代以来，我们已经学到了很多关于震荡的知识。

At that time, concussion was not known, even repeated concussion to cause CTE, chronic traumatic encephalopathy in football players, CTE, which became a hot topic, was known only in boxers.

当时，脑震荡还不为人所知，甚至反复脑震荡导致CTE，足球运动员慢性创伤性脑病，成为热门话题的CTE只有拳击运动员知道。

So I became very well-informed at the time about concussions, and there was surprising little known soccer players had a high incidence of concussion at that time.

所以当时我对脑震荡非常了解，而且令人惊讶的是，当时鲜为人知的足球运动员脑震荡的发病率很高。

It wasn't known if there were long-term sequela, and usually there are not long-term sequela as long as you don't get repeated concussions.

是否有长期后遗症尚不清楚，通常只要不反复发生脑震荡，就不会留下长期后遗症。

So now what we generally recommend, if someone has a concussion, we usually get an MR scan if it's severe.

所以现在我们通常建议，如果有人患有脑震荡，如果情况严重，我们通常会进行核磁共振扫描。

MR scans usually don't show anything.

MR 扫描通常不会显示任何内容。

They would show a contusion if there's any bruising of the brain, but they don't show the molecular abnormalities that occur with a concussion.

如果大脑有任何瘀伤，它们会显示出挫伤，但它们不会显示脑震荡时发生的分子异常。

So the best way to figure out how severe it is and when a person has recovered is to do more sophisticated neurologic testing.

因此，了解病情严重程度以及患者何时康复的最佳方法是进行更复杂的神经系统测试。

Eye tracking is a very sensitive way, detect problems with the brain after a concussion because you won't track as well.

眼动追踪是一种非常敏感的方法，可以在脑震荡后检测大脑的问题，因为你的追踪效果也不好。

And in fact, many sports, football, hockey are incorporating preseason eye tracking testing.

事实上，许多体育运动，如足球、曲棍球都在季前赛中纳入眼动追踪测试。

I see.

我懂了。

To get a baseline.

以获得基线。

To get a baseline.

以获得基线。

Interesting.

有趣的。

Of course, some of the players will game the system because they still don't want to be taken out, so they may try to perform not as well as they could on their eye tracking on their I see.

当然，有些玩家会玩弄系统，因为他们仍然不想被淘汰，所以他们可能会尝试在他们的“我看到”上进行眼球追踪时表现得不那么好。

They throw the test, they throw the, so their baseline is, I mean, I don't think that's very common, but that's a way you can game the system, but as long as it's performed well, that's a very good way of detecting subtle problems with the brain.

他们进行测试，他们进行测试，所以他们的基线是，我的意思是，我认为这不是很常见，但这是你可以玩弄系统的一种方式，但只要它表现良好，这就是检测大脑微妙问题的一种非常好的方法。

You're a vision scientist, so you understand how important all the circuits are in terms of, and the visual system is unique because it tests the brain from the retina all the way back to the occipital lobe.

您是一名视觉科学家，因此您了解所有电路的重要性，并且视觉系统是独一无二的，因为它测试从视网膜一直到枕叶的大脑。

So it's the whole longitudinal access of the brain that's being tested.

因此，正在测试的是大脑的整个纵向通路。

Andrew Huberman:

安德鲁·休伯曼：

Yeah.

是的。

I'm always struck by when I see these newsreel highlights of a player goes down, they stay down and then they're helped up and everyone cheers, and then they might hobble off, take a few moments, and then how are they gauging the decision to put the person back in and the, it's perplexing to me how they would determine that is that you and I both know that the neurons, the nerve cells in the brain very likely could be injured, maybe even on their way to death after a head injury, but that the actual dying off of the tissue could take several minutes, hours, maybe even days.

当我看到这些新闻片中球员倒下的片段时，我总是感到震惊，他们倒下，然后他们被扶起来，每个人都欢呼，然后他们可能会一瘸一拐地走开，花点时间，然后他们如何衡量让这个人回来的决定，令我困惑的是，他们如何确定你和我都知道大脑中的神经元，神经细胞很可能会受伤，甚至可能在头部受伤后死亡，但是组织的实际死亡可能需要几分钟、几小时、甚至几天。

So putting someone back in to get hit more seems really risky, but at the same time, that's their profession.

因此，让某人重新受到更多打击似乎确实很冒险，但与此同时，这就是他们的职业。

That's their choice.

这是他们的选择。

And so you don't necessarily want to make the decision to take someone out of a game or a job or have them stop driving if they don't actually need to stop.

因此，如果某人实际上不需要停车，您不一定想要做出让某人退出游戏或工作或让他们停止驾驶的决定。

So it's a tricky thing.

所以这是一件棘手的事情。

Gary Steinberg:

加里·斯坦伯格：

It is tricky, and I think we have better methods of, even at the, if you're talking about sports on the sideline of doing testing, there are neurosurgeons there now who are part of the process as far as recovering in general, it's good to not stress the brain, but total absence of sensory information, sensory deprivation for long periods is not a good idea.

这很棘手，我认为我们有更好的方法，即使在进行测试的同时谈论体育运动，现在也有神经外科医生参与了总体恢复过程，不要给大脑带来压力是好的，但完全缺乏感觉信息，长期剥夺感觉不是一个好主意。

Andrew Huberman:

安德鲁·休伯曼：

Just staying home in the dark with sunglasses on also not a good idea.

在黑暗中戴着墨镜呆在家里也不是一个好主意。

Gary Steinberg:

加里·斯坦伯格：

Exactly.

正是如此。

So you want to make sure the brain still has input, but you don't want to overstress it when you're recovering from a concussion.

所以你要确保大脑仍然有输入，但当你从脑震荡中恢复时，你不想让它承受过大的压力。

Andrew Huberman:

安德鲁·休伯曼：

Sounds like doing all the things to keep blood pressure relatively low.

听起来像是采取一切措施来保持血压相对较低。

LDL cholesterol relatively low.

低密度脂蛋白胆固醇相对较低。

So interesting what you said earlier that statins might be vascular protective even in the absence of high cholesterol.

有趣的是，您之前所说的，即使在没有高胆固醇的情况下，他汀类药物也可能具有血管保护作用。

Yeah,

是的，

Gary Steinberg:

加里·斯坦伯格：

There's a lot of good evidence for that.

有很多很好的证据证明这一点。

In fact, some studies have suggested that taking statins reduces the risk of cognitive decline, including conditions like Alzheimer's.

事实上，一些研究表明服用他汀类药物可以降低认知能力下降的风险，包括阿尔茨海默病等疾病。

Andrew Huberman:

安德鲁·休伯曼：

Interesting.

有趣。

I know that statins are a bit of a controversial topic among listeners because some people report, I think have this right, that statins can give them a kind of a brain fog if they take the wrong one or excessive amounts.

我知道他汀类药物在听众中是一个有争议的话题，因为有些人报告说，如果他们服用错误的药物或过量服用他汀类药物，他汀类药物会给他们带来一种脑雾，我认为这是正确的。

Gary Steinberg:

加里·斯坦伯格：

Yeah.

是的。

Andrew Huberman:

安德鲁·休伯曼：

I'm not challenging what you're saying, I just

我并不是在挑战你所说的，我只是

Gary Steinberg:

加里·斯坦伯格：

Hear No, no, no.

听到不，不，不。

Andrew Huberman:

安德鲁·休伯曼：

I just hear the shouts in the comment section and I don't take a, but my cholesterol is in check, but I'm hearing more and more about some of these benefits of statins.

我只是听到评论部分的喊叫声，我没有服用，但我的胆固醇得到了控制，但我越来越多地听到他汀类药物的一些好处。

It's

这是

Gary Steinberg:

加里·斯坦伯格：

Interesting.

有趣。

Yeah, and the information is still emerging for a traumatic brain injury in general.

是的，关于创伤性脑损伤的信息仍在不断涌现。

Not a good idea to take an aspirin as opposed to a stroke or a TIA

与中风或 TIA 相比，服用阿司匹林并不是一个好主意

Andrew Huberman:

安德鲁·休伯曼：

Where you would want to take an aspirin,

如果您想服用阿司匹林，

Gary Steinberg:

加里·斯坦伯格：

Right, because if you have injuries, say you have a contusion to the brain and there's some traumatic damage, taking a blood thinner might cause that to worsen or cause a hemorrhage.

是的，因为如果你受伤了，比如说你的大脑受到挫伤，并且有一些外伤性损伤，服用血液稀释剂可能会导致情况恶化或导致出血。

Andrew Huberman:

安德鲁·休伯曼：

What about caffeine?

那么咖啡因呢？

Is there any evidence that caffeine can increase stroke or ischemia?

有证据表明咖啡因会增加中风或缺血吗？

I like coffee and I like yerba mate tea, so I'd be reluctant to give it up, but I consume it in moderation.

我喜欢咖啡，也喜欢马黛茶，所以我不愿意放弃它，但我会适量饮用。

Is there any direct relationship

有没有直接关系

Gary Steinberg:

加里·斯坦伯格：

There?

在那里？

I don't know any relationship unless you're taking so much that your blood pressure is sky high.

我不知道这有什么关系，除非你服用太多药物导致血压飙升。

My blood

我的血

Andrew Huberman:

安德鲁·休伯曼：

Pressure

压力

Gary Steinberg:

加里·斯坦伯格：

Tends to be pretty up, lots of benefits evidently to caffeine in terms of health.

往往很不错，咖啡因在健康方面显然有很多好处。

Andrew Huberman:

安德鲁·休伯曼：

I agree with you there.

我同意你的观点。

I have a question about something that many people are starting to do now, which is to get exploratory.

我对许多人现在开始做的事情有一个疑问，那就是进行探索。

MRI actually did one of these.

MRI 实际上做了其中之一。

I wasn't gifted one, I just decided to bite the bullet and pay for it is a whole body scan.

我没有天赋，我只是决定硬着头皮支付全身扫描费用。

They put me in the tube, did an MR, I get everything from tip to toe and I learned a few things.

他们把我放进管子里，做了核磁共振，我从头到脚得到了一切，我学到了一些东西。

I learned that I have a slight, I think it's L three or L four disc bulge that explained a little bit of pseudo sciatica, and I've been able to work around that and keep that strong.

我了解到我有轻微的，我认为是L三或L四椎间盘突出，这解释了一点假性坐骨神经痛，我已经能够解决这个问题并保持坚强。

I learned that fortunately for me, I only have one white spot on the brain.

我了解到，幸运的是，我的大脑上只有一个白点。

I was told that you could have one per decade.

有人告诉我，每十年可以拥有一个。

I'm nearing 50.

我已经快50岁了

So I feel very lucky there, especially given that I've hit my head a few times skateboarding and doing martial arts and things like that.

所以我在那里感到非常幸运，特别是考虑到我在玩滑板和做武术之类的事情时曾多次撞到过头。

So I feel lucky.

所以我觉得很幸运。

But I also know people that go in for these scans and get the report that they have a growth of some sort, or they have multiple white spots as they're called on the brain, which is damage to tissue, the neural tissue.

但我也知道有人进行这些扫描并得到报告说他们有某种生长，或者他们的大脑上有多个白点，这是对组织、神经组织的损害。

What is your thought on these exploratory slash preventative scans?

您对这些探索性斜线预防性扫描有何看法？

Do you think they're useful?

你觉得它们有用吗？

Do you feel like they cause undue concern?

您是否觉得他们引起了不必要的关注？

I mean, this is a new thing.

我的意思是，这是一个新事物。

People going out and getting their brain scanned

人们出去接受大脑扫描

Gary Steinberg:

加里·斯坦伯格：

And people are getting total body scans.

人们正在接受全身扫描。

So I think there are benefits and risks involved.

所以我认为这既有好处也有风险。

So the benefit is that you might pick up something that should be treated like an early cancer or a large aneurysm in the brain, which would have a higher chance to bleed.

因此，这样做的好处是，您可能会发现一些应该接受治疗的疾病，例如早期癌症或大脑中的大动脉瘤，这些疾病出血的可能性更高。

But many times, and I see patients all the time who were referred for a tiny aneurysm blister on a blood vessel in the brain that was found incidentally on a total body scan and these aneurysms, which can be one or two millimeters, sometimes we don't even consider those as real aneurysms.

但很多时候，我总是看到病人因全身扫描时偶然发现的大脑血管上的微小动脉瘤水泡而被转诊，这些动脉瘤可能只有一两毫米，有时我们甚至不认为它们是真正的动脉瘤。

They don't need to be treated in most cases.

在大多数情况下，他们不需要治疗。

And so it's a little controversial because people can be worried about them even if they're reassured.

所以这有点争议，因为即使人们放心了，他们也会担心。

Other examples are you find something in the brain or elsewhere in the body, you're not sure what it is.

其他例子是你在大脑或身体其他地方发现了一些东西，但你不确定它是什么。

And then in order to determine what it is, patients start having more invasive biopsies and tests, which can lead to what we call iatrogenic injuries.

然后为了确定它是什么，患者开始进行更多侵入性活检和测试，这可能导致我们所说的医源性损伤。

Iatrogenic is caused by the physicians.

医源性是由医生引起的。

So I think you have to be very thoughtful when you interpret the results of these total body or even brain scans.

所以我认为当你解释这些全身甚至大脑扫描的结果时，你必须非常深思熟虑。

And I would recommend talking with a specialist about it if you're concerned.

