Dr. Peter Attia: Exercise, Nutrition, Hormones for Vitality & Longevity
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。
Today, my guest is Dr. Peter Attia.
今天，我的嘉宾是彼得·阿蒂亚博士。
Dr. Attia is a physician who's focused on nutritional, supplementation-based, behavioral, prescription drug, and other interventions that promote health span and lifespan.
Attia 博士是一位医生，专注于营养、补充剂、行为、处方药和其他促进健康寿命和寿命的干预措施。
His expertise spans from exercise physiology to sleep physiology, emotional and mental health, and pharmacology.
他的专业知识涵盖运动生理学、睡眠生理学、情绪和心理健康以及药理学。
Today, we talk about all those areas of health, starting with the very basics, such as how to evaluate one's own health status and how to define one's health trajectory.
今天，我们从最基本的开始讨论所有这些健康领域，例如如何评估自己的健康状况以及如何定义自己的健康轨迹。
We also talk about the various sorts of interventions that one can take in order to optimize vitality while also extending longevity, that is lifespan.
我们还讨论了人们可以采取的各种干预措施，以优化活力，同时延长寿命，即寿命。
Dr. Attia is uniquely qualified to focus on the complete depth and breadth of topics that we cover, and indeed, these are the same topics that he works with his patients on in his clinic every day.
阿提亚博士拥有独特的资质，能够专注于我们所涵盖主题的完整深度和广度，事实上，这些主题与他每天在诊所与患者一起工作的主题相同。
Dr. Attia earned his Bachelor of Science in Mechanical Engineering and Applied Mathematics and his MD from Stanford University School of Medicine.
Attia 博士在斯坦福大学医学院获得机械工程和应用数学理学学士学位以及医学博士学位。
He then went on to train at Johns Hopkins Hospital in general surgery, one of the premier hospitals in the world, where he was the recipient of several prestigious awards, including Resident of the Year.
然后，他继续在约翰·霍普金斯医院接受普通外科培训，这是世界上最好的医院之一，在那里他获得了多项著名奖项，包括年度住院医师奖。
He's been an author on comprehensive reviews of general surgery.
他是普通外科综合评论的作者。
He spent two years at the National Institutes of Health as a surgical oncology fellow at the National Cancer Institute, where his work focused on immune-based therapies for melanoma.
他在美国国立卫生研究院担任了两年的国家癌症研究所的外科肿瘤学研究员，他的工作重点是黑色素瘤的免疫疗法。
In the fields of science and medicine, it is well understood that we are much the product of our mentors and the mentoring we receive.
在科学和医学领域，众所周知，我们很大程度上是我们的导师和我们接受的指导的产物。
Dr. Attia has trained with some of the best and most innovative lipidologists, endocrinologists, gynecologists, sleep physiologists, and longevity scientists in the United States and Canada.
阿蒂亚博士曾接受过美国和加拿大一些最优秀、最具创新精神的脂质学家、内分泌学家、妇科医生、睡眠生理学家和长寿科学家的培训。
So the expertise that funnels through him and that he shares with us today is really harnessed from the best of the best and his extensive training and expertise.
因此，他今天与我们分享的专业知识确实来自最优秀的人才以及他广泛的培训和专业知识。
By the end of today's episode, you will have answers to important basic questions, such as should you have blood work?
在今天的节目结束时，您将获得重要基本问题的答案，例如您应该进行血液检查吗？
How often should you do blood work?
您应该多久进行一次血液检查？
What specific things should you be looking for on that blood work that are either counterintuitive or not often discussed, and yet that immediately and in the long term influence your lifespan and health span?
在血液检查中，您应该寻找哪些具体的事情，这些事情要么违反直觉，要么不经常讨论，但会立即和长期影响您的寿命和健康寿命？
We talk about hormone health and hormone therapies for both men and women.
我们谈论男性和女性的激素健康和激素疗法。
We talk about drug therapies that can influence the mind as well as the body, and of course, we talk about supplementation, nutrition, exercise, and predictors of lifespan and health span.
我们谈论可以影响心灵和身体的药物疗法，当然，我们谈论补充、营养、锻炼以及寿命和健康寿命的预测因素。
It is an episode rich with information.
这是一个信息丰富的剧集。
For some of you, you may want to get out a pen and paper in order to take notes.
对于某些人来说，您可能需要拿出笔和纸来记笔记。
For others of you that learn better simply by listening, I just want to remind you that we have timestamped all this information so that you can go back to the specific topics most of interest to you.
对于其他仅通过聆听就能学得更好的人，我只是想提醒您，我们已为所有这些信息添加了时间戳，以便您可以返回到您最感兴趣的特定主题。
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。
Speaker 3:
演讲者3：
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Altra 跑鞋注重空间。
The space to go further, to feel better, to do something you never thought possible, and this space starts with Altra fit.
让您走得更远、感觉更好、做一些您从未想过可能的事情的空间，而这个空间始于 Altra fit。
Unlike traditional running shoes, Altra fit gives toes more room to move naturally, so every step is strong, balanced, and comfortable.
与传统跑鞋不同，Altra fit 为脚趾提供了更多自然移动的空间，因此每一步都强劲、平衡且舒适。
Whatever you're lacing up for, stay out there with Altra.
无论您要做什么，请与 Altra 一起出去。
Shop now at altrarunning.com.
立即前往 altrarunning.com 购买。
That's A-L-T-R-Arunning.com.
那是 A-L-T-R-Arunning.com。
Speaker 4:
演讲者4：
This Labor Day at Lowe's, get up to 45% off select major appliances, plus deals on select materials and tools to keep the job moving.
今年劳动节，Lowe's 精选主要家电可享受高达 45% 的折扣，此外还提供精选材料和工具的优惠，以保证工作顺利进行。
Right now, get a free DeWalt 20V Max battery two-pack when you buy a select DeWalt 20V Max tool.
现在，购买精选 DeWalt 20V Max 工具即可免费获赠 DeWalt 20V Max 电池两节。
At Lowe's, we have what you need to keep your job moving.
在劳氏，我们拥有您保持工作顺利进行所需的一切。
Valid through 9/13, while supplies last.
有效期至 9 月 13 日，送完即止。
Selection varies by location.
选择因地点而异。
See lowes.com for more details.
请访问 lowes.com 了解更多详情。
Andrew Huberman:
安德鲁·休伯曼：
And now for my discussion with Dr. Peter Attia.
现在我与 Peter Attia 博士进行讨论。
Peter, thanks for joining me today.
彼得，谢谢你今天加入我的行列。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Thanks for having me, man.
谢谢你有我，伙计。
Andrew Huberman:
安德鲁·休伯曼：
I've been looking forward to this for a very long time.
我对此期待已久。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Ah, so have I.
啊，我也一样。
Andrew Huberman:
安德鲁·休伯曼：
I'm a huge fan of your podcast.
我是你播客的超级粉丝。
I know that you went to Stanford and worked with a number of people that are colleagues of mine, so for me, this is already a thrill just to be doing this.
我知道你曾在斯坦福大学就读，并与我的许多同事一起工作，所以对我来说，能够做到这一点就已经很令人兴奋了。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah.
是的。
Likewise.
同样地。
Andrew Huberman:
安德鲁·休伯曼：
I have a ton of questions, but I want to start off with something that I wonder a lot about and that I know many other people wonder about, which is how to assess their current health and their trajectory in terms of health and wellbeing, specifically as it relates to blood work.
我有很多问题，但我想从我很想知道的事情开始，我知道很多其他人也想知道，那就是如何评估他们当前的健康状况以及他们在健康和福祉方面的轨迹，特别是与血液检查有关的情况。
So what are your thoughts on blood work?
那么您对血液检查有何看法？
Is it necessary for the typical person?
对于一般人来说有必要吗？
So this is somebody who's not dealing with some acute syndrome or illness.
所以这个人没有患上某种急性综合症或疾病。
And at what age would you suggest people start getting blood work?
您建议人们在什么年龄开始进行血液检查？
How frequently should they get blood work?
他们应该多久进行一次血液检查？
How often do you get blood work done, et cetera?
您多久进行一次血液检查等？
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah.
是的。
There's a lot there.
那里有很多东西。
The way I talk about this with patients is first taking everything back to the objective.
我与患者谈论这个问题的方式是首先将一切回归到目标。
So what's the thing we're trying to optimize?
那么我们要尝试优化的是什么？
So if a person says, "Look, I'm trying to break 10 hours for an Ironman," I don't know that blood work is going to be a game-changing aspect of their trajectory and their training.
因此，如果一个人说，“看，我正在努力为铁人三项赛打破 10 小时”，我不知道血液检查会成为他们轨迹和训练中改变游戏规则的方面。
They're going to benefit much more from sort of functional analyses of performance.
他们将从性能的功能分析中受益更多。
So I'm assuming, based on the question, that you're really coming at this through the lens of living longer and living better through the lifespan, health span lens.
因此，根据这个问题，我假设您确实是从寿命、健康寿命的角度来看寿命更长、生活得更好。
Andrew Huberman:
安德鲁·休伯曼：
Mostly.
主要是。
Yeah.
是的。
And just, I think most people have some sense of their vitality or lack of vitality, but I think everyone wonders whether or not they could feel better and whether or not blood work will give them a window into how they might go about feeling better.
只是，我认为大多数人对自己的活力或缺乏活力都有一定的感觉，但我想每个人都想知道他们是否会感觉更好，以及血液检查是否会给他们一个窗口，让他们了解如何感觉更好。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah, I think it does to some extent, but I also think that it has a lot of blind spots.
是的，我认为在某种程度上确实如此，但我也认为它有很多盲点。
So I kind of break things down into the two vectors that make up longevity, which are lifespan and health span So lifespan is the easiest of those vectors to understand because it's pretty binary.
所以我把事物分解成构成长寿的两个向量，即寿命和健康寿命。所以寿命是这些向量中最容易理解的，因为它是相当二元的。
You're alive or you're not alive, you're respiring or you're not, you make ATP or you don't, end of story.
你要么活着，要么已经死了，要么有呼吸，要么没有呼吸，要么产生 ATP，要么不产生 ATP，故事结束了。
So what gets in the way of lifespan is essentially the four horsemen of disease.
因此，阻碍寿命的本质是疾病四骑士。
So atherosclerotic disease, cancer, neurodegenerative disease, and metabolic disease, which directly isn't the cause of many deaths, but basically creates the foundation to all of those other diseases.
因此，动脉粥样硬化疾病、癌症、神经退行性疾病和代谢疾病虽然不是许多死亡的直接原因，但基本上为所有其他疾病奠定了基础。
So, if you're a non-smoker, what I just rattled off is about 80% of your death.
所以，如果你不吸烟，我刚才所说的大约是你死亡的 80%。
So how does blood work help address those?
那么血液检查如何帮助解决这些问题呢？
It varies.
它有所不同。
So on the atherosclerotic standpoint, it's a very good predictor of risk if you know what to look for.
因此，从动脉粥样硬化的角度来看，如果您知道要寻找什么，那么它是一个非常好的风险预测指标。
So primarily ApoB would be the single most important lipoprotein that we care about.
因此，ApoB 基本上是我们关心的最重要的脂蛋白。
I can explain what that means in a second.
我可以立即解释这意味着什么。
And then also, other markers of inflammation, endothelial health, and metabolic health.
然后还有炎症、内皮健康和代谢健康的其他标志物。
When it comes to cancer, blood testing in the sense of biomarkers is not particularly helpful outside of knowing that the second leading environmental or modifiable cause of cancer is metabolic ill health after smoking.
当谈到癌症时，除了知道癌症的第二大环境或可改变原因是吸烟之后的代谢不良之外，生物标志物意义上的血液检测并没有特别帮助。
So we don't actually know a lot about cancer in the sense of what causes it.
因此，我们实际上对癌症的病因了解不多。
It's really stochastic and it's a lot of bad luck.
这确实是随机的，而且运气不好。
So we know that smoking drives it, and we know that even though epidemiologically we say obesity drives it, what it really means is metabolic poor health.
所以我们知道吸烟是导致肥胖的原因，而且我们知道，尽管从流行病学的角度来说，我们说肥胖是导致肥胖的原因，但它的真正含义是代谢不良。
It's probably the hyperinsulinemia that comes with obesity that drives it.
可能是肥胖带来的高胰岛素血症导致了这种情况。
So biomarkers help with that, but there's still an enormous blind spot to cancer.
因此，生物标志物可以帮助解决这一问题，但癌症仍然存在巨大的盲点。
We could talk about liquid biopsies aside because those aren't really biomarker studies, but put that away.
我们可以把液体活检放在一边，因为它们并不是真正的生物标志物研究，但把它放在一边。
On the neurodegenerative side, I don't think we have a lot of insight that comes to understanding Parkinson's disease.
在神经退行性疾病方面，我认为我们对帕金森病的了解还不够深入。
But when it comes to dementia, particularly Alzheimer's disease, which is the most prevalent form of dementia, I think the biomarkers can be quite helpful.
但当谈到痴呆症，特别是阿尔茨海默病（这是最常见的痴呆症形式）时，我认为生物标志物非常有帮助。
They overlap a lot with the atherosclerotic diseases.
它们与动脉粥样硬化疾病有很多重叠。
So the same things that drive the risk of heart disease are driving the risk of dementia.
因此，导致心脏病风险的因素也同样会导致患痴呆症的风险。
And then there's some novel stuff as well.
然后还有一些新奇的东西。
If you include genetic testing, which you can get out of a blood test, we get a whole suite of genes, not just ApoE, but far more nuanced stuff than that that can also play a role.
如果你把基因测试包括在内，你可以从血液测试中得到这一点，我们会得到一整套基因，不仅仅是 ApoE，还有比这更微妙的东西也可以发挥作用。
So you can stratify risk in that sense.
因此，您可以从这个意义上对风险进行分层。
So in aggregate, I would say blood testing and biomarkers provides pretty good insight into lifespan.
因此，总的来说，我认为血液检测和生物标志物可以很好地了解寿命。
When you get into health span, you have the cognitive, physical, emotional domains.
当你进入健康范围时，你就有了认知、身体、情感领域。
I think here the biomarkers are far less helpful, and here we rely more on functional testing.
我认为生物标志物在这里的帮助要小得多，在这里我们更多地依赖于功能测试。
So when it comes to the cognitive piece, you can do cognitive testing.
所以当涉及到认知部分时，你可以进行认知测试。
In terms of long-term risk, a lot of the things that imply good cognitive health as you age are in line with the same things that you would do to reduce the risk of dementia.
就长期风险而言，随着年龄的增长，许多暗示良好认知健康的事情与降低痴呆风险的事情是一致的。
So all the biomarkers that you would look to improve through dementia risk reduction, you would be improving through cognitive health.
因此，您希望通过降低痴呆症风险来改善的所有生物标志物，您都可以通过认知健康来改善。
On the physical side, outside of looking at hormone levels and things which we look at extensively and understanding how those might aid in or prevent some of the metrics that matter, this is a biomarker aside thing.
在身体方面，除了观察激素水平和我们广泛观察的事物并了解它们如何有助于或阻止某些重要指标之外，这是一个生物标记物。
I'd be much more interested in a person's DEXA, CPET testing, VO2 max testing, zone two lactate testing, fat oxidation.
我对一个人的 DEXA、CPET 测试、最大摄氧量测试、第二区乳酸测试、脂肪氧化更感兴趣。
Those what I would consider more functional tests that give me far more insight into that.
我认为这些是更多的功能测试，它们让我对此有更深入的了解。
And then, of course, the emotional piece, which depending on who you are, might be the single most important piece without which none of this other stuff matters.
然后，当然，情感部分，这取决于你是谁，可能是最重要的部分，没有它，其他东西都不重要。
If you're a totally miserable human being, your relationships suck.
如果你是一个完全悲惨的人，你的人际关系就会很糟糕。
I don't think any of this other stuff matters.
我认为其他任何事情都不重要。
And certainly there's nothing that I'm looking at in biomarkers that's giving me great insight into that.
当然，我在生物标志物中看到的东西并没有让我对此有深入的了解。
Andrew Huberman:
安德鲁·休伯曼：
Do you ask about emotional state or do you try and assess emotional state indirectly when you do an intake with one of your patients?
当您与一位患者一起服用药物时，您是否询问情绪状态或尝试间接评估情绪状态？
Dr. Peter Attia:
彼得·阿蒂亚博士：
Probably not so much in the intake because I think it takes a while to form a relationship with a patient before that starts to become something that they're necessarily going to want to talk with you about.
可能没有那么多，因为我认为需要一段时间才能与患者建立关系，然后才能开始成为他们必然想与您谈论的事情。
But I definitely think of it as an important part of what we do, and I think without it, none of this other stuff really matters.
但我绝对认为它是我们工作的重要组成部分，而且我认为没有它，其他事情都不重要。
Again, the irony of thinking about how many years I spent sort of in pursuit of fully optimizing every detail of everything without any attention being paid to that dimension is not lost on me.
再次，讽刺的是，我花了多少年的时间来追求全面优化每件事的每一个细节，却没有注意到这个维度，这对我来说并没有消失。
And look, there are some patients who that's something that's compartmentalized.
你看，有些病人的情况是被区分开来的。
Maybe they're doing well in that department or maybe they aren't, but they just aren't willing to engage on that yet.
也许他们在那个部门做得很好，也可能不是，但他们只是还不愿意参与其中。
Andrew Huberman:
安德鲁·休伯曼：
In terms of frequency of blood testing, if somebody feels pretty good and is taking a number of steps, exercise, nutrition, et cetera, to try and extend lifespan and improve health span, is once a year frequent enough?
就血液检测的频率而言，如果某人感觉良好，并且正在采取一系列措施、锻炼、营养等，以尝试延长寿命和改善健康寿命，那么一年一次的频率是否足够？
And should a 20-year-old start getting blood work done just to get a window into what's going on, assuming that they can afford it or their insurance can cover it?
假设一个 20 岁的人有能力负担或者他们的保险可以承保，那么他是否应该开始做血液检查，只是为了了解正在发生的情况？
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah.
是的。
Look, I certainly think everybody should be screened early in life because if you look at what's the single most prevalent genetic driver of atherosclerosis is Lp .
看，我当然认为每个人都应该在生命早期进行筛查，因为如果你看看动脉粥样硬化最普遍的遗传驱动因素是 Lp 。
So unfortunately, most physicians don't know what Lp is, and yet somewhere between 8 and 12% of the population has a high enough, and depending on who you...
不幸的是，大多数医生不知道 Lp 是什么，但 8% 到 12% 的人的 Lp 足够高，这取决于你是谁……
I had a recent guest on my podcast who suggested it could be as high as 20% have a high enough Lp that it is contributing to atherosclerosis.
最近我的播客上有一位嘉宾表示，可能高达 20% 的人拥有足够高的 Lp，从而导致动脉粥样硬化。
So to not want to know that when it's genetically determined.
所以不想知道它何时由基因决定。
This is something that you're born with this and you only need to really check it once.
这是你与生俱来的东西，你只需要真正检查一次。
Why we wouldn't want to know that in a 20-year-old when it can contribute to a lot of the early atherosclerosis we see in people, it's leaving money on the table in my opinion.
为什么我们不想知道，在 20 岁的人身上，它会导致我们在人们身上看到的许多早期动脉粥样硬化，在我看来，它是在浪费金钱。
The frequency with which you need to test really comes down to the state of interventions.
您需要测试的频率实际上取决于干预措施的状态。
I don't think it makes sense to just do blood tests for the sake of doing blood tests.
我认为仅仅为了验血而验血是没有意义的。
There has to be a reason.
一定有一个原因。
Is something changing?
有什么变化吗？
A blood test is, for the most part, a static intervention.
血液检查在很大程度上是一种静态干预。
It's a look at a window in time, and there's benefit in having a few of those over the course of a year If you're unsure about a level.
这是对一个时间窗口的观察，如果你不确定自己的水平，那么在一年的时间里进行一些这样的观察是有好处的。
So if something comes back and it doesn't look great, yeah, it might make sense just to recheck it without reacting to it.
因此，如果返回的内容看起来不太好，是的，重新检查而不对其做出反应可能是有意义的。
But typically, in patients, we might check blood two to four times a year, but we're also probably doing things in there to now check, like, "Hey, we gave this drug.
但通常情况下，我们可能每年检查患者的血液两到四次，但我们现在也可能会在那里做一些事情来检查，比如，“嘿，我们给了这种药物。
Did it have the desired outcome?
是否达到了预期的效果？
You put on three pounds of muscle and lost three pounds of fat.
您增加了三磅肌肉并减少了三磅脂肪。
Did it have the desired outcome?"
达到了想要的结果吗？”
Andrew Huberman:
安德鲁·休伯曼：
Speaking of tracking weight and fat lean mass percentages, is that something that you recommend your patients do pretty often?
说到跟踪体重和脂肪瘦质量百分比，您是否建议患者经常这样做？
I know people that step on the scale every day.
我认识每天都站在体重秤上的人。
I know people like myself that frankly might step on the scale three times a year.
坦白说，我认识像我这样的人，一年可能会站上三次体重秤。
I don't really care.
我真的不在乎。
I pay attention to other things that are far more subjective.
我关注其他更加主观的事情。
Maybe I'm making a huge mistake.
也许我犯了一个巨大的错误。
What are your thoughts about quantitative measurements of weight, BMI for the typical person?
您对一般人的体重、BMI 的定量测量有何看法？
Dr. Peter Attia:
彼得·阿蒂亚博士：
I think they're pretty crude.
我认为它们非常粗糙。
I'd rather take a DEXA annually, and then maybe follow weight a little bit more closely to get a sense of it.
我宁愿每年进行一次 DEXA，然后可能更密切地关注体重以了解它。
And so with a DEXA, you're getting, at least the way we look at the data, four pieces of information.
因此，通过 DEXA，至少从我们查看数据的方式来看，您将获得四项信息。
Now, most people when they do a DEXA-- Should I explain what that is?
现在，大多数人在进行 DEXA 时——我应该解释一下那是什么吗？
Andrew Huberman:
安德鲁·休伯曼：
Yeah.
是的。
I think some people might not know what DEXA is.
我想有些人可能不知道DEXA是什么。
In fact, I confess I have a crude understanding of what it is.
事实上，我承认我对它是什么有一个粗略的理解。
Tell me if where I'm wrong and hopefully where I'm at least partially right.
告诉我我哪里错了，希望我哪里至少部分正确。
My understanding is that there are a number of different ways to measure lean mass to non-lean mass ratio, and there's one where they put you underwater, there's one where they put you into some sort of non-underwater chamber.
我的理解是，有很多不同的方法来测量瘦质量与非瘦质量的比率，有一种方法是将你放入水下，有一种方法将你放入某种非水下室中。
There's calipering.
有卡尺。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yep.
是的。
Andrew Huberman:
安德鲁·休伯曼：
And then there's the looking in the mirror and pinching and changing the lighting.
然后就是照镜子、捏捏和改变灯光。
Dr. Peter Attia:
彼得·阿蒂亚博士：
It's funny.
很有趣。
If you've done it enough, I can sort of tell my body fat by my abs.
如果你做得足够多，我可以通过我的腹肌来判断我的身体脂肪。
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Dr. Peter Attia:
彼得·阿蒂亚博士：
So I can sort of tell by how good the six-pack or how bad the six-pack is, what the leanness is.
所以我可以通过六块腹肌的好坏来判断六块腹肌的瘦程度。
And that's actually not a terrible way to do it.
这实际上并不是一个糟糕的方法。
A bodybuilder, for example, which I've never been, can tell you the difference between being 6%, 7%, 8%, 10% -
例如，我从未做过的健美运动员可以告诉你 6%、7%、8%、10% 之间的区别 -
Andrew Huberman:
安德鲁·休伯曼：
Wow
哇
Dr. Peter Attia:
彼得·阿蒂亚博士：
...
...
just based on the degree of visibility within the abs.
仅基于腹肌内的可见度。
But basically, a DEXA scan is an X-ray.
但基本上，DEXA 扫描是 X 射线检查。
So it's the same principle as just getting a chest X-ray where ionizing radiation is passed through the body, and there's a plate behind the body that collects what comes through.
因此，这与进行胸部 X 光检查的原理相同，其中电离辐射穿过身体，并且身体后面有一个板来收集穿过的辐射。
And the denser the medium that the electrons are trying to go through, the less of them that are collected.
电子试图穿过的介质越密集，收集到的电子就越少。
So when you look at an X-ray, as everybody's probably seen an X-ray, that which is white is most dense.
所以当你看 X 射线时，正如每个人都可能看过 X 射线一样，白色的密度最大。
So if you had a piece of metal in your pocket, it would show up as a bright white thing.
因此，如果你的口袋里有一块金属，它会显示为亮白色的东西。
That's why ribs and bones show up as white.
这就是为什么肋骨和骨头显示为白色。
And the things that are the least dense, like the lungs, where it's just air, are the blackest, and everything is a shade of gray in between.
密度最小的东西，比如肺部，里面只有空气，是最黑的，一切都是介于两者之间的灰色阴影。
So a DEXA is just doing that effectively, but it's a moving X-ray.
所以 DEXA 只是有效地做到了这一点，但它是一种移动的 X 射线。
So you lay down on a bed, and it takes maybe 10 minutes, and this little very low-power X-ray kind of goes over your body, and the plate beneath it is collecting information that is basically allowing it to differentiate between three things: bone mineral content, fat, other.
所以你躺在床上，可能需要 10 分钟，这种能量非常低的 X 射线会穿过你的身体，它下面的板正在收集信息，基本上可以让它区分三样东西：骨矿物质含量、脂肪和其他。
And the other is quantified as lean body mass.
另一个被量化为去脂体重。
So that's organs, muscles, everything else.
这就是器官、肌肉和其他一切。
So when most people do a DEXA, they get the report back, and the reports are horrible.
所以当大多数人做 DEXA 时，他们会收到报告，而且报告很糟糕。
I've yet to see one company that can do this in a way that isn't abjectly horrible.
我还没有见过一家公司能够以一种不那么可怕的方式做到这一点。
We've created our own template.
我们创建了自己的模板。
So we have our own dashboard for how we do this because we've just given up on trying to use theirs.
因此，我们有自己的仪表板来说明如何做到这一点，因为我们刚刚放弃尝试使用他们的仪表板。
But the first thing most people look at is, "What's my body fat?" And this is the gold standard outside of like MRI or something that's only used for research purposes.
但大多数人首先关注的是“我的体脂是多少？”这是 MRI 或仅用于研究目的的技术之外的黄金标准。
So a DEXA is going to produce a far better estimate of body fat than calipers or buoyancy testing or things like that, provided the machinery is well calibrated and the operator knows how to use it.
因此，只要机器经过良好校准并且操作员知道如何使用它，DEXA 就能比卡尺或浮力测试或类似工具更好地估计身体脂肪。
I've heard some people argue that in the hands of the guy who's been doing calipers his whole life, it can probably be comparable with calipers.
我听有人说，在做了一辈子卡钳的家伙手里，大概可以和卡钳媲美了。
But nevertheless, for an off-the-shelf tech, DEXA's amazing.
但无论如何，对于一项现成的技术来说，DEXA 是令人惊叹的。
Of the four things that get spit out of the DEXA, we think that the body fat is the least interesting.
在 DEXA 检测到的四项内容中，我们认为身体脂肪是最无意义的。
And so I would rank that as fourth on the list of what's germane to your health.
因此，我将其排在与您的健康密切相关的列表中的第四位。
The other three things that you get spit out are bone mineral density, visceral fat, and then the metrics that allow you to basically compute what's called appendicular lean mass index and fat-free mass index.
您得到的其他三项内容是骨矿物质密度、内脏脂肪，然后是允许您基本上计算所谓的四肢去脂质量指数和去脂质量指数的指标。
And so those three metrics are significantly more important than body fat.
因此，这三个指标比体脂重要得多。
And the reason is as follows.
原因如下。
So bone mineral density basically speaks to your risk of osteoporosis and osteopenia.
因此，骨矿物质密度基本上反映了您患骨质疏松症和骨质减少的风险。
And that doesn't sound very sexy to people our age.
对于我们这个年纪的人来说，这听起来不太性感。
50-year-old guys listening to this, it's like, yeah, big deal, but for a 50-year-old woman, this is a huge deal.
50 岁的男人听了这句话，会觉得，是的，这是一件大事，但对于 50 岁的女人来说，这是一件大事。
A woman who's just about to go through menopause or has just gone through menopause is at an enormous risk for osteopenia and then ultimately osteoporosis because estrogen is the single most important hormone in regulating bone mineral density.
即将进入更年期或刚刚经历更年期的女性面临着骨质减少以及最终骨质疏松症的巨大风险，因为雌激素是调节骨矿物质密度的最重要的激素。
And we can come back and talk about why that's the case, but it's very interesting how the biomechanics of bones work and why estrogen specifically is so important.
我们可以回过头来讨论为什么会出现这种情况，但是骨骼的生物力学如何发挥作用以及为什么雌激素如此重要是非常有趣的。
And this is a huge cause of morbidity.
这是发病的一个重要原因。
So if you're over the age of 65 and you fall and break your hip, your one-year morbidity is about 30% to 40%.
因此，如果您超过 65 岁，并且摔倒并骨折了髋部，那么您的一年发病率约为 30% 至 40%。
Andrew Huberman:
安德鲁·休伯曼：
Wow.
哇。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Which again, just to put that in English, if you're 65 or older, you fall and break your hip, there's a 30% to 40% chance you're dead in a year.
再说一次，用英语来说，如果你 65 岁或以上，你摔倒并摔断臀部，一年内你有 30% 到 40% 的机会死亡。
Andrew Huberman:
安德鲁·休伯曼：
Wow.
哇。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Bones matter.
骨头很重要。
So we want to really get a sense of where you stack up for your age, for your sex, and if you're anywhere off the pace, we have to ramp up our strategy and be super aggressive about how to increase that, or at a minimum prevent any further decay.
因此，我们想要真正了解你在年龄、性别方面的表现，如果你有任何落后的节奏，我们必须加强我们的策略，并非常积极地了解如何增加这一点，或者至少防止任何进一步的衰退。
Andrew Huberman:
安德鲁·休伯曼：
And are there age-related charts for these sorts of things?
这类事情有与年龄相关的图表吗？
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah.
是的。
This all gets spit out into what's called a Z-score.
这一切都被转化为所谓的 Z 分数。
So when you're looking at your BMD, it's going to give you a Z-score.
因此，当您查看 BMD 时，它会给您一个 Z 分数。
So a Z-score of zero means, and you understand this, but it's Z-score referring to a probability distribution in a standard mode.
所以 Z 分数为零意味着，你明白这一点，但它的 Z 分数指的是标准模式下的概率分布。
So Z-score of zero means you're at the 50th percentile for your age and sex.
因此，Z 分数为零意味着您处于年龄和性别的第 50 个百分位数。
A Z-score of plus one, you're one standard deviation above, minus one below, et cetera.
Z 分数加一，则您的标准差高出一个，标准差低一，等等。
There's also a T-score, which is doing the same thing, but comparing you to a young person.
还有一个 T 分数，它做同样的事情，但将你与年轻人进行比较。
And so the T-score is technically used to make the diagnosis of osteopenia or osteoporosis.
因此，T 分数在技术上可用于诊断骨质减少或骨质疏松症。
We tend to look more at the Z-score and basically say, "Look, if your Z-score right now is minus one, in four years, I want your Z-score to be zero." Not necessarily because you've increased that entire way, but maybe you've increased slightly while it's expected that you would have declined.
我们倾向于更多地关注 Z 分数，基本上会说：“看，如果你现在的 Z 分数是负一，那么四年后，我希望你的 Z 分数为零。”不一定是因为您一路上涨，但也许您在预期会下降的同时略有上涨。
Andrew Huberman:
安德鲁·休伯曼：
I see.
我明白了。
What are some things that we can do to improve bone mineral density at any age?
我们可以做哪些事情来提高任何年龄段的骨矿物质密度？
Dr. Peter Attia:
彼得·阿蒂亚博士：
So it turns out there's a real critical window in which we are malleable.
事实证明，存在一个真正的关键窗口，我们在其中具有可塑性。
So depending on the age at which someone's listening to us discuss this, if you're under 20, 25, you are still in that time of your life when you are able to reach your potential.
因此，根据听我们讨论这个问题的人的年龄，如果您在 20 岁或 25 岁以下，您仍然处于生命中能够发挥潜力的时期。
So, it turns out that strength training is probably the single best thing you can do.
所以，事实证明，力量训练可能是你能做的最好的事情。
And this was a surprise to me because we did an AMA on this topic a little while ago, and that's when I got really deep on this with our analysts.
这让我感到惊讶，因为不久前我们就这个主题做了一次 AMA，那时我就与我们的分析师深入探讨了这个问题。
My assumption was running must be the best.
我的假设是运行一定是最好的。
Like some sort of impact must be the best thing you can do.
就像某种影响一定是你能做的最好的事情。
I assumed running would be better than swimming and cycling, but it turned out that powerlifting was probably the best thing you could do.
我以为跑步会比游泳和骑自行车更好，但事实证明举重可能是你能做的最好的事情。
And I think once you understand how bones work, it became more clear, which is powerlifting is really putting more of a shear force from the muscle via the tendon onto the bone.
我认为一旦你了解了骨骼的工作原理，就会变得更加清楚，举重实际上是将更多的剪切力从肌肉通过肌腱施加到骨骼上。
And that's what the bones are really sensing.
这就是骨头真正感受到的。
They're sensing that shear force that's being applied through the bone in a compressive way, depending on the bone, of course, and that's what's basically activating the osteoblasts, which are the cells that are allowing bone to be built.
他们感知到以压缩方式通过骨骼施加的剪切力，当然，这取决于骨骼，这基本上就是激活成骨细胞的原因，成骨细胞是允许骨骼形成的细胞。
So this turns out to be probably more important for females, because how high you can get during that period of development, say till you're 20 or 25, basically sets your trajectory for the rest of your life.
所以这对女性来说可能更重要，因为在这个发展时期，比如 20 岁或 25 岁，你能达到多高，基本上决定了你余生的轨迹。
Andrew Huberman:
安德鲁·休伯曼：
Mm.
嗯。
Dr. Peter Attia:
彼得·阿蒂亚博士：
So where we get into real trouble is with patients who, for example, used large amounts of inhaled steroids during that period of their life because let's say they had really bad asthma.
因此，我们真正遇到麻烦的是那些在生命的这段时期使用大量吸入类固醇的患者，因为假设他们患有非常严重的哮喘。
Or patients who needed large amounts of corticosteroids for some other immune-related condition.
或者需要大量皮质类固醇治疗其他免疫相关疾病的患者。
So during their critical window of development, they were taking a drug that was impairing this process.
因此，在发育的关键时期，他们服用的药物会损害这一过程。
So, we have some patients like that in our practice, and that's just an enormous liability that we're working really hard to overcome, with nutrition, with hormones, with drugs, with training.
因此，我们在实践中遇到了一些这样的患者，这是一个巨大的责任，我们正在努力克服，通过营养、激素、药物和培训。
And it's just something you have to be aware of.
这只是你必须注意的事情。
Andrew Huberman:
安德鲁·休伯曼：
I wasn't aware that inhalants for asthma and things of that sort can impair bone mineral density.
我不知道治疗哮喘的吸入剂和类似的东西会损害骨矿物质密度。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah.
是的。
If they're steroid-based.
如果它们是基于类固醇的。
Some of them, of course, are just beta agonists, and they're fine.
当然，其中一些只是β受体激动剂，而且没问题。
Andrew Huberman:
安德鲁·休伯曼：
So anything corticosterone-like?
那么有类似皮质酮的东西吗？
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yep.
是的。
Andrew Huberman:
安德鲁·休伯曼：
Interesting.
有趣。
And then I always get asked this question, and I always reflexively want to say no, but I don't really know the answer, so I don't reply.
然后我总是被问到这个问题，我总是条件反射地想说不，但我真的不知道答案，所以我不回答。
What about topical corticosterone?
外用皮质酮怎么样？
People will put cortisone cream.
人们会放可的松霜。
To me, it seems almost inconceivable that it would have a systemic effect, but then again, what do I know?
对我来说，它会产生系统性影响几乎是不可想象的，但话又说回来，我知道什么？
Dr. Peter Attia:
彼得·阿蒂亚博士：
It's all dose and time related.
这都与剂量和时间有关。
So, if you're talking about like I've got a little rash under my skin, I'm going to put corticosteroids on, probably not.
所以，如果你说的是我的皮肤下有一点皮疹，我会使用皮质类固醇，可能不会。
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Dr. Peter Attia:
彼得·阿蒂亚博士：
But certainly with enough of it put on, it is absorbed, so it could be an issue.
但肯定的是，如果涂抹得足够多，它就会被吸收，所以这可能是一个问题。
But that's not typically what we're concerned with.
但这通常不是我们关心的。
We're mostly concerned with people that are taking even modest amounts of prednisone for months, years at a time, or like I said, kids that are using steroid inhalers for years and years and years.
我们最关心的是那些连续几个月、几年服用少量泼尼松的人，或者像我说的那样，那些年复一年使用类固醇吸入器的孩子。
Again, I'm not suggesting that if your kid's on a steroid inhaler, they shouldn't be.
再说一次，我并不是建议如果你的孩子正在使用类固醇吸入器，他们就不应该这样做。
You have to solve the most important problem, and if asthma is the most important problem, so be it.
你必须解决最重要的问题，如果哮喘是最重要的问题，那就这样吧。
I think you just want to turn that into, okay, well, how much more imperative is it that our kid is doing things that are putting a high amount of stress on their bones and via their muscles to make sure that they're in that maximal capacity to build?
我想你只是想把它变成，好吧，好吧，我们的孩子所做的事情对他们的骨骼和肌肉施加很大的压力，以确保他们处于最大的建造能力，这有多重要？
Andrew Huberman:
安德鲁·休伯曼：
Do you think that somebody in their 30s or 40s or 50s could still benefit from strength training in terms of bone mineral density and longevity, as it relates to bone mineral density, given that there's this key window earlier, or they might have missed that window?
您是否认为 30 多岁、40 多岁或 50 多岁的人仍然可以从骨矿物质密度和寿命方面的力量训练中受益，因为它与骨矿物质密度有关，因为这个关键窗口较早出现，或者他们可能错过了这个窗口？
Dr. Peter Attia:
彼得·阿蒂亚博士：
Oh, yeah.
