Dr. Peter Attia: Improve Vitality, Emotional & Physical Health & Lifespan
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, his second time on the podcast.
今天，我的嘉宾是彼得·阿蒂亚博士，他第二次参加播客。
Dr. Peter Attia is a medical doctor who did his training at Stanford School of Medicine, Johns Hopkins School of Medicine, and the National Institutes of Health.
Peter Attia 博士是一名医生，曾在斯坦福大学医学院、约翰霍普金斯大学医学院和美国国立卫生研究院接受培训。
He is a world expert in all things related to healthspan, vitality, and longevity.
他是与健康、活力和长寿相关的所有领域的世界专家。
In this episode, we focused on many topics, focusing mainly, however, on healthspan and longevity and mental health.
在这一集中，我们关注了许多主题，但主要关注的是健康寿命、长寿和心理健康。
Healthspan and longevity, of course, relate to how long one lives, and Dr. Attia goes systematically through the seven major causes of death worldwide, beginning with cardiovascular disease and cerebrovascular disease, also cancer, also accident-related deaths, dementia, deaths of despair, and in every case explains the three or four major levers that one can employ in order to offset, that is, to prevent those major causes of death.
当然，健康寿命和寿命与人的寿命有关，阿提亚博士系统地介绍了世界范围内的七大死因，从心血管疾病和脑血管疾病开始，还有癌症、事故相关死亡、痴呆症、绝望死亡，并在每一种情况下解释了人们可以采用的三到四种主要手段来抵消，即预防这些主要死因。
What follows is an incredibly informative and actionable set of tools for anyone, male, female, young, or old.
接下来是一套信息丰富且可操作的工具，适合任何人，无论男性、女性、年轻人还是老年人。
He explains the behavioral, nutritional, supplementation-based, and prescription drug-based approaches that one can use in order to extend healthspan and longevity.
他解释了人们可以使用的行为、营养、补充剂和处方药方法来延长健康寿命和寿命。
Dr. Attia explains the key tests and markers that we should all pay attention to if our goal is to extend our healthspan, and how to do so while maximizing our vitality.
阿提亚博士解释了如果我们的目标是延长健康寿命，我们都应该注意的关键测试和标志物，以及如何在最大限度地提高我们的活力的同时做到这一点。
This is something that not a lot of people think about when they think about healthspan and longevity.
当考虑健康寿命和长寿时，很多人都没有想到这一点。
But as Dr. Attia illustrates for us, emotional health has everything to do with our physical health and vice versa.
但正如阿提亚博士向我们展示的那样，情绪健康与我们的身体健康息息相关，反之亦然。
And he shares quite openly about his own experiences in pursuing ways to improve emotional health and thereby healthspan, lifespan, and vitality.
他非常公开地分享了自己在寻求改善情绪健康从而延长健康、寿命和活力的方法方面的经验。
Dr. Attia is quite open about his own experiences exploring different practices to improve emotional health as ways not just to improve healthspan, longevity, and vitality, but of course, also to derive the most meaning and satisfaction from life.
阿蒂亚博士对自己探索改善情绪健康的不同实践的经验持开放态度，这些方法不仅可以延长健康寿命、长寿和活力，当然也可以从生活中获得最大的意义和满足感。
Throughout today's discussion, we also discussed Dr. Attia's newly released book, which is entitled "Outlive: The Science and Art of Longevity." This is a phenomenal book.
在今天的讨论中，我们还讨论了阿蒂亚博士新出版的书，书名为《长寿：长寿的科学与艺术》。这是一本非凡的书。
I've read it cover to cover now three times.
我已经从头到尾读了三遍了。
I have extensive notes written throughout.
我在全文中写下了大量的笔记。
And the book, of course, focuses on longevity and healthspan, and also has an extensive section on emotional health that gets quite detailed into Dr. Attia's personal experiences with emotional health and tools to improve emotional health that are very actionable for anybody to use.
当然，这本书的重点是长寿和健康寿命，并且还有关于情绪健康的广泛章节，其中非常详细地介绍了阿蒂亚博士在情绪健康方面的个人经历以及改善情绪健康的工具，这些工具对任何人来说都是非常可行的。
I think the best way for me to summarize my feelings about the book would simply be to read the back jacket quote, which I provided.
我认为总结我对这本书的感受的最好方法就是阅读我提供的背面夹克引言。
So I read, quote, "Finally, there is a modern, thorough, clear, and actionable manual for how to maximize our immediate and long-term health.
所以我读到，引用：“最后，有一本现代的、彻底的、清晰的、可操作的手册，指导如何最大限度地提高我们的近期和长期健康。
Firmly grounded in data and real-life conditions, this is the most accurate and comprehensive health guide published to date.
这是迄今为止发布的最准确、最全面的健康指南，以数据和现实生活条件为坚实基础。
'Outlive' is not just informative, it is important." And indeed, "Outlive" is an important book, as is the discussion that Dr. Attia so graciously provided us in today's episode.
《Outlive》不仅提供了丰富的信息，而且很重要。”事实上，《Outlive》是一本重要的书，阿蒂亚博士在今天的节目中慷慨地为我们提供的讨论也是如此。
"Outlive" is released on March 28th, 2023, and is available for pre-order prior to that date.
《Outlive》于 2023 年 3 月 28 日发行，并可在此日期之前预订。
You can find a link to where it's sold in the show note captions.
您可以在演出注释标题中找到其销售地点的链接。
Before we begin, I'd like to emphasize that this podcast is separate from my teaching and research roles at Stanford.
在开始之前，我想强调一下，这个播客与我在斯坦福大学的教学和研究角色是分开的。
It is, however, part of my desire and effort to bring zero cost to consumer information about science and science-related tools 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：
There is so much NFL on ESPN right now.
ESPN 上现在有很多 NFL 节目。
Monday Night Football, plus pre-game and post-game.
周一橄榄球之夜，以及赛前和赛后。
NFL Live, NFL Prime Time.
NFL 直播，NFL 黄金时间。
Everything you need to stay on top of every game, every week.
每周掌握每场比赛所需的一切。
Unbelievable.
难以置信。
And now NFL Network is on the ESPN app.
现在 NFL Network 已登陆 ESPN 应用程序。
More football, more coverage, more ways to watch.
更多足球比赛、更多报道、更多观看方式。
Football's on all season long on ESPN and streaming on the ESPN app.
ESPN 提供整个赛季的足球赛事直播，并通过 ESPN 应用程序进行直播。
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。
Dr. Attia, Peter, welcome back.
阿提亚博士，彼得，欢迎回来。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Thanks, man.
谢谢，伙计。
Good to be back and sounding better this time.
很高兴回来并且这次听起来更好了。
Andrew Huberman:
安德鲁·休伯曼：
Looking forward to talking about a number of important topics with you that you cover in your book.
期待与您讨论您在书中涉及的一些重要主题。
Maybe we could start off by trying to set the frame for what people should be thinking about in terms of vitality and especially longevity.
也许我们可以首先尝试为人们在活力尤其是长寿方面应该思考的问题设定一个框架。
Dr. Peter Attia:
彼得·阿蒂亚博士：
So I think you have to be mindful of how you define these terms.
所以我认为你必须注意如何定义这些术语。
And I'm not going to suggest that the way I define them is the only way or necessarily the best way, but I think from a clinical perspective, it's the way that makes the most sense to me, having thought about this for the better part of a decade.
我不会说我定义它们的方式是唯一的方式或必然是最好的方式，但我认为从临床角度来看，这对我来说是最有意义的方式，因为我已经思考了这十年的大部分时间。
So it involves some bifurcation between lifespan and healthspan.
因此，它涉及寿命和健康寿命之间的一些分歧。
Lifespan is very easy for people to understand.
寿命对于人们来说是很容易理解的。
It is binary.
它是二进制的。
You are alive or you are not alive.
你还活着，或者你已经死了。
And clearly part of longevity is about how long you live.
显然，长寿的一部分取决于你能活多久。
Now, I think for a lot of people, that tends to be where the discussion ends.
现在，我认为对于很多人来说，这往往是讨论结束的地方。
That tends to be the focus of it, right?
这往往是焦点，对吧？
It's sort of like longevity somehow implies living for 100 years, 120 years, something to that extent.
这有点像长寿在某种程度上意味着活100年、120年，或者某种程度的。
We talk a lot about maximum lifespan.
我们经常谈论最长寿命。
Even in laboratory experiments with mice, that's one of the metrics that's discussed is what's maximal lifespan of the animals?
即使在小鼠实验室实验中，讨论的指标之一就是动物的最大寿命是多少？
But there's an equally, if not slightly, I think, potentially more important part of longevity, which is healthspan.
但我认为，对于长寿来说，还有一个同样重要（如果不是稍微重要）的部分，那就是健康寿命。
And healthspan is squishier, and I think it requires some definition.
健康寿命则更加模糊，我认为它需要一些定义。
Now, the medical definition of healthspan is the period of time by which you are free from disability and disease.
现在，健康寿命的医学定义是您没有残疾和疾病的时间段。
I find that to be a not particularly helpful definition.
我发现这并不是一个特别有用的定义。
Because by that definition, you and I have the same health span today that we did 30 years ago.
因为根据这个定义，你我今天的健康寿命与 30 年前相同。
But I know you pretty well, you know me pretty well.
但我很了解你，你也很了解我。
Thirty years ago, we were twice the men we are now based on what we believe our health span is, right?
三十年前，我们的健康寿命是现在男性的两倍，对吗？
In terms of our cognitive function, our physical performance, and things like that.
就我们的认知功能、身体表现等等而言。
So I've clearly experienced the deterioration of my physical function, as I'm sure you have, going back to when you were a teenager, late teenager, early 20s, and I think that needs to be captured somehow in health span.
所以我清楚地经历了我的身体机能的恶化，我相信你也经历过，回到你十几岁、十几岁末、20岁出头的时候，我认为需要在健康跨度中以某种方式捕捉到这一点。
So the way I think of health span really is along these three dimensions: physical, cognitive, and emotional.
所以我对健康寿命的看法实际上是沿着这三个维度：身体、认知和情感。
Again, not necessarily suggesting that that's the only way to do it, but I do think that clinically it makes the most sense.
再说一次，并不一定表明这是唯一的方法，但我确实认为在临床上这是最有意义的。
And so therefore, anything that really becomes a question of longevity has to address all of these issues.
因此，任何真正成为长寿问题的事情都必须解决所有这些问题。
Lifespan, physical health beyond that of just straight up disability and disease, cognitive health independent of and separate from pathology such as dementia, and emotional health, which, of course, is by far the most complicated of all of these because we have no biomarkers for it.
寿命、超越直接残疾和疾病的身体健康、独立于痴呆等病理学的认知健康，以及情绪健康，当然，这是所有这些中最复杂的，因为我们没有生物标志物。
It's not like you can get a scan on somebody and determine the state of this.
你不可能对某人进行扫描并确定其状态。
But nevertheless, it's important, right?
但无论如何，这很重要，对吧？
And it dramatically factors into quality of life.
它极大地影响了生活质量。
Andrew Huberman:
安德鲁·休伯曼：
So with all of that in mind, what are the major exit points for people along the lifespan route?
那么考虑到所有这些，人们在生命周期中的主要出口点是什么？
So start with the binary one, dead or alive.
所以从二元的开始，死的还是活的。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah.
是的。
Andrew Huberman:
安德鲁·休伯曼：
Right?
对吗？
I think most everyone who's healthy would like to be alive rather than dead.
我认为大多数健康的人都希望活着而不是死。
So what are the typical ways that people exit from alive to dead, and how can people stay on the freeway of life, so to speak?
那么，人从生到死的典型方式有哪些，又如何才能在生命的高速公路上继续行驶呢？
Dr. Peter Attia:
彼得·阿蒂亚博士：
So this is, again, a great analysis.
所以这又是一个很好的分析。
We internally, in our practice, call this the death bar analysis.
在我们内部的实践中，我们将其称为死亡酒吧分析。
And it's a surprisingly trivial analysis that I'm just surprised the death bars aren't plastered front and center on every doctor's office.
这是一个令人惊讶的微不足道的分析，我只是惊讶死亡酒吧没有贴在每个医生办公室的前面和中间。
So if you simply just look at actuarial data, which are readily available through the CDC, and do a little bit of data manipulation and analysis, you can pretty quickly realize what the horsemen of death are.
因此，如果你只是查看精算数据（这些数据可以通过疾病预防控制中心轻松获得），并进行一些数据操作和分析，你就可以很快意识到死亡骑士是什么。
Because there's largely speaking kind of four horsemen of death.
因为基本上可以说是死亡四骑士。
The first and most consequential in terms of the numbers is the diseases of atherosclerosis.
就数字而言，第一个也是最重要的是动脉粥样硬化疾病。
So that's cardiovascular disease being the lion's share of that, but also cerebrovascular disease.
因此，心血管疾病占其中的大部分，但也有脑血管疾病。
So anything that has to do with atherosclerosis rises to the top.
因此，与动脉粥样硬化有关的任何事情都会上升到最重要的位置。
Now that's true in the United States, but it's even more true outside of the United States.
在美国确实如此，但在美国之外更是如此。
It's even more true globally.
在全球范围内更是如此。
So in other words, when you look at the relative difference between the number one cause of death in the US and number two, which is cancer, the gap is actually smaller in the US than globally.
换句话说，当你观察美国第一大死因和第二大死因癌症之间的相对差异时，你会发现美国的差距实际上比全球要小。
Globally, it's enormous.
从全球来看，这是巨大的。
We're talking about 18 to 19 million people a year that are dying of atherosclerotic cardiovascular disease in the world, whereas number two is cancer at about 11 million.
我们谈论的是世界上每年有 18 至 1900 万人死于动脉粥样硬化性心血管疾病，而排名第二的是癌症，约有 1100 万人。
Andrew Huberman:
安德鲁·休伯曼：
How does the number change when you include cerebrovascular disease?
当包括脑血管疾病时，数字会如何变化？
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah, it adds a bit to it.
是的，它增加了一点。
Cerebrovascular disease has-- largely speaking, you can die sort of through embolic events, which are the majority of them.
很大程度上来说，脑血管疾病可能会因栓塞事件而死亡，而栓塞事件占其中的大多数。
Those-
那些——
Andrew Huberman:
安德鲁·休伯曼：
Could you explain for people what embolic events are?
您能为人们解释一下什么是栓塞事件吗？
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah.
是的。
So taking a step back, what does the brain need more than anything?
那么退一步来说，大脑最需要的是什么？
It needs blood flow.
它需要血液流动。
Anything that interrupts blood flow to the brain that results in ischemia is devastating, and it's devastating in a more readily apparent fashion than virtually any other organ.
任何中断大脑血流而导致缺血的因素都是毁灭性的，而且其破坏性比任何其他器官都更明显。
So one way that that can happen is if a clot or disruption of blood flow occurs through obstruction of blood flow.
因此，可能发生这种情况的一种方式是，如果血流受阻而发生凝块或血流中断。
So that can occur through a clot.
所以这可以通过凝块发生。
So for example, if a person has atrial fibrillation and a blood clot gets festering in the right atrium and they happen to have a hole in between the atria of their hearts called a patent foramen ovale, and a clot goes from right to left, it can make its way up into the arterial circulation and happen that way, where you occlude blood flow.
举例来说，如果一个人患有心房颤动，并且血块在右心房溃烂，而他们的心房之间恰好有一个孔，称为未闭卵圆孔，并且血块从右向左流动，它可以进入动脉循环并以这种方式发生，从而阻塞血流。
The much more common way it occurs is the same way it occurs in the heart, which is you have plaque buildup, and that plaque becomes unstable.
它发生的更常见方式与心脏中发生的方式相同，即斑块堆积，并且斑块变得不稳定。
That plaque ruptures, and the rupture of that plaque results in an immediate attempt by the body to fix the problem.
斑块破裂，斑块破裂导致身体立即尝试解决问题。
But in doing so, it walls off the artery, meaning the blood flow distal to that point so that now blood is acutely being robbed of that.
但在这样做的过程中，它隔离了动脉，这意味着血液流向该点的远端，因此现在血液被急剧剥夺。
However, there are other ways that people can have this problem.
然而，人们还可以通过其他方式解决这个问题。
And so you have the whole hemorrhagic side of this.
所以你就有了整个出血的一面。
So you can have small blood vessels in the brain that will rupture as a result of high blood pressure, for example.
例如，大脑中的小血管可能会因高血压而破裂。
So hypertension factors into both sides of this equation, both in the heart and in the brain.
因此，高血压会影响这个等式的两边，包括心脏和大脑。
The majority of these are embolic, however.
然而，其中大多数是栓塞。
So don't quote me on this exactly, but call it four or five to one strokes result from an embolic phenomenon as opposed to a hemorrhagic phenomenon, a bleeding phenomenon.
因此，不要完全引用我的话，而是称其为四或五比一中风是由栓塞现象引起的，而不是出血现象，即出血现象。
Andrew Huberman:
安德鲁·休伯曼：
I don't want to take us too far off on a tangent, but as long as we're here talking about bleeds versus clots, what are some of the major risks for bleeds?
我不想离题太远，但只要我们在这里谈论出血与血栓，出血的主要风险是什么？
I know some people out there have genetic predispositions for being bleeders, as they're sometimes called, or clotters.
我知道有些人有出血的遗传倾向，有时也被称为“出血者”。
So things like factor V Leiden mutations, which can be exacerbated in women, for instance, by taking certain oral contraceptives.
比如莱顿因子 V 突变，女性服用某些口服避孕药后，这种突变可能会加剧。
And there's huge lists.
还有大量的清单。
If people are interested in them, they can look up what are the factors controlling bleeding and predispose people to being a clotter.
如果人们对它们感兴趣，他们可以查找控制出血和使人容易出现血栓的因素是什么。
But for the typical person out there who feels healthy but might do well to know whether or not they are predisposed to be a bleeder or a clotter, what sorts of things rise to the top of that list and that people might want to check into?
但对于那些感觉健康但可能最好知道自己是否容易出血或血栓的典型人来说，什么样的事情会成为最重要的事情，人们可能想要检查一下呢？
Dr. Peter Attia:
彼得·阿蒂亚博士：
Well, there might be two different things going on in that question.
嗯，这个问题可能有两种不同的情况。
But I think if your question is when we look at the subset of people who are at highest risk for hemorrhagic strokes, the far more germane question is not underlying coagulopathy.
但我认为，如果你的问题是当我们观察出血性中风风险最高的人群时，那么更密切的问题不是潜在的凝血病。
The far more germane question really comes down to blood pressure.
更密切的问题实际上归结为血压。
Blood pressure would be the first, second, and the third driver of that.
血压将是第一个、第二个和第三个驱动因素。
So hypertension is hands down the leading driver of hemorrhagic stroke phenomenon.
因此，高血压无疑是出血性中风现象的主要原因。
Andrew Huberman:
安德鲁·休伯曼：
Okay, so I'll just briefly interrupt and ask, since sometimes your recommendations deviate from the standards that one would find online or in the typical doctor's office, at what point do you get concerned?
好的，所以我只是简单地打断一下并询问，因为有时您的建议偏离了人们在网上或典型医生办公室找到的标准，您在什么时候会担心？
Dr. Peter Attia:
彼得·阿蒂亚博士：
Well, I actually find myself quite in line with the most recent available data on blood pressure.
嗯，实际上我发现自己与最新的血压数据非常一致。
And this has been-- obviously, this is a topic that's of high concern to any doctor who's taking care of patients, who even pays a fraction of attention to the available literature, which is that basically with each subsequent blood pressure trial, the data are becoming clearer and clearer that the more aggressively you manage blood pressure to be within the 120 over 80 range, the better.
显然，这是任何照顾病人的医生都高度关注的话题，他们甚至很少关注现有的文献，基本上在随后的每次血压试验中，数据都变得越来越清晰，你越积极地将血压控制在 120 到 80 的范围内，效果就越好。
So, there's a recent study that even looked at going from what used to be considered acceptable, which was 130 to 135, over 80 to 85.
因此，最近有一项研究甚至着眼于从过去被认为可以接受的范围（即 130 到 135，从 80 到 85）进行调整。
We used to basically say that's the first level of hypertension, and we would say, "Well, do you really need to be better than that?" And the answer turns out to be yes, you do.
我们过去基本上说这是高血压的第一级，我们会说，“那么，你真的需要比这更好吗？”答案是肯定的，你会的。
If you want to reduce heart attacks and strokes, it's better to be 120 over 80 than 135 over 85.
如果你想减少心脏病和中风的发生，最好是80岁以上120岁，而不是85岁以上135岁。
Now, this is a whole other rabbit hole that we don't need to go down, but it's a total obsession of mine, which is how do you measure a person's blood pressure?
现在，这是一个完全不同的兔子洞，我们不需要深入下去，但它完全是我的痴迷，这就是如何测量一个人的血压？
I think this is potentially, I'd have to give it thought, but honestly, I could say top three under-diagnosed fixable problems in the United States today, and probably globally.
我认为这是有可能的，我必须考虑一下，但老实说，我可以说当今美国乃至全球范围内三大未被诊断的可修复问题。
In other words, there are too many people walking around with high blood pressure who don't know it.
换句话说，有太多患有高血压的人却不自知。
And I think part of the problem is it's something that is mostly done in the doctor's office, and the readings that you get in the doctor's office can be often misleading.
我认为部分问题在于这主要是在医生办公室完成的，而你在医生办公室获得的读数往往会产生误导。
You've heard of this phenomenon of white coat hypertension.
您听说过这种白大衣高血压现象。
So you go to the doctor, your blood pressure is virtually never measured correctly in the doctor's office.
所以当你去看医生时，你的血压实际上在医生的办公室里从来没有被正确测量过。
Andrew Huberman:
安德鲁·休伯曼：
That cuff they put on and that-
他们戴上的手铐——
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah
是啊
Andrew Huberman:
安德鲁·休伯曼：
...
...
little squeeze bulb that's not accurate.
小挤压灯泡不准确。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah.
是的。
If you look at the rigor with which you need to measure a person's blood pressure, the right way to do it is the person has to be sitting like this for five minutes, doing nothing.
如果你看看测量一个人的血压需要的严格程度，正确的方法是这个人必须像这样坐五分钟，什么也不做。
Andrew Huberman:
安德鲁·休伯曼：
Okay, folks, so when you go to the doctors now, you don't let them take your blood pressure-
好吧，伙计们，所以当你现在去看医生时，不要让他们测量你的血压-
Dr. Peter Attia:
彼得·阿蒂亚博士：
Don't let them take your blood pressure out of the gate
不要让他们把你的血压带出大门
Andrew Huberman:
安德鲁·休伯曼：
...
...
until you've been sitting for five minutes.
直到你坐了五分钟。
And that doesn't include in the waiting room.
这还不包括候诊室。
Because if you walk from the waiting room-
因为如果你从候诊室走出来——
Dr. Peter Attia:
彼得·阿蒂亚博士：
Right, because then you get up and walk over.
是的，因为然后你站起来走过去。
Right
右
Andrew Huberman:
安德鲁·休伯曼：
Okay, so make them stand there.
好吧，那就让他们站在那里吧。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Right.
对。
So you want to be sitting there like this.
所以你想像这样坐在那里。
A manual cuff is better than an automated cuff, but not enough people use manual blood pressure.
手动袖带比自动袖带更好，但使用手动血压的人还不够多。
So a manual blood pressure means they put a cuff on you and they actually put a stethoscope on the brachial artery, and they're using the human ear to listen.
因此，手动血压意味着他们给你戴上袖带，实际上他们在肱动脉上放了一个听诊器，他们用人耳来听。
Which believe it or not, you would think a machine is better, but it's not.
不管你信不信，你会认为机器更好，但事实并非如此。
The machine can be misled by different sounds.
机器可能会被不同的声音误导。
Now, I don't want to suggest that automated cuffs are useless.
现在，我不想说自动袖口没有用。
They're not.
他们不是。
But when an automated cuff gives you an answer that is potentially suspect, always back it up with a manual.
但是，当自动袖带给出的答案可能令人怀疑时，请务必附上手册进行备份。
I'm pretty relentless about checking my blood pressure.
我非常坚持检查血压。
And so I'll do side to side manual versus automated every day, and there's easily a 10 to 15 point difference between them.
因此，我每天都会进行手动与自动的对比，它们之间很容易存在 10 到 15 点的差异。
Andrew Huberman:
安德鲁·休伯曼：
Maybe this is a silly question, but can people check their own blood pressure?
也许这是一个愚蠢的问题，但是人们可以检查自己的血压吗？
Dr. Peter Attia:
彼得·阿蒂亚博士：
Meaning manually?
手动的意思？
Andrew Huberman:
安德鲁·休伯曼：
Yeah.
是的。
Could I get a cuff and a bulb and learn how to do it?
我可以买一个袖带和一个灯泡来学习如何操作吗？
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah, I think so.
是的，我想是的。
I can do it, but honestly, I usually have my wife do it.
我可以做，但老实说，我通常让我的妻子做。
She's a nurse.
她是一名护士。
But it's not rocket science to check blood pressure.
但检查血压并不是什么复杂的事情。
I guarantee you there's a great video on YouTube that explains the physiology of it, and if you're willing to splurge on a good enough stethoscope and cuff.
我向你保证，YouTube 上有一个很棒的视频，可以解释它的生理学，如果你愿意花钱买一个足够好的听诊器和袖带的话。
The cuff I have is really easy to use.
我的袖带非常好用。
Once you put it on, it's in a single thing.
一旦你戴上它，它就变成了一件事情。
I'm squeezing the bulb and looking at the pressure gauge while I've got the stethoscope on my artery.
我将听诊器放在我的动脉上，同时挤压灯泡并查看压力表。
Andrew Huberman:
安德鲁·休伯曼：
Given the importance of blood pressure and this arteriosclerosis being at the top of the list of risks for dying, it seems to me it might be worth the expense.
考虑到血压的重要性以及动脉硬化是死亡风险的首要因素，在我看来，这可能是值得的。
What's a typical range of cost for the quality of a cuff like this, that looks like?
对于这样的袖带质量来说，典型的成本范围是多少？
Dr. Peter Attia:
彼得·阿蒂亚博士：
It's not an ordinance.
这不是法令。
I feel like my blood pressure cuff is $40, and the stethoscope is a couple of hundred bucks if you're getting a good one.
我觉得我的血压袖带是 40 美元，听诊器如果你买个好的，就几百美元。
And a good automated cuff, I have no affiliation with any of these companies.
还有一个很好的自动袖带，我与这些公司没有任何隶属关系。
I use two automated cuffs.
我使用两个自动袖带。
One's called Withings and the other one's made by a company called Omron, O-M-R-O-N.
一个叫做 Withings，另一个是由一家名为 Omron（O-M-R-O-N）的公司制造的。
And they're both decent, but again, they tend to run high, and I have yet to find a credible explanation from cardiologists as to why.
它们都很不错，但同样，它们往往会很高，我还没有从心脏病专家那里找到关于原因的可信解释。
Everybody acknowledges that the manual one, when done correctly, is the answer.
每个人都承认，如果操作正确，手动操作就是答案。
But I've heard wonky answers about why automated ones are sometimes incorrect.
但我听到过关于为什么自动化有时会出错的奇怪答案。
And again, it's just made me realize we're not checking blood pressure often enough on people.
再说一遍，这让我意识到我们没有足够频繁地检查人们的血压。
We're overly relying on blood pressures in the doctor's office, which are not being done correctly.
我们过度依赖医生办公室的血压测量，但测量方法并不正确。
So we basically have our patients do this relentlessly.
所以我们基本上让我们的病人坚持不懈地这样做。
Andrew Huberman:
安德鲁·休伯曼：
So how often-- Let's say someone buys this, because I think for $240, I realize that's prohibitive for some people, but given the cost of some of the other things that are discussed on this and many other podcasts-
那么，假设有人买这个，因为我认为 240 美元，我意识到这对某些人来说是令人望而却步的，但考虑到这个播客和许多其他播客中讨论的其他一些东西的成本，多久一次——
Dr. Peter Attia:
彼得·阿蒂亚博士：
First of all, I would just have people start with an automated cuff to begin with.