如果您担心的话，我建议您与专家讨论。

But people wonder, I have this, we were discussing it earlier today actually with one of your colleagues, and what if you're found to have a 1.75 millimeter aneurysm?

但人们想知道，我有这个，我们今天早些时候实际上正在与你的一位同事讨论这个问题，如果发现你有一个 1.75 毫米的动脉瘤怎么办？

If it's really even an aneurysm?

如果真的是动脉瘤呢？

Should you change your lifestyle for something like that, I would recommend, no, you should forget about it, get a follow-up scan, but you may very well live and die with this little blister that is of no consequence.

如果你因为类似的事情而改变你的生活方式，我建议，不，你应该忘记它，进行后续扫描，但你很可能会带着这个无关紧要的小水泡生存和死亡。

So as I say, I think you have to be careful about how you interpret and how you act on these findings.

正如我所说，我认为你必须谨慎对待如何解释这些发现以及如何根据这些发现采取行动。

Andrew Huberman:

安德鲁·休伯曼：

Maybe we can talk about lifestyle factors because I think anyone listening to this is going to think, I don't want to stroke.

也许我们可以谈谈生活方式因素，因为我认为任何听到这个的人都会想，我不想中风。

I don't want transient ischemic attack.

我不想出现短暂性脑缺血发作。

I don't want hemorrhage.

我不想出血。

I don't want any of this stuff.

我不想要这些东西。

And we already discussed a little bit about how what's good for your heart generally is good for the brain, but I think most people strive to eat well, meaning not excessively, also not undereat to hopefully eat a lot of unprocessed or minimally processed foods and to avoid smoking, perhaps avoid alcohol in excess, avoid hard drugs, get exercise.

我们已经讨论过对心脏有益的食物通常对大脑也有好处，但我认为大多数人都努力吃得好，也就是说不要吃得过多，也不要吃得不足，希望吃大量未加工或最低限度加工的食物，并避免吸烟，也许避免过量饮酒，避免服用烈性药物，进行锻炼。

And so I think people generally try and do all these things, get good sleep, et cetera.

所以我认为人们通常会尝试做所有这些事情，获得​​良好的睡眠等等。

But at some level, I think everyone also wants to know when are they in their safest kind of shape for avoiding a stroke?

但在某种程度上，我想每个人也想知道他们什么时候处于避免中风的最安全的状态？

Is there sort of a blood pressure cutoff where we could say, okay, if you keep your blood pressure resting blood pressure below blank, you're doing pretty well.

是否存在某种血压截止值，我们可以说，好吧，如果您将静息血压保持在空白血压以下，那么您的情况就很好。

And if your cholesterol is below blank, you're doing pretty well and then you just while keeping moderation in mind, try and live a life that reduces the probability of getting a stroke or some other blood related neural attack.

如果你的胆固醇低于空白，那么你就做得很好，然后你只要记住适度，尝试过一种降低中风或其他一些与血液相关的神经攻击的可能性的生活。

Gary Steinberg:

加里·斯坦伯格：

Well, I think it has to be individualized to some extent.

嗯，我认为它必须在某种程度上因人而异。

And over time, the standards and the guidelines have changed.

随着时间的推移，标准和指南发生了变化。

It used to be if your systolic blood pressure that's the upper number was under 1 30, 1 30 or under, that was considered normal and it would not lead to problems.

过去，如果您的收缩压上限低于 1 30、1 30 或更低，则被认为是正常的，不会导致问题。

Now the guidelines suggests that one 20 or lower is better in large studies.

现在指南表明，在大型研究中，20 或更低的分数更好。

But as an example, when my blood pressure gets under one 20, I feel lightheaded.

但举个例子，当我的血压低于一二十时，我会感到头晕。

In fact, I had an event about 15 years ago when I was overdoing it.

事实上，大约 15 年前，我曾经做过一件事情，当时我做得太过分了。

I shouldn't have been overdoing exercise or overdoing, overdoing everything I was in.

我不应该过度锻炼或过度，过度做我所做的一切。

I was fifth Stanford faculty member that over hard it.

我是斯坦福大学第五位经历过困难的教员。

That was a joke that among Stanford faculty, I was 56 and I operated all day in two operating rooms.

这是一个笑话，在斯坦福大学的教员中，我已经 56 岁了，整天在两个手术室里做手术。

I got done early.

我很早就完成了。

It was in the spring, and I took a run up to the dish and then I took a red eye to Houston for a meeting and I emailed on the flight, got an hour or two asleep, went to the meeting, was fine.

那是在春天，我跑去吃菜，然后我红着眼睛去休斯敦参加一个会议，我在飞机上发电子邮件，睡了一两个小时，然后去参加会议，一切都很好。

It was a stroke meeting with a bunch of scientists, neurologists, and scientists.

这是一次由一群科学家、神经学家和科学家参加的中风会议。

There were about 120 people.

大约有120人。

There were two neurosurgeons there plus me and drank some coffee at noon.

那里有两个神经外科医生加上我，中午喝了点咖啡。

I went for a run.

我去跑步了。

I like running.

我喜欢跑步。

And that day in Houston, it was 90 degrees and 85% humidity and got back, had a glass of tea, went back to the meeting, had some more coffee.

那天在休斯顿，气温为 90 度，湿度为 85%，回来后喝了一杯茶，继续参加会议，又喝了一些咖啡。

And then as the afternoon session opened up, I start to feel lightheaded.

当下午的会议开始时，我开始感到头晕。

And next thing I know, I'm looking up at the chandelier and they're shouting, stroke, cardiac arrest, seizure, and they're starting to pump on my chest.

接下来我知道的是，我抬头看着枝形吊灯，他们在喊叫，中风，心脏骤停，癫痫发作，他们开始在我的胸口上抽气。

So they rushed me to the hospital where I had a simultaneous workup for cardiac arrest and stroke.

于是他们赶紧把我送到医院，在那里我同时接受了心脏骤停和中风的检查。

And after, I'll make the story short, after a hundred thousand dollars workup, it was determined I had a faint because I was overdoing it.

之后，我会长话短说，经过十万美元的检查后，确定我晕倒了，因为我做得太过分了。

So since then, now I try to get seven to eight hours sleep a night.

所以从那时起，现在我尝试每晚睡七到八个小时。

Great.

伟大的。

That's clearly the bedrock of health.

这显然是健康的基石。

I increased.

我增加了。

I used to get three to five hours sleep a night.

我以前每晚睡三到五个小时。

Now I get seven to nine if I can do it, cut back on coffee, on caffeine, and I don't push myself to exercise like I used to.

现在，如果可以的话，我会喝七到九，减少咖啡和咖啡因的摄入量，而且我不会像以前那样强迫自己锻炼身体。

If I'm feeling a little fatigued, I'm on an anti-hypertensive agent, but I actually don't take it every day because for me, it's better to have a pressure 1 25 to 1 35.

如果我感觉有点疲劳，我会服用抗高血压药物，但实际上我并不是每天都服用，因为对我来说，血压最好保持在 1 25 到 1 35 之间。

And it's true for some of my patients, if you've got some disease in your arteries, you may not want to have such a low blood pressure.

对于我的一些患者来说确实如此，如果您的动脉患有某种疾病，您可能不希望血压如此低。

So I would individualize it.

所以我会个性化它。

But in general, you want to take care of your body like I've learned and probably maybe you've learned over time.

但总的来说，你想像我学到的那样照顾你的身体，也许随着时间的推移你也学到了。

I'm

我是

Andrew Huberman:

安德鲁·休伯曼：

Learning.

学习。

I mean, this is very interesting.

我的意思是，这很有趣。

I tend to have low blood pressure.

我有低血压倾向。

It runs in my family to have low blood pressure.

我的家族遗传有低血压。

I can definitely relate to the hard driving ambition phenotype.

我绝对能体会到努力进取的野心表型。

I think it's worth people hearing this because it's characteristic of a lot of people in high intensity professions, and I made the joke about Stanford faculty, but I think it's true.

我认为人们听到这个是值得的，因为这是很多从事高强度职业的人的特征，我开了斯坦福大学教师的玩笑，但我认为这是真的。

I think that if you're ambitious, you tend to overdo a bit more.

我认为如果你有雄心壮志，你往往会做得太过分。

That's something I'm certainly working on and I've run a very busy life and learning to slow down, prioritize, sleep, prioritize meditation, nons, sleep, deep rest is something I've benefited from a lot.

这当然是我正在努力的事情，我的生活非常忙碌，学习放慢速度、优先考虑、睡眠、优先冥想、非、睡眠、深度休息是我受益匪浅的事情。

Journaling, things of that sort that really just slow the pace.

写日记之类的事情确实会减慢节奏。

I think that in the landscape of health optimization, we can often put ourselves into modes of excess in the other direction, meaning doing so much to try and avoid issues with health that we end up creating issues with health.

我认为，在健康优化的背景下，我们常常可以将自己置于另一个方向的过度模式，这意味着我们做了很多努力来试图避免健康问题，但最终却造成了健康问题。

But yeah, certainly reducing caffeine intake and prioritizing sleep are key.

但是，是的，减少咖啡因摄入量和优先考虑睡眠肯定是关键。

So I appreciate that you shared that story.

所以我很感激你分享这个故事。

So if somebody has naturally low blood pressure and starts to feel a bit, let's just say sleep or woozy in the afternoon, would you recommend that they obviously not take a pressure lowering drug, but that they add a bit of salt to their diet, that they feel free to exercise less?

因此，如果有人天生血压低，并且开始感觉有点，比如说下午睡觉或头晕，你会建议他们明显不服用降压药物，而是在饮食中添加一点盐，让他们随意减少运动吗？

I'm a little bit confused.

我有点困惑。

I also love to run and do resistance training.

我也喜欢跑步和做阻力训练。

Gary Steinberg:

加里·斯坦伯格：

Well, I would recommend they take their blood pressure.

好吧，我建议他们测量血压。

So you want to try to correlate any symptoms you're having with vital signs that you modify, right?

所以你想尝试将你出现的任何症状与你改变的生命体征联系起来，对吗？

So take your blood pressure if you're feeling faint, if it's low, one thing you can do easily is to hydrate.

因此，如果您感到头晕或血压较低，请测量血压，您可以轻松做的一件事就是补充水分。

That was something else.

那是另一回事。

I used to not drink much because I don't want to have to pee in the operating

我以前喝得不多，因为我不想在手术中小便

Andrew Huberman:

安德鲁·休伯曼：

Room.

房间。

I can imagine that'd be pretty uncomfortable.

我可以想象那会很不舒服。

Yeah, I don't want to be the patient that you're operating on when you have to go use the bathroom.

是的，我不想成为你做手术时必须去洗手间的病人。

Gary Steinberg:

加里·斯坦伯格：

So now, and then I'll reveal that I had a kidney stone, which is common among surgeons.

所以现在我会透露我患有肾结石，这在外科医生中很常见。

This was a decade ago, and since then I hydrate all the time.

那是十年前的事了，从那时起我就一直在补水。

So I hydrate to the point that my urine is crystal clear all the time,

所以我会补充水分，让尿液一直清澈见底，

Andrew Huberman:

安德鲁·休伯曼：

And that helps with some of the brain clarity.

这有助于大脑的清晰度。

So interesting.

太有趣了。

I've done a little bit of work with people in the special operations community, and I think people hear about them and they think, oh, what's the magic potion that they're taking?

我与特种作战界的人们做了一些工作，我想人们听说了他们之后会想，哦，他们服用的神奇药水是什么？

What are they doing?

他们在做什么？

And they do a number of very interesting things, but one of them is they really emphasize hydration.

他们做了许多非常有趣的事情，但其中之一是他们非常强调补水。

They're just like hydration water, sometimes water with electrolytes if they're working in hot conditions.

它们就像水合水，如果在炎热的条件下工作，有时是含有电解质的水。

Just hydration, hydration, hydration.

就是补水、补水、补水。

I

我

Gary Steinberg:

加里·斯坦伯格：

Was skeptical and I used to dehydrate.

我很怀疑，而且我曾经脱水过。

I felt better dehydrated and fit.

我感觉脱水更好了，身体也更健康了。

But as I've matured, I think it's very, very important.

但随着我的成熟，我觉得这非常非常重要。

And for your blood pressure, for your general health and for your kidneys.

为了您的血压、您的整体健康和您的肾脏。

Andrew Huberman:

安德鲁·休伯曼：

Yeah.

是的。

You mentioned sleep.

你提到了睡眠。

Is there a relationship between sleep deprivation and stroke risk?

睡眠不足和中风风险之间有关系吗？

Gary Steinberg:

加里·斯坦伯格：

That's a great question.

这是一个很好的问题。

There's interestingly, strokes occur more commonly during sleep.

有趣的是，中风在睡眠期间更常见。

It's not known why.

目前尚不清楚原因。

One theory is that it's related to circadian rhythms.

一种理论认为它与昼夜节律有关。

I don't know if there's a relationship between sleep deprivation and stroke.

我不知道睡眠不足和中风之间是否有关系。

Andrew Huberman:

安德鲁·休伯曼：

I'd like to take a brief break and acknowledge one of our sponsors.

我想短暂休息一下并感谢我们的一位赞助商。

Element.

元素。

Element is an electrolyte drink that has everything you need.

Element 是一种电解质饮料，拥有您所需的一切。

That means the electrolytes, sodium, magnesium, and potassium in the correct amounts and ratios and nothing you don't, which means no sugar.

这意味着电解质、钠、镁和钾的含量和比例正确，没有任何不合适的东西，这意味着没有糖。

Now, I and others on this podcast have talked about the critical importance of hydration for proper brain and body functioning.