哦，是的。
No, no. This is essential for the rest of life because you're now trying to prevent the falloff.
不，不。这对于余生至关重要，因为你现在正在努力防止衰退。
So basically, the way it works is from birth to, say, 20, you're in growth.
所以基本上，它的运作方式是从出生到20岁，你都在成长。
From 20 to 50, you plateau.
从 20 到 50，你就进入了平台期。
At 50, men start to decline, but it's really small.
男人到了50岁，就开始衰退，但幅度非常小。
Women start to decline, and it's precipitous.
女性开始衰退，而且是急剧衰退。
Andrew Huberman:
安德鲁·休伯曼：
And it's related to the drop in estrogen associated-
这与雌激素的下降有关-
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah
是啊
Andrew Huberman:
安德鲁·休伯曼：
...
...
with menopause or premenopause.
患有更年期或绝经前。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Correct.
正确。
Andrew Huberman:
安德鲁·休伯曼：
And can we get into any of the broad contours of what that strength training looks like?
我们能否大致了解一下力量训练的大致情况？
We had Dr. Andy Galpin on the show.
安迪·加尔平博士参加了我们的节目。
We talked a lot about ways to build strength versus hypertrophy versus endurance, et cetera.
我们讨论了很多关于增强力量、增肌、耐力等的方法。
I think there's pretty good agreement across the fields of physiotherapy, et cetera, of physiology and medicine in terms of how to do that.
我认为物理治疗等生理学和医学领域在如何做到这一点方面达成了很好的共识。
But my understanding is fairly low repetition ranges, so this is anywhere from one to six repetitions.
但我的理解是重复范围相当低，所以重复次数从一到六次不等。
Typically not aiming for a pump hypertrophy, that sort of thing, but heavy loads that are hard to move, 80% of one repetition maximum or more, done with long rest periods, two to three times a week type thing.
通常目标不是泵肥大之类的事情，而是难以移动的大负荷，一次重复次数最多的 80% 或更多，长时间休息，每周 2 到 3 次之类的事情。
Is that about right?
是这样吗？
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah.
是的。
If you look at the literature on this, it's going to differentiate powerlifting from weightlifting.
如果你看一下这方面的文献，就会发现力量举和举重之间的区别。
In other words, yeah, you do need to be kind of moving against a very heavy load.
换句话说，是的，你确实需要承受非常重的负担。
Now again, that can look very different depending on your level of experience.
再说一遍，根据您的经验水平，这可能看起来非常不同。
Like, I really like deadlifting.
就像，我真的很喜欢硬拉。
Now, I can count the number of days left in my life when I'm going to want to do sets over 400 pounds, but ...
现在，当我想要做超过 400 磅的组数时，我可以计算我的生命还剩下多少天，但是......
I'll pick and choose the days that I do.
我会挑选我要做的日子。
But I grew up doing those things.
但我是在做这些事情的过程中长大的。
I'm comfortable with those movements.
我对这些动作感到很舒服。
If I had a 60-year-old woman who's never lifted weights in her life who we now have to get lifting, we could get her to deadlift, but I think I wouldn't make perfect the enemy of good.
如果我有一个 60 岁的女人，她一生中从未举重过，而我们现在必须让她举重，我们可以让她硬拉，但我认为我不会让完美成为善良的敌人。
I'd be happy to put her on a leg press machine and just get her doing that.
我很乐意将她放在腿部推举机上并让她这样做。
It's not as pure a movement as a deadlift, but who cares, right?
它不像硬拉那样纯粹的运动，但谁在乎呢，对吧？
We can still put her at a heavy load for her and do so safely.
我们仍然可以为她承担重担，并且安全地这样做。
So now that said, there was a study that was done in Australia, and hopefully we can find a link to it.
话虽如此，澳大利亚进行了一项研究，希望我们能找到它的链接。
There's a video on YouTube that actually kind of has the PI sort of walking through the results.
YouTube 上有一个视频，实际上是 PI 演示了结果。
Andrew Huberman:
安德鲁·休伯曼：
Nice.
不错。
Dr. Peter Attia:
彼得·阿蒂亚博士：
I could send it to you, Evan.
我可以把它寄给你，埃文。
Andrew Huberman:
安德鲁·休伯曼：
Okay.
好的。
Yeah, we'll try to do that.
是的，我们会尝试这样做。
Dr. Peter Attia:
彼得·阿蒂亚博士：
And it's just amazing.
这真是太棒了。
They took a group of older women, they look like they're in their 60s or 70s, who had never lifted weights in their life, who had osteopenia and some probably already had osteoporosis, and they basically just put them on a strength training protocol.
他们找了一群年龄较大的女性，她们看起来60多岁或70多岁，一生中从未举重过，患有骨质减少症，有些可能已经患有骨质疏松症，他们基本上只是让她们接受力量训练。
And it is remarkable to watch these women.
观察这些女性真是太了不起了。
They're doing good mornings, they're doing deadlifts, they're picking heavy things up off the ground.
他们在做早安，他们在做硬拉，他们在从地上捡起重物。
I think one woman was picking up...
我觉得有一个女人正在接...
God, I want to say she was picking 50, 60 kilos up off the ground.
天哪，我想说她正在从地上捡起 50、60 公斤的东西。
Just staggering sums of weight for these women who have never done anything, and their bone health is improving at this age.
对于这些从未做过任何事的女性来说，体重是惊人的，而且她们的骨骼健康在这个年龄段正在改善。
So, the goal, frankly, is to just never get to the point where you have to do this for the first time.
所以，坦率地说，我们的目标是永远不要达到必须第一次这样做的地步。
Strength training is such an essential part of our existence that it's never too late to start, but you should never stop.
力量训练是我们生存的重要组成部分，开始永远不会太晚，但永远不应该停止。
Andrew Huberman:
安德鲁·休伯曼：
Love that advice.
喜欢这个建议。
Is it a systemic effect or a local effect?
是全身效应还是局部效应？
So for instance, let's say that...
举例来说，我们可以说...
Well, my mother's in her late 70s.
嗯，我妈妈已经 70 多岁了。
She actually used to be really strong when we were kids.
事实上，当我们还是孩子的时候，她曾经非常坚强。
She could move this fish tank that was in my room long before I could move it, and she's really strong.
早在我搬动我房间里的鱼缸之前，她就已经能搬动它了，而且她真的很强。
Over the years, I wouldn't call her frail by any means, but I certainly think she could benefit from some strength training.
多年来，我无论如何都不会说她虚弱，但我当然认为她可以从一些力量训练中受益。
Let's say she were to start doing some leg presses or start even with air squats and maybe work up to some pushups.
假设她要开始做一些腿举，或者甚至从空蹲开始，也许还可以做一些俯卧撑。
Are the effects all local, meaning if she were to just train her legs or just do pushups, would it only be the loads applied to the limbs and muscles and tissues that were involved?
这些影响都是局部的吗？也就是说，如果她只是训练腿部或只是做俯卧撑，是否只是施加到所涉及的四肢、肌肉和组织上的负荷？
Dr. Peter Attia:
彼得·阿蒂亚博士：
I think that's where the bulk of it is, yeah.
我认为这就是大部分内容，是的。
Andrew Huberman:
安德鲁·休伯曼：
Okay.
好的。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah.
是的。
Andrew Huberman:
安德鲁·休伯曼：
So you need to train the whole body, essentially.
所以本质上你需要训练整个身体。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah.
是的。
Now, keep in mind, the diagnosis of osteopenia and osteoporosis is based on only three locations, the left hip, the right hip, and the lumbar spine.
现在，请记住，骨质减少和骨质疏松症的诊断仅基于三个位置：左髋部、右髋部和腰椎。
So, that's just the convention by which we make the diagnosis.
所以，这只是我们做出诊断的惯例。
And I think part of that has to do with that's where the majority of the insults occur.
我认为部分原因是大多数侮辱发生的地方。
Now, not all of the insults.
现在，并不是所有的侮辱。
I've seen people that have, because of horrible bone density, they're fracturing ankles and tibia, fibula, they're having low tib-fib fractures just walking.
我见过一些人，由于骨质密度太低，他们的脚踝、胫骨、腓骨骨折，他们在走路时就会出现低位胫骨-腓骨骨折。
So clearly bone density outside of those regions does matter, but much of it is really focused on...
很明显，这些区域之外的骨密度确实很重要，但其中大部分实际上集中在......
And by the way, you fall, you break a wrist, so this is a systemic issue.
顺便说一下，你摔倒了，手腕骨折了，所以这是一个系统性问题。
But the majority of the response is a local response, because it really comes down to putting a load directly on that bone and then having that bone in kind respond by laying down more bone.
但大部分反应是局部反应，因为它实际上归结为直接在该骨头上施加负载，然后通过放置更多骨头来让该骨头做出同样的反应。
Speaker 3:
演讲者3：
Altra running shoes are all about space.
Altra 跑鞋注重空间。
The space to go further, to feel better, to do something you never thought possible.
可以走得更远、感觉更好、做一些你从未想过可能的事情的空间。
And this space starts with Altra fit.
而这个空间就从Altra fit开始。
Unlike traditional running shoes, Altra fit gives toes more room to move naturally, so every step is strong, balanced, and comfortable.
与传统跑鞋不同，Altra fit 为脚趾提供了更多自然移动的空间，因此每一步都强劲、平衡且舒适。
Whatever you're lacing up for, stay out there with Altra.
无论您要做什么，请与 Altra 一起出去。
Shop now at altrarunning.com.
立即前往 altrarunning.com 购买。
That's A-L-T-R-Arunning.com.
那是 A-L-T-R-Arunning.com。
Andrew Huberman:
安德鲁·休伯曼：
You mentioned falling and the problems with falling and breaking things and mortality related to that.
你提到了跌倒以及跌倒和摔坏东西的问题以及与之相关的死亡率。
I wonder whether or not there are also health-related effects of just having weak bones that are not just about falling and breaking a bone and dying a year later, even though that's obviously very severe.
我想知道骨骼脆弱是否也会对健康产生影响，而不仅仅是跌倒、骨折并在一年后死亡，尽管这显然非常严重。
Because I think when people hear about that, some people might think, "Well, I'll just be more careful."
因为我认为当人们听到这个消息时，有些人可能会想，“好吧，我会更加小心。”
Dr. Peter Attia:
彼得·阿蒂亚博士：
Mm-hmm.
嗯嗯。
Andrew Huberman:
安德鲁·休伯曼：
"I'll just move more slowly.
“我只会走得慢一点。
I'll sit in a wheelchair if I need to, even though I might be able to walk, if it keeps me from falling." Some people, I think, adopt that mentality.
如果需要的话，我会坐在轮椅上，即使我可以走路，只要它能防止我跌倒。”我认为有些人采取了这种心态。
What are some of the benefits of having high bone mineral density for men and women that are perhaps independent of risk of injury?
对于男性和女性来说，高骨矿物质密度有哪些可能与受伤风险无关的好处？
Dr. Peter Attia:
彼得·阿蒂亚博士：
Well, I think it's actually the inverse of what you just said, right?
嗯，我认为这实际上与你刚才所说的相反，对吗？
It's sort of like you have to sort of be able to articulate what it is you want in your marginal decade.
这有点像你必须能够清楚地表达出你在人生的最后十年想要什么。
So we use this thing in our practice called the marginal decade.
所以我们在实践中使用这个东西，称为边缘十年。
Marginal decade is the last decade of your life.
边缘十年是你生命的最后十年。
So everyone will have a marginal decade.
所以每个人都会有一个边缘十年。
That's the only thing I can tell you with absolute certainty.
这是我唯一可以绝对肯定地告诉你的事情。
Right?
正确的？
Andrew Huberman:
安德鲁·休伯曼：
I believe you.
我相信你。
Dr. Peter Attia:
彼得·阿蒂亚博士：
There's no immortality.
没有不朽。
There's no hidden elixir that's going to help us live to be whatever.
没有任何隐藏的灵丹妙药可以帮助我们活成任何样子。
We're all going to be in our last decade at some point.
在某个时刻，我们都将进入最后十年。
And outside of people who die suddenly or through an accident, most of us know when we're in that marginal decade.
除了突然死亡或因事故死亡的人之外，我们大多数人都知道自己何时处于那个边缘十年。
You might not know the day you enter it, but most people who are old enough, if you tell them, "Are you in the last decade of your life?" they probably have a sense that they are.
你可能不知道自己是在哪一天进入的，但对于大多数年龄足够大的人来说，如果你告诉他们：“你正处于生命的最后十年吗？”他们可能有这样的感觉。
So I think the exercise that we like to go through with our patients very early on is have them in exquisite detail, more detail than they've ever considered.
因此，我认为我们希望尽早与患者一起进行的练习是让他们了解精致的细节，比他们想象的更详细。
So we have to prompt them with 50 questions, lay out what their marginal decade should look like.
因此，我们必须向他们提出 50 个问题，列出他们的边缘十年应该是什么样子。
Andrew Huberman:
安德鲁·休伯曼：
Wow.
哇。
That's a serious exercise.
这是一项严肃的练习。
Dr. Peter Attia:
彼得·阿蒂亚博士：
It's a very serious exercise, right?
这是一个非常严肃的练习，对吧？
Tell me everything that is going to happen in your marginal decade.
告诉我在你的最后十年里将会发生的一切。
I don't know when it's going to be, Andrew.
我不知道什么时候会发生，安德鲁。
It could be 87 to 97 if we're doing well, right?
如果我们做得好的话可能是87到97，对吧？
It might be 79 to 89.
可能是79到89。
I don't know.
我不知道。
But it would really be a very nuanced exploration of that topic.
但这确实是对该主题的非常细致的探索。
And I think until you do that, all of this other stuff is just abstract and kind of nonsense.
我认为，在你这样做之前，所有其他的东西都只是抽象的、无意义的。
Until a person can tell you what it is that they want to be doing in that last decade, you can't design a program to get them there.
除非一个人能够告诉你他们在过去十年里想做什么，否则你无法设计一个计划来帮助他们实现这一目标。
Think about it Someone wants to do an Ironman, we take it for granted that we know what the objective is.
想想看，有人想做铁人三项，我们理所当然地知道我们的目标是什么。
I have to be able to swim two and a half miles.
我必须能够游两英里半。
I have to be able to get out, take my wetsuit off, hop on my bike, ride 112 miles, get off my bike, take the bike shoes off, put the run shoes on, run 26.2 miles.
我必须能够下车，脱掉潜水衣，跳上自行车，骑 112 英里，下车，脱掉自行车鞋，穿上跑鞋，跑 26.2 英里。
We get it.
我们明白了。
We know what the objective is.
我们知道目标是什么。
And only by knowing that can you train.
只有知道这一点，你才能进行训练。
Can you imagine if I said to you, "Andrew, I'm going to have you do an athletic event in a year.
你能想象如果我对你说：“安德鲁，我要让你在一年内参加一项体育赛事。
Start training.
开始训练。
I'm not going to tell you what it is."
我不会告诉你那是什么。”
Andrew Huberman:
安德鲁·休伯曼：
Right.
对。
Dr. Peter Attia:
彼得·阿蒂亚博士：
"Just do it."
“就这么做吧。”
Andrew Huberman:
安德鲁·休伯曼：
Right.
对。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Could be playing basketball.
可能是在打篮球。
It could be swimming to Catalina Island.
它可能正在游向卡塔利娜岛。
It could be running 100 miles.
它可以跑 100 英里。
You wouldn't be able to do it.
你将无法做到这一点。
So similarly, if we don't know what our marginal decade is meant to be, there's no way to train for it.
同样，如果我们不知道我们的边缘十年是什么，就没有办法进行训练。
Andrew Huberman:
安德鲁·休伯曼：
Do you think this is a good exercise for anyone and everyone to do on their own, regardless of age?
您认为这是一个适合任何人、每个人（无论年龄）自己进行的良好练习吗？
Here, I'm hearing this-
在这里，我听到这个——
Dr. Peter Attia:
彼得·阿蒂亚博士：
Absolutely
绝对
Andrew Huberman:
安德鲁·休伯曼：
...
...
and I'm thinking, I need to think about when my last decade might be and what I want that to look like.
我在想，我需要考虑我的最后十年是什么时候，以及我希望它是什么样子。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Absolutely.
绝对的。
When I say we do it with our patients, that's only because that's the population I work with, but there's simply no reason everybody shouldn't be going through this exercise.
当我说我们对我们的病人这样做时，那只是因为我的工作对象就是这些人，但没有理由每个人都不应该进行这项练习。
Andrew Huberman:
安德鲁·休伯曼：
And then you sort of back script from there.
然后你可以从那里编写后台脚本。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah.
是的。
Andrew Huberman:
安德鲁·休伯曼：
Figure out what people should be doing-
弄清楚人们应该做什么——
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah, exactly
是的，正是如此
Andrew Huberman:
安德鲁·休伯曼：
...
...
given their current health status.
鉴于他们目前的健康状况。
Dr. Peter Attia:
彼得·阿蒂亚博士：
That's exactly right.
完全正确。
We call it back casting.
我们称之为回铸造。
So the first step we do is once we've really delineated what the objective function looks like, we then say, "Okay, how do you break down that into metrics that we can measure?" So, you described doing a whole bunch of things.
因此，我们要做的第一步是，一旦我们真正描述了目标函数的样子，我们就会说：“好吧，你如何将其分解为我们可以衡量的指标？”所以，你描述了做了很多事情。
Okay, just to let you know, to do that will require a VO2 max of 30 milliliters of oxygen per minute per kilogram.
好的，只是让您知道，要做到这一点，最大摄氧量需要每分钟每公斤 30 毫升氧气。
And the person will say, "Okay, what does that mean?" We'll say, "Well, that's a measure of your maximal uptake of oxygen, and that declines at about 8% to 10% per decade.
这个人会说：“好吧，这是什么意思？”我们会说，“嗯，这是你最大摄氧量的衡量标准，每十年大约下降 8% 到 10%。
So if you have to be at 30, and let's just assume you're going to be doing that at 90, so what do you need to be at 80, 70, 60, 50?
所以，如果你必须在 30 岁，让我们假设你会在 90 岁做到这一点，那么你需要在 80、70、60、50 岁时做到什么？
Okay, here's what it would need to be at 50.
好的，这就是 50 级时需要的值。
Okay, what are you now?" Ah.
好吧，你现在怎么样了？”啊。
There's a big gap.
差距很大。
You're below where you need to be now.
你现在还没有达到你应该达到的水平。
So you're obviously higher than 30 now, but if you're only at 42 now and you need to be at 30 in 40 years, you're not going to cut it.
所以你现在显然高于30岁，但如果你现在只有42岁，而你需要在40年后达到30岁，你就不会削减它。
You have to be a lot fitter.
你必须变得更健康。
Okay, now let's do the same exercise around strength and stability.
好的，现在让我们围绕力量和稳定性做同样的练习。
And without exception, most people when they do this exercise will find out they're well below where they need to be.
无一例外，大多数人在进行这项练习时都会发现自己远低于应有的水平。
So the gravity of aging is more vicious than people realize, and therefore, the height of your glider needs to be much higher than you think it is when you're our age if you want to be able to do the things we probably want to be able to do when we're 90.
因此，衰老的严重性比人们意识到的更为严重，因此，如果你想在 90 岁时能够做我们可能想做的事情，你的滑翔机的高度需要比你在我们这个年纪时想象的要高得多。
Andrew Huberman:
安德鲁·休伯曼：
I absolutely love this approach.
我非常喜欢这种方法。
I've never done it in terms of my health.
就我的健康而言，我从来没有这样做过。
I've always thought about what I want to accomplish in the next three to six months or next year or so.
我一直在思考我想在未来三到六个月或明年左右完成什么。
Dr. Peter Attia:
彼得·阿蒂亚博士：
And by the way, that's a great approach.
顺便说一句，这是一个很好的方法。
That's forecasting.
这就是预测。
Forecasting is fantastic.
预测太棒了。
Forecasting is really good at short-term things.
预测确实擅长短期事物。
It doesn't work for long-term things.
对于长期的事情来说，这不起作用。
Long-term, you have to do back casting.
从长远来看，你必须进行背投。
Andrew Huberman:
安德鲁·休伯曼：
This back casting approach really appeals to me because in my career, oops, excuse me, I never anticipated I'd be podcasting.
这种背投方式真的很吸引我，因为在我的职业生涯中，哎呀，对不起，我从来没有预料到我会做播客。
But that's what I did.
但这就是我所做的。
At some point as an undergraduate, I looked at professors and thought, "That looks like a pretty good life.
当我还是一名本科生时，我看着教授并想：“这看起来是一种相当美好的生活。
They seem pretty happy." I talked to a few of them, and then I figured out what I need to do at each stage in order to get to that next rung on the ladder, and just kind of figured it out in a back casting kind of way, as you refer to it.
他们看起来很高兴。”我和他们中的一些人交谈过，然后我弄清楚了我在每个阶段需要做什么，才能到达阶梯上的下一个梯级，就像你提到的那样，以一种后投的方式找到了它。
I think this is incredibly useful because it puts all the questions about blood work and how often to get blood work and what to measure in a really nice context that's highly individualized.
我认为这非常有用，因为它将所有有关血液检查、血液检查频率以及测量内容的所有问题都放在一个高度个性化的非常好的环境中。
I've never heard of this before.
我以前从未听说过这个。
Dr. Peter Attia:
彼得·阿蒂亚博士：
And I should give a nod to Annie Duke.
我应该向安妮·杜克致敬。
I used to always refer to this as reverse engineering.
我过去总是将其称为逆向工程。
But in Annie Duke's book, she wrote about this exact thing and called it back casting, and I was like, "I like the term back casting better." I think it's more intuitive than reverse engineering.
但在安妮·杜克的书中，她写了关于这件事，并将其称为“回选”，我当时想，“我更喜欢这个词“回选”。我认为这比逆向工程更直观。
Andrew Huberman:
安德鲁·休伯曼：
Yeah, there's a real genius to it, because it sets so many things into the appropriate bins and trajectories.
是的，它确实是一个天才，因为它将如此多的东西设置到适当的容器和轨迹中。
I've heard you talk before about some of the prime movers for longevity and all-risk mortality.
我以前听您谈论过长寿和全险死亡率的一些主要推动因素。
And I'd love for you to review a little bit of that for us.
我希望您能为我们回顾一下其中的一些内容。
I think we all know that we shouldn't smoke because it's very likely that we'll die earlier if we smoke nicotine.
我想我们都知道我们不应该吸烟，因为如果我们吸尼古丁，我们很可能会早死。
I'm neither a marijuana nor a nicotine smoker, so I feel on stable ground there.
我既不吸食大麻，也不吸食尼古丁，所以我感觉自己的处境很稳定。
But anytime we see smoking nowadays, people really want to distinguish between cannabis and nicotine.
但现在每当我们看到吸烟时，人们真的想区分大麻和尼古丁。
So I am curious about any differences there in terms of impact on longevity.
所以我很好奇它们对寿命的影响有何差异。
But in that context, what are the things that anyone and everyone can do, should do, to live longer, basically?
但在这种情况下，基本上，任何人和每个人都可以做、应该做哪些事情来延长寿命？
Dr. Peter Attia:
彼得·阿蒂亚博士：
How long you got?
你还有多久？
Andrew Huberman:
安德鲁·休伯曼：
Well, you tell me.
好吧，你告诉我。
You tell me.
你告诉我。
I'd like my final decade to be between 90 and 100.
我希望我的最后十年寿命在 90 到 100 之间。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Oh, no, I meant how long do you-
哦，不，我的意思是你要多久-
Andrew Huberman:
安德鲁·休伯曼：
No, I'm just kidding.
不，我只是开玩笑。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah, yeah.
是啊，是啊。
Andrew Huberman:
安德鲁·休伯曼：
I'm just kidding.
我只是开玩笑。
Dr. Peter Attia:
彼得·阿蒂亚博士：
And will we spend from now until you're 90 talking about this?
从现在到你90岁我们会一直谈论这个吗？
Andrew Huberman:
安德鲁·休伯曼：
Well, there's a risk of that.
嗯，有这样的风险。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah.
是的。
Andrew Huberman:
安德鲁·休伯曼：
But top contour is fine.
但顶部轮廓很好。
I know you've done a lot of content on this.
我知道您已经在这方面做了很多内容。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah, yeah.
是啊，是啊。
Andrew Huberman:
安德鲁·休伯曼：
And we will give people links to some of that more in-depth content.
我们将为人们提供一些更深入内容的链接。
But let's say we're on a short flight from here to San Diego.
但假设我们正在从这里飞往圣地亚哥的短途航班。
We're in Los Angeles now.
我们现在在洛杉矶。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Very well.
很好。
Andrew Huberman:
安德鲁·休伯曼：
And we've got takeoff and landing, and we don't want to kink our neck too much by doing this thing.
我们已经起飞和降落，我们不想因为做这件事而过度扭伤我们的脖子。
So if I just said, "Hey, give me the extended version of the three-by-five card."
因此，如果我只是说：“嘿，给我一张三乘五卡片的扩展版本。”
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah.
是的。
Andrew Huberman:
安德鲁·休伯曼：
What does that look like?
那看起来像什么？
Dr. Peter Attia:
彼得·阿蒂亚博士：
So let's start with a couple of the things that you've already highlighted.
让我们从您已经强调的几件事开始。
So smoking.
所以抽烟。
How much does smoking increase your risk of all-cause mortality?
吸烟会增加多少全因死亡风险？
And the reason we like to talk about what's called ACM or all-cause mortality is it's really agnostic to how you die.
我们之所以喜欢谈论所谓的 ACM 或全因死亡率，是因为它实际上与你的死亡方式无关。
And that doesn't always make sense.
但这并不总是有意义。
If you're talking about a very specific intervention like an anti-cancer therapeutic, you really care about cancer-specific mortality or heart-specific mortality.
如果您谈论的是一种非常具体的干预措施，例如抗癌治疗，那么您确实关心癌症特异性死亡率或心脏特异性死亡率。
But when we talk about these sort of broad things, we like to talk about ACM.
但当我们谈论这些广泛的事情时，我们喜欢谈论 ACM。
So, using smoking, smoking is approximately a 40% increase in the risk of ACM.
因此，吸烟会使患 ACM 的风险增加大约 40%。
Andrew Huberman:
安德鲁·休伯曼：
And what does that translate to in...
这意味着什么......
That means I'm shortening my life by 40%?
这意味着我的寿命缩短了 40%？
Dr. Peter Attia:
彼得·阿蒂亚博士：
No, it means at any point in time, there's a 40% greater risk that you're going to die relative to a non-smoker and a never smoker.
不，这意味着在任何时间点，相对于不吸烟者和从不吸烟者，您的死亡风险要高出 40%。
Andrew Huberman:
安德鲁·休伯曼：
Got it.
明白了。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah.
是的。
So it's important to distinguish.
所以区分很重要。
It doesn't mean your lifespan is going to be 40% less.
这并不意味着您的寿命会缩短 40%。
It means at any point in time standing there, your risk of death is 40% higher.
这意味着无论何时站在那儿，您的死亡风险都会增加 40%。
And by the way, that'll catch up with you.
顺便说一句，这会赶上你的。
At some point, that catches up.
在某些时候，这会迎头赶上。
High blood pressure, it's about a 20 to 25% increase in all-cause mortality.
高血压会使全因死亡率增加约 20% 至 25%。
You take something really extreme, like end-stage kidney disease.
你会采取一些非常极端的情况，比如终末期肾病。
So these are patients that are on dialysis waiting for an organ.
这些是正在接受透析等待器官的患者。
And again, there's a confounder there because what's the underlying condition that leads you to that?
再说一遍，这里有一个混杂因素，因为导致你出现这种情况的根本条件是什么？
It's profound hypertension, significant type 2 diabetes that's been uncontrolled.
这是严重的高血压、严重的2型糖尿病，但尚未得到控制。
That's enormous.
那是巨大的。
That's about 175% increase in ACM.
这相当于 ACM 增加了约 175%。
So the hazard ratio is like 2.75.
所以风险比约为 2.75。
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Type 2 diabetes is probably about a 1.25 as well, so a 25% increase.
2 型糖尿病也可能约为 1.25，即增加了 25%。
So now the question is: how do you improve?
所以现在的问题是：你如何改进？
So what are the things that improve those?
那么有哪些事情可以改善这些呢？
So now here we do this by comparing low to high achievers on other metrics.
因此，现在我们通过比较其他指标上的低成就者和高成就者来做到这一点。
So if you look at low muscle mass versus high muscle mass, what is the improvement?
那么，如果你比较低肌肉质量和高肌肉质量，有什么改进呢？
And it's pretty significant.
这非常重要。
It's about 3X.
大约是3X。
So if you compare low muscle mass people to high muscle mass people as they age, the low muscle mass people have about a 3X hazard ratio, or a 200% increase in all-cause mortality.
因此，如果将低肌肉质量的人和高肌肉质量的人随着年龄的增长进行比较，就会发现低肌肉质量的人的风险比约为 3 倍，即全因死亡率增加 200%。
Now, if you look at the data more carefully, you realize that it's probably less the muscle mass fully doing that, and it's more the high association with strength.
现在，如果您更仔细地查看数据，您就会意识到，完全做到这一点的可能不是肌肉质量，而是与力量的高度关联。
And when you start to tease out strength, you can realize that strength could be probably 3.5X as a hazard ratio, meaning about 250% greater risk if you have low strength to high strength.
当你开始梳理力量时，你会意识到力量的风险比可能是 3.5 倍，这意味着如果你从低强度到高强度，风险会增加约 250%。
Andrew Huberman:
安德鲁·休伯曼：
And high strength is the ability to move loads at 80 to 90% of one repetition-
高强度是指一次重复移动 80% 到 90% 的负载的能力 -
Dr. Peter Attia:
彼得·阿蒂亚博士：
So it's all defined by given studies.
所以这都是由给定的研究定义的。
So the most common things that are used are actually for the purposes of experiments that make it easy to do, and I don't even think they're the best metrics.
因此，最常见的东西实际上是为了使实验变得容易做而目的，我什至不认为它们是最好的指标。
So they're usually using grip strength, leg extensions, and wall sits, squats, things like that.
所以他们通常会使用握力、腿部伸展、靠墙坐、深蹲等等。
Andrew Huberman:
安德鲁·休伯曼：
Okay.
好的。
Dr. Peter Attia:
彼得·阿蒂亚博士：
So how long can you sit in a squatted position at 90 degrees without support would be a great demonstration of quad strength.
因此，在没有支撑的情况下，你能以 90 度的蹲姿坐多久，这将是股四头肌力量的一个很好的展示。
A leg extension, how much weight can you hold for how long relative to body weight, things like that.
腿部伸展，相对于体重，你能保持多少重量多长时间，诸如此类。
We have a whole strength program that we do with our patients.
我们为患者制定了一套完整的力量训练计划。
We have something called the SMA, so it's the Strength Metrics Assessment, and we put them through 11 tests that are really difficult.
我们有一种叫做 SMA 的东西，所以它是强度指标评估，我们让它们通过 11 项非常困难的测试。
Like a dead hang is one of them.
就像死吊就是其中之一。
Like how long can you dead hang your body weight, stuff like that.
比如你的体重能坚持多久之类的。
So we're trying to be more granular in that insight, but tie it back to these principles.
因此，我们试图更细致地了解这一见解，但将其与这些原则联系起来。
If you look at cardiorespiratory fitness, it's even more profound.
如果你看看心肺健康，它的意义就更深远了。
So if you look at people who are in the bottom 25% for their age and sex in terms of VO2 max, and you compare them to the people that are just at the 50th to 75th percentile, you're talking about a 2X difference roughly in the risk of ACM.
因此，如果您观察最大摄氧量在年龄和性别方面处于最低 25% 的人，并将他们与仅位于 50% 至 75% 的人进行比较，您会发现 ACM 风险大约有 2 倍的差异。
If you compare the bottom 25% to the top 2.5%, so you're talking about bottom quarter to the elite for a given age, you're talking about 5X.
如果你将底层 25% 的人与顶层 2.5% 的人进行比较，那么你谈论的是给定年龄的底层四分之一与精英阶层，那么你谈论的是 5X。
Andrew Huberman:
安德鲁·休伯曼：
Wow.
哇。
Dr. Peter Attia:
彼得·阿蒂亚博士：
400% difference in all-cause mortality.
全因死亡率差异 400%。
That's probably the single strongest association I've seen for any modifiable behavior.
这可能是我所见过的任何可修改行为的最强烈的关联。
Andrew Huberman:
安德鲁·休伯曼：
Incredible.
难以置信。
So when you say elite, these are people that are running marathons at a pretty rapid clip?
那么当你说精英时，这些人是以相当快的速度跑马拉松的人吗？
Dr. Peter Attia:
彼得·阿蒂亚博士：
Not necessarily.
不一定。
It's just like what the VO2 max is for that.
这就像最大摄氧量的含义一样。
Like my VO2 max would be in the elite for my age group.
就像我的最大摄氧量在我的年龄组中属于精英。
But again, I'm training very deliberately to make sure that it's in that.
但我再次强调，我正在非常刻意地训练，以确保做到这一点。
So I wouldn't consider myself elite at anything anymore, but I still maintain a VO2 max that is elite for my age.
所以我不再认为自己在任何事情上都是精英，但我仍然保持着我这个年龄的精英的最大摄氧量。
Andrew Huberman:
安德鲁·休伯曼：
I'd consider you an elite physician and podcaster.
我认为你是一位精英医生和播客。
And guy all around.
还有周围的家伙。
But true.
但事实如此。
But in terms of...
但就...
Okay, so for the-
好吧，所以对于-
Dr. Peter Attia:
彼得·阿蒂亚博士：
But the point is you don't have to be a world-class athlete to be elite here.
但关键是你不必成为世界级的运动员才能成为这里的精英。
Andrew Huberman:
安德鲁·休伯曼：
Got it.
明白了。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah.
是的。
Andrew Huberman:
安德鲁·休伯曼：
Got it.
明白了。
So maybe we could talk a little bit about the specifics around the training to get into the top two tiers there, because it seems that those are enormous positive effects of cardiovascular exercise, far greater than the sorts of numbers that I see around, let's just say supplement A or supplement B.
因此，也许我们可以谈谈有关训练的具体细节，以进入前两层，因为这些似乎是心血管运动的巨大积极影响，远远大于我看到的数字，我们只说补充剂 A 或补充剂 B。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Well, and this is my whole pet peeve in life.
好吧，这就是我一生中最讨厌的事情。
It's like I just can't get enough of the machinating and arguing about this supplement versus that supplement, and I feel like you shouldn't be having those arguments until you have your exercise house in order.
就好像我对这种补充剂与那种补充剂的阴谋和争论总是受够了，我觉得在你把你的健身房整理好之前，你不应该进行这些争论。
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Dr. Peter Attia:
彼得·阿蒂亚博士：
You shouldn't be arguing about this nuance of your carnivore diet versus this nuance of your paleo diet versus this nuance of your vegan diet until you can deadlift your body weight for 10 reps.
在你能够硬举自己的体重 10 次之前，你不应该争论你的肉食饮食与你的旧石器饮食的这种细微差别与你的纯素饮食的这种细微差别。
Then you can come and talk about those things.
然后你就可以过来谈谈这些事情。
Or something like let's just come up with some metrics.
或者让我们提出一些指标。
Andrew Huberman:
安德鲁·休伯曼：
Yeah.
是的。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Until your VO2 max is at least to the 75th percentile, and you're able to dead hang for at least a minute, and you're able to wall sit for at least two, like we could rattle off a bunch of relatively low-hanging fruit.
直到您的最大摄氧量至少达到第 75 个百分位，并且您能够静止悬挂至少一分钟，并且您能够在墙上静坐至少两分钟，就像我们可以快速说出一堆相对容易实现的水果一样。
I wish there was a rule that said you couldn't talk about anything else health-related.
我希望有一条规则规定你不能谈论任何其他与健康相关的事情。
Like you just-
就像你刚刚——
Andrew Huberman:
安德鲁·休伯曼：
Well, we can make that rule.
好吧，我们可以制定这个规则。
Dr. Peter Attia:
彼得·阿蒂亚博士：
No one will listen to it.
没有人会听它。
Andrew Huberman:
安德鲁·休伯曼：
I don't know about that.
我对此一无所知。
We can make whatever rules we want.
我们可以制定任何我们想要的规则。
We can call it Attia's rule.
我们可以称之为阿蒂亚规则。
One thing I've done before on this podcast and on social media is just borrowing from the tradition in science, which is it's inappropriate to name something after yourself unless you were a scientist before 1950.
我之前在这个播客和社交媒体上做过的一件事只是借鉴了科学的传统，那就是除非你是 1950 年之前的科学家，否则以自己的名字命名某些东西是不合适的。
But it's totally appropriate to name things after other people.
但以别人的名字命名事物是完全合适的。
So I'm going to call it Attia's rule.
所以我将其称为阿蒂亚规则。
Until you can do the following things, don't talk about supplements.
在你能做到以下这些事情之前，不要谈论补充剂。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Please refrain from talking about supplements and nutrition.
请不要谈论补充剂和营养。
Andrew Huberman:
安德鲁·休伯曼：
There it is.
就在那里。
Hereafter, thought of, referred to- ...
此后，想到、提及——...
and referenced as Attia's rule.
并被称为阿蒂亚规则。
I coined the phrase, not him.
这句话是我创造的，不是他。
So there's no ego involved, but it is now Attia's rule.
所以这不涉及自我，但现在这是阿蒂亚的规则。
Watch out.
当心。
#attiasrule.
#attiasrule。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Oh, God.
哦，上帝。
Andrew Huberman:
安德鲁·休伯曼：
Wikipedia entry, Attia's rule.
维基百科条目，阿提亚规则。
In all seriousness, and I am serious about that, dead hang for about a minute seems like a really good goal for a lot of people, at least to-
说实话，我对此很认真，对于很多人来说，静止悬吊大约一分钟似乎是一个非常好的目标，至少可以-
Dr. Peter Attia:
彼得·阿蒂亚博士：
That's our goal.
这就是我们的目标。
I think we have a minute and a half is the goal for a 40-year-old woman.