首先，我会让人们从自动袖带开始。
Andrew Huberman:
安德鲁·休伯曼：
Okay
好的
Dr. Peter Attia:
彼得·阿蒂亚博士：
And just start with there.
从那里开始。
We generally have people do it for two weeks.
我们通常让人做两周。
We give our patients a little spreadsheet that automatically calculates averages and stuff like that, tells them what to record and where.
我们为患者提供了一个小电子表格，可以自动计算平均值之类的东西，告诉他们要记录什么以及在哪里记录。
And we just say, "Look, for two weeks, we want to see two recordings a day.
我们只是说，“看，两周以来，我们希望每天看到两个录音。
And do a morning and an afternoon/PM recording twice a day for two weeks, and let us see those numbers, and we'll scrutinize them further.
并在两周内每天两次进行上午和下午/下午的记录，让我们看到这些数字，我们将进一步审查它们。
And if those numbers come in fine, let's revisit in a year."
如果这些数字没有问题，我们一年后再来讨论。”
Andrew Huberman:
安德鲁·休伯曼：
Will a day ever come when a watch or a wristband can do this really well?
有一天，手表或腕带能真正做到这一点吗？
Dr. Peter Attia:
彼得·阿蒂亚博士：
So, I hope so, and I'm investigating it.
所以，我希望如此，我正在对此进行调查。
I'm actually Going to be trying one out in a couple of weeks with a company that I tried two years ago.
实际上，我将在几周内与我两年前尝试过的一家公司一起尝试一个。
Two years ago, when I tried it, I was not impressed, so I kind of punted on it.
两年前，当我尝试它时，我并没有留下深刻的印象，所以我有点押注它。
The company, which I guess I'll not share the name of the company just yet, but they claim that it's significantly better.
该公司，我想我暂时不会透露该公司的名称，但他们声称它明显更好。
So I'm going to put it to the test again, and it's basically a continuous monitor.
所以我要再次对其进行测试，它基本上是一个连续监视器。
So it's a wrist device that about every 15 minutes throughout the course of the day will check your blood pressure.
因此，它是一款腕式设备，全天大约每 15 分钟就会检查一次您的血压。
To me, this would be honestly probably more important.
对我来说，老实说这可能更重要。
You know how much emphasis I place on CGM as a great thing to be able to test.
你知道我有多强调 CGM 是一件值得测试的好东西。
Andrew Huberman:
安德鲁·休伯曼：
Continuous glucose monitoring.
连续血糖监测。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Right.
对。
I would argue this would be more important.
我认为这会更重要。
When the day comes that we can continuously assess people's blood pressure, it would be an integral part of a person's health checkup once a year is do two weeks of continuous blood pressure monitoring.
当有一天我们可以连续评估人们的血压时，每年一次的连续两周的血压监测将成为一个人健康检查的一个组成部分。
Right now, to do that, which I've done as well, is so cumbersome that it borders on absurd.
现在，这样做（我也这样做过）是如此麻烦，以至于近乎荒谬。
You actually have to wear a blood pressure cuff that is attached to a clumsy device that goes through the whole insufflation exercise every 15 minutes, including while you're sleeping.
实际上，您必须佩戴血压袖带，该袖带连接到一个笨拙的设备上，该设备每 15 分钟进行一次整个吹气练习，包括在您睡觉时。
It provides some insight, but it's so disruptive that it's not what we really want.
它提供了一些见解，但它具有破坏性，因此不是我们真正想要的。
The dream would be like a patch that you could put, I don't know, over your chest that can somehow impute changes in blood flow or something like that and regulate.
梦想就像一个贴片，我不知道，你可以把它贴在你的胸口上，它可以以某种方式反映血流的变化或类似的东西并进行调节。
But we'll see.
但我们会看到。
Between optical sensors and things like that, I hope that we're getting closer to having something.
在光学传感器和类似的东西之间，我希望我们离拥有一些东西越来越近。
Andrew Huberman:
安德鲁·休伯曼：
So I don't want a stroke.
所以我不想中风。
I don't want to bleed in the brain.
我不想让大脑流血。
I don't want to clot.
我不想凝结。
As long as we're at this number one on the list, arteriosclerosis being the number one killer, what are the major ways to prevent it?
只要我们排在第一位，动脉硬化是头号杀手，那么预防它的主要方法是什么？
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah.
是的。
So there's three big ones that stand out top and center, and then there's kind of a fourth one that I think is the foundational piece.
因此，有三个大的部分在顶部和中间突出，然后是第四个，我认为这是基础部分。
So the three big ones we've talked about, one, blood pressure.
我们谈到的三大问题，一是血压。
So if your blood pressure is 120 over 80 or better, that's important.
因此，如果您的血压为 120 高于 80 或更高，那就很重要了。
The second is not smoking.
第二是不吸烟。
So it turns out that smoking and blood pressure are both devastating for arteries but for different reasons.
事实证明，吸烟和血压都会对动脉造成破坏，但原因不同。
Right?
正确的？
So smoking is devastating from a chemical perspective.
因此，从化学角度来看，吸烟具有破坏性。
So it's completely irritating to the endothelium.
所以它完全刺激内皮细胞。
So the endothelium, as you know, is the single cell lining that is the innermost part of the arterial and arterial wall.
因此，如您所知，内皮是单细胞衬里，是动脉和动脉壁的最里面的部分。
So this is a pretty special organ.
所以这是一个非常特殊的器官。
Again, it's a bit naive but understandable that people just think of arteries as tubes.
再说一遍，人们只是将动脉视为管道，这有点天真，但可以理解。
They're much more complicated than that.
它们比这复杂得多。
They have many layers to them.
他们有很多层次。
But this particular layer is unusually important.
但这个特定的层异常重要。
It has an outsized importance because it is the one that's in contact with the luminal side, right, where the blood is flowing in the tube, and anything that injures that has significant consequences.
它具有极其重要的意义，因为它与管腔一侧（右侧）接触，血液在管中流动，任何受伤都会产生严重后果。
So smoking is irritating to that in a chemical way, and blood pressure is irritating to that in a mechanical way.
因此，吸烟以化学方式刺激它，而血压以机械方式刺激它。
So those two things basically that's the low-hanging fruit in my world, right?
所以这两件事基本上就是我世界中唾手可得的成果，对吧？
You just don't want to have those things causing irritation to the endothelium because that renders you now susceptible to the third factor, which is ApoB-bearing lipoproteins.
您只是不想让这些东西刺激内皮细胞，因为这会使您现在容易受到第三个因素的影响，即携带 ApoB 的脂蛋白。
Andrew Huberman:
安德鲁·休伯曼：
I want to talk about ApoB in depth, but as long as don't smoke is the second recommendation on the list, can we better define smoking and what's being smoked?
我想深入谈谈ApoB，但只要不吸烟是清单上的第二个建议，我们是否可以更好地定义吸烟以及吸烟的内容？
So assume nicotine for-
所以假设尼古丁用于-
Dr. Peter Attia:
彼得·阿蒂亚博士：
Right
右
Andrew Huberman:
安德鲁·休伯曼：
...
...
what about cannabis, and what about vaping of nicotine and cannabis?
大麻怎么样？尼古丁和大麻的电子烟怎么样？
Because vaping has become so much more common.
因为电子烟已经变得越来越普遍。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah.
是的。
It's a great question, and it's sadly something we don't have a great answer for.
这是一个很好的问题，但遗憾的是我们没有一个很好的答案。
So I can certainly tell you that there's no reason to believe that smoking cannabis is somehow better than smoking cigarettes.
所以我可以肯定地告诉你，没有理由相信吸大麻在某种程度上比吸香烟更好。
But the dose seems to be significantly lower.
但剂量似乎显着降低。
In other words, let's consider a person who smokes a pack a day for 20 years.
换句话说，我们假设一个人每天吸一包烟，持续了 20 年。
We call that a 20-pack-year smoker.
我们称其为年吸烟 20 包的吸烟者。
Someone who smokes two packs a day for 15 years is a 30-pack-year smoker.
每天吸两包烟长达 15 年的人是一个年吸 30 包烟的人。
That's a person who's dramatically increased their risk of many cancers, including lung cancer, and also their risk of cardiovascular and cerebrovascular disease.
这样的人患多种癌症的风险显着增加，包括肺癌，以及心脑血管疾病的风险。
Again, I'm not a THC guy, so I can't necessarily speak for the habits of people that are smoking marijuana.
再说一次，我不是 THC 人，所以我不一定能代表吸食大麻的人的习惯。
I can't imagine they're smoking that much.
我无法想象他们抽烟那么多。
Andrew Huberman:
安德鲁·休伯曼：
Probably not.
可能不会。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah.
是的。
So while on a joint to cigarette basis, they're probably equivalent in terms of harm.
因此，虽然就香烟和香烟而言，它们的危害可能是相当的。
I don't know.
我不知道。
Let's say a person smokes a joint a day.
假设一个人每天吸一支烟。
That would be like smoking a cigarette a day.
这就像每天吸一支烟一样。
That's a 20th of a pack.
这是一包 20 个。
Again, I don't want to say that there's no downside to that, but it's probably significantly less.
再说一次，我不想说这没有缺点，但它可能要少得多。
So I don't think the risk fully tracks.
所以我认为风险并未完全追踪。
I think the same is probably true for vaping.
我认为电子烟可能也是如此。
And I want to be clear, I don't think vaping is a good idea.
我想澄清的是，我不认为电子烟是一个好主意。
The last time I looked at the data on this, it was surprisingly sparse, but to me, the only advantage I could see to vaping was if it was the only way a person would stop smoking.
上次我查看这方面的数据时，数据出人意料地稀疏，但对我来说，我能看到电子烟的唯一优势是，如果这是一个人戒烟的唯一方法。
So I sort of looked at it as it was definitely the lesser of two evils, but by far the better scenario was not to do any of these things.
所以我认为这绝对是两害相权取其轻，但到目前为止更好的情况是不做任何这些事情。
If nicotine is what you're after, there are better ways to get nicotine, for example, through lozenges and gum and things like that.
如果您想要尼古丁，那么有更好的方法来获取尼古丁，例如通过含片和口香糖之类的东西。
So you shouldn't be turning to those things to do it, but if it was like if gum is here and cigarettes are here, vaping was probably here.
所以你不应该求助于这些东西来做到这一点，但是如果就像口香糖在这里并且香烟在这里一样，那么电子烟可能就在这里。
But boy, I don't know.
但是孩子，我不知道。
Andrew Huberman:
安德鲁·休伯曼：
For those listening, Peter spaced his hands far apart for gum and smoking and put vaping about a third of the way from gum ...
对于那些听的人来说，彼得将双手分开很远的距离来吸口香糖和吸烟，并将电子烟放在口香糖的三分之一处......
toward smoking.
走向吸烟。
In other words, vaping isn't good for you, but it's not as bad as smoking.
换句话说，电子烟对你没有好处，但也没有吸烟那么糟糕。
Dr. Peter Attia:
彼得·阿蒂亚博士：
That would be my-- You've probably looked into this as well.
那是我的——你可能也研究过这个。
What are your views on this?
您对此有何看法？
Andrew Huberman:
安德鲁·休伯曼：
Yeah, we did an episode on nicotine.
是的，我们做了一集关于尼古丁的节目。
I did an episode on cannabis, and the discussion around cannabis gets a little contentious for reasons that aren't important.
我做了一集关于大麻的节目，围绕大麻的讨论由于一些不重要的原因而引起了一些争议。
It's kind of funny.
这有点好笑。
The moment someone starts to confront cannabis as a potential health harm, people say it's not nearly as bad as alcohol, which is a crazy argument, right?
当有人开始将大麻视为潜在的健康危害时，人们会说它远没有酒精那么糟糕，这是一个疯狂的论点，对吧？
Getting hit by a bus isn't nearly as bad as getting hit by a motorcycle in most cases, but sometimes.
在大多数情况下，被公共汽车撞到并不像被摩托车撞到那么严重，但有时却如此。
So that's just kind of silly.
所以这有点愚蠢。
And clearly, cannabis has medical applications.
显然，大麻具有医疗用途。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah.
是的。
Andrew Huberman:
安德鲁·休伯曼：
Clearly.
显然。
And then it becomes an issue of the ratio of THC to CBD.
然后就变成了 THC 与 CBD 的比例问题。
Pure CBD forms actually being quite effective for the treatment of certain forms of epilepsy.
纯 CBD 形式实际上对于治疗某些形式的癫痫症非常有效。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah.
是的。
Andrew Huberman:
安德鲁·休伯曼：
So-called Charlotte's Web.
所谓的夏洛特的网。
That's actually what it's called.
这实际上就是它的名字。
Very high THC-containing cannabis clearly predisposes, especially young males, to later onset psychosis.
含有非常高的四氢大麻酚（THC）的大麻显然容易导致晚发性精神病，尤其是年轻男性。
Those data are starting to become clear.
这些数据开始变得清晰。
Clear enough, to me anyway, that people ought to be aware of them, at least, and maybe make decisions on the basis of those.
无论如何，对我来说，很清楚的是，人们至少应该意识到它们，并可能在此基础上做出决定。
When it comes to the smoking versus vaping, it's just very apparent that the chemical constituents of the vape and what people are inhaling are terrible for people and are loaded with carcinogens and a bunch of other stuff, many of which cross the blood-brain barrier.
当谈到吸烟与电子烟时，很明显，电子烟的化学成分和人们吸入的物质对人来说很糟糕，并且含有致癌物质和许多其他物质，其中许多物质可以穿过血脑屏障。
So that's what worries me the most.
所以这是我最担心的。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Mm-hmm.
嗯嗯。
Andrew Huberman:
安德鲁·休伯曼：
Obviously, I'm not a clinician, but anytime I hear about small molecules, these small inorganic molecules getting across the blood-brain barrier and then being maintained in neurons for many years, I worry because the experiment is ongoing mostly in young people.
显然，我不是临床医生，但每当我听到小分子，这些无机小分子穿过血脑屏障，然后在神经元中保留多年，我都会担心，因为该实验主要在年轻人中进行。
So anyway, without going too far down that track, I think if people can avoid smoking and vaping, they should.
所以无论如何，在不走得太远的情况下，我认为如果人们可以避免吸烟和电子烟，他们就应该这样做。
And as you mentioned, there are other delivery devices for nicotine and cannabis.
正如您所提到的，还有其他尼古丁和大麻的输送装置。
Tinctures-
酊剂-
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah
是啊
Andrew Huberman:
安德鲁·休伯曼：
...
...
and patches and gums and things, edibles, that if people choose to use those substances, they can offset.
还有贴剂、口香糖和其他东西、食品，如果人们选择使用这些物质，它们就可以抵消。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah.
是的。
I think sometimes people would benefit to imagine what the surface area of the lung is.
我认为有时人们可以想象一下肺部的表面积是多少。
Right?
正确的？
If you took the alveolar air sacs of the lungs and spread them out, you would easily cover a tennis court.
如果你把肺部的肺泡气囊展开并展开，你可以轻松地覆盖一个网球场。
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Remarkable.
卓越。
Dr. Peter Attia:
彼得·阿蒂亚博士：
So-
所以——
Andrew Huberman:
安德鲁·休伯曼：
Yeah
是啊
Dr. Peter Attia:
彼得·阿蒂亚博士：
...
...
just think about any time you inhale something, your body is so adept at absorbing it.
想想看，每当你吸入某种东西时，你的身体就非常善于吸收它。
We have this unbelievable system for gas exchange that was designed for gas exchange, and any time you're putting something else in that way, you're doing a really good job of getting it into your body.
我们有这个令人难以置信的气体交换系统，它是为气体交换而设计的，每当你以这种方式放入其他东西时，你就可以很好地将其进入你的身体。
So be mindful of what that is.
所以要注意那是什么。
And look, that applies to pollution, too.
看，这也适用于污染。
The PM2.5 data is pretty good.
PM2.5数据还不错。
So particulates that are less than 2.5 microns are getting straight into the body, which is a great argument for avoiding air pollution.
因此，小于 2.5 微米的颗粒物会直接进入人体，这是避免空气污染的一个很好的论据。
Right?
正确的？
I always find it funny.
我总觉得很有趣。
Not to get off on this tangent, but to me, the most compelling arguments around cleaner energy have nothing to do with greenhouse gases.
并不是要偏离这个主题，但对我来说，围绕清洁能源最引人注目的论点与温室气体无关。
They have to do with air pollution.
它们与空气污染有关。
Andrew Huberman:
安德鲁·休伯曼：
Mm.
嗯。
Dr. Peter Attia:
彼得·阿蒂亚博士：
I promise you, more people are dying from the particulate matters in air that result from burning coal than are ever going to die from the CO2 emissions that result from that.
我向你保证，死于燃烧煤炭所产生的空气中颗粒物的人比死于燃烧煤炭所产生的二氧化碳排放的人还要多。
And I would argue that's going to be two orders of magnitude.
我认为这将是两个数量级。
It's not even in the same zip code.
甚至不在同一个邮政编码中。
Andrew Huberman:
安德鲁·休伯曼：
That makes sense.
这是有道理的。
During the fires, which seem to follow me, because when I was in Northern California there were a bunch of fires, and we were constantly looking.
在火灾期间，它似乎跟随我，因为当我在北加州时，有很多火灾，我们一直在寻找。
You'd wake up in the morning, everything was covered with ash.
早上醒来，一切都被灰烬覆盖。
My dog was having trouble breathing.
我的狗呼吸困难。
I was having trouble breathing.
我呼吸困难。
Everyone was suffering.
每个人都在受苦。
But there are websites that one can go.
但有些网站可以访问。
You can just look at air pollution.
你可以看看空气污染情况。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah.
是的。
Andrew Huberman:
安德鲁·休伯曼：
And we tend to only do this during fires.
我们往往只在发生火灾时才这样做。
And then when I'm in Southern California, there tend to be fires here.
当我在南加州时，这里往往会发生火灾。
So it's correlation, not causation, but for sure, I didn't set those fires, folks.
所以这是相关性，而不是因果关系，但可以肯定的是，我没有放那些火，伙计们。
But- ...
但是——...
it's clear that it disrupts your breathing for a very long period of time.
很明显，它会在很长一段时间内扰乱您的呼吸。
But it's the long tail of that that we're really talking about here.
但我们在这里真正讨论的是它的长尾。
The very small particulate that we know firefighters, for instance, and certain industrial workers can end up with that stuff embedded in their brain tissue for extremely long periods, and it's just not good.
例如，我们所知道的非常小的颗粒物，例如消防员和某些产业工人，最终可能会在很长一段时间内将这些东西嵌入他们的脑组织中，这就是不好的。
You make a really interesting point about the call for cleaner energy.
关于清洁能源的呼吁，你提出了一个非常有趣的观点。
Can we run that one up to Washington or settle some of the debates about climate change just by getting straight to the-
我们能否将这一问题提交给华盛顿，或者通过直接讨论来解决一些有关气候变化的争论——
Dr. Peter Attia:
彼得·阿蒂亚博士：
Right.
对。
I feel like this should-
我觉得这应该——
Andrew Huberman:
安德鲁·休伯曼：
...
...
health needs.
健康需求。
Just bypass all the garbage that's being spewed back and forth and basically get to the issue at hand, right?
只要绕过所有来回喷出的垃圾，基本上就可以解决手头的问题，对吧？
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah.
是的。
Just make it better for people to not die from the direct consequence.
只是让人们更好地避免死于直接后果。
Andrew Huberman:
安德鲁·休伯曼：
So trying to avoid -- Such a difficult word to say, especially for a neuroscientist.
所以要尽量避免——这个词很难说，特别是对神经科学家来说。
Arteriosclerosis.
动脉硬化。
Did I get it right?
我做对了吗？
Dr. Peter Attia:
彼得·阿蒂亚博士：
Well, it's athero, which is easier because yeah.
嗯，这是 athero，这更容易，因为是的。
Andrew Huberman:
安德鲁·休伯曼：
Atherosclerosis.
动脉粥样硬化。
Oh, there.
哦，在那里。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah.
是的。
It's much easier.
这容易多了。
Andrew Huberman:
安德鲁·休伯曼：
Okay.
好的。
I've been making life more complicated for myself.
我一直在让自己的生活变得更加复杂。
Typical of me.
典型的我。
Okay.
好的。
So blood pressure, keeping it-
所以血压，保持它-
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah
是啊
Andrew Huberman:
安德鲁·休伯曼：
...
...
120 over 80 or better.
120 超过 80 或更好。
Don't smoke.
不要吸烟。
Let's just throw in don't vape.
我们就扔进去吧，不要吸烟。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Sure.
当然。
Andrew Huberman:
安德鲁·休伯曼：
I'm going to just plant my flag on it.
我要在上面插上我的旗帜。
Just don't vape.
只是不要吸烟。
Dr. Peter Attia:
彼得·阿蒂亚博士：
I'm with you.
我和你在一起。
Andrew Huberman:
安德鲁·休伯曼：
There are other ways to get those things in your system if you really want to get nicotine or cannabis into your system.
如果您确实想让尼古丁或大麻进入您的系统，还有其他方法可以让这些东西进入您的系统。
ApoB.
载脂蛋白B。
What's the story with ApoB?
ApoB 有何故事？
Dr. Peter Attia:
彼得·阿蒂亚博士：
Okay.
好的。
So to explain this, you have to tolerate a little bit of chemistry.
因此，要解释这一点，您必须容忍一点化学反应。
So everybody's heard of cholesterol, and I certainly devote quite a bit of time in the book to explaining this because it is so important.
每个人都听说过胆固醇，我当然在书中花了相当多的时间来解释这一点，因为它非常重要。
And it's definitely one of those areas where I initially received a lot of pushback from the editor, and there was a thought that, hey, this is a bit more technical than it needs to be.
这绝对是我最初收到编辑很多反对的领域之一，并且有一种想法，嘿，这比它需要的技术性要强一些。
But I think that sometimes you do need to resort to longer dissertations to dispel mythology.
但我认为有时你确实需要诉诸较长的论文来消除神话。
So cholesterol is a lipid.
所以胆固醇是一种脂质。
It is a molecule that the body synthesizes.
它是人体合成的分子。
It is a molecule that is essential for life.
它是生命所必需的分子。
So if you cannot synthesize cholesterol, you can't live.
因此，如果你不能合成胆固醇，你就无法生存。
You'll die in utero.
你会死在子宫里。
So there are rare genetic conditions that prevent the successful synthesis of cholesterol.
因此，存在一些罕见的遗传条件会阻止胆固醇的成功合成。
Embryos that have those mutations do not survive.
具有这些突变的胚胎无法存活。
Okay, so why do we need this stuff?
好吧，那我们为什么需要这个东西呢？
So we need this stuff primarily for two reasons.
所以我们需要这些东西主要有两个原因。
First, it makes up a very important structural component of cell membranes.
首先，它构成细胞膜非常重要的结构成分。
So as you know, a cell is a sphere.
如您所知，细胞是一个球体。
We look at them and think they're circles, but they're spheres and they're fluid, right?
我们看着它们，认为它们是圆形，但它们是球体，而且是流体，对吗？
They aren't just like little perfect big bowling balls or balloons.
它们不仅仅是小而完美的大保龄球或气球。
They actually morph and shape and move in these paths, and this is what allows cells to be next to each other and all sorts of things.
它们实际上在这些路径中变形、塑造和移动，这就是细胞彼此相邻以及各种事物相邻的原因。
They also have channels across all of them, and those channels are held in place by, among other things, cholesterol and phospholipids.
它们还具有贯穿所有细胞的通道，这些通道由胆固醇和磷脂等物质固定。
The second thing that makes cholesterol so important, it is the precursor to some of the most important hormones in our body.
胆固醇如此重要的第二件事是，它是我们体内一些最重要激素的前体。
So our sex hormones, testosterone, estrogen, progesterone, in addition to glucocorticoids.
所以我们的性激素，睾酮，雌激素，黄体酮，除了糖皮质激素。
If you look at them, it's really funny.
如果你看看他们，真的很有趣。
If you Google give me the structure of these things, you're like, wow, they're all basically the same.
如果你用谷歌给我这些东西的结构，你会想，哇，它们基本上都是一样的。
They all look really similar, and they're all pretty much just templates of cholesterol.
它们看起来都非常相似，而且几乎都是胆固醇的模板。
So understandably, when it's something that's that important, the body would leave nothing to chance.
所以可以理解的是，当事情如此重要时，身体不会留下任何机会。
We make all of our own cholesterol.
我们自己制造所有胆固醇。
The cholesterol that you eat in food, largely irrelevant.
你在食物中吃的胆固醇基本上无关紧要。
It's esterified cholesterol, so it means it has an ester side chain.
它是酯化胆固醇，因此意味着它具有酯侧链。
It's too bulky to absorb in the gut, so most cholesterol that you eat in food just goes out your GI tract.
它体积太大，无法被肠道吸收，因此您在食物中摄入的大多数胆固醇都会排出胃肠道。
Okay, so we have this super important molecule that every cell in the body makes, but there's a bit of a problem.
好的，我们已经有了体内每个细胞都会产生的这种超级重要的分子，但是有一个问题。
There's actually two problems.
其实有两个问题。
The first problem is not every cell can make as much as it needs all the time.
第一个问题是并不是每个细胞都能一直生产出所需的量。
So you have this demand problem.
所以你有这个需求问题。
So for example, if you're sick, you're going to need to make far more glucocorticoids.
例如，如果您生病了，您将需要制造更多的糖皮质激素。
Your body's response is going to be to ramp up cortisol production to mobilize fuel and do a whole bunch of other things, and certain cells, like the adrenal glands, are going to be called on to rise to a higher level of performance.
你的身体的反应将是增加皮质醇的产生，以调动燃料并做很多其他事情，并且某些细胞，如肾上腺，将被要求提高到更高的性能水平。
And they're not going to be able to make enough cortisol.
他们将无法产生足够的皮质醇。
So they're going to have to borrow or take cholesterol from other cells in the body.
因此，他们将不得不从体内的其他细胞借用或获取胆固醇。
In fact, one of the things we used to notice in the ICU, I never knew why it was happening.
事实上，我们过去在重症监护室注意到的一件事，我从来不知道为什么会发生。
I now know, is the few times I would accidentally order the wrong set of labs on a patient in the ICU and also order a lipid test or something, you would always notice their cholesterol levels were dropping.
我现在知道，有几次我不小心给重症监护病房的病人安排了错误的实验室检查，并且还安排了血脂测试或其他检查，你总是会注意到他们的胆固醇水平正在下降。
Serum cholesterol levels.
血清胆固醇水平。
And I now realize why.
我现在明白为什么了。
Because they were basically just funneling cholesterol to the adrenals to make more of the cortisol that they needed to combat whatever they were in the ICU for, which is usually the most severe form of stress the body is under.
因为他们基本上只是将胆固醇输送到肾上腺，以产生更多的皮质醇，以对抗他们在重症监护病房中的一切，这通常是身体承受的最严重的压力形式。
So you have to be able to transport this stuff.
所以你必须能够运输这些东西。
And then the second problem is, as you know, cholesterol being a lipid is not water-soluble.
第二个问题是，如您所知，胆固醇是一种脂质，不溶于水。
So the most dominant highway in the body is the circulatory system.
所以体内最主要的高速公路就是循环系统。
We can use the lymphatic system and things like that, but for the most part, we use our circulatory system as the highway to move stuff around.
我们可以使用淋巴系统和类似的东西，但在大多数情况下，我们使用循环系统作为移动物体的高速公路。
And the highway is made up of water.
高速公路是由水组成的。
Plasma, which is the liquid component of your blood, is water.
血浆是血液的液体成分，是水。
And therefore, things that are water-soluble move easily.
因此，水溶性的东西很容易移动。
So glucose, sodium, electrolytes, all of those things are dissolvable in water, and therefore, they don't need a carrier.
所以葡萄糖、钠、电解质，所有这些东西都可以溶于水，因此，它们不需要载体。
You just dissolve them in the water and they can go.
你只需将它们溶解在水中，它们就可以消失。
So that's why your liver can make glucose that your brain can easily get, and there doesn't need to be a carrier or an intermediary or anything like that.
这就是为什么你的肝脏可以产生大脑可以轻松获取的葡萄糖，并且不需要载体或中介或类似的东西。
But unfortunately, with cholesterol being a lipid, we can't do that.