现在，我和这个播客中的其他人讨论了水合作用对于大脑和身体正常功能的至关重要性。

Even a slight degree of dehydration can diminish cognitive and physical performance.

即使是轻微程度的脱水也会降低认知和身体表现。

It's also important that you get adequate electrolytes.

获得充足的电解质也很重要。

The electrolytes, sodium, magnesium, and potassium are critical for the functioning of all the cells in your body, especially your neurons, your nerve cells.

电解质、钠、镁和钾对于体内所有细胞的功能至关重要，尤其是神经元、神经细胞。

Drinking element dissolved in water makes it very easy to ensure that you're getting adequate hydration and adequate electrolytes.

饮用溶解在水中的元素可以很容易地确保您获得足够的水分和电解质。

To make sure I'm getting proper amounts of hydration and electrolytes, I dissolve one packet of element in about 16 to 32 ounces of water when I wake up in the morning, and I drink that basically first thing in the morning.

为了确保我获得适量的水合作用和电解质，当我早上醒来时，我将一包元素溶解在大约 16 至 32 盎司的水中，并且我基本上早上第一件事就是喝它。

I'll also drink element dissolved in water during any kind of physical exercise I'm doing, especially in hot days when I'm sweating a lot, losing water and electrolytes.

我还会在进行任何体育锻炼时饮用溶解在水中的元素，尤其是在炎热的日子里，当我出汗很多、失去水分和电解质时。

They have a bunch of different great tasting flavors of element.

他们有一堆不同的美味元素。

My favorite is the watermelon, although I confess, I also like the raspberry and the citrus.

我最喜欢的是西瓜，虽然我承认，我也喜欢覆盆子和柑橘。

Basically, I like all the flavors.

基本上所有的口味我都喜欢。

And Element has also just released a new line of canned sparkling element.

Element 还刚刚推出了新系列的罐装起泡元素。

So these aren't the packets you dissolve in water.

所以这些不是溶解在水中的小包。

These are cans of element that you crack open like any other canned drink, like a soda, but you're getting your hydration and your electrolytes with no sugar.

这些是元素罐，您可以像其他罐装饮料（例如苏打水）一样将其打开，但您可以在不加糖的情况下补充水分和电解质。

If you'd like to try Element, you can go to drink element spelled LM t.com/Huberman to claim a free element sample pack with the purchase of any element drink mix.

如果您想尝试 Element，您可以前往“drink element”拼写为 LM t.com/Huberman，购买任何 element 混合饮料即可领取免费的 element 样品包。

Again, that's drink element.com/Huberman to claim a free sample pack.

再次强调，请访问 element.com/Huberman 索取免费样品包。

I'm going to tell a horror story, but not I want to repeat not to demonize chiropractors.

我要讲一个恐怖故事，但不是我想重复一遍，不要妖魔化脊椎按摩师。

Here's the positive story.

这是积极的故事。

I had a back thing that my back hurt and I wasn't sure what I needed to do, and a chiropractor gave me some exercises to do that essentially were of the UPD dog movement in yoga.

我的背部受伤了，我不确定我需要做什么，脊椎按摩师给了我一些练习，基本上是瑜伽中的 UPD 狗运动。

That my understanding is it helped the disc bulge kind of work its way back into the spinal column, and it worked terrifically well.

我的理解是，它帮助椎间盘突出回到脊柱，而且效果非常好。

I took no medication, I required no surgery, and I eventually learned to correct some imbalances that have led me to not have that issue again.

我没有服用任何药物，也不需要进行手术，我最终学会了纠正一些不平衡，这些不平衡使我不再出现这个问题。

It was really remarkable, and this chiropractor essentially saved me from surgery and I'm forever grateful.

这真的太了不起了，这位脊椎按摩师基本上使我免于手术，我永远感激不已。

So I think there are excellent chiropractors out there, but when I was a postdoc living in San Francisco, I had a roommate, I believe she was a neurology resident, and she came back from the clinic at UCSF and she told me the story that a patient had come in who was experiencing some hemi paralysis of the face.

所以我认为那里有优秀的脊椎按摩师，但是当我还是一名住在旧金山的博士后时，我有一个室友，我相信她是一名神经科住院医师，她从加州大学旧金山分校的诊所回来，她告诉我一个故事，一位患者进来了，她正在经历一些面部偏瘫。

That patient, I believe it was a young woman, had gone for a neck adjustment or head adjustment at a chiropractor.

那个病人，我相信是一位年轻女性，去脊椎按摩师处进行颈部调整或头部调整。

She ended

她结束了

Gary Steinberg:

加里·斯坦伯格：

Up with a dissection of her artery

解剖她的动脉

Andrew Huberman:

安德鲁·休伯曼：

And something had happened and she had essentially a stroke.

发生了一些事情，她基本上是中风了。

And so I share both these stories to make very clear that I have nothing against chiropractors, but I think any health practitioners, they come in a range of talents, and this was really like for me, an alarm and I decided at that point I would never allow a chiropractor to adjust neck.

所以我分享这两个故事是为了清楚地表明，我并不反对脊椎按摩师，但我认为任何健康从业者，他们都有各种各样的才能，这对我来说真的就像一个警报，从那时起我决定我永远不会允许脊椎按摩师调整颈部。

I said, okay, you can make adjustments to my back.

我说，好吧，你可以调整一下我的背部。

You can give me suggestions about exercises to do, but how common are these?

您可以给我一些有关练习的建议，但这些练习有多常见？

You said it's a hemi dissection.

你说的是半解剖。

Gary Steinberg:

加里·斯坦伯格：

It's a dissection of an artery.

这是动脉的解剖。

Either the vertebral artery in the back or the carotid artery up closer in the front,

要么是后面的椎动脉，要么是前面更近的颈动脉，

Andrew Huberman:

安德鲁·休伯曼：

So no cutting.

所以没有切割。

When you say dissection, they're basically making an adjustment.

当你说解剖时，他们基本上是在进行调整。

Gary Steinberg:

加里·斯坦伯格：

Well, what happens is, and I agree with I'm, we're on the same page.

好吧，发生的事情是，我同意我的观点，我们意见一致。

I recommend patients if they're going to have chiropractor not to have manipulation of their neck, that's what occurs.

我建议患者，如果他们要接受脊椎按摩师的治疗，不要对他们的颈部进行操作，这就是发生的情况。

It's not common, but I see it.

这并不常见，但我看到了。

We see it.

我们看到了。

What happens is the artery is damaged.

发生的情况是动脉受损。

The manipulation of moving the bone in the soft tissues causes a tear in the wall of the artery, and what occurs interestingly is that the blood that's usually in the space, the lumen, the middle of the artery gets into the wall and causes a false lumen, a false passage, and that blood in the wall pushes part of the wall into the main artery obstructing flow and sometimes causing a clot deform that can be dislodged and go up to the brain.

在软组织中移动骨头的操作会导致动脉壁撕裂，有趣的是，通常在空间、管腔、动脉中部的血液进入管壁并导致假管腔、假通道，管壁中的血液将部分管壁推入主动脉，阻碍血流，有时会导致凝块变形，从而被移出并上升到大脑。

Yikes.

哎呀。

Andrew Huberman:

安德鲁·休伯曼：

And there's no way to know whether or not this is going to happen.

并且没有办法知道这是否会发生。

Gary Steinberg:

加里·斯坦伯格：

No. That's why I recommend not having neck manipulation by a chiropractor, even if it's rare.

不。这就是为什么我建议不要让脊椎按摩师进行颈部按摩，即使这种情况很少见。

It's so devastating when it occurs that personally I would avoid that.

当它发生时，它是如此具有破坏性，我个人会避免这种情况。

Andrew Huberman:

安德鲁·休伯曼：

Yes.

是的。

I tell the chiropractor, stay away from anything above the shoulders please.

我告诉脊椎按摩师，请远离肩膀以上的任何东西。

And then the back work has been beneficial.

然后后面的工作是有益的。

Again, these exercises perhaps the most beneficial thing about it.

同样，这些练习也许是最有益的。

As long as we're there.

只要我们在。

I realize it's a bit of a niche condition, but what about hanging upside down?

我意识到这有点小众条件，但是倒挂怎么样？

I had one of these inversion tables.

我有一张这样的倒转表。

I really enjoyed that thing, but then once I looked at my camera phone while I was hanging upside down and it looked like I was going to blow a gasket from all the vasculature in my forehead, is it bad to hang upside down?

我真的很喜欢那件事，但是当我倒挂时看着我的拍照手机，看起来我要把前额所有脉管系统的垫圈吹掉，倒挂是不是很糟糕？

Gary Steinberg:

加里·斯坦伯格：

No evidence that it's bad.

没有证据表明它不好。

Oh

噢

Andrew Huberman:

安德鲁·休伯曼：

Good.

很好。

Oh good.

哦，很好。

Maybe I'll get an inversion table again.

也许我会再次得到一个反演表。

As long as you don't stay there, of course you add some.

只要你不留在那里，当然你就加一些。

Okay, great.

好的，太好了。

Would you let your kids play football or rugby?

你会让你的孩子踢足球或橄榄球吗？

Gary Steinberg:

加里·斯坦伯格：

That's a great question.

这是一个很好的问题。

I would not.

我不会。

That's my personal decision.

这是我个人的决定。

I think there are a lot of benefits to children playing football, rugby, like any sport, it's a team sport.

我认为孩子们踢足球、橄榄球有很多好处，就像任何运动一样，它是一项团队运动。

A lot of good skills are learned besides just the physicality of it, the coordination, but being a team player and the socialization.

除了身体素质、协调性之外，还可以学到很多好的技能，还有团队合作和社交能力。

But I think talking about tackle football, I think the risk there is still risk.

但我认为谈论铲球足球时，我认为风险仍然存在。

We're just learning about it and even high school players who many years ago were found to have multiple concussions are showing up when they're doing autopsies with some of this chronic traumatic encephalopathy.

我们刚刚了解到这一点，甚至多年前被发现患有多次脑震荡的高中球员在对一些慢性创伤性脑病进行尸检时也出现了。

I wanted to play football as a kid and I'm not that big.

我小时候想踢足球，但我没那么大。

I mean, I'm a big guy and my parents didn't let me, which is fortunate because I mean I'm sure I would've been put at risk for injuries, not just head injuries, other injuries.

我的意思是，我是个大个子，我的父母不允许我这么做，这很幸运，因为我确信我会面临受伤的风险，而不仅仅是头部受伤，还有其他受伤。

My son, who's a very good athlete, he played four years of high school baseball and soccer, was asked to try out for the quarterback position his senior year, and we went out to try out and he decided with my encouragement not to play.

我的儿子是一名非常优秀的运动员，他在高中打了四年棒球和足球，高年级时被要求尝试四分卫位置，我们出去尝试，但在我的鼓励下他决定不参加比赛。

Andrew Huberman:

安德鲁·休伯曼：

Did he go to gun high school?

他上过枪械高中吗？

Gary Steinberg:

加里·斯坦伯格：

Yeah, he went to Menlo.

Yeah, he went to Menlo.

Andrew Huberman:

安德鲁·休伯曼：

Okay.

好的。

I went to Gunn.

I went to Gunn.

Our football team at that time was bad enough that there was no incentive to play.

那时我们的足球队已经很糟糕了，没有动力去踢球。

What about soccer and heading the ball?

足球和头球怎么样？

I've actually heard that can be problematic, which to me, at first when I heard that I was like, no, there's no way.

我实际上听说这可能会有问题，对我来说，一开始当我听说我的时候，我想，不，没有办法。

I mean the ball is so light, but is there any evidence that repeated heading the ball?

我的意思是球很轻，但是有没有证据表明重复头球？

Gary Steinberg:

加里·斯坦伯格：

There is.

有。

Again, it's not a incontrovertible, but there is some evidence that multiple headings can cause some concussions and some long-term injury.

再说一次，这并不是无可争议的，但有一些证据表明多次头球可能会导致一些脑震荡和一些长期伤害。

Again, when I study this in detail as the 49 ERs neurosurgeon back in the nineties, there was very little data, although there was some evidence even then that soccer players had a high incidence and particularly female soccer players had a high incidence of concussion surprisingly.

同样，当我在 90 年代作为 49 急诊室神经外科医生详细研究这一问题时，数据很少，尽管当时就有一些证据表明足球运动员脑震荡的发生率很高，特别是女足球运动员的脑震荡发生率高得令人惊讶。

But now there's much more evidence that head injuries and even heading the ball may lead to some injury.

但现在有更多证据表明头部受伤甚至头球可能会导致一些伤害。

Andrew Huberman:

安德鲁·休伯曼：

I feel like if a sport is not your profession, the risk benefit analysis is pretty clear.

我觉得如果一项运动不是你的职业，那么风险收益分析就非常清楚了。

Why box?

Why box?

I understand it's a great sport.

我知道这是一项很棒的运动。

There's a lot to learn there.

那里有很多东西要学。

Done a little bit of it in the past, but unless you're going to get paid substantial amounts of money and maybe even then it's probably not worth it.

Done a little bit of it in the past, but unless you're going to get paid substantial amounts of money and maybe even then it's probably not worth it.

Gary Steinberg:

加里·斯坦伯格：

Well, I feel the same way.

嗯，我也有同样的感觉。

It is different for professional athletes.

对于职业运动员来说则不同。

I mean, this is their job.