我认为我们有一分半钟是一个40岁女性的目标。
Two minutes is the goal for a 40-year-old man.
两分钟是一个40岁男人的目标。
So we adjust them up and down based on age and gender.
因此，我们根据年龄和性别对它们进行上下调整。
Andrew Huberman:
安德鲁·休伯曼：
Great.
太棒了。
And then the wall sit, what are some numbers-
然后墙就坐了，有哪些数字-
Dr. Peter Attia:
彼得·阿蒂亚博士：
We don't use a wall sit.
我们不使用靠墙坐。
We do just a straight squat, air squat, at 90 degrees, and I believe two minutes is the standard for both men and women at 40.
我们只是做一个90度的直蹲，空蹲，我相信两分钟是40岁男性和女性的标准。
Andrew Huberman:
安德鲁·休伯曼：
Great.
太棒了。
And then, because for some people thinking in terms of VO2 max is a little more complicated.
然后，因为对于某些人来说，最大摄氧量的思考有点复杂。
They might not have access to the equipment or to measure it, et cetera.
他们可能无法使用设备或对其进行测量等。
What can we talk about, think about in terms of cardiovascular?
我们可以谈论什么，从心血管角度思考什么？
So run a mile at seven minutes or less, eight minutes or less?
那么，在七分钟或更少、八分钟或更少的时间内跑一英里？
Dr. Peter Attia:
彼得·阿蒂亚博士：
That's a good question.
这是个好问题。
So there are really good VO2 max estimators online, and you can plug in your activity du jour, so be it a bike, run, or rowing machine, and it can give you a sense of that.
因此，网上有非常好的最大摄氧量估算器，您可以插入您的日常活动，无论是骑自行车、跑步还是划船机，它都可以给您一种感觉。
And I used to know all of those.
我曾经知道所有这些。
Andrew Huberman:
安德鲁·休伯曼：
Oh, that's okay.
哦，没关系。
Dr. Peter Attia:
彼得·阿蒂亚博士：
But now that I just actually do the testing, I don't recall them.
但现在我真的做了测试，我不记得它们了。
But it's exactly that line of thinking.
但这正是这种思路。
Like, can you run a mile in this time?
比如，你这次能跑一英里吗？
If you can, your VO2 max is approximately this.
如果可以的话，您的最大摄氧量大约是这个。
Andrew Huberman:
安德鲁·休伯曼：
Great.
太棒了。
Dr. Peter Attia:
彼得·阿蒂亚博士：
And I think somewhere in my podcast realm, I've got all those charts posted of this is by age, by sex, this is what the VO2 max is in each of those buckets.
我想在我的播客领域的某个地方，我已经发布了所有这些图表，这些图表是按年龄、性别划分的，这就是每个桶中的最大摄氧量。
Andrew Huberman:
安德鲁·休伯曼：
Terrific.
太棒了。
We'll provide links just to those.
我们将仅提供这些链接。
We'll have our people find those links.
我们会让我们的员工找到这些链接。
And then you mentioned deadlifting body weight 10 times.
然后你提到自重硬拉10次。
Dr. Peter Attia:
彼得·阿蒂亚博士：
I just made that one up.
我刚刚编了一个。
Andrew Huberman:
安德鲁·休伯曼：
I-
我-
Dr. Peter Attia:
彼得·阿蒂亚博士：
That's not one that we include, but something-
这不是我们所包括的，而是一些东西——
Andrew Huberman:
安德鲁·休伯曼：
Something like that.
类似的事情。
Dr. Peter Attia:
彼得·阿蒂亚博士：
We use farmer carries.
我们使用农夫运载工具。
So we'll say for a male, you should be able to farmer carry your body weight for, I think we have two minutes.
所以我们会说，对于男性来说，你应该能够承受你的体重，我想我们有两分钟的时间。
Andrew Huberman:
安德鲁·休伯曼：
Right.
对。
Dr. Peter Attia:
彼得·阿蒂亚博士：
So that's half your body weight in each hand.
所以每只手的重量都是你体重的一半。
You should be able to walk with that for two minutes.
您应该能够带着它步行两分钟。
For women, I think we're doing 75% of body weight or something like that, yeah.
对于女性来说，我认为我们正在做体重的 75% 或类似的事情，是的。
Andrew Huberman:
安德鲁·休伯曼：
Great.
太棒了。
I love it.
我喜欢它。
As indirect measures of how healthy and-
作为衡量健康程度和-
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah.
是的。
Huge measure
巨大的措施
Andrew Huberman:
安德鲁·休伯曼：
...
...
we are and how long we're going to live.
我们现在是什么以及我们还能活多久。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah.
是的。
It's basically grip strength.
基本上就是握力。
It's mobility.
这是流动性。
Again, walking with that much weight for some people initially is really hard.
同样，对于某些人来说，最初负重行走确实很困难。
We use different things like vertical jump, ground contact time if you're jumping off a box, things like that.
我们使用不同的指标，比如垂直跳跃、触地时间（如果你从箱子上跳下来）等等。
So it's really trying to capture-- And it's an evolution, right?
所以它真的试图捕捉——这是一种进化，对吧？
I think the test is going to get only more and more involved as we get involved.
我认为随着我们的参与，测试将会变得越来越多。
Because it took us about a year.
因为我们花了大约一年的时间。
Beth Lewis did the majority of the work to develop this.
Beth Lewis 完成了开发此功能的大部分工作。
Beth runs our strength and stability program in the practice, and basically, I just tasked her with like, "Hey, go out to the literature and come up with all of the best movements that we think are proxies for what you need to be the most kickass," what we call centenarian decathlete, which is the person living in their marginal decade at their best.
贝丝在练习中负责我们的力量和稳定性计划，基本上，我只是给她布置了这样的任务：“嘿，查阅文献，想出所有我们认为最好的动作，这些动作可以代表你成为最厉害的人，”我们称之为百岁十项全能运动员，也就是生活在人生巅峰的边缘十年的人。
Andrew Huberman:
安德鲁·休伯曼：
Well, what I'm about to say is certainly a mechanistic leap, but if you look at the literature on exercise-related neurogenesis in mice, or brain atrophy or brain hypertrophy, et cetera, in animal models, it's very clear that the best way to get a nervous system to atrophy, to lose neurons, shrink neurons, and/or lose connections between neurons, is to stop that animal from moving.
好吧，我要说的肯定是机械上的飞跃，但如果你看一下关于小鼠运动相关神经发生，或动物模型中脑萎缩或脑肥大等的文献，很明显，让神经系统萎缩、失去神经元、收缩神经元和/或失去神经元之间的连接的最佳方法是阻止该动物运动。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yep.
是的。
Andrew Huberman:
安德鲁·休伯曼：
Or to de-enrich its environment, deprive it of some sensory input or multiple sensory inputs.
或者去丰富它的环境，剥夺它的一些感官输入或多种感官输入。
And the best way to enhance the size of neurons, the number of connections between neurons, and maybe even the number of neurons, is to enrich its environment and get it moving while enriching that environment.
增强神经元大小、神经元之间连接数量、甚至神经元数量的最佳方法是丰富其环境，并在丰富该环境的同时使其运动。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Andrew, I think it's very difficult for me to say that the same is not true in humans.
安德鲁，我认为我很难说人类的情况并非如此。
And so the first time this became clear to me was in 2014.
我第一次清楚这一点是在 2014 年。
I had an analyst, Dan Pelchar, and I said, "Dan, I'm going to give you a project that is vexing me to no end, which is, I want you to look at all of the literature that we have, both mechanistic and clinical trial data, that talks about Alzheimer's prevention.
我有一位分析师丹·佩尔查尔（Dan Pelchar），我说：“丹，我要给你一个让我烦恼不已的项目，那就是，我希望你看看我们拥有的所有关于阿尔茨海默病预防的文献，包括机制和临床试验数据。
And I want to know every single type of input, and I want to have a clear sense of via what mechanism does it offer what mode of protection." And it took Dan, and this was obviously we iterated a lot on this together, and he came back with kind of an amazing presentation that took almost nine months to a year of work.
我想知道每种类型的输入，并且我想清楚地了解它通过什么机制提供什么模式的保护。”丹，显然我们一起对此进行了很多迭代，他带着一个令人惊叹的演示回来了，花了近九个月到一年的时间。
And what amazed me was when he came back to it, he said, "The single greatest efficacy we can point to is exercise." And I was like, "Dan, that's got to be nonsense, dude.
令我惊讶的是，当他回过头来时，他说：“我们能指出的最大功效就是锻炼。”我当时想，“丹，那肯定是胡说八道，伙计。
There's no way exercise is the single best thing you can do for the brain.
运动绝不是对大脑最好的事情。
There has to be some drug you've missed.
一定有某种药物你错过了。
There has to be some other thing that you've missed." And he's like, "No. This is hands down the best thing." Because it's not just what it's doing to BDNF, it's not just what it's doing to vascular endothelium, it's not just what it's doing to glucose disposal and insulin signaling, all these things.
一定还有其他事情你错过了。”他说：“不。这无疑是最好的事情。”因为它不仅仅对 BDNF 起作用，不仅仅对血管内皮起作用，也不仅仅对葡萄糖处理和胰岛素信号传导等所有这些起作用。
It's just touching every aspect of the brain.
它只是触及大脑的各个方面。
And I was very skeptical for about six months, kind of really pushed on him, and I was like, "I think you're missing something, Dan.
在大约六个月的时间里，我非常怀疑，真的有点逼迫他，我想，“我认为你错过了一些东西，丹。
I think you're missing something." And then finally in the end, looped in Richard Isaacson, who's a neurologist that we work with really closely on Alzheimer's prevention.
我认为你错过了一些东西。”最后，理查德·艾萨克森 (Richard Isaacson) 登场，他是一位神经科医生，我们在预防阿尔茨海默病方面与我们密切合作。
And ultimately, it turned into a paper that we wrote, basically, about this topic and a few others.
最终，它变成了我们写的一篇论文，基本上是关于这个主题和其他一些主题的。
Because again, I thought, "Are you sure it's not EPA and DHA?
因为我又想，“你确定这不是 EPA 和 DHA 吗？
That's got to have a bigger impact." And again, there's a lot of things that I think do matter, and there's a whole host of things that we do for Alzheimer's prevention, but I think you're absolutely right.
这一定会产生更大的影响。”再说一次，我认为有很多事情确实很重要，我们为预防阿尔茨海默病做了很多事情，但我认为你是绝对正确的。
There's not one thing that I'll tell patients is more important than exercising.
我会告诉患者没有一件事比锻炼更重要。
And by the way, it's not the sort of pathetic recommendations that are made.
顺便说一句，这并不是那种可悲的建议。
You have to exercise a lot more if you want to get this maximum benefit.
如果你想获得最大的好处，你必须进行更多的锻炼。
The maximum benefit comes going from nothing to something.
最大的利益来自于从无到有。
So if you go from being completely sedentary to doing 15 MET hours per week, you'll get probably a 50% reduction in risk.
因此，如果您从完全久坐改为每周进行 15 小时 MET 运动，您的风险可能会降低 50%。
Andrew Huberman:
安德鲁·休伯曼：
Wow.
哇。
Dr. Peter Attia:
彼得·阿蒂亚博士：
So a MET hour, a MET, just for people who don't know, is a metabolic equivalent.
所以一个 MET 小时，一个 MET，对于那些不知道的人来说，是一个代谢当量。
So we're exerting about 1.3 Mets sitting here talking.
所以我们正在努力坐在这里谈论 1.3 Mets。
If we were sitting here being quiet, it would be about one MET.
如果我们安静地坐在这里，大约需要 1 MET。
Walking really briskly would be about five Mets.
如果真的快走的话，大约需要五个大都会。
So 15 MET hours per week would be three one-hour really brisk walks.
因此，每周 15 MET 小时相当于 3 次 1 小时的快走。
That's not a lot of work.
这并不是很多工作。
But just going from doing nothing to doing that would give you 50% of the benefit that you would get from going all the way.
但仅仅从无所事事到有所作为就会给你带来一路走来所获得的 50% 的好处。
Now, again, I think- I'm personally a little skeptical of how much that's...
现在，我再次认为——我个人对这个数字有点怀疑……
I think it's probably a bit less than that.
我认为可能比这个少一点。
I think there's more upside than people appreciate, but the studies, I don't think can truly capture that.
我认为它的好处比人们想象的要多，但我认为这些研究并不能真正体现这一点。
But look, there's no reason to not be exercising more than that and capture more benefit, even though the rate at which you accrue it is less.
但是，你看，没有理由不进行更多的锻炼并获得更多的好处，即使你获得好处的速度较低。
And it also speaks to the health span side of this, which is not necessarily captured in those data.
这也说明了健康跨度方面，这些数据不一定包含这一点。
The health span gets back to the functional piece we opened with, which is, what do you want to be doing in your marginal decade?
健康跨度回到了我们开头的功能性部分，也就是说，你想在你的最后十年做什么？
Do you want to be able to pick up a great-grandkid if they come running at you?
如果曾孙朝你跑来，你想抱起他们吗？
Do you want to be able to get up off the floor?
您想能够从地板上站起来吗？
Do you want to be able to play on the floor with a kid and then get up on your own?
您想和孩子一起在地板上玩耍，然后自己站起来吗？
Andrew Huberman:
安德鲁·休伯曼：
Yeah, and I think most people are thinking final years of life, they're trying to think, how can they take themselves to the bathroom?
是的，我认为大多数人都在思考生命的最后几年，他们试图思考，他们如何才能自己去洗手间？
They're thinking, how can they sit up off the toilet?
他们在想，他们怎么能从马桶上坐起来呢？
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yep.
是的。
Andrew Huberman:
安德鲁·休伯曼：
You have really basic vegetative type functions, right?
你确实有基本的植物人类型的功能，对吧？
At some level.
在某种程度上。
I love this, again, this idea of marginal decade and using that as a way to back cast to actual methods and behaviors, and protocols that one should be doing on a daily basis.
我再次喜欢这个边缘十年的想法，并用它作为一种方式来支持实际的方法和行为，以及人们应该每天执行的协议。
I'll use anecdata, as it's now called, to cite just I know three Nobel Prize winners, which doesn't mean anything except that they did beautiful work, but the point is that they're all in their 90s.
我将使用现在所谓的轶事来引用我所知道的三位诺贝尔奖获得者，这除了表明他们做了出色的工作外没有任何意义，但重点是他们都已经90多岁了。
So I'll name them because I'm complimenting them for what they've done, not just their work, but what I'm about to describe.
所以我给他们起名字是因为我赞扬他们所做的事情，不仅仅是他们的工作，还有我将要描述的事情。
So Eric Kandel at Columbia, Nobel Prize winner for work on memory, Torsten Wiesel for work on neuroplasticity, and then Richard Axel, who's also at Columbia, Nobel Prize-winning work for molecular biology of smell and molecular biology generally.
哥伦比亚大学的埃里克·坎德尔 (Eric Kandel) 因记忆研究获得诺贝尔奖，托斯顿·维塞尔 (Torsten Wiesel) 因神经可塑性研究获得诺贝尔奖，然后是哥伦比亚大学的理查德·阿克塞尔 (Richard Axel)，他因嗅觉分子生物学和分子生物学研究获得诺贝尔奖。
All three of them still alive.
他们三个都还活着。
Richard's younger compared to the other two.
与其他两人相比，理查德更年轻。
All three of them either swim, jog, or play tennis or racquetball, I think is Richard's thing, multiple times per week.
他们三个要么游泳、慢跑，要么打网球或壁球，我认为这是理查德的爱好，每周多次。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Mm.
嗯。
Andrew Huberman:
安德鲁·休伯曼：
They're all cognitively still extremely sharp, still interested in the arts, doing science, curious about science, running laboratories, writing books, going on podcasts.
他们的认知仍然非常敏锐，仍然对艺术感兴趣，从事科学，对科学感到好奇，管理实验室，写书，上播客。
It's incredible.
太不可思议了。
Again, that's anecdata, but I was kind of surprised to learn that colleagues that were so intellectually strong were also so obsessed with exercise.
再说一次，这都是轶事，但我有点惊讶地发现智力如此强大的同事也如此痴迷于锻炼。
They really are obsessed with their exercise routine and early on linked that to some of their intellectual vigor over time.
他们确实对自己的锻炼习惯很着迷，并且很早就将其与随着时间的推移而产生的智力活力联系起来。
I want to just also use that as a jumping-off point to ask about one kind of niche thing, but it comes up.
我也想以此为起点来询问一种利基事物，但它出现了。
I don't think I'm going to out which one of those told me this, but one of those three individuals chews an excessive amount of Nicorette.
我不认为我会找出其中哪一个告诉我这一点，但这三个人中有一个咀嚼了过量的尼古雷特。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Mm.
嗯。
Andrew Huberman:
安德鲁·休伯曼：
Used to be a smoker, and I asked him why, and he said, because in his estimation, it's protective against Parkinson's and Alzheimer's, or at least the nicotinic acetylcholine augmentation of nicotine, because nicotine is an acetylcholine receptor, obviously, is known to create a state of focus and neural enhancement.
曾经是一个吸烟者，我问他为什么，他说，因为在他看来，它可以预防帕金森氏症和阿尔茨海默氏症，或者至少可以增强尼古丁的烟碱乙酰胆碱，因为尼古丁是一种乙酰胆碱受体，显然，众所周知，它可以创造一种专注状态和神经增强。
What are your thoughts about not smoking?
对于不吸烟，你有什么想法？
I want to be really clear.
我想说得很清楚。
People, don't smoke nicotine, vape nicotine.
人们，不要吸尼古丁，不要吸尼古丁。
It's going to shorten your life.
它会缩短你的寿命。
Just terrible idea.
真是糟糕的主意。
Addictive, et cetera, in my opinion.
在我看来，上瘾等等。
But what are your thoughts about augmenting acetylcholine through the use of nicotine in order to keep the brain healthy and focused?
但是，您对通过使用尼古丁增强乙酰胆碱以保持大脑健康和注意力集中有何看法？
Again, this is one Nobel Prize winner, so it's truly N of one, but he's so convinced that this matches up with the mechanistic data on acetylcholine and cognition that I'd love to get your thoughts on it.
再说一次，这是一位诺贝尔奖获得者，所以这确实是其中之一，但他非常确信这与乙酰胆碱和认知的机械数据相匹配，我很想听听你的想法。
Dr. Peter Attia:
彼得·阿蒂亚博士：
So I can't speak to the AD prevention component of it.
所以我不能谈论它的 AD 预防部分。
I'd have to run that by a couple of my colleagues who I collaborate with on that.
我必须由几个与我合作的同事来运行它。
But I can definitely speak to the cognitive enhancement piece of it, and I actually did an AMA on this probably a year ago, where I went into all of the gory details of it and talked about my own use of nicotine, which I'll cycle on and off.
但我绝对可以谈论它的认知增强部分，实际上我大概在一年前就做了一个 AMA，在那里我详细介绍了它的所有血淋淋的细节，并谈论了我自己对尼古丁的使用，我会断断续续地循环使用尼古丁。
I've been doing it for the last 10 years.
过去 10 年我一直这样做。
Andrew Huberman:
安德鲁·休伯曼：
What form do you take it in?
你采取什么形式？
Dr. Peter Attia:
彼得·阿蒂亚博士：
I used to use the gum.
我以前用过口香糖。
I don't like the gum anymore, so now I like these little lozenges.
我不再喜欢口香糖了，所以现在我喜欢这些小含片。
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Dr. Peter Attia:
彼得·阿蒂亚博士：
I'll tell you a funny story about this.
我会告诉你一个关于这件事的有趣的故事。
So our mutual acquaintance, David Sinclair, mentioned a company to me a year ago.
我们共同的熟人 David Sinclair 一年前向我提到了一家公司。
He's like, "Hey, have you heard of this company?" And I forget the name of the company, but he gave me some name.
他说：“嘿，你听说过这家公司吗？”我忘记了公司的名字，但他给了我一些名字。
So I go online, and it's like this company's selling nicotine.
于是我上网一看，好像这家公司在卖尼古丁。
And I'm like, "I wonder why he's asking me to do this." Well, I'll just order a bunch, and then we'll figure out why, because there was some reason we were doing this potentially through an investment.
我想，“我想知道他为什么要我这样做。”好吧，我会订购一批，然后我们会找出原因，因为有某种原因我们可能通过投资来做到这一点。
So I literally ordered a lifetime supply of this stuff, and it's pretty good.
所以我真的订购了这些东西的终身供应，而且非常好。
It's a really nice little patch because the thing I didn't like about the gum was I hated just the taste of it.
这是一个非常好的小补丁，因为我不喜欢口香糖的地方是我讨厌它的味道。
So then the next week, I'm talking to David, and I'm like, "By the way, I ordered all that nicotine stuff you told me about." He's like, "What?" And he goes, "Oh, oh, the company's name was something else." It was totally unrelated.
所以下周，我和大卫谈话，我说，“顺便说一句，我订购了你告诉我的所有尼古丁东西。”他说：“什么？”他说：“哦，哦，公司的名字是别的。”这是完全无关的。
I was like, "Oh, God." So the short answer is, I think this stuff is absolutely a concentration-enhancing substance.
我当时想，“哦，上帝。”所以简短的回答是，我认为这东西绝对是一种提高浓度的物质。
It is addictive, and people need to be wary of that.
它会让人上瘾，人们需要对此保持警惕。
Now, it's not addictive to everybody.
现在，并不是每个人都会上瘾。
I personally experience no addiction to it whatsoever.
我个人对它没有任何上瘾的感觉。
So I could do it every day for 30 days and stop and experience no withdrawal.
所以我可以每天都这样做，持续 30 天，然后停下来，不会出现任何戒断现象。
I could forget about it.
我可以忘记它。
It doesn't really seem to matter.
这似乎并不重要。
You have to be careful with the dose, truthfully.
说实话，你必须小心剂量。
Remember, one cigarette is about one milligram of nicotine, and a lot of these lozenges will plow four to eight milligrams into you in one shot.
请记住，一支香烟大约含有一毫克尼古丁，而很多这些含片会一次性向您注入四到八毫克尼古丁。
And for someone who is naïve to that like I am, four milligrams is a lot of nicotine in one bolus.
对于像我这样对此一无所知的人来说，一丸中四毫克就含有大量尼古丁。
So you just have to be very mindful of it.
所以你必须非常注意它。
I got a lot of flak when I did this AMA for obvious reasons, but people were like: How can you, as a doctor, encourage people to use nicotine?
当我做这个 AMA 时，出于显而易见的原因，我受到了很多批评，但人们的反应是：作为一名医生，你怎么能鼓励人们使用尼古丁呢？
And I was like: First of all, I'm not encouraging anybody to use it.
我当时想：首先，我不鼓励任何人使用它。
I just want to be able to talk about the biochemistry of it, and if disclosing that I use it from time to time is an endorsement, then I apologize for that.
我只是想能够谈论它的生物化学，如果透露我不时使用它是一种认可，那么我为此道歉。
But on the list of things that you can do to make your brain ...
但在你可以做的事情清单上，你可以做一些让你的大脑......
a little more focused, I would consider this infinitely safer than what a lot of people are doing, which is using stimulants.
更专注一点，我认为这比很多人正在做的使用兴奋剂要安全得多。
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Dr. Peter Attia:
彼得·阿蒂亚博士：
To me, I just tell patients outright, "We are under no circumstance prescribing stimulants."
对我来说，我只是直截了当地告诉患者：“我们在任何情况下都不会开兴奋剂。”
Andrew Huberman:
安德鲁·休伯曼：
Interesting.
有趣。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah.
是的。
We're not giving anybody Adderall.
我们不会给任何人服用阿得拉。
We're not giving anybody Vyvanse or any of these things.
我们不会向任何人提供 Vyvanse 或任何此类东西。
Not to say they don't have an appropriate clinical use, but they should be prescribed under the care of somebody who's really monitoring the use case for it.
并不是说它们没有适当的临床用途，但它们应该在真正监控用例的人的照顾下开处方。
And using that as a tool to enhance concentration and cognitive performance is not something we're comfortable doing.
使用它作为增强注意力和认知能力的工具并不是我们愿意做的事情。
Andrew Huberman:
安德鲁·休伯曼：
Yeah, it's rampant on college campuses.
是啊，大学校园里这种现象很普遍。
Dr. Peter Attia:
彼得·阿蒂亚博士：
I can only imagine.
我只能想象。
Andrew Huberman:
安德鲁·休伯曼：
Armodafinil, modafinil, which are slightly different, of course.
Armodafinil，莫达非尼，当然略有不同。
But so non-clinical use, not prescribed for ADHD, but just, it's rampant.
但非临床用途，不是针对多动症的处方，但它很猖獗。
Recreational use, study-based use.
娱乐用途、学习用途。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Now, the data I've seen on modafinil suggests that it only really provides a nootropic benefit in someone who is deprived of sleep.
现在，我看到的关于莫达非尼的数据表明，它只对睡眠不足的人提供促智作用。
Is there data that in a totally well-rested person, there is a nootropic benefit of modafinil?
是否有数据表明，对于完全休息的人来说，莫达非尼有促智作用？
Andrew Huberman:
安德鲁·休伯曼：
I don't know.
我不知道。
I have one experience with armodafinil where I took a half a recommended dosage, was prescribed by a doctor.
我有一次服用阿莫达非尼的经历，当时我服用了医生处方推荐剂量的一半。
I went to give a talk, this was in Hawaii, and four hours into the talk, my co-speaker came up to me and just said, "Well, first of all, you got a little bit of spit in the corner of your mouth, and second of all, you haven't blinked in three minutes, and third, there's only two people left in the audience." I was so lasered in that I forgot the context.
我去夏威夷做演讲，演讲四个小时后，我的搭档演讲者走过来对我说：“好吧，首先，你嘴角有一点口水，其次，你已经三分钟没有眨眼了，第三，观众席上只剩下两个人了。”我太着迷了，以至于忘记了上下文。
I'm a little bit of a tunnel vision, OCD type- ...
我有点目光短浅，强迫症类型——...
anyway, but that was all it took.
无论如何，但这就是全部了。
I never took any more of it.
我再也没有拿过它。
It was a powerful stimulant.
这是一种强大的兴奋剂。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Mm.
嗯。
Andrew Huberman:
安德鲁·休伯曼：
I take 300 milligrams of Alpha GPC now and again before some cognitive work, sometimes before workouts, and I do subjectively feel that it narrows my focus in a nice way.
在一些认知工作之前，有时在锻炼之前，我时不时地服用 300 毫克 Alpha GPC，我确实主观地觉得它以一种很好的方式缩小了我的注意力。
But I don't take it more than once or twice a day and more than once or twice a week.
但我每天服用的次数不会超过一两次，每周服用的次数不会超过一两次。
I just sit-
我只是坐着——
Dr. Peter Attia:
彼得·阿蒂亚博士：
So this is an example of where, how we're talking about exercise versus nutrition and supplements for longevity, I think there may be a whole bunch of things that are kind of interesting around focus, but nothing would compare to changing our environment.
所以这是一个例子，说明我们如何谈论运动与营养和长寿补充剂，我认为围绕焦点可能有很多有趣的事情，但没有什么比改变我们的环境更好的了。
Like, I think that if I compare my focus today to my focus when I was in college, there's no comparison.
就像，我认为如果我将今天的注意力与我在大学时的注意力进行比较，那就没有可比性。
In college, I was truly a robot.
在大学里，我确实是一个机器人。
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Dr. Peter Attia:
彼得·阿蒂亚博士：
But I think a large part of it was there was no distraction.
但我认为很大一部分原因是没有分心。
There was no email.
没有电子邮件。
Andrew Huberman:
安德鲁·休伯曼：
Right.
对。
Dr. Peter Attia:
彼得·阿蒂亚博士：
There was no social media.
没有社交媒体。
Andrew Huberman:
安德鲁·休伯曼：
Right.
对。
Dr. Peter Attia:
彼得·阿蒂亚博士：
There was no internet.
没有互联网。
I was in college when Mosaic launched in the early '90s.
Mosaic 在 90 年代初推出时，我正在上大学。
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Dr. Peter Attia:
彼得·阿蒂亚博士：
And you had to walk like a mile to get to the computer lab on a big Sun workstation to do anything in some computer code language.
你必须步行一英里才能到达大型 Sun 工作站上的计算机实验室，才能用某种计算机代码语言执行任何操作。
So when you're sitting in your room studying, there was no distraction.
因此，当您坐在房间里学习时，不会有任何干扰。
And I think that's a far greater component of what it means to be focused than the challenges we have today.
我认为，这比我们今天面临的挑战更重要。
So, my thoughts on this would be if we really wanted to return to a state of focus, we're going to have to individually do something about our environment.
所以，我对此的想法是，如果我们真的想回到专注状态，我们就必须单独对我们的环境做一些事情。
And I don't know what the answer is.
我不知道答案是什么。
I've tried every little trick I can think of, like closing my browsers when I'm writing and stuff, but I'm just not strong enough willed.
我已经尝试了所有我能想到的小技巧，比如在写作时关闭浏览器之类的，但我只是意志不够坚强。
I'll pick up my phone every 20 minutes to look and see if I missed a text message or something stupid.
我会每隔 20 分钟拿起手机查看是否错过了一条短信或一些愚蠢的事情。
Andrew Huberman:
安德鲁·休伯曼：
That's pretty infrequent.
这种情况相当罕见。
I did an episode on habits, and looking at the data, it seems that people are getting interrupted or interrupting themselves about once every three minutes in the typical workplace.
我做了一集关于习惯的节目，从数据来看，在典型的工作场所中，人们似乎每三分钟就会被打扰或打断自己一次。
Now that typical has changed with a lot more people working at home.
现在，随着越来越多的人在家工作，这种情况已经发生了变化。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah.
是的。
Andrew Huberman:
安德鲁·休伯曼：
I do put my phone away when I try and work, but nothing focuses me like a deadline.
当我尝试工作时，我确实会把手机收起来，但没有什么比最后期限更能让我集中注意力的了。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah.
是的。
Andrew Huberman:
安德鲁·休伯曼：
A little bit of fear-based urgency.
有点基于恐惧的紧迫感。
That's it.
就是这样。
Grant deadlines, drop deadlines, as I call them, or podcasts we're going to record today, that nothing works quite like it, but such is life.
授予最后期限，放弃最后期限，正如我所说的，或者我们今天要录制的播客，没有什么比它更有效的了，但这就是生活。
Well, thanks for that offshoot about nicotine.
好吧，感谢有关尼古丁的分支。
Again, you're not recommending it, I'm not recommending it.
再说一遍，你不推荐，我也不推荐。
But it's clear that augmenting the acetylcholine system, which is what nicotine does in its various forms, and some related type pharmacology, does enhance focus, and pretty potently.
但很明显，增强乙酰胆碱系统（尼古丁的各种形式以及一些相关类型的药理学）确实可以增强注意力，而且非常有效。
So I think it's going to be an interesting area for real clinical trials and things of that sort.
所以我认为这对于真正的临床试验和类似的事情来说将是一个有趣的领域。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah.
是的。
Andrew Huberman:
安德鲁·休伯曼：
Love to chat about hormone therapies and hormones generally.
喜欢谈论激素疗法和激素。
When Robert Sapolsky came on the podcast, we talked a little bit about menopause and the data around menopause.
当罗伯特·萨波尔斯基 (Robert Sapolsky) 出现在播客中时，我们谈论了一些关于更年期和更年期相关数据的话题。
He's very interested in these findings that, I think I'm going to get this right, that whether or not women benefit from estrogen therapy to offset menopause really depends on when that therapy is initiated.
他对这些发现非常感兴趣，我想我会做对的，即女性是否能从雌激素疗法中受益以抵消更年期实际上取决于该疗法何时开始。
I don't know if you're aware of those data, but he claimed that if they begin estrogen therapy in the middle to tail end of menopause, the outcomes can be quite bad.
我不知道你是否了解这些数据，但他声称，如果他们在更年期中后期开始雌激素治疗，结果可能会很糟糕。
Whereas if they initiate those estrogen therapies as they enter menopause or even before menopause, then the outcomes can be quite good.
然而，如果她们在进入更年期甚至更年期之前开始这些雌激素治疗，那么结果可能会非常好。
I don't know what percentage of the patients you treat are male versus female and what ages those patients are, of course, but what are your thoughts about estrogen therapy for women, menopause, and hormone therapies generally for women, maybe even testosterone therapy?
当然，我不知道您治疗的患者中男性和女性的比例是多少，以及这些患者的年龄，但您对女性雌激素治疗、更年期和一般女性激素治疗，甚至睾酮治疗有何看法？
You hear about that these days.
这些天你听说过这件事。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah.
是的。
Andrew Huberman:
安德鲁·休伯曼：
And then we'll talk about men.
然后我们来谈谈男人。
Dr. Peter Attia:
彼得·阿蒂亚博士：
So our practice is probably 70/30 male/female, so we have lots of women, and this is a very important topic.
所以我们的实践可能是 70/30 的男性/女性，所以我们有很多女性，这是一个非常重要的话题。
It's also probably...
这也很可能是...
Let me think.
让我想想。
I just want to make sure I'm not being hyperbolic when I say this.
我只是想确保我说这句话时没有夸张。
Yep, I don't think I am.
是的，我不认为我是。
It's hands down the biggest screw-up of the entire medical field in the last 25 years.
这无疑是过去 25 年来整个医学领域最大的失误。
Now again, it's possible in the next hour I'll think of-
现在，我可能会在接下来的一个小时内想到——
Andrew Huberman:
安德鲁·休伯曼：
Nope
不，不
Dr. Peter Attia:
彼得·阿蒂亚博士：
...
...
there's a bigger screw-up.
有一个更大的错误。
But I don't-
但我不-
Andrew Huberman:
安德鲁·休伯曼：
Another giant screw-up.
又一个巨大的失误。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah.
是的。
But I don't think I will.
但我想我不会。
I'm pretty confident that I won't be able to think of a bigger act of incompetence than what happened with the Women's Health Initiative in the late '90s and early 2000s, which is effectively the study that turned the entire medical field off hormone replacement therapy for women So it's important, I think, to explain what this study looked at.
我非常有信心，我想不出比 20 世纪 90 年代末和 2000 年代初的女性健康倡议更严重的无能行为了，这项研究实际上使整个医学领域不再对女性进行激素替代疗法。所以我认为，解释一下这项研究的目的很重要。
So this was a study that was conducted in response to the widely held belief in the '70s and '80s that women should be placed on hormones as they're going through menopause.
因此，这项研究是为了回应 70 年代和 80 年代人们普遍持有的观点，即女性在经历更年期时应该服用激素。
Right?
正确的？
Menopause is...
更年期是...
I guess maybe I'll even take a step back.
我想也许我会退后一步。
I don't know how much your audience is familiar with how estrogen, progesterone work.
我不知道各位观众对雌激素、黄体酮的作用原理了解多少。
Is it worth going into that stuff?
值得研究那些东西吗？
Andrew Huberman:
安德鲁·休伯曼：
Yeah, probably worth mentioning a bit of the top contour.
是的，可能值得一提的是顶部轮廓。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah.
是的。
Andrew Huberman:
安德鲁·休伯曼：
Some of them might be familiar with it.
他们中的一些人可能对此很熟悉。
We've done episodes on estrogen, testosterone, but frankly, as I think back to those, we didn't really go into the biology of estrogen, testosterone enough.
我们已经完成了有关雌激素、睾酮的剧集，但坦率地说，当我回想起这些时，我们并没有真正深入了解雌激素、睾酮的生物学。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah.
是的。
So, actually, an interesting aside that I always tell my female patients who get a kick out of this.
所以，实际上，有一个有趣的旁白，我总是告诉我的女性患者，她们会从中得到乐趣。
When you look at a woman's labs, you'll see her estrogen, her progesterone, her FSH, her LH, her testosterone, her sex hormone binding globulin, all these things.
当你查看女性的实验室时，你会看到她的雌激素、黄体酮、FSH、LH、睾酮、性激素结合球蛋白，所有这些东西。
But based on the units they're reported in, it's a very distorting picture of what the most common androgen is in her body.
但根据报告的单位，这对她体内最常见的雄激素的描述非常扭曲。
If you actually convert them to the same units, she has much more testosterone in her body than estrogen.
如果你真的把它们换算成相同的单位，你会发现她体内的睾丸激素比雌激素多得多。
Andrew Huberman:
安德鲁·休伯曼：
Interesting.
有趣。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah.
是的。
Andrew Huberman:
安德鲁·休伯曼：
I did not know that.
我不知道。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah.
是的。
Andrew Huberman:
安德鲁·休伯曼：
Then again, I've never been a woman getting my hormone profile done.
话又说回来，我从来都不是一个做激素分析的女人。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah.
是的。
So even though a woman's testosterone is much less than a man's level, it's still more than she has estrogen in her body.
因此，尽管女性的睾酮水平远低于男性的水平，但仍然高于体内的雌激素水平。
Andrew Huberman:
安德鲁·休伯曼：
Wow.
哇。
Dr. Peter Attia:
彼得·阿蒂亚博士：
So phenotypically, right, estrogen is the hormone that's dominating.
所以从表型来看，雌激素是占主导地位的激素。
She has much higher estrogen than a man and much lower testosterone than a man.
她的雌激素比男性高得多，睾丸激素比男性低得多。
But in absolute amounts, she has more testosterone than estrogen.
但从绝对数量来看，她的睾酮水平高于雌激素水平。
Just worth pointing that out.
值得指出的是。
Andrew Huberman:
安德鲁·休伯曼：
Incredible.
难以置信。
Dr. Peter Attia:
彼得·阿蒂亚博士：
So what's happening to a woman from the age she starts menstruating till she goes through menopause, outside of pregnancy and birth control and stuff like that, is she has this cycle roughly every 28 days, but it can vary, where at the beginning of her period, we call that day zero, her estrogen and progesterone are very low.
因此，女性从开始月经的年龄一直到绝经期，除了怀孕和节育之类的事情之外，她大约每 28 天就有一次周期，但情况可能会有所不同，在月经开始时，我们称之为零天，她的雌激素和黄体酮水平非常低。
You can't measure them.
你无法测量它们。
And then what happens is the estrogen level starts to rise, and it rises in response to a hormone called follicle stimulating hormone, FSH, that is getting her ready to ovulate.