但不幸的是，由于胆固醇是一种脂质，我们不能这样做。
Just as water and oil don't mix, cholesterol and plasma don't mix.
正如水和油不能混合一样，胆固醇和血浆也不能混合。
So the body had to come up with a trick, and the trick was designing a vehicle that was water-soluble on the outside and fat-soluble on the inside that you could bury the cholesterol inside, along with triglycerides, and on the outside, it was covered in protein, which is water-soluble, and that's the thing that moves around.
所以身体必须想出一个技巧，这个技巧就是设计一种外部水溶性、内部脂溶性的载体，你可以将胆固醇和甘油三酯埋藏在里面，而在外部，它被蛋白质覆盖，这是水溶性的，这就是四处移动的东西。
And that thing is called a lipoprotein.
那个东西叫做脂蛋白。
And as its name suggests, it's part lipid, part protein.
顾名思义，它部分是脂质，部分是蛋白质。
Lipid on the inside, protein on the outside.
脂质在里面，蛋白质在外面。
And those lipoproteins come largely in two different families.
这些脂蛋白主要来自两个不同的家族。
So one family comes from a lineage called ApoB.
因此，有一个家族来自一个称为 ApoB 的谱系。
So the ApoB family, which is short for apolipoprotein B-100, is a family that is derived from the liver, and each of those lipoproteins has one and only one apolipoprotein B-100 on it.
因此，ApoB 家族是载脂蛋白 B-100 的缩写，是一个源自肝脏的家族，每种脂蛋白上都有一个且仅有一个载脂蛋白 B-100。
We shorten it and just call it ApoB because we don't really worry about apolipoprotein B-48, which is attached to chylomicrons that are responsible for fat absorption in the gut.
我们将其缩写为 ApoB，因为我们并不真正担心载脂蛋白 B-48，它附着在负责肠道脂肪吸收的乳糜微粒上。
They're very short-lived.
它们的寿命非常短暂。
They don't really factor into atherosclerosis.
它们并不真正影响动脉粥样硬化。
For the purists out there, there's an ApoB 48.
对于纯粹主义者来说，有 ApoB 48。
We're not going to talk about it.
我们不会谈论它。
So when I say ApoB, what I'm talking about is a protein that wraps around a subset of these lipoproteins.
因此，当我说 ApoB 时，我指的是包裹这些脂蛋白的一个子集的蛋白质。
There's another family of lipoproteins called ApoA, or apolipoprotein A.
还有另一个脂蛋白家族，称为 ApoA，或载脂蛋白 A。
This is a much more complicated family, and I'm not going to talk about it here because it would take an hour to just explain how the apolipoprotein A family works.
这是一个复杂得多的家族，我不打算在这里讨论它，因为仅仅解释载脂蛋白 A 家族的工作原理就需要一个小时。
But I'll give the punchline is there are many apolipoprotein As.
但我要说的重点是有很多载脂蛋白A。
There's variable numbers of ApoAs on those proteins, and they are all part of a family called high-density lipoproteins.
这些蛋白质上的 ApoA 数量各不相同，它们都是高密度脂蛋白家族的一部分。
Back to the ApoB guys, they are of the low-density lipoprotein lineage.
回到 ApoB 人，他们属于低密度脂蛋白谱系。
So You've heard the term LDL and HDL.
您听说过“低密度脂蛋白”和“高密度脂蛋白”这个术语。
What is it referring to?
它指的是什么？
It's basically referring to the relative concentrations of protein and lipids in the lipoproteins, and not surprisingly, based on their names, the HDLs are higher density, more protein, less lipid.
它基本上指的是脂蛋白中蛋白质和脂质的相对浓度，毫不奇怪，根据它们的名称，高密度脂蛋白密度更高，蛋白质更多，脂质更少。
The LDLs, low-density lipoproteins, and VLDLs, very low-density lipoproteins, and IDLs, intermediate-density lipoproteins, are all lower density, which means more lipid to protein.
LDL（低密度脂蛋白）、VLDL（极低密度脂蛋白）和IDL（中密度脂蛋白）的密度都较低，这意味着蛋白质中的脂质较多。
They're different sizes.
它们的尺寸不同。
There's a whole bunch of other things going on.
还有一大堆其他事情正在发生。
The most important fact in all of this is that the ApoBs are atherogenic.
所有这一切中最重要的事实是 ApoB 具有致动脉粥样硬化作用。
So what we're about to talk about next is perpetuated by lipoproteins that have an ApoB on them.
所以我们接下来要讨论的是带有 ApoB 的脂蛋白。
So everything in the story right now is just about how do you get cholesterol around the body?
所以现在故事中的一切都只是关于如何让胆固醇进入体内？
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
And these proteins that have lipid in the middle.
这些蛋白质中间有脂质。
So let's just take ApoB, for example.
我们以 ApoB 为例。
Many, many billions of them floating around in our body, even in the healthiest of people.
许多、数十亿的细菌漂浮在我们的体内，即使是在最健康的人体内。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yep.
是的。
Andrew Huberman:
安德鲁·休伯曼：
And they're being shuttled to tissues that need them, like the adrenals, muscle, heart, et cetera.
它们被运送到需要它们的组织，如肾上腺、肌肉、心脏等。
What sets the demand for these things?
是什么决定了对这些东西的需求？
So for instance, could somebody have relatively high LDL, maybe even higher than sort of high end of chart or even above high-end ApoB, but there's some sort of demand, metabolic demand, or they're weight training a lot, or they're running marathons, and so they need a lot of LDL.
例如，某人的 LDL 水平可能相对较高，甚至可能高于图表的高端，甚至高于 ApoB 的高端，但存在某种需求、代谢需求，或者他们进行大量举重训练，或者他们正在跑马拉松，因此他们需要大量 LDL。
The reason I ask this is because it's so easy for the uninformed person, which I include myself in that group, to just hear, oh, LDL bad, cholesterol bad, ApoB bad, when in fact, you very graciously spelled out the fact that these things actually perform a functional role in the healthy body.
我之所以问这个问题，是因为对于那些不知情的人来说，我自己也属于这一群体，很容易听到，哦，低密度脂蛋白不好，胆固醇不好，载脂蛋白B不好，而事实上，你非常客气地阐明了这些东西实际上在健康身体中发挥着功能性作用的事实。
So before we get into why they are or can be bad, why would you want a low-density lipoprotein?
因此，在我们了解它们为何有害或可能有害之前，您为什么需要低密度脂蛋白？
What is that doing for somebody?
这是为某人做什么？
And is there any circumstance where the way people are exercising or thinking or not sleeping or sleeping too much, it's that a higher level actually reflects a healthy metabolic need?
是否有任何情况下，人们锻炼、思考、不睡觉或睡得太多的方式，较高的水平实际上反映了健康的代谢需求？
Dr. Peter Attia:
彼得·阿蒂亚博士：
We don't have any evidence of that to date.
迄今为止我们还没有任何证据证明这一点。
All of the functions that I described can be done by the HDL.
我描述的所有功能都可以由 HDL 完成。
So the high-density lipoproteins, the ApoAs, can do all of it.
因此，高密度脂蛋白 ApoA 可以完成这一切。
Andrew Huberman:
安德鲁·休伯曼：
So ApoB and low-density lipoproteins are just the necessary-
所以ApoB和低密度脂蛋白只是必需的——
Dr. Peter Attia:
彼得·阿蒂亚博士：
We don't actually-
我们实际上并不-
Andrew Huberman:
安德鲁·休伯曼：
...
...
the waste?
浪费？
I mean, I-
我的意思是，我——
Dr. Peter Attia:
彼得·阿蒂亚博士：
No, we don't understand why we have them, Andrew.
不，我们不明白为什么要有它们，安德鲁。
This is the part that's really interesting to me.
这是我真正感兴趣的部分。
Most species do not even have ApoB.
大多数物种甚至没有 ApoB。
And as a result of that, most species are chemically incapable of atherosclerosis.
因此，大多数物种在化学上都不会发生动脉粥样硬化。
Andrew Huberman:
安德鲁·休伯曼：
So if someone could zero out their ApoB and their LDL, we assume they would function just fine.
因此，如果有人能够将他们的 ApoB 和 LDL 归零，我们假设他们的功能会很好。
Dr. Peter Attia:
彼得·阿蒂亚博士：
We know they would because we have certain people who walk around with genetic mutations that render them that way.
我们知道他们会这样做，因为我们有某些人携带着基因突变，导致他们变成这样。
Andrew Huberman:
安德鲁·休伯曼：
Wow.
哇。
Okay.
好的。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Furthermore, we also know that there's a bit of a myth out there that cholesterol, the cholesterol you measure in your blood is essential for brain health, for example.
此外，我们还知道，存在一些误解，例如，胆固醇（您在血液中测量的胆固醇）对于大脑健康至关重要。
That's an understandable thing, right?
这是可以理解的事情，对吧？
You can speak to this very eloquently, the role of cholesterol in the brain.
你可以非常雄辩地谈论胆固醇在大脑中的作用。
Andrew Huberman:
安德鲁·休伯曼：
Yeah, I wrote down when I was a postdoc at Stanford, because I always point out I was born at Stanford, trained at Stanford, worked at-- I'll probably die at Stanford, hopefully a long time from now.
是的，我在斯坦福大学做博士后时就写下了这一点，因为我总是指出我出生在斯坦福大学，在斯坦福大学接受训练，在斯坦福大学工作——我可能会在斯坦福大学去世，希望从现在起很长一段时间。
You'll tell me how long from now.
你会告诉我多久之后。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Well, we're going to do the Charlie Munger thing and make sure that you never go back to Stanford, so that you can't die there.
好吧，我们要做查理·芒格的事情，确保你永远不会回到斯坦福大学，这样你就不会死在那里。
Andrew Huberman:
安德鲁·休伯曼：
There, exactly.
就在那里。
Dr. Peter Attia:
彼得·阿蒂亚博士：
There you go.
就这样吧。
Andrew Huberman:
安德鲁·休伯曼：
Cured already.
已经痊愈了。
When I was a postdoc, I worked with a guy named Ben Barres, who I know you know, probably as a different person then, for reasons that people can look up Ben's name.
当我还是一名博士后时，我和一个名叫本·巴雷斯的人一起工作，我知道你认识他，当时可能是另一个人，因为人们可以查找本·巴雷斯的名字。
Anyway, incredible scientist, but there was someone in his lab that discovered that cholesterol is a critical component of the synaptogenesis process, the formation of connections between neurons in the developing brain.
无论如何，令人难以置信的科学家，但他的实验室里有人发现胆固醇是突触发生过程的关键组成部分，突触发生过程是发育中的大脑中神经元之间连接的形成。
And then that went on to lead to the discovery of things like thrombospondins being important for synaptogenesis, et cetera.
然后这导致了诸如血小板反应蛋白之类对突触发生很重要的物质的发现，等等。
But cholesterol sits central in the brain development mechanisms.
但胆固醇在大脑发育机制中起着核心作用。
Like you want cholesterol around-
就像你想要胆固醇一样-
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah
是啊
Andrew Huberman:
安德鲁·休伯曼：
...
...
for brain development.
用于大脑发育。
In fact, I think very low-fat diets and very low-cholesterol diets during early development can really impair brain development, as I understand.
事实上，据我所知，我认为早期发育期间的极低脂肪饮食和极低胆固醇饮食确实会损害大脑发育。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah, it's not entirely clear why, but here's what we know.
是的，目前还不完全清楚原因，但这是我们所知道的。
When you're born, your serum cholesterol levels are very low.
当您出生时，您的血清胆固醇水平非常低。
So infants and children have very low levels of cholesterol.
因此婴儿和儿童的胆固醇水平非常低。
They would have...
他们本来...
And I should explain one thing that's important.
我应该解释一件重要的事情。
Andrew Huberman:
安德鲁·休伯曼：
They're not myelinated yet, right?
他们还没有髓鞘，对吗？
Sorry to interrupt, but the myelin, of course, the sheathing around neuronal axons, which accelerates the propagation of nerve signals and which is deficient in things like multiple sclerosis, is essentially fat made up of phospholipid and requires cholesterol for synthesis.
很抱歉打断一下，髓鞘质，当然是神经元轴突周围的鞘，它加速神经信号的传播，并且在多发性硬化症等疾病中缺乏，本质上是由磷脂组成的脂肪，需要胆固醇来合成。
But young children are not very well myelinated.
但幼儿的髓鞘发育还不是很好。
I mean, the spinal cord is myeli-- The spinal tracts are myelinated, but-
我的意思是，脊髓是有髓鞘的——脊髓束是有髓鞘的，但是——
Dr. Peter Attia:
彼得·阿蒂亚博士：
So this is what's interesting, right?
这就是有趣的地方，对吧？
We would all agree that cholesterol is more important to infants and children than to anybody else, right?
我们都同意胆固醇对婴儿和儿童比其他任何人都更重要，对吗？
It would be the most important substrate for CNS development, and yet infants and children have virtually unmeasurable levels of cholesterol.
它是中枢神经系统发育最重要的基质，但婴儿和儿童的胆固醇水平实际上无法测量。
It really starts to take off in your teenage years, right?
它真的在你十几岁的时候就开始起飞了，对吧？
So cholesterol basically, serum cholesterol levels rise basically monotonically throughout life.
所以胆固醇基本上，血清胆固醇水平在一生中基本上单调上升。
Women get a big bump at menopause, so it really goes up for them.
女性在更年期时会出现很大的肿块，所以对她们来说确实会增加。
But What's interesting is how do we reconcile the fact that infants and children have really low levels of serum cholesterol, yet clearly undergo CNS maturation without any problems?
但有趣的是，我们如何调和婴儿和儿童的血清胆固醇水平确实很低的事实，但显然中枢神经系统的成熟没有任何问题？
And it basically comes down to the following.
基本上可以归结为以下几点。
What you measure in the serum is but a fraction of the total body pool of cholesterol.
您在血清中测量到的只是体内胆固醇总量的一小部分。
So we get a little bit of the light under the-- What's the streetlamp under the-
所以我们在下面看到了一点光--下面的路灯是什么-
Andrew Huberman:
安德鲁·休伯曼：
The drunk under a-
醉酒者在-
Dr. Peter Attia:
彼得·阿蒂亚博士：
The drunk or the streetlamp problem-
醉酒者或路灯问题-
Andrew Huberman:
安德鲁·休伯曼：
Lamp post or yeah, exactly
灯柱或者是的，完全正确
Dr. Peter Attia:
彼得·阿蒂亚博士：
...
...
which is just because we're looking there, we tend to think that that's what we're seeing.
这只是因为我们正在看那里，我们倾向于认为这就是我们所看到的。
But if you took the entire circulatory pool of cholesterol, it's about 10% of your total body cholesterol.
但如果您摄入了整个循环系统中的胆固醇，那么它大约占您体内总胆固醇的 10%。
It's a tiny fraction of it.
这只是其中的一小部分。
So it's what we measure because that's all we have access to, but it really represents virtually none of it.
这就是我们测量的内容，因为这是我们能够访问的所有内容，但它实际上并不代表任何内容。
I do want to say something because you mentioned LDL.
我确实想说点什么，因为你提到了低密度脂蛋白。
I want to tie this back to the reader, or the listener rather.
我想将这一点与读者，或者更确切地说是听众联系起来。
ApoB refers to the lipoprotein, the singular lipoprotein wrapped around an LDL particle.
ApoB 是指脂蛋白，是包裹在 LDL 颗粒周围的单一脂蛋白。
So if you happen to be lucky enough that your doctor measures an ApoB level, it's a blood test.
因此，如果您足够幸运，您的医生测量了 ApoB 水平，那么这就是血液检查。
It says ApoB x number of milligrams per deciliter.
它表示 ApoB x 每分升毫克数。
That's measuring the concentration of that protein.
这是测量该蛋白质的浓度。
It is a direct measurement of the concentration of LDL and VLDL particles.
它是 LDL 和 VLDL 颗粒浓度的直接测量。
When you have a blood test that says LDL, it usually doesn't say LDL.
当您的血液测试显示低密度脂蛋白时，通常不会显示低密度脂蛋白。
It usually says LDL-C or LDL cholesterol, because LDL is not a laboratory measurement.
通常说的是 LDL-C 或 LDL 胆固醇，因为 LDL 不是实验室测量值。
LDL cholesterol is a laboratory measurement, and it's just taking the total number of LDL particles, breaking them apart, and measuring how much cholesterol is in them.
低密度脂蛋白胆固醇是一种实验室测量方法，它只是获取低密度脂蛋白颗粒的总数，将它们分解，然后测量其中的胆固醇含量。
So LDL-C measures the total concentration of cholesterol in the LDLs.
因此，LDL-C 测量的是 LDL 中胆固醇的总浓度。
ApoB measures the number of them.
ApoB 测量它们的数量。
Andrew Huberman:
安德鲁·休伯曼：
Got it.
明白了。
Dr. Peter Attia:
彼得·阿蒂亚博士：
And they're different.
他们是不同的。
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Dr. Peter Attia:
彼得·阿蒂亚博士：
But one of them is far superior at predicting risk, and it's ApoB.
但其中之一在预测风险方面表现出色，那就是 ApoB。
The number of particles is much more predictive of risk than the amount of cholesterol contained within them.
颗粒的数量比颗粒中所含胆固醇的含量更能预测风险。
Andrew Huberman:
安德鲁·休伯曼：
Fascinating.
令人着迷。
First time I've understood HDL, LDL, and these lipoproteins in a way that makes sense.
我第一次以一种有意义的方式理解高密度脂蛋白、低密度脂蛋白和这些脂蛋白。
So thank you.
所以谢谢你。
I'm sure others feel the same way.
我相信其他人也有同样的感觉。
What ApoB level is your red flag cutoff, right?
您的 ApoB 水平是多少危险信号截止值，对吧？
I actually had my ApoB measured recently, and I'm definitely above the high end, so-
事实上，我最近测量了我的 ApoB，而且我绝对高于高端，所以-
Dr. Peter Attia:
彼得·阿蒂亚博士：
Well, we'll be discussing this over dinner on Saturday night.
好吧，我们将在周六晚上的晚餐时讨论这个问题。
Andrew Huberman:
安德鲁·休伯曼：
Yeah, exactly.
是的，完全正确。
And just to tie this back, I hope that's a steak dinner and that should be fine given the fact that dietary cholesterol has no direct link to ApoB and LDL.
顺便说一句，我希望这是一顿牛排晚餐，考虑到膳食胆固醇与 ApoB 和 LDL 没有直接关系，这应该没问题。
Dr. Peter Attia:
彼得·阿蒂亚博士：
That's true, but dietary saturated fat does.
这是事实，但饮食中的饱和脂肪确实如此。
Andrew Huberman:
安德鲁·休伯曼：
Ah, okay.
啊，好吧。
So I'll-
所以我会-
Dr. Peter Attia:
彼得·阿蒂亚博士：
Which is not to say we're not going to have a steak.
这并不是说我们不会吃牛排。
Andrew Huberman:
安德鲁·休伯曼：
Right.
对。
Dr. Peter Attia:
彼得·阿蒂亚博士：
We will, but I just-
我们会的，但我只是——
Andrew Huberman:
安德鲁·休伯曼：
Not necessarily one of the fattier cuts.
不一定是最肥的部位之一。
Although probably will be for me.
虽然可能适合我。
So what's the high-end flag?
那么什么是高端标志呢？
At what point do you start saying, "Ah, we need to do something"?
你什么时候开始说“啊，我们需要做点什么”？
And then we'll talk about what people can do.
然后我们将讨论人们可以做什么。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah.
是的。
So this is a complicated question because it depends on so many factors.
所以这是一个复杂的问题，因为它取决于很多因素。
The first factor it depends on is what is your objective?
它取决于的第一个因素是您的目标是什么？
And I do pose this question directly to a patient, right?
我确实直接向患者提出这个问题，对吧？
So I say, "Look, we've got this disease that's the number one cause of death.
所以我说，“看，我们患上了这种疾病，它是头号死因。
Now, you can die with it or you can die from it.
现在，你可以和它一起死，也可以死于它。
Those are your choices.
这些是你的选择。
Statistically speaking, more people will die from it than anything else.
从统计数据来看，死于此病的人比其他任何疾病都要多。
But if you live long enough, we will all die with it to some extent." So if you're me, and I come from a family history, as you know, I write about this in the book, where basically every man in my family except one has died of atherosclerosis, and they have all done so very prematurely.
但如果你活得足够长，我们都会在某种程度上与它一起死去。”所以，如果你是我，我有家族史，你知道，我在书中写到了这一点，基本上我家族中除了一个人之外的每个男人都死于动脉粥样硬化，而且他们都过早地去世了。
My dad lost brothers in their 40s and 50s.
我父亲在 40 多岁和 50 多岁的时候失去了兄弟。
By some miracle, my dad is still alive at 86.
奇迹的是，我父亲86岁了还活着。
But I think that's in large part because he at least had the good sense to listen to doctors and take medication to lower his cholesterol and blood pressure.
但我认为这在很大程度上是因为他至少有良好的判断力，听医生的话并服用药物来降低胆固醇和血压。
If your objective is to not die from heart disease and only to die with it, then you want ApoB as low as possible.
如果您的目标是不死于心脏病而只是死于心脏病，那么您希望 ApoB 尽可能低。
Now, how low you go depends on when you start, because one way to think about this is it's an area under the curve problem.
现在，你能走多低取决于你什么时候开始，因为思考这个问题的一种方法是它是曲线下的区域问题。
The longer you wait to start doing something about this, the more aggressively you need to do something about it.
你等待开始采取行动的时间越长，你就越需要积极采取行动。
I think a better way to think about this, though, is to go back to what we talked about with smoking.
不过，我认为思考这个问题的更好方法是回到我们谈论吸烟的话题。
So would you agree that smoking is causally related to lung cancer?
那么您同意吸烟与肺癌有因果关系吗？
Andrew Huberman:
安德鲁·休伯曼：
Yes.
是的。
Dr. Peter Attia:
彼得·阿蒂亚博士：
So just to be clear, Andrew, you do not think that it's just an association that smokers get more lung cancer.
安德鲁，需要澄清的是，您并不认为这只是吸烟者患肺癌更多的关联。
Andrew Huberman:
安德鲁·休伯曼：
No, I do not.
不，我不。
Dr. Peter Attia:
彼得·阿蒂亚博士：
In other words, you believe that smoking causes lung cancer then?
换句话说，您认为吸烟会导致肺癌吗？
Andrew Huberman:
安德鲁·休伯曼：
Yes.
是的。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Okay.
好的。
Andrew Huberman:
安德鲁·休伯曼：
There are a number of mechanistic steps-
有许多机械步骤 -
Dr. Peter Attia:
彼得·阿蒂亚博士：
A number of things that can-- yes, yeah
有很多事情可以——是的，是的
Andrew Huberman:
安德鲁·休伯曼：
...
...
in between.
之间。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Got it.
明白了。
Andrew Huberman:
安德鲁·休伯曼：
If somebody was really wanting to drill into the logic, they could say, "Okay, it's not actually the smoking, it's some disruption of the endothelial cell lining that-"
如果有人真的想深入探讨其中的逻辑，他们可以说，“好吧，这实际上不是吸烟，而是内皮细胞衬里的一些破坏——”
Dr. Peter Attia:
彼得·阿蒂亚博士：
But smoking triggers that.
但吸烟会引发这种情况。
Andrew Huberman:
安德鲁·休伯曼：
I assume so.
我想是这样。
Dr. Peter Attia:
彼得·阿蒂亚博士：
And I agree with you, by the way.
顺便说一下，我同意你的观点。
I think the data are very clear.
我认为数据非常清楚。
Andrew Huberman:
安德鲁·休伯曼：
I'm very relieved to hear that.
听到这个我很放心。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah.
是的。
But I'm going someplace very important here because if there's one topic that doesn't get enough attention in medicine, it's causality.
但我要去的地方非常重要，因为如果有一个话题在医学上没有得到足够的关注，那就是因果关系。
And causality is an obsession of mine.
因果关系是我的痴迷。
Most of the day, on some level, I sit around thinking about causality.
在某种程度上，一天的大部分时间我都坐着思考因果关系。
And I think the hardest part about studying medicine with respect to human beings is how difficult it is to infer causality for most things that we do.
我认为研究人类医学最困难的部分是推断我们所做的大多数事情的因果关系是多么困难。
So If you believe that smoking is causally related to lung cancer, then smoking cessation reduces the probability of lung cancer.
因此，如果您认为吸烟与肺癌有因果关系，那么戒烟会降低患肺癌的概率。
That is a logical equivalency.
这是逻辑上的等价。
There can be no debate about that.
对此毫无争议。
What if I said to you, "Andrew, this is going to be our new philosophy around smoking cessation.
如果我对你说：“安德鲁，这将是我们关于戒烟的新理念。
I'm going to anoint you the tsar of smoking cessation." So if people pick up smoking, no problem.
我将任命你为戒烟沙皇。”因此，如果人们开始吸烟，没有问题。
We're going to let them smoke.
我们要让他们抽烟。
But we're going to assess their risk for lung cancer using a model that predicts when their 10-year risk of lung cancer gets above a certain level, we're going to recommend that they stop smoking.
但我们将使用一个模型来评估他们患肺癌的风险，该模型可以预测当他们 10 年患肺癌的风险超过一定水平时，我们将建议他们戒烟。
So we're going to look at their age, their sex, their family history, some biomarkers that might help us.
因此，我们将研究他们的年龄、性别、家族史以及一些可能对我们有帮助的生物标志物。
We're going to even do scans of their lungs.
我们甚至要对他们的肺部进行扫描。
And once we think they cross a threshold where their risk of lung cancer is high enough, let's just say it's 25%, boom, you make them stop.
一旦我们认为他们跨过一个阈值，即他们患肺癌的风险足够高，我们就说是 25%，繁荣，你让他们停止。
You tell them it's time to stop.
你告诉他们是时候停止了。
Is that a logical approach to treating smoking and lung cancer?
这是治疗吸烟和肺癌的合理方法吗？
Or would it be better to say, given that we know cigarettes are causally related to this, how about you never start smoking, and the minute you do, we pull the cigarette out of your mouth and explain to you that you're doing something that is causally related?
或者更好的说法是，既然我们知道香烟与此有因果关系，那么你永远不要开始吸烟，一旦你吸烟，我们就把香烟从你嘴里拔出来，并向你解释你正在做一些与此有因果关系的事情，怎么样？
Of course, it would be the latter, not the former.
当然，是后者，而不是前者。
It would be idiotic to suggest that we endorse smoking until you cross a certain threshold.
如果你建议我们支持吸烟直到你跨过某个阈值，那是愚蠢的。
Well, this now becomes the germane question.
好吧，这现在变成了一个密切相关的问题。
There is no ambiguity that ApoB is causally related to atherosclerosis.
毫无疑问，ApoB 与动脉粥样硬化有因果关系。
How can I tell you that?
我怎么能告诉你呢？
I can tell you that looking at all of the clinical trial literature, all of the epidemiologic literature, and perhaps even most importantly, the Mendelian randomizations.
我可以告诉你，查看所有的临床试验文献、所有的流行病学文献，甚至可能是最重要的孟德尔随机化。
All of these things tell us, because by the way-
所有这些事情告诉我们，因为顺便说一句——
Andrew Huberman:
安德鲁·休伯曼：
Mendelian randomizations meaning genetic mutant humans out there that make very little ApoB or excessive ApoB.
孟德尔随机化意味着基因突变的人类会产生很少的 ApoB 或过量的 ApoB。
Dr. Peter Attia:
彼得·阿蒂亚博士：
And very much, exactly.
非常非常，完全正确。
So we have a whole gradient.
所以我们有一个完整的梯度。
Andrew Huberman:
安德鲁·休伯曼：
So you can say if you make very little, you aren't going to die as quickly-
所以你可以说，如果你赚得很少，你就不会死得那么快——
Dr. Peter Attia:
彼得·阿蒂亚博士：
That's right
没错
Andrew Huberman:
安德鲁·休伯曼：
...
...
in your life as if you make too much.
在你的生活中，就好像你赚得太多一样。
Dr. Peter Attia:
彼得·阿蒂亚博士：
That's right.