我的意思是，这是他们的工作。

I remember talking with Steve Young at one point about continuing to play or finally deciding to retire, and I was thinking, what if I was asked to retire as a neurosurgeon at the prime of my career?

我记得有一次和史蒂夫·杨谈论过继续打球或者最终决定退役，我在想，如果我在职业生涯的巅峰时期被要求以神经外科医生的身份退役怎么办？

It's your profession, it's your income.

这是你的职业，也是你的收入。

It's how you identify yourself.

这就是你识别自己的方式。

Your self-esteem is dependent on it.

你的自尊取决于它。

Your family maybe put pressure on you as a professional athlete athlete if you're not a professional athlete.

如果您不是职业运动员，您的家人可能会给您作为职业运动员的压力。

I think for me, and this is my own opinion individually, I think there's less of a controversy and there's so many other sports which benefit in the same way as football or boxing.

I think for me, and this is my own opinion individually, I think there's less of a controversy and there's so many other sports which benefit in the same way as football or boxing.

Why not participate in those?

为什么不参加那些呢？

That's my feeling, but I know it's a controversial subject.

这是我的感觉，但我知道这是一个有争议的话题。

Yeah.

是的。

Andrew Huberman:

安德鲁·休伯曼：

Maybe we can circle back a little bit.

也许我们可以绕回来一点。

On a fairly common scenario, you're in the attic and you're looking for something, you stand up, boom, you hit your head on a beam and you are kind of dizzy for a bit.

在一个相当常见的场景中，你在阁楼里正在寻找东西，你站起来，砰的一声，你的头撞到了横梁上，你有点头晕。

Or recently our podcast team was on tour in Australia and the way that the shelf over the kitchen sink and our Airbnb was arranged, it was certain that everyone pretty much would hit their head hard on that thing at some point.

或者最近我们的播客团队在澳大利亚巡演，厨房水槽上方的架子和我们的 Airbnb 的布置方式，可以肯定的是，每个人在某个时候都会对这件事深感头疼。

Does one need to worry about one kind of dizzy inducing head hit from everyday life?

日常生活中是否需要担心一种令人头晕的头部撞击？

I think a lot of people are scared, like do they do brain damage or is the evolutionary adaptation, which is the thick skull sufficient to keep us safe in most cases?

I think a lot of people are scared, like do they do brain damage or is the evolutionary adaptation, which is the thick skull sufficient to keep us safe in most cases?

Gary Steinberg:

加里·斯坦伯格：

I don't think you need to worry in general, especially if your symptoms resolve within a relatively short period of time,

我认为您一般不需要担心，特别是如果您的症状在相对较短的时间内消失，

Andrew Huberman:

安德鲁·休伯曼：

Such as how long a day or two?

比如一天或两天多长时间？

Gary Steinberg:

加里·斯坦伯格：

Yeah, I mean even if you have a mild concussion and you recover within a day or two, I don't think there's any need to worry or get a scan and it's a commonplace occurrence.

Yeah, I mean even if you have a mild concussion and you recover within a day or two, I don't think there's any need to worry or get a scan and it's a commonplace occurrence.

Andrew Huberman:

安德鲁·休伯曼：

Yeah, I think your answer will set a lot of minds at ease because people do worry.

是的，我认为你的回答会让很多人放心，因为人们确实担心。

I mean, there's something so mysterious about the stuff that occurs inside the cranial vault.

我的意思是，颅顶内部发生的事情非常神秘。

We can't look to something, we can't take our pulse.

我们无法观察某些事物，也无法把握脉搏。

It's just it's so hard to know what's going on in there.

只是很难知道里面发生了什么。

Gary Steinberg:

加里·斯坦伯格：

Well, as you say, that's why we develop very thick skulls to protect the most important organ

嗯，正如你所说，这就是为什么我们会发展出非常厚的头骨来保护最重要的器官

Andrew Huberman:

安德鲁·休伯曼：

Because after all, the tissue doesn't regenerate, at least not much of it.

因为毕竟组织不会再生，至少不会再生太多。

There are a few areas where there are neurons that can replenish.

有几个区域的神经元可以补充。

Gary Steinberg:

加里·斯坦伯格：

I'm going to take issue with you at that because the prior notion of course, was that once nerve cells in the brain die, they don't regenerate.

我会对此提出异议，因为当然，之前的观念是一旦大脑中的神经细胞死亡，它们就不会再生。

And for a long time it was thought, you don't produce any new nerve cells, any new stem cells in the brain, and we used to think after an injury or a disease like a stroke, when that tissue was damaged and you were paralyzed or you couldn't talk, that there was no way to recover that those circuits were dead.

很长一段时间以来，人们认为，大脑中不会产生任何新的神经细胞、任何新的干细胞，我们过去常常认为，在受伤或中风等疾病之后，当组织受损，你会瘫痪或无法说话时，没有办法恢复这些电路已经死亡。

It turns out that is not true, and we are learning that.

事实证明这不是真的，我们正在了解这一点。

I think in recent years when I trained there was no hope to restore function in patients who had a stroke, traumatic brain injury, spinal cord injury, and other diseases, A LS, Lou Gehrig's disease, Parkinson's Disease.

我想，近年来，当我训练时，患有中风、脑外伤、脊髓损伤和其他疾病、肌萎缩侧索硬化症、卢伽雷氏病、帕金森氏病的患者没有希望恢复功能。

Now we are learning that there is hope.

现在我们知道还有希望。

We know that stem cells do form in the adult brain that's not controversial anymore.

我们知道干细胞确实在成人大脑中形成，这不再有争议。

We know that other circuits can take over for circuits that were dead and we know now, and this is some of the work that we're doing with chronic stroke patients who we thought could not recover after six months at all.

我们知道其他回路可以取代已经死亡的回路，我们现在知道了，这是我们正在对慢性中风患者所做的一些工作，我们认为这些患者在六个月后根本无法康复。

We know that there are ways of promoting regeneration or recovery of function.

我们知道有一些方法可以促进再生或功能恢复。

We're still working out the details of that.

我们仍在研究细节。

But for instance, we've done studies, and this is still in clinical trial phase with patients who are years out from a stroke.

但举例来说，我们已经进行了研究，目前仍处于临床试验阶段，对象是距中风多年的患者。

They've been through rehab, they've been through physical therapy, and 90% or more of recovery after a stroke occurs in the first six months.

They've been through rehab, they've been through physical therapy, and 90% or more of recovery after a stroke occurs in the first six months.

After that time, patients are not going to recover.

在那之后，患者将无法康复。

And now we are finding in some of our early trials with patients that if you, for instance, put in stem cells into the brain or another treatment which was approved by the FDA, the very first for chronic stroke, if you put a stimulator on the vagus nerve in the neck and stimulate coupled with physical therapy, intensive physical therapy, you can improve arm function in those patients.

现在我们在对患者进行的一些早期试验中发现，例如，如果将干细胞放入大脑或 FDA 批准的另一种治疗方法（这是第一个针对慢性中风的治疗方法），如果您在颈部迷走神经上放置刺激器并结合物理治疗、强化物理治疗进行刺激，就可以改善这些患者的手臂功能。

In our patients that we've treated in multiple trials, we're seeing early indications that patients years out from a stroke can start to recover function in their arms, in their legs, in their speech.

在我们多次试验中治疗过的患者中，我们看到了早期迹象，表明中风多年后的患者可以开始恢复手臂、腿部和言语的功能。

And we don't know all the mechanisms, but the old notion that these circuits are dead is simply not true.

我们并不知道所有的机制，但“这些电路已经死亡”的旧观念根本不正确。

They can be resurrected.

They can be resurrected.

And so this is part of the excitement about discovery and doing research and trying to translate into the clinical arena.

因此，这是对发现和研究并试图转化为临床领域的兴奋的一部分。

Andrew Huberman:

安德鲁·休伯曼：

Yeah, oftentimes this boils down to really critical of the moment decisions.

是的，通常这可以归结为对当下决定的真正批评。

I'll tell a story.

I'll tell a story.

I won't reveal the hospital or the exact players involved, but some years ago, an ex-girlfriend of mine who then was just somebody I was friends with slash dating contacted me and said that her dad had had a stroke and I was near that hospital.

我不会透露那家医院或具体的参与者，但几年前，我的一位前女友（当时只是我的斜线约会朋友）联系我，说她父亲中风了，而我就在那家医院附近。

So I went and spoke to the resident and the resident who was overseeing the case essentially said, look, it's hopeless.

所以我去和那位居民交谈，负责监督此案的居民基本上说，看，这是没有希望的。

There's a huge necrotic piece of tissue in there.

里面有一块巨大的坏死组织。

The probability of any kind of quality of life is essentially zero.

任何一种生活质量的概率基本上为零。

My suggestion, and I was there as the resident made, the suggestion would be to remove him from life support essentially, and the other members of the family were like, oh my goodness, this is not a situation anyone wants to be in.

我的建议，正如住院医生所提出的那样，我在那里，建议基本上是让他脱离生命维持系统，而家庭的其他成员就像，哦，天哪，这不是任何人想要的情况。

I made a couple of calls, including to someone who's previously been a guest on this podcast who's highly qualified to know about this sort of thing.

我打了几个电话，其中包括一个以前曾是这个播客的嘉宾的人，他非常有资格了解这类事情。

They asked a couple of questions about the location of the stroke, which side of the brain it was on, and said, keep him alive.

They asked a couple of questions about the location of the stroke, which side of the brain it was on, and said, keep him alive.

There's a good chance that he'll have some degree of recovery of function.

他的功能很有可能得到一定程度的恢复。

So that's what they did.

所以他们就是这么做的。

And indeed, while he lost some motor abilities, lost some speech abilities and has some disruption of affect where he'll sort of spontaneously laugh or cry from time to time, he has, at least by my observation, been able to enjoy substantial amounts of life, interacting with grandkids, enjoying holidays and actually took, I was told some physical steps at some point with assistance with the walkers, done a lot of physical rehab, obviously a really hard situation, but it told me that oftentimes when we think that all is lost, not all is lost even in people in their seventies.

事实上，虽然他失去了一些运动能力，失去了一些言语能力，并且有一些情感障碍，他会时不时地自发地笑或哭，但至少根据我的观察，他能够享受大量的生活，与孙辈互动，享受假期，并实际上在步行者的帮助下在某些时候采取了一些身体步骤，做了很多身体康复，显然是一个非常困难的情况，但它告诉我，很多时候，当我们认为一切都失去了时，并非一切都已结束。即使是七十多岁的人也迷失了。

Gary Steinberg:

加里·斯坦伯格：

It has to do with plasticity and we all wish we were neonates or infants because the body, including the brain, is so plastic.

这与可塑性有关，我们都希望自己是新生儿或婴儿，因为包括大脑在内的身体具有很强的可塑性。

That's the ability to regenerate tissue and circuits and recover.

这就是组织和回路再生并恢复的能力。

So if an infant has a stroke and is paralyzed on one side, usually they can make an excellent, if not complete recovery.

So if an infant has a stroke and is paralyzed on one side, usually they can make an excellent, if not complete recovery.

This is

这是

Andrew Huberman:

安德鲁·休伯曼：

The, as I recall from my undergraduate years, the Kenard principle.

The, as I recall from my undergraduate years, the Kenard principle.

If you're going to have a brain injury, have it early in life.

如果您将遭受脑损伤，请尽早接受。

Gary Steinberg:

加里·斯坦伯格：

Exactly.

正是如此。

So I mean you notice this too, when I cut myself, now it can take a week for that cut to heal when my granddaughter, who's six years old, cuts herself the next day, it's totally healed.

所以我的意思是你也注意到了这一点，当我割伤自己时，现在伤口可能需要一周才能愈合，而我六岁的孙女第二天割伤了自己，伤口就完全愈合了。

So

所以

Andrew Huberman:

安德鲁·休伯曼：

Little kids are like salamanders, right?

小孩子就像蝾螈，对吧？

They almost, by the way, that was a biology joke.

顺便说一句，他们几乎认为这是一个生物学笑话。

They're not like salamanders, but salamanders can regenerate entire limbs by the maintenance of a small stem cell population at the tip of the limb bud or what would be the limb bud.

它们不像蝾螈，但蝾螈可以通过维持肢芽尖端或可能的肢芽处的一小部分干细胞群来再生整个肢体。

And it is remarkable how kids can regenerate without a scar.

令人惊奇的是，孩子们能够在没有疤痕的情况下再生。

Oftentimes, they can't grow an entire hand back, but it's kind of striking how much plasticity there is, and

通常，他们无法长出整只手，但可塑性之强令人震惊，而且

Gary Steinberg:

加里·斯坦伯格：

That's what we're trying to develop are new ways of promoting plasticity in the adult brain as an example.

这就是我们正在努力开发的促进成人大脑可塑性的新方法。

So we think stem cells injected through various mechanisms.

So we think stem cells injected through various mechanisms.

Stimulation of the brain or the vagal nerve as an example, can promote plasticity.

例如，刺激大脑或迷走神经可以促进可塑性。

In a sense.

从某种意义上说。

We think what's happening is that these methods can turn the adult brain into an infant brain in some ways.

我们认为正在发生的事情是，这些方法可以在某些方面将成人大脑变成婴儿大脑。

Andrew Huberman:

安德鲁·休伯曼：

Where are the stem cells coming from in these experiments?

Where are the stem cells coming from in these experiments?

Gary Steinberg:

加里·斯坦伯格：

It depends.

It depends.

There are different sources.