然后雌激素水平开始上升，这是对一种称为卵泡刺激素（FSH）的激素的反应，这种激素使她准备好排卵。
And she ovulates at about the midpoint of her cycle.
她大约在月经周期的中间排卵。
So if we're just going to make the math easy, on day 14, she's going to release a follicle from one of her ovaries.
因此，如果我们想让数学变得简单的话，在第 14 天，她将从她的一个卵巢中释放出一个卵泡。
And the estrogen level is sort of rising.
雌激素水平正在上升。
We love to measure hormones on day five because I want to have a standardized way in which I measure her hormones.
我们喜欢在第五天测量荷尔蒙，因为我想要有一个标准化的方法来测量她的荷尔蒙。
So our women know if we're in the business of trying to understand her hormones, the day her period starts, even if it's just a day of spotting, that becomes our benchmark.
因此，我们的女性知道，如果我们致力于了解她的荷尔蒙，那么她月经开始的那一天，即使只是发现的一天，也会成为我们的基准。
And then day five, I want to see every hormone on that day.
然后第五天，我想看到那天的每一种激素。
And if everything is going well, I know what her FSH, LH, estradiol, and progesterone should be on that day.
如果一切顺利，我知道那天她的 FSH、LH、雌二醇和黄体酮应该是多少。
So the estrogen rises, starts to come down a little bit as she ovulates, and then the luteinizing hormone kicks on because it's now going to prepare her uterus for the lining to accommodate a pregnancy.
因此，雌激素会上升，在排卵时开始略有下降，然后黄体生成素就会启动，因为它现在要为子宫内膜做好准备以适应怀孕。
So now you start to see estradiol go back.
所以现在你开始看到雌二醇回归。
But now, for the first time, progesterone goes up.
但现在，黄体酮第一次上升。
So progesterone has been doing nothing for 14 days, and now it starts to rise.
那么黄体酮已经有14天没有任何作用，现在又开始上升。
And actually, progesterone is the hormone that's dominating the second half, which is called her luteal cycle.
事实上，黄体酮是主导后半段的激素，这被称为黄体周期。
So the first 14 days is the follicular cycle, second is the luteal cycle.
所以前14天是卵泡周期，第二天是黄体周期。
So once you get to about the halfway point of that, which is now, just to do the math, 21 days in, the body has figured out if she's pregnant or not.
因此，一旦到了大约中间点，即现在，只需进行数学计算，21 天后，身体就可以判断出她是否怀孕了。
And again, most of the time she's not going to be pregnant.
再说一遍，大多数时候她不会怀孕。
So the body says, "Oh, I don't need this lining that I've been preparing.
所以身体说：“哦，我不需要我一直在准备的衬里。
I'm going to shed it." So now progesterone and estrogen start crashing, and the lining is what is being shed, and that is the menses.
我要把它甩掉。”现在黄体酮和雌激素开始崩溃，内膜正在脱落，那就是月经。
By the way, it's that last seven days of that cycle that in a susceptible woman is what creates those PMS symptoms.
顺便说一句，易受影响的女性正是在该周期的最后 7 天产生了这些经前综合症症状。
And actually this is something that you would probably have a better understanding of than me.
事实上，你可能比我更理解这一点。
There is something about this in a susceptible woman where the enormous reduction of progesterone so quickly is probably impacting something in her brain.
对于易受影响的女性来说，黄体酮如此迅速地大幅减少可能会影响她大脑中的某些东西，这与此有关。
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Dr. Peter Attia:
彼得·阿蒂亚博士：
So I think this is a legitimate thing, right?
所以我认为这是合法的事情，对吧？
It's not like, "Oh, she's crazy because she's having all these PMS symptoms." No. We know that that's the case because if you put women on progesterone for those seven days, those symptoms go away.
这并不是说，“哦，她疯了，因为她有所有这些经前综合症症状。”不会。我们知道情况确实如此，因为如果女性在这 7 天内服用黄体酮，这些症状就会消失。
Andrew Huberman:
安德鲁·休伯曼：
Interesting.
有趣。
Dr. Peter Attia:
彼得·阿蒂亚博士：
So if you can stabilize their progesterone during the last half of their luteal phase, and sometimes we would just do it for the entire luteal phase, just put them on a low dose of progesterone, all PMS symptoms vanish.
因此，如果你能在黄体期的后半段稳定他们的黄体酮，有时我们会在整个黄体期做到这一点，只需给他们服用低剂量的黄体酮，所有经前综合症症状都会消失。
Andrew Huberman:
安德鲁·休伯曼：
Very interesting.
非常有趣。
I'll have to look up where the progesterone receptors are located in the brain.
我得查一下黄体酮受体在大脑中的位置。
The Allen Brain Institute now has beautiful data of in situ hybridization, which for folks that don't understand, is looking at RNA and sort of where genes and proteins ought to be expressed in the human brain by using actual human brain tissue sections as opposed to just mice.
艾伦脑研究所现在拥有原位杂交的精彩数据，对于那些不了解的人来说，它正在通过使用实际的人脑组织切片（而不是仅仅使用小鼠）来研究 RNA 以及基因和蛋白质应该在人脑中表达的位置。
So I'll take a look.
所以我会看一下。
I think it'll give some insight into-
我认为这会给人一些洞察——
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah.
是的。
I'm really curious.
我真的很好奇。
Yeah
是啊
Andrew Huberman:
安德鲁·休伯曼：
...
...
what that progesterone emotionality link might be and where it might exist neural circuit wise.
黄体酮与情绪的联系可能是什么，以及它可能存在于神经回路的何处。
Dr. Peter Attia:
彼得·阿蒂亚博士：
So then when the estrogen and progesterone reach their nadir again, that starts the cycle.
因此，当雌激素和孕激素再次达到最低点时，循环就开始了。
So that cycle is happening over and over and over again.
所以这个循环一遍又一遍地发生。
Okay, so it became well known in the '50s that, okay, a woman's going to stop menstruating at some point.
好吧，所以在 50 年代众所周知，女人会在某个时候停止月经。
Her estrogen goes down.
她的雌激素下降了。
Why don't we just give her estrogen?
我们为什么不直接给她雌激素呢？
Because that's clearly going to help with some of the symptoms of menopause.
因为这显然有助于缓解更年期的一些症状。
So what do women experience when they go through menopause?
那么女性在更年期的时候会经历什么呢？
The first symptoms are what are called vasomotor symptoms.
第一个症状是所谓的血管舒缩症状。
So this is usually in the form of night sweats, hot flashes.
所以这通常表现为盗汗、潮热。
And depending on the woman, this can be really significant, right?
根据女性的不同，这可能非常重要，对吧？
These are women who can have a hard time sleeping.
这些女性可能很难入睡。
They can be having hot flashes during the middle of the day.
他们可能会在中午出现潮热。
They can wake up soaked in a pool of sweat.
他们醒来时可能会浑身是汗。
Those tend to pass after a couple of years, and then they get into sort of the more long-term complications of menopause.
这些症状往往会在几年后消失，然后就会出现更长期的更年期并发症。
So what we call vaginal atrophy, vaginal dryness, and then the stuff that we talked about a while ago, which is the osteopenia, osteoporosis.
所以我们所说的阴道萎缩、阴道干燥，还有我们刚才谈到的骨质减少、骨质疏松症。
A lot of women will complain of brain fog.
很多女性会抱怨脑雾。
So clearly this was an issue, and it was recognized 70 years ago.
很明显这是一个问题，而且 70 年前就已经认识到了这一点。
Why don't we give women estrogen back to replace that hormone?
为什么我们不给女性补充雌激素来替代这种激素呢？
And so that went on for a couple of decades, maybe less, maybe a decade.
这样的情况持续了几十年，也许更短，也许十年。
And then it was realized, wait a minute, we were driving up the risk of uterine cancer.
然后我们意识到，等一下，我们正在增加患子宫癌的风险。
And the reason for that is if you just give estrogen with no progesterone to antagonize it, you will thicken the endometrium endlessly, and you will increase the risk of hyperplasia.
原因是，如果只给予雌激素，而不给予黄体酮来拮抗，就会使子宫内膜不断增厚，增加增生的风险。
Well, you'll definitely undergo hyperplasia and then ultimately dysplasia.
嗯，你肯定会经历增生，然后最终发育不良。
Dysplasia is pre-cancerous, and ultimately, we were seeing that.
发育不良是癌前病变，最终我们看到了这一点。
So people figured out, well, actually, if you want to give estrogen to a woman who still has her uterus, you have to give her progesterone as well.
所以人们发现，事实上，如果你想给一个仍然有子宫的女性注射雌激素，你还必须给她注射黄体酮。
You have to be able to have a hormone to oppose the estrogen.
你必须能够有一种激素来对抗雌激素。
And then that became effectively in the 19, call it the 1970s-ish, the standard for HRT.
然后这在 19 世纪开始生效，称之为 1970 年代左右，HRT 的标准。
So in the early 1990s, the NIH said, "Look, we haven't really studied this.
因此，在 20 世纪 90 年代初，美国国立卫生研究院 (NIH) 表示：“看，我们还没有真正研究过这个问题。
We have a ton of epidemiology that says giving women hormones seems to be doing really good things.
我们有大量的流行病学资料表明，给女性注射激素似乎确实有好处。
They feel better, so all their symptoms go away.
他们感觉好多了，所以所有症状都消失了。
They seem to have lower risk of heart disease, lower risk of cardiovascular disease, lower risk of bone fractures.
他们患心脏病的风险似乎较低，患心血管疾病的风险较低，骨折的风险较低。
Everything seems to get better.
一切似乎都在变得更好。
Lower risk of diabetes.
降低患糖尿病的风险。
But we haven't tested this in a randomized prospective trial.
但我们尚未在随机前瞻性试验中对此进行测试。
So let's do this." So that became the WHI.
那么我们就这样做吧。”这就是 WHI。
And it randomized-- It had two parallel arms.
它是随机的——它有两个平行的臂。
So it had a group for women who did not have a uterus.
所以它有一个针对没有子宫的女性的团体。
So these are women that had undergone hysterectomy for some other reason.
这些是因其他原因接受子宫切除术的女性。
And then it had a group for women that did have their uterus.
然后它有一个针对确实有子宫的女性的小组。
In the first group, there was a placebo arm and then an estrogen-only arm.
在第一组中，有一个安慰剂组，然后是一个纯雌激素组。
And in the other group, there was a progesterone plus estrogen versus a placebo.
在另一组中，有黄体酮加雌激素与安慰剂。
Everything about the way this study was done is a bit wonky.
关于这项研究的进行方式的一切都有点奇怪。
Some of it is justifiable, but it's important to understand.
其中一些是有道理的，但理解这一点很重要。
First, the women were all way outside of menopause.
首先，这些女性已经完全脱离了更年期。
So none of these women were started when you would normally start HRT.
因此，这些女性中没有一个是在正常开始激素替代治疗时开始的。
And there were probably several reasons for that, but one of them is, and I think this is a legitimate reason, they wanted hard outcomes.
可能有几个原因，但其中之一是，我认为这是一个合理的原因，他们想要硬的结果。
They wanted to know death rates.
他们想知道死亡率。
And if you're doing this on women in their 50s, you just weren't going to get it.
如果你对 50 多岁的女性做这个，你就不会明白。
Right?
正确的？
You couldn't-
你不能-
Andrew Huberman:
安德鲁·休伯曼：
You have to wait too long.
你必须等待太久。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah, you got to wait too long.
是啊，你得等太久了。
And this was only going to be like a seven to 10-year study.
这只是一项为期七到十年的研究。
So they had to do this on women who were much older.
所以他们必须对年龄大得多的女性做这件事。
They also disproportionately took much sicker women.
他们还不成比例地收治了病情严重的女性。
I believe the prevalence, and again, I'm going to get some of these numbers wrong and people are going to get all phosphorylated, but I'm in the ballpark, right?
我相信这种流行率，而且，我会弄错其中一些数字，人们会全部被磷酸化，但我在大概范围内，对吧？
Something like 30, 40% of these women were smokers.
这些女性中有大约 30%、40% 是吸烟者。
The prevalence of obesity, diabetes was enormous.
肥胖症、糖尿病的患病率非常高。
So they really disproportionately picked the most unhealthy population they could that was pretty advanced in age.
因此，他们确实不成比例地选择了年龄相当大、最不健康的人群。
And again, I think part of that was to say, "Look, we want to make sure that after seven years, we really know if there's a difference in these causes of death." The other thing is this is kind of weird, although again, I understand their rationale for it, but this is a great example of be very careful when you look at a clinical trial that it remotely represents the patients you're interested in treating.
再说一次，我认为其中一部分是说，“看，我们想确保七年后，我们真的知道这些死因是否存在差异。”另一件事是，这有点奇怪，尽管我再次理解他们的基本原理，但这是一个很好的例子，当你查看远程代表你有兴趣治疗的患者的临床试验时要非常小心。
So they also treated no patients who were symptomatic.
因此他们也没有治疗有症状的患者。
The rationale being, if we include in the study patients who are symptomatic, those who are randomized to placebo will drop out.
理由是，如果我们将有症状的患者纳入研究中，那么那些随机接受安慰剂的患者就会退出。
Andrew Huberman:
安德鲁·休伯曼：
Okay.
好的。
It makes sense in terms of study design.
就研究设计而言，这是有意义的。
Makes no sense if the study design is intended to mimic the real world.
如果研究设计的目的是模仿现实世界，那就毫无意义。
Dr. Peter Attia:
彼得·阿蒂亚博士：
That's right.
没错。
So now let's just keep track of the three issues.
现在让我们来跟踪这三个问题。
We have a disproportionately unhealthy patient population who are not symptomatic, and we're starting them more than 10 years after menopause.
我们有不成比例的不健康患者，他们没有症状，而且我们在绝经十多年后才开始治疗。
The next thing that they did, which again, I understand why they did it, but it's now the fourth strike against this study is, and I've spoken with the PI of the study and asked this question point blank.
他们所做的下一件事，我再次理解他们为什么这样做，但现在这是针对这项研究的第四次打击，我已经与该研究的 PI 交谈过，并直接问了这个问题。
I'm actually going to have her on my podcast at some point soon to go over this in more detail, is why did you use conjugated equine estrogen and MPA, which is a synthetic form of progesterone?
事实上，我很快就会让她出现在我的播客上，以便更详细地讨论这个问题，你为什么要使用结合马雌激素和 MPA（黄体酮的合成形式）？
Andrew Huberman:
安德鲁·休伯曼：
Horse-
马-
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yes
是的
Andrew Huberman:
安德鲁·休伯曼：
...
...
estrogen?
雌激素？
Dr. Peter Attia:
彼得·阿蒂亚博士：
It's horse urine.
这是马尿。
They collect horse urine, so they're getting the-- It's-
他们收集马尿，所以他们得到——它是——
Andrew Huberman:
安德鲁·休伯曼：
Horses do urinate a lot, or at least when they urinate, it seems like a large volume of urine from what I've observed.
马确实会排尿很多，或者至少当它们排尿时，根据我的观察，似乎排尿量很大。
Dr. Peter Attia:
彼得·阿蒂亚博士：
You have a lot of experience with this?
你在这方面有很多经验吗？
Andrew Huberman:
安德鲁·休伯曼：
No, but my sister rode horses for a little while.
没有，但我姐姐骑过一会儿马。
My high school girlfriend had a horse, and that thing, the peas were legendary.
我高中时的女朋友有一匹马，而豌豆那东西很有传奇色彩。
It's a male horse.
这是一匹公马。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah.
是的。
Andrew Huberman:
安德鲁·休伯曼：
Yeah.
是的。
Dr. Peter Attia:
彼得·阿蒂亚博士：
So, the conjugated equine estrogen is the estrogen that's collected from female horses, and then it's a synthetic progesterone.
因此，结合马雌激素是从雌马身上收集的雌激素，然后是合成的黄体酮。
And I said to the person, I said, "Well, why didn't you use what we use today, which is bioidentical estrogen and progesterone?" Like today, when we put women on estrogen, we use a-- It's an FDA product called the VIVEL DOT.
我对那个人说，“好吧，你为什么不使用我们今天使用的生物同质雌激素和黄体酮？”就像今天，当我们让女性服用雌激素时，我们使用一种 FDA 产品，称为 VIVEL DOT。
So it's a patch that you just put on, and it's estradiol, but it's bioidentical estradiol.
所以这是一个你刚刚贴上的贴片，它是雌二醇，但它是生物同质的雌二醇。
And we use what's called micronized progesterone, so bioidentical progesterone.
我们使用所谓的微粉化黄体酮，即具有生物同质性的黄体酮。
And she said, "Well, at the time, we just wanted to test what was currently being used." And I said, "Totally makes sense." But again, now you have four considerations that you have to keep in mind.
她说：“好吧，当时我们只是想测试一下目前正在使用的东西。”我说：“完全有道理。”但同样，现在您必须牢记四个注意事项。
Okay, so despite those four considerations, and I'm going to make a case for you why I think the MPA created a real problem in that study, the synthetic progesterone.
好吧，尽管有这四个考虑因素，我还是要向您说明为什么我认为 MPA 在该研究中造成了一个真正的问题，即合成黄体酮。
When the preliminary results were first made available, but not yet peer-reviewed and not yet published, there was a huge fiasco, huge press announcement about it, suggesting that the women receiving the CEE plus MPA in the group with a uterus had a higher incidence of breast cancer And that basically became the headline that never went away, though it turned out not to be true.
当初步结果首次公布、但尚未经过同行评审、尚未发表时，出现了一场巨大的惨败，媒体对此发表了巨大的公告，表明在有子宫的群体中接受 CEE 加 MPA 的女性乳腺癌发病率更高，这基本上成为了永远不会消失的头条新闻，尽管事实证明并非如此。
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Let's talk about the numbers.
我们来谈谈数字。
What was the increase in the risk of breast cancer in that group?
该组患乳腺癌的风险增加了多少？
Which gets to one of my, if you've ever listened to me on the podcast, rail on something.
这涉及到我的一个问题，如果你曾经在播客上听过我的演讲，那就抱怨一下吧。
Andrew Huberman:
安德鲁·休伯曼：
Listen, I have about 3,800 pet peeves and counting.
听着，我有大约 3,800 个烦恼，而且还在增加。
My laboratory staff know a good number of them.
我的实验室工作人员认识其中的很多人。
Dr. Peter Attia:
彼得·阿蒂亚博士：
So here, I'll add to one of them.
所以在这里，我将添加其中之一。
Andrew Huberman:
安德鲁·休伯曼：
You do not have to apologize for having many pet peeves, because as long as they have experience and data to support them, it provides a better life.
你不必因为有很多烦恼而道歉，因为只要有经验和数据支持，它就能提供更好的生活。
Dr. Peter Attia:
彼得·阿蒂亚博士：
So one of my biggest pet peeves is, and my team knows this because sometimes they'll occasionally do this, and I'll have to remind them.
所以我最大的烦恼之一是，我的团队知道这一点，因为有时他们偶尔会这样做，我必须提醒他们。
You never talk about a relative risk change without an absolute risk accommodating it.
如果没有绝对风险来适应相对风险变化，就永远不会谈论相对风险变化。
Right?
正确的？
So what does that look like?
那看起来是什么样子的呢？
So the relative risk increase of breast cancer in the estrogen plus MPA group versus the placebo was 25, 27%, and that became the only headline.
因此，雌激素加 MPA 组与安慰剂组相比，乳腺癌的相对风险增加了 25%、27%，这成为唯一的标题。
HRT increases risk of breast cancer by 27%.
HRT 会使患乳腺癌的风险增加 27%。
Now, I don't think that's true at all today, but let's even look at the data.
现在，我认为今天的情况完全不正确，但让我们看一下数据。
What was the ARR?
ARR 是多少？
What was the absolute risk increase?
绝对风险增加是多少？
It was a difference between five cases per thousand and four cases per thousand.
千分之五和千分之四之间存在差异。
So the ARR was 0.1%, one case in a thousand.
因此，ARR 为 0.1%，即千分之一。
And it's true, going from four in a thousand to five in a thousand is a 25% increase, but it's a completely inappropriate context.
确实，从千分之四到千分之五增加了 25%，但这是一个完全不合适的背景。
Andrew Huberman:
安德鲁·休伯曼：
I agree, and I feel like headlines of that sort, which have come up recently around various dietary interventions, we won't go there, at least not for the time being, are nothing short of criminal because they really distort people's thinking, but also they steer the course of science and medicine for, as you pointed out, for decades, if not longer.
我同意，而且我觉得最近出现的围绕各种饮食干预措施的此类头条新闻，我们不会去那里，至少暂时不会，无异于犯罪，因为它们确实扭曲了人们的思维，但正如您所指出的，它们也引导了科学和医学的进程，即使不是更长时间，也将持续数十年。
And they can really take us off our health track in serious ways.
它们确实会让我们严重偏离健康轨道。
Dr. Peter Attia:
彼得·阿蒂亚博士：
So I'll bring this meandering to a close, which is to say, even though I could spend the next hour talking about all of the ways in which this study was flawed and all of the very unethical things that were done by a number of the investigators who went out of their way to mask the truth of this study from the world.
所以我要结束这个曲折的故事，也就是说，尽管我可以在接下来的一个小时里谈论这项研究的所有缺陷，以及一些研究人员所做的所有非常不道德的事情，他们不遗余力地向世界掩盖这项研究的真相。
I'll tell a woman today, we're going to start you on this when you're going through menopause.
今天我要告诉一位女士，当您经历更年期时，我们将开始为您做这件事。
We're using bioidentical hormones, and if your upper bound risk of breast cancer is one case in a thousand, you should at least weigh that against all of the other benefits, which I'll talk about.
我们使用生物同质激素，如果您患乳腺癌的风险上限是千分之一，您至少应该权衡所有其他好处，我将讨论这一点。
Now, there's something else I want to say, because a moment ago, I alluded to the fact that I think the MPA might've been the biggest issue in that study.
现在，我还想说点别的，因为刚才我提到了这样一个事实：我认为 MPA 可能是该研究中最大的问题。
So there were two findings in that study that were negative.
因此该研究中有两项结果是否定的。
One was the small increase in the risk of heart disease and a small increase in the risk of breast cancer.
一是心脏病风险小幅增加，乳腺癌风险小幅增加。
But consider the other group.
但考虑另一组。
We forgot about the group that didn't have a uterus, because remember, those women got estrogen only versus placebo.
我们忘记了没有子宫的群体，因为请记住，这些女性只服用雌激素而不是安慰剂。
What was the difference in breast cancer there?
那里的乳腺癌有什么不同？
Well, this is interesting because it didn't reach statistical significance, but its P value was 0.06 or 0.07.
嗯，这很有趣，因为它没有达到统计显着性，但它的 P 值为 0.06 或 0.07。
So it came very close, but it was in the opposite direction.
所以它非常接近，但方向相反。
It was a 24% risk reduction, about one in a thousand as well.
风险降低了 24%，大约是千分之一。
So when you had estrogen plus MPA, you had a barely statistically significant, the P value was 0.05, so it just hit statistical significance, one in a thousand cases for breast cancer, and then you had one in a thousand cases, but P value of 0.07 for reduction of risk of breast cancer, which to me suggests that the MPA, the synthetic progesterone, was playing more of a role than anything else.
因此，当您服用雌激素加 MPA 时，几乎没有统计学显着性，P 值为 0.05，所以它刚刚达到统计显着性，千分之一的乳腺癌病例，然后您有千分之一的病例，但降低乳腺癌风险的 P 值为 0.07，对我来说，这表明 MPA（合成黄体酮）比其他任何东西都发挥了更大的作用。
The second thing I point out is oral estrogen, which we no longer use, does increase coagulability.
我指出的第二件事是我们不再使用的口服雌激素确实会增加凝血能力。
It does increase the ability of the blood to clot a little bit.
它确实增加了血液凝固的能力。
And when we look at the more recent data on HRT using topical estrogen or patches of estrogen, we don't see that at all.
当我们查看使用局部雌激素或雌激素贴片进行激素替代疗法的最新数据时，我们根本看不到这一点。
In fact, we see the opposite now.
事实上，我们现在看到的情况恰恰相反。
So now we see the risk of heart disease going down in women with estradiol.
现在我们发现服用雌二醇的女性患心脏病的风险有所下降。
Andrew Huberman:
安德鲁·休伯曼：
And some women will be arriving to those treatments with mutations and things like factor V Leiden and other clotting factors.
一些女性将接受带有突变以及 V 因子莱顿和其他凝血因子等物质的治疗。
Is it appropriate to say that everyone, both male and female, should know whether or not they have mutant forms of factor V Leiden?
是否可以说每个人，无论男性还是女性，都应该知道自己是否具有 V 因子 Leiden 突变形式？
Dr. Peter Attia:
彼得·阿蒂亚博士：
We don't typically test people for factor V.
我们通常不会测试人们的因子 V。
My wife actually has it, but we didn't learn it until she had HELLP syndrome giving birth to our first daughter.
我的妻子实际上患有这种疾病，但直到她生下我们的第一个女儿时，我们才知道它患有 HELLP 综合征。
But we kind of look for more family history reason to be testing things like that.
但我们有点寻找更多的家族史原因来测试这样的事情。
We take a pretty detailed family history, so we'll look for clotting issues there.
我们会收集非常详细的家族史，因此我们会寻找那里的凝血问题。
Andrew Huberman:
安德鲁·休伯曼：
So your reflex nowadays is to put women on these topical estrogen therapies?
那么您现在的反应是让女性接受这些局部雌激素疗法？
Dr. Peter Attia:
彼得·阿蒂亚博士：
Well, it's to basically have the discussion, right?
嗯，基本上是为了进行讨论，对吧？
Andrew Huberman:
安德鲁·休伯曼：
Yeah.
是的。
Dr. Peter Attia:
彼得·阿蒂亚博士：
So here's where we still struggle.
所以这就是我们仍在挣扎的地方。
If it were up to me, I'd prefer for a woman's HRT to be provided by her GYN because we want to be able to work in partnership with the GYN who we would like to see an endometrial ultrasound done every year.
如果由我决定，我更希望女性的 HRT 由她的妇科医生提供，因为我们希望能够与妇科医生合作，我们希望每年都能看到妇科医生进行子宫内膜超声检查。
Some would argue that's overkill, but we think she'd be having a Pap smear every year as well.
有些人会认为这太过分了，但我们认为她每年都会进行子宫颈抹片检查。
So if we're looking at the cervix, we want to look at the endometrium.
因此，如果我们要检查子宫颈，我们就要检查子宫内膜。
We want to make sure the lining isn't too thick.
我们要确保衬里不要太厚。
The other thing I should say, Andrew, is today we now realize that not all women can tolerate progesterone.
我要说的另一件事是，安德鲁，今天我们意识到并非所有女性都能耐受黄体酮。
So you have to be careful.
所以你必须小心。
So assuming, again, a woman still has her uterus, the estrogen solves most of the problems, but then you have to decide, can she tolerate the progesterone?
因此，再次假设女性仍然有子宫，雌激素可以解决大部分问题，但你必须决定，她能忍受黄体酮吗？
And it needs to be, if given systemically, like 100 to 200 milligrams.
如果全身给药，则需要大约 100 至 200 毫克。
And for some women, that is a life-saving intervention.
对于一些女性来说，这是一种挽救生命的干预措施。
They start sleeping better, their hair gets thicker, they feel better.
他们开始睡得更好，头发变得更浓密，感觉更好。
But for some women, it literally drives them crazy.
但对于一些女性来说，这确实让她们发疯。
It's probably the reciprocal of what we were seeing in the case of women with PMS.
这可能与我们在患有经前综合症的女性案例中看到的情况相反。
So in those situations, we say, "Great, we're done with oral progesterone." We just use a progesterone-coated IUD.
因此，在这种情况下，我们会说：“太好了，我们已经不再使用口服黄体酮了。”我们只使用涂有黄体酮的宫内节育器。
So then you get the local progesterone in the uterus for protection and the systemic estrogen.
然后你会在子宫中获得局部黄体酮的保护和全身性的雌激素。
Andrew Huberman:
安德鲁·休伯曼：
Fascinating.
令人着迷。
What about oral contraception in women?
女性口服避孕药怎么样？
So the use of estrogen chronically through people's college years or 20s, 30s, maybe even teens, who knows.
因此，人们在大学时期或二十多岁、三十多岁，甚至十几岁的时候就长期使用雌激素，谁知道呢。
What's known about the long-term effects, if any?
对于长期影响（如果有的话）已知多少？
Dr. Peter Attia:
彼得·阿蒂亚博士：
I've got to be honest with you, I don't think I know enough to comment on it.
我必须对你说实话，我认为我的了解不足以对此发表评论。
It's not something that really impacts my patient population.
这并不是真正影响我的患者群体的事情。
At least in what I see, more women are using IUDs for contraception than OCs.
至少在我看来，使用宫内节育器避孕的女性比使用口服避孕药的女性要多。
We use OCs sometimes in women who are premenopausal for symptomatic control, but we'll typically use a low estrogen, so a very low synthetic estrogen, which I don't like using these very much, but if it's the only thing that we can get to control certain symptoms, and we'll use it half per cycle.
我们有时会在绝经前的女性中使用口服避孕药来控制症状，但我们通常会使用低雌激素，即非常低的合成雌激素，我不太喜欢使用这些，但如果这是我们可以控制某些症状的唯一方法，我们每个周期会使用一半。
But it's typically not something we're that experienced with.
但这通常不是我们有经验的事情。
Andrew Huberman:
安德鲁·休伯曼：
What about testosterone?
睾丸激素呢？
Because you mentioned that nanogram per ml, when you set everything to the same, I guess it's nanogram per deciliter-
因为你提到每毫升纳克，当你将所有内容设置为相同时，我猜它是每分升纳克 -
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah
是啊
Andrew Huberman:
安德鲁·休伯曼：
...
...
as it would be to normalize everything.
因为这将使一切正常化。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Versus picogram per mole, yeah.
与每摩尔皮克相比，是的。
Andrew Huberman:
安德鲁·休伯曼：
Right, yeah.
对，是的。
And so what Peter was pointing out before is that you look at your charts, and they're all in these different measures, and so when you normalize, testosterone is actually higher than estrogen in women.
彼得之前指出的是，你看一下你的图表，它们都有不同的衡量标准，所以当你正常化时，女性的睾酮水平实际上高于雌激素。
That's a surprise to me.
这让我很惊讶。
Do you prescribe testosterone therapy to women ever?
您曾经给女性开过睾酮疗法吗？
Dr. Peter Attia:
彼得·阿蒂亚博士：
We do sometimes, but I do it with much more caution because I don't have the data.
有时我们会这样做，但我会更加谨慎，因为我没有数据。
Right?
正确的？
What we'll say is, look, we're now really outside of an area where I can point to a lot of data.
我们要说的是，看，我们现在确实超出了我可以指出大量数据的范围。
Like, when it comes to estrogen and progesterone, I'll happily go toe to toe with anybody who wants to make the case that it's dangerous.
就像，当谈到雌激素和黄体酮时，我很乐意与任何想要证明它是危险的人进行正面交锋。
Similarly, when it comes to using testosterone in men, I'll spend all day, and I can go through that literature until the other person cries and wants to just call uncle, right?
同样，当谈到在男性中使用睾酮时，我会花一整天的时间，我可以浏览那些文献，直到另一个人哭了，想喊叔叔，对吗？
When it comes to-
当谈到——
Andrew Huberman:
安德鲁·休伯曼：
And then you prescribe them testosterone.
然后你给他们开睾丸激素。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah.
是的。
When it comes to testosterone in women, don't have that data.
当谈到女性睾丸激素时，没有这些数据。
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Dr. Peter Attia:
彼得·阿蒂亚博士：
And I'd love to see that trial done.
我很乐意看到试验完成。
So what's the sweet spot?
那么最甜蜜的地方是什么？
How do we reconcile that?
我们如何协调这一点？
So it's not something I consider standard, and basically, if a woman, her testosterone, first of all, is staggeringly low, and again, even though her testosterone's low compared to a male, we still have a range.
所以这不是我认为标准的东西，基本上，如果一个女人，她的睾丸激素首先是惊人的低，而且，即使她的睾丸激素与男性相比较低，我们仍然有一个范围。
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Dr. Peter Attia:
彼得·阿蒂亚博士：
So if it's really at the bottom of that range, she's really having difficulty putting on muscle mass and really complaining of low libido, I think in that situation, we'll go ahead and use topical testosterone, and replace her to a level that is still physiologically normal.
因此，如果确实处于该范围的底部，那么她确实很难增加肌肉质量并且确实抱怨性欲低下，我认为在这种情况下，我们将继续使用局部睾酮，并将她替换到生理上仍然正常的水平。
Andrew Huberman:
安德鲁·休伯曼：
Yeah, that's key because when people hear HRT, they think about supraphysiological seems to be the term like thrown out.
是的，这很关键，因为当人们听到 HRT 时，他们认为超生理学似乎已经被抛弃了。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah, I've never seen a single symptom in a single woman that I've put testosterone on in terms of acne, body hair, things like that.
是的，我从来没有在一个女性身上看到过任何在我注射睾酮后出现的症状，比如痤疮、体毛等等。
Those are real symptoms that you have to be aware of.
这些是您必须注意的真实症状。
But clitoral enlargement and things like that, that doesn't happen under physiologic normal conditions.
但阴蒂增大之类的事情在正常生理条件下不会发生。
Andrew Huberman:
安德鲁·休伯曼：
I'd love to talk a little bit about hormone replacement therapy in men.
我想谈谈男性激素替代疗法。
When one looks on social media and the internet, there seems to be a younger and younger cohort of guys, people in their teens and 20s, showing up to the table thinking that injecting testosterone cypionate or taking Anavar or whatever it is is going to be the right idea.
当人们浏览社交媒体和互联网时，似乎有越来越年轻的一群人，十几岁和二十多岁的人，出现在餐桌前，认为注射环戊丙酸睾酮或服用 Anavar 或其他任何药物都是正确的想法。
They mainly seem to be focused on cosmetic effects.
他们似乎主要关注美容效果。
I'm not a physician, so I can't say whether or not they were actually hypogonadal, et cetera, but it seems to me, again, correct me if I'm wrong, but it seems to me that similar to the Attia's rule as it relates to longevity, that we could come up with a broad contour rule in which if a male of any age is not trying to get decent sleep, exercise appropriately, appropriate nutrition, minding their social connections, et cetera, the idea of going straight to testosterone seems like a bad idea.
我不是医生，所以我不能说他们是否真的性腺功能减退等等，但在我看来，如果我错了，请再次纠正我，但在我看来，与长寿相关的阿蒂亚规则类似，我们可以提出一个广泛的轮廓规则，其中如果任何年龄的男性不试图获得良好的睡眠，适当的锻炼，适当的营养，关注他们的社会关系等等，那么直接去的想法睾酮似乎是个坏主意。
That said, just like with depression and antidepressants, there is a kind of a cliff after which low enough testosterone or low enough serotonin prevents people from sleeping, exercise, social connection, et cetera.
也就是说，就像抑郁症和抗抑郁药一样，存在一种悬崖，之后足够低的睾丸激素或足够低的血清素会阻碍人们的睡眠、锻炼、社交联系等。
So I do want to acknowledge that.
所以我确实想承认这一点。
But with that in mind, how do you think about, and perhaps occasionally prescribe, and direct your patients in terms of hormone replacement therapy in men?
但考虑到这一点，您如何考虑（也许偶尔会开出处方）并指导您的患者进行男性激素替代疗法？
Person in their 30s, person in their 40s, who's doing almost all the other things correctly.
30多岁的人，40多岁的人，几乎所有其他事情都做得正确。
What sorts of levels do you think are meaningful?
您认为什么样的级别才有意义？
Because the range is tremendous in terms of blood tests.
因为血液检查的范围是巨大的。
300 nanograms per deciliter, I think, on the low end now in the US, all the way up to 900 or 1,200.
我认为现在美国的浓度是每分升 300 纳克，一直到 900 或 1,200 纳克。
That's an enormous range.
这是一个巨大的范围。
What are some of the other hormones you like to look at?
您还想了解哪些其他激素？
Estrogen, DHT, and so on.
雌激素、DHT等。
Dr. Peter Attia:
彼得·阿蒂亚博士：
So a lot to unpack there.
那里有很多东西需要解压。
So let's start with the ranges, right?
那么让我们从范围开始吧？
So the ranges you gave are for total testosterone, of course, and we don't spend a lot of time looking at that.
当然，您给出的范围是总睾酮水平，我们不会花很多时间研究这个。
I used to spend more time looking at total and free when I used more tricks to modulate it.
当我用更多的技巧来调制它时，我会花更多的时间看total和free。
So I'm actually far more simple in my manipulation of testosterone today than I was six or seven years ago.
所以，我现在对睾酮激素的控制实际上比六七年前要简单得多。
Six or seven years ago, we would use a microdose of Anavar to lower SHBG in a person who had normal testosterone but low free testosterone.
六七年前，我们会使用微剂量的 Anavar 来降低睾酮水平正常但游离睾酮水平较低的人的性激素结合球蛋白 (SHBG)。
Andrew Huberman:
安德鲁·休伯曼：
What was a low dose of Anavar in that context?
在这种情况下，Anavar 的低剂量是多少？
Dr. Peter Attia:
彼得·阿蒂亚博士：
10 milligrams subling two to three times a week.
10 毫克，每周细化 2 至 3 次。
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Anavar basically being DHT.
Anavar 基本上是 DHT。
Oxandrolone being the active ingredient.
氧雄龙是活性成分。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Oxandrolone, yeah.
氧雄龙，是的。
Exactly.
确切地。
Andrew Huberman:
安德鲁·休伯曼：
And again, we're not recommending this.
再说一次，我们不推荐这样做。
This actually, if you're playing a competitive sport, can get you banned from that sport.
实际上，如果您正在参加一项竞技运动，这可能会导致您被禁止参加该运动。
Dr. Peter Attia:
彼得·阿蒂亚博士：
No, yeah.
不，是的。
This is-
这是——
Andrew Huberman:
安德鲁·休伯曼：
It can also get you banned from having children if you do it incorrectly.
如果您做得不正确，它还可能导致您禁止生育孩子。
So-
所以——
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah.