没错。
So Mendelian randomization is such an elegant tool where you basically let genes do the randomization.
因此，孟德尔随机化是一个非常优雅的工具，基本上让基因进行随机化。
And as you said, there is a gradation of LDL concentration or ApoB concentration that occurs from insanely low to insanely high, and this is a wildly polygenic, polymorphic set of conditions.
正如您所说，LDL 浓度或 ApoB 浓度存在从极低到极高的梯度，这是一组极其多基因、多态性的条件。
And we can look at the outcomes of those people based on the random sorting of those genes, and there's no ambiguity.
我们可以根据这些基因的随机排序来查看这些人的结果，并且没有任何歧义。
LDL is causally related.
LDL 是有因果关系的。
LDL cholesterol or ApoB, causally related to atherosclerosis.
LDL 胆固醇或 ApoB，与动脉粥样硬化有因果关系。
Well, if that's true, and I haven't seen a credible argument that it's not.
好吧，如果这是真的，而且我还没有看到任何可信的论据来证明事实并非如此。
There are people who argue that it's not, by the way, but they just don't have credibility in their arguments.
顺便说一句，有些人认为事实并非如此，但他们的论点根本不可信。
Then you have to say that what we're doing in medicine today is very backwards.
那你就不得不说我们现在在医学上所做的事情是非常落后的。
Because what we're doing in medicine today is the following.
因为我们今天在医学领域所做的事情如下。
We're saying-- I'm coming at this in a long way, but your question is so important that I want to answer it this way.
我们是说——我花了很长时间才谈到这个问题，但你的问题非常重要，所以我想这样回答。
We're answering your question today as follows.
今天我们就您的问题回答如下。
We're saying, Andrew, let's do a 10-year risk calculation of your risk of MACE.
我们说，安德鲁，让我们对您的 MACE 风险进行 10 年风险计算。
MACE stands for major adverse cardiac event.
MACE 代表主要不良心脏事件。
It is the metric we use in medicine.
这是我们在医学中使用的度量标准。
So a major adverse cardiac event is a heart attack, stroke or death basically resulting from these things.
因此，主要的不良心脏事件是心脏病发作、中风或死亡，基本上是由这些事情引起的。
And we have calculators that are pretty good at predicting your 10-year event risk.
我们的计算器可以很好地预测您的 10 年事件风险。
They'll look at your cholesterol levels, your blood pressure.
他们会检查你的胆固醇水平和血压。
They'll ask if you smoke.
他们会问你是否吸烟。
They'll ask some family history questions, and they'll spit out a number.
他们会问一些家族史问题，然后他们会给出一个数字。
Now we should do yours after the fact.
现在我们应该在事后做你的事。
And I don't know if we did it for a person who's in your mid-40s, it would probably spit out less than 5% risk for a major adverse cardiac event in the next 10 years.
我不知道如果我们为 40 多岁的人做这件事，未来 10 年内发生重大心脏不良事件的风险可能会低于 5%。
In fact, the models don't even work if age is below 40.
事实上，如果年龄低于 40 岁，这些模型甚至不起作用。
So the first time I went to do one of these tests when I was in my mid-30s, I couldn't do it.
所以当我30多岁的时候第一次去做这些测试时，我做不到。
The algorithm breaks.
算法崩溃了。
It just doesn't work.
它就是行不通。
So the implication there is if your MACE risk is less than 5%, the thinking is you do not need to treat LDL or ApoB.
因此，如果您的 MACE 风险低于 5%，则意味着您不需要治疗 LDL 或 ApoB。
I argue that that makes absolutely no sense.
我认为这完全没有意义。
It's just as idiotic as the analogy I used around smoking.
这就像我用吸烟做的类比一样愚蠢。
If a risk is causal and it is modifiable, it should be modified regardless of the risk tail in duration.
如果风险是因果性的并且是可修改的，则无论风险尾部的持续时间如何，都应该对其进行修改。
So then the question becomes to what level?
那么问题就变成什么水平了？
And again, the earlier you start, the less aggressive you need to be, the less damage that's there already.
再说一次，你越早开始，你需要的攻击性就越小，已经存在的损害就越小。
So for example, we do CT angiograms on our patients.
例如，我们对患者进行 CT 血管造影。
If the CT angiogram shows no evidence of calcification, no evidence of soft plaque, that means grossly their coronary arteries are still normal.
如果CT血管造影没有显示钙化的证据，没有软斑块的证据，那就意味着他们的冠状动脉仍然正常。
Histologically, they're probably not because nobody probably makes it to our age with histologically perfect coronary arteries.
从组织学角度来看，它们可能不是，因为没有人能够活到我们这个年纪，拥有组织学上完美的冠状动脉。
We might be satisfied with a person's ApoB being at the fifth percentile of the population, which would be about 60 milligrams per deciliter.
我们可能会对一个人的 ApoB 处于人口的第五个百分位数感到满意，即大约每分升 60 毫克。
But if we have any other factors, meaning we're starting later in life or a person already has gross evidence of disease, calcification, soft plaque, family history is significant, any other risk factors are present, we'll treat ApoB to 30 to 40 milligrams per deciliter, which is probably the first percentile
但如果我们有任何其他因素，意味着我们开始较晚，或者一个人已经有疾病、钙化、软斑块、家族史显着的明显证据，存在任何其他危险因素，我们会将 ApoB 治疗至 30 至 40 毫克/分升，这可能是第一个百分位数
Andrew Huberman:
安德鲁·休伯曼：
And if somebody's sitting up in the, say, low 130s, what kind of flag does that raise for you?
如果有人的坐姿在 130 多岁以下，这会给你带来什么样的影响？
And I realize it's highly contextual.
我意识到这是高度相关的。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah.
是的。
Andrew Huberman:
安德鲁·休伯曼：
Age, et cetera.
年龄等等。
Dr. Peter Attia:
彼得·阿蒂亚博士：
No, it's a huge red flag.
不，这是一个巨大的危险信号。
Again, just because something is causal doesn't mean you're guaranteed to get it.
再说一次，仅仅因为某件事是因果关系并不意味着你一定会得到它。
There are smokers who don't get lung cancer.
有些吸烟者不会患肺癌。
So, there's going to be somebody listening to this who says, "My grandmother's 95 years old.
所以，会有人听完后说：“我祖母已经 95 岁了。
Her cholesterol is sky-high, and she's alive and well." And I will say absolutely.
她的胆固醇很高，但她还活着，而且活得很好。”我会说绝对。
There are a lot of people walking around that way, just as there are a lot of smokers walking around who don't get lung cancer.
有很多人走在这条路上，就像有很多吸烟者没有患肺癌一样。
You can't impute these things on an individual basis.
你不能将这些事情归咎于个人。
You basically have to ask the question, how do I make the best judgment about an individual from heterogeneous population data, and based on what are causal and non-causal inferences around risk?
您基本上必须问这样的问题：我如何根据异质群体数据并基于风险的因果和非因果推论对个体做出最佳判断？
So, to me, if a person has very high ApoB and they do not want to be treated for it, then the best we would do is say, let's at least establish that there are no other risk factors present, and let's at least do the most investigation we can around the existing damage.
因此，对我来说，如果一个人的 ApoB 非常高，并且他们不想接受治疗，那么我们最好的做法是，至少确定不存在其他风险因素，并且至少对现有损害进行尽可能多的调查。
And if that person has a perfect CT angiogram, I'm going to push less hard than if they have a devastating angiogram.
如果那个人有完美的 CT 血管造影，我会比他们有毁灭性的血管造影更不那么努力。
And by the way, devastating in my book is just any amount of calcification or soft plaque.
顺便说一句，在我的书中，毁灭性的只是任何数量的钙化或软斑块。
Anything that shows up grossly that you can see on a CT scan means that you've got a decade plus of really bad histology building up to it.
任何你在 CT 扫描上看到的明显的东西都意味着你已经有十多年的非常糟糕的组织学积累了。
Andrew Huberman:
安德鲁·休伯曼：
Yeah.
是的。
This issue of causality, I think now becomes very clear as to why that is so crucial, and really appreciate the way you spelled that out.
我认为这个因果关系问题现在变得非常清楚为什么它如此重要，并且非常欣赏您阐明这一点的方式。
So let's say somebody's ApoB is 80, 100, let's say 130, for example.
假设某人的 ApoB 是 80、100，例如 130。
What sorts of things can they do to reduce that number?
他们可以采取哪些措施来减少这个数字？
Is this always going to be prescription medication?
这总是处方药吗？
And if so, what are the more common forms of prescription medication that work best?
如果是这样，最有效的处方药有哪些常见形式？
What are their side effect profiles, and so on?
它们的副作用是什么？等等？
Dr. Peter Attia:
彼得·阿蒂亚博士：
So, yeah.
所以，是的。
Usually, once you want to start getting down into the 30 to 60 range, you're going to require pharmacotherapy.
通常，一旦您想开始降到 30 到 60 的范围内，您将需要药物治疗。
But usually, we want to see how far we can get with nutrition.
但通常情况下，我们想看看我们在营养方面能走多远。
So fixing insulin resistance in an insulin-resistant person will bring this down.
因此，修复胰岛素抵抗者的胰岛素抵抗将会降低这种情况。
So one of the hallmarks of insulin resistance is elevated triglycerides.
因此，胰岛素抵抗的标志之一是甘油三酯升高。
We haven't talked about triglycerides, but they warrant some attention because I mentioned it earlier, but one of the other things that the lipoproteins carry is triglycerides.
我们还没有讨论甘油三酯，但它们值得一些关注，因为我之前提到过，但脂蛋白携带的其他物质之一是甘油三酯。
So you're carrying fat and cholesterol.
所以你携带着脂肪和胆固醇。
And if you recall, ApoB represents the number of particles.
如果您还记得的话，ApoB 代表粒子数。
So the purpose of them is to be carrying around mostly cholesterol, but if you have a high amount of triglyceride, you're basically using up cargo space on the ships.
因此，它们的目的是携带大部分胆固醇，但如果甘油三酯含量很高，那么基本上就会耗尽船上的货舱空间。
And so you need more ships.
所以你需要更多的船只。
So if a person has elevated triglycerides, and I consider anything over 100 to be elevated, even though most laboratory tests would consider normal to be up to 150 milligrams per deciliter.
因此，如果一个人的甘油三酯升高，并且我认为超过 100 的甘油三酯就会升高，尽管大多数实验室测试认为甘油三酯高达 150 毫克/分升是正常的。
We would want to fix their insulin resistance, bring the trigs way down.
我们想要修复他们的胰岛素抵抗，降低触发次数。
I would want to see trigs no more than two times the HDL cholesterol.
我希望看到的甘油三酯不超过高密度脂蛋白胆固醇的两倍。
So if their HDL cholesterol is 60 milligrams per deciliter, I consider 120 to be through-the-roof high, and ideally, we want trigs at or below HDL cholesterol.
因此，如果他们的 HDL 胆固醇为 60 毫克/分升，我认为 120 已经极高，理想情况下，我们希望 Trig 等于或低于 HDL 胆固醇。
Andrew Huberman:
安德鲁·休伯曼：
Trigs being triglycerides.
Trigs 是甘油三酯。
Dr. Peter Attia:
彼得·阿蒂亚博士：
That's right.
没错。
Andrew Huberman:
安德鲁·休伯曼：
So and-
所以和-
Dr. Peter Attia:
彼得·阿蒂亚博士：
And that's basically a big interest
这基本上是一个很大的兴趣
Andrew Huberman:
安德鲁·休伯曼：
...
...
does that mean lower in dietary fat?
这是否意味着膳食脂肪含量较低？
Dr. Peter Attia:
彼得·阿蒂亚博士：
No. Actually, it's most easily accomplished through carbohydrate restriction.
不。实际上，通过限制碳水化合物最容易实现。
Yeah.
是的。
Triglycerides in some ways are an integral of carbohydrate consumption.
在某些方面，甘油三酯是碳水化合物消耗的一部分。
Any energy restriction will get it for you, but it's most sensitive to restriction of-- Even under eucaloric conditions, carbohydrate restriction will lower triglycerides.
任何能量限制都会为您带来好处，但最敏感的是限制——即使在正常热量条件下，碳水化合物限制也会降低甘油三酯。
So again, energy restriction would be first order of business.
因此，能源限制将再次成为首要任务。
But within that, carbohydrate restriction will probably get you there quicker.
但在此范围内，限制碳水化合物可能会让你更快地达到目标。
So, you sort of take the low-hanging fruit off the table.
所以，你可以把容易实现的目标从桌面上拿下来。
Andrew Huberman:
安德鲁·休伯曼：
And where does exercise play a role?
运动在哪里发挥作用？
Dr. Peter Attia:
彼得·阿蒂亚博士：
Minimal role.
最小的作用。
Yeah.
是的。
Andrew Huberman:
安德鲁·休伯曼：
For improving insulin sensitivity?
为了提高胰岛素敏感性？
Dr. Peter Attia:
彼得·阿蒂亚博士：
No, I'm sorry.
不，对不起。
For improving lipids in general.
一般用于改善血脂。
Yeah.
是的。
Andrew Huberman:
安德鲁·休伯曼：
Okay.
好的。
But it can improve insulin sensitivity.
但它可以提高胰岛素敏感性。
Dr. Peter Attia:
彼得·阿蒂亚博士：
It can.
可以。
Absolutely.
绝对地。
Yeah.
是的。
Andrew Huberman:
安德鲁·休伯曼：
Especially combinations of resistance training and cardiovascular exercise.
尤其是阻力训练和心血管运动的结合。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah.
是的。
Andrew Huberman:
安德鲁·休伯曼：
Correct.
正确。
Yeah.
是的。
Dr. Peter Attia:
彼得·阿蒂亚博士：
So once it comes down to pharmacotherapy, you basically have several classes of drugs.
因此，一旦涉及药物治疗，基本上就有几类药物。
So the most obvious and the one that most people are aware of are called statins.
因此，最明显且大多数人都知道的药物称为他汀类药物。
So statins work both directly and indirectly on the problem.
因此他汀类药物可以直接或间接地解决这个问题。
So directly, they work by targeting an enzyme very high in the synthetic pathway of cholesterol production.
因此，它们直接针对胆固醇生成合成途径中非常高的酶起作用。
And the enzyme is called HMG CoA reductase, and I think it's the second committed step.
这种酶称为 HMG CoA 还原酶，我认为这是第二个关键步骤。
I could be wrong on that.
我可能是错的。
I don't think it's the first committed step.
我不认为这是第一步。
But that enzyme gets targeted ubiquitously throughout the body, and in response to that, the liver senses a reduction in the body's pool of cholesterol.
但这种酶遍及全身，作为反应，肝脏感觉到体内胆固醇的减少。
And the liver really tries to regulate this.
肝脏确实试图调节这一点。
So the liver, in response to that, increases its expression of LDL receptors.
因此，肝脏对此做出反应，增加 LDL 受体的表达。
So the liver itself has LDL receptors on its surface, and as the body's pool of cholesterol goes down, the liver senses this reduction and says, "I want to bring more cholesterol in." More LDL receptors go up and more ApoB particles are coming out of circulation.
因此，肝脏本身的表面就有低密度脂蛋白受体，当身体胆固醇池下降时，肝脏会感觉到这种减少，并说：“我想引入更多胆固醇。”更多的 LDL 受体上升，更多的 ApoB 颗粒从循环中排出。
So that's really the dominant way that they work, and in fact, that's the dominant way that all of these drugs work.
这确实是它们发挥作用的主要方式，事实上，这也是所有这些药物发挥作用的主要方式。
So another class of drug is called ezetimibe.
因此，另一类药物称为依折麦布。
It works by blocking-- We could get as technical as you want on this.
它通过阻塞起作用——我们可以得到你想要的技术。
It's called the Niemann-Pick C1-like one transporter in the enterocyte.
它被称为肠上皮细胞中的 Niemann-Pick C1 样转运蛋白。
I like to explain this.
我想解释一下这一点。
I borrow this explanation from Tom Dayspring.
我借用了汤姆·戴斯普林的这个解释。
But the enterocyte is obviously the luminal gut side cell that is responsible for absorption of cholesterol Remember I said earlier, most of the cholesterol you eat, you don't absorb.
但肠上皮细胞显然是负责吸收胆固醇的肠腔侧细胞，记住我之前说过，你吃的大部分胆固醇，你都不会吸收。
The reason you can't absorb it is an esterified cholesterol molecule cannot come in the Niemann-Pick C1Like1 transporter.
您无法吸收它的原因是酯化胆固醇分子无法进入 Niemann-Pick C1Like1 转运蛋白。
It's physically too large.
它的物理尺寸太大了。
But the cholesterol that you synthesize, which once it makes its way back to the liver, gets secreted in bile down the intestine, that is unesterified and readily fits into that transporter.
但是，您合成的胆固醇一旦返回肝脏，就会在胆汁中分泌到肠道，它是未酯化的，很容易融入转运蛋白。
So I kind of describe that guy as the ticket taker at the bar.
所以我形容那个人是酒吧的售票员。
He lets everybody in as long as they fit through the door.
只要能进门的人，他都会让他们进来。
There's a checkpoint inside the bar that basically says, "Do we have too much cholesterol?
酒吧内有一个检查站，基本上是在说：“我们的胆固醇是否过多？
If so, spit it out." And there's another door that acts more like the bouncer, and he's called the ATP binding cassette G5/G8, and he spits excess cholesterol out.
既然如此，那就吐出来吧。”还有另一扇门的作用更像是保镖，他被称为 ATP 结合盒 G5/G8，他会吐出多余的胆固醇。
And if that system's working fine, everything is great, but in a lot of people, that ATP binding cassette doesn't work very well, and it can't properly regulate the total body pool of cholesterol.
如果该系统工作正常，一切都很好，但对于很多人来说，ATP 结合盒不能很好地工作，并且无法正确调节体内胆固醇总量。
So there's a drug called ezetimibe that simply blocks the ticket taker.
所以有一种叫做依折麦布的药物可以简单地阻止检票员。
Andrew Huberman:
安德鲁·休伯曼：
Are there side effects to statins and ezetimibe?
他汀类药物和依折麦布有副作用吗？
Dr. Peter Attia:
彼得·阿蒂亚博士：
Ezetimibe has virtually no side effects.
依折麦布几乎没有副作用。
You can think of it as a drug that's acting outside the body, right?
你可以把它想象成一种在体外起作用的药物，对吗？
It's sort of acting on a turnstile door in your gut.
这有点像作用在你肠道里的旋转栅门上。
I have seen one patient get loose stools from it that became enough of an issue that we discontinued it.
我曾见过一名患者因使用该产品而出现稀便，这已经成为一个严重的问题，因此我们停止使用该产品。
I would say that when ezetimibe is combined with a statin, which is very commonly done, it's not unheard of.
我想说的是，当依折麦布与他汀类药物联合使用时（这种情况很常见），并非闻所未闻。
I can't give you a number, but it could be as high as 10% that you see an elevation in transaminases, which are enzymes that are made by the liver in response to some irritation.
我无法提供具体数字，但转氨酶升高的幅度可能高达 10%，转氨酶是肝脏在受到某些刺激时产生的酶。
So, this is where I think it's unclear what the clinical significance of that is.
因此，我认为目前还不清楚其临床意义是什么。
We tend to abort the strategy in the presence of elevated transaminases.
当转氨酶升高时，我们倾向于放弃该策略。
Even though the literature says you don't need to, our view is we have other options, why would we tolerate any inflammation if you don't need to?
尽管文献说你不需要，但我们认为我们还有其他选择，如果你不需要，我们为什么要容忍任何炎症呢？
Statins do have side effects.
他汀类药物确实有副作用。
So 5% of people genuinely and legitimately get a muscle soreness that can be debilitating.
因此，5% 的人确实会感到肌肉酸痛，这可能会导致身体虚弱。
It could feel like the worst workout you've ever had.
这可能感觉像是你经历过的最糟糕的锻炼。
Imagine you hadn't lifted weights in six months, and then you came over and I made you do the most brutal workout of your life.
想象一下，你已经六个月没有举重了，然后你过来，我让你做了你一生中最残酷的锻炼。
You know how you would feel the next day?
你知道第二天你会有什么感受吗？
Andrew Huberman:
安德鲁·休伯曼：
That happens every time I come over to-- Well, I work out often, but every time I come over to your house, you put me through the most brutal workout I've ever been through.
每次我去——嗯，我经常锻炼身体，但每次我去你家，你都会让我经历我经历过的最残酷的锻炼。
I think you and Cam Haynes are the two people who've managed to put me through workouts that kept me sore for at least two weeks after each visit.
我想你和卡姆·海恩斯是帮助我完成训练的两个人，每次训练后我都会感到疼痛至少两周。
Dr. Peter Attia:
彼得·阿蒂亚博士：
So that soreness, imagine you would have that persisting, that 5% of people get that response from a statin.
因此，想象一下这种疼痛会持续存在，5% 的人从他汀类药物中得到这种反应。
And obviously that's just non-- It's a non-do.
显然，这只是不——这是不做的事。
There's a narrower subset of people that do get brain fog and do experience brain fog from statins.
有一小部分人确实会出现脑雾，并且确实会因他汀类药物而出现脑雾。
And we don't really understand the why there.
我们并不真正理解其中的原因。
We have some theories as to why.
我们有一些关于原因的理论。
Maybe they're getting too much of a reduction in central cholesterol synthesis.
也许他们的中枢胆固醇合成减少太多了。
Again, it's a subjective finding, but given that we have so many tools in the toolkit, we don't have to tolerate side effects with these drugs anymore.
同样，这是一个主观发现，但鉴于我们的工具包中有如此多的工具，我们不必再忍受这些药物的副作用。
There was a day when you had somebody who just had a heart attack, and they're basically looking down the barrel of being on a statin for the rest of their life, and there were two of them and they had tons of side effects and it didn't matter.
有一天，有人刚刚心脏病发作，他们基本上看不起余生服用他汀类药物的可能性，其中有两个人，他们有大量的副作用，但这并不重要。
Today, while there are probably nine statins out there, there are really only four that we even use, and at least two of them have such a low side effect profile.
如今，虽然可能有九种他汀类药物，但我们实际上使用的实际上只有四种，而且其中至少有两种副作用如此之低。
They're not as potent, but they have a-- Potent is the wrong word.
它们没有那么强大，但它们有一个——“强大”这个词用错了。
They don't have the same effect, but they're very potent because at least one of them you're taking at such a low dose that we've got lots of statin options.
它们没有相同的效果，但它们非常有效，因为至少其中一种药物的剂量很低，以至于我们有很多他汀类药物的选择。
The third side effect of statins, which again, not common, but can't be ignored, is insulin resistance.
他汀类药物的第三个副作用是胰岛素抵抗，虽然不常见，但也不能忽视。
And this is one of the benefits of at least having periodic CGM tracking is we'll see this.
这是至少定期 CGM 跟踪的好处之一，我们会看到这一点。
We had a patient who happened to be wearing CGM in general, and then we started him on 10 milligrams of rosuvastatin, which is probably the workhorse statin right now.
我们有一位患者碰巧一般都在进行 CGM，然后我们开始给他服用 10 毫克瑞舒伐他汀，这可能是目前主力的他汀类药物。
That's the generic name for Crestor.
这是 Crestor 的通用名称。
And he pings us a couple of weeks later and he's like, "Man, my glucose is like 10 points up consistently from where it has normally been." Kind of hummed and hawed.
几周后，他给我们发了 ping，他说，“伙计，我的血糖比正常情况持续高出 10 个点。”有点嗡嗡作响。
We troubleshooted a few things.
我们解决了一些问题。
After two months, we were like, "Let's just stop the Crestor and see if that fixes it." And it immediately fixed it.
两个月后，我们想，“让我们停止 Crestor，看看是否能解决问题。”它立即修复了它。
We reintroduced the Crestor and it happened again.
我们重新推出了 Crestor，这种情况又发生了。
So there was no doubt in my mind or low doubt in my mind that Crestor was responsible for that.
因此，我毫不怀疑或不太怀疑克雷斯托应对此事负责。
And again, you could say, well, maybe that's not that clinically significant, but I would argue, why bother?
再说一次，你可能会说，好吧，也许这没有那么临床意义，但我会争辩说，为什么要麻烦呢？
I have other choices.
我还有其他选择。
So those are your two big ones.
这是你的两个大人物。
The next one that is really the big one are PCSK9 inhibitors.
下一个真正重要的药物是 PCSK9 抑制剂。
So, gosh, coming up about 20 years ago maybe, a woman named Helen Hobbs made a discovery of a group of people that had a disease called familial hypercholesterolemia.
所以，天哪，大约 20 年前，一位名叫海伦·霍布斯 (Helen Hobbs) 的女士发现了一群患有家族性高胆固醇血症的人。
So FH or familial hypercholesterolemia is a very genetic heterogeneous condition.
因此，FH 或家族性高胆固醇血症是一种遗传异质性很强的疾病。
Going back to that Mendelian randomization study, these are the people on the far end that show us how high lipid levels cause atherosclerosis.
回到孟德尔随机化研究，这些人向我们展示了高脂质水平如何导致动脉粥样硬化。
So these people have very high cholesterol levels, typically north of 300 milligrams per deciliter.
因此，这些人的胆固醇水平非常高，通常超过每分升 300 毫克。
Their LDL cholesterol alone is, by definition, at least 190 milligrams per deciliter.
根据定义，仅他们的 LDL 胆固醇就至少为每分升 190 毫克。
Very high incidence of atherosclerosis in these people, along with other injuries.
这些人的动脉粥样硬化以及其他损伤的发病率非常高。
They have so much cholesterol they accumulate it in their tendons, in their eyes.
他们体内的胆固醇过多，会积聚在肌腱和眼睛中。
It's a really devastating condition if not managed correctly.
如果管理不当，这确实是一种毁灭性的情况。
And she discovered this mutation in a gene for PCSK9 that codes for a protein that degrades LDL receptors.
她在 PCSK9 基因中发现了这种突变，该基因编码一种降解 LDL 受体的蛋白质。
So these people had hyperfunctioning PCSK9 genes.
所以这些人的 PCSK9 基因功能亢进。
So their genes were just chomping down all the LDL receptors in the liver, so these people weren't clearing LDL.
所以他们的基因只是吞噬肝脏中的所有低密度脂蛋白受体，所以这些人并没有清除低密度脂蛋白。
About five years later, another subset of the population were discovered that were the exact opposite.
大约五年后，发现另一部分人群的情况恰恰相反。
These people had hypofunctioning PCSK9.
这些人的 PCSK9 功能低下。
They had virtually unmeasurable...
他们拥有几乎无法估量的...
These people had LDL cholesterol levels of 10 to 20 milligrams per deciliter, and not surprisingly, they had no heart disease.
这些人的低密度脂蛋白胆固醇水平为每分升 10 至 20 毫克，毫不奇怪，他们没有心脏病。
So that led to the development of a couple of amazing drugs that are now used.
因此，这导致了现在使用的几种令人惊奇的药物的开发。
So I take one of these drugs.
所以我服用其中一种药物。
I've been taking one of these drugs for, I don't know, I probably started in 2015.
我不知道，我可能从 2015 年开始服用其中一种药物。
So it's an injectable drug.
所以它是一种注射药物。
I take it every two weeks and it's called a PCSK9 inhibitor.
我每两周服用一次，它被称为 PCSK9 抑制剂。
So the drug blocks the protein, and therefore gives me more LDL receptors, yanks more ApoB out of circulation.
因此，这种药物会阻断蛋白质，从而给我带来更多的 LDL 受体，将更多的 ApoB 排除在循环之外。
Andrew Huberman:
安德鲁·休伯曼：
Interesting.
有趣。
When we were talking about side effects, I was thinking, are there any short-term benefits?
当我们谈论副作用时，我在想，有什么短期好处吗？
So I guess we'd call this positive side effects, but let's think of it more directly in line with the underlying biology.
所以我想我们会称之为积极的副作用，但让我们更直接地根据潜在的生物学来思考它。
Let's say my ApoB is mid-range to high, let's say 100.
假设我的 ApoB 为中高，假设为 100。
80 to 100.