有不同的来源。

So some of the studies I've done previously with other companies, they made the stem cells either from bone marrow donors, so they were mesenchymal or another group made the cells from fetal neural tissue.

因此，我之前与其他公司进行的一些研究，他们要么从骨髓捐赠者中制造干细胞，所以它们是间充质的，要么另一组从胎儿神经组织中制造细胞。

Andrew Huberman:

安德鲁·休伯曼：

Okay, so just to orient people inside the bone, you have the marrow.

Okay, so just to orient people inside the bone, you have the marrow.

Most people know that because they've ordered it at a restaurant cow marrow that is typically the cells within the marrow contain, as I recall, a hemopoietic population.

大多数人都知道这一点，因为他们在餐馆点了牛骨髓，我记得，骨髓内的细胞通常含有造血细胞群。

So a population of sort of potential blood cells, cells that can become blood cells or other things.

这是一群潜在的血细胞，可以变成血细胞或其他东西的细胞。

And if taken out, put into a Petri dish and given the appropriate factors, you can drive the fate of those stem cells to be, say, neurons or cardiac cells, and then you're taking those cells and you're injecting them into the brains of patients in the hopes that they will become neural cells, neurons that will incorporate into the circuitry.

如果取出来，放入培养皿中并给予适当的因素，你可以将这些干细胞的命运驱动为神经元或心肌细胞，然后你将这些细胞注射到患者的大脑中，希望它们能成为神经细胞，神经元将融入电路。

Gary Steinberg:

加里·斯坦伯格：

Actually, that was the initial notion 20 years ago when we started doing this, was that these cells you put in become these exogenous cells.

实际上，这是 20 年前我们开始做这件事时的最初想法，就是你放入的这些细胞会变成这些外源细胞。

You inject become neurons and astrocytes and oligodendrocytes all the cells in the brain and that the neurons reconstitute circuits.

你将大脑中的所有细胞注射成为神经元、星形胶质细胞和少突胶质细胞，神经元重建电路。

That is not how they work.

他们不是这样工作的。

The way they work, and this is why it may not matter what particular type of stem cell you put in.

The way they work, and this is why it may not matter what particular type of stem cell you put in.

The way they work primarily is by secreting very powerful proteins, molecules, growth factors that promote native recovery.

它们的主要工作方式是分泌非常强大的蛋白质、分子和生长因子，促进天然恢复。

So they promote angiogenesis, they promote native neurogenesis, endogenous glio, agenesis, synaptogenesis.

因此它们促进血管生成，它们促进天然神经发生、内源性神经胶质细胞、发育不全、突触发生。

But the main benefit may be that they modulate the immune system.

但主要的好处可能是它们可以调节免疫系统。

That's what we're finding.

这就是我们所发现的。

So by modulating somehow the immune system in the brain, they are able to induce plasticity and recover function.

因此，通过以某种方式调节大脑中的免疫系统，它们能够诱导可塑性并恢复功能。

Andrew Huberman:

安德鲁·休伯曼：

Interesting.

有趣。

I am tempted here to weave in the stories that date back to the nineties, but that we see more and more of mostly studies in rodents, but a few in humans showing that there are dormant stem cell populations in certain compartments of the brain, the dentate gyrus of the hippocampus, the olfactory bulb, et cetera, that upon hyperoxygenation or increasing blood flow to the brain, largely by virtue of exercise, but also sometimes by way of engaging in learning tasks and exercise that you can basically cause the release of stem cells that normally would lie dormant.

我很想在这里编织一些可以追溯到九十年代的故事，但我们看到越来越多的研究主要是在啮齿类动物中进行的，但也有一些在人类中的研究表明，在大脑的某些区室、海马齿状回、嗅球等中存在休眠的干细胞群，在过度氧合或增加流向大脑的血液时，这主要是通过锻炼，但有时也通过参与学习任务和锻炼来实现。基本上可以导致通常处于休眠状态的干细胞的释放。

Is that literature reason enough to suggest that people who've had a stroke continue to move their body to walk at exercise, maybe do resistance training, maybe even some skill related training?

该文献是否足以表明中风患者继续移动身体进行步行锻炼，也许进行阻力训练，甚至可能进行一些与技能相关的训练？

Gary Steinberg:

加里·斯坦伯格：

Yes.

是的。

There's a lot of evidence that activity, physical therapy, even forced activity is very beneficial.

有大量证据表明，活动、物理治疗、甚至强迫活动都非常有益。

And it's not just stimulating endogenous stem cells in the brain, but it's multiple mechanisms.

它不仅仅是刺激大脑中的内源性干细胞，而且是多种机制。

It's recruiting circuits that were not involved before.

这是以前没有涉及过的招募线路。

For instance, studies that have been done on stroke patients who make a recovery show that not only is the side of the stroke improving in some cases, but the other side of the brain is showing increased activity, so circuits on the other side of the brain may be contributing to the recovery on the side of the stroke brain.

例如，对康复的中风患者进行的研究表明，在某些情况下，不仅中风一侧的情况有所改善，而且大脑的另一侧也显示出活动增加，因此大脑另一侧的回路可能有助于中风一侧大脑的恢复。

So it's much more complex than we thought it was

所以它比我们想象的要复杂得多

Andrew Huberman:

安德鲁·休伯曼：

Years ago, I developed an affection for a literature, it wasn't a very prominent literature, but I found it really interesting is the work of a guy named Timothy Shallert and Theresa Jones.

几年前，我对一种文学产生了兴趣，那不是一种非常著名的文学，但我发现真正有趣的是一个名叫蒂莫西·沙勒特和特里萨·琼斯的人的作品。

Gary Steinberg:

加里·斯坦伯格：

Yeah, I know both.

Yeah, I know both.

Andrew Huberman:

安德鲁·休伯曼：

Are you familiar with this?

你熟悉这个吗？

Yeah,

是的，

Gary Steinberg:

加里·斯坦伯格：

We almost recruited to our department.

我们差一点就招到我们部门了。

Yeah.

是的。

Andrew Huberman:

安德鲁·休伯曼：

The sort of overarching theme of this literature was it was animal work, but I think some of it might've been translated to humans, which was that for instance, if somebody has damage on one side of the brain because of the way the circuits are organized, and of course you know this better than anyone Gary, but that one might experience deficits in limb movement on the opposite side, and that the tendency for somebody like that is to then over rely on the intact limbs, essentially lean on the intact limbs, and the approach that they took to try and recover function was really interesting.

这些文献的总体主题是它是动物工作，但我认为其中一些可能已经转化为人类，例如，如果某人由于回路的组织方式而在大脑的一侧受到损伤，当然你比任何人都更了解加里，但一个人可能会在另一侧经历肢体运动缺陷，而这样的人的倾向是过度依赖完整的四肢，基本上依靠完整的四肢，以及他们尝试的方法恢复功能真的很有趣。

They had these animals and I think eventually there was some human work done, I could be mistaken, tie up the more active uninjured arm or leg or hand, such that they then had to rely on the nondominant or let's just call it injured, sometimes even flacid paralysis limb.

他们拥有这些动物，我认为最终完成了一些人类工作，我可能会弄错，绑住更活跃的未受伤的手臂、腿或手，这样他们就不得不依赖非优势肢体，或者让我们称之为受伤的、有时甚至是松弛性瘫痪的肢体。

And in that way, they could generate a lot of plasticity that normally would escape the patient, especially in the days and weeks following the injury, just forcing movement or forcing the attempt to move of the injured pathway.

通过这种方式，它们可以产生大量通常会逃避患者的可塑性，尤其是在受伤后的几天和几周内，只是迫使患者移动或强迫尝试移动受伤的通路。

I find this literature to be so striking and maybe one that should deserve more attention.

I find this literature to be so striking and maybe one that should deserve more attention.

Yeah, it's

是的，这是

Gary Steinberg:

加里·斯坦伯格：

Called constraint therapy, and not only has it been shown in animal studies preclinically, but it's been shown in some clinical studies of patients with stroke.

称为约束疗法，不仅在临床前的动物研究中得到了证明，而且在一些中风患者的临床研究中也得到了证明。

In fact, one of the trials we did with transplanting stem cells into the brain included restraining the good limb to force use of the other limb.

事实上，我们进行的一项将干细胞移植到大脑中的试验包括限制好肢体以强制使用另一肢。

So there's some very intriguing data suggesting that that's important.

有一些非常有趣的数据表明这很重要。

However, some of the animal studies also suggest that you may have to wait a time if you force use of the involved limb too soon, it can be detrimental to the recovery.

然而，一些动物研究也表明，如果过早强迫使用受影响的肢体，可能需要等待一段时间，这可能不利于康复。

I see.

我懂了。

So there may be an important temporal factor there in terms of the timing of when you do that,

因此，就您执行此操作的时间而言，可能存在一个重要的时间因素，

Andrew Huberman:

安德鲁·休伯曼：

Is there anything that people can do or take for neuroprotection after an injury to essentially try and rescue neurons that would otherwise die?

人们在受伤后可以做或采取什么措施来保护神经元，以基本上尝试拯救否则会死亡的神经元？

Gary Steinberg:

加里·斯坦伯格：

Right, so this is a very interesting subject.

是的，所以这是一个非常有趣的话题。

Back in the late 1980s, 1990s, a lot of emphasis was placed on trying to protect the brain against acute stroke.

早在 20 世纪 80 年代末和 90 年代，人们就非常重视保护大脑免受急性中风的影响。

Different pharmacologic agents were tried, probably a thousand different drugs were tried, which blocked the pathway leading to cell death.

人们尝试了不同的药物，可能尝试了上千种不同的药物，从而阻断了导致细胞死亡的途径。

So interestingly, when you deprive the brain and the neurons of oxygen and glucose, they don't die immediately and it takes some time and it's actually an active process.

有趣的是，当你剥夺大脑和神经元的氧气和葡萄糖时，它们不会立即死亡，而是需要一些时间，这实际上是一个活跃的过程。

So the release of these excitatory amino acids occurs.

因此，这些兴奋性氨基酸就会释放。

So normally, as you know, glutamate, aspartate are important neurotransmitters in the brain and you need them to function.

通常情况下，如您所知，谷氨酸、天冬氨酸是大脑中重要的神经递质，您需要它们才能发挥作用。

But after a stroke, when there's a deprivation of oxygen and gluc glucose and a mismatch between the metabolism and the supply of oxygen and glucose, for some reason there's a release of these excitatory amino acids like glutamate, and that causes an influx of calcium into the neurons, which is the final common pathway to dying.

但中风后，当氧气和葡萄糖缺乏，新陈代谢与氧气和葡萄糖的供应不匹配时，由于某种原因，谷氨酸等兴奋性氨基酸会释放，导致钙流入神经元，这是最终的常见死亡途径。

And then there are other pathways that can then lead to release of free radicals, which are more damaging, and those can cause another type of cell death called apoptotic cell death.

还有其他途径可以导致自由基的释放，自由基的破坏性更大，并且可以导致另一种类型的细胞死亡，称为细胞凋亡。

That's a cell death that occurs and requires protein synthesis.

That's a cell death that occurs and requires protein synthesis.

And then with reperfusion, say the artery opens up, then you've got a lot of inflammation.

And then with reperfusion, say the artery opens up, then you've got a lot of inflammation.

So these pharmacological treatments, as I say, a thousand of 'em were tried and they were found to be very effective in preclinical stroke models so we could cure stroke in the lab.

因此，正如我所说，这些药物治疗方法已经尝试了上千种，结果发现它们在临床前中风模型中非常有效，因此我们可以在实验室中治愈中风。

My lab studied this for probably 15 years and there was no doubt we could cure stroke if we got the drugs on board even after the stroke within a few hours, but it never was able to be translated to the clinical arena except for one case.

我的实验室对此进行了大约 15 年的研究，毫无疑问，如果我们在中风发生后几个小时内服用药物，我们就可以治愈中风，但除了一个案例之外，它从未能够转化为临床领域。

So besides drugs that were tried, another method of protecting the brain was tried called mild hypothermia, and that was a process of reducing the brain temperature and body temperature just a few degrees from 37 degrees centigrade to 33, and we were one of the first to show that that was protective even after the stroke in animals,

因此，除了尝试过的药物之外，还尝试了另一种保护大脑的方法，称为轻度低温，这是一种将大脑温度和体温从 37 摄氏度降低到 33 摄氏度的过程，我们是第一个证明即使在动物中风后这种方法也具有保护作用的人之一，

Andrew Huberman:

安德鲁·休伯曼：

My understanding is that when you cool neural tissue, you quiet, its electrical activity.

My understanding is that when you cool neural tissue, you quiet, its electrical activity.

In fact, this is a common tool for experimentation in neuroscience laboratories.

事实上，这是神经科学实验室实验的常用工具。

You want to shut down a brain area transiently, you cool it down,

You want to shut down a brain area transiently, you cool it down,

Gary Steinberg:

加里·斯坦伯格：

Right?

对吗？

And in fact, de hypothermia has a profound effect on shutting down the metabolism.

事实上，体温过低对于停止新陈代谢具有深远的影响。

So that's why when someone, particularly kids fall into a frozen pond with ice cold water, they can survive there for half an hour and make a complete recovery because their body temperature is dropped down to very low like 20 degrees centigrade.

这就是为什么当一个人，特别是孩子掉进冰冷的水池里时，他们可以在那里生存半个小时并完全恢复，因为他们的体温降到了很低的20摄氏度。

But this is less, this is just a few degrees.