是的。
So a microdose of this has to be small enough that it doesn't impair your body's ability to make testosterone.
因此，微剂量必须足够小，以免损害身体产生睾酮的能力。
But Anavar has such a high affinity for SHBG that it basically distracts your SHBG from binding your testosterone.
但 Anavar 对性激素结合球蛋白 (SHBG) 的亲和力如此之高，以至于它基本上会分散您的性激素结合球蛋白 (SHBG) 与睾酮结合的注意力。
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Freeing up testosterone.
释放睾酮。
Dr. Peter Attia:
彼得·阿蒂亚博士：
That's exactly right.
完全正确。
So, the goal was how do I just give you more free testosterone?
所以，我的目标是如何给你更多的游离睾酮？
So if a patient shows up and they've got a total testosterone of 900 nanograms per deciliter, which would place them at, depending on the scale you look at, the scale we look at, that would place you at about the 70th percentile, but your free testosterone is eight nanograms per deciliter.
因此，如果患者就诊，他们的总睾酮水平为每分升 900 纳克，这将使他们处于大约第 70 个百分位的位置，具体取决于您所观察的范围，我们所观察的范围，这将使您处于大约第 70 个百分位数，但您的游离睾酮水平为每分升 8 纳克。
So that's pretty bad.
所以这很糟糕。
That means you're less than 1% free.
这意味着您的自由度不到 1%。
A guy should be about 2% free T.
一个人应该有大约 2% 的自由 T。
So that dude should be closer to 16 to 18 nanograms per deciliter.
所以那个家伙应该接近每分升 16 到 18 纳克。
So in that situation that I just gave you, his SHBG is really high.
所以在我刚才给你的那种情况下，他的性激素结合球蛋白（SHBG）非常高。
His SHBG is probably in the 80 to 90 range.
他的性激素结合球蛋白 (SHBG) 可能在 80 到 90 范围内。
Andrew Huberman:
安德鲁·休伯曼：
That's very high.
那是非常高的。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah.
是的。
Andrew Huberman:
安德鲁·休伯曼：
Because I think the upper range is somewhere around 55, 56.
因为我认为上限在 55、56 左右。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Exactly.
正是如此。
Andrew Huberman:
安德鲁·休伯曼：
Yeah.
是的。
Dr. Peter Attia:
彼得·阿蒂亚博士：
So we would first back stall for what's driving his SHBG.
所以我们首先要了解是什么驱动了他的 SHBG。
So there's basically three hormones.
所以基本上有三种激素。
So genetics plays a huge role in this.
所以遗传学在这方面发挥着巨大的作用。
There's no question that just out of the box, people have a different set point for SHBG.
毫无疑问，人们对性激素结合球蛋白 (SHBG) 的设定点不同。
Mine is incredibly low.
我的低得令人难以置信。
My SHBG is in the 30s, 20s to 30s.
我的性激素结合球蛋白（SHBG）在30多岁、20多岁到30多岁。
But from a hormone perspective, there's basically three hormones that run it.
但从激素的角度来看，基本上有三种激素在起作用。
So estradiol being probably the most important, insulin, and thyroxine.
因此，雌二醇可能是最重要的，其次是胰岛素和甲状腺素。
Andrew Huberman:
安德鲁·休伯曼：
Okay.
好的。
Dr. Peter Attia:
彼得·阿蒂亚博士：
So we're going to look at all of those and decide if any of those are playing a role.
因此，我们将研究所有这些，并确定其中是否有任何一个发挥了作用。
So insulin suppresses it.
所以胰岛素会抑制它。
So this is actually the great irony of helping a person get metabolically healthy, is in the short run you can actually lower their free testosterone, all things equal.
因此，这实际上是帮助一个人获得代谢健康的巨大讽刺，从短期来看，在所有条件相同的情况下，你实际上可以降低他们的游离睾酮。
Because as insulin comes down, SHBG goes up, and if testosterone hasn't gone up with it, you're lowering free testosterone.
因为随着胰岛素的下降，性激素结合球蛋白 (SHBG) 会上升，如果睾酮没有随之上升，游离睾酮就会降低。
Andrew Huberman:
安德鲁·休伯曼：
So somebody who goes on a very low carbohydrate diet in an attempt to drop some water and drop some weight is going to increase their SHBG-
因此，如果有人为了减少水分和体重而采取极低碳水化合物饮食，那么他们的性激素结合球蛋白（SHBG）就会增加——
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah.
是的。
If their insulin goes down enough
如果他们的胰岛素下降足够
Andrew Huberman:
安德鲁·休伯曼：
...
...
bind up testosterone, less free testosterone.
结合睾酮，减少游离睾酮。
I can tell the carnivore diet people are going to be coming after me with bone marrow in hand.
我知道肉食饮食的人们将会拿着骨髓来追随我。
But then again, after this discussion extends a little further, I'm sure the vegans will be coming after me with celery stalks.
但话又说回来，在这个讨论进一步延伸之后，我确信素食主义者会用芹菜茎来追随我。
So it's a...
所以这是一个...
Dr. Peter Attia:
彼得·阿蒂亚博士：
So then the same as with estradiol.
那么与雌二醇相同。
So except in the opposite direction.
所以除了相反的方向。
So higher estradiol is higher SHBG.
因此，雌二醇越高，性激素结合球蛋白 (SHBG) 也越高。
So again, occasionally you'll see a guy with normal testosterone, but he's a very high aromatase activity person.
再说一遍，偶尔你会看到一个睾丸激素正常的人，但他是一个芳香酶活性非常高的人。
So he has a lot of the enzyme that converts testosterone into estradiol.
所以他有很多将睾酮转化为雌二醇的酶。
You can lower estradiol a bit with an aromatase inhibitor, and that can bring down SHBG.
您可以使用芳香酶抑制剂稍微降低雌二醇，从而降低性激素结合球蛋白 (SHBG)。
Now again, these things individually are rarely enough to move the needle.
现在再说一遍，这些事情单独来看很少足以起到推动作用。
The last is thyroxine.
最后一个是甲状腺素。
So if you have a person whose thyroid is out of whack, you have to fix that before you...
所以，如果你身边有人甲状腺功能不正常，你必须先解决这个问题……
If their T4 is out of whack, you're going to interfere with SHBG.
如果他们的 T4 出了问题，你就会干扰性激素结合球蛋白 (SHBG)。
There are also some supplements, which I think you've probably talked about these on the podcast.
还有一些补充内容，我想您可能已经在播客上讨论过这些内容。
I feel like I've heard you talk about these on the podcast.
我觉得我在播客上听到过你谈论这些。
Andrew Huberman:
安德鲁·休伯曼：
Yeah, there are a few that will adjust.
是的，有一些会调整。
There's this idea, now there's a much better review that just came out.
有这个想法，现在刚刚出现了更好的评论。
I'll send it to you.
我会把它发给你。
I'd love your thoughts on it, and I've been perusing it line by line.
我很想听听你对此的想法，我一直在逐行阅读它。
But I'd love input from experts like you on the use of tongkat ali for reducing SHBG.
但我希望像您这样的专家就使用东革阿里来减少性激素结合球蛋白 (SHBG) 提供意见。
In my experience, it does free up some testosterone, by which mechanism it isn't exactly clear, and the effects aren't that dramatic.
根据我的经验，它确实会释放一些睾酮，但具体机制尚不清楚，而且效果也没有那么显着。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah.
是的。
Andrew Huberman:
安德鲁·休伯曼：
Right?
对吗？
There are probably multiple effects.
可能有多种影响。
For all we know it increases libido, and it does generally by way of increasing estrogen slightly, which can also increase libido in some individuals.
据我们所知，它会增加性欲，通常是通过稍微增加雌激素来增加性欲，这也可以增加某些人的性欲。
So we don't know the exact mode of action.
所以我们不知道确切的作用方式。
So we've talked about a few.
我们已经讨论了一些。
The one that a few years back people were claiming could reduce SHBG was stinging nettles.
几年前，人们声称可以减少性激素结合球蛋白（SHBG）的就是荨麻。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Stinging nettles.
荨麻。
Yeah.
是的。
Andrew Huberman:
安德鲁·休伯曼：
Stinging nettle, well, urinating seems to be coming up multiple times on this podcast for whatever reason.
荨麻，嗯，不管出于什么原因，小便似乎在这个播客上多次出现。
Stinging nettle extract, the most pronounced effect of that was you could basically urinate over a car when taking SHBG.
荨麻提取物，最明显的效果是，服用性激素结合球蛋白（SHBG）后，你基本上可以在汽车上小便。
What the underlying mechanism of that was, I do not know.
我不知道其根本机制是什么。
I took it for a short while.
我拿了一会儿。
It didn't drop my SHBG very much, but it did drop my DHT sufficiently so that I stopped taking it.
它并没有大幅降低我的性激素结合球蛋白（SHBG），但它确实充分降低了我的双氢睾酮（DHT），因此我停止服用它。
Dr. Peter Attia:
彼得·阿蒂亚博士：
You felt that, yeah.
你感觉到了，是的。
Andrew Huberman:
安德鲁·休伯曼：
I do not like anything that impedes DHT.
我不喜欢任何阻碍 DHT 的东西。
I don't care if my hairline retreats.
我不在乎我的发际线是否后退。
I don't care about any of that.
我不在乎这些。
DHT to me is something to be coveted and held onto because you feel so much better when your DHT is in the appropriate range.
DHT 对我来说是值得追求和坚持的东西，因为当你的 DHT 处于适当的范围时，你会感觉好多了。
And would love your thoughts on that-
并会喜欢你对此的想法-
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah
是啊
Andrew Huberman:
安德鲁·休伯曼：
...
...
at some point, too.
在某些时候也是如此。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Again, it really depends on the guy, and it depends on what risk you're trying to manage, right?
再说一遍，这真的取决于这个人，也取决于你想要管理的风险，对吧？
So prostate size starts to become one of the issues with DHT.
因此，前列腺大小开始成为 DHT 的问题之一。
Andrew Huberman:
安德鲁·休伯曼：
Luckily, my prostate-specific antigen is low.
幸运的是，我的前列腺特异性抗原很低。
And DHT, the things that I know can reduce it are things like finasteride, Propecia, things like-
还有 DHT，我知道可以减少它的药物有非那雄胺、保法止等——
Dr. Peter Attia:
彼得·阿蒂亚博士：
Dutasteride.
度他雄胺。
Yeah
是啊
Andrew Huberman:
安德鲁·休伯曼：
...
...
right.
对。
Things that people take to try and avoid hair loss can dramatically reduce DHT and lead to all sorts of terrible sexual side effects, mood-based side effects, et cetera.
人们为避免脱发而服用的药物会显着降低 DHT 水平，并导致各种可怕的性副作用、情绪副作用等。
But, yeah, so I'm not aware of anything that can be taken in supplement form that can really profoundly drop SHBG.
但是，是的，所以我不知道有什么补充剂可以真正显着降低性激素结合球蛋白（SHBG）。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah.
是的。
We don't spend much attention on it anymore.
我们不再花太多注意力在它上面。
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Basically, I used to have a much more complicated differential diagnosis eight years ago.
基本上，八年前我曾经有过更复杂的鉴别诊断。
I would drive patients nuts with the whiteboard diagrams I would draw for them, when in the end, I think they were just like, "Dude, just what do I need to take?" Today we take a much more simple approach.
我会用我为他们绘制的白板图表让病人发疯，最后，我认为他们就像，“伙计，我需要吃什么？”今天我们采用一种更简单的方法。
So the first question is should you or should you have your free testosterone being higher?
所以第一个问题是你的游离睾酮水平应该更高吗？
That's the metric I care about.
这就是我关心的指标。
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Is free testosterone is the first most important, the second most important is estradiol.
第一重要的是游离睾酮，第二重要的是雌二醇。
Andrew Huberman:
安德鲁·休伯曼：
And sorry to interrupt, but you said if you look at your total testosterone, you want the free T to be about 2% of your total.
很抱歉打扰一下，您说过如果您查看您的总睾酮水平，您希望游离 T 占总睾酮水平的 2% 左右。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Well, it should be, right?
嗯，应该是这样，对吧？
Andrew Huberman:
安德鲁·休伯曼：
Now somewhere-
现在某处——
Dr. Peter Attia:
彼得·阿蒂亚博士：
I might not change that anymore.
我可能不会再改变这一点了。
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Dr. Peter Attia:
彼得·阿蒂亚博士：
So in other words, if a guy's at 1%, then I know I have to really boost his total testosterone.
换句话说，如果一个人的睾酮水平为 1%，那么我知道我必须真正提高他的总睾酮水平。
If he's only going to get 1 to 1.5% of it converted to free-
如果他只想将其中的 1% 到 1.5% 转化为免费——
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm
嗯嗯
Dr. Peter Attia:
彼得·阿蒂亚博士：
...
...
I need to boost him.
我需要激励他。
Andrew Huberman:
安德鲁·休伯曼：
And do you-
而你呢——
Dr. Peter Attia:
彼得·阿蒂亚博士：
And that's why I don't care if he's outside the range.
这就是为什么我不在乎他是否在范围之外。
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Dr. Peter Attia:
彼得·阿蒂亚博士：
I'll have a guy whose free T...
我会有一个人免费T...
I might have to get a guy's total T up to 1,500 to get his free T to 18.
我可能需要让一个人的总 T 达到 1,500 才能把他的自由 T 达到 18。
Andrew Huberman:
安德鲁·休伯曼：
I see.
我明白了。
So free T is the target.
所以自由T就是目标。
I like this approach.
我喜欢这种方法。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Free T is what we treat.
我们对待的是免费T。
Andrew Huberman:
安德鲁·休伯曼：
And do you still use Anavarx-
你还在使用 Anavarx-
Dr. Peter Attia:
彼得·阿蒂亚博士：
I don't use Anavar
我不使用 Anavar
Andrew Huberman:
安德鲁·休伯曼：
...
...
Anxial, sorry, to try and lower SHBG?
焦虑，抱歉，想尝试降低 SHBG？
Dr. Peter Attia:
彼得·阿蒂亚博士：
I don't, no.
我不，不。
Andrew Huberman:
安德鲁·休伯曼：
Because it's too potent?
因为太厉害了？
Dr. Peter Attia:
彼得·阿蒂亚博士：
No, because it's just too complicated for patients.
不，因为这对患者来说太复杂了。
Andrew Huberman:
安德鲁·休伯曼：
Yes.
是的。
Dr. Peter Attia:
彼得·阿蒂亚博士：
It's a drug that can't be taken orally, so you have to take it under the tongue, right?
这是一种不能口服的药物，所以必须舌下含服，对吗？
Andrew Huberman:
安德鲁·休伯曼：
Like a troche or something.
像锭剂什么的。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Right.
对。
Andrew Huberman:
安德鲁·休伯曼：
Yeah.
是的。
Dr. Peter Attia:
彼得·阿蒂亚博士：
I had one patient once who, even though we told him about 87 times that, he was swallowing the Anavars, and his liver function...
我曾经有一个病人，尽管我们告诉他大约 87 次，他还是吞下了 Anavars，而且他的肝功能......
And we're talking 10 milligrams three times a week as a ...
我们所说的每周 3 次 10 毫克作为...
tiny dose, and three months of him or whatever, two months of him swallowing that every time tripled his liver function test.
小剂量，三个月或者其他什么，两个月他吞咽，每次他的肝功能测试都会增加三倍。
So it's like, I was like, "It's just not worth the hassle of doing this for perfection.
所以我就想，“为了完美而费尽心思这样做是不值得的。
In reality, we can fix this another way." So the first order question is, do we believe clinically you will benefit from normalizing your free testosterone or taking it to a level that's, call it 80th to 90th percentile?
事实上，我们可以用另一种方式解决这个问题。”因此，首要问题是，我们是否相信在临床上您会受益于使游离睾酮正常化或将其提高到 80 至 90 个百分位数的水平？
So upper normal limit of physiologic ranges.
所以生理范围的正常上限。
That's the first order question, and that's going to come down to symptoms, and that's going to come down to some biomarkers.
这是首要问题，这将归结为症状，这将归结为一些生物标志物。
I think there's two years ago...
我记得是两年前...
Was it two years ago or maybe a year ago?
是两年前还是一年前？
Very good study came out that looked at pre-diabetic men, you've probably talked about this study, and looking at insulin resistance and glucose disposal with and without testosterone, and the evidence was overwhelmingly clear.
非常好的研究针对糖尿病前期男性，您可能已经谈论过这项研究，并研究有或没有睾酮的胰岛素抵抗和葡萄糖处理，证据非常清楚。
Testosterone improves glycemic control.
睾酮可改善血糖控制。
Testosterone improves insulin signaling.
睾酮可改善胰岛素信号传导。
This shouldn't be surprising, by the way, given the role muscles play as a glucose reservoir and a glucose sink.
顺便说一句，考虑到肌肉作为葡萄糖储存库和葡萄糖汇的作用，这并不奇怪。
So now I include that as one of the things that we will consider as a factor for using testosterone.
所以现在我将其作为我们考虑使用睾酮的因素之一。
Now, again, it's not the only one, so you can accomplish that with exercise, you can accomplish that with these other things, but then you get into a little bit of the vicious cycle of will having a normalized testosterone facilitate you doing those things better?
现在，再说一遍，它不是唯一的，所以你可以通过锻炼来实现这一目标，你可以通过其他事情来实现这一目标，但随后你会陷入恶性循环，正常化的睾酮会帮助你更好地完成这些事情吗？
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Dr. Peter Attia:
彼得·阿蒂亚博士：
So let's just assume we come to the decision that this person is a good candidate for testosterone replacement therapy.
因此，我们假设我们决定此人是睾酮替代疗法的良好候选人。
The next question is what's the method we're going to do it?
下一个问题是我们要采取什么方法？
Are we going to do it indirectly or directly?
我们要间接还是直接这样做？
Now, we used to use a lot of Clomid in our practice.
现在，我们在实践中使用了大量的克罗米芬。
And have you talked about Clomid on the podcast?
您在播客上谈论过克罗米芬吗？
Andrew Huberman:
安德鲁·休伯曼：
Haven't talked too much about it.
还没有谈论太多。
No, we've talked a little bit about the fact that some people taking things like anastrozole to reduce aromatase activity can potentially run into trouble because they think, oh, well, more testosterone good, lower estrogen bad, and then they end up with issues like joint pain, memory issues, and severe drops in libido.
不，我们已经讨论过这样一个事实，即有些人服用阿那曲唑等药物来减少芳香酶活性可能会遇到麻烦，因为他们认为，哦，好吧，更多的睾酮好，降低的雌激素不好，然后他们最终会出现关节疼痛、记忆问题和性欲严重下降等问题。
And I think a lot of the reason why-
我认为很多原因是——
Dr. Peter Attia:
彼得·阿蒂亚博士：
And even fat accumulation.
甚至脂肪堆积。
So if estrogen-
所以如果雌激素-
Andrew Huberman:
安德鲁·休伯曼：
Interesting
有趣
Dr. Peter Attia:
彼得·阿蒂亚博士：
...
...
is too low, you can develop adiposity in a way that you wouldn't otherwise.
太低，您可能会以一种原本不会的方式发展肥胖。
There's a great New England Journal paper, it's probably 10 years old now, that looked at five, I believe it was five different doses of testosterone cypionate.
《新英格兰杂志》上有一篇很棒的论文，可能已经有 10 年历史了，看起来有五种，我相信那是五种不同剂量的环丙酸睾酮。
So these men were chemically castrated and divided into 10 groups.
于是这些人被化学阉割并分成10组。
It's pretty remarkable study.
这是一项非常了不起的研究。
Andrew Huberman:
安德鲁·休伯曼：
Somebody signed up for this study.
有人报名参加了这项研究。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah.
是的。
So you were with and without anastrozole and five doses of testosterone.
所以你有或没有阿那曲唑和五剂睾酮。
Andrew Huberman:
安德鲁·休伯曼：
Okay.
好的。
Dr. Peter Attia:
彼得·阿蒂亚博士：
So now you basically had five testosterone levels plus or minus high or low estradiol.
所以现在你基本上有五个睾酮水平加上或减去高或低的雌二醇。
And the results were really clear that the higher your testosterone and the more your estradiol was in that 30 to 50 range, the better you were.
结果非常清楚，您的睾丸激素越高，雌二醇越多，在 30 到 50 的范围内，您就越好。
So if estrogen was too low, even in the presence of high testosterone, the outcomes were less significant.
因此，如果雌激素太低，即使存在高睾酮，结果也不那么重要。
Andrew Huberman:
安德鲁·休伯曼：
And this is 30 to 50 nanograms per deciliter, not 30 to 50% of one's testosterone.
这是每分升 30 至 50 纳克，而不是睾酮的 30% 至 50%。
Okay, great.
好的，太好了。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Okay, so-
好吧，那么——
Andrew Huberman:
安德鲁·休伯曼：
So we haven't talked, but Clomid is...
所以我们还没有谈过，但克罗米芬是……
We have not talked a lot about Clomid.
我们还没有过多谈论克罗米芬。
I'd love to get your thoughts on Clomid.
我很想了解您对克罗米芬的看法。
Dr. Peter Attia:
彼得·阿蒂亚博士：
So clomiphene is a fertility drug.
所以克罗米芬是一种生育药物。
It's a synthetic hormone.
它是一种合成激素。
It's actually two drugs, enclomiphene and I forget the other one.
它实际上是两种药物，恩克罗米芬，我忘记了另一种。
And it tells the pituitary to secrete FSH and LH.
它告诉垂体分泌 FSH 和 LH。
And so the advantage of Clomid is it's oral, and it's meant to be taken orally.
所以克罗米芬的优势在于它是口服的，而且它应该口服。
So a typical starting dose would be like 50 milligrams three times a week.
因此，典型的起始剂量约为每周 3 次，每次 50 毫克。
And if you do that, you'll notice in most men, especially young men, FSH, LH goes up.
如果你这样做，你会注意到大多数男性，尤其是年轻男性，FSH、LH 都会上升。
In any man, the FSH and LH go up, but if a man still has testicular reserve, he'll make lots of testosterone in response to that.
任何男性的 FSH 和 LH 都会上升，但如果男性仍有睾丸储备，他就会产生大量睾丸激素作为回应。
Because that's the first order question we're trying to answer is, is your failure to make testosterone central or peripheral?
因为我们要回答的首要问题是，你未能使睾酮成为中枢性激素还是外周性激素？
Andrew Huberman:
安德鲁·休伯曼：
Yeah, and I think, just want to point out, again, correct me if I'm wrong, but my understanding is that a lot of the drugs that we're talking about, the synthetic compounds, testosterone, estrogen, things related to growth hormone, et cetera, were discovered and designed in order to treat and...
是的，我想，只是想再次指出，如果我错了，请纠正我，但我的理解是，我们正在谈论的很多药物，合成化合物，睾酮，雌激素，与生长激素相关的东西等等，都是为了治疗和设计而发现和设计的。
Excuse me.
对不起。
In order to isolate and treat exactly these kinds of syndromes, whether or not it was the hypothalamus, the pituitary, or the target tissue, the ovaries or the testes.
为了准确地分离和治疗这些类型的综合征，无论是下丘脑、垂体，还是靶组织、卵巢或睾丸。
Correct?
正确的？
Dr. Peter Attia:
彼得·阿蒂亚博士：
Correct, yeah.
正确，是的。
I think the easiest way to go about doing this is just give the hormone that's missing without attention to where the deficiency is.
我认为最简单的方法就是给予缺失的激素，而不注意缺陷在哪里。
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Why this becomes relevant is if you have a 35-year-old guy whose testosterone is low, but you can demonstrate that it's low because he's not getting enough of a signal from the pituitary, why would you bother giving him more testosterone when he has the capacity?
为什么这变得相关是因为，如果你有一个 35 岁的男性，他的睾酮水平较低，但你可以证明睾酮水平较低是因为他没有从垂体获得足够的信号，那么当他有能力时，为什么要费心给他更多的睾酮水平呢？
He has the Leydig cells and the Sertoli cells to make testosterone.
他有间质细胞和支持细胞来产生睾酮。
He just needs the signal.
他只需要信号。
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Sometimes, though not always, just a course of Clomid can wake him up and he's back to making normal testosterone.
有时，尽管并非总是如此，只需服用一个疗程的克罗米芬就能叫醒他，让他恢复正常的睾酮水平。
Andrew Huberman:
安德鲁·休伯曼：
So he'll do this three times a week, 50 milligrams three times a week for a short course, and then-
所以他会每周做三次，短期疗程每周三次，每次 50 毫克，然后——
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah, we would do it for eight to 12 weeks, and then we reevaluate.
是的，我们会做八到十二周，然后重新评估。
Andrew Huberman:
安德鲁·休伯曼：
And estrogen and testosterone will increase in parallel.
而且雌激素和睾酮也会平行增加。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yes.
是的。
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Dr. Peter Attia:
彼得·阿蒂亚博士：
And again, it depends.
再说一遍，这取决于情况。
Aromatase activity is dependent on how much body fat you have and genetics.
芳香酶活性取决于您体内的脂肪含量和遗传因素。
And if estradiol gets too high, we think if it gets over about 55, 60, we will give microdoses of anastrozole.
如果雌二醇太高，我们认为如果超过 55、60，我们将给予微剂量的阿那曲唑。
But it has to be real microdoses.
但它必须是真正的微剂量。
You cannot pound people with anastrozole.
你不能用阿那曲唑打人。
To give you perspective, the sort of on-label use, like if you just go to a pharmacy and order anastrozole, you're going to get one milligram tablets.
为了让您了解这种标签上的用途，就像您去药房订购阿那曲唑一样，您将获得一毫克片剂。
We can't give anybody a milligram.
我们不能给任何人一毫克。
Andrew Huberman:
安德鲁·休伯曼：
And they'll feel like garbage.
他们会觉得自己像垃圾。
Dr. Peter Attia:
彼得·阿蒂亚博士：
We have to have it compounded at .1 milligrams, and we might give a patient .1 two to three times a week.
我们必须将其配制为 0.1 毫克，并且我们可能每周给患者服用 0.1 次两到三次。
That would be a big dose of anastrozole.
那将是大剂量的阿那曲唑。
Andrew Huberman:
安德鲁·休伯曼：
Yeah, I think that the typical TRT clinic out there is giving 200 milligrams per mil, one mil, 200 milligrams of testosterone once every two weeks, and then hitting people with multiple milligrams of anastrozole, and they're all over the place.
是的，我认为典型的 TRT 诊所每两周给予 200 毫克/百万、一百万、200 毫克睾酮，然后用多毫克阿那曲唑治疗患者，而且到处都是。
Dr. Peter Attia:
彼得·阿蒂亚博士：
I've never really understood.
我从来没有真正理解过。
I guess I shouldn't be surprised, but it kind of blows my mind that these TRT clinics are up all over the place, given how bad...
我想我不应该感到惊讶，但考虑到这些 TRT 诊所到处都是，这有点让我震惊，考虑到有多糟糕......
I see the results because I have patients that come from them, and I don't understand why they're so incompetent.
我看到这些结果是因为我的病人来自他们，我不明白为什么他们如此无能。
Andrew Huberman:
安德鲁·休伯曼：
I actually think it's worse than that.
我实际上认为情况比这更糟糕。
I think that they simply don't understand and don't care because it's a pill mill and it's a money mill.
我认为他们根本不理解也不关心，因为这是一个药丸厂，也是一个金钱厂。
I think that nowadays it seems almost everybody who's doing TRT is taking lower doses more frequently, every other day or twice a week, dividing the dose, and being very, very careful with these estrogen or aromatase blockers.
我认为现在似乎几乎所有进行 TRT 的人都更频繁地服用较低剂量，每隔一天或每周两次，分开剂量，并且对这些雌激素或芳香酶阻滞剂非常非常小心。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Most of our patients do not take aromatase inhibitors.
我们的大多数患者不服用芳香酶抑制剂。
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Dr. Peter Attia:
彼得·阿蒂亚博士：
It's not needed.
不需要。
It's really only the high aromatizers that need it.
实际上只有高芳香剂才需要它。
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Dr. Peter Attia:
彼得·阿蒂亚博士：
And so yeah, when we'll talk about testosterone, we'll talk about dosing there, because I agree, the more frequently you can take it, the better.
所以，是的，当我们谈论睾酮时，我们会谈论那里的剂量，因为我同意，你服用它的次数越多越好。
And frankly, you don't need to go more frequently than twice a week.
坦率地说，您每周去的次数不需要超过两次。
Andrew Huberman:
安德鲁·休伯曼：
Because it's so slow acting.
因为动作太慢了。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah.
是的。
The half-life of the drug is, I think it's about three and a half days is the plasma half-life or something like that.
该药物的半衰期是，我认为大约是三天半，血浆半衰期或类似的东西。
I could be off a little bit, but twice a week dosing is really nice.
我可能会稍微休息一下，但每周两次给药确实很好。
So if you go to a testosterone clinic that's giving you 200 every two weeks, 50 twice a week is the same total dose.
因此，如果您去的睾酮诊所每两周注射 200 粒睾酮，那么每周两次 50 粒睾酮的总剂量是相同的。
Which, by the way, is a physiologic dose.
顺便说一句，这是生理剂量。
That's not going to give somebody any of the side effects you would see.
这不会给某人带来任何你会看到的副作用。
You're not going to get acne with that.
这样你就不会长粉刺了。
You're not going to get gynecomastia.
你不会得男性乳房发育症。
You're not going to get anything.
你不会得到任何东西。
The only real side effect you get from that is you will get testicular atrophy.
唯一真正的副作用是睾丸萎缩。
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Dr. Peter Attia:
彼得·阿蒂亚博士：
That is enough to suppress.
这足以镇压。
Andrew Huberman:
安德鲁·休伯曼：
Yeah.
是的。
To maintain fertility, what do you typically do for...
为了保持生育能力，您通常会做什么...
To get them-
为了得到他们——
Dr. Peter Attia:
彼得·阿蒂亚博士：
So I'll finish the story on Clomid-
所以我会完成关于克罗米芬的故事-
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm
嗯嗯
Dr. Peter Attia:
彼得·阿蒂亚博士：
...
...
because we currently do not use Clomid, and that's due to a really interesting observation that we made that I don't think has been reported in the literature yet, which is that Clomid was increasing levels of a sterol that we also happen to measure called desmosterol.
因为我们目前不使用克罗米芬，这是因为我们做了一个非常有趣的观察，我认为文献中还没有报道过，那就是克罗米芬增加了一种甾醇的水平，我们也碰巧测量了一种叫做去莫甾醇的甾醇。
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
I'm not familiar with that.
我对此不太熟悉。
Dr. Peter Attia:
彼得·阿蒂亚博士：
So in the way that cholesterol is made, there's two pathways that make cholesterol.
因此，在胆固醇的生成方式中，有两种生成胆固醇的途径。
So it starts with two carbon subunits, like acetyl-CoA, and it kind of marches down a pathway, bifurcates, and cholesterol is the finished product of both.
所以它从两个碳亚基开始，比如乙酰辅酶A，它沿着一条路径前进，分叉，胆固醇是两者的最终产物。
But in one of those pathways, the molecule right before cholesterol is called desmosterol.
但在其中一种途径中，胆固醇之前的分子称为去莫甾醇。
In the other pathway, it's called lathosterol.
在另一种途径中，它被称为黄甾醇。
So we constantly measure lathosterol and desmosterol because we want to know how much cholesterol is being synthesized in the body, not just what your cholesterol is.
因此，我们不断测量拉索甾醇和去氨甾醇，因为我们想知道体内合成了多少胆固醇，而不仅仅是您的胆固醇含量。
We want to know how much cholesterol you reabsorb, and those markers are really important to us when we're looking at cardiovascular disease risk.
我们想知道您重吸收了多少胆固醇，当我们研究心血管疾病风险时，这些标记物对我们来说非常重要。
So when we gave patients Clomid, we were noticing a almost universal rise in their desmosterol levels.
因此，当我们给患者服用克罗米芬时，我们注意到他们的去氨甾醇水平几乎普遍上升。
Now, the most obvious explanation for that, though the last time I looked, I couldn't find clear explanation for this in any of the clinical trials that led to the approval of Clomid.
现在，对此最明显的解释是，尽管我上次查看时，在导致克罗米芬获得批准的任何临床试验中都找不到对此的明确解释。
So I don't know if it was described.
所以不知道有没有描述过。
In fact, maybe it wasn't known.
事实上，也许并不为人所知。
I suspect it is inhibiting the enzyme, which I think is called delta 24-desaturase, that turns desmosterol into cholesterol.
我怀疑它抑制了一种酶，我认为这种酶被称为 Delta 24-去饱和酶，可将去氨甾醇转化为胆固醇。
Makes sense if you inhibit that enzyme, you're going to see a rise in desmosterol.
如果你抑制这种酶，你就会看到去氨甾醇的增加，这是有道理的。
This wouldn't have been a concern to me if not for the fact that Tom Dayspring, who's one of the physicians we work with, who's one of the world's experts in lipids, pointed out a very obscure story, which was that the very first drug ever approved to treat cardiovascular disease, at least to treat hypercholesterolemia, was a drug that attacked the same enzyme.
如果不是汤姆·戴斯普林（Tom Dayspring）（我们合作的医生之一、世界脂质专家之一）指出了一个非常晦涩的故事，那就不是我担心的问题，那就是第一个被批准用于治疗心血管疾病（至少是治疗高胆固醇血症）的药物是一种攻击同一种酶的药物。
So this was in the early 1960s, I believe, maybe the mid-60s.
我相信那是 20 世纪 60 年代初，也许是 60 年代中期。
This drug was approved, and it lowered cholesterol.
这种药物获得批准，可以降低胆固醇。
And it was approved on the basis of lowering cholesterol.
并且是在降低胆固醇的基础上获得批准的。
Now, today, no drug for ASCVD is approved on the basis of it lowering cholesterol.
目前，还没有一种治疗 ASCVD 的药物能够降低胆固醇而获得批准。
That's not a high enough bar.
这还不够高。
You have to reduce events.
你必须减少事件。
You actually have to show that you're preventing heart attacks and death.
您实际上必须证明您正在预防心脏病发作和死亡。
But at the time, it was like, "Hey, it lowers cholesterol.
但当时，就像是，“嘿，它可以降低胆固醇。
It's got to be good." Well, in the late '60s, it was pulled from the market because events were going up.
一定会很好。”嗯，在 60 年代末，由于事件不断升级，它被从市场上撤下。
So cholesterol was coming down, events were going up.
所以胆固醇在下降，事件在增加。
How could that be?
怎么可能呢？
We don't know.
我们不知道。
What we are suspecting is that desmosterol, which is still a sterol, was potentially more damaging and created more oxidative stress in the endothelium in the subendothelial space than cholesterol.
我们怀疑的是，去莫甾醇仍然是一种甾醇，与胆固醇相比，它可能更具破坏性，并且在内皮下空间的内皮细胞中产生更多的氧化应激。
Andrew Huberman:
安德鲁·休伯曼：
I see.
我明白了。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Which would at least suggest to us, and again, we're taking a lot of leaps here, that maybe having high desmosterol, very high desmosterol, is not a good thing.
这至少向我们表明，我们在这里迈出了很大的一步，也许具有高去氨甾醇，非常高的去氨甾醇，并不是一件好事。
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Dr. Peter Attia:
彼得·阿蒂亚博士：
And so once we kind of pieced all that together a few years ago, we were like, "Yeah, we're just not going to prescribe Clomid anymore." And we then switched to HCG, which we used to use sometimes instead of Clomid, but it's more cumbersome to work with.
因此，几年前，一旦我们将所有这些整合在一起，我们就会说：“是的，我们不会再开克罗米芬了。”然后我们改用 HCG，我们有时会用它来代替克罗米芬，但使用起来比较麻烦。
It needs to be refrigerated.
它需要冷藏。
It's a much more fragile molecule.
它是一种更加脆弱的分子。
Andrew Huberman:
安德鲁·休伯曼：
Yeah.
是的。
I think we talked about this once.
我想我们曾经讨论过这个问题。
It's almost like if you accidentally knock over the little bottle, it's basically gone bad.
就好像如果你不小心打翻了小瓶子，它基本上就坏了。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah.
是的。
Andrew Huberman:
安德鲁·休伯曼：
Travel with it is very challenging.
带着它旅行是非常具有挑战性的。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Can't travel with it.
不能带着它去旅行。
Andrew Huberman:
安德鲁·休伯曼：
Yeah.
是的。
Dr. Peter Attia:
彼得·阿蒂亚博士：
It's a needle, it's an injection, subcu, so easy to administer.
它是一根针，它是一种注射剂，subcu，所以很容易管理。
It's not IM or anything like that, but it's just more of a hassle factor.
这不是即时通讯或类似的东西，但它只是一个更麻烦的因素。
But that said, it has the benefit that Clomid does, which is it preserves testicular function, it preserves testicular volume.
但话虽如此，它具有克罗米芬的好处，即保留睾丸功能，保留睾丸体积。
So, bodybuilders will often use this in their post-cycle therapy as a way to kind of recover function, and we would just use it now as ongoing therapy for a guy who still has testicular reserve.
因此，健美运动员经常在周期后治疗中使用它作为恢复功能的一种方式，而我们现在将它用作仍然有睾丸储备的人的持续治疗。
Andrew Huberman:
安德鲁·休伯曼：
So on its own, no testosterone, no aromatase inhibitor, nothing.
所以就其本身而言，没有睾酮，没有芳香酶抑制剂，什么都没有。
Just a way to crank out a bit more testosterone from the testes, maybe some additional estrogen also.
只是一种从睾丸中产生更多睾酮的方法，也许还有一些额外的雌激素。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah.
是的。
And HCG is a different model.
而HCG是不同的模型。
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Dr. Peter Attia:
彼得·阿蒂亚博士：
HCG is just an analog of luteinizing hormone.
HCG 只是黄体生成素的类似物。
So it's basically like giving them luteinizing hormone
所以这基本上就像给他们黄体生成素
Andrew Huberman:
安德鲁·休伯曼：
So it's going to crush endogenous luteinizing hormone levels, right?
所以它会降低内源性黄体生成激素水平，对吧？
Because of feedback.
因为有反馈。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Actually, yeah.