80 到 100。
And I improve my insulin resistance through nutrition, but we decide it doesn't go down so much, so we're going to continue to try and knock this number down and I take any number of different drugs to reduce it.
我通过营养改善了我的胰岛素抵抗，但我们认为它不会下降那么多，所以我们将继续尝试降低这个数字，我服用许多不同的药物来减少它。
Do I immediately start to feel better?
我立即开始感觉好些了吗？
Dr. Peter Attia:
彼得·阿蒂亚博士：
Nope.
不。
Andrew Huberman:
安德鲁·休伯曼：
So there's no-
所以没有-
Dr. Peter Attia:
彼得·阿蒂亚博士：
You feel nothing.
你什么感觉都没有。
Andrew Huberman:
安德鲁·休伯曼：
Okay.
好的。
Dr. Peter Attia:
彼得·阿蒂亚博士：
You'll feel nothing.
你不会有任何感觉。
Andrew Huberman:
安德鲁·休伯曼：
And I think that's an important point because of the causality issue that we were talking about earlier.
我认为这是很重要的一点，因为我们之前讨论过因果关系问题。
Because a lot of people are walking around out there feeling fine.
因为很多人在外面走来走去都感觉很好。
Their ApoB might be a bit high.
他们的 ApoB 可能有点高。
They either know it or don't know it, but they think, "Well, I'm feeling fine." And you gave a very rational argument earlier as to why, because of the causality involved, it makes far more sense to intervene.
他们要么知道，要么不知道，但他们会想：“嗯，我感觉很好。”您早些时候给出了一个非常理性的论点，说明为什么由于所涉及的因果关系，干预更有意义。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah, we don't want to rely on feeling when it comes to atherosclerosis.
是的，当谈到动脉粥样硬化时，我们不想依赖感觉。
Just to put some perspective on this, when I was in medical school, and I think I even write about this in the book, we had a pathology lecture where the professor stands up there and he says "What is the most common presentation of a heart attack?" And us keener first-year med students' hands shoot straight up.
只是为了对此有一些看法，当我在医学院时，我想我什至在书中写到了这一点，我们有一个病理学讲座，教授站在那里，他说“心脏病发作最常见的表现是什么？”我们这些热心的一年级医学生的手都伸直了。
"Chest pain." "No, that's not the most common." "Oh, shoulder pain radiating down the left arm." "No." "Nausea?" "No." "Shortness of breath?" "No, no, no." We rattled this off for a few minutes, and he goes, "Death." The single most common presentation for a myocardial infarction is death.
“胸痛。” “不，这不是最常见的。” “哦，肩部疼痛从左臂延伸出去。” “不。” “恶心？” “不。” “气促？” “不，不，不。”我们喋喋不休地讨论了几分钟，然后他说：“死亡。”心肌梗塞最常见的单一表现是死亡。
That was 25 years ago.
那是25年前的事了。
Today, it's probably not the most common because advanced cardiac life support is so much better, but it's still strikingly common.
如今，它可能不是最常见的，因为高级心脏生命支持要好得多，但它仍然非常常见。
So-
所以——
Andrew Huberman:
安德鲁·休伯曼：
Well, you could say that the best predictor of a heart attack is still a heart attack.
好吧，你可以说心脏病发作的最佳预测指标仍然是心脏病发作。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Well, I mean-
嗯，我的意思是——
Andrew Huberman:
安德鲁·休伯曼：
I'm not saying that the best underlying predictor.
我并不是说最好的潜在预测因子。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah.
是的。
Andrew Huberman:
安德鲁·休伯曼：
And actually, this hits home.
事实上，这很切中要害。
When I was a postdoc, I was living in San Francisco, and I'll never forget this, taking my coffee out on my porch in the morning.
当我还是一名博士后时，我住在旧金山，我永远不会忘记这一点，早上我在门廊上喝咖啡。
This is right near the UCSF Parnassus campus, and this guy's walking down the street, he's probably about my age, and I said, "Hello," and he said, "Hello." He walked a few more steps, and boom, he just hit the concrete and died right in front of me.
这里就在加州大学旧金山分校帕纳苏斯校区附近，这个人走在街上，他的年龄可能和我差不多，我说，“你好，”他说，“你好。”他又走了几步，然后砰的一声，他就撞到了水泥地上，死在了我的面前。
It took a minute or two to know that he was truly dead.
过了一两分钟我才知道他真的死了。
I'll never forget it, because that's a-
我永远不会忘记它，因为那是——
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah, it's very traumatic
是的，这是非常痛苦的
Andrew Huberman:
安德鲁·休伯曼：
...
...
for a non-surgeon, it's an event, right?
对于非外科医生来说，这是一个事件，对吧？
Dr. Peter Attia:
彼得·阿蒂亚博士：
Sure.
当然。
Andrew Huberman:
安德鲁·休伯曼：
And I followed up on this, and because his family, the whole thing, because they wanted a report and no cocaine in his system, no prior history of any kind of health issues.
我跟进了这件事，因为他的家人，整个事情，因为他们想要一份报告，并且他的系统中没有可卡因，没有任何类型的健康问题的历史。
But he was just strolling along and just boom, as if he'd been hit by a bus.
但他只是在漫步，然后就发出“砰”的一声，就好像他被公共汽车撞了一样。
It was crazy.
太疯狂了。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah.
是的。
So again, this is just one of those things where we're going to spend a lot of time talking about things that feel good and feel bad when you change them, right?
再说一次，这只是我们将花费大量时间讨论改变它们时感觉良好和感觉糟糕的事情之一，对吧？
Like if you take a person who's not sleeping well, but who thinks they're sleeping well, and you ask them for a leap of faith, which is, "Hey, give me a month to help you sleep really well." Yeah, you're going to feel better.
就像如果你找一个睡眠不好但自认为睡得很好的人，你要求他们有一个信念的飞跃，那就是，“嘿，给我一个月的时间来帮助你睡得很好。”是的，你会感觉好一些。
You might not know it now because you don't know how bad you're sleeping now.
你现在可能不知道，因为你不知道自己现在睡得有多糟糕。
You've become acclimated to this.
你已经习惯了这个。
But this is not one of those domains.
但这不是这些领域之一。
Exercise, nutrition, sleep, all those things, when you do those things better, you feel better.
锻炼、营养、睡眠，所有这些事情，当你把这些事情做得更好时，你会感觉更好。
But I don't want to overpromise on this.
但我不想对此做出过多的承诺。
You're not going to feel better in the moment when you fix your lipids, but you'll feel better when you don't have a heart attack.
当你调整血脂时，你不会感觉好些，但当你没有心脏病发作时，你会感觉好些。
Andrew Huberman:
安德鲁·休伯曼：
So by all this logic, everybody should get their ApoB measured.
因此，按照所有这些逻辑，每个人都应该测量 ApoB。
How early in life should people do that?
人们应该在多大年纪就这样做？
Starting in their 20s?
从20多岁开始？
In their 30s?
30多岁？
Dr. Peter Attia:
彼得·阿蒂亚博士：
Certainly, if you have a family history that is of any concern.
当然，如果您有令人担忧的家族史。
If I could live my life over again, if I knew everything then that I know today, yeah, I would've had mine measured in my 20s.
如果我能重新开始我的生活，如果我知道今天所知道的一切，是的，我会在 20 多岁的时候测量我的生活。
I didn't get my ApoB measured for the first time probably till I was in my 40s because that's...
我可能直到 40 多岁才第一次测量 ApoB，因为那是......
Well, yeah, maybe late 30s, early 40s, right?
嗯，是的，也许是 30 岁末、40 岁出头，对吧？
I had my first calcium scan when I was 35, and I had to beg, borrow, steal to get it done because everyone was like, "Why does a 35-year-old want to do this?" But I just felt something was wrong given my family history.
我 35 岁时进行了第一次钙扫描，我不得不乞讨、借钱、偷窃才能完成，因为每个人都在想，“为什么 35 岁的人想做这个？”但考虑到我的家族史，我只是觉得有些不对劲。
And I'm glad I did.
我很高兴我做到了。
I'm glad I did that because I learned something that completely changed the direction of my life.
我很高兴我这么做了，因为我学到了一些东西，彻底改变了我的人生方向。
Andrew Huberman:
安德鲁·休伯曼：
Okay, I know my ApoB numbers and that I might be that guy who's up above 100, so I'm going to get this treated.
好吧，我知道我的 ApoB 数值，而且我可能就是那个高于 100 的人，所以我要接受治疗。
That's a promise to myself.
这是对我自己的承诺。
We covered the three major risk factors, which were blood pressure, keeping that in check, don't smoke, and ApoB, and we've now talked about the things to adjust ApoB levels.
我们讨论了三个主要的危险因素，即血压、控制血压、不吸烟和 ApoB，现在我们讨论了调整 ApoB 水平的事项。
We did not really talk about things to adjust blood pressure.
我们并没有真正谈论调节血压的事情。
I'm assuming exercise sits as one of the foremost-
我假设锻炼是最重要的之一-
Dr. Peter Attia:
彼得·阿蒂亚博士：
Exercise, nutrition.
锻炼、营养。
Yeah, weight management is a huge one here.
是的，体重管理在这里很重要。
So, you take a person who's blood-- And this is one of those things where we don't immediately jump on the pharmacotherapy train with blood pressure, because here there are side effects sometimes.
所以，你拿一个有血的人来说——这是我们不会立即跳上血压药物治疗列车的事情之一，因为有时会有副作用。
And you do have to worry about overshooting You don't really have to worry about overshooting a person's lipids.
您确实不必担心血脂超标。您实际上不必担心人的血脂超标。
We do back off if we overshoot, but it doesn't cause a symptom.
如果我们超调了，我们确实会后退，但这不会引起任何症状。
There's not a short-term immediate risk from doing that.
这样做不会带来短期的直接风险。
If you overshoot somebody's blood pressure medication, you trade one problem for another problem.
如果你过量服用某人的降血压药物，你就会用一个问题换另一个问题。
They become lightheaded when they get up to pee at night, they fall and bang their head.
当他们晚上起床小便时会感到头晕，他们会摔倒并撞到头。
That's a devastating consequence.
这是一个毁灭性的后果。
Totally unacceptable.
完全不能接受。
So our goal is to see how much we can lower blood pressure without medication before we turn to medication.
因此，我们的目标是在转向药物治疗之前看看不使用药物可以将血压降低多少。
And let's be clear, the meds today are so much better than they used to be.
让我们明确一点，今天的药物比以前好得多。
Again, there was a day when the side effects of these medicines were miserable.
又有一天，这些药物的副作用令人痛苦。
That's simply not the case today.
今天的情况根本不是这样。
ACE inhibitors, angiotensin receptor blockers, these things are very well-tolerated, especially the ARBs.
ACE抑制剂、血管紧张素受体阻滞剂这些东西耐受性都很好，尤其是ARB。
So again, almost anybody can be on these things, but if we could get a person to lose 10 pounds and exercise every day, we see great effects with Zone 2 stuff.
再说一次，几乎任何人都可以做这些事情，但如果我们能让一个人减掉 10 磅并每天锻炼，我们就会看到第 2 区的事情有很大的效果。
So kind of the low intensity cardio.
低强度有氧运动就是这样。
Andrew Huberman:
安德鲁·休伯曼：
What's your recommendation there?
你那里有什么推荐？
I know you talk about this in the book, but I've thrown out numbers about 150 to 180 minutes per week.
我知道你在书中谈到了这一点，但我给出了每周大约 150 到 180 分钟的数字。
You go a bit higher?
你走得更高一点吗？
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah.
是的。
We go 180 to 250, 240.
我们从 180 到 250、240。
Yeah.
是的。
I like to see three to four hours a week of Zone 2.
我喜欢每周看 2 区三到四个小时。
So that's an important piece, and sleep is an important piece.
所以这是一个重要的部分，睡眠也是一个重要的部分。
So get the sleep right, get the exercise right.
所以，保证充足的睡眠，保证充足的锻炼。
If you're overnourished, let's correct that problem, and if all of that doesn't work, and by the way, that works a lot of the time.
如果你营养过剩，让我们纠正这个问题，如果所有这些都不起作用，顺便说一句，这在很多时候都有效。
No, that works most of the time.
不，大多数时候这都是有效的。
If that doesn't work, then we've got pharmacotherapy.
如果这不起作用，那么我们就采取药物治疗。
There is still a true phenomenon of essential hypertension, which is in individuals for whom all the fixable stuff has been fixed and they still have high blood pressure.
仍然存在一种真正的原发性高血压现象，即所有可修复的东西都已修复但仍然患有高血压的个体。
We still have to medicate those folks.
我们仍然需要为这些人提供药物治疗。
By the way, there's something that I want to mention here that doesn't get much attention, but it's so important, which is the effect of high blood pressure on the kidney and also the brain itself.
顺便说一句，我想在这里提一下，虽然没有引起太多关注，但却非常重要，那就是高血压对肾脏以及大脑本身的影响。
We've talked about the brain, we've talked about the heart, but the kidney doesn't get enough attention.
我们谈论了大脑，我们谈论了心脏，但肾脏没有得到足够的关注。
The kidney is a remarkable organ, and I think if you're really in this game of trying to live longer.
肾脏是一个非凡的器官，我想如果你真的想活得更久的话。
If you think, "Hey, maybe we'll live 80, 85 years, but if we start doing all of these other things and really optimizing our behaviors, that could be 95." Well, you have to start thinking about the capacity of the kidney.
如果你想，“嘿，也许我们会活 80、85 岁，但如果我们开始做所有这些其他事情并真正优化我们的行为，那可能会活到 95 岁。”好吧，你必须开始考虑肾脏的容量。
And once the glomerular filtration rate falls below a certain level, you have to be very careful with how you live your life.
一旦肾小球滤过率低于一定水平，您就必须非常小心自己的生活方式。
And unfortunately, this is one of those things that is another sort of mistake that's made in modern medicine, which is we don't pay enough attention to how to measure kidney function correctly.
不幸的是，这是现代医学所犯的另一种错误，即我们对如何正确测量肾功能没有给予足够的重视。
We rely very heavily on something called creatinine, as opposed to looking at another biomarker called cystatin C, which is far more accurate.
我们非常依赖一种叫做肌酸酐的东西，而不是寻找另一种叫做胱抑素 C 的生物标志物，后者要准确得多。
And we also tolerate too low of a kidney function for a person's age.
而且我们还可以容忍对于一个人的年龄而言肾功能过低的情况。
So we might look at someone who's 50, whose kidney function is at 65% and say, "You're totally fine." Because it's true that at 65%, there is no problem.
因此，我们可能会看着 50 岁、肾功能仅为 65% 的人说：“你完全没问题。”因为确实65%是没有问题的。
But you're not thinking, well, if this person has to live another 40 years and this continues to go down, they're going to potentially be staring down the barrel of needing dialysis the last five years of their life.
但你不会想，如果这个人还得再活 40 年，而且这种情况继续恶化，他们可能会在生命的最后五年里面临需要透析的困境。
Again, you want to die with compromised kidney function, but never from compromised kidney function.
再说一次，你希望死于肾功能受损，但绝不能死于肾功能受损。
In fact, the hazard ratio of all-cause mortality associated with compromised kidney function is even greater than that of heart disease.
事实上，与肾功能受损相关的全因死亡的风险比甚至比心脏病还要大。
Once you cross that threshold, lights out.
一旦跨过门槛，灯就灭了。
Once you are needing dialysis, your risk of death is higher than that of someone with high blood pressure, smoking, even someone who has cancer.
一旦需要透析，您的死亡风险就会高于高血压、吸烟甚至癌症患者。
You have a higher risk of death having end-stage renal disease than you do having cancer.
患终末期肾病的死亡风险比患癌症的风险更高。
So the kidney is so sensitive to blood pressure.
所以肾脏对血压非常敏感。
This is a tiny organ that on every pump of your heart is getting 20% to 25% of your blood.
这是一个微小的器官，心脏的每次泵血都会吸收 20% 到 25% 的血液。
Andrew Huberman:
安德鲁·休伯曼：
Wow.
哇。
Dr. Peter Attia:
彼得·阿蒂亚博士：
So just imagine how sensitive and susceptible it is to elevated blood pressure.
因此，想象一下它对血压升高是多么敏感和敏感。
Andrew Huberman:
安德鲁·休伯曼：
We've covered quite a few corners of avoiding the major killer, atherosclerosis.
我们已经介绍了避免主要杀手动脉粥样硬化的一些方法。
Let's talk about cancer.
我们来谈谈癌症。
Nobody wants cancer.
没有人想要癌症。
Everybody seems to know somebody who has had or has died of cancer, and probably no surprise given that it's number two on the list.
每个人似乎都认识患有癌症或已经死于癌症的人，考虑到癌症在名单上排名第二，这可能并不奇怪。
What are the numbers and what can people do to offset cancer?
数字是多少？人们可以采取哪些措施来抵消癌症？
And of course, there are huge number of different types of cancer.
当然，癌症有很多不同类型。
And inside of this conversation, you remarked that it might be good to have a conversation about alcohol, which we didn't talk about in the last discussion.
在这次谈话中，您说谈论酒精可能会很好，但我们在上次讨论中没有讨论这一点。
But if alcohol is involved or is a risk factor rather for cardiovascular disease or cerebrovascular disease, now would probably be the time to mention it.
但如果酒精与心血管疾病或脑血管疾病有关或者是一个危险因素，那么现在可能是时候提及它了。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah.
是的。
This has been looked at in a number of ways.
人们已经从多种方面审视了这一点。
So if you look at top line epidemiology and you've heard of these things called the French paradox, which is, oh, come on, they eat all of this fatty stuff and drink all this wine, and they have a slightly lower risk of cardiovascular disease.
所以，如果你看看流行病学，你就会听说过“法国悖论”，那就是，哦，来吧，他们吃了所有这些脂肪类的东西，喝了所有这些酒，他们患心血管疾病的风险略低。
You just have to throw that stuff out the window because there's so many confounders there that it's useless epidemiology.
你只需要把这些东西扔到窗外，因为那里有太多混杂因素，以至于它是毫无用处的流行病学。
If you really look at the data clearly, and there was actually a really elegant analysis that included some genetic studies that came out in JAMA about a year ago.
如果你真的仔细观察数据，就会发现实际上有一个非常优雅的分析，其中包括大约一年前在《美国医学会杂志》上发表的一些基因研究。
It's actually pretty clear that there is no dose of ethanol that is healthy.
事实上很明显，没有任何剂量的乙醇是健康的。
Okay, so there's no J curve.
好吧，所以没有 J 曲线。
So there used to be this literature that said there's a J curve associated with ethanol.
曾经有文献说，乙醇存在一条 J 曲线。
So meaning, at total abstinence, there's a slightly higher risk of death than if you're drinking one drink a day.
因此，完全戒酒的死亡风险比每天喝一杯的风险略高。
And then if you go beyond one drink a day, the rate of death starts to climb.
如果你每天喝一杯以上，死亡率就会开始上升。
The problem with that analysis, so there's just been a lot of consternation around that.
该分析存在问题，因此引起了很多恐慌。
But the problem with those analyses are multiple But the most important of these are that the abstainers have a reason for abstaining, typically.
但这些分析的问题是多方面的，但其中最重要的是，弃权者通常都有弃权的理由。
And those reasons can't be extracted statistically from these analyses.
这些原因无法从这些分析中统计出来。
So I'll leave it at that without-- I've written many blog posts about this.
所以我就这样吧——我已经写了很多关于这个的博客文章。
If people are really interested, they can go and talk about that.
如果人们真的感兴趣，他们可以去谈论这个。
I also do talk about this a little bit in the book, by the way.
顺便说一下，我在书中也谈到了这一点。
But the short answer is there is no dose of ethanol that is healthy.
但简单的回答是，没有任何剂量的乙醇是健康的。
I would argue that it's not a straight line of risk, but it probably goes, I think from zero to one, there's probably no measurable harm for most people.
我认为这不是一条直线风险，但我认为从零到一，对大多数人来说可能没有可衡量的伤害。
Andrew Huberman:
安德鲁·休伯曼：
One per day or one per week?
每天一次还是每周一次？
Dr. Peter Attia:
彼得·阿蒂亚博士：
Probably one per day, up to one per day.
大概一天一次，最多一天一次。
It's probably very difficult to discern the harm, but I'm going to put a caveat on that, that I'll come back to.
辨别其危害可能非常困难，但我要对此提出警告，稍后我会再谈。
And then I think the risk starts to climb pretty steeply after that, and I think it climbs non-linearly after that.
然后我认为此后风险开始急剧上升，并且我认为此后风险呈非线性上升。
That is my reading of the literature.
这就是我阅读的文献。
Okay.
好的。
So then how do you decide if you're going to have up to one drink a day?
那么，您如何决定是否每天最多喝一杯呢？
And by the way, that's not the same as seven a week, because that doesn't mean seven in a day.
顺便说一句，这与每周七次不同，因为这并不意味着一天七次。
Andrew Huberman:
安德鲁·休伯曼：
Right.
对。
Which we know is really detrimental.
我们知道这确实是有害的。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Right.
对。
Andrew Huberman:
安德鲁·休伯曼：
Especially for the brain.
特别是对于大脑。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Right.
对。
Andrew Huberman:
安德鲁·休伯曼：
But also the cascades that result from disrupted sleep, not just for that one night, but multiple nights.
还有因睡眠中断而导致的一系列连锁反应，不仅是那一晚，而是多个晚上。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah.
是的。
Andrew Huberman:
安德鲁·休伯曼：
Yeah, the literature I've seen on alcohol, now again, this is an emerging literature because what you're describing is exactly right.
是的，我看过关于酒精的文献，现在再说一遍，这是新兴文献，因为你所描述的完全正确。
But people are now-- Some more conservative folks are starting to place it at two drinks per week total, beyond which you start running into issues, especially for women in terms of breast cancer risk, which is something maybe we can circle back on.
但现在人们——一些更保守的人开始将其限制为每周喝两杯，超过这个量你就会开始遇到问题，特别是对于女性来说，患乳腺癌的风险很高，这也许是我们可以回过头来讨论的问题。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah.
是的。
Look, my view is if you can not drink at all, you're better off not drinking at all.
听着，我的观点是，如果你根本不能喝酒，那你最好根本不喝酒。
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Dr. Peter Attia:
彼得·阿蒂亚博士：
And people always say to me, "Well, Peter, what's your view on this?" And my view is, I do drink.
人们总是对我说：“彼得，你对此有何看法？”我的观点是，我确实喝酒。
I'll go weeks at a time without having a drink.
我会连续几个星期不喝酒。
I've had one drink since I saw you last a couple of weeks ago because I've been sick.
自从几周前上次见到你以来，我已经喝过一杯酒了，因为我病了。
So I'm thinking, "Well, gosh.
所以我在想，“好吧，天哪。
The deck is stacked against me right now.
现在形势对我不利。
Why would I do anything to stack it more?"
为什么我要采取任何措施来堆积更多呢？”
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Dr. Peter Attia:
彼得·阿蒂亚博士：
But my philosophy, which is half tongue in cheek, but is true, is I just don't drink bad alcohol.
但我的哲学是半开玩笑的，但却是真实的，那就是我只是不喝劣质的酒。
My wife saw me do this the other day.
前几天我妻子看到我这样做。
We opened up a bottle of wine, and it was a very expensive bottle of wine, and I took a sip and I was like-- Yeah, I just dumped my glass.
我们打开了一瓶酒，这是一瓶非常昂贵的酒，我喝了一口，然后我就想——是的，我刚刚把杯子倒掉了。
I was like, "I don't know.
我当时想，“我不知道。
It just doesn't taste right to me." And it tasted fine to her.
它只是不适合我的味道。”而且她觉得味道很好。
So I don't think it was that the wine had spoiled.
所以我不认为酒变质了。
It was just I didn't like the taste of it enough to justify drinking it.
只是我不喜欢它的味道，不足以证明喝它是合理的。
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Dr. Peter Attia:
彼得·阿蒂亚博士：
I was like, "I don't feel like drinking it."
我当时想，“我不想喝它。”
Andrew Huberman:
安德鲁·休伯曼：
Yeah.
是的。
I'm fortunate.
我很幸运。
There were times in life, certainly college and portions of graduate school when I drank, but I've never really enjoyed the taste or experience of alcohol.
生活中有时我会喝酒，尤其是在大学和研究生院的部分时间，但我从来没有真正享受过酒精的味道或体验。
So all the alcohol on the planet could disappear, I wouldn't even notice.
所以地球上所有的酒精都会消失，我什至都没有注意到。
But I'll have one every once in a while.
但我每隔一段时间就会有一个。
I'm sort of that mindset.
我就是这种心态。
But great to hear that zero is better than any, because I think everyone agrees on that.
但很高兴听到零比任何都好，因为我认为每个人都同意这一点。
So it doesn't appear that alcohol can be directly linked to cardiovascular disease and cerebrovascular disease, although-
因此，酒精似乎与心血管疾病和脑血管疾病没有直接关系，尽管——
Dr. Peter Attia:
彼得·阿蒂亚博士：
Well, I-
嗯，我——
Andrew Huberman:
安德鲁·休伯曼：
...
...
there are these indirect effects through insulin.
通过胰岛素可以产生这些间接作用。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah, I was about to say.
是的，我正想说。
Andrew Huberman:
安德鲁·休伯曼：
Altering insulin sensitivity.
改变胰岛素敏感性。
Dr. Peter Attia:
彼得·阿蒂亚博士：
And through sleep.
并通过睡眠。
Andrew Huberman:
安德鲁·休伯曼：
And through sleep.
并通过睡眠。
Yeah.
是的。
Dr. Peter Attia:
彼得·阿蒂亚博士：
I think the impact of sleep on cardiovascular and cerebrovascular disease is profound, and I do think that the impact of ethanol on sleep is underappreciated.
我认为睡眠对心脑血管疾病的影响是深远的，而且我确实认为乙醇对睡眠的影响被低估了。
Andrew Huberman:
安德鲁·休伯曼：
Yeah.
是的。
And here, I think we should do a little nod to Matt Walker, the great Matt Walker.
在这里，我想我们应该向马特·沃克致敬，伟大的马特·沃克。
Because 10 years ago, if someone had a conversation about sleep and how critical it is and how not getting enough quality sleep is dangerous, people would have just kind of shake their heads and say, "What's the evidence for that?" I think Matt really deserves most of the credit for alerting people to these issues around not getting enough sleep.
因为十年前，如果有人谈论睡眠的重要性以及睡眠质量不足的危险性，人们只会摇摇头说：“这有什么证据吗？”我认为马特确实值得称赞，因为他提醒人们注意睡眠不足的这些问题。
It's just remarkable what's happened in the last decade thanks to Matt.
感谢马特，过去十年发生的事情真是非同寻常。
Dr. Peter Attia:
彼得·阿蒂亚博士：
And while we're on that topic, we have the other next horsemen of death, the neurodegenerative diseases.
当我们谈论这个话题时，我们还有其他下一个死亡骑士，即神经退行性疾病。
I think those are also heavily impacted, especially on the dementia side, by ethanol.
我认为这些也受到乙醇的严重影响，尤其是在痴呆方面。
So again, I want to be careful when I say this stuff.
再说一遍，我说这些话时要小心。
I don't believe in fear-mongering.
我不相信散布恐惧。
Okay?
好的？
I just said a moment ago, I'll say it again.
我刚才就说过了，我再说一遍。
I drink alcohol, and I'm going to continue to drink alcohol.
我喝酒，而且我还会继续喝酒。
But I think that one has to make the trade-offs, which is like if I really do love the taste of certain Spanish wines, I really do love the taste of certain tequilas, certain mezcals, and I really do love the taste of certain weird, esoteric Belgian beers.
但我认为人们必须做出权衡，就像我真的喜欢某些西班牙葡萄酒的味道，我真的喜欢某些龙舌兰酒、某些梅斯卡尔酒的味道，我真的喜欢某些奇怪、深奥的比利时啤酒的味道。
And it really does give me pleasure to consume those things.
消费这些东西确实让我很高兴。
In the same way it gives me pleasure to consume certain foods that are quite vapid.
同样地，吃某些无味的食物也给我带来快乐。
There's no upside in consuming a brownie that my kid just made, except for the fact that my kid just made it, and it's fun to eat the brownie with them.