但这更少，这只是几度。

So the amount there is a slight decrease in the metabolic activity, but that does not account for all the protection.

因此，代谢活动的量略有减少，但这并不能解释所有的保护作用。

It's due to the fact that hypothermia, mild hypothermia blocks many of those detrimental pathways.

这是因为体温过低、轻度体温过低会阻断许多有害途径。

It blocks partly the release of those excitor amino acids, glutamate.

它部分阻止那些兴奋氨基酸谷氨酸的释放。

It blocks the calcium influx, it blocks the inflammation, and so that's probably why it works so well.

It blocks the calcium influx, it blocks the inflammation, and so that's probably why it works so well.

It even blocks that other pathway of program cell death because it hits all these pathways.

It even blocks that other pathway of program cell death because it hits all these pathways.

It's multifactorial, it's very effective.

这是多方面的，非常有效。

And in fact, it was finally shown in the early two thousands in prospective randomized studies that one type of stroke, actually two types, I should say two types of stroke are benefited by cooling the brain quickly.

事实上，在前两千项前瞻性随机研究中，最终表明，一种类型的中风，实际上是两种类型，我应该说两种类型的中风都受益于大脑的快速冷却。

One is cardiac arrest from ventricular fibrillation and prospective studies, which were published in 2002, show that if you cool patients who have cardiac arrest and then are resuscitated out in the field down to between 32 and 34 degrees centigrade from 37, much better outcomes neurologically.

一是心室颤动引起的心脏骤停，2002 年发表的前瞻性研究表明，如果对心脏骤停的患者进行降温，然后在现场将温度从 37 摄氏度降至 32 至 34 摄氏度，神经学结果会好得多。

That's from global ischemia.

那是因为全球缺血。

That's the noble blood getting to the brain briefly.

那是高贵的血液短暂地进入大脑。

And the other area where it's been shown to have better outcomes is in neonatal what's called hypoxic ischemic injury.

And the other area where it's been shown to have better outcomes is in neonatal what's called hypoxic ischemic injury.

Those are neonates who have lack of blood flow.

这些是血液循环不足的新生儿。

For some reason, the brain when they're born and if you cool them, it's been shown in studies up to 10 years later that they have better cognitive outcomes.

由于某种原因，在他们出生时，如果你对他们进行冷却，长达 10 年后的研究表明，他们的认知结果会更好。

So for cardiac arrest in the mid two thousands, I think it was 2003, the American Heart Association determined it was a standard of care, a guideline that you had to cool patients after cardiac arrest.

因此，对于两千中间的心脏骤停，我认为是在 2003 年，美国心脏协会确定了这是一个护理标准，一个在心脏骤停后必须对患者进行降温的指南。

Yes.

是的。

How

如何

Andrew Huberman:

安德鲁·休伯曼：

Was the cooling done in the experiments that you were involved in?

您参与的实验中是否进行了冷却？

Gary Steinberg:

加里·斯坦伯格：

Yeah, so there were many ways to do it, but in the animal models you can just cool 'em with a cooling blanket actually in people.

是的，有很多方法可以做到这一点，但在动物模型中，你可以用实际上在人类身上的冷却毯来冷却它们。

We got very interested in this.

我们对此非常感兴趣。

In fact, when I saw in the laboratory that it was so effective and that we could cure it mouse and rat stroke by cooling, I started cooling my patients in the operating room because I felt even if it hadn't been proven in patients that it was so effective.

In fact, when I saw in the laboratory that it was so effective and that we could cure it mouse and rat stroke by cooling, I started cooling my patients in the operating room because I felt even if it hadn't been proven in patients that it was so effective.

It's the gold standard now actually for neuroprotection against stroke in the laboratory.

它现在实际上是实验室中针对中风的神经保护的黄金标准。

So back in the 1990s, I started cooling all of my patients.

早在 20 世纪 90 年代，我就开始给所有病人降温。

We started by cooling them, by packing 'em in ice and putting alcohol on 'em, but the operating room staff appropriately didn't like that alcohol is flammable.

We started by cooling them, by packing 'em in ice and putting alcohol on 'em, but the operating room staff appropriately didn't like that alcohol is flammable.

So then we started using cooling blankets and then a number of companies started developing cooling catheters, and I worked with several of these so you can actually cool very quickly if you put a catheter into a vessel, say in the groin and infuse cold saline, which doesn't get into the circulation, but it cools the blood and the cooled blood then circulates.

So then we started using cooling blankets and then a number of companies started developing cooling catheters, and I worked with several of these so you can actually cool very quickly if you put a catheter into a vessel, say in the groin and infuse cold saline, which doesn't get into the circulation, but it cools the blood and the cooled blood then circulates.

Other ways of cooling are to putting on special devices, which cool quickly, and that's what's used now are external devices.

其他的冷却方式就是加装特殊的设备，冷却速度很快，现在用的就是外部设备。

People are working on cooling just the head with helmets.

人们正在研究用头盔来冷却头部。

So it's still an active field of investigation for stroke and also for cardiac arrest.

因此，它仍然是中风和心脏骤停的一个活跃的研究领域。

Actually, it has not been proven in, well-designed prospective trials that it works for garden variety focal stroke, it works for cardiac arrest where there's global lack of blood flow to the brain when the heart stops.

Actually, it has not been proven in, well-designed prospective trials that it works for garden variety focal stroke, it works for cardiac arrest where there's global lack of blood flow to the brain when the heart stops.

It hasn't been proven yet for the kind of stroke we've been talking about where there's a single blocked artery to the brain.

对于我们一直在谈论的那种大脑中的一条动脉被阻塞的中风，目前还没有得到证实。

Andrew Huberman:

安德鲁·休伯曼：

So interesting.

太有趣了。

I mean, a lot of times on this podcast we talk about the critical need for body temperature to drop by one to three degrees to get into deep sleep.

我的意思是，在这个播客中，我们多次谈论体温下降一到三度才能进入深度睡眠的迫切需要。

We had Craig Heller, our colleague from the biology department at on the podcast where we talked about some of the Palmer cooling, and I'm essentially cooling the soles of the feet, the palms of the hands in the upper part of the face as a way to more rapidly reduce core body temperature.

克雷格·海勒（Craig Heller）是我们生物系的同事，他在播客中谈到了一些帕尔默冷却技术，我主要是冷却脚底、脸上部的手掌，以更快地降低核心体温。

I think these are fascinating areas for exploration that obviously have clinical applications, but also you'd imagine for some of the things we're talking about before, just to provide a bit of neuroprotection after a head hit or provide a bit of neuroprotection perhaps even as it relates to aging, spending a little bit of time, maybe 10 minutes a day, not badly hypothermic please people, but slightly hypothermic and then bringing the body temperature back up.

I think these are fascinating areas for exploration that obviously have clinical applications, but also you'd imagine for some of the things we're talking about before, just to provide a bit of neuroprotection after a head hit or provide a bit of neuroprotection perhaps even as it relates to aging, spending a little bit of time, maybe 10 minutes a day, not badly hypothermic please people, but slightly hypothermic and then bringing the body temperature back up.

Gary Steinberg:

加里·斯坦伯格：

Yeah, I mean, I wouldn't recommend if you have a head injury or a TIA to stick your head in a snowbank, but even with traumatic brain injury, severe, not just concussion but severe TBI traumatic brain injury studies were done looking at cooling hypothermia, and it's called mild hypothermia because it's just a few degrees, and the studies were very suggestive, but didn't get to the point that it was proven, although certain subgroups who were cooled quickly seemed to do better.

Yeah, I mean, I wouldn't recommend if you have a head injury or a TIA to stick your head in a snowbank, but even with traumatic brain injury, severe, not just concussion but severe TBI traumatic brain injury studies were done looking at cooling hypothermia, and it's called mild hypothermia because it's just a few degrees, and the studies were very suggestive, but didn't get to the point that it was proven, although certain subgroups who were cooled quickly seemed to do better.

So I think it's a subject that's still being studied, and as I say, it's easy for us to do in the operating room.

所以我认为这是一个仍在研究​​的课题，正如我所说，这对我们来说在手术室里很容易做到。

You don't want to cool too much that can then interfere with other metabolic functions and clotting parameters, and there can cause increased infection if you go too low for too long.

您不想降温太多，否则会干扰其他代谢功能和凝血参数，而且如果降温时间过长，可能会导致感染增加。

But I still let my patients cool just a few degrees.

但我仍然让我的病人降温几度。

And we've had some anecdotal cases where patients have had problems, and because we cooled them, we think it made a benefit.

我们遇到过一些病人遇到问题的轶事案例，因为我们给他们降温，我们认为这有好处。

For instance, we had one patient who we hadn't even done, I was getting ready to do a bypass to sew a scalp artery to a brain artery, but we hadn't even, I think, made the skin incision and the patient had a cardiac arrest and it lasted for a long time.

For instance, we had one patient who we hadn't even done, I was getting ready to do a bypass to sew a scalp artery to a brain artery, but we hadn't even, I think, made the skin incision and the patient had a cardiac arrest and it lasted for a long time.

So we were pumping on the chest, couldn't restore a function, and it was way outside the amount of time that you would've expected a good recovery.

因此，我们对胸部进行抽气，但无法恢复功能，而且这也远远超出了您预期的良好恢复时间。

But the patient had been cooled down to 33 degrees before by the time it had happened, and then we finally got the heart started.

但事发时病人的体温已经降到33度了，然后我们终于开始了心跳。

We ended up putting some restoring flow through catheters and a heart lung machine, and remarkably, the guy made a complete recovery.

我们最终通过导管和心肺机进行了一些恢复流动，值得注意的是，这个人完全康复了。

So anecdotal, but cases like that suggest maybe cooling even a few degrees has a protective effect on the brain.

这是轶事，但类似的案例表明，即使是几度的降温也可能对大脑产生保护作用。

We certainly know it is true for cardiac arrest global ischemia.

我们当然知道心脏骤停全球缺血确实如此。

Andrew Huberman:

安德鲁·休伯曼：

What are your thoughts on platelet rich plasma PRP these days?

您最近对富血小板血浆 PRP 有什么看法？

We hear so much about PRP.

我们听说过很多关于 PRP 的事情。

I think it's FDA approved for certain things, right?

我认为 FDA 批准了某些用途，对吗？

People will get blood drawn, they'll spin down platelets and then put in platelet rich plasma.

人们会抽血，离心血小板，然后注入富含血小板的血浆。

A few years ago, people were making claims out there about PRP containing stem cells.

几年前，人们声称 PRP 含有干细胞。

Just for the record, my understanding, I'm sure someone will argue with me online, they always do, but my understanding is that PRP contains very few, if any stem cells and that it's not legal to assert that PRP is stem cell therapy, but PRP seems to be something that after an injury or in anticipation of a surgery, people are starting to do more and more because they can go drop a few thousand dollars and, I don't know, get this infusion of PRP.

Just for the record, my understanding, I'm sure someone will argue with me online, they always do, but my understanding is that PRP contains very few, if any stem cells and that it's not legal to assert that PRP is stem cell therapy, but PRP seems to be something that after an injury or in anticipation of a surgery, people are starting to do more and more because they can go drop a few thousand dollars and, I don't know, get this infusion of PRP.

Does it work to help recover brain tissue or preserve brain tissue?

它是否有助于恢复脑组织或保存脑组织？

Is there any evidence of that whatsoever?

有任何证据表明这一点吗？

Gary Steinberg:

加里·斯坦伯格：

I'm not an expert on platelet rich plasma, but my reading of the literature ally suggests there's not hard evidence that it's beneficial.

我不是富含血小板血浆的专家，但我对文献的阅读表明，没有确凿的证据表明它是有益的。

I think one has to be a little careful.

我认为必须要小心一点。

For instance, I still get emails every few weeks from people saying, I've had a stroke or I've had a head injury, and should I go to Russia or India or Mexico and get stem cell therapy?

For instance, I still get emails every few weeks from people saying, I've had a stroke or I've had a head injury, and should I go to Russia or India or Mexico and get stem cell therapy?

Andrew Huberman:

安德鲁·休伯曼：

Yeah, this is a big topic area

是的，这是一个很大的话题领域

Gary Steinberg:

加里·斯坦伯格：

Topic, and you may have discussed it in another podcast.

主题，您可能已经在另一个播客中讨论过它。

I

我

Andrew Huberman:

安德鲁·休伯曼：

Have not.

Have not.

I'll do a solo episode on stem cells and what they are and what they aren't.

我将制作一个关于干细胞以及它们是什么和不是什么的独奏节目。

I just will, just, sorry to interrupt, but I'm aware of a clinic in Florida that was injecting stem cells into the eyes of patients with macular degeneration and some other eye issues, and those patients rapidly went blind.

I just will, just, sorry to interrupt, but I'm aware of a clinic in Florida that was injecting stem cells into the eyes of patients with macular degeneration and some other eye issues, and those patients rapidly went blind.

Yeah, I was going to bring that up too.

是的，我也想提出这一点。

And that's what led the FDA to really clamp down on stem cell clinics in the us, although

这就是导致 FDA 真正打压美国干细胞诊所的原因，尽管

Gary Steinberg:

加里·斯坦伯格：

They haven't clamped down on those type clinics as well as they should.

他们没有像他们应该的那样对这些类型的诊所进行打击。

But I tell patients, no, if you go out of the country often you don't know what you're getting.

但我告诉病人，不，如果你经常出国，你就不知道自己会得到什么。

If there's not an equivalent of an FDA, which is overseeing it, you don't know whether these, where they come from, sometimes they're not published literature, you don't know where they're derived.