事实上，是的。
And you don't really see much of an impact on LH, but you do see endogenous testosterone production go down.
您实际上并没有看到对 LH 产生太大影响，但您确实看到内源性睾酮生成量下降。
Actually, no, I correct that.
事实上，不，我纠正一下。
Both FSH and LH will go down on a high enough dose.
如果剂量足够高，FSH 和 LH 都会下降。
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yep.
是的。
Andrew Huberman:
安德鲁·休伯曼：
Just as a mention, and here I'm not making recommendations, but one supplement I've talked a lot about publicly is Fadogia agrestis, which is this weird Nigerian shrub that-
顺便提一下，我在这里并不是提出建议，但我公开谈论过很多次的一种补充剂是 Fadogia agrestis，这是一种奇怪的尼日利亚灌木，它-
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah
是啊
Andrew Huberman:
安德鲁·休伯曼：
...
...
that does-
那确实-
Dr. Peter Attia:
彼得·阿蒂亚博士：
You talked about this on Tim's podcast, I think
我想你在蒂姆的播客上谈到了这个
Andrew Huberman:
安德鲁·休伯曼：
...
...
on Tim's podcast and Joe's podcast and there was a bit of a backlash because it does turn out that at high doses in rodent studies, it can cause some toxicity to the testes.
在蒂姆的播客和乔的播客上，有一些强烈反对，因为在啮齿动物研究中，高剂量确实会对睾丸造成一些毒性。
But at lower doses, it does seem to increase luteinizing hormone.
但在较低剂量下，它似乎确实会增加黄体生成激素。
And after talking about this, a number of people went out there, did pre and post-blood work, and the consistent effect seems to be an increase in luteinizing hormone.
讨论完这个之后，很多人都出去做了抽血前和抽血后的检查，一致的效果似乎是黄体生成素的增加。
There's a noticeable effect on testicular size and volume, so a lot of people take this and be like, "Oh, their balls are getting bigger," and so they get all excited that something good is happening.
这对睾丸的大小和体积有显着的影响，所以很多人都会觉得，“哦，他们的睾丸变大了”，所以他们对发生的好事感到兴奋。
But we don't know the long-term safety and efficacy of something like Fadogia, whether or not it needs to be cycled, things like-
但我们不知道像 Fadogia 这样的东西的长期安全性和有效性，是否需要循环，比如——
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah, this is why I'm also very leery of the supplements in this space, because at least when we're using hCG or testosterone, we have so many years of data.
是的，这就是为什么我也对这个领域的补充剂非常怀疑，因为至少当我们使用 hCG 或睾酮时，我们有这么多年的数据。
You have to remember how many women are using this stuff for reproductive medicine.
你必须记住有多少女性正在使用这种东西进行生殖医学。
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Dr. Peter Attia:
彼得·阿蒂亚博士：
So, I think the FDA has a lot of faults.
所以，我认为FDA有很多错误。
I think I have an entire podcast devoted to the corruption of the FDA and all of the mistakes that have been made with respect to their oversight in especially generic drugs.
我想我有一个完整的播客专门讨论 FDA 的腐败以及他们在监督特别是仿制药方面所犯的所有错误。
But it's way more regulated than the Wild Wild West of nutty supplement land.
但它比坚果补充剂领域的狂野西部受到更多监管。
Andrew Huberman:
安德鲁·休伯曼：
Absolutely.
绝对的。
I think that the reason for talking about things like tongkat and Fadogia was to provide some intermediate discussion between doing all the correct things, but no supplementation or hormone therapy, and then going straight to hormone therapy.
我认为谈论东革和法多吉亚之类的事情的原因是为了在做所有正确的事情但不进行补充或激素治疗，然后直接进行激素治疗之间提供一些中间讨论。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah, it-
是的，它-
Andrew Huberman:
安德鲁·休伯曼：
It's sort of like the leap from, "I can't focus very well," to Ritalin, right?
这有点像从“我不能很好地集中注意力”到利他林的跨越，对吧？
Without a real diagnosis of ADHD to, oh, well, maybe some things like Alpha-GPC, low doses of nicotine, right?
如果没有真正诊断出多动症，哦，好吧，也许一些像 Alpha-GPC、低剂量尼古丁这样的东西，对吧？
But I agree entirely.
但我完全同意。
The sourcing is important.
货源很重要。
The dosages are worked out empirically on an individual basis, and there aren't randomized control trials.
剂量是根据个人经验确定的，没有随机对照试验。
There just aren't.
只是没有。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah, and have kind of like a seven...
是的，有点像七...
This is another Peter principle, right?
这是另一个彼得原理，对吗？
So I've got a lot of patients that come into the practice and, during our intake, we go through, "What drugs and supplements are you taking right now?" And a lot of people come in, "I'm not taking anything, Peter.
因此，我有很多患者开始接受治疗，在我们服药期间，我们会询问“您现在正在服用什么药物和补充剂？”很多人进来说：“我不会拿任何东西，彼得。
You're in charge now.
现在你负责了。
Tell me what you think." And then you get a lot of people that come in and they're like, "We're going to need an extra few pages for this part of the documentation."
告诉我你的想法。”然后你会看到很多人进来，他们会说，“我们需要额外的几页来完成这部分文档。”
Andrew Huberman:
安德鲁·休伯曼：
Right.
对。
The people who travel with a suitcase that you can hear as they walk through the airport-
那些带着手提箱旅行的人，当他们走过机场时，你可以听到他们的声音——
Dr. Peter Attia:
彼得·阿蒂亚博士：
Right
右
Andrew Huberman:
安德鲁·休伯曼：
...
...
from all the pills rattling.
从所有的药丸嘎嘎作响。
Dr. Peter Attia:
彼得·阿蒂亚博士：
And so I give these patients a little homework exercise, which is you have to answer these seven questions for every supplement you take, and here's the spreadsheet, and let's talk about it.
所以我给这些病人做了一些家庭作业，就是你必须为你服用的每一种补充剂回答这七个问题，这是电子表格，让我们来讨论一下。
And it basically just runs through, it's basically walking you through the logic of why do you take this molecule.
它基本上只是贯穿始终，它基本上引导你了解为什么要服用这个分子的逻辑。
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Dr. Peter Attia:
彼得·阿蒂亚博士：
And I think for many people, when they do that, it's very sobering, right?
我认为对于很多人来说，当他们这样做时，这是非常清醒的，对吧？
A lot of them will come back and be like, "You know what?
他们中的很多人会回来说：“你知道吗？
I don't think I can come up with any reason along this really rigorous line of thinking as to why I'm taking 80% of this stuff."
我认为我无法按照这种非常严格的思路找出任何理由来解释为什么我要拿走 80% 的这些东西。”
Andrew Huberman:
安德鲁·休伯曼：
Well, I know people, and actually we know some of the same people, who are fanatic about red light on the testes, sunning their testes, putting ice packs on their testes.
嗯，我认识一些人，实际上我们认识一些同样的人，他们热衷于睾丸上的红光，晒他们的睾丸，在他们的睾丸上放冰袋。
It's kind of all over the place.
到处都是这样的情况。
The number of things that people are trying and doing in order to increase testosterone output from their testes is pretty remarkable.
人们为了增加睾丸激素的分泌而尝试和做的事情数量是相当惊人的。
And that said, among some of the women I know, the number of things that they're doing to try and promote longevity and fertility, and in particular skin health, hair health, and nail health is also kind of outrageous.
也就是说，在我认识的一些女性中，她们为促进长寿和生育能力，特别是皮肤健康、头发健康和指甲健康而做的事情数量也有点令人震惊。
Everything from collagen to red light therapies, which may actually have some efficacy in certain cases, but-
从胶原蛋白到红光疗法，这一切实际上在某些情况下可能有一定的疗效，但是-
Dr. Peter Attia:
彼得·阿蒂亚博士：
As an interesting aside
作为一个有趣的旁白
Andrew Huberman:
安德鲁·休伯曼：
...
...
there's a hunger there, right?
那里有饥饿，对吗？
Dr. Peter Attia:
彼得·阿蒂亚博士：
Oh, for sure.
哦，当然。
One of the things that I hope gets a lot more attention is the use of rapamycin for preserving ovarian health.
我希望得到更多关注的一件事是使用雷帕霉素来保护卵巢健康。
Andrew Huberman:
安德鲁·休伯曼：
Hmm.
嗯。
Dr. Peter Attia:
彼得·阿蒂亚博士：
So the animal literature on this is pretty impressive.
因此，有关这方面的动物文献非常令人印象深刻。
So in mouse models, rapamycin will preserve ovarian life.
因此，在小鼠模型中，雷帕霉素将保留卵巢的生命。
Andrew Huberman:
安德鲁·休伯曼：
Interesting.
有趣。
Dr. Peter Attia:
彼得·阿蒂亚博士：
And it makes sense, right?
这是有道理的，对吧？
It totally makes sense why the most potent geroprotective molecule we have would also preserve and extend ovarian life, at least in mice.
这完全有道理，为什么我们拥有的最有效的老年保护分子也能保护和延长卵巢寿命，至少在小鼠中是这样。
So, I'd love to see the clinical trials done in women to test this hypothesis.
因此，我很乐意看到在女性中进行的临床试验来检验这一假设。
Andrew Huberman:
安德鲁·休伯曼：
I definitely want to come back to this because that's a key thing I know that a lot of people are interested in female fertility out there, including their male partners.
我肯定想回到这个话题，因为这是我知道很多人对女性生育能力感兴趣的关键事情，包括她们的男性伴侣。
So, now I understand why you don't prescribe clomiphene because of this potential desmosterol link.
所以，现在我明白为什么你不开克罗米芬了，因为这种潜在的去莫甾醇联系。
What about testosterone therapy?
睾酮疗法怎么样？
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah, so then-
是啊，那么——
Andrew Huberman:
安德鲁·休伯曼：
So less frequent, lower doses, less or no estrogen inhibition or aromatase inhibition.
因此频率较低，剂量较低，较少或没有雌激素抑制或芳香酶抑制。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Again, we're only using an aromatase blocker, and we use Arimidex when we do.
再说一次，我们只使用芳香酶阻滞剂，并且当我们使用时我们使用瑞宁得。
It's just to get that estradiol into the range we want.
只是为了让雌二醇达到我们想要的范围。
I like to see it between 30 and 50.
我喜欢看30到50之间的。
That's the sweet spot.
这就是最甜蜜的地方。
And, I don't know, I would say like a third, maybe a...
而且，我不知道，我会说像第三个，也许是......
Not even a third.
连三分之一都没有。
I'd say probably 20% of men require a microdose of anastrozole to get into that range.
我想说大概 20% 的男性需要微剂量的阿那曲唑才能达到这个范围。
Most do not.
大多数没有。
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Dr. Peter Attia:
彼得·阿蒂亚博士：
And I'd rather err on the side of being a little high than a little low.
我宁愿犯一点高一点，也不愿犯一点低。
So I never really want to be below 25.
所以我从来不想低于25岁。
Sometimes it's just below 25 and it is what it is, that's fine.
有时它只是低于 25，但就是这样，那很好。
But if we're suppressing it to below 25, I never want to be in that zone.
但如果我们将其抑制到 25 以下，我就永远不想处于该区域。
And then, yes, so TRT is ultimately giving testosterone cypionate is usually what we use.
然后，是的，所以 TRT 最终提供的是我们通常使用的环丙酸睾酮。
Andrew Huberman:
安德鲁·休伯曼：
Injectable, so as opposed to cream or pellet.
可注射，与乳膏或颗粒不同。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Correct.
正确。
I used to use pellets with women for some who were really adamant about the convenience of it.
我曾经对一些非常坚信其便利性的女性使用颗粒剂。
But for a bunch of reasons, I'm mostly not doing that, and I've never been a fan of pellets in men.
但由于多种原因，我大多不这样做，而且我从来都不喜欢男性的颗粒。
Andrew Huberman:
安德鲁·休伯曼：
You can't control the dosages once it's in, right?
一旦投入就无法控制剂量，对吗？
Dr. Peter Attia:
彼得·阿蒂亚博士：
Well, even if you know the dose, yeah, that's obviously a problem.
好吧，即使你知道剂量，是的，这显然是一个问题。
But there's a big difference between putting a pellet into a man and a woman.
但将颗粒注射到男性和女性体内之间存在很大差异。
So when you're putting an estrogen pellet into a woman, it's like It's that big.
所以当你把雌激素颗粒放入女性体内时，它就像那么大。
When you're putting enough pellets into a man for six months of testosterone, it's two sums of pellets that are longer than my finger.
当你给一个男人注射足够六个月的睾酮丸时，两颗丸子比我的手指还长。
So you're putting a V shape-
所以你要摆出V字形-
Andrew Huberman:
安德鲁·休伯曼：
Where are you putting this?
你把这个放在哪里？
Dr. Peter Attia:
彼得·阿蒂亚博士：
You're putting it into the gluteal fat.
你把它放入臀肌脂肪中。
Andrew Huberman:
安德鲁·休伯曼：
Mm.
嗯。
Dr. Peter Attia:
彼得·阿蒂亚博士：
So it's just a more morbid procedure, and I don't think it's necessary.
所以这只是一个更病态的程序，我认为没有必要。
I think if you know how to manage it, through the injections.
我想如果你知道如何通过注射来控制它。
And now-
而现在——
Andrew Huberman:
安德鲁·休伯曼：
Injections are no big deal.
注射没什么大不了的。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah.
是的。
Well, especially now if you're doing...
好吧，尤其是现在如果你正在做...
We're having them do sub-Q injections anyway, so it's not IM.
无论如何我们都会让他们进行 sub-Q 注射，所以这不是 IM。
They're using a 5/8 inch to a one-inch 25-gauge needle, which is about the smallest needle you can push the oil through, once to twice a week.
他们使用 5/8 英寸到 1 英寸的 25 号针，这大约是您可以将油推入的最小针，每周一次到两次。
And by the way, if they're real needle phobes, we use Zyestid, which is a preloaded pen.
顺便说一句，如果他们真的有针头恐惧症，我们会使用 Zyestid，这是一种预装笔。
Andrew Huberman:
安德鲁·休伯曼：
And are you having all men take HCG to maintain fertility and testicular size?
你们是否让所有男性都服用 HCG 来维持生育能力和睾丸大小？
Dr. Peter Attia:
彼得·阿蒂亚博士：
Only if they want to.
只要他们愿意。
Andrew Huberman:
安德鲁·休伯曼：
Got it.
明白了。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah.
是的。
Andrew Huberman:
安德鲁·休伯曼：
And-
还有——
Dr. Peter Attia:
彼得·阿蒂亚博士：
And by the way, we do not like to use TRT in men who-- We don't like to use testosterone specifically in men who still want to maintain fertility.
顺便说一句，我们不喜欢对那些仍想保持生育能力的男性使用 TRT。
We just steer them away from that.
我们只是引导他们远离这一点。
Andrew Huberman:
安德鲁·休伯曼：
Because total sperm count goes down.
因为精子总数下降了。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah.
是的。
We just say, why risk it?
我们只是说，为什么要冒险呢？
We'd rather use HCG.
我们宁愿使用HCG。
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah.
是的。
Andrew Huberman:
安德鲁·休伯曼：
Just on its own.
就靠它自己。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah, just wait till you're done reproducing.
是的，等你复制完再说。
Bank sperm, wait till you're done reproducing before we go to testosterone.
储存精子，等到你完成繁殖后再使用睾酮。
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
What are some of the benefits and what are some of the cautionary notes with appropriate TRT, meaning of the kind of contour that we're talking about here, a lower dose with the yes or no low estrogen control?
适当的 TRT 有哪些好处，有哪些注意事项，我们在这里讨论的轮廓的含义，较低剂量以及是或否低雌激素控制？
What did generally people report?
人们通常报告什么？
How do they feel?
他们感觉如何？
What does it allow them to do that they couldn't do or feel before?
它能让他们做哪些以前做不到或感觉不到的事情？
And then in terms of what are the markers to look for?
那么要寻找哪些标记呢？
Is it LDL, blood pressure, water retention, acne, those kinds of things?
是低密度脂蛋白、血压、水分潴留、痤疮之类的吗？
Are there some other things as well?
还有其他一些事情吗？
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah, it depends on the doses, right?
是的，这取决于剂量，对吗？
Again, we're using these in really low doses, so it's pretty rare that we'd have a patient on more than 100 milligrams a week of testosterone.
同样，我们使用的剂量非常低，因此患者每周服用超过 100 毫克睾酮的情况非常罕见。
I think for comparison, a bodybuilder could easily take 500 to 1,000 during a high growth phase.
我认为作为比较，健美运动员在高速生长阶段可以轻松地进行 500 到 1,000 次。
Andrew Huberman:
安德鲁·休伯曼：
I know some of these guys, they go ballistic.
我认识其中一些人，他们脾气暴躁。
Or they're doing moderate levels of testosterone cypionate, but they're also taking Dianabol, Oxandrolone, SARMs, and a bunch of other things.
或者他们正在服用中等水平的环戊丙酸睾酮，但他们也服用大力补、氧雄龙、SARM 和许多其他药物。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah.
是的。
Andrew Huberman:
安德鲁·休伯曼：
Their stacks are kind of ridiculous.
他们的筹码有点可笑。
No disrespect to that sport, but people are dying like crazy in that sport right now.
无意对这项运动不敬，但现在人们在这项运动中疯狂死去。
Dr. Peter Attia:
彼得·阿蒂亚博士：
It's outside of physiology.
这是生理学之外的。
Andrew Huberman:
安德鲁·休伯曼：
Yeah, and I think for 99% of people listening, they hear bodybuilder and they just go, "Why would somebody do that anyway?"
是的，我认为 99% 的人在听到健美运动员时就会问，“为什么有人会这么做呢？”
Dr. Peter Attia:
彼得·阿蒂亚博士：
Right.
对。
Andrew Huberman:
安德鲁·休伯曼：
I think that's the typical response.
我认为这是典型的反应。
Dr. Peter Attia:
彼得·阿蒂亚博士：
So the point is, but we owe those guys a great deal of gratitude because they've shown us the boundaries.
所以重点是，我们非常感谢这些人，因为他们向我们展示了界限。
Andrew Huberman:
安德鲁·休伯曼：
Including the women.
包括女性。
Dr. Peter Attia:
彼得·阿蒂亚博士：
That's right.
没错。
Andrew Huberman:
安德鲁·休伯曼：
Right, yeah.
对，是的。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah.
是的。
And so those bodybuilders have taught us a lot about what happens.
所以那些健美运动员教会了我们很多关于发生的事情。
And so yeah, the bloating, the water retention, acne, hair loss, hair growth, all of those things we understand.
是的，腹胀、保水、痤疮、脱发、头发生长，所有这些我们都了解。
The truth of it is we just don't see those things in our patients.
事实上，我们只是在患者身上看不到这些东西。
Andrew Huberman:
安德鲁·休伯曼：
But 100 milligrams per week is a very low output.
但每周 100 毫克的产量非常低。
My understanding is-
我的理解是——
Dr. Peter Attia:
彼得·阿蒂亚博士：
But it's a physiologic dose.
但这是生理剂量。
Andrew Huberman:
安德鲁·休伯曼：
Yeah.
是的。
Dr. Peter Attia:
彼得·阿蒂亚博士：
The reality of it is it's enough for most people.
现实是对于大多数人来说已经足够了。
Andrew Huberman:
安德鲁·休伯曼：
Yeah.
是的。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Probably the highest we've ever had to go is maybe 70 twice a week.
可能我们所经历过的最高次数可能是每周两次 70 次。
Andrew Huberman:
安德鲁·休伯曼：
What's the youngest patient you've ever had to put on TRT?
您接受过 TRT 治疗的最年轻的患者多大？
Dr. Peter Attia:
彼得·阿蒂亚博士：
Actual testosterone?
真正的睾丸激素？
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Probably...
大概...
That's a good question.
这是个好问题。
I'm thinking about maybe 40.
我在想也许40。
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
I think that's great for people to hear because I know that a lot of guys in their 20s are thinking TRT is the way to go, and I would argue unless you're doing everything else right and you're still hypogonadal and you're really struggling, put that time off because also the fertility issue you want to delay, delay, delay.
我认为这对人们来说很好，因为我知道很多 20 多岁的男人都认为 TRT 是正确的出路，我认为除非你做的一切都正确，而且你仍然性腺功能低下并且你真的很挣扎，所以推迟时间，因为还有生育问题你想推迟，推迟，推迟。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Well, again, it depends.
好吧，再说一遍，这取决于情况。
When we say TRT, if you're in your 20s and there's no other way, I would hope you would be steered toward HCG to at least preserve testicular function.
当我们说 TRT 时，如果您 20 多岁，没有其他办法，我希望您转向 HCG，至少可以保留睾丸功能。
Now again, we don't actually know if after being on HCG for 10 years, your pituitary will still work.
再说一次，我们实际上并不知道服用 HCG 10 年后，您的垂体是否仍然有效。
Andrew Huberman:
安德鲁·休伯曼：
Right, you won't be able to make your own luteinizing hormone.
是的，你将无法制造自己的黄体生成素。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Exactly.
正是如此。
So it might be the case that you're going to need something upstream of that, like Clomid to kickstart it.
因此，您可能需要一些上游的东西，例如克罗米芬（Clomid）来启动它。
But again, I don't want anybody who's listening to this who's using Clomid for fertility to think that there's anything wrong with it.
但再次强调，我不希望任何正在使用克罗米芬（Clomid）来生育的人认为它有什么问题。
My concern over this became if you're going to be on this for 10 years, is it problematic?
我对此的担忧是，如果你要这样做10年，这会有问题吗？
Not if you're using this for a course of IVF or something like that.
如果您将其用于 IVF 或类似课程，则不会。
So again, if we felt that someone's pituitary was not working, I would be happy to put three months of Clomid on them to try to see if we could blast it back.
所以，如果我们觉得某人的垂体不起作用，我会很乐意给他们服用三个月的克罗米芬，看看是否可以将其恢复。
Andrew Huberman:
安德鲁·休伯曼：
Do you have men cycle on and off testosterone at these low dosages?
你们有男性在如此低剂量的睾丸激素循环中使用和停用睾酮吗？
Are they taking a month vacation from it every once in a while?
他们是否每隔一段时间就休一个月的假？
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah, it totally depends.
是的，这完全取决于。
I was talking to a patient yesterday where we just decided to change his cycle.
昨天我和一位病人交谈，我们刚刚决定改变他的周期。
Eight weeks on, then eight weeks on HCG, eight weeks on, then eight weeks on HCG.
八周，然后八周 HCG，八周，然后八周 HCG。
So that's going to be a cycle that maintains his testosterone level, but fluctuates between endogenous, exogenous, endogenous, exogenous.
所以这将是一个维持睾酮水平的循环，但在内源性、外源性、内源性、外源性之间波动。
Sometimes we'll just do testosterone on, off, on, off, and there it's like how much can he replenish naturally?
有时我们只是开、关、开、关睾丸激素，然后就想他能自然补充多少？
But understanding his T will dip during those off cycles.
但在那些非周期期间，对他的 T 的理解会下降。
Andrew Huberman:
安德鲁·休伯曼：
Seems to me there's a tremendous incentive for somebody to develop a molecule that can directly target SHBG besides Oxandrolone and Anavar.
在我看来，除了 Oxandrolone 和 Anavar 之外，还有巨大的动力去开发一种可以直接靶向 SHBG 的分子。
Right?
正确的？
If one could just drop SHBG just the tiniest bit, it seems like one could adjust the free T in a way that would be great.
如果我们可以只去掉最微小的一点 SHBG，那么似乎我们可以以一种很棒的方式调整自由 T。
I don't know why that molecule's so hard to target, but somebody ought to do it.
我不知道为什么这个分子这么难瞄准，但应该有人去做。
The chemistry can't be that hard.
化学不可能那么难。
Dr. Peter Attia:
彼得·阿蒂亚博士：
I talked with Patrick Arnold about this many years ago.
很多年前我和帕特里克·阿诺德谈过这个问题。
I wish I could remember what his idea-- He had a comment about this that at the time made sense, and I don't remember what it was because I had that thought, too, like, man, especially for that subset of guys who have normal testosterone, but they're just over binding it.
我希望我能记住他的想法——他对此有一个评论，当时是有道理的，我不记得那是什么，因为我也有这个想法，特别是对于那些睾酮水平正常的人来说，但他们只是过度束缚它。
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
I'm really glad that you brought up this issue of total testosterone versus free T.
我真的很高兴您提出了总睾酮与游离 T 的问题。
And the reason is, ever since going on podcasts and talking about this stuff and talking about it on this podcast, people will send me their numbers.
原因是，自从在播客上谈论这些东西并在这个播客上谈论它之后，人们就会向我发送他们的电话号码。
They'll send me their charts.
他们会把他们的图表发给我。
And then they'll send photos of themselves.
然后他们会发送自己的照片。
And I can tell you, while I'm not a clinician and I haven't done fancy statistics on it, there's very little correlation between someone's absolute testosterone and how they appear.
我可以告诉你，虽然我不是临床医生，也没有做过花哨的统计数据，但一个人的绝对睾酮水平与他们的外表之间几乎没有相关性。
Some of these guys look really lean, really strong, and they'll say, "Oh, total testosterone is 550." 480.
其中一些人看起来非常瘦，非常强壮，他们会说，“哦，总睾酮水平是 550。” 480.
And then other people, testosterone is 860, but you look at them and you think, "Oh, they kind of have a doughy look to them." And so it's got to be this free testosterone thing.
而其他人，睾丸激素是 860，但你看着他们，你会想，“哦，他们看起来有点软乎乎的。”所以它一定是这种免费的睾酮激素。
Dr. Peter Attia:
彼得·阿蒂亚博士：
I would-
我会-
Andrew Huberman:
安德鲁·休伯曼：
Plus estrogen, et cetera.
再加上雌激素等等。
But also cosmetically-
但也从美容角度来说——
Dr. Peter Attia:
彼得·阿蒂亚博士：
Well, but so training and nutrition too, right?
嗯，但是训练和营养也是如此，对吧？
Andrew Huberman:
安德鲁·休伯曼：
Yeah, absolutely.
是的，绝对是。
Dr. Peter Attia:
彼得·阿蒂亚博士：
I think for all this talk about testosterone, which I enjoy talking about, and I enjoy talking about the data on long-term health consequences of testosterone, because it's another controversial topic.
我认为尽管如此，我还是喜欢谈论睾酮，我喜欢谈论睾酮对长期健康影响的数据，因为这是另一个有争议的话题。
I also think people kind of overstate its importance.
我还认为人们有点夸大了它的重要性。
Andrew Huberman:
安德鲁·休伯曼：
I agree.
我同意。
Dr. Peter Attia:
彼得·阿蒂亚博士：
And I think there's a group of people who think, "If I could just fix my testosterone, everything will be better." And it's sort of like, no, actually, that's not true at all.
我认为有一群人认为，“如果我能修复我的睾丸激素，一切都会更好。”有点像，不，实际上，这根本不是真的。
Really, the only purpose in my mind of fixing testosterone is to give you the capacity to work harder.
确实，在我看来，修复睾丸激素的唯一目的是让你有能力更加努力地工作。
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Dr. Peter Attia:
彼得·阿蒂亚博士：
It's really going to help you recover more from your workouts.
它确实会帮助您从锻炼中恢复更多。
This should just give you a greater ability to experience muscle protein synthesis.
这应该会让你更有能力体验肌肉蛋白质的合成。
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Dr. Peter Attia:
彼得·阿蒂亚博士：
So, if I just give you a bunch of testosterone and you sit on the couch and your nutrition doesn't change and you're not exercising anymore, you're not going to experience any benefits of this thing.
所以，如果我只是给你一堆睾丸激素，而你坐在沙发上，你的营养没有改变，你不再锻炼，你就不会体验到这东西的任何好处。
My testosterone level has fluctuated quite a bit throughout my life.
在我的一生中，我的睾酮水平波动很大。
And when I think about as an adult, not including when I was sort of a fanatical teenager, but as an adult, when was I at my absolute most insane physique?
当我作为一个成年人思考时，不包括当我是一个狂热的青少年时，但作为一个成年人，我什么时候处于绝对最疯狂的体质？
Like my best performance on a DEXA scan would've been 30...
就像我在 DEXA 扫描中的最佳表现是 30...
I was 38 years old.
我当时38岁。
By DEXA, I was 7% body fat.
通过 DEXA，我的体脂含量为 7%。
My fat-free mass index was like 23.2, 23.3 kilograms per meter squared.
我的去脂体重指数约为每平方米 23.2、23.3 公斤。
I was huge, strong, and totally ripped.
我很大，很强壮，而且完全被撕裂了。
My testosterone was in the toilet.
我的睾丸激素在厕所里。
I was over-training like crazy.
我疯狂地过度训练。
I was exercising probably 26 hours a week, killing it in the gym, swimming like a banshee, cycling like my life depended on it, grossly over-trained, low T, but physically looked like twice the guy I am today.
我每周锻炼大概 26 个小时，在健身房里拼尽全力，像女妖一样游泳，像我的生命依赖一样骑自行车，严重过度训练，T 值低，但身体看起来是我现在的两倍。
Today, my T's probably twice as high as it was then.
今天，我的 T 可能是以前的两倍。
So now you could say, "Well, Peter, what if you took T back then?
所以现在你可以说，“好吧，Peter，如果你当时把 T 拿回来怎么办？
How much better could you have been?" Sure.
你还能做得更好吗？”当然。
But again, I think the take home is just giving somebody T doesn't do much of anything.
但同样，我认为带回家的只是给某人 T 并没有做任何事情。
It probably helps on the insulin resistance front without any other thing.
它可能在没有任何其他作用的情况下对胰岛素抵抗有帮助。
But to me, that's a waste.
但对我来说，这是一种浪费。
That's squandering the gift that it is giving you, which is the ability to do more work and capture the benefit of it via muscle protein synthesis.
这是在浪费它给你的天赋，即做更多工作并通过肌肉蛋白质合成获得其好处的能力。
Andrew Huberman:
安德鲁·休伯曼：
I agree, and I think that the psychological effect of testosterone, whether or not it's exogenous or endogenous, is it makes effort feel good.
我同意，而且我认为睾酮的心理作用，无论是外源性的还是内源性的，都是让努力感觉良好。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah.
是的。
Andrew Huberman:
安德鲁·休伯曼：
At some level, it really seems to do that, and Sapolsky tells me the main reason, or mechanistically the main reason that it can do that is by adjusting levels of activity in the amygdala.
在某种程度上，它似乎确实能做到这一点，萨波尔斯基告诉我，它能做到这一点的主要原因，或者从机制上来说，它能做到这一点的主要原因是通过调整杏仁核的活动水平。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Interesting.
有趣。
Andrew Huberman:
安德鲁·休伯曼：
And so there's some interesting imaging there.
所以那里有一些有趣的图像。
I'd love to chat more about the cholesterol pathway.
我很想更多地讨论胆固醇途径。
And I know this is a huge landscape as well, but I think we're doing a good job of diving in deep but not getting stuck in the underlying currents at all.
我知道这也是一个巨大的景观，但我认为我们在深入研究方面做得很好，但根本没有陷入潜在的潮流中。
There's tremendous debate about whether or not dietary cholesterol directly relates to or does not relate to serum cholesterol, LDL, and HDL.
关于膳食胆固醇是否与血清胆固醇、低密度脂蛋白和高密度脂蛋白直接相关或不相关，存在巨大争议。
Here's my-
这是我的-
Dr. Peter Attia:
彼得·阿蒂亚博士：
Is there?
有吗？
Andrew Huberman:
安德鲁·休伯曼：
Well, let me put it this way.
好吧，让我这样说。
There are people that argue -- I'm certainly not arguing that.
有人争论——我当然不会争论。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah.
是的。
Andrew Huberman:
安德鲁·休伯曼：
There are people that argue that if one eats a ton of saturated fat, that LDL goes up and HDL goes down.
有人认为，如果一个人吃了一吨饱和脂肪，低密度脂蛋白就会上升，高密度脂蛋白就会下降。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Oh, okay, but that's not dietary cholesterol per se.
哦，好吧，但这本身并不是膳食胆固醇。
Andrew Huberman:
安德鲁·休伯曼：
No, not dietary cholesterol per se.
不，不是膳食胆固醇本身。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah.
是的。
Okay.
好的。
Andrew Huberman:
安德鲁·休伯曼：
And then there are people that argue that any increase in saturated fat intake is going to be bad, that you already synthesize enough cholesterol for hormone production, et cetera.
还有人认为，饱和脂肪摄入量的任何增加都是不好的，你已经合成了足够的胆固醇来产生激素，等等。
I'd like to talk about this in terms of how one should read their charts.
我想从如何阅读图表的角度来谈谈这一点。
My LDL is in what I'm told is healthy range.
我的低密度脂蛋白处于健康范围内。
My HDL is in what I'm told is healthy range.
我的 HDL 处于健康范围内。
I do try and not overeat things like butter, cheese, and red meat, but I do eat some of those things, and I feel pretty good.
我确实尝试不吃太多黄油、奶酪和红肉之类的东西，但我确实吃了一些这些东西，而且我感觉很好。
But most people are operating under the assumption that eating saturated fat is bad, and you only do it insofar as you want to taste it.
但大多数人都认为吃饱和脂肪是不好的，而且只有当你想尝尝的时候才会这么做。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Mm-hmm.
嗯嗯。
Andrew Huberman:
安德鲁·休伯曼：
And then, of course, there's a small group of people that love to eat organs and meats and really pack cholesterol, and would argue that it doesn't matter if your LDL is 870, it's not going to impact your health.
当然，还有一小部分人喜欢吃内脏和肉类，而且胆固醇含量很高，他们会认为，即使你的 LDL 是 870，也没关系，不会影响你的健康。
What's the reality around LDL, HDL, dietary cholesterol, saturated fat, at least in your view?
至少在您看来，低密度脂蛋白、高密度脂蛋白、膳食胆固醇、饱和脂肪的实际情况是怎样的？
Dr. Peter Attia:
彼得·阿蒂亚博士：
So first, let's differentiate between cholesterol and fat, just for the listener, because we use them...
首先，让我们区分一下胆固醇和脂肪，只是为了听众，因为我们使用它们......
I want to make sure people understand.
我想确保人们理解。
Andrew Huberman:
安德鲁·休伯曼：
Sure.
当然。
Dr. Peter Attia:
彼得·阿蒂亚博士：
So cholesterol is a really complicated molecule.
所以胆固醇是一个非常复杂的分子。
So it's a ringed molecule.
所以它是一个环状分子。
God, I used to know exactly what its structure was, but it could have 36 carbons for all I remember.
天哪，我曾经确切地知道它的结构是什么，但据我所知它可能有 36 个碳。
It is a lipid, so it is a hydrophobic molecule that is synthesized by every cell in the human body.
它是一种脂质，因此是一种疏水性分子，由人体内的每个细胞合成。
It is so important that without it, if you look at sort of genetic conditions that impair cholesterol synthesis, depending on their severity, they can be fatal in utero.
它非常重要，如果没有它，如果你观察一下损害胆固醇合成的遗传条件，根据其严重程度，它们可能会在子宫内致命。
So in other words, anything that really interferes with our ability to produce cholesterol is a threat to us as a species.
换句话说，任何真正干扰我们产生胆固醇的能力的事物都会对我们这个物种构成威胁。
And the reason for that is cholesterol makes up the cell membrane of every cell in our body.
原因是胆固醇构成了我们体内每个细胞的细胞膜。
So, as you know, but maybe the listeners don't, even though a cell is a spherical thing, it has to be fluid, right?
所以，正如你所知，但也许听众不知道，即使细胞是球形的东西，它也必须是流体的，对吗？
It's not just a rigid sphere, like a blow-up ball, right?
它不仅仅是一个刚性球体，就像充气球一样，对吗？
It's got to be able to kind of move in this way to mesh with other cells.
它必须能够以这种方式移动以与其他细胞啮合。
It also has to accommodate having porous structures that traverse its membrane to allow ions and things like that to go across.
它还必须适应穿过其膜的多孔结构，以允许离子和类似的东西穿过。
And it's cholesterol that gives the fluidity to that membrane.
胆固醇赋予膜流动性。
It's also, as you're alluding to, the backbone of some of the most important hormones in our body.
正如您所提到的，它也是我们体内一些最重要的激素的支柱。
Estrogen, progesterone, testosterone, cortisol.
雌激素、黄体酮、睾酮、皮质醇。
So we have this thing, super important.
所以我们有这个东西，非常重要。
Okay.
好的。
Then let's talk about can you get cholesterol in your diet?
那么我们来谈谈饮食中能摄入胆固醇吗？
Yes, you can eat foods that are rich in cholesterol.
是的，您可以吃富含胆固醇的食物。
What was known in 1960, but somehow escaped everybody's imagination until finally the American Heart Association acknowledged this a few years ago, is that the cholesterol you eat does not really make it into your body.
1960 年，大家都知道，但不知为何，大家都没有想到这一点，直到美国心脏协会几年前才承认这一点：您吃下的胆固醇并没有真正进入您的身体。
And the reason for that is it's esterified.
原因是它被酯化了。
So we have...
所以我们有...
And not to get too nerdy, but I really think it's important people understand how this thing works.
不要太书呆子气，但我真的认为人们了解这个东西是如何工作的很重要。
So we have cells in our gut, enterocytes, they're the endothelial cells of our gut.
所以我们的肠道中有细胞，肠上皮细胞，它们是肠道的内皮细胞。
Each one of them has basically two transporters on them.
每一艘基本上都有两个运输机。
So the first is called the Niemann-Pick C1-like 1 transporter.
所以第一个被称为 Niemann-Pick C1-like 1 转运蛋白。
The second is called the ATP binding cassette G5/G8.
第二个称为 ATP 结合盒 G5/G8。
Okay.
好的。
The Niemann-Pick C1-like 1 transporter will bring in any sterol, cholesterol, zoo sterol, phytosterol.
Niemann-Pick C1-like 1 转运蛋白将引入任何甾醇、胆固醇、动物甾醇、植物甾醇。
Any sterol that fits through the door will come in.
任何能穿过门的甾醇都会进来。
Virtually all of that is the cholesterol we produce that gets taken back to the liver, that the liver packages in bile and secretes.