吃我孩子刚做的布朗尼蛋糕没有什么好处，除了我的孩子刚刚做的，而且和他们一起吃布朗尼蛋糕很有趣。
So we come back to this thing about longevity is also about health span, and part of health span is quality of life.
所以我们回到长寿这个问题也与健康寿命有关，而健康寿命的一部分是生活质量。
And I write about this in the book that I think there was a day when my approach to this was purely an engineering approach, which was we are going to optimize every molecule of my being for this.
我在书中写道，我认为有一天我的方法纯粹是一种工程方法，我们将为此优化我存在的每个分子。
And if you go so far down that rabbit hole that the quality of your life deteriorates, what's the point?
如果你在这个兔子洞里走得很远，以至于你的生活质量下降了，那还有什么意义呢？
So that's why I think for somebody like you who says you could take all the alcohol off the face of the earth, I wouldn't even notice, then that's a great reason not to bother drinking.
所以这就是为什么我认为对于像你这样的人说你可以把地球上所有的酒精带走，我什至都不会注意到，那么这是一个不喝酒的好理由。
I wouldn't put myself at the opposite end of that spectrum, but I'm probably further to the spectrum, where, yeah, if you told me I could never drink alcohol again, I would be fine with it, but I'd be giving something up that I enjoy.
我不会把自己放在这个范围的另一端，但我可能会更进一步，是的，如果你告诉我我再也不能喝酒，我会接受，但我会放弃一些我喜欢的东西。
But at the same time, I know if I have two drinks with dinner, my sleep sucks, and therefore, that's just a threshold I rarely, rarely cross.
但与此同时，我知道如果我晚餐时喝两杯，我的睡眠就会很糟糕，因此，这只是我很少、很少跨越的门槛。
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Well, I certainly have my vices.
嗯，我当然有我的恶习。
Alcohol just doesn't happen to be one of them.
酒精恰好不是其中之一。
What about cancer?
那么癌症呢？
Again, nobody wants cancer.
再说一次，没有人想要癌症。
We've all known people who've died of cancer or have had cancer.
我们都认识死于癌症或患有癌症的人。
What can be done to reduce one's risk of cancer?
可以采取哪些措施来降低患癌症的风险？
Dr. Peter Attia:
彼得·阿蒂亚博士：
Well, you asked earlier about the numbers, so let's throw some numbers out there.
好吧，您之前问过这些数字，所以让我们提供一些数字。
So globally, we're talking about 11, 12 million deaths per year, about half the number of ASCVD.
因此，在全球范围内，每年有 11、1200 万人死亡，大约是 ASCVD 人数的一半。
Still a staggering number.
仍然是一个惊人的数字。
At the individual level, put it this way, somewhere between one in three and one in four chance, anyone listening to this or watching this is going to get cancer in their lifetime.
在个人层面上，这样说吧，任何听到或看到这个的人有三分之一到四分之一的机会在一生中患上癌症。
Andrew Huberman:
安德鲁·休伯曼：
But what's the probability they will die from that cancer?
但他们死于这种癌症的可能性有多大呢？
Dr. Peter Attia:
彼得·阿蒂亚博士：
Half of that.
一半。
About a one in six chance of dying.
大约有六分之一的死亡机会。
Andrew Huberman:
安德鲁·休伯曼：
Okay, so is it true that every male gets prostate cancer?
好吧，那么每个男性都会患前列腺癌吗？
In other words-
换句话说——
Dr. Peter Attia:
彼得·阿蒂亚博士：
Every man-
每个男人——
Andrew Huberman:
安德鲁·休伯曼：
...
...
on their deathbed, men have-
在临终之际，人们——
Dr. Peter Attia:
彼得·阿蒂亚博士：
Every man will die with prostate cancer, and some will die from it.
每个男人都会死于前列腺癌，有些人会死于前列腺癌。
Andrew Huberman:
安德鲁·休伯曼：
Got it.
明白了。
Dr. Peter Attia:
彼得·阿蒂亚博士：
You and I have prostate cancer right now.
你和我现在都患有前列腺癌。
Andrew Huberman:
安德鲁·休伯曼：
Thank you for informing me.
谢谢你通知我。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yes.
是的。
Hopefully, we will not die of it.
希望我们不会因此而死。
We should not die of it.
我们不应该因此而死。
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Prostate cancer, colon cancer are cancers that no one should ever die from because they are so easy to screen for, they are so easy to treat when they are in their infancy, that it's totally unacceptable that people are dying from this.
前列腺癌、结肠癌是任何人都不应该死于的癌症，因为它们很容易筛查，在婴儿期很容易治疗，人们因此而死亡是完全不可接受的。
There are other cancers for which I can't really say that.
还有其他癌症我真的不能这么说。
Breast cancer, much more complicated.
乳腺癌，要复杂得多。
Pancreatic cancer, much more complicated.
胰腺癌，要复杂得多。
Glioblastoma multiforme, much more complicated.
多形性胶质母细胞瘤，要复杂得多。
So as you said a second ago, cancer is not a disease, it is a category of diseases.
正如您刚才所说，癌症不是一种疾病，而是一类疾病。
It's not just that each organ is different and breast differs from pancreatic, it's that within breast cancer, ER/PR positive, HER2 new positive is a totally different disease from the triple negative breast cancers.
这不仅仅是每个器官不同，乳腺与胰腺不同，而是在乳腺癌中，ER/PR阳性、HER2新阳性与三阴性乳腺癌是完全不同的疾病。
Andrew Huberman:
安德鲁·休伯曼：
Those with BRCA mutations or non-BRCA mutations.
那些有 BRCA 突变或非 BRCA 突变的人。
Yeah.
是的。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Well, even putting that aside, just looking at the hormone profile of the individual breast cancers, they're totally different diseases.
好吧，即使抛开这一点，只要看看各个乳腺癌的激素特征，它们就是完全不同的疾病。
So it's not just that breast cancer is different from prostate cancer, it's that all breast cancers are quite different.
因此，不仅乳腺癌与前列腺癌不同，而且所有乳腺癌都非常不同。
Andrew Huberman:
安德鲁·休伯曼：
Maybe I should frame the question a little differently then, given the vast number of different types of cancers and categories within those.
考虑到大量不同类型的癌症及其类别，也许我应该稍微不同地阐述这个问题。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Well, no. Your question is still a fair one.
嗯，不。你的问题仍然是一个公平的问题。
Andrew Huberman:
安德鲁·休伯曼：
Okay.
好的。
Dr. Peter Attia:
彼得·阿蒂亚博士：
I just wanted to throw that caveat out there.
我只是想提出这个警告。
So now to your question.
现在回答你的问题。
Okay, so what do we know?
好吧，那么我们知道什么呢？
It turns out that we can very comfortably speak to several things.
事实证明，我们可以轻松地谈论几件事。
One is the role that genes play.
一是基因发挥的作用。
So maybe I'll just spend one second on a gene 101 thing for the viewer.
所以也许我会花一秒钟为观众介绍基因 101 的事情。
We want to differentiate between what are called germline mutations and somatic mutations.
我们想要区分所谓的种系突变和体细胞突变。
So your germline and my germline are set.
这样你的种系和我的种系就确定了。
When we were born, our germline mutations, any mutations we have in germline genes are inherited from our parents.
当我们出生时，我们的种系突变，我们种系基因中的任何突变都是从我们的父母遗传的。
Andrew Huberman:
安德鲁·休伯曼：
They're non-negotiable.
他们是没有商量余地的。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Non-negotiable.
没有商量的余地。
Andrew Huberman:
安德鲁·休伯曼：
Non-negotiable.
没有商量的余地。
Dr. Peter Attia:
彼得·阿蒂亚博士：
You got those things.
你得到了那些东西。
Andrew Huberman:
安德鲁·休伯曼：
Yeah.
是的。
Dr. Peter Attia:
彼得·阿蒂亚博士：
So question one is: how much of cancer results from those types of genetic mutations?
所以问题一是：有多少癌症是由这些类型的基因突变引起的？
And the answer is very little, less than 5%.
而且答案是很少，不到5%。
Now, you mentioned one a moment ago, BRCA.
现在，您刚才提到了一个，BRCA。
Okay, so mutations in BRCA are germline mutations.
好的，BRCA 突变属于种系突变。
A woman will get a BRCA mutation from one of her parents, and we will often have a sense of that just from the family history.
一名女性会从她的父母之一那里获得 BRCA 突变，我们通常会从家族史中感受到这一点。
When mom and sister and aunt and grandmother had breast cancer, you've got a breast cancer gene.
当妈妈、姐妹、阿姨和祖母患有乳腺癌时，您就带有乳腺癌基因。
Now, it might be BRCA, it might be another gene that's not BRCA.
现在，它可能是 BRCA，也可能是另一个不是 BRCA 的基因。
But there's no ambiguity, and we test for these genes, mostly just for insurance purposes, frankly, but there's no ambiguity that that was a germline transmission of a gene that is driving cancer.
但毫无疑问，我们测试这些基因，坦率地说，主要只是出于保险目的，但毫无疑问，这是导致癌症的基因的种系传播。
But 95-plus percent of cancers are not arising from germline mutations.
但 95% 以上的癌症并非由种系突变引起。
They are arising from somatic mutations or acquired mutations.
它们是由体细胞突变或获得性突变引起的。
So the question then becomes: what is driving somatic mutation?
那么问题就变成了：是什么驱动了体细胞突变？
And the two clearest indications of drivers of somatic mutation are smoking and obesity.
体细胞突变驱动因素的两个最明显的迹象是吸烟和肥胖。
Smoking we've talked about.
我们已经讨论过吸烟。
Let's put that aside for a moment.
让我们暂时把它放在一边。
Andrew Huberman:
安德鲁·休伯曼：
I'm so surprised about obesity.
我对肥胖感到非常惊讶。
I don't know why I'm surprised, but I've never heard this.
我不知道为什么我会感到惊讶，但我从来没有听说过这个。
I'm probably just naive to the literature.
我可能只是对文学很天真。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah.
是的。
So obesity is now the second most prevalent environmental driver of cancer.
因此，肥胖现在是第二大最普遍的癌症环境驱动因素。
Now, I will argue, and I think I argue this in the book hopefully pretty convincingly.
现在，我要争论，我想我在书中的争论希望非常令人信服。
I don't think it's obesity per se.
我不认为这本身就是肥胖。
I think obesity is just a masquerading proxy.
我认为肥胖只是一个伪装的代表。
What is obesity?
什么是肥胖？
Obesity simply is defined by body mass index.
肥胖简单地由体重指数来定义。
Well, first of all, I don't think I'm obese, but I'm way overweight on BMI.
嗯，首先，我不认为我肥胖，但我的体重指数超重了。
You probably are, too.
你可能也是。
So let's just acknowledge-
所以让我们承认——
Andrew Huberman:
安德鲁·休伯曼：
I'm clinically diagnosable as obese.
我在临床上可以诊断为肥胖。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Are you?
你是吗？
Andrew Huberman:
安德鲁·休伯曼：
Oh, no. Well, clinically maybe as a-
哦，不。嗯，临床上可能作为-
Dr. Peter Attia:
彼得·阿蒂亚博士：
That would be a BMI over 30.
那就是 BMI 超过 30。
Andrew Huberman:
安德鲁·休伯曼：
Ah, sorry.
啊，抱歉。
Dr. Peter Attia:
彼得·阿蒂亚博士：
I don't think you're probably there.
我想你可能不在场。
Andrew Huberman:
安德鲁·休伯曼：
No, but if I measure my weight by height-
不，但是如果我用身高来衡量我的体重——
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah.
是的。
My BMI is probably 27 or 28.
我的 BMI 大概是 27 或 28。
Andrew Huberman:
安德鲁·休伯曼：
Okay.
好的。
It's been a little while since I've checked.
自从我检查以来已经有一段时间了。
I only know body fat percentages-
我只知道体脂率-
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah
是啊
Andrew Huberman:
安德鲁·休伯曼：
...
...
and things like that.
诸如此类的事情。
Dr. Peter Attia:
彼得·阿蒂亚博士：
So basically, BMI is a far from perfect proxy, but at the population level, it's what we use.
所以基本上，BMI 远非完美的替代指标，但在人口层面，我们使用的是它。
I wish we would get off it, by the way.
顺便说一句，我希望我们能摆脱它。
I think it's really crap.
我认为这真的很糟糕。
I wish-
我希望——
Andrew Huberman:
安德鲁·休伯曼：
Because it doesn't take into account lean versus-
因为它没有考虑精益与-
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah
是啊
Andrew Huberman:
安德鲁·休伯曼：
...
...
non-lean tissue.
非瘦肉组织。
Dr. Peter Attia:
彼得·阿蒂亚博士：
I think we could get better data if we looked at waist-to-height ratio.
我认为如果我们关注腰围与身高的比例，我们可以获得更好的数据。
That's a way better metric.
这是一个更好的衡量标准。
So this is just a quick test for everybody.
所以这只是对每个人的一个快速测试。
Andrew Huberman:
安德鲁·休伯曼：
Uh-huh.
嗯嗯。
Dr. Peter Attia:
彼得·阿蒂亚博士：
I'm going to argue your BMI is less relevant to me than your eye color, but if your waist circumference is more than 50% of your height, you should be concerned.
我要说的是，你的 BMI 与我的相关性不如你的眼睛颜色，但如果你的腰围超过身高的 50%，你就应该担心了。
Andrew Huberman:
安德鲁·休伯曼：
Okay.
好的。
Well, then I'm okay.
嗯，那我就没事了。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah, you're fine by that metric, right?
是的，按照这个标准你还不错，对吧？
Andrew Huberman:
安德鲁·休伯曼：
Yeah.
是的。
Dr. Peter Attia:
彼得·阿蒂亚博士：
That's important.
这很重要。
So if you're six feet tall, your waist better be under 36 inches.
因此，如果您身高 6 英尺，那么您的腰围最好低于 36 英寸。
And if it's over, I would argue that's the definition of obesity, not your BMI being over 30.
如果一切都结束了，我认为这就是肥胖的定义，而不是你的 BMI 超过 30。
So Back to this issue, because we're using such a crude measurement, it basically is catching a whole bunch of stuff.
回到这个问题，因为我们使用的是如此粗略的测量，所以它基本上捕获了一大堆东西。
But the question is, what's driving it?
但问题是，是什么在推动它？
And I think if you really look at the physiology of cancer, I don't think it's obesity.
我认为如果你真正研究癌症的生理学，我不认为这是肥胖。
I think it's two things that come with obesity, insulin resistance, which is two thirds to three quarters of obese individuals are insulin resistant, and inflammation.
我认为肥胖会带来两件事：胰岛素抵抗（三分之二到四分之三的肥胖者患有胰岛素抵抗）和炎症。
And I think those two things, with the inflammation and the immune dysfunction, with the insulin resistance, and the hyper basically tonic growth stimulus that's coming, that's what's driving cancer.
我认为这两件事，炎症和免疫功能障碍，胰岛素抵抗，以及即将到来的过度生长刺激，就是导致癌症的原因。
So again, is it because a person is storing extra fat and their love handles that that's driving the risk of cancer?
那么，是否是因为一个人储存了多余的脂肪并且他们的爱处理了这会增加患癌症的风险呢？
No. Those are just two things that are coming along for the ride.
不。这些只是随之而来的两件事。
So beyond those two things, and there are also certain environmental toxins we absolutely know are doing this, right?
因此，除了这两件事之外，我们绝对知道还有某些环境毒素正在造成这种情况，对吗？
So we understand that people who have exposure to asbestos have a much higher risk of certain types of lung cancers and things like that.
因此，我们知道接触石棉的人患某些类型肺癌等疾病的风险要高得多。
But for the most part, those are our big risks.
但在大多数情况下，这些都是我们的巨大风险。
Beyond that, we talk about alcohol in certain cases.
除此之外，我们在某些情况下还会谈论酒精。
Absolutely.
绝对地。
Alcohol is a carcinogen.
酒精是一种致癌物质。
The dose part still isn't clear to me.
我仍然不清楚剂量部分。
I don't know, is one drink a day moving the needle much on cancer risk per se?
我不知道，每天喝一杯对癌症风险本身是否有很大影响？
It's not clear.
目前还不清楚。
Andrew Huberman:
安德鲁·休伯曼：
And it might depend on those genetic predispositions.
这可能取决于这些遗传倾向。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yes.
是的。
So yeah, if step one is don't get cancer, you have no control over your genes, you have control over smoking, you have control over insulin sensitivity.
所以，是的，如果第一步是不患癌症，你就无法控制你的基因，你可以控制吸烟，你可以控制胰岛素敏感性。
I wish I could sit here and tell you that there is a proven anti-cancer diet or that if you do X amount of exercise per week, you're going to not get cancer.
我希望我能坐在这里告诉你，有一种经过验证的抗癌饮食，或者如果你每周进行 X 量的运动，你就不会患癌症。
We just don't have a fraction of the control over cancer that we have with cardiovascular disease.
我们对癌症的控制能力远不及对心血管疾病的控制能力。
We don't understand the disease well enough, so we don't understand the initiation process and the propagation process.
我们对这种疾病的了解还不够深入，所以不了解它的起始过程和传播过程。
And we have to rely much more on screening.
我们必须更多地依赖筛查。
Andrew Huberman:
安德鲁·休伯曼：
Are there good whole body screens for cancer?
有好的全身癌症筛查吗？
In other words, can I walk into a tube and, or a cylinder rather, and get screened for the presence of tumors any and everywhere in the body outside the brain?
换句话说，我可以走进一个管子，或者更确切地说是一个圆柱体，并在大脑以外的身体任何地方接受肿瘤的存在筛查吗？
Because the brain's a little harder to get to, right?
因为大脑有点难接触，对吧？
Dr. Peter Attia:
彼得·阿蒂亚博士：
Believe it or not, the brain is actually pretty easy to screen for-
不管你信不信，大脑实际上很容易筛查——
Andrew Huberman:
安德鲁·休伯曼：
Because it's so fatty and floating in water.
因为它太肥了而且漂浮在水中。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Well, and also the head.
嗯，还有头部。
When you put the head into an MRI scanner, there's no movement.
当你将头部放入核磁共振扫描仪中时，头部没有任何运动。
It's the least motion artifact is in the brain.
这是大脑中运动伪影最少的。
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Dr. Peter Attia:
彼得·阿蒂亚博士：
So when you use something called diffusion weighted imaging with background subtraction in an MRI, a technology that was actually pioneered in the brain for stroke identification-
因此，当你在 MRI 中使用一种称为扩散加权成像和背景扣除的技术时，这项技术实际上是在大脑中率先用于中风识别的技术 -
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm
嗯嗯
Dr. Peter Attia:
彼得·阿蒂亚博士：
...
...
it's also really good at looking for tumors as well.
它也非常擅长寻找肿瘤。
So let me make the argument for why screening matters, because this is again, kind of an area where I go far down a rabbit hole in a way that I think traditional medicine would argue against.
因此，让我来论证为什么筛查很重要，因为这又是一个我陷入困境的领域，我认为传统医学会反对这种方式。
So my argument for screening is an argument at the individual level, and it goes as follows.
所以我关于筛查的论点是个人层面的论点，其内容如下。
To my knowledge, there is not a single example of a cancer that is more effectively treated when the burden of cancer cells in the body is higher than when it is lower.
据我所知，没有一个例子表明当体内癌细胞负担较高时比体内癌细胞负担较低时治疗癌症更有效。
So the two examples I think I talk about in the book are colon cancer and breast cancer.
所以我想我在书中谈论的两个例子是结肠癌和乳腺癌。
So when you take an individual with Stage 4 colon cancer, that means that the cancer has left the colon and is now outside of the colon, so it's usually in the liver at a minimum, potentially in the lungs or in the brain.
因此，当您检测患有第 4 期结肠癌的个体时，这意味着癌症已经离开结肠，现在位于结肠之外，因此它通常至少在肝脏中，也可能在肺部或大脑中。
That person's five-year survival is very low.
那人的五年生存率很低。
Their 10-year survival is zero.
他们的 10 年生存率为零。
We will treat them with a very aggressive regimen of multiple drugs.
我们将采用非常积极的多种药物治疗方案来治疗他们。
And again, you'll get a five-year survival of maybe 10 to 20%, and by 10 years, nobody's alive.
再说一次，你的五年生存率可能是 10% 到 20%，而到了 10 年，就没有人活着了。
If you take a person with Stage 3 colon cancer, so the colon cancer is big and it's even in the lymph nodes around the colon, but at least grossly, you can't see those cells in the liver.
如果你拿一个患有第三期结肠癌的人来说，那么结肠癌很大，甚至在结肠周围的淋巴结中，但至少从总体上看，你在肝脏中看不到这些细胞。
Microscopically, of course, we know they're there because if you don't treat those patients, they still die of colon cancer.
当然，在显微镜下，我们知道它们的存在，因为如果不治疗这些患者，他们仍然会死于结肠癌。
But you whack them with the same chemo regimen that you are going to give the metastatic patients, 80% of those people are alive in five years.
但是如果你用与转移性患者相同的化疗方案来治疗他们，其中 80% 的人会在五年内存活下来。
So night and day difference in survival.
所以夜间和白天的生存差异。
What's the difference?
有什么区别？
In the person with metastatic cancer, you're treating a person with hundreds of billions of cells.
对于患有转移性癌症的人来说，您正在治疗一个拥有数千亿个细胞的人。
In the adjuvant setting, we call it adjuvant when you treat people who have only microscopic disease, you're treating billions of cells.
在佐剂环境中，当你治疗仅患有微观疾病的人时，我们称之为佐剂，你正在治疗数十亿个细胞。
The same is true with breast cancer.
乳腺癌也是如此。
So we have the clinical trial data to put them side by side.
所以我们有临床试验数据可以将它们并列放置。
So rule number one is don't get cancer.
所以第一条规则就是不要得癌症。
Rule number two is catch cancer as early as possible if you're going to get it.
第二条规则是，如果您要患癌症，请尽早发现它。
Which brings us to your question of how do you screen for it?
这让我们想到了您如何筛选它的问题？
The first line of screening is imaging, is a sort of visualization.
筛选的第一线是成像，是一种可视化。
So you have cancers that occur outside the body that you can look at directly.
因此，您可以直接观察发生在体外的癌症。
So skin cancer, you can look directly at the skin.
所以皮肤癌，可以直接看皮肤。
Esophageal, gastric, colon cancer, those are outside the body.
食道癌、胃癌、结肠癌，那些都是体外的。
Right?
正确的？
Mouth to anus embryologically is outside the body, so you can put a scope in and you can look directly at the cancer.
从胚胎学角度来说，口腔到肛门是在体外的，所以你可以把一个窥镜放进去，就可以直接看到癌症。
But for all other cancers that are inside the body, you have to rely on some sort of imaging modality Although now we're starting to look at these things called liquid biopsies.
但对于体内的所有其他癌症，你必须依赖某种成像方式，尽管现在我们开始研究这些称为液体活检的东西。
So blood tests that are looking for cell-free DNA, and the cell-free DNA gives us a sense of, based on the epigenetic signature of what you're looking at, hey, is there a cancer in the body?
因此，血液测试旨在寻找游离 DNA，而游离 DNA 根据您所观察到的表观遗传特征，让我们有一种感觉，嘿，体内是否存在癌症？
And if so, what tissue is it potentially coming from based on these epigenetic signatures?
如果是这样，根据这些表观遗传特征，它可能来自什么组织？
So the problem with relying on any one modality is a problem of sensitivity and specificity optimization.
因此，依赖任何一种方式的问题都是敏感性和特异性优化的问题。
Now with MRI scanners, which are in some ways the best way to do this because they don't have radiation, so you don't want to be incurring damage as you do this.
现在有了核磁共振扫描仪，从某些方面来说，这是最好的方法，因为它们没有辐射，所以你不想在这样做时受到损害。
The irony of doing a whole-body CT scan to screen for cancer is your whole-body CT scan would be close to 30 to 50 millisieverts of radiation.
具有讽刺意味的是，进行全身 CT 扫描来筛查癌症是全身 CT 扫描会产生接近 30 到 50 毫西弗的辐射。
It's a staggering sum of radiation.
这是一个惊人的辐射总量。
So-
所以——
Andrew Huberman:
安德鲁·休伯曼：
Does that mean that people should-- Sorry to pull you off this, but I was going to ask about this anyway, avoiding going through the whole-body scanner at the airport.
这是否意味着人们应该——抱歉打扰你了，但我还是想问这个问题，避免在机场接受全身扫描仪。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Noise.
噪音。
So low.
这么低。
Yeah.
是的。
Going through a whole-body scanner at the airport or even getting a DEXA scan-
在机场接受全身扫描仪，甚至进行 DEXA 扫描 -
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm
嗯嗯
Dr. Peter Attia:
彼得·阿蒂亚博士：
...
...
these are trivial amounts of radiation.
这些只是微不足道的辐射量。
Andrew Huberman:
安德鲁·休伯曼：
What about flying?
飞行呢？
You hear that pilots get more cancer this time.
你听说这次飞行员得了更多癌症。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah.
是的。
If you're a pilot who's flying over the North Pole back and forth and back and forth, you're probably getting five to 10 millisieverts a year.
如果您是一名飞行员，在北极上空来回飞行，您每年可能会承受 5 到 10 毫西弗的气温。
The NRC suggests that nobody should get more than 50 millisieverts a year.
NRC 建议任何人每年接触的热量不应超过 50 毫西弗。
Andrew Huberman:
安德鲁·休伯曼：
So you and I both travel a fair amount.
所以你和我都经常旅行。
But typical travel for the busy person, let's say, two round-trip flights of more than two hours per month and an international trip every three months.
但对于忙碌的人来说，典型的旅行是每月两次两个多小时的往返航班，每三个月一次国际旅行。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Probably still less than a millisievert a year.
每年可能还不到毫西弗。
Yeah.
是的。
Living at sea level, one millisievert a year.
生活在海平面，每年一毫西弗。
Living at a mile elevation, if you lived in Denver, you're at two millisieverts a year, basically.
生活在海拔一英里的地方，如果你住在丹佛，基本上每年的气温是两毫西弗。
Andrew Huberman:
安德鲁·休伯曼：
I have to ask, standing in front of the microwave.
我必须站在微波炉前问。
We've got friends, they ask and they ask-
我们有朋友，他们不断地问——
Dr. Peter Attia:
彼得·阿蒂亚博士：
With or without testes on the counter.
柜台上有或没有睾丸。
Andrew Huberman:
安德鲁·休伯曼：
That's an inside joke that unfortunately and fortunately deserves no description.
这是一个内部笑话，不幸的是，幸运的是，不值得描述。
And Peter's not referring to me.
彼得指的不是我。
But people worry about other sources of radiation.
但人们担心其他辐射源。
So it doesn't sound like the microwave is a concern.
所以听起来微波炉并不是一个问题。
What are the other major sources of radiation?
其他主要辐射源有哪些？
Dr. Peter Attia:
彼得·阿蒂亚博士：
Outside of sort of nuclear stuff-
除了核材料之外——
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm
嗯嗯
Dr. Peter Attia:
彼得·阿蒂亚博士：
...
...
where things go sadly wrong.
可悲的是事情出了问题。
Andrew Huberman:
安德鲁·休伯曼：
Yeah.
是的。
If you live near a plant or there's been an event.
如果您住在工厂附近或发生过活动。
Dr. Peter Attia:
彼得·阿蒂亚博士：
It's mostly at the hands of medical professionals, right?
它主要由医疗专业人员负责，对吗？
It's the CT scanner and the PET scanner are hands down the biggest source of radiation.
CT 扫描仪和 PET 扫描仪无疑是最大的辐射源。
Andrew Huberman:
安德鲁·休伯曼：
What about the X-rays at the dentist when they go-
当他们去看牙医时，X光片怎么样——
Dr. Peter Attia:
彼得·阿蒂亚博士：
They're very low
他们很低
Andrew Huberman:
安德鲁·休伯曼：
...
...
where they scurry behind the wall-
他们在墙后奔跑——
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah
是啊
Andrew Huberman:
安德鲁·休伯曼：
...
...
and put me under the lead blanket.