If there's not an equivalent of an FDA, which is overseeing it, you don't know whether these, where they come from, sometimes they're not published literature, you don't know where they're derived.

We've seen cases of patients going elsewhere, getting injections into the brain or the spinal cord and developing tumors or other problems.

我们见过一些患者去其他地方接受大脑或脊髓注射并出现肿瘤或其他问题的病例。

So I discouraged that and I was going to bring up, even in this country, these clinics, and that was published a number of years ago, that clinic in Florida, those patients had macular degeneration and they were losing their sight, but they could still see to some extent, they had their own adipose tissue taken.

所以我不鼓励这样做，我打算提起，即使在这个国家，这些诊所，几年前发表的，佛罗里达州的那个诊所，那些患者患有黄斑变性，他们正在失去视力，但他们仍然可以在某种程度上看到，他们自己的脂肪组织被摘除。

They sorted it for certain stem cells, mesenchymal stem cells, and it was re-injected into the eye, should have been safe, right?

他们把它分选为某些干细胞，间充质干细胞，然后重新注射到眼睛里，应该是安全的吧？

Their own cells even.

Their own cells even.

And as you say, several of 'em went blind, irreversibly irreversibly.

正如你所说，他们中的一些人失明了，不可逆转、不可逆转。

So I think this is very important to highlight the dangers of stem cell therapy in general.

所以我认为这对于强调干细胞治疗的总体危险非常重要。

There's a lot of hope for it.

人们对它抱有很大的希望。

I mean, we're engaged.

I mean, we're engaged.

We're just finishing a trial, a first in human trial at Stanford using cells we developed in my lab 20 years ago.

我们刚刚完成一项试验，这是斯坦福大学使用我们 20 年前在实验室开发的细胞进行的首次人体试验。

It took us 20 years to prove that they were safe, effective, didn't cause tumors, and the study is looking very promising.

我们花了20年的时间才证明它们是安全、有效、不会引起肿瘤的，而且这项研究看起来非常有前景。

It's a phase one study and we're making plans to do a phase two study with control patients, which you always want to do, but despite the hope, there is still a lot of hype, and I think it's very important to be careful about getting therapies that are not proven.

It's a phase one study and we're making plans to do a phase two study with control patients, which you always want to do, but despite the hope, there is still a lot of hype, and I think it's very important to be careful about getting therapies that are not proven.

Andrew Huberman:

安德鲁·休伯曼：

And while we wouldn't want anyone to take any kind of unnecessary risk, to me anyway, this goes back to the beginning of our conversation, that there's something very different about a knee from the brain, right?

虽然我们不希望任何人冒任何不必要的风险，但无论如何对我来说，这又回到了我们谈话的开始，膝盖和大脑有很大不同，对吧？

I'm not saying go get stem cells injected into your knee, but should you be the sort of person that wants to do that because you feel that's within your rights?

I'm not saying go get stem cells injected into your knee, but should you be the sort of person that wants to do that because you feel that's within your rights?

Again, I don't tell people what to do, and you go to a clinic, they get stem cells or I don't know, they take stem cells from some source and put them into your knee.

再说一遍，我不会告诉人们该怎么做，你去诊所，他们会获取干细胞，或者我不知道，他们从某个来源获取干细胞并将其放入你的膝盖中。

I mean, that's a very different situation than injecting into the brain spinal

我的意思是，这与注射到脑脊髓中的情况非常不同

Gary Steinberg:

加里·斯坦伯格：

Cord.

Cord.

Some of the approaches to treat diseases of the brain or injuries to the brain are not injecting directly into the brain.

一些治疗脑部疾病或脑部损伤的方法不是直接注射到脑部。

They're injecting intravenously or intra arterial threading a catheter up, as we discussed in injecting in the brain, those cells, it turns out, don't even get into the brain.

他们通过导管进行静脉内或动脉内注射，正如我们在大脑注射中所讨论的那样，事实证明，这些细胞甚至没有进入大脑。

And the idea is that in some of the better studies that have been done in animals that they work, by modulating the immune system systemically, those cells get trapped in the lung and the spleen, which people describe as bioreactors and modulate the immune system, which does make some sense.

这个想法是，在一些对动物进行的更好的研究中，通过系统性地调节免疫系统，这些细胞被困在肺和脾中，人们将其描述为生物反应器并调节免疫系统，这确实有一定道理。

As I say, we think one of the main benefits of these stem cells is that they modulate the immune system, and that helps with plasticity in the brain, but even intravenous delivery can be dangerous to the brain.

正如我所说，我们认为这些干细胞的主要好处之一是它们可以调节免疫系统，这有助于大脑的可塑性，但即使是静脉注射也可能对大脑造成危险。

Andrew Huberman:

安德鲁·休伯曼：

This is an area that we will spend a lot more time on during this podcast.

这是我们在本播客中将花费更多时间的领域。

Despite what you just said, I think the data I've seen from your laboratory, and as you told me, there's a trial that's finishing up now that features those data or that is where those data arrive from, rather are really impressive.

不管你刚才说什么，我认为我从你的实验室看到的数据，正如你告诉我的，现在正在完成一项试验，其中包含这些数据，或者这些数据来自哪里，确实令人印象深刻。

I mean, some people who were largely immobile or aphasic, they couldn't speak in some cases, are able to speak or move, and that's really remarkable.

I mean, some people who were largely immobile or aphasic, they couldn't speak in some cases, are able to speak or move, and that's really remarkable.

It's really exciting.

这真的很令人兴奋。

So I think that the future of stem cells and stroke therapy is pretty bright, at least from where I sit.

所以我认为干细胞和中风治疗的未来是相当光明的，至少从我看来是这样。

Gary Steinberg:

加里·斯坦伯格：

We don't want to oversell this, but some of the results in certain patients are remarkable.

我们不想过分夸大这一点，但某些患者的一些结果是显着的。

I mean, the patients and their families say it's changed their lives.

我的意思是，患者和他们的家人说这改变了他们的生活。

If you see them before and after, it's almost like a miracle.

如果你在之前和之后看到它们，这几乎就像一个奇迹。

Others are not as impressive.

其他人则没有那么令人印象深刻。

But so far in our trial, and we've treated 17 of the 18 intended patients, almost all the patients have recovered to some extent, and many of them have improved in a meaningful way if you use certain scales.

But so far in our trial, and we've treated 17 of the 18 intended patients, almost all the patients have recovered to some extent, and many of them have improved in a meaningful way if you use certain scales.

So again, we want to be cautious.

So again, we want to be cautious.

We're going to do a prospective randomized blinded controlled study, and that's the way it should be done.

我们将进行一项前瞻性随机盲对照研究，这就是应该进行的方式。

And if that's positive, it would lead to a phase three larger study.

如果这是积极的，这将导致第三阶段更大规模的研究。

Again, blinded, controlled, and if that's positive, then it would lead to commercialization, FDA approval.

再次强调，盲目、受控，如果这是积极的，那么它将导致商业化，并获得 FDA 的批准。

It's a long process.

这是一个漫长的过程。

I've spent 23 years and more than 46 million in grants and philanthropy getting it to this stage.

我花了 23 年时间和超过 4600 万美元的捐款和慈善事业才走到了这个阶段。

Wow.

哇。

Yeah.

是的。

Andrew Huberman:

安德鲁·休伯曼：

Wow.

哇。

That's a lot of time and a lot of money.

这需要大量的时间和金钱。

Amazing.

惊人的。

Gary Steinberg:

加里·斯坦伯格：

That's the way science and translation to clinical medicine is.

这就是科学和临床医学转化的方式。

Andrew Huberman:

安德鲁·休伯曼：

I would be remiss if I didn't ask, what are some of the things that you think could accelerate that process?

如果我不问你认为哪些事情可以加速这一过程，那就是我的失职了？

Or is that just the slow iterative process that a science in medicine?

或者这只是医学科学缓慢的迭代过程？

I mean, for instance, if there was five times as much money, would the science progress at five times the rate?

我的意思是，例如，如果有五倍的钱，科学进步的速度会是五倍吗？

Probably not.

可能不会。

Gary Steinberg:

加里·斯坦伯格：

No. But money is a factor.

不，但钱是一个因素。

It's not the only factor.

It's not the only factor.

The FDA is appropriately very cautious.

FDA 非常谨慎。

I think other countries, the equivalent of the FDA moves things along a little quicker, especially for therapies where there's no other treatment.

我认为其他国家，相当于 FDA 的机构，进展得更快一些，特别是对于没有其他治疗方法的治疗。

So I think those factors are important and would accelerate it.

所以我认为这些因素很重要并且会加速这一进程。

I think greater collaboration with industry and promoting more academic industry kinds of relationships would help because the government agencies do not provide enough money to do the final stage.

I think greater collaboration with industry and promoting more academic industry kinds of relationships would help because the government agencies do not provide enough money to do the final stage.

There's called this valley of death where you get initial encouraging data even clinically, but you can't move the hurdle to get it into FDA approval because of money.

这就是所谓的“死亡之谷”，在那里你甚至可以在临床上获得令人鼓舞的初步数据，但由于金钱的原因你无法扫除获得 FDA 批准的障碍。

In some cases.

在某些情况下。

I've seen as an example, a number of very good stem cell therapies not make it because the companies went bankrupt.

我举个例子，一些非常好的干细胞疗法因为公司破产而未能成功。

The board of directors of the company felt the results were good but not good enough, and they pulled the funding.

公司董事会认为结果不错，但还不够好，因此撤回了资金。

So this is a whole area which I was not well informed of until I got into this of how you move through the FDA and how you work with industry.

因此，在我了解如何通过 FDA 以及如何与行业合作之前，我对整个领域都不太了解。

I haven't formed a company yet, but I am going to have to because for the next trial, this trial, I was fortunate to get a grant from serm, California Institute for Regenerative Medicine of $12 million.

I haven't formed a company yet, but I am going to have to because for the next trial, this trial, I was fortunate to get a grant from serm, California Institute for Regenerative Medicine of $12 million.

Andrew Huberman:

安德鲁·休伯曼：

That's taxpayer dollars.

That's taxpayer dollars.

Gary Steinberg:

加里·斯坦伯格：

Exactly.

正是如此。

Andrew Huberman:

安德鲁·休伯曼：

Great use of taxpayer money, putting it to really forward thinking research.

充分利用纳税人的钱，将其用于真正具有前瞻性的研究。

Gary Steinberg:

加里·斯坦伯格：

But the next trial and our results are good enough that we probably will only need if we do a statistical power analysis, 69 patients.

但下一次试验和我们的结果足够好，我们可能只需要对 69 名患者进行统计功效分析。

Initially we thought we'd need 170 patients, but the results keep getting better and better.

最初我们认为需要 170 名患者，但结果越来越好。

So now it seems we would only need about 69 patients that will cost at least 45 million, and as the trials get larger, even more.

所以现在看来​​我们只需要大约 69 名患者，这将花费至少 4500 万美元，而且随着试验规模的扩大，甚至更多。

So yeah, we need to figure out a better way to allocate money to make these advances.

所以，是的，我们需要找到一种更好的方式来分配资金来取得这些进展。

Andrew Huberman:

安德鲁·休伯曼：

It sounds like a company or some role of industry is going to be necessary.

听起来一家公司或某个行业的角色是必要的。

Gary Steinberg:

加里·斯坦伯格：

Well, you might be interested in investing, right?

好吧，您可能对投资感兴趣，对吗？

Andrew Huberman:

安德鲁·休伯曼：

Well, this podcast is always available free.

嗯，这个播客始终免费提供。

The Standard Human Lab podcast.

标准人类实验室播客。

Our premium channel actually generates money.

我们的优质渠道实际上可以赚钱。

We do ask me anythings and things of that sort.

我们确实会问我类似的问题。

We have donors that have come in for a dollar match, and we do philanthropy to laboratories at Stanford, Salk Institute, Columbia University, we've already done that.

We have donors that have come in for a dollar match, and we do philanthropy to laboratories at Stanford, Salk Institute, Columbia University, we've already done that.

We're going to do more of this.

We're going to do more of this.

Well,

嗯，

Gary Steinberg:

加里·斯坦伯格：

I was being facetious.

我是在开玩笑。

Andrew Huberman:

安德鲁·休伯曼：

No, listen, we could explore it.

不，听着，我们可以探索它。

One of the guidelines is that we fund research on humans exclusively.

其中一项指导方针是我们专门资助针对人类的研究。

So we could talk about that.

所以我们可以谈谈这个。

The former colleague of ours at Stanford once told me the joke, we'll see if I get in trouble for this joke, which is that there are two kinds of Stanford faculty, Stanford faculty with companies and Stanford faculty with successful companies.

The former colleague of ours at Stanford once told me the joke, we'll see if I get in trouble for this joke, which is that there are two kinds of Stanford faculty, Stanford faculty with companies and Stanford faculty with successful companies.

So we, we'll see what comes down the pike from that.

所以我们会看看接下来会发生什么。

But many of the technologies and discoveries that have been made at Stanford have spun off into.

但斯坦福大学取得的许多技术和发现已经衍生出来。

There are these little companies like Genentech and other companies like that, that are not strictly Stanford relations, but of course other universities too.

有像基因泰克这样的小公司和其他类似的公司，严格来说与斯坦福大学没有关系，当然也有其他大学。

But the universities are where the basic research is done, and then somebody has to implement those.