事实上，所有这些都是我们产生的胆固醇，它们被带回肝脏，肝脏将其包装在胆汁中并分泌。
So that's what aids in our digestion, which is another thing I should have mentioned earlier.
这就是帮助我们消化的东西，这是我之前应该提到的另一件事。
In addition to using cholesterol for cell membranes and hormones, we wouldn't be able to digest our food without cholesterol because it's what makes up the bile salts.
除了将胆固醇用于细胞膜和激素之外，没有胆固醇我们就无法消化食物，因为它是胆汁盐的组成部分。
So our own cholesterol is basically recirculated in a pool throughout our body, and this is the way it gets back into the body.
所以我们自己的胆固醇基本上在我们身体的一个池中再循环，这就是它返回身体的方式。
It's through this Niemann-Pick C1-like 1 transporter.
它是通过这个类似于 Niemann-Pick C1 的 1 转运蛋白实现的。
When it gets in there, this is the checkpoint of regulation.
当它进入那里时，这就是监管的检查点。
This is where the body says, "Do you have enough cholesterol in the body?
这就是身体在说的：“你体内有足够的胆固醇吗？
Yes or no?" If yes, I will let that cholesterol make its way into the circulation.
是还是不是？”如果是的话，我会让胆固醇进入循环。
So it'll go off the basolateral side of the cell, not the luminal side into the body.
因此它会从细胞的基底外侧进入体内，而不是从腔侧进入体内。
Alternatively, the body says, "You know what?
或者，身体会说：“你知道吗？
We have enough cholesterol.
我们有足够的胆固醇。
I'm going to let you poop this out." And now the ATP binding cassette will shoot it out.
我会让你把这个拉出来。”现在 ATP 结合盒会将其射出。
It'll go back into the luminal side and away it goes.
它会回到管腔一侧并消失。
So all of the cholesterol in our body is not esterified, meaning it doesn't have that big bulky side chain attached to it.
因此，我们体内的所有胆固醇都没有被酯化，这意味着它没有附着那么大的侧链。
The cholesterol you eat is esterified.
你吃的胆固醇被酯化了。
And an esterified cholesterol molecule simply can't physically pass through that Niemann-Pick C1-like 1 transporter.
而且酯化的胆固醇分子根本无法物理通过 Niemann-Pick C1 样 1 转运蛋白。
Now, we probably manage to de-esterify 10% to 15% of our dietary cholesterol.
现在，我们可能设法将饮食中胆固醇的 10% 至 15% 脱酯化。
So in other words, there are small amounts of dietary cholesterol that do make their way into our circulation.
换句话说，有少量膳食胆固醇确实进入了我们的循环。
But it represents a small fraction of our total body's pool of cholesterol.
但它只占我们全身胆固醇的一小部分。
Again, this was known even by Ancel Keys, the guy who turned fat into the biggest boogeyman of all time.
再说一遍，连安塞尔·凯斯（Ancel Keys）也知道这一点，他把胖子变成了有史以来最大的妖怪。
Ancel Keys acknowledged this in the 1960s.
Ancel Keys 在 20 世纪 60 年代承认了这一点。
Dietary cholesterol plays no role in serum cholesterol.
膳食胆固醇对血清胆固醇没有影响。
Again, it took the American Heart Association another 60 years to figure that out, but even now they acknowledge that.
美国心脏协会又花了 60 年才弄清楚这一点，但即使现在他们也承认这一点。
Andrew Huberman:
安德鲁·休伯曼：
So-
所以——
Dr. Peter Attia:
彼得·阿蒂亚博士：
Dietary cholesterol has no bearing.
膳食胆固醇没有影响。
Andrew Huberman:
安德鲁·休伯曼：
So why is it that it's pretty easy to find studies or at least people who are highly credentialed from good institutions claiming that eating saturated fat, cheese and-
那么，为什么很容易找到研究，或者至少是那些获得良好机构认可的人，声称吃饱和脂肪、奶酪和——
Dr. Peter Attia:
彼得·阿蒂亚博士：
Saturated fat's different
饱和脂肪不一样
Andrew Huberman:
安德鲁·休伯曼：
...
...
saturated fat and red meat, things that are rich in cholesterol, to be more specific, is bad for us in terms of our eventual LDL.
更具体地说，饱和脂肪和红肉等富含胆固醇的食物对我们最终的低密度脂蛋白有害。
Dr. Peter Attia:
彼得·阿蒂亚博士：
So this is two different things.
所以这是两件不同的事情。
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Dr. Peter Attia:
彼得·阿蒂亚博士：
So saturated fat consumption in many people will raise LDL cholesterol.
因此，许多人摄入饱和脂肪会升高低密度脂蛋白胆固醇。
So it's important to differentiate between the-- What is saturated fat?
因此，区分以下内容非常重要：什么是饱和脂肪？
So saturated fat, of course, is a fatty acid, just so people understand.
所以饱和脂肪当然是一种脂肪酸，正如人们所理解的那样。
Totally different molecule from cholesterol.
与胆固醇完全不同的分子。
Cholesterol is this very complicated ring structure, multiple rings stuck together.
胆固醇是一种非常复杂的环结构，多个环粘在一起。
SFA, saturated fat, is just a long-chain fatty acid that is fully saturated, meaning it has no double bonds, and it can exist in isolation, it can exist in a triglyceride, triacylglyceride, or a phospholipid or all sorts of things like that.
SFA，饱和脂肪，是一种完全饱和的长链脂肪酸，这意味着它没有双键，它可以单独存在，可以存在于甘油三酯、三酰基甘油酯或磷脂或各种类似的物质中。
So when we eat foods that contain fat, basically there are three distinctions for that fat.
所以当我们吃含有脂肪的食物时，脂肪基本上有三个区别。
Is it saturated?
饱和了吗？
Is it monounsaturated, one double bond?
它是单不饱和的，一个双键吗？
Or is it polyunsaturated, two or more double bonds?
或者它是多不饱和的、两个或多个双键？
The observation that eating saturated fat raises cholesterol is generally correct.
吃饱和脂肪会增加胆固醇的观察结果通常是正确的。
But because if we're going to start talking about LDL, we have to explain what LDL is.
但因为如果我们要开始谈论低密度脂蛋白，我们就必须解释什么是低密度脂蛋白。
This is another one of those things that's just so grossly misunderstood that it makes having discussions about this very complicated.
这是另一件被严重误解的事情，使得对此的讨论变得非常复杂。
Let's go back to the cholesterol problem, right?
让我们回到胆固醇问题，对吧？
So every cell in our body makes cholesterol, and almost without exception, they make enough.
因此，我们体内的每个细胞都会产生胆固醇，而且几乎无一例外，它们都会产生足够的胆固醇。
There are a handful of times, however, when a cell needs to borrow cholesterol from another cell.
然而，有时一个细胞需要从另一个细胞借用胆固醇。
Okay, so how would you do this, right?
好吧，那么你会怎么做，对吧？
So if you're playing God for a minute and you want to design a system, you have to be able to transport cholesterol from one cell to another.
因此，如果你暂时扮演上帝的角色并且想要设计一个系统，那么你必须能够将胆固醇从一个细胞运输到另一个细胞。
The most logical place you would transport this is through the circulation.
最合理的运输方式是通过流通。
And the problem with circulation is it's water.
循环的问题是水。
Plasma is water.
血浆是水。
So now you have this problem, which is I want to transport cargo that is hydrophobic-
所以现在你遇到了这个问题，那就是我想运输疏水性的货物-
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm
嗯嗯
Dr. Peter Attia:
彼得·阿蒂亚博士：
...
...
in a hydrophilic medium.
在亲水介质中。
Can't do it.
做不到。
So if you think about all the things that we transport in our blood, sodium, electrolytes, glucose, things like that, they're water soluble.
因此，如果你考虑一下我们在血液中输送的所有物质，如钠、电解质、葡萄糖等，它们都是水溶性的。
It's easy.
这很容易。
They just move back and forth in our blood with no chaperone.
它们只是在我们的血液中来回移动，没有陪伴。
But when you want to move cholesterol, you have to package it in something that's hydrophilic That something is called a lipoprotein.
但是当你想转移胆固醇时，你必须将其包装在亲水性的东西中，即脂蛋白。
So we have these spherical molecules that are lipid on the inside, protein on the outside, lipoprotein, and inside they contain cholesterol and triglycerides.
所以我们有这些球形分子，里面是脂质，外面是蛋白质，脂蛋白，里面含有胆固醇和甘油三酯。
So now you've got this spherical thing, triglyceride, cholesterol on the inside, and it's chaperoned by a hydrophilic molecule that allows it to move through our circulation.
所以现在你有了这个球形的东西，里面有甘油三酯和胆固醇，它由亲水性分子陪伴，使其能够在我们的循环中移动。
And those lipoproteins exist in different densities.
这些脂蛋白以不同的密度存在。
So if you run these out on a gel electrophoresis plate, you'll identify different densities.
因此，如果您在凝胶电泳板上运行这些，您将识别出不同的密度。
The density is a function of how much protein and how much lipid is in it.
密度是其中蛋白质含量和脂质含量的函数。
So the highest density of this is called a high-density lipoprotein, and the lowest density of this is called a very low-density lipoprotein, a VLDL.
因此，密度最高的称为高密度脂蛋白，密度最低的称为极低密度脂蛋白，即 VLDL。
And then next to that you have an LDL, a low-density lipoprotein, and then next to that you have an IDL, an intermediate density lipoprotein.
接下来是 LDL，一种低密度脂蛋白，然后是 IDL，一种中密度脂蛋白。
So, it actually goes VLDL, IDL, LDL.
所以，它实际上是 VLDL、IDL、LDL。
But anyway, so when people say, "My LDL is high," or, "My LDL is 100," what are they saying?
但无论如何，当人们说“我的 LDL 很高”或“我的 LDL 是 100”时，他们在说什么？
They're saying the cholesterol concentration of my LDL particles is 100 milligrams per deciliter.
他们说我的低密度脂蛋白颗粒的胆固醇浓度是每分升 100 毫克。
So the total cholesterol concentration you have in your circulation is that number that says total cholesterol.
因此，您循环中的总胆固醇浓度就是表示总胆固醇的数字。
So if someone's blood panel says, "My total cholesterol is 200," it means that if you take all the lipoproteins in their circulation, bust them open, and measure the cholesterol content, it's 200 milligrams per deciliter.
因此，如果某人的血液检查结果显示“我的总胆固醇是 200”，则意味着如果您将其循环中的所有脂蛋白打开并测量胆固醇含量，则结果为每分升 200 毫克。
And for all intents and purposes, because the IDLs are so short-lived, that's basically the sum of your LDL cholesterol, your VLDL cholesterol, and your HDL cholesterol.
出于所有意图和目的，由于 IDL 的寿命非常短暂，它基本上是 LDL 胆固醇、VLDL 胆固醇和 HDL 胆固醇的总和。
Those three things sum to your total cholesterol.
这三项总和就是您的总胆固醇。
Andrew Huberman:
安德鲁·休伯曼：
What about LDLa that you mentioned earlier?
您之前提到的 LDLa 怎么样？
Dr. Peter Attia:
彼得·阿蒂亚博士：
LP little a is another-
LP小a是另一个-
Andrew Huberman:
安德鲁·休伯曼：
LP.
LP。
Excuse me
对不起
Dr. Peter Attia:
彼得·阿蒂亚博士：
...
...
yeah.
是的。
He's another actor.
他是另一个演员。
He is a special type of LDL that, again, in sort of 10 to 20% of the population is a really bad actor.
他是一种特殊类型的 LDL，在 10% 到 20% 的人口中，他是一个非常糟糕的演员。
So that's an LDL that has another apolipoprotein on it called apolipoprotein little a.
这是一种 LDL，上面有另一种载脂蛋白，称为载脂蛋白小 a。
Andrew Huberman:
安德鲁·休伯曼：
Got it.
明白了。
Dr. Peter Attia:
彼得·阿蒂亚博士：
The other thing I'll just say on this, because earlier I mentioned ApoB, there are two broad families of lipoproteins.
我要说的另一件事是，因为之前我提到过 ApoB，脂蛋白有两大家族。
There are those that are wrapped in ApoBs and those that are wrapped in ApoAs.
有些是由 ApoB 包裹的，有些是由 ApoA 包裹的。
The ApoA family is the HDL family.
ApoA 家族是 HDL 家族。
The ApoB family is the VLDL, IDL, LDL family.
ApoB 家族包括 VLDL、IDL、LDL 家族。
Andrew Huberman:
安德鲁·休伯曼：
I see.
我明白了。
So for somebody who, let's say their total cholesterol is, let's just stay with 200-
因此，对于那些总胆固醇为 200 的人来说，
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah
是啊
Andrew Huberman:
安德鲁·休伯曼：
...
...
for simplicity, what do you like to see in terms of the HDL/LDL ratio?
为简单起见，您希望看到 HDL/LDL 比率是多少？
Dr. Peter Attia:
彼得·阿蒂亚博士：
Couldn't care less.
一点也不在乎。
I only care about ApoB.
我只关心ApoB。
I only care about ApoB.
我只关心ApoB。
I care about the causative agent of atherosclerosis.
我关心动脉粥样硬化的病因。
ApoB is the thing that drives atherosclerosis.
ApoB 是导致动脉粥样硬化的因素。
Andrew Huberman:
安德鲁·休伯曼：
And what levels are attractive or repulsive for you when you see levels of ApoB that are blank, you get really concerned.
当您看到空白的 ApoB 水平时，您会感到非常担心，什么水平对您有吸引力或令人厌恶。
What range?
什么范围？
Dr. Peter Attia:
彼得·阿蒂亚博士：
It depends on the person's objectives.
这取决于人的目标。
So again, we take a very different view.
因此，我们再次采取了截然不同的观点。
We have-
我们有-
Andrew Huberman:
安德鲁·休伯曼：
Vitality now, and I want to live to be 100.
现在充满活力，我想活到100岁。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah.
是的。
So if you tell me-
所以如果你告诉我-
Andrew Huberman:
安德鲁·休伯曼：
I'm assuming some taper
我假设有一些锥度
Dr. Peter Attia:
彼得·阿蒂亚博士：
...
...
if you tell me you want to live to be 100, you're going to need to keep your ApoB below 30 milligrams per deciliter.
如果您告诉我您想活到 100 岁，您需要将 ApoB 保持在 30 毫克/分升以下。
Andrew Huberman:
安德鲁·休伯曼：
Let's say I want to live to be 100, but I als- Well, how about I don't care how long I live, but I want to feel great while I live.
假设我想活到 100 岁，但我也——好吧，我不在乎我能活多久，但我想在活着的时候感觉很棒。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Again, it depends, right?
再说一遍，这取决于情况，对吧？
Anybody who's had a heart attack is going to be compromised in their ability to feel well after.
任何心脏病发作过的人术后感觉良好的能力都会受到影响。
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Right?
对吗？
So-
所以——
Andrew Huberman:
安德鲁·休伯曼：
I guess I say it that way because if you're going to tell me that in order to achieve that live to 100 level, I'm going to have to give up my personal life and my-
我想我这么说是因为如果你要告诉我，为了达到 100 级，我将不得不放弃我的个人生活和我的——
Dr. Peter Attia:
彼得·阿蒂亚博士：
No, no. But to get-
不，不。但为了得到——
Andrew Huberman:
安德鲁·休伯曼：
...
...
my brain functioning, then I'm not really interested in it.
我的大脑功能正常，那么我对此并不真正感兴趣。
Yeah
是啊
Dr. Peter Attia:
彼得·阿蒂亚博士：
Sure.
当然。
But to get LDL levels, and really, again, people think of it as LDL.
但要获得低密度脂蛋白水平，实际上，人们再次将其视为低密度脂蛋白。
It's really ApoB, right?
这真的是 ApoB，对吗？
ApoB is this total concentration of LDL and VLDL, and that's what matters.
ApoB 是 LDL 和 VLDL 的总浓度，这才是最重要的。
Those are the big atherogenic particles.
这些是大的致动脉粥样硬化颗粒。
LDL also includes the Lp , although the concentration of Lp is relatively speaking so small that it doesn't generally show up as much in the ApoB.
LDL 还包括 Lp ，尽管 Lp 的浓度相对而言很小，因此通常不会在 ApoB 中出现那么多。
So we treat ApoB, and basically what it comes down to is you want ApoB to be as close to the level as it was when you were born.
所以我们对待 ApoB，基本上归根结底就是你希望 ApoB 接近你出生时的水平。
So we start developing heart disease when we're born.
因此，我们一出生就开始患上心脏病。
That's just the way it is.
事情就是这样。
The autopsy studies make this abundantly clear.
尸检研究清楚地表明了这一点。
When you look at autopsies of young people who are dying in their 20s, and this was first done in the 1970s, it was again repeated.
当你观察 20 多岁的年轻人的尸检时，这种情况在 20 世纪 70 年代首次进行，现在又被重复了。
Again, it's always done after we have a war, right?
再说一次，这总是在我们发生战争之后完成的，对吧？
So in the 1970s, it was done on people who died in Vietnam.
所以在 20 世纪 70 年代，人们对在越南死去的人进行了这种手术。
In the early 2000s, it was done on mostly young men, but some young women who were dying in Iraq and Afghanistan.
2000 年代初，这项手术的对象主要是年轻男性，但也有一些在伊拉克和阿富汗死去的年轻女性。
And we saw without any ambiguity that cardiovascular disease is already taking hold in people who are 18, 19, 20 years old.
我们毫不含糊地看到，心血管疾病已经在 18、19、20 岁的人群中流行。
Andrew Huberman:
安德鲁·休伯曼：
Wow.
哇。
Dr. Peter Attia:
彼得·阿蒂亚博士：
And to be clear, they aren't going to die of atherosclerosis at that age.
需要明确的是，他们在那个年龄不会死于动脉粥样硬化。
They're still 40, 50 years away from it.
他们距离这个目标还有 40、50 年。
But this is a lifelong disease.
但这是一种终生疾病。
And we also know that the disease can't really develop until ApoB reaches a certain threshold, and that's the threshold that most of us get to by the time we're in our teens.
我们还知道，只有 ApoB 达到某个阈值，这种疾病才会真正发展起来，而这正是我们大多数人在青少年时期就会达到的阈值。
So it's this really young ApoB level of 20 to 30 milligrams per deciliter that makes it impossible to get atherosclerosis.
因此，正是每分升 20 至 30 毫克的 ApoB 水平才使得人们不可能患上动脉粥样硬化。
So ApoB is necessary but not sufficient to develop ASCVD.
因此ApoB对于ASCVD的发展是必要的但还不够。
Now that...
现在那...
Go ahead.
继续吧。
Andrew Huberman:
安德鲁·休伯曼：
Oh, I'm sorry.
哦，对不起。
I was just going to ask, what are some of the top behavioral, nutritional, supplementation, if any, based, and prescription drug-based ways to target ApoB?
我只是想问，针对 ApoB 的最重要的行为、营养、补充剂（如果有的话）和基于处方药的方法是什么？
Dr. Peter Attia:
彼得·阿蒂亚博士：
Well, nutritionally, you basically have two big tools, right?
嗯，从营养角度来说，你基本上有两个重要的工具，对吧？
And it depends on what's driving up ApoB.
这取决于 ApoB 升高的原因。
So ApoB, remember, is the concentration of LDL and VLDL particles.
所以请记住，ApoB 是 LDL 和 VLDL 颗粒的浓度。
And what do they carry?
他们携带什么？
Cholesterol and triglycerides.
胆固醇和甘油三酯。
So anything that reduces cholesterol and reduces triglycerides is going to reduce ApoB.
因此，任何降低胆固醇和甘油三酯的方法都会降低 ApoB。
Triglycerides are generally driven by carbohydrate intake So more insulin resistance, more carbohydrate intake, more triglycerides.
甘油三酯通常是由碳水化合物摄入量驱动的，因此胰岛素抵抗越多，碳水化合物摄入量越多，甘油三酯就越多。
Clinically, this is readily apparent to anyone who treats patients.
在临床上，这对于任何治疗患者的人来说都是显而易见的。
If you restrict carbohydrates, you will reduce triglycerides.
如果限制碳水化合物，就会降低甘油三酯。
That just happens all day long.
这种事整天都会发生。
But if you reduce triglycerides by raising fat intake so much, it can still raise ApoB.
但如果你通过大量增加脂肪摄入来降低甘油三酯，它仍然可以提高 ApoB。
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Dr. Peter Attia:
彼得·阿蒂亚博士：
So you have to be able to think about it.
所以你必须能够考虑一下。
So in an ideal world, it's can you lower saturated fat, which tends to be the one that is most driving ApoB, while lowering carbohydrate and then see what you can get.
因此，在理想的情况下，您可以降低饱和脂肪（这往往是最能驱动 ApoB 的脂肪），同时降低碳水化合物，然后看看您能得到什么。
But here's the reality of it is, there's nobody with dietary intervention that's going to get to a level of 30 milligrams per deciliter.
但现实是，没有人通过饮食干预能够达到每分升 30 毫克的水平。
I've never seen anybody.
我从来没有见过任何人。
Andrew Huberman:
安德鲁·休伯曼：
Pure dietary intervention.
纯粹的饮食干预。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah.
是的。
Andrew Huberman:
安德鲁·休伯曼：
So what are the other things that can move it?
那么还有哪些东西可以推动它呢？
Dr. Peter Attia:
彼得·阿蒂亚博士：
It's got to be pharmacologic at this point.
这个时候就应该有药理作用了。
Andrew Huberman:
安德鲁·休伯曼：
Statin-type interventions?
他汀类干预措施？
Dr. Peter Attia:
彼得·阿蒂亚博士：
Well, now you have multiple classes of drugs.
好吧，现在你有多种药物。
So the tried and true is the statin.
因此，经过验证的、真实的药物是他汀类药物。
So statins work by inhibiting cholesterol synthesis, and the net effect of that is that the...
因此，他汀类药物通过抑制胆固醇合成发挥作用，其净效应是……
So the liver is really sensitive to cholesterol levels.
所以肝脏对胆固醇水平非常敏感。
It doesn't want too much, it doesn't want too little.
它不想要太多，也不想要太少。
When you inhibit cholesterol synthesis, the liver says, "I want more cholesterol." So it puts more LDL receptors on its surface, and it pulls the LDL out of circulation.
当你抑制胆固醇合成时，肝脏会说：“我想要更多胆固醇。”因此，它在其表面放置了更多的低密度脂蛋白受体，并将低密度脂蛋白从循环中拉出。
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Dr. Peter Attia:
彼得·阿蒂亚博士：
That's what lowers the LDL in the circulation.
这就是降低循环中低密度脂蛋白的原因。
So again, nine statins in use today.
今天再次使用九种他汀类药物。
We typically use four of them.
我们通常使用其中四个。
The side effect profile, contrary to all the statin-hating propaganda out there, very benign.
与所有讨厌他汀类药物的宣传相反，其副作用非常良性。
Right?
正确的？
5% of people experience muscle soreness, which reverses upon cessation.
5% 的人会出现肌肉酸痛，停止服用后这种情况会消失。
Andrew Huberman:
安德鲁·休伯曼：
Cognitive effects?
认知效应？
Dr. Peter Attia:
彼得·阿蒂亚博士：
Again, in terms of actual comparing it at a placebo, no effect whatsoever.
同样，就与安慰剂的实际比较而言，没有任何效果。
Right?
正确的？
So does that mean that you put a patient on it, they won't complain of something?
那么这是否意味着你让病人使用它，他们就不会抱怨什么？
No. But if you look at clinical trials, there's no evidence whatsoever that statins impair cognition.
不会。但如果你看一下临床试验，就会发现没有任何证据表明他汀类药物会损害认知。
There's also no evidence in clinical trials that they accelerate the risk of neurodegenerative disease.
临床试验中也没有证据表明它们会增加患神经退行性疾病的风险。
In fact, it's the opposite.
事实上，事实恰恰相反。
Now there's a very nuanced case we make, Andrew, which is we'll look at patients with highly suppressed desmosterol levels.
安德鲁，现在我们提出一个非常微妙的案例，那就是我们将研究去氨甾醇水平高度抑制的患者。
We will back off.
我们会后退。
We do want to maintain desmosterol above a certain level because of some evidence that is still, I think, very preliminary, but enough for us that we say, "Why take the chance?
我们确实希望将去氨甾醇维持在一定水平之上，因为我认为一些证据仍然非常初步，但足以让我们说，“为什么要冒险？
We have so many other tools to lower cholesterol.
我们有很多其他工具来降低胆固醇。
Why would we over-suppress synthesis in a susceptible individual?" So the next tool you look at is a drug that blocks the absorption or the reabsorption of cholesterol.
为什么我们要过度抑制易感个体的合成？”因此，您要考虑的下一个工具是阻止胆固醇吸收或重吸收的药物。
Remember that Niemann-Pick C1-like one transporter?
还记得那种类似 Niemann-Pick C1 的运输机吗？
So that guy has a drug called ezetimibe that just mechanically blocks it.
那家伙有一种叫做依折麦布的药物，它可以机械地阻断它。
And that's why I mentioned earlier we measure all those sterols in people, so we also measure things called phytosterols, and the phytosterols give us an indication of how active that transporter is.
这就是为什么我之前提到我们测量人体中所有的甾醇，所以我们也测量称为植物甾醇的物质，植物甾醇让我们知道转运蛋白的活跃程度。
So the higher your phytosterols, the more likely you are to respond to ezetimibe.
因此，您的植物甾醇含量越高，您对依折麦布产生反应的可能性就越大。
Next class of drugs is a drug that blocks cholesterol synthesis, but only in the liver.
下一类药物是阻止胆固醇合成的药物，但仅限于肝脏。
So the statin does it globally.
所以他汀类药物在全球范围内发挥作用。
This other drug called bempedoic acid does it only in the liver.
另一种称为 bempedoic 酸的药物仅在肝脏中发挥作用。
So it has a very similar mechanism to statins, different enzyme.
所以它与他汀类药物有非常相似的机制，不同的酶。
Not quite as potent, but way fewer side effects.
虽然没有那么有效，但副作用却少得多。
So any patient that's having a response to statins that's adverse, we'll try this other thing.
因此，任何对他汀类药物有不良反应的患者，我们都会尝试其他方法。
Andrew Huberman:
安德鲁·休伯曼：
What's it called one more time?
再来一次叫什么？
Dr. Peter Attia:
彼得·阿蒂亚博士：
Bempedoic acid.
苯培多酸。
Andrew Huberman:
安德鲁·休伯曼：
Bempedoic acid.
苯培多酸。
Dr. Peter Attia:
彼得·阿蒂亚博士：
The most potent drug of the lot is the PCSK9 inhibitor.
该批次中最有效的药物是 PCSK9 抑制剂。
So PCSK9 is a protein that was discovered in the late '90s, I believe, is responsible for the degradation of LDL receptors.
所以我认为 PCSK9 是 90 年代末发现的一种蛋白质，负责 LDL 受体的降解。
This was first discovered in people who had a condition called familial hypercholesterolemia, or FH.
这是首先在患有家族性高胆固醇血症（FH）的人身上发现的。
So these are people that have incredibly high cholesterol.
这些人的胆固醇含量非常高。
Typically, their total cholesterol level is 300.
通常，他们的总胆固醇水平为 300。
Their LDL cholesterol is typically north of 200 milligrams per deciliter.
他们的 LDL 胆固醇通常超过每分升 200 毫克。
This is a disease that is defined by the phenotype, not the genotype.
这是一种由表型而非基因型定义的疾病。
So the phenotype has a very clear definition, which I basically just gave you.
所以表型有一个非常明确的定义，我基本上刚刚给了你。
The genotype is there's a million paths to get there.
基因型是有一百万条路径可以到达那里。
There's over 3,000 mutations that are known to produce that phenotype.
已知有 3,000 多种突变会产生这种表型。
This was discovered to be one of them.
这被发现是其中之一。
In people who had hyperfunctioning PCSK9, this protein was just constantly hammering and destroying the LDL receptors, and so their LDL would be huge, and by extension, their total cholesterol would be.
在 PCSK9 功能亢进的人中，这种蛋白质不断地打击和破坏 LDL 受体，因此他们的 LDL 会很大，推而广之，他们的总胆固醇也会很大。
So in 2006, Helen Hobbs and colleagues discovered an opposite group of population, people who had LDL cholesterol naturally of 10 to 20 milligrams per deciliter, which would be an ApoB of about 20 milligrams per deciliter and who never got heart disease.
因此，2006 年，Helen Hobbs 及其同事发现了一组相反的人群，他们的 LDL 胆固醇自然水平为每分升 10 到 20 毫克，ApoB 水平为每分升约 20 毫克，并且从未患过心脏病。
They were immune to heart disease no matter how long they lived.
无论他们活多久，他们都对心脏病免疫。
And they had the opposite.
而他们却恰恰相反。
They had hypofunctioning PCSK9.
他们的 PCSK9 功能低下。
And so that was 2006, the New England Journal of Medicine.
这就是 2006 年的《新英格兰医学杂志》。
That basically got a whole bunch of drug companies hot on the trail of producing a drug to mimic it.
这基本上让一大群制药公司热衷于生产模仿它的药物。
So now we have these antibodies and they're wildly effective.
现在我们有了这些抗体，而且它们非常有效。
Andrew Huberman:
安德鲁·休伯曼：
What percentage of your patients over 45 do you have on either a statin or on one of these other class of compounds?
在 45 岁以上的患者中，服用他汀类药物或其他一类化合物的患者所占的比例是多少？
Dr. Peter Attia:
彼得·阿蒂亚博士：
Well, often it's in combinations, and I would say 80%.
嗯，通常是组合，我想说 80%。
Andrew Huberman:
安德鲁·休伯曼：
Eight zero.
八零。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Well, you have to remember what our objective is.
好吧，你必须记住我们的目标是什么。
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Dr. Peter Attia:
彼得·阿蒂亚博士：
We're in the business of trying to make sure people live as long as possible.
我们致力于确保人们尽可能长寿。
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Dr. Peter Attia:
彼得·阿蒂亚博士：
And you have to take a worldview of this, right?
你必须对此有一个世界观，对吧？
What's the most prevalent cause of death globally?
全球最常见的死亡原因是什么？
Andrew Huberman:
安德鲁·休伯曼：
I'd say cardiovascular disease.
我想说的是心血管疾病。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah.
是的。
And how close is it?
距离有多近？
So the last year before COVID, COVID kind of messes up these numbers a little bit, but if you go to 2019, 18.6 million people died of heart disease.
因此，在新冠疫情爆发之前的最后一年，新冠疫情让这些数字有点混乱，但如果你到 2019 年，就会发现 1860 万人死于心脏病。
Number two, cancer, 10 million.
第二，癌症，一千万。
Nothing's in the zip code of atherosclerosis.
动脉粥样硬化的邮政编码中没有任何内容。
And if you remember what I just said, if you took everybody in their 20s and reduced them to a level of that of a child, you'd make ASCVD an orphan disease.
如果你还记得我刚才所说的话，如果你把每个 20 多岁的人都降低到儿童的水平，你就会让 ASCVD 成为一种孤儿病。
So the question is, can you do that-
所以问题是，你能做到吗-
Andrew Huberman:
安德鲁·休伯曼：
Why don't we hear more about this?
为什么我们没有听到更多有关此事的消息？
I realize there's some nuance.
我意识到有一些细微差别。
It's not straightforward.
这并不简单。
It's not as simple as saying, "Eat less cheese, red meat, and watch your LDL.
这并不像说“少吃奶酪、红肉，并注意你的低密度脂蛋白”那么简单。
Get on a statin." But why do we hear so little about ApoB in the general discussion?
服用他汀类药物。”但为什么我们在一般性讨论中很少听到有关 ApoB 的信息呢？
Social media is such a skewed landscape-
社交媒体是一个如此扭曲的景观——
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah
是啊
Andrew Huberman:
安德鲁·休伯曼：
...
...
as we know.
据我们所知。
People shouting into tunnels of varying clarity.
人们在不同清晰度的隧道中喊叫。
Some are beautiful bronze tunnels with clean walls, and others are sewer lines, right?
有些是美丽的青铜隧道，墙壁干净，有些是下水道，对吧？
And they all converge in the same place-
而且他们都汇聚在同一个地方——
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah
是啊
Andrew Huberman:
安德鲁·休伯曼：
...
...
right, as we know.
是的，据我们所知。
But why do we hear so little about this?
但为什么我们对此知之甚少呢？
I'm not on a statin, but now I'm beginning to think that maybe that might be a good idea to consider, one of these other compounds.
我没有服用他汀类药物，但现在我开始认为，考虑其他化合物之一也许是个好主意。
I don't know the last time I looked at my ApoB specifically.
我不知道上次具体查看我的 ApoB 是什么时候。
I'm guessing my physician did, but why don't we hear more about this?
我猜我的医生做到了，但为什么我们没有听到更多关于这方面的信息呢？
This sounds so important.
这听起来很重要。
It sounds like the most important conversation because all the hormone stuff and all the stuff about smoking and head injuries and ADHD and all the rest is irrelevant if you're dead, right?
这听起来像是最重要的对话，因为如果你死了，所有荷尔蒙的东西、所有关于吸烟、头部受伤、注意力缺陷多动症的东西都无关紧要了，对吧？
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah.
是的。
It's a great question.
这是一个很好的问题。
I don't think I have a great insight as to why this isn't more front and center.
我不认为我对为什么这不更重要和更中心有深刻的见解。
I think the bigger problem is why don't we even understand how to think about it.
我认为更大的问题是为什么我们甚至不明白如何思考它。
And there's a whole chapter in my book I'm working on that really gets to this problem of why aren't we looking at atherosclerosis in terms of treating the causative agent?
我正在写的书中有一整章真正解决了这个问题：为什么我们不从治疗致病因素的角度来看待动脉粥样硬化？
Instead, we look at modifying 10-year risk.
相反，我们着眼于修改 10 年风险。
So that's the fundamental difference between what I call Medicine 2.0 and Medicine 3.0.
这就是我所说的医学 2.0 和医学 3.0 之间的根本区别。
Medicine 2.0, which is what we're generally practicing today when it comes to ASCVD, says, "Look, we will treat you.
医学 2.0，也就是我们今天在 ASCVD 方面普遍采用的方法，说：“看，我们会治疗你。
We will lower that LDL cholesterol." They still don't talk about ApoB, but that's a very American thing.
我们将降低低密度脂蛋白胆固醇。”他们仍然不谈论 ApoB，但那是非常美国化的事情。
If you go outside of the United States, everybody's talking about ApoB.
如果您走出美国，每个人都会谈论 ApoB。
It's in the guidelines in Europe and Canada, everywhere else.
欧洲和加拿大以及其他地方的指导方针中都包含了这一点。
The United States is very stubborn on this, and it's due to a couple of really weird personalities in the lipid world.
美国对此非常顽固，这是由于脂质世界中有几个非常奇怪的人物。
But the paradigm is when your 10-year risk reaches 5%, when there's a 5% chance that you're going to have a heart attack, stroke, or die in the next 10 years, now it's time to treat you.
但典型情况是，当您的 10 年风险达到 5% 时，即您在未来 10 年内心脏病发作、中风或死亡的可能性为 5% 时，现在就该对您进行治疗了。
Medicine 3.0 says that's not the way to think about it.
医学 3.0 说这不是思考的方式。
You treat the causative agent.
您治疗病原体。
If there's a causative agent, you treat it.
如果有致病因素，就治疗它。
If blood pressure raises the risk of heart disease, you lower blood pressure.
如果血压会增加患心脏病的风险，您就需要降低血压。
If smoking raises the risk of something, you treat smoking.
如果吸烟会增加某种风险，你就治疗吸烟。
And the reason that the risk model is so bad when you're looking at 10-year risk is age is the biggest driver of risk.
当你考虑 10 年风险时，风险模型如此糟糕的原因是年龄是风险的最大驱动因素。
Bar none, right?
没有一个，对吧？
So if you take a 70-year-old with perfect lipids and perfect blood pressure and perfect everything, their 10-year risk of ASCVD is probably four to five times higher than the most unhealthy 30-year-old.
因此，如果你拿一个血脂和血压都完美的 70 岁老人来说，一切都完美的话，他们 10 年患 ASCVD 的风险可能比最不健康的 30 岁老人高四到五倍。
It's not even close.
还差得很远。
Andrew Huberman:
安德鲁·休伯曼：
Yeah.
是的。
It's a lot like eye disease.
这很像眼病。
There are exceptions, of course, but we always say that the biggest risk factor for going blind from glaucoma is being an older person, frankly.
当然也有例外，但坦率地说，我们总是说，因青光眼而失明的最大风险因素是年龄较大。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Right.
对。
So if you could identify what the risk factors are for glaucoma, imagine if the paradigm was we're only going to treat it when your risk of blindness reaches 5%, which isn't triggered until you're old enough anyway.
因此，如果您能确定青光眼的风险因素是什么，想象一下如果范例是我们只会在您失明的风险达到 5% 时才进行治疗，而这种情况直到您足够大时才会触发。
Wouldn't you rather know that when you're 30-
当你30岁的时候你难道不想知道吗-
Andrew Huberman:
安德鲁·休伯曼：
Absolutely
绝对
Dr. Peter Attia:
彼得·阿蒂亚博士：
...
...
and say, "Wait, if maybe being in the sun without sunglasses or using this type of eye drop or something like that has a negative impact, I would rather know that sooner." So that's the fundamental difference.
并说：“等等，如果不戴墨镜在阳光下或使用这种类型的眼药水或类似的东西会产生负面影响，我宁愿早点知道。”这就是根本的区别。
It's a philosophical difference with respect to prevention.
这是预防方面的哲学差异。
And I will acknowledge that in one element of prevention, I make no consideration.
我承认，在预防的一项要素中，我没有考虑。
I am only coming at this through the lens of the individual.
我只是从个人的角度来看待这个问题。
I am never coming at this through the lens of society.
我从来不会通过社会的视角来看待这个问题。
That makes my life easier, and it makes the problem I'm solving easier.
这让我的生活更轻松，也让我解决的问题更容易。
I don't have to answer the quality-adjusted life year problem.
我不必回答质量调整生命年问题。
I don't have to ask the question, is it economical to treat people at 30?