把我放在铅毯下面。
Dr. Peter Attia:
彼得·阿蒂亚博士：
They're very low-
他们的水平很低——
Andrew Huberman:
安德鲁·休伯曼：
Okay
好的
Dr. Peter Attia:
彼得·阿蒂亚博士：
...
...
relatively speaking.
相对而言。
Andrew Huberman:
安德鲁·休伯曼：
Okay.
好的。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Fluoroscopy is very high.
透视率非常高。
They tend to try to cover up all of you that they-- So for example, if they were doing a fluoroscopic study of your kidney because you had a stone or if you were getting an injection into-- If they were doing a fluoroscopic guided injection of one of your discs in your neck-
他们倾向于试图掩盖你们所有人——例如，如果他们因为您有结石而对您的肾脏进行荧光镜检查，或者如果您正在接受注射——如果他们正在对您颈部的一个椎间盘进行荧光镜引导注射——
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm
嗯嗯
Dr. Peter Attia:
彼得·阿蒂亚博士：
...
...
that would be a locally pretty high dose, but they're going to cover the hell out of you elsewhere.
这对于当地来说是相当高的剂量，但他们会在其他地方覆盖你的地狱。
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Dr. Peter Attia:
彼得·阿蒂亚博士：
And again, if you get one of these things, it's not the end of the world, but boy, I wouldn't want to be getting one a month.
再说一次，如果你得到这些东西中的一件，那不是世界末日，但是天哪，我不想每个月得到一件。
And back to the point about screening, a chest, abdomen, pelvis CT scan is probably-- Look, there's probably a scanner out there now that's moving fast enough that it's much lower, but I'll give you an example.
回到关于筛查的话题，胸部、腹部、骨盆 CT 扫描可能是——看，现在可能有一台扫描仪移动得足够快，速度要低得多，但我会给你一个例子。
Okay.
好的。
Remember how I talked about we do CT angiograms on all of our patients for coronary artery disease?
还记得我说过我们对所有冠状动脉疾病患者进行 CT 血管造影吗？
An off-the-shelf scanner for this is 20 millisieverts of radiation.
现成的扫描仪的辐射强度为 20 毫西弗。
Andrew Huberman:
安德鲁·休伯曼：
Okay, so calibrate me because-
好吧，所以校准我，因为-
Dr. Peter Attia:
彼得·阿蒂亚博士：
That's 40% of your annual allotment.
这是您年度拨款的 40%。
Andrew Huberman:
安德鲁·休伯曼：
Oh, wow, so the medical practitioners really are the major culprits here.
哦，哇，原来医生才是罪魁祸首。
Dr. Peter Attia:
彼得·阿蒂亚博士：
That's right.
没错。
So what we say is, and I think most doctors are now realizing this is, no, it behooves you to pay a little bit more to go to a really good place that can do that scan for 2 millisieverts, meaning they have a much faster CT scanner, much better software, and they're better engineers.
所以我们所说的是，我想大多数医生现在都意识到，不，你应该多花一点钱去一个真正好的地方，可以进行 2 毫西弗的扫描，这意味着他们拥有更快的 CT 扫描仪、更好的软件，而且他们是更好的工程师。
So they have better engineering that they can do on the scanner to get that done.
因此，他们可以在扫描仪上进行更好的工程设计来完成这项工作。
So for someone listening to this, here's my take.
对于听这个的人来说，这是我的看法。
Do not get a CT scan or any imaging study without asking, "How much radiation am I seeing?" And if a person can't tell you how many millisieverts of radiation you're being exposed to, then just say, "I'm going to wait a minute until somebody can tell me that."
在进行 CT 扫描或任何影像学检查时，请先询问“我看到了多少辐射？”如果一个人无法告诉您您受到了多少毫西弗的辐射，那么只需说：“我要等一下，直到有人可以告诉我这一点。”
Andrew Huberman:
安德鲁·休伯曼：
I realize-
我意识到——
Dr. Peter Attia:
彼得·阿蒂亚博士：
And keep in mind, if 50 is the most you should ever be exposed to in a year, there better be a damn good reason why I'm going to get 25 in a day.
请记住，如果 50 是您一年内应该接触的最多次数，那么我最好有一个非常充分的理由为什么我要在一天内接触 25。
Now, there are some people who have to do this.
现在，有些人必须这样做。
If you're a cancer patient and they're scanning you as a part of your treatment, you have to pick and choose between those two opportunities.
如果您是一名癌症患者，并且他们对您进行扫描作为治疗的一部分，您必须在这两个机会之间做出选择。
So I also don't want to create some fear-mongering where-
所以我也不想制造一些散布恐惧的事情——
Andrew Huberman:
安德鲁·休伯曼：
Sure
当然可以
Dr. Peter Attia:
彼得·阿蒂亚博士：
...
...
oh my God, if you hit 50 in a year, you're hosed.
天哪，如果你一年内达到 50 分，你就完蛋了。
No. It's just I wouldn't want to hit 50 a year every year for my whole life, and I certainly wouldn't want to be hitting hundreds a year for any period of time.
不，只是我不想一生中每年都达到 50 岁，而且我当然也不想在任何一段时间内每年达到数百岁。
Andrew Huberman:
安德鲁·休伯曼：
I think we're just trying to raise awareness and also calibrate people to what the sources are, and so they can make good choices, not to place them into this chronic state of fear or even an acute state of fear.
我认为我们只是想提高人们的认识，让人们了解信息来源，这样他们就可以做出正确的选择，而不是让他们陷入这种长期的恐惧状态，甚至是急性的恐惧状态。
Dr. Peter Attia:
彼得·阿蒂亚博士：
So for that reason, we prefer MRI scanners because there's no radiation.
因此，出于这个原因，我们更喜欢 MRI 扫描仪，因为没有辐射。
Andrew Huberman:
安德鲁·休伯曼：
I realize this might sound like a specialized circumstance, but I'll just start off with my own, which is when I was a graduate student, I worked with fixatives, so paraformaldehyde.
我意识到这听起来像是一个特殊的情况，但我将从我自己的情况开始，那是当我还是一名研究生时，我使用固定剂，所以多聚甲醛。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Mm-hmm.
嗯嗯。
Andrew Huberman:
安德鲁·休伯曼：
Glutaraldehyde.
戊二醛。
We know that these are mutagens.
我们知道这些是诱变剂。
They mutate cells.
它们使细胞发生突变。
Not good.
不好。
You do some molecular biology in the lab.
你在实验室做一些分子生物学。
You use DNA intercalating dye, those little bands in gels.
你使用 DNA 嵌入染料，即凝胶中的小条带。
The reason they label them is because they get between the DNA.
他们给它们贴上标签的原因是因为它们位于 DNA 之间。
Not good to get into your own DNA.
进入你自己的 DNA 并不好。
And that's a very specialized circumstance.
这是一个非常特殊的情况。
I also injected radioactive proline into the animals and things of that sort.
我还将放射性脯氨酸注射到动物和类似的东西中。
Again, very specialized, and yet most people, I think, will be exposed to pesticides They'll put stuff on their lawn, or they'll have paint thinners and things of that sort.
再说一次，非常专业，但我认为大多数人都会接触杀虫剂，他们会在草坪上放一些东西，或者他们会有油漆稀释剂之类的东西。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Mm-hmm.
嗯嗯。
Andrew Huberman:
安德鲁·休伯曼：
Is there any sense of what the average, if one can, average risk is incurred in terms of carcinogens, just through interaction with weed killers, paint thinner, detergents around the house that we now know?
我们现在知道，仅仅通过与除草剂、油漆稀释剂、清洁剂在房子周围的相互作用，致癌物的平均风险（如果可以的话）是否有任何意义？
There's some major lawsuits that have been successful against the manufacturers of these things.
针对这些产品的制造商的一些重大诉讼已经取得成功。
What is the real cancer risk created by having those kinds of solvents and pesticides and things around?
周围有这些溶剂和杀虫剂之类的东西会产生什么真正的癌症风险？
Dr. Peter Attia:
彼得·阿蒂亚博士：
I don't think I know, truthfully.
说实话，我想我不知道。
I think it's very complicated to calculate such things when their ubiquity is so high.
我认为当它们的普遍性如此之高时，计算这些东西是非常复杂的。
So one argument is, look, it's kind of baked into the baseline prevalence of cancer today because these things are so ubiquitous.
因此，一个论点是，看，它已经融入到当今癌症患病率的基线中，因为这些东西是如此普遍。
Andrew Huberman:
安德鲁·休伯曼：
Yeah.
是的。
Asbestos, in California, for whatever reason, it seems that there's an asbestos warning on pretty much every building, if you look carefully enough, except maybe the ones built in the last five years.
石棉，在加利福尼亚州，无论出于何种原因，如果你仔细观察的话，似乎几乎所有建筑物上都有石棉警告，除了过去五年建造的建筑物。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Right.
对。
Andrew Huberman:
安德鲁·休伯曼：
I don't think I've ever worked in a building where the elevator was updated in terms of the inspection.
我想我从来没有在电梯在检查方面进行过更新的大楼工作过。
It was almost like 10 years back.
差不多是10年前的事了。
You always see it while you're in the elevator.
当你在电梯里时你总是会看到它。
No one seems to worry about those, or where there was not an asbestos warning or a lead warning.
似乎没有人担心这些，或者没有石棉警告或铅警告的地方。
It seems like it's just kind of everywhere, and they're noting it in these little flags.
似乎它无处不在，他们在这些小旗帜中注意到了这一点。
I don't walk around worried about it.
我不会担心它到处走动。
I don't lose sleep over it, but it sounds like a real risk or else they wouldn't bother, right?
我不会因此而失眠，但这听起来确实存在风险，否则他们不会打扰，对吧？
Clearly, they're just trying to cover their legal backs.
显然，他们只是想保护自己的法律权益。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah, it might be more CYA than anything at this point.
是的，在这一点上，CYA 可能比任何事情都重要。
I don't know how much of a risk asbestos poses when it's not being agitated.
我不知道石棉在不被搅动的情况下会带来多大的风险。
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Dr. Peter Attia:
彼得·阿蒂亚博士：
In other words, I don't know that the asbestos in the ceiling four layers up is really a problem.
换句话说，我不知道四层天花板上的石棉真的是一个问题。
But if they had to come in here and rip this ceiling apart, I don't know that I'd want to be in here either.
但如果他们不得不进来并撕开天花板，我也不知道我是否愿意呆在这里。
Andrew Huberman:
安德鲁·休伯曼：
Right.
对。
It was like post 9/11, a lot of the workers-
就像 9/11 事件后，很多工人——
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah
是啊
Andrew Huberman:
安德鲁·休伯曼：
...
...
down at the World Trade Center pits, because that's what was left, sadly, developed cancers, right?
在世贸中心的维修站，因为不幸的是，那里留下了癌症，对吗？
Probably from exposure to those kinds of things.
可能是因为接触过这些东西。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Well, I would argue it's also-
好吧，我认为这也是——
Andrew Huberman:
安德鲁·休伯曼：
Jet fuels
喷气燃料
Dr. Peter Attia:
彼得·阿蒂亚博士：
...
...
just the unbelievable amount of pollution, micro pollution that was in the air following those things.
这些东西之后，空气中产生了令人难以置信的污染量和微污染。
That's devastating stuff.
那是毁灭性的事情。
So yeah, those are fortunately the outlier events that are dramatic.
是的，幸运的是，这些都是戏剧性的异常事件。
But again, my focus is basically, look, I could hermetically seal myself somewhere in the world, maybe, and maybe that would reduce my risk by 1%.
但我的重点基本上是，看，我可以将自己密封在世界的某个地方，也许，也许这会让我的风险降低 1%。
But I'm going to focus my energy on what I control, because that's really hard for me to control.
但我会把精力集中在我能控制的事情上，因为这对我来说真的很难控制。
I like focusing my energy on things I can control.
我喜欢将精力集中在我可以控制的事情上。
What I can control is the timing and frequency of my screening.
我能控制的是筛选的时间和频率。
I can't control my genes anymore.
我再也无法控制我的基因了。
They are what they are.
他们就是他们。
I got whatever predisposing cancer genes I'm going to get.
我得到了我将得到的任何诱发癌症的基因。
I might be lucky in this regard in that I seem to get all these horrible heart disease genes and maybe not as much-- But you could also argue, there are cancer bad genes in me that we don't really know about because everybody was dying of heart disease so young.
在这方面，我可能很幸运，因为我似乎获得了所有这些可怕的心脏病基因，也许没有那么多——但你也可能会说，我身上有一些我们并不真正了解的癌症坏基因，因为每个人都那么年轻就死于心脏病。
But boy, am I going to control the screening thing.
但是，我要控制放映的事情吗？
Andrew Huberman:
安德鲁·休伯曼：
What source of genetic screening do you recommend to your patients?
您向患者推荐什么来源的基因筛查？
Because there are a lot of them.
因为它们的数量很多。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah.
是的。
Andrew Huberman:
安德鲁·休伯曼：
There's 23andMe, there's whole genome sequencing places available now in a variety of formats.
23andMe 提供多种形式的全基因组测序服务。
Dr. Peter Attia:
彼得·阿蒂亚博士：
This is actually one of the questions our research team is working on as we speak.
这实际上是我们的研究团队正在研究的问题之一。
So we're trying to decide-- So we do genetic screening for certain things, like APOE is a gene we want to know in everybody.
所以我们正在努力决定——所以我们对某些事情进行基因筛查，比如 APOE 是我们想了解每个人身上的一个基因。
Andrew Huberman:
安德鲁·休伯曼：
For its role in neurodegenerative disease?
因为它在神经退行性疾病中的作用？
Dr. Peter Attia:
彼得·阿蒂亚博士：
Correct.
正确。
Specifically in Alzheimer's disease.
特别是阿尔茨海默病。
We are selectively using cancer screening in some patients, but in our practice, it's less important because we're generally so aggressive anyway that it turns out to be a little bit moot.
我们有选择地对一些患者进行癌症筛查，但在我们的实践中，这并不那么重要，因为我们通常都非常积极，以至于结果证明它有点没有实际意义。
We don't learn a lot in the genetic screening that's changing our screening practices because we're so thorough in our family history and we're so aggressive in everybody, regardless of family history.
我们在改变我们筛查实践的基因筛查中并没有学到太多东西，因为我们对家族史了解得太透彻，而且无论家族史如何，我们对每个人都如此咄咄逼人。
But I think there's a place for these things.
但我认为这些东西都有其用武之地。
For example, if you're looking for reimbursement on certain tests.
例如，如果您正在寻求某些测试的报销。
I'll give you an example.
我给你举个例子。
So colon cancer historically was not covered by a colonoscopy screening for colon cancer was not covered until you were 50.
因此，结肠镜检查历来不承保结肠癌，直到 50 岁才承保结肠癌筛查。
That's been bumped to 45.
已增至 45。
We still think everybody should be screened no later than 40.
我们仍然认为每个人都应该在 40 岁之前接受筛查。
Andrew Huberman:
安德鲁·休伯曼：
No. I haven't had one, so I suppose I should.
不，我还没有，所以我想我应该拥有。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah.
是的。
Look, I'm 50 and I've had three already.
瞧，我已经 50 岁了，而且已经有了三个了。
So again, why?
再说一遍，为什么？
Because colon cancer is not just the third leading cause of cancer death, it's 100% preventable.
因为结肠癌不仅是癌症死亡的第三大原因，而且它是 100% 可以预防的。
Why?
为什么？
Because every colon cancer comes from a polyp, and every polyp can be seen on a colonoscopy.
因为每一个结肠癌都源自息肉，而每一个息肉都可以通过结肠镜检查看到。
So there's simply no reason to not know that.
所以根本没有理由不知道这一点。
And that has to be weighed against the cost of the colonoscopy, both the financial cost and the risks, which are very low, but not zero.
这必须与结肠镜检查的成本（财务成本和风险）进行权衡，这些成本非常低，但并非为零。
There's a risk that comes from electrolyte abnormalities and hypotension from the bowel prep.
肠道准备过程中存在电解质异常和低血压的风险。
There's a risk from the sedation, and there's obviously a risk of bleeding or perforation that comes from the colonoscopy itself.
镇静剂存在风险，并且结肠镜检查本身显然存在出血或穿孔的风险。
Again, in a generally healthy person, those risks are so low that they're almost difficult to quantify, as evidenced by a recent New England Journal of Medicine paper that was a very anti-colonoscopy paper, which I won't get into because it's probably a little bit of a tangent.
同样，对于一个总体健康的人来说，这些风险是如此之低，以至于几乎难以量化，正如最近《新英格兰医学杂志》上一篇非常反对结肠镜检查的论文所证明的那样，我不会深入讨论它，因为它可能有点离题。
But what's interesting is despite being a very anti-colonoscopy paper, this paper does a better job demonstrating the safety of colonoscopy than anything else.
但有趣的是，尽管这篇论文非常反对结肠镜检查，但它比其他任何论文都更好地证明了结肠镜检查的安全性。
It just was an oddly designed experiment.
这只是一个设计奇怪的实验。
So the biggest challenge with aggressive screening posture is the specificity problem, which is when you stack more and more modalities around these things, you're going to start finding things that aren't cancer.
因此，积极筛查姿势的最大挑战是特异性问题，即当你围绕这些事情堆叠越来越多的方式时，你将开始发现不是癌症的东西。
So MRI has a very high sensitivity.
因此MRI具有非常高的灵敏度。
In English, that just means if a cancer is present, an MRI is very likely to see it But it has a very low specificity, which means, in English, it will see a bunch of things and think they are cancer when they are not.
用英语来说，这只是意味着如果存在癌症，核磁共振成像很可能会看到它，但它的特异性非常低，这意味着，用英语来说，它会看到一堆东西，并认为它们是癌症，而实际上它们不是。
And it's most troubled by glandular tissue.
其中最受腺体组织困扰。
So glandular tissue is the Achilles' heel of MRI.
因此，腺体组织是 MRI 的致命弱点。
And therefore, when you use, as we do, whole-body MRI for cancer screening, we tell our patients going in, "There's like a 25% chance we're going to find something that is not cancer but will require us to do further investigation.
因此，当您像我们一样使用全身 MRI 进行癌症筛查时，我们会告诉接受检查的患者，“我们有大约 25% 的机会会发现不是癌症的东西，但需要我们做进一步的调查。
If you're not cool with that, which is totally fine, we probably shouldn't do this." And again, most people are okay with that, but it helps to set that expectation going in.
如果你对此不满意，那完全没问题，我们可能不应该这样做。”再说一次，大多数人都同意这一点，但这有助于设定这种期望。
That you're going to probably be chasing your tail looking at some stupid thyroid nodule that is absolutely nothing.
你可能会追着尾巴看一些愚蠢的甲状腺结节，这绝对没什么。
I can't tell you how many useless thyroid nodules we've had to get ultrasounds on that prove to be absolutely nothing, but you have to follow them for a couple of years to make sure they're nothing.
我无法告诉你有多少无用的甲状腺结节，我们必须进行超声波检查，结果证明它们绝对没有什么，但你必须跟踪它们几年，以确保它们什么都不是。
Andrew Huberman:
安德鲁·休伯曼：
What is the typical cost of a whole-body MRI?
全身 MRI 的一般费用是多少？
Dr. Peter Attia:
彼得·阿蒂亚博士：
Right.
对。
Andrew Huberman:
安德鲁·休伯曼：
And so for people who are not your patients, how would they go about getting those?
那么对于不是您的患者的人来说，他们将如何获得这些呢？
Because I think most people's general practitioner is not going to script that out for them.
因为我认为大多数人的全科医生不会为他们编写脚本。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Correct.
正确。
I don't know the short answer because I don't know how many different places are doing it.
我不知道简短的答案，因为我不知道有多少不同的地方正在这样做。
I can tell you that we use a couple of different facilities, and I should disclose that I'm a founder of one of them.
我可以告诉你，我们使用几个不同的设施，我应该透露我是其中一个的创始人。
But we use a scanner that probably-- We send our patients to anywhere they want to go, but within a certain company that we like, that's not a company I have any affiliation with, and I believe they're charging about $2,500.
但我们使用的扫描仪可能 - 我们将患者送到他们想去的任何地方，但在我们喜欢的某家公司内，那家公司与我没有任何关系，我相信他们的收费约为 2,500 美元。
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Since you don't have an affiliation, can you mention that?
既然你没有隶属关系，你能提一下吗？
Because for instance, you are not my physician, sadly for me, and luckily for you, but I'd love to get a whole-body MRI, so what is this company?
因为举例来说，你不是我的医生，这对我来说是可悲的，对你来说是幸运的，但我很想进行全身核磁共振检查，那么这家公司是什么？
Dr. Peter Attia:
彼得·阿蒂亚博士：
So the company that makes the MRI that we're using right now is called Prenuvo.
所以我们现在使用的 MRI 制造公司叫做 Prenuvo。
I interviewed the chief technology officer and the head radiologist of that company on one of my podcasts.
我在我的一个播客中采访了该公司的首席技术官和首席放射科医生。
It's a super interesting technology based out of Vancouver.
这是一项来自温哥华的超级有趣的技术。
And for a long time, that was the only scanner in the world.
很长一段时间，这是世界上唯一的扫描仪。
So I had my first scan back in 2015.
所以我在 2015 年进行了第一次扫描。
I went up to Vancouver to get it done.
我去了温哥华去完成这件事。
Probably had my first two up there.
可能我的前两个在那里。
They've now opened locations all over the country.
他们现在已经在全国各地开设了分店。
So they've got one in the Bay Area, they've probably got one here in LA.
所以他们在湾区有一个，他们可能在洛杉矶也有一个。
I know they have one in Dallas.
我知道他们在达拉斯有一个。
So they've got them all over the place.
所以他们到处都有它们。
Andrew Huberman:
安德鲁·休伯曼：
Great.
太棒了。
Dr. Peter Attia:
彼得·阿蒂亚博士：
And then the company that I'm affiliated with is a different type of company that does all sorts of diagnostics.
我所属的公司是一家不同类型的公司，提供各种诊断服务。
But among them is we have a Prenuvo scanner in that company.
但其中之一是我们在那家公司有一台 Prenuvo 扫描仪。
That company's called Biograph, and that's in the Bay Area.
那家公司叫 Biograph，位于湾区。
Andrew Huberman:
安德鲁·休伯曼：
Biograph.
传记。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Biograph, yeah.
传记，是的。
Andrew Huberman:
安德鲁·休伯曼：
Spelled as one would expect.
拼写正如人们所期望的那样。
Dr. Peter Attia:
彼得·阿蒂亚博士：
One word.
一句话。
Yep.
是的。
Andrew Huberman:
安德鲁·休伯曼：
Yep.
是的。
Well, that's very helpful in terms of understanding the general risk and ways to offset cancer to the extent that one can.
嗯，这对于了解一般风险和尽可能抵消癌症的方法非常有帮助。
And certainly what the consideration should be.
当然也应该考虑什么。
Number three on the list of ways to die.
死亡方式清单上排名第三的。
We should just title this "Ways to Die," or we should title this "How Not to Die." Too early.
我们应该将其命名为“死亡之道”，或者我们应该将其命名为“如何不死”。太早了。
Neurodegenerative disease.
神经退行性疾病。
This is an area I'm somewhat familiar with, not because of my own experience, thankfully, but because of my relationship to the neuroscience community.
这是我有点熟悉的领域，谢天谢地，不是因为我自己的经验，而是因为我与神经科学界的关系。
And last time I checked, I was told that everyone experiences some age-related cognitive decline.
上次我检查时，我被告知每个人都会经历一些与年龄相关的认知能力下降。
So we all get less proficient at focus, memory, complex context-dependent task switching, all that stuff, as we get older.
因此，随着年龄的增长，我们在注意力、记忆力、复杂的依赖于上下文的任务切换等方面都会变得不那么熟练。
But it's the slope of that line that really can be controlled to some extent, and that Alzheimer's dementia represents just a steep downward acceleration of all of that.
但在某种程度上真正可以控制的是这条线的斜率，而阿尔茨海默氏痴呆症只是所有这一切的急剧下降加速。
That was what I was told.
他们就是这么告诉我的。
I'm guessing that even though I reside in the-- Not kind of, but I reside in that community, that some of that is being revised, especially with respect to the underlying causes of Alzheimer's, because there's a lot of controversy, even scandal, around this whole APP, APOB, amyloid plaque tangle stuff, which is the stuff of textbooks-
我猜，即使我居住在——不是那种，但我居住在那个社区，其中一些内容正在被修改，特别是关于阿尔茨海默氏症的根本原因，因为围绕整个 APP、APOB、淀粉样斑块缠结的东西存在很多争议，甚至是丑闻，这些都是教科书上的内容——
Dr. Peter Attia:
彼得·阿蒂亚博士：
Right
右
Andrew Huberman:
安德鲁·休伯曼：
...
...
for medical students and neuroscience students.
适合医学生和神经科学学生。
What is the story with neurodegenerative disease, Alzheimer's in particular?
神经退行性疾病，特别是阿尔茨海默氏症的故事是怎样的？
How can we offset it?
我们怎样才能抵消它呢？
And perhaps, as importantly, how can we all slow our own cognitive decline, irrespective of whether or not we get what is called Alzheimer's dementia?
也许，同样重要的是，无论我们是否患有所谓的阿尔茨海默氏痴呆症，我们如何才能减缓自己的认知能力下降？
Dr. Peter Attia:
彼得·阿蒂亚博士：
So Alzheimer's disease is both the most prevalent form of dementia and the most prevalent neurodegenerative disease.
因此，阿尔茨海默病既是最常见的痴呆症，也是最常见的神经退行性疾病。
So it occupies that unique spot.
所以它占据了这个独特的位置。
We're talking about roughly six million people in the United States have Alzheimer's disease.
我们谈论的是美国大约有六百万人患有阿尔茨海默病。
Andrew Huberman:
安德鲁·休伯曼：
That's one in...
那是其中之一...
Well, let's see.
好吧，让我们看看。
I haven't checked that number.
我还没有查过那个号码。
Dr. Peter Attia:
彼得·阿蒂亚博士：
About 2% of the total population.
约占总人口的2%。
Andrew Huberman:
安德鲁·休伯曼：
Okay.
好的。
Dr. Peter Attia:
彼得·阿蒂亚博士：
But that doesn't include those with mild cognitive impairment or pre-dementia or other forms of dementia.
但这不包括那些患有轻度认知障碍或痴呆前期或其他形式痴呆症的人。
And of course, the right metric is not what percent of the population, which of course includes children, things like that.
当然，正确的衡量标准不是占人口的百分比，其中当然包括儿童之类的。
It's, so the more-
是这样，所以更——
Andrew Huberman:
安德鲁·休伯曼：
That's a function of age.
这是年龄的函数。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah.
是的。
So-
所以——
Andrew Huberman:
安德鲁·休伯曼：
Right.
对。
But is age the major risk factor for getting Alzheimer's?
但年龄是患阿尔茨海默病的主要危险因素吗？
Dr. Peter Attia:
彼得·阿蒂亚博士：
Hands down.
把手放下。
Andrew Huberman:
安德鲁·休伯曼：
Like we say with glaucoma, a disease I'm much more familiar with because my lab worked on it for many years, the biggest risk factor for getting glaucoma is age.
就像我们对青光眼所说的那样，我对这种疾病更加熟悉，因为我的实验室对此进行了多年的研究，患青光眼的最大风险因素是年龄。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah.
是的。
The greatest risk factor for cardiovascular disease is age.
心血管疾病的最大危险因素是年龄。
The greatest risk factor for cancer is age.
癌症的最大危险因素是年龄。
We tend to not spend a lot of time talking about that because it's not a modifiable risk.
我们往往不会花很多时间讨论这个问题，因为它不是一个可以改变的风险。
So, we tend to focus on modifiable risk factors.
因此，我们倾向于关注可改变的风险因素。
So what else can we tell you, just to give you lay of the land?
那么我们还能告诉你什么，只是为了让你了解一下情况呢？
So the second most prevalent neurodegenerative disease would probably be Lewy body dementia, followed by Parkinson's disease, although the rate of growth of Parkinson's disease is the highest.
因此，第二流行的神经退行性疾病可能是路易体痴呆，其次是帕金森病，尽管帕金森病的增长率最高。
So I think those three diseases we want to really be paying a lot of attention to.