但大学是基础研究完成的地方，然后必须有人去实施这些研究。

Gary Steinberg:

加里·斯坦伯格：

Stanford's getting much better.

斯坦福大学的情况越来越好。

When I came to Stanford in 1974, the medical center was more like an NIH of the west, and there was not a lot of clinical excellence except for cardiac surgery.

1974年我来到斯坦福的时候，这个医学中心更像是西方的NIH，除了心脏外科以外，没有太多临床卓越的东西。

Norm Shumway and radiation oncology, Henry Kaplan, who had developed the first radiation method for treating lymphoma, and we were great at making basic discoveries, not very good at translating them.

Norm Shumway and radiation oncology, Henry Kaplan, who had developed the first radiation method for treating lymphoma, and we were great at making basic discoveries, not very good at translating them.

But over the last, what, 50 years, Stanford has gotten much better at translating them into clinical therapies and even doing some of that work at Stanford, not farming it out to other places.

但在过去 50 年里，斯坦福大学在将它们转化为临床疗法方面取得了很大的进步，甚至在斯坦福大学完成了一些工作，而不是将其外包给其他地方。

So I think that's another area that we need to encourage.

所以我认为这是我们需要鼓励的另一个领域。

Andrew Huberman:

安德鲁·休伯曼：

Well, the proximity to big tech is built into the fabric of the Bay Area.

嗯，靠近大型科技公司已经融入了湾区的结构之中。

Now.

现在。

There's just no escaping that, and I think overall it's not without, its sometimes issues, but overall, I think it's a really good thing, facilitates the most rapid possible flow between basic science discovery and implementation at large.

There's just no escaping that, and I think overall it's not without, its sometimes issues, but overall, I think it's a really good thing, facilitates the most rapid possible flow between basic science discovery and implementation at large.

I want to make sure that we cover just a little bit about vagal stimulation.

我想确保我们只介绍一点关于迷走神经刺激的内容。

A lot of listeners, this podcast are familiar with the vagus nerve as this very extensive pathway connecting brain and body in both directions.

这个播客的很多听众都熟悉迷走神经，因为这条非常广泛的通路在两个方向上连接大脑和身体。

The common idea out there is that the vagus is associated with calming because it's in the parasympathetic arm of the autonomic nervous system, the so-called rest and digest pathway.

The common idea out there is that the vagus is associated with calming because it's in the parasympathetic arm of the autonomic nervous system, the so-called rest and digest pathway.

But I happen to know, and I'm sure you know from experimentation and from clinical work that oftentimes vagal stimulation is a way of bringing, say, depressed patients up to more alertness.

But I happen to know, and I'm sure you know from experimentation and from clinical work that oftentimes vagal stimulation is a way of bringing, say, depressed patients up to more alertness.

That vagal stimulation is not always about calming.

迷走神经刺激并不总是意味着平静。

It can be about alerting the brain more, making the brain more alert.

它可以更多地提醒大脑，让大脑更加警觉。

So what sorts of vagal stimulation are you doing given that the vagal pathway is so extensive?

那么，考虑到迷走神经通路如此广泛，您正在做什么类型的迷走神经刺激呢？

Which branch of the Vegas do you stimulate?

Which branch of the Vegas do you stimulate?

It goes around the year.

It goes around the year.

It's in the neck, it goes down through the gut.

It's in the neck, it goes down through the gut.

I mean, we're talking basically about a super highway of, I mean, it kind of reminds me of the Austin Freeway system.

我的意思是，我们基本上谈论的是一条超级高速公路，我的意思是，这让我想起了奥斯汀高速公路系统。

If you've ever driven in Austin, it's like the freeways going every which direction.

如果您曾经在奥斯汀开车，就会发现就像高速公路向各个方向延伸一样。

Whenever I'm there, I'm like, the freeway system here is kind of like the Vegas, so which avenue do you stimulate in order to get a desired effect?

Whenever I'm there, I'm like, the freeway system here is kind of like the Vegas, so which avenue do you stimulate in order to get a desired effect?

Gary Steinberg:

加里·斯坦伯格：

Right?

对吗？

Well, for stroke, and as I alluded to vagal nerve stimulation coupled with physical therapy, physical activity, very intensive, was the very first FDA approved treatment for chronic stroke patients.

Well, for stroke, and as I alluded to vagal nerve stimulation coupled with physical therapy, physical activity, very intensive, was the very first FDA approved treatment for chronic stroke patients.

That was approved in 20 21 3 years ago, and it was shown in the study that compared with non stimulation, in other words, putting the stimulator on, but not stimulating and doing the therapy that patients did better, it was a modest improvement, but it felt to be meaningful and it was shown to be effective at 90 days, only three months.

That was approved in 20 21 3 years ago, and it was shown in the study that compared with non stimulation, in other words, putting the stimulator on, but not stimulating and doing the therapy that patients did better, it was a modest improvement, but it felt to be meaningful and it was shown to be effective at 90 days, only three months.

Now, recently at the last international stroke meeting this past February, it was presented, and I don't know if it's been published yet, that those results hold up for up to a year.

Now, recently at the last international stroke meeting this past February, it was presented, and I don't know if it's been published yet, that those results hold up for up to a year.

So the way it works presumably, is that you stimulate the entire vagus nerve in the neck, and it's not the peripheral effects on the heart or the other autonomic organs where it's working it's stimulation that goes back to the brain because when you stimulate a nerve, it doesn't go in one direction, and that's probably how it works for depression.

So the way it works presumably, is that you stimulate the entire vagus nerve in the neck, and it's not the peripheral effects on the heart or the other autonomic organs where it's working it's stimulation that goes back to the brain because when you stimulate a nerve, it doesn't go in one direction, and that's probably how it works for depression.

Also not a systemic, and the vagus has lots of connection with brain functions, and it's not completely clear which areas are being stimulated to recover from stroke or improve depression, but it's brain stimulation that somehow, again, resurrect circuits or induces plasticity in circuits.

Also not a systemic, and the vagus has lots of connection with brain functions, and it's not completely clear which areas are being stimulated to recover from stroke or improve depression, but it's brain stimulation that somehow, again, resurrect circuits or induces plasticity in circuits.

Again, it's something that we're learning about, and I think not just vagal nerve stimulation, but stimulation of the brain is becoming a very important innovative treatment for many brain diseases and injuries.

Again, it's something that we're learning about, and I think not just vagal nerve stimulation, but stimulation of the brain is becoming a very important innovative treatment for many brain diseases and injuries.

Andrew Huberman:

安德鲁·休伯曼：

Is the vagal stimulation, is it invasive or can you use an external stimulator?

迷走神经刺激是侵入性的还是可以使用外部刺激器？

Gary Steinberg:

加里·斯坦伯格：

It's invasive.

It's invasive.

You have to do an operation.

You have to do an operation.

It's low risk, very few side effects.

It's low risk, very few side effects.

Occasionally it can cause some problems with swallowing, which are usually temporary because the vagal nerve, the recurrent vagal nerve supplies, the larynx, the vocal cord, so it's an implanted stimulator, but the stimulation could be turned on and off with an external magnet device.

Occasionally it can cause some problems with swallowing, which are usually temporary because the vagal nerve, the recurrent vagal nerve supplies, the larynx, the vocal cord, so it's an implanted stimulator, but the stimulation could be turned on and off with an external magnet device.

Andrew Huberman:

安德鲁·休伯曼：

Incredible.

难以置信。

Gary, Dr. Steinberg, I want to thank you for several things.

加里、斯坦伯格博士，我要感谢你们几件事。

First of all, for coming here today to share with us right up until the point we hit hot mics, meaning we started recording, you were getting calls about patients.

First of all, for coming here today to share with us right up until the point we hit hot mics, meaning we started recording, you were getting calls about patients.

I know you're still in the operating room.

I know you're still in the operating room.

You were our department chair for more than two decades,

你担任我们系主任二十多年了

Gary Steinberg:

加里·斯坦伯格：

25 years.

25 年。

Andrew Huberman:

安德鲁·休伯曼：

25 years.

25 年。

Thank you for that.

谢谢你。

And still just so active in this area doing cutting edge research and stem cells and so much more.

并且在这一领域仍然非常活跃，从事前沿研究和干细胞等等。

So as an extremely busy person who has many important duties, you are literally a brain surgeon to take the time out of your schedule to come here and share with us all this information about how to keep our brain healthy, the relationship between alcohol and nicotine.

So as an extremely busy person who has many important duties, you are literally a brain surgeon to take the time out of your schedule to come here and share with us all this information about how to keep our brain healthy, the relationship between alcohol and nicotine.

Fortunately, caffeine's not on the list, but don't overdo it, folks.

幸运的是，咖啡因不在名单上，但不要过量，伙计们。

Neuroprotection the discussion about TBI, something we've never discussed on this podcast, transient ischemic attacks, and just a really vast survey of things that concern a lot of people, and that also now having heard what you've shared also, it puts in a position now to empower themselves to take some agency over their brain health, which is something that I think most people really fear, that this thing inside our skulls is outside the reach of our efforts to try and maintain health.

神经保护，关于 TBI 的讨论，我们在这个播客中从未讨论过，短暂性脑缺血发作，以及对很多人关心的事情进行的一项非常广泛的调查，而且现在也听到了你分享的内容，它现在使他们能够授权自己采取一些机构来控制他们的大脑健康，这是我认为大多数人真正担心的事情，我们头骨内的这个东西超出了我们努力维持健康的努力的范围。

And clearly you've explained how that is not the case, and there are things we can do to both protect ourselves and to overcome challenges should they arise.

显然，您已经解释了为什么情况并非如此，我们可以采取一些措施来保护自己并克服出现的挑战。

So on behalf of myself and all the listeners and viewers, I just want to say thank you so much, and hopefully as these trials continue to develop, you'll come back and update us on the progress.

因此，我谨代表我自己以及所有听众和观众对你们表示非常感谢，并希望随着这些试验的继续发展，你们会回来向我们通报最新进展情况。

Andrew,

安德鲁，

Gary Steinberg:

加里·斯坦伯格：

It's been a real pleasure.

这真是一种乐趣。

Thank you for inviting me.

谢谢你邀请我。

Andrew Huberman:

安德鲁·休伯曼：

Thank you for joining me for today's discussion with Dr. Gary Steinberg.

感谢您参加今天与加里·斯坦伯格博士的讨论。

To learn more about the research in the Steinberg Laboratory and Clinic, please refer to our show note captions.

要了解有关斯坦伯格实验室和诊所的研究的更多信息，请参阅我们的节目说明文字。

If you're learning from and or enjoying this podcast, please subscribe to our YouTube channel.

如果您正在学习或喜欢此播客，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 follow the podcast on both Spotify and Apple by clicking the follow tab, and you can leave us up to a five star review.

此外，请通过单击“关注”选项卡关注 Spotify 和 Apple 上的播客，您可以给我们留下五星级的评论。

Please also check out the sponsors mentioned at the beginning and throughout today's episode.

另请查看今天节目开头和整个节目中提到的赞助商。

That's the best way to support this podcast.

这是支持这个播客的最佳方式。

If you have questions for me or comments about the podcast or topics or guests you'd like me to consider for the Huberman Lab podcast, please put those in the comments section on YouTube.

如果您对我有疑问或对播客有意见，或者希望我为 Huberman Lab 播客考虑主题或嘉宾，请在 YouTube 上的评论部分留言。

I do read all the comments if you're not already following me on social media.

如果您还没有在社交媒体上关注我，我会阅读所有评论。

I'm Huberman Lab on all social media platforms, so that's Instagram X, LinkedIn threads, and Facebook, and on all those platforms, I discuss science and science related tools, some of which overlap with the content of the Huberman Lab podcast, but much of which is distinct from the content on the Huberman Lab podcast.

我是所有社交媒体平台上的 Huberman Lab，包括 Instagram X、LinkedIn 帖子和 Facebook，在所有这些平台上，我讨论科学和科学相关工具，其中一些与 Huberman Lab 播客的内容重叠，但其中大部分与 Huberman Lab 播客上的内容不同。

So again, it's Huberman Lab on all social media channels.

再说一次，所有社交媒体渠道上都是 Huberman Lab。

If you haven't already subscribed to our Neural Network newsletter, the Huberman Lab podcast, neural Network Newsletter is a free monthly newsletter in the form of brief PDFs of one to three pages that are protocols that describe things like how to best do deliberate cold exposure, deliberate heat exposure.

如果您还没有订阅我们的神经网络时事通讯（Huberman Lab 播客），神经网络时事通讯是一份免费的月度时事通讯，采用一到三页的简短 PDF 形式，这些协议描述了如何最好地进行故意冷暴露、故意热暴露等内容。

We have a foundational fitness protocol, a neuroplasticity and learning protocol, ways to optimize your sleep, dopamine, and much more, all available at zero cost.

我们有基本的健身方案、神经可塑性和学习方案、优化睡眠的方法、多巴胺等等，所有这些都可以零成本获得。

You simply go to Huberman lab.com, go to the menu tab, scroll down to newsletter, and enter your email, and we do not share your email with anybody.

您只需访问 Huberman lab.com，转到菜单选项卡，向下滚动到时事通讯，然后输入您的电子邮件，我们不会与任何人共享您的电子邮件。

Thank you once again for joining me for today's discussion with Dr. Gary Steinberg.

再次感谢您参加今天与加里·斯坦伯格博士的讨论。

And last but certainly not least, thank you for your interest in science.

最后但并非最不重要的一点是，感谢您对科学的兴趣。