我不用问这个问题，30岁给人治病经济吗？
I don't know the answer to that question, but I also know that when you're trying to solve really complicated problems, the more you can simplify, the better.
我不知道这个问题的答案，但我也知道，当你试图解决非常复杂的问题时，你能简化得越多越好。
So I've just acknowledged openly not solving that.
所以我只是公开承认没有解决这个问题。
If you want to criticize me for it, that's fine.
如果你想批评我，那也没关系。
Let's be transparent.
让我们保持透明。
But all I care about is the person I'm sitting across from, and in that situation, it's really their decision if they can justify the cost of treatment.
但我关心的只是我对面的人，在这种情况下，他们是否能证明治疗费用是合理的，这实际上是他们的决定。
Andrew Huberman:
安德鲁·休伯曼：
An esoteric question and then a less esoteric question.
一个深奥的问题，然后是一个不太深奥的问题。
The esoteric question relates to something that I think is a little bit niche, but not necessarily so, which is peptides and stem cells and PRP.
这个深奥的问题与我认为有点小众但不一定如此的东西有关，即肽、干细胞和 PRP。
I don't want to go off on too much of a tangent on rehab, but I know you've done a number of posts on social media recently that were, I have to just tell you, are really thoughtful, and I really appreciate that you're willing to share your own tissue rehabilitation experience and point people to that because this is a landscape that a lot of people are in, and they don't know how to navigate it.
我不想在康复问题上偏离太多主题，但我知道你最近在社交媒体上发了很多帖子，我不得不告诉你，这些帖子真的很周到，我真的很感激你愿意分享你自己的组织康复经验，并向人们指出这一点，因为这是很多人所处的环境，他们不知道如何驾驭它。
And a mutual friend of ours, not to be named, sent me a text and said, "I'm going to be talking to Attia, and what do you know about studies on things like BPC 157?" This gastric peptide that anecdotally, again, anecdotally, people report getting injections of this in the shoulder, knee, et cetera, and feeling so much better, so much faster, but there really aren't good studies, controlled studies.
我们共同的一位不愿透露姓名的朋友给我发了一条短信，说：“我要和 Attia 谈谈，你对 BPC 157 等研究了解多少？”据说，人们在肩膀、膝盖等处注射了这种胃肽，感觉好多了，速度也快了，但确实没有好的研究、对照研究。
And you hear all the same sorts of things about platelet-rich plasma, PRP, which if someone tells you there are a lot of stem cells in them, they're lying.
你会听到关于富含血小板的血浆（PRP）的所有同样的事情，如果有人告诉你其中有很多干细胞，那么他们在撒谎。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah.
是的。
Andrew Huberman:
安德鲁·休伯曼：
There are not a lot of stem cells in them.
它们里面没有很多干细胞。
And you also hear about stem cells, which are not FDA approved, at least for most uses in this country, but certainly people are flying down to Colombia and getting injections and what is your understanding or experience with things like BPC 157 specifically?
您还听说过干细胞，它未经 FDA 批准，至少在这个国家的大多数用途上是这样，但人们肯定会飞到哥伦比亚进行注射，您对 BPC 157 等药物的理解或经验是什么？
Because peptides is a huge landscape.
因为肽是一个巨大的景观。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah.
是的。
Andrew Huberman:
安德鲁·休伯曼：
We should probably do a whole episode on peptides.
我们或许应该做一整集关于肽的内容。
Things like PRP.
像 PRP 这样的东西。
PRP is now approved for-- Women are getting injections of this into their ovaries to improve follicle count.
PRP 现已被批准用于——女性将其注射到卵巢中以改善卵泡数量。
We know this.
我们知道这一点。
People are getting injections of PRP into every tissue and organ in- Hell, men are getting injected into their penis, so I hear, for all sorts of reasons that are unclear to me.
人们正在将 PRP 注射到地狱里的每个组织和器官中——地狱，男人被注射到他们的阴茎中，所以我听说，出于各种我不清楚的原因。
What's the deal with PRP, BPC-157, and stem cells?
PRP、BPC-157 和干细胞有何关系？
Do you ever see interesting effects?
你见过有趣的效果吗？
Are you curious about these compounds?
您对这些化合物感到好奇吗？
Do you prescribe or direct people towards these?
您是否规定或指导人们这样做？
The FDA-approved ones, of course.
当然是 FDA 批准的。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah.
是的。
So short answer is I'm definitely curious about them and I'd love to see the work done, but I also think this is about as Wild Wild West as it gets.
所以简短的回答是，我对它们确实很好奇，我很乐意看到工作完成，但我也认为这就是狂野西部。
PRP less so, but certainly stem cells and peptides.
PRP 不太如此，但干细胞和肽肯定如此。
And I just think if you're going to do something without a clinical trial, you got to show up with a lot more data.
我只是认为，如果你打算在没有临床试验的情况下做某事，你就必须提供更多的数据。
Right?
正确的？
So let's use rapamycin as an example.
让我们以雷帕霉素为例。
Right?
正确的？
I'm a huge proponent of rapamycin, and you can say, "Well, Peter, how can you take or prescribe rapamycin for geroprotective effects when we do not have a human clinical trial demonstrating that it lengthens life?" And the answer is because I have 84 other pieces of data that all point in the same direction across every model organism going back more than a billion years.
我是雷帕霉素的大力支持者，你可以说，“好吧，彼得，当我们没有人体临床试验证明雷帕霉素可以延长寿命时，你怎么能服用或开出雷帕霉素来达到老年保护作用呢？”答案是因为我还有 84 条其他数据，这些数据在每个模型生物体中都指向同一个方向，可以追溯到 10 亿多年前。
And that's really different from Joey, Sammy, and Sally did this thing, and I think it works.
这与乔伊、萨米和莎莉所做的事情确实不同，我认为它有效。
And they just can't be compared.
而且它们根本无法比较。
Now, I have no idea if stem cells work.
现在，我不知道干细胞是否有效。
I have no idea if BPC-157 works.
我不知道 BPC-157 是否有效。
I have no idea, frankly, if PRP even works, though it might seem to have some efficacy in some indications.
坦率地说，我不知道 PRP 是否有效，尽管它似乎对某些适应症有一定的功效。
For example, maybe when it comes to early hair loss, maybe when it comes to certain joint issues.
例如，也许涉及到早期脱发，也许涉及到某些关节问题。
But the reality of it is I think we just have to accept the fact that everything we do has an opportunity cost, and that opportunity cost is sometimes financial, but I actually find a lot of times it's in time and effort and energy that goes into something.
但现实是，我认为我们必须接受这样一个事实，即我们所做的一切都有机会成本，而机会成本有时是财务上的，但我实际上发现很多时候，做某事需要时间、精力和精力。
Now, when I was waiting to get my shoulder surgery, this is an injury that I've had forever.
现在，当我等待肩部手术时，这是我永远的伤病。
Right?
正确的？
This injury was actually probably the greatest source of discomfort I had swimming the Catalina Channel the last time in 2009.
事实上，这次受伤可能是我 2009 年上次游泳卡塔利娜海峡时最大的不适来源。
So that tells you how long I've had this injury.
这可以告诉你我受伤多久了。
But I sort of knew at some point I'm going to have to have it fixed.
但我知道在某个时候我必须把它修好。
And I went down this rabbit hole like, "Hey, is there anything I can do to avoid having surgery?
我陷入了这个兔子洞，“嘿，我能做些什么来避免接受手术吗？
Would infusing a million stem cells into it work?" And in speaking with as many orthopedic surgeons as I could, the answer was kind of unambiguously no. And by the way, it doesn't mean you wouldn't feel better if I injected a bunch of stem cells into your shoulder.
将一百万个干细胞注入其中有用吗？”在与尽可能多的骨科医生交谈后，答案明确是否定的。顺便说一句，这并不意味着如果我向你的肩膀注射一堆干细胞，你的感觉不会好一点。
There are a lot of reasons that might make you feel better, just like there are a bunch of reasons you can feel better if somebody injects saline directly into your joint.
有很多原因可能会让您感觉更好，就像有人直接向您的关节注射生理盐水有很多原因可以让您感觉更好一样。
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah.
是的。
So the question is: Is it going to fix the underlying problem?
所以问题是：它能解决根本问题吗？
And if so, will it do so by what mechanism?
如果是的话，它会通过什么机制来实现？
So I'm pretty sure that if you took 1,000 people with my particular injury and injected them with stem cells, it wouldn't do a thing because of the nature of my injury.
所以我很确定，如果你给 1000 名患有我的特殊损伤的人注射干细胞，由于我受伤的性质，这不会有任何作用。
I had a complete labral tear.
我的盂唇完全撕裂。
Are there some injuries that might benefit from it?
是否有一些伤害可以从中受益？
Yeah, possible.
是的，有可能。
So the question is: How would you design the trial to narrow down your patient population correctly so that you might see a signal?
所以问题是：您将如何设计试验来正确缩小患者群体范围，以便您可以看到信号？
Because the other risk of doing a trial is you have too much of a heterogeneous patient population, you don't know what the heck you're really doing, and you get meaningless results.
因为进行试验的另一个风险是你有太多异质的患者群体，你不知道自己到底在做什么，并且得到毫无意义的结果。
You get a null result when in fact there's a small signal but you were underpowered to pick it up because you only had 10% of your patient population that was the right patient population to get that.
当实际上有一个很小的信号但您没有足够的能力来接收它时，您会得到一个空结果，因为您只有 10% 的患者群体是正确的患者群体来接收该信号。
So will we ever get there?
那么我们能到达那里吗？
I don't know because I don't see what the incentive is.
我不知道，因为我不明白动机是什么。
Right?
正确的？
You have people who are making money hand over fist doing procedures on the basis of I'm not sure what.
有些人靠拳头做程序赚钱，我不确定是基于什么。
What would their motivation or incentive be to sort of see this legitimized?
他们希望看到这一点合法化的动机或动机是什么？
You'd really have to be able to say, well, there really needs to be sort of a pharma angle to this.
你真的必须能够说，嗯，确实需要从制药的角度来看待这个问题。
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Dr. Peter Attia:
彼得·阿蒂亚博士：
It's sort of one of the wishes I had, right?
这也是我的愿望之一吧？
If I was a billionaire, I feel like the way I would probably waste all of my money would be running clinical trials on stuff nobody cared about.
如果我是亿万富翁，我觉得我可能会浪费所有的钱来对没人关心的东西进行临床试验。
Andrew Huberman:
安德鲁·休伯曼：
Yeah.
是的。
Dr. Peter Attia:
彼得·阿蒂亚博士：
It would just be-
那就只是——
Andrew Huberman:
安德鲁·休伯曼：
Likewise.
同样。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah.
是的。
Andrew Huberman:
安德鲁·休伯曼：
I would join you because that would be-- Yesterday we recorded a sit-down with somebody from Caltech who works on aggression and rage and other things related to that, and has identified peptides that are approved by the FDA for other reasons that seem to adjust anxiety, might even adjust aggression and pathologic aggression, and went off on to a long description of why none of these drugs exist on the market for the treatment of psychiatric illness, and yet probably would work.
我会加入你们，因为昨天我们记录了与来自加州理工学院的某人的一次坐下来，他致力于攻击性和愤怒以及与此相关的其他事情，并且已经确定了 FDA 出于其他原因批准的肽，这些肽似乎可以调整焦虑，甚至可能调整攻击性和病理性攻击，并继续详细描述为什么市场上没有这些药物用于治疗精神疾病，但可能会起作用。
And what's missing is a billionaire or a billion-dollar company that is willing to invest in something that very likely will work, but the market value isn't quite there, or it failed in a previous trial, and so no one wants to touch it with a 10-foot pole.
而缺少的是一位亿万富翁或一家价值数十亿美元的公司，他们愿意投资一些很可能会起作用的东西，但市场价值并不完全存在，或者在之前的试验中失败了，所以没有人愿意用 10 英尺长的杆子去碰它。
Hopefully, someone listening to this will be incentivized to provide this sort of a venue for the kind of work that we're talking about.
希望听到这个的人会受到激励，为我们正在谈论的工作提供这种场所。
I have to ask-
我得问——
Dr. Peter Attia:
彼得·阿蒂亚博士：
But I want to make one other point, Andrew, which is, to me, the problem with a lot of these things is it's a crutch.
但我想指出另一点，安德鲁，对我来说，很多这些东西的问题是它是一个拐杖。
It's sort of like what we talked about with like, "Hey, just fix my T, man, and everything's going to be fine." And it's like, no, that's just the beginning.
这有点像我们谈论的那样，“嘿，修好我的 T，伙计，一切都会好起来的。”就好像，不，这只是开始。
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Dr. Peter Attia:
彼得·阿蒂亚博士：
What I worry about when I see people who are clamoring for this stuff is a lot of times they don't realize that whether it's psychologically or otherwise, they sort of say, "Well, now that I've had this thing done, I don't have to do the hard work of the real rehab." If I've learned anything through my shoulder surgery, and I'm now three and a half months out.
当我看到那些大声要求这些东西的人时，我担心的是很多时候他们没有意识到，无论是心理上还是其他方面，他们都会说，“好吧，既然我已经完成了这件事，我就不必做真正康复的艰苦工作了。”如果说我从肩部手术中学到了什么的话，那我现在就只剩下三个半月的时间了。
Andrew Huberman:
安德鲁·休伯曼：
How does it feel?
感觉如何？
Dr. Peter Attia:
彼得·阿蒂亚博士：
Amazing.
太棒了。
Look, I still can't do a lot of stuff.
瞧，我还是做不了很多事情。
It's going to be a while.
这还需要一段时间。
I haven't even been able to shoot a bow yet, and it'll probably be a year before I'll go back to long dead hangs and heavy deadlifts.
我什至还没能拉弓，可能要一年后我才能回到长距离悬垂和大重量硬拉。
I don't know, maybe nine months, but I'm not there yet.
我不知道，也许九个月，但我还没到那一步。
But what I learned through a really amazing prehab and rehab process is Like you just got to do the work.
但我通过一个非常令人惊奇的预康复和康复过程学到的是，就像你只需要完成这项工作一样。
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Dr. Peter Attia:
彼得·阿蒂亚博士：
And it's freaking hard.
这太难了。
Shoulders are the most tedious, boring thing in the world.
肩膀是世界上最乏味、最无聊的东西。
Three days a week, I am doing-- Four days a week, I am doing one hour of just dedicated stuff for this shoulder that is super uncomfortable, super boring, super frustrating.
每周三天，我正在做——每周四天，我专门为这个肩膀做一小时的事情，这非常不舒服，超级无聊，超级令人沮丧。
But I have faith in the methodology, right?
但我对方法论有信心，对吗？
And I think a lot of people are saying, "Just shoot the stem cells into me, and I don't have to do any of that stuff." And the reality of it is, I think that's a very dangerous place to be.
我想很多人都在说，“只要将干细胞注射到我体内，我就不需要做任何事情了。”现实是，我认为那是一个非常危险的地方。
Andrew Huberman:
安德鲁·休伯曼：
Have you ever tried BPC-157?
您尝试过 BPC-157 吗？
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah, we tried it.
是的，我们尝试过。
Again, maybe seven, eight years ago, we had a bunch of patients ask about it.
再说一次，也许七、八年前，我们有一群病人问过这个问题。
So my view is, okay, I was pretty convinced that there was no safety downside to it.
所以我的观点是，好吧，我非常确信它没有安全方面的缺点。
So I was like, well, I wouldn't prescribe it to a patient unless I tried it myself.
所以我想，好吧，除非我自己尝试过，否则我不会给病人开这种药。
So me and another doc in the practice, Ralph, we did it for, I don't know, a couple of months.
所以我和另一位实习医生拉尔夫，我们做了几个月，我不知道。
I didn't notice a single thing.
我什么也没注意到。
Andrew Huberman:
安德鲁·休伯曼：
Hmm.
嗯。
Interesting.
有趣的。
Well, thank you for that.
嗯，谢谢你。
Shifting to a less esoteric, but-- and I think probably more important topic overall, metabolomics.
转向一个不那么深奥但我认为总体上可能更重要的主题：代谢组学。
We were talking about this before we sat down to record.
在我们坐下来录音之前我们正在讨论这个问题。
What is/what are metabolomics?
什么是代谢组学？
Why should we be thinking about them?
我们为什么要考虑他们？
I have some idea of what it might be about.
我大概知道它可能是关于什么的。
But most people, I think, are not thinking about metabolomics at all.
但我认为大多数人根本没有考虑代谢组学。
And for those that are, I'm sure they could learn more.
对于那些愿意的人，我相信他们可以学到更多。
So tell us about metabolomics and what you'd like to see more of in the world of metabolomics.
请告诉我们有关代谢组学的信息以及您希望在代谢组学领域看到更多内容。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah.
是的。
So omics is just the term that we use to describe the study of something.
所以组学只是我们用来描述某事物研究的术语。
So genomics, right, is the broad study of genes and proteomics, the broad study of proteins, and things like that.
因此，基因组学是对基因和蛋白质组学、蛋白质等的广泛研究。
So metabolomics is just study of metabolites.
所以代谢组学只是代谢物的研究。
And metabolites, unlike a lot of these other things, there are a relatively finite number of these things.
与许多其他物质不同，代谢物的数量相对有限。
Many of which are known, but some of which are not known.
其中许多是已知的，但也有一些是不为人所知的。
So glucose is a metabolite.
所以葡萄糖是一种代谢物。
Acetyl-CoA is a metabolite.
乙酰辅酶A是一种代谢物。
Lactate is a metabolite.
乳酸是一种代谢物。
And so the question is: what do we know about these things and how they work?
所以问题是：我们对这些东西了解多少以及它们如何运作？
And more importantly, what do we know about certain physiologic states and the metabolomic profile that results from them?
更重要的是，我们对某些生理状态以及由此产生的代谢组学概况了解多少？
So let's use two extreme examples, like exercise.
让我们举两个极端的例子，比如锻炼。
Everybody understands the data are unambiguously clear.
大家都明白，数据是明确无误的。
Exercise produces about the most favorable phenotype imaginable.
锻炼可以产生可以想象到的最有利的表型。
So if you wanted to take a genomics approach to understanding that, you might look at: is there a change in the genome when you exercise?
因此，如果您想采用基因组学方法来理解这一点，您可以看看：当您锻炼时，基因组是否发生变化？
And the answer is probably not, but maybe if you looked at the methylation patterns in epigenome, you could look at epigenomic studies.
答案可能是否定的，但也许如果你研究表观基因组中的甲基化模式，你可以看看表观基因组研究。
But you might instead look at the proteomic side of that.
但你可能会看看蛋白质组学的一面。
Like what is gene expression doing?
比如基因表达在做什么？
And there you would see a lot of changes.
在那里你会看到很多变化。
Well, what I don't think people are really understanding, although there was a very interesting paper that just came out two weeks ago that looks for novel metabolites that are changing, is there a huge signal in a metabolomic profile that looks different in the state of exercise versus non-exercise?
好吧，我认为人们并没有真正理解，尽管两周前刚刚发表了一篇非常有趣的论文，寻找正在变化的新代谢物，但代谢组学谱中是否存在一个巨大的信号，在运动状态与非运动状态下看起来不同？
Andrew Huberman:
安德鲁·休伯曼：
Mm.
嗯。
Dr. Peter Attia:
彼得·阿蒂亚博士：
And could that represent part of how exercise is transmitting its benefit through the body?
这是否可以代表运动如何通过身体传递其益处的一部分？
Andrew Huberman:
安德鲁·休伯曼：
Mm.
嗯。
Dr. Peter Attia:
彼得·阿蒂亚博士：
People always talk about the holy grail of metabolomics would be: can you find a pill to mimic exercise?
人们总是谈论代谢组学的圣杯是：你能找到一种模仿运动的药物吗？
And I think the answer to that question is going to be undoubtedly no, for a couple of reasons.
我认为这个问题的答案无疑是否定的，原因有几个。
One, even if you could mimic the longevity sort of lifespan parts of it, you could never mimic the health span parts of it.
第一，即使你可以模仿它的长寿部分，你也永远无法模仿它的健康寿命部分。
But what if you could do both, right?
但如果你能同时做到这两点呢？
What if there were small molecules that can replicate some of the protective benefits of exercise, and you could combine those with exercise?
如果有小分子可以复制运动的一些保护作用，并且可以将这些与运动结合起来，会怎么样？
What if those could be treatments for other disease states, like diabetes, things like that?
如果这些可以治疗其他疾病，例如糖尿病等，该怎么办？
So that's why I think this field of metabolomics is relatively untapped, and I think potentially the next sort of frontier.
这就是为什么我认为代谢组学领域相对尚未开发，并且我认为可能是下一个前沿领域。
Andrew Huberman:
安德鲁·休伯曼：
Speaking of frontiers, I hear a lot nowadays about GLP-1 and pharmacology that prescription drugs that mimic or increase GLP-1 directly.
说到前沿，我现在听到很多关于 GLP-1 和药理学的内容，即处方药可以直接模拟或增加 GLP-1。
Glucagon-like peptide.
胰高血糖素样肽。
People are talking about this as the blockbuster obesity drug.
人们将其视为重磅减肥药。
I haven't heard this much talk about a drug to adjust human body weight favorably since the discussions of fen-phen when I was in college.
自从我上大学时讨论芬芬以来，我还没有听到过这么多关于调节人体体重的药物的讨论。
And then, of course, fen-phen was pulled from the market because people were dying, not left and right, but enough people died that they pulled it from the market.
然后，当然，芬芬被从市场上撤下，因为人们正在死亡，而不是左或右，但死亡的人足够多，所以他们将其从市场上撤下了。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Which by the way, is an interesting story.
顺便说一句，这是一个有趣的故事。
It was the enantiomer that they chose to use that was the wrong enantiomer, and what it resulted in was-- God, I think it was like-
他们选择使用的对映异构体是错误的对映异构体，结果是——天啊，我想这就像——
Andrew Huberman:
安德鲁·休伯曼：
Some mitral valve collapse, disciple
有的二尖瓣塌陷，弟子
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah.
是的。
Was it MVP?
是MVP吗？
Yeah, it was something in the mitral valve.
是的，那是二尖瓣里的东西。
Yeah, I think the chordae tendineae were rupturing in the mitral valve.
是的，我认为二尖瓣的腱索破裂了。
And it was mostly young women, I think, were getting horrible pulmonary disease as a result of it, probably pulmonary hypertension or something like that.
我认为，大多数是年轻女性，因此患上了可怕的肺部疾病，可能是肺动脉高压或类似的疾病。
But there were two enantiomers of the drug, and had they just used the other one, this issue wouldn't have happened.
但该药物有两种对映体，如果他们只使用另一种，就不会出现这个问题。
And there was a stupid reason why they made the choice to use the one they did.
他们选择使用他们所做的那个有一个愚蠢的原因。
And it's one of those things where once you make the mistake, you're never going back.
这是一旦你犯了错误，你就永远不会回头的事情之一。
It's not like that company could say, "Okay, wait, we want a do-over, but we're going to do it with the right version." So it's a tragic outcome.
这家公司不会说：“好吧，等等，我们想要重来，但我们会用正确的版本来做。”所以这是一个悲惨的结果。
But you're absolutely right.
但你是绝对正确的。
I think the GLP-1 agonists have more efficacy, and for all intensity and for everything we can see, certainly seem safer.
我认为 GLP-1 激动剂具有更高的功效，并且对于所有强度和我们所看到的一切，看起来肯定更安全。
Andrew Huberman:
安德鲁·休伯曼：
Are you excited about them?
你对他们感到兴奋吗？
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah, I am.
是的，我是。
Yeah.
是的。
I think we're just seeing the tip of the iceberg.
我认为我们只看到了冰山一角。
They're not miracle drugs, right?
它们不是灵丹妙药，对吧？
They come with problems, right?
他们带着问题来，对吧？
Which is they're catabolic across the board.
也就是说，它们是全面分解代谢的。
So patients are losing fat, but they're losing muscle as well.
因此，患者在减少脂肪的同时，也在减少肌肉。
So-
所以——
Andrew Huberman:
安德鲁·休伯曼：
You just sent all the gym jockeys running from semaglutide and all.
你刚刚让所有的健身房骑师都远离索马鲁肽之类的。
That's all you have to say.
这就是你要说的。
All you have to say nowadays about something is that it's going to drop testosterone, lower fertility- Change someone's skin, hair, or nails, and it could extend life to being 250 years old and people are gone.
如今，关于某件事，你不得不说的就是它会降低睾丸激素，降低生育能力——改变某人的皮肤、头发或指甲，它可以将寿命延长到 250 岁，然后人们就会去世。
Humans are humans.
人类就是人类。
That's a neuroscience and psychology issue, not a biology medicine issue.
这是神经科学和心理学问题，而不是生物医学问题。
But I'm pleased to hear that you're excited by them because I hear a lot of excitement.
但我很高兴听到你对它们感到兴奋，因为我听到了很多兴奋。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah.
是的。
Andrew Huberman:
安德鲁·休伯曼：
I haven't heard anything disastrous about them.
我没有听说过他们有什么灾难性的事情。
Dr. Peter Attia:
彼得·阿蒂亚博士：
It takes a while to get people up to dose.
人们需要一段时间才能适应剂量。
So if you're looking at semaglutide, the dose that was studied, so they did a one-year trial, or maybe it was a little over that, maybe 60 weeks.
因此，如果你正在研究索马鲁肽，他们进行了为期一年的试验，或者可能比这个剂量稍长一些，可能是 60 周。
But it took about 16 weeks to get the patients comfortably up to 2.4 milligrams weekly, which was the dose that they ultimately stayed on.
但患者花了大约 16 周的时间才达到每周 2.4 毫克的剂量，这是他们最终坚持使用的剂量。
In our experience when we use it, we don't even usually go up to 2.4 milligrams.
根据我们的使用经验，我们通常甚至不会达到 2.4 毫克。
We can usually get enough benefit between one and two milligrams, and we usually move people along a little bit quicker.
我们通常可以在一到两毫克之间获得足够的益处，而且我们通常可以更快地让人们前进。
But we've definitely had our share of patients who can't tolerate it due to the nausea.
但我们确实有一些患者因为恶心而无法忍受。
Andrew Huberman:
安德鲁·休伯曼：
Interesting.
有趣。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Which might be part of how it's working, right?
这可能是它工作原理的一部分，对吧？
Is the sort of suppression of appetite, which if taken to an extreme, can produce nausea.
是一种抑制食欲的行为，如果达到极端，会产生恶心。
Andrew Huberman:
安德鲁·休伯曼：
Interesting.
有趣。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah, I think most of the effect of semaglutide is central, not peripheral.
是的，我认为索马鲁肽的大部分作用是中枢的，而不是外周的。
Andrew Huberman:
安德鲁·休伯曼：
Huh.
呵呵。
So I don't know.
所以我不知道。
I saw one paper that GLP-1 is acting both on cells in the periphery to cause gut distension in some ways, or sort of make people feel full through promotion of literally mechanoreceptors that make people feel as if their stomach is distended even though their stomach is empty, and then perhaps some central hypothalamic effects.
我看到一篇论文说，GLP-1 作用于外周细胞，以某种方式引起肠道扩张，或者通过促进机械感受器使人们感到饱足，即使胃是空的，也会让人感觉胃部扩张，然后可能会产生一些中枢下丘脑效应。
Is that what you think?
你是这么想的吗？
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah, I think it's doing...
是的，我认为它正在做...
I would bet 80% of it's in the hypothalamus.
我敢打赌 80% 都在下丘脑。
It is also improving insulin sensitivity in the periphery, but I don't think that that's accounting for much of its benefit.
它还可以改善外周的胰岛素敏感性，但我认为这并不能解释它的大部分好处。
Andrew Huberman:
安德鲁·休伯曼：
Super interesting.
超级有趣。
Dr. Peter Attia:
彼得·阿蒂亚博士：
And there's next gen versions of these that seem to be more long-lasting.
而且这些产品的下一代版本似乎更耐用。
So right now, if you look at coming off semaglutide, you're going to see a weight regain.
所以现在，如果你考虑停用索马鲁肽，你会看到体重反弹。
So there's newer versions that seem to preserve the weight loss even off the drug.
因此，更新的版本似乎即使不使用药物也能保持减肥效果。
Andrew Huberman:
安德鲁·休伯曼：
I see.
我明白了。
Dr. Peter Attia:
彼得·阿蒂亚博士：
So it begs the ultimate question, which is what's the total use case for this going to be?
因此，这就引出了一个终极问题：它的总用例是什么？
Is this going to be a drug you cycle on and off, or is it going to be a drug that a person has to stay on indefinitely?
这是一种可以循环使用的药物，还是一种必须无限期服用的药物？
And if so, will they become tachyphylactic?
如果是这样，他们会变得快速预防吗？
Will they gain a resistance to it?
他们会对此产生抵抗力吗？
So it's still super early days on these things.
所以这些事情现在还处于早期阶段。
Andrew Huberman:
安德鲁·休伯曼：
My hope is that it would be a little bit like the way that you described testosterone and estrogen therapies, that it would allow people to do more of the behavioral work that's absolutely required for health span and lifespan.
我的希望是，它会有点像你描述的睾酮和雌激素疗法的方式，它会让人们做更多的健康寿命和寿命绝对需要的行为工作。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yep.
是的。
And we've also seen on the flip side of that, you can cheat through semaglutide, right?
我们也看到了另一方面，你可以通过索马鲁肽作弊，对吗？
You can drink a lot of calories and sort of get around the drug.
你可以喝大量的卡路里并避开药物。
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Dr. Peter Attia:
彼得·阿蒂亚博士：
So, for example, we always encourage patients who want to lose weight to really just eliminate alcohol.
例如，我们总是鼓励想要减肥的患者真正戒酒。
That's the cheapest, easiest trick to lose weight.
这是最便宜、最简单的减肥方法。
And so if you're still drinking a lot of alcohol, which is incredibly caloric, and just drinking a lot of caloric stuff, we've seen that that's less...
因此，如果你仍然喝大量的酒精，这是令人难以置信的热量，并且只是喝大量热量的东西，我们发现那会更少......
This is just anecdotal with our patients, but we've seen that it's easier to get around the benefits of the drug that way.
这只是我们患者的轶事，但我们已经发现，通过这种方式更容易规避药物的好处。
Andrew Huberman:
安德鲁·休伯曼：
Interesting.
有趣。
I so appreciate your answers today.
我非常感谢您今天的回答。
First of all, they were incredibly thorough and pointed towards real-world application.
首先，它们非常彻底，并指向现实世界的应用。
I also just want to thank you more broadly for the work that you do, because obviously you have this incredible clinical experience and patient population that you work very closely with.
我还想更广泛地感谢您所做的工作，因为显然您拥有令人难以置信的临床经验和与您密切合作的患者群体。
But I see you really as one of the few, both clinicians, and I realize you're an MD.
但我确实认为您是为数不多的临床医生之一，而且我意识到您是一名医学博士。
Did you do a PhD as well?
你也读过博士学位吗？
No, but I consider you a scientist clinician.
不，但我认为你是一名科学家临床医生。
A clinician scientist is the appropriate wording of that, of course, in the way that you really still drill into studies in detail.
当然，“临床科学家”是最恰当的措辞，因为你实际上仍然深入研究细节。
I know a lot of clinicians, not all of them do that, for sure.
我认识很多临床医生，但肯定不是所有人都这样做。
And the fact that you're so hungry for the new incoming knowledge as well as the old literature.
事实上，你对新知识和旧文献都非常渴望。
So, it's an incredibly rich data set in that brain of yours, and I really appreciate you sharing it with us, both in your podcast, in the upcoming book, which I think that we'll certainly have you on here again in anticipation of that.
所以，这是你大脑中极其丰富的数据集，我真的很感谢你在你的播客和即将出版的书中与我们分享它，我认为我们肯定会再次邀请你在这里期待这一点。
But I know I and a ton of other people are really excited for the book and in the way that you approach social media and your podcast and going on podcasts.
但我知道我和很多其他人都对这本书以及你处理社交媒体和播客以及继续播客的方式感到非常兴奋。
So, thank you so much.
所以，非常感谢你。
I learned a ton.
我学到了很多。
I know everyone learned a ton.
我知道每个人都学到了很多东西。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Thanks, Andrew.
谢谢，安德鲁。
Great to be here, man.
很高兴来到这里，伙计。
Andrew Huberman:
安德鲁·休伯曼：
Thank you.
谢谢你。
Thank you for joining me today for my discussion with Dr. Peter Attia, all about the things that we can do in order to maximize our lifespan and health span.
感谢您今天与我一起与 Peter Attia 博士进行讨论，讨论我们可以做些什么来最大限度地延长我们的寿命和健康寿命。
I highly recommend people check out Dr. Attia's podcast, "The Drive." It is excellent, as you can imagine based on today's conversation, and it's easily available on Apple Podcasts, Spotify, Overcast, and Google.
我强烈建议人们查看 Attia 博士的播客“The Drive”。正如您今天的对话所想象的那样，它非常出色，并且可以在 Apple Podcasts、Spotify、Overcast 和 Google 上轻松获取。
Please also check out Dr. Attia's website.
另请查看 Attia 博士的网站。
It's peterattiamd.com.
这是 peterattiamd.com。
There you can find links to his podcast episodes, as well as a sign-up for his excellent weekly newsletter.
在那里您可以找到他的播客剧集的链接，以及订阅他精彩的每周时事通讯。
That newsletter provides terrific information related to health that anyone can benefit from.
该时事通讯提供了与健康相关的精彩信息，任何人都可以从中受益。
If you're learning from and/or enjoying this podcast, please subscribe to our YouTube channel.
如果您正在学习和/或喜欢此播客，请订阅我们的 YouTube 频道。
That's a simple, zero-cost way to support us.
这是支持我们的一种简单、零成本的方式。
Please also subscribe to the podcast on Spotify and Apple.
另请订阅 Spotify 和 Apple 上的播客。
And on both Spotify and Apple, you have the opportunity to leave us up to a five-star review.
在 Spotify 和 Apple 上，您都有机会给我们留下五星级的评价。
If you have questions or comments or suggestions about topics you'd like us to cover or guests you'd like us to interview on the Huberman Lab podcast, please put those in the comments section on YouTube.
如果您对您希望我们在 Huberman Lab 播客上报道的主题或采访嘉宾有疑问、意见或建议，请将这些问题放在 YouTube 的评论部分。
We do read all those comments, and we do take them to heart.
我们确实阅读了所有这些评论，并且确实将它们牢记在心。
Please also check out the sponsors mentioned at the beginning of today's podcast.
另请查看今天播客开头提到的赞助商。
And check out Momentous Supplements, our new partners in the supplement space, and check out Athletic Greens.
并查看我们在补充剂领域的新合作伙伴 Momentous Supplements，以及 Athletic Greens。
That's the best way to support this podcast.
这是支持这个播客的最佳方式。
If you're not already following us on social media, please do so.
如果您还没有在社交媒体上关注我们，请这样做。
We are hubermanlab on Twitter, and we are also hubermanlab on Instagram, and both places I cover science and science-related tools, some of which overlap with the content of the Huberman Lab podcast, but much of which is unique from the content covered on the Huberman Lab podcast.
我们在 Twitter 上是 hubermanlab，在 Instagram 上也是 hubermanlab，我在这两个地方都介绍了科学和科学相关工具，其中一些内容与 Huberman Lab 播客的内容重叠，但其中很多内容与 Huberman Lab 播客所涵盖的内容是独特的。
Again, that's hubermanlab on Instagram and hubermanlab on Twitter.
同样，这是 Instagram 上的 hubermanlab 和 Twitter 上的 hubermanlab。
Please also check out our Neural Network monthly newsletter.
另请查看我们的神经网络每月通讯。
This is a newsletter that has summaries of podcast episodes.
这是一份包含播客剧集摘要的时事通讯。
It also includes a lot of actionable protocols.
它还包括许多可操作的协议。
It's very easy to sign up for the newsletter.
订阅时事通讯非常容易。
You go to hubermanlab.com, click on the menu, go to Newsletter.
您访问 hubermanlab.com，单击菜单，转到新闻通讯。
You supply your email, but we do not share your email with anybody.
您提供您的电子邮件，但我们不会与任何人分享您的电子邮件。
We have a very clear and rigorous privacy policy, which is we do not share your email with anybody.
我们有非常明确和严格的隐私政策，即我们不会与任何人分享您的电子邮件。
And the newsletter comes out once a month, and it is completely zero cost.
而且简讯每月出一期，而且完全是零成本。
Again, just go to hubermanlab.com and go to the Neural Network Newsletter.
同样，只需访问 hubermanlab.com 并访问神经网络通讯。
I'd also like to point out that the Huberman Lab podcast has a clips channel.
我还想指出，Huberman Lab 播客有一个剪辑频道。
So these are brief clips, anywhere from three to 10 minutes, that encompass single concepts and actionable protocols related to sleep, to focus, interviews with various guests.
因此，这些都是简短的剪辑，从三到十分钟不等，包含与睡眠相关的单一概念和可操作的协议，重点是对不同嘉宾的采访。
We talk about things like caffeine, when to drink caffeine relative to sleep.
我们谈论诸如咖啡因之类的事情，以及相对于睡眠而言何时喝咖啡因。
Alcohol, when and how and if anyone should ingest it relative to sleep.
酒精，何时、如何以及是否有人应该在睡眠时摄入酒精。
Dopamine, serotonin, mental health, physical health, and on and on.
多巴胺、血清素、心理健康、身体健康等等。
All the things that relate to the topics most of interest to you.
与您最感兴趣的主题相关的所有内容。
You can find that easily by going to YouTube.
您可以通过访问 YouTube 轻松找到该内容。
Look for Huberman Lab clips in the search area, and it will take you there.
在搜索区域中查找 Huberman 实验室剪辑，它会带您到那里。
Subscribe, and we are constantly updating those with new clips.
订阅，我们会不断更新新剪辑。
This is especially useful, I believe, for people that have missed some of the earlier episodes, or you're still working through the back catalog of Huberman Lab podcasts, which admittedly can be rather long.
我相信，对于那些错过了一些早期剧集的人，或者您仍在浏览 Huberman Lab 播客的后台目录的人来说，这特别有用，诚然，这些目录可能相当长。
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。