所以我认为这三种疾病是我们真正需要高度关注的。
As you know, there are a lot of other neurodegenerative diseases.
如您所知，还有许多其他神经退行性疾病。
Every one of these things is devastating.
这些事情中的每一件都是毁灭性的。
Andrew Huberman:
安德鲁·休伯曼：
Multiple sclerosis.
多发性硬化症。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah, multiple sclerosis, ALS, Huntington's disease.
是的，多发性硬化症、ALS、亨廷顿舞蹈症。
These are awful diseases.
这些都是可怕的疾病。
There are also other kinds of dementia.
还有其他类型的痴呆症。
Vascular dementia is not Alzheimer's dementia, but it produces comparable symptoms.
血管性痴呆不是阿尔茨海默氏痴呆，但它会产生类似的症状。
Each of these things, by the way, are slightly different.
顺便说一句，每件事都略有不同。
Lewy body is a dementia.
路易体是一种痴呆症。
It's a dementing disease, but it also has a movement component.
这是一种痴呆症，但也有运动成分。
So it sort of sits on a spectrum that's loosely halfway between Alzheimer's disease and Parkinson's disease.
因此，它大致位于阿尔茨海默病和帕金森病之间。
We talked obviously about age being the number one risk factor, kind of not that interesting because you can't do anything about it.
我们显然谈到年龄是第一大风险因素，这有点没那么有趣，因为你对此无能为力。
So the real goal is as we age, what are we doing to reduce risk?
因此，真正的目标是随着年龄的增长，我们应该做什么来降低风险？
Well, let's start with an important gene, the gene that everybody's heard of.
好吧，让我们从一个重要的基因开始，每个人都听说过的基因。
Certainly, came up a lot on the "Limitless" special where Chris Hemsworth made the decision to reveal something that none of us expected when we started that whole series, which was that he ended up being homozygous for the APOE4 isoform.
当然，在“无限”特别节目中，克里斯·海姆斯沃斯决定透露一些我们在开始整个系列时都没有预料到的事情，那就是他最终成为 APOE4 亚型的纯合子。
So maybe folks understand we have two copies of every gene.
所以也许人们知道我们每个基因都有两个副本。
So for gene X, you have copy that you got from your mom and copy that you got from your dad and the APOE gene is kind of a unique gene in that it has three different isoforms that are all considered normal.
因此，对于基因 X，您拥有从母亲那里获得的副本和从父亲那里获得的副本，而 APOE 基因是一种独特的基因，因为它具有三种不同的亚型，这些亚型都被认为是正常的。
None of them are mutations.
它们都不是突变。
So you have the E2 isoform, the E3 isoform, and the E4 isoform.
因此，您有 E2 同工型、E3 同工型和 E4 同工型。
The E4 isoform is the OG isoform.
E4亚型是OG亚型。
That's the one that we have historically had as far back as we can go.
这是我们历史上最久远的历史。
We actually think the E4 isoform offered a lot of advantages back in the day.
事实上，我们认为 E4 同工型在当时提供了很多优势。
It's a bit of a pro-inflammatory isoform and it certainly offered protection against infections, especially parasitic infections in the CNS, which would've been a really important thing to select for 200,000 years ago.
它是一种促炎亚型，它确实可以预防感染，尤其是中枢神经系统中的寄生虫感染，这在 20 万年前是一个非常重要的选择。
Andrew Huberman:
安德鲁·休伯曼：
How do parasites get into the CNS when you have blood-brain barrier, you got a thick skull?
当你有血脑屏障、你的头骨很厚时，寄生虫如何进入中枢神经系统？
Not you.
不是你。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Trauma.
外伤。
Andrew Huberman:
安德鲁·休伯曼：
I'm not telling you-
我不是告诉你-
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah
是啊
Andrew Huberman:
安德鲁·休伯曼：
...
...
you have a thick skull, but it just seems like parasites in other tissues would be an issue because what we're talking about here-
你的头骨很厚，但其他组织中的寄生虫似乎会成为一个问题，因为我们在这里讨论的是-
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah
是啊
Andrew Huberman:
安德鲁·休伯曼：
...
...
is brain disease.
是脑部疾病。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah.
是的。
Andrew Huberman:
安德鲁·休伯曼：
Anyway, I don't want to take us off course, but-
无论如何，我不想让我们偏离路线，但是——
Dr. Peter Attia:
彼得·阿蒂亚博士：
But it probably offered some protection outside of the brain as well.
但它也可能在大脑之外提供一些保护。
Anyway, the E3 isoform, I think, showed up, God, I think 50,000 years ago and the E2 isoform showed up very recently, about 10,000 years ago.
无论如何，我认为 E3 同工型出现了，上帝，我想是在 5 万年前，而 E2 同工型最近才出现，大约 1 万年前。
Now today we realize that there's a clear stratification of risk when it comes to Alzheimer's disease that tracks with those isoforms.
现在我们意识到，当涉及到与这些亚型相关的阿尔茨海默病时，存在明显的风险分层。
So because you have two copies, you basically have six combinations of how you can combine those genes.
因为你有两个拷贝，所以你基本上有六种组合方式来组合这些基因。
You could be two two, two three, two four, three three, three four, four four.
你可以是二二、二三、二四、三三、三四、四四。
The prevalence of them is basically as follows.
其流行情况基本如下。
Three three is now the most common.
现在三三是最常见的。
Three is the most common.
三是最常见的。
So double three is 55-ish percent of the population.
所以双三是人口的 55% 左右。
The next most common is the three four, which is about 25% of the population and then after that most things are kind of a rounding error.
其次最常见的是三四，大约占人口的 25%，之后的大多数情况都是四舍五入误差。
So two threes and two fours would be the next most common.
因此，两个三和两个四将是第二常见的。
Four fours are very rare and two twos are the rarest of them all.
四个四非常罕见，两个二是其中最罕见的。
Two twos are less than 1%.
两个两还不到1%。
Four fours are about 1 to 2%.
四四大约是1%到2%。
Very important point here is that the E4 genes are not deterministic.
这里非常重要的一点是 E4 基因不是确定性的。
So they're highly associated with the risk, but they're not deterministic.
因此它们与风险高度相关，但它们不是确定性的。
There are at least three deterministic genes in Alzheimer's disease.
阿尔茨海默病至少存在三个决定性基因。
One is called PSEN1, another one is called PSEN2, and another one is called APP.
一种称为 PSEN1，另一种称为 PSEN2，另一种称为 APP。
Those genes collectively make up about 1% of cases of people with Alzheimer's disease.
这些基因加起来约占阿尔茨海默病患者的 1%。
So they're fortunately very rare genes, but sadly they are deterministic, meaning if you have those genes you do get Alzheimer's disease and what's perhaps most devastating about those genes is how early the onset is of the disease.
因此，幸运的是它们是非常罕见的基因，但遗憾的是它们是确定性的，这意味着如果你有这些基因，你就会患上阿尔茨海默病，而这些基因最具破坏性的可能是这种疾病的发病时间有多早。
These are people that are usually getting Alzheimer's disease in their 50s.
这些人通常在 50 多岁时患上阿尔茨海默病。
So we do have a patient in our practice, actually she's spoken about this very openly, whose mom had one of these genes.
所以我们在实践中确实有一位患者，实际上她非常公开地谈论过这一点，她的妈妈有这些基因之一。
And she got Alzheimer's disease in her early 50s.
她在50岁出头时就患上了阿尔茨海默病。
I think she might have made it into her 60s before she died, but absolutely devastating consequences here.
我想她死前可能已经六十多岁了，但这绝对是毁灭性的后果。
Andrew Huberman:
安德鲁·休伯曼：
Why do people with Alzheimer's die?
阿尔茨海默病患者为何会死亡？
Because I know about the hippocampal degeneration, hippocampus of course being an area of the brain important for learning and memory, but is there brain stem degeneration?
因为我知道海马变性，海马当然是大脑中对学习和记忆很重要的区域，但是有脑干变性吗？
Do they lose breathing centers or cardiovascular control?
他们会失去呼吸中枢或心血管控制吗？
Dr. Peter Attia:
彼得·阿蒂亚博士：
No, usually what happens is it's sort of failure to thrive, aspiration, things like that.
不，通常发生的情况是发展失败、抱负之类的事情。
Yeah.
是的。
So it's usually they just stop eating or they can't control secretions, they aspirate, they get a pneumonia or they really lose the ability to even sense pain in their body and therefore they'll get an ulcer and they don't realize it and it'll become cellulitic and they'll develop a horrible infection in response to it.
所以通常他们只是停止进食，或者他们无法控制分泌物，他们误吸，他们得了肺炎，或者他们真的失去了甚至感觉身体疼痛的能力，因此他们会得溃疡，但他们没有意识到，它会变成脂肪团，他们会因此而发展出可怕的感染。
Andrew Huberman:
安德鲁·休伯曼：
I see.
我明白了。
So it's a body vulnerability.
所以这是身体的弱点。
The reason I ask is every once in a while a news report will come out based on a legitimate case study where They'll do a scan on some person and discover that they're missing literally half their cerebral cortex, huge chunks of brain, and they're functioning relatively normally.
我问的原因是，每隔一段时间就会有一篇基于合法案例研究的新闻报道，他们会对某人进行扫描，发现他们实际上缺失了一半的大脑皮层，大块的大脑，而且他们的功能相对正常。
And so here we're talking about a neurodegenerative disease of relatively-- It's widespread, but there are a few hotspots, of course-
所以在这里我们谈论的是一种相对--它很普遍，但当然也有一些热点--的神经退行性疾病-
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah
是啊
Andrew Huberman:
安德鲁·休伯曼：
...
...
in the brain that degenerate more profoundly than others, and the people dying.
在比其他人退化更严重的大脑中，以及正在死亡的人中。
So that makes sense.
所以这是有道理的。
It extends to lack of peripheral awareness or control and then some acute injury or infection.
它延伸到缺乏外围意识或控制，然后是一些急性损伤或感染。
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。
Dr. Peter Attia:
彼得·阿蒂亚博士：
You mentioned earlier some of the controversy, right?
您之前提到了一些争议，对吗？
So what are we talking about here?
那么我们在这里谈论什么呢？
Well, and I do write about this at length in the chapter on Alzheimer's disease because I think this is a very important point, which is the index case for Alzheimer's disease.
嗯，我确实在关于阿尔茨海默病的章节中详细地写了这一点，因为我认为这是非常重要的一点，这是阿尔茨海默病的索引病例。
There's always an index case.
总有一个索引案例。
There's the quote unquote "patient zero." The index case was a woman who 100 years later we realized had an APP mutation.
有一句话“零号病人”没有被引用。指示病例是一位女性，100 年后我们意识到她患有 APP 突变。
Obviously, these are APP or PSEN1, but she had one of these deterministic genes that led to a very early onset of disease, which, by the way, without which we may not have come up with the diagnosis because had she just got Alzheimer's disease in her 70s, it would've just been referred to as senility, which was not interesting enough to pay attention to.
显然，这些是 APP 或 PSEN1，但她拥有这些决定性基因之一，导致疾病很早就发病，顺便说一句，如果没有这些基因，我们可能无法做出诊断，因为如果她在 70 多岁时刚刚患上阿尔茨海默病，它只会被称为衰老，这不够有趣，值得关注。
But I think it probably set the field on the path towards an overemphasis on amyloid beta.
但我认为这可能会让这个领域走上过度强调β淀粉样蛋白的道路。
And it's not really clear how important amyloid is, which is not to say it's not important.
目前尚不清楚淀粉样蛋白有多重要，但这并不是说它不重要。
It is important, and there's no ambiguity that amyloid is responsible for the changes that we see in the brain.
这很重要，而且毫无疑问，淀粉样蛋白是我们在大脑中看到的变化的原因。
But it's not crystal clear because there are lots of autopsies that are done on people that are completely healthy and have died with no cognitive impairment, and they're chock-full of amyloid.
但这还不是很清楚，因为对完全健康且死亡时没有认知障碍的人进行了大量尸检，而且他们体内充满了淀粉样蛋白。
So what we don't fully understand is exactly what does removing amyloid do.
所以我们不完全了解去除淀粉样蛋白到底有什么作用。
The other thing that complicates the story is there has been no shortage of drugs that target amyloid that have seemed unsuccessful.
另一件让故事变得复杂的事情是，针对淀粉样蛋白的药物并不缺乏，但似乎并不成功。
Andrew Huberman:
安德鲁·休伯曼：
And, just to clarify, when you say amyloid, you mean people have died with their brains examined in autopsy and see that there are tons of so-called amyloid plaques?
而且，澄清一下，当你说淀粉样蛋白时，你的意思是人们死后大脑经过尸检，发现有大量所谓的淀粉样蛋白斑块？
Dr. Peter Attia:
彼得·阿蒂亚博士：
Correct.
正确。
Andrew Huberman:
安德鲁·休伯曼：
Different than arterial plaques, of course-
当然，与动脉斑块不同-
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah
是啊
Andrew Huberman:
安德鲁·休伯曼：
...
...
but within the brain, so the two hallmarks of Alzheimer's histopathologically would be plaques and tangles.
但在大脑内部，因此阿尔茨海默氏症的组织病理学两个标志是斑块和缠结。
And even that now is, of course, coming under question.
当然，即便如此，现在也受到质疑。
But that's what we teach every neuroscience-
但这就是我们教授每门神经科学的内容——
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah
是啊
Andrew Huberman:
安德鲁·休伯曼：
...
...
graduate student.
研究生。
It's what we teach every undergraduate.
这是我们教给每个本科生的内容。
It's also what we teach every medical student, and not just at Stanford, but everywhere.
这也是我们教给每个医学生的内容，不仅仅是在斯坦福大学，而是在任何地方。
So I have heard that the link between APP and whether or not one develops genes related to APP, and whether or not it's cleaved at one site or another is just what you were describing and risk for Alzheimer's-
所以我听说 APP 与一个人是否发育出与 APP 相关的基因以及它是否在一个或另一个位点被切割之间的联系正是您所描述的以及患阿尔茨海默病的风险 -
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah
是啊
Andrew Huberman:
安德鲁·休伯曼：
...
...
is a question.
是一个问题。
Dr. Peter Attia:
彼得·阿蒂亚博士：
So it's basically a cleavage question, right?
所以这基本上是一个分裂问题，对吗？
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Dr. Peter Attia:
彼得·阿蒂亚博士：
So people with the APP mutation, I think, have one extra cleavage site.
因此，我认为具有 APP 突变的人有一个额外的切割位点。
They result in one extra cleavage of amyloid, and then it misfolds.
它们会导致淀粉样蛋白发生额外的裂解，然后发生错误折叠。
And the misfolding is what the plaque is that's being created.
错误折叠就是正在创建的牌匾。
That also then predisposes them to the neurofibrillary tangles.
这也使它们容易出现神经原纤维缠结。
And, again-
而且，再一次——
Andrew Huberman:
安德鲁·休伯曼：
But all this is under question now, right?
但现在这一切都受到质疑，对吗？
Dr. Peter Attia:
彼得·阿蒂亚博士：
Well-
嗯-
Andrew Huberman:
安德鲁·休伯曼：
This is what I was told, and when I look, it sounds like there were some papers early in the chain of discovery, in the research in Alzheimer's, that were either wrong because they were intentionally falsified-
这就是我被告知的，当我查看时，听起来好像在发现链的早期，在阿尔茨海默氏症的研究中，有一些论文要么是错误的，因为它们被故意伪造了——
Dr. Peter Attia:
彼得·阿蒂亚博士：
There was an intentionally falsified paper on one particular amyloid variant, and that clearly set the field back a decade because a lot of people went down that rabbit hole based on deliberately falsified data.
有一篇关于一种特定淀粉样蛋白变体的故意伪造的论文，这显然使该领域倒退了十年，因为很多人根据故意伪造的数据陷入了那个兔子洞。
Andrew Huberman:
安德鲁·休伯曼：
So then what happened to that guy?
那么那个家伙后来怎么样了？
I don't know why I assume it was a guy, but what happened to that guy?
我不知道为什么我认为那是一个男人，但是那个男人发生了什么？
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah, it's a good question.
是的，这是一个好问题。
I think I wrote one piece about it when it happened.
我想当它发生时我写了一篇关于它的文章。
I actually reached out to the person who broke the story because I wanted to have them on my podcast, and I forget why he didn't do it.
事实上，我联系了爆料这个故事的人，因为我想让他们出现在我的播客上，但我忘记了他为什么不这么做。
I forget why he wouldn't commit to it or something like that.
我忘记了他为什么不承诺这样做或类似的事情。
But I thought it was a little odd because I thought this would be a great way to talk about this.
但我觉得这有点奇怪，因为我认为这是谈论这个问题的好方法。
I do not know what came of that scandal.
我不知道那桩丑闻发生了什么。
In other words, I haven't paid attention to it for probably nine months, so I don't know.
换句话说，我大概有九个月没有关注它了，所以我不知道。
Obviously, the paper's probably been recalled, but I don't know what disciplinary action was taken.
显然，这篇论文可能已被召回，但我不知道采取了什么纪律处分。
The field is-- I don't know.
这个领域是——我不知道。
I don't want to speak like I'm in the field because I'm not, so I want to be careful what I say, but I think the field is probably in a bit of a crisis because there have been so many bets placed on anti-amyloid therapies and amyloid biomarkers and amyloid everything, and we just haven't seen efficacy.
我不想说得像我在这个领域一样，因为我不是，所以我想小心我所说的话，但我认为这个领域可能有点危机，因为抗淀粉样蛋白疗法、淀粉样蛋白生物标志物和淀粉样蛋白的一切都下了很多赌注，但我们只是没有看到疗效。
So contrast that with cardiovascular disease, where you have this ApoB biomarker.
因此，与心血管疾病形成鲜明对比的是，心血管疾病中存在 ApoB 生物标志物。
You understand the pathophysiology of how it works.
您了解其工作原理的病理生理学。
You have drugs that target it.
你有针对它的药物。
So you have a biomarker, so you give somebody a drug that lowers ApoB.
所以你有一个生物标志物，所以你给某人一种降低 ApoB 的药物。
You can measure ApoB.
您可以测量 ApoB。
That's a really important and obvious thing to be able to do.
这是一件非常重要且显而易见的事情。
And then you have clinical outcomes, which is, oh, when you take a bunch of people in primary prevention, it takes this long before you see an effect.
然后你就会得到临床结果，也就是说，哦，当你让一群人进行一级预防时，需要很长时间才能看到效果。
In secondary prevention, it only takes this long to see an effect.
在二级预防中，只需要这么长时间就能看到效果。
Different risk stratifications, all these different things.
不同的风险分层，所有这些不同的事情。
We don't have any of that for Alzheimer's disease.
我们没有任何针对阿尔茨海默病的药物。
So we do use-- There are now serum amyloid biomarkers that we use, and we do track these in our highest-risk patients, but only because we believe, and I don't know if we're right, by the way, that lower is better, and therefore, if we make these changes to you and your serum amyloid levels come down, that that tells us something about what's happening in your brain that's favorable.
所以我们确实使用——现在我们使用血清淀粉样蛋白生物标志物，我们确实在最高风险的患者中跟踪这些生物标志物，但这只是因为我们相信，顺便说一下，我不知道我们是否正确，越低越好，因此，如果我们对你进行这些改变，你的血清淀粉样蛋白水平下降，那就告诉我们一些关于你的大脑中发生的有利的事情。
But I would hate to represent that we are practicing nearly the level of precision medicine there that we are in cardiovascular medicine.
但我不想说我们在那里实践的精准医疗水平几乎与我们在心血管医学领域的水平相当。
When it comes to Alzheimer's disease, maybe take a step back.
当谈到阿尔茨海默病时，也许退后一步。
When it comes to brain health, I think there are a handful of things that seem unequivocally true, and there's a lot of stuff that is signal-to-noise ratio that's really low.
当谈到大脑健康时，我认为有一些事情看起来毫无疑问是正确的，而且有很多东西的信噪比非常低。
So the unequivocally true things for brain health are sleep matters.
因此，对于大脑健康来说，最重要的事情就是睡眠。
Another unequivocally true thing for brain health is that lower LDL cholesterol and ApoB is better than higher.
对于大脑健康来说，另一个明确的事实是，较低的 LDL 胆固醇和 ApoB 比较高的水平更好。
Another thing that is unequivocally true is not having type 2 diabetes matters.
另一件明确的事实是，患有 2 型糖尿病并不重要。
Andrew Huberman:
安德鲁·休伯曼：
To having really good-
拥有真正的好-
Dr. Peter Attia:
彼得·阿蒂亚博士：
Being, yeah, but-
是的，但是——
Andrew Huberman:
安德鲁·休伯曼：
Be insulin sensitive, not insensitive
对胰岛素敏感，而不是不敏感
Dr. Peter Attia:
彼得·阿蒂亚博士：
...
...
being insulin sensitive matters.
胰岛素敏感很重要。
Sleeping adequately matters.
充足的睡眠很重要。
Having lower lipids matters.
降低血脂很重要。
Those three things are clear, and the fourth one that is unequivocally clear is exercise matters.
这三件事是明确的，第四件事是明确明确的，那就是锻炼问题。
More exercise-
多运动——
Andrew Huberman:
安德鲁·休伯曼：
Any specific form of exercise?
有什么具体的锻炼方式吗？
Dr. Peter Attia:
彼得·阿蒂亚博士：
So I tried to answer this question on a recent AMA that I did, because the answer is more is always better.
所以我试图在最近的 AMA 中回答这个问题，因为答案越多越好。
But I tried to have one of our analysts look at it through the lens of if you could only exercise three hours a week, what would be the highest use case?
但我试图让我们的一位分析师从这样的角度来看待这个问题：如果你每周只能锻炼三个小时，那么最高的用例是什么？
And our interpretation of the literature was if you could only spend three hours a week exercising, you'd be best off doing one hour of low-intensity cardio, one hour of strength, and one hour of interval training.
我们对文献的解释是，如果你每周只能花三个小时锻炼，那么你最好做一小时低强度有氧运动、一小时力量训练和一小时间歇训练。
So if someone who said, "I only want the minimum effective dose," you're going to get a pretty good bang for your buck doing that.
因此，如果有人说：“我只想要最低有效剂量”，那么你这样做就会得到很大的回报。
But I would argue if your brain really matters to you, do more.
但我认为，如果你的大脑真的对你很重要，那就多做一些。
Andrew Huberman:
安德鲁·休伯曼：
One hour of interval training is no joke.
一小时的间歇训练可不是闹着玩的。
Dr. Peter Attia:
彼得·阿蒂亚博士：
No, because you're going to spread that out over probably at least two workouts.
不，因为你可能会将其分散到至少两次锻炼中。
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。
But Andrew, those four things are basically the only thing where there's no ambiguity about the benefit.
但是安德鲁，这四件事基本上是唯一没有明确好处的事情。
But-
但是——
Andrew Huberman:
安德鲁·休伯曼：
What about head hits?
撞到头部怎么办？
Don't hit your head.
别撞到头了
Dr. Peter Attia:
彼得·阿蒂亚博士：
Seems almost assuredly true in a susceptible individual for sure.
对于易感个体来说，这几乎肯定是正确的。
So I put that.
所以我这么说。
Yeah.
是的。
Maybe we could include that as well.
也许我们也可以将其包括在内。
Andrew Huberman:
安德鲁·休伯曼：
Well, I just imagine one of the things I've been learning recently is I know you boxed for a number of years when you were younger.
好吧，我只是想象我最近学到的一件事是我知道你年轻时打了很多年拳击。
I boxed a little bit, hit my head a number of times skateboarding.
我打了一点拳击，玩滑板时撞到了我的头好几次。
But we think about sports injuries as the major cause of head injuries, but then I've got colleagues at Stanford that say-
但我们认为运动损伤是头部受伤的主要原因，但我在斯坦福大学的同事们说——
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah, but car accidents are horrible
是的，但是车祸很可怕
Andrew Huberman:
安德鲁·休伯曼：
...
...
car accidents, bike accidents.
车祸、自行车事故。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah.
是的。
Andrew Huberman:
安德鲁·休伯曼：
I've got so many colleagues and children of colleagues growing up in and around campus that were hit by cars on Woodside Road or a mere small object surrounded by three, what does a car weigh?
我有很多在校园内和周围长大的同事和同事的孩子，他们在伍德赛德路上被汽车撞到，或者被三个人包围的小物体撞到，一辆车有多重？
3,000 pounds or something like that?
3,000英镑或者类似的东西？
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah, more usually.
是的，更常见的是。
Andrew Huberman:
安德鲁·休伯曼：
It's unbelievable the number of head injuries and then construction sites because those ridiculous little hard hats which don't protect against anything except, I don't know, maybe windblown hair.
头部受伤和建筑工地的数量令人难以置信，因为那些可笑的小安全帽不能防止任何东西，除了我不知道，也许是风吹的头发。
The whole situation predisposed people to head injuries, very common on construction sites.
整个情况使人们容易头部受伤，这在建筑工地上很常见。
And then say nothing of military, et cetera.
然后更不用说军事等等。
So I think that I was told that the best thing to do if you get a head injury is to not get another one.
所以我认为有人告诉我，如果头部受伤，最好的办法就是不要再受伤。
In other words, if you can, stop doing the activity that leads to more head injury.
换句话说，如果可以的话，停止进行会导致更多头部受伤的活动。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah.
是的。
The other thing that I think is emerging, and I hope it is studied rigorously, is the use of hyperbaric oxygen immediately following a TBI, a traumatic brain injury.
我认为正在出现的另一件事是在 TBI（一种创伤性脑损伤）后立即使用高压氧，我希望对其进行严格研究。
I reached out to Dom D'Agostino a little while ago to kind of, because he knows a lot about this lit, to say, "Hey, is there anything out there that's really kind of turnkey convincing?" And he said, "Not yet." They're still doing it.
不久前，我联系了多姆·达戈斯蒂诺（Dom D'Agostino），因为他对这方面了解很多，我对他说：“嘿，有什么东西真的是令人信服的交钥匙工程吗？”他说：“还没有。”他们仍在这样做。
So I would do this.
所以我会这样做。
If I was in a car accident tomorrow and sustained a concussion, and by the way, I'm not a proponent of hyperbaric oxygen.
如果我明天遭遇车祸并遭受脑震荡，顺便说一句，我不是高压氧的支持者。
So we have an internal white paper that we wrote inside quite recently where I examined, when I say I examined, the analyst team examined, and I pushed back and reviewed.
因此，我们最近写了一份内部白皮书，我在其中进行了检查，当我说我进行了检查时，分析师团队进行了检查，然后我进行了反驳和审查。
And I came away very bearish on hyperbaric oxygen.
我对高压氧非常看空。
I don't think it's harmful, but I think all of the claims are nonsense.
我不认为这是有害的，但我认为所有的说法都是无稽之谈。
Telomere extension is totally irrelevant.
端粒延伸完全无关。
And if you actually look at the studies, they're the worst done studies I've ever seen in my life.
如果你真正看一下这些研究，它们是我一生中见过的最糟糕的研究。
I'm sure you've seen some of these where it's like you put these people in a hyperbaric chamber and then watch them do cognitive tasks after, and they're so much better.
我相信你已经见过其中的一些，就像你把这些人放在高压舱里，然后观察他们执行认知任务，他们好多了。
Well, the fine print is they don't even have placebo groups here.
好吧，重要的是他们这里甚至没有安慰剂组。
Can you imagine doing a study without a placebo group?
你能想象在没有安慰剂组的情况下进行研究吗？
Or your placebo group doesn't go into a sham chamber.
或者你的安慰剂组不会进入假室。
Andrew Huberman:
安德鲁·休伯曼：
Yeah.
是的。
One of the big problems of the proliferation of all these pay-to-play journals, meaning journals that will basically publish a paper with minimal or poor peer review because they charge in order to publish-
所有这些付费期刊激增的一个大问题是，这些期刊基本上会在同行评审很少或很差的情况下发表论文，因为它们为了发表而收费——
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah
是啊
Andrew Huberman:
安德鲁·休伯曼：
...
...
and then offer free access.
然后提供免费访问。
Free access sounds great, but when it's pay-to-play type journals, there's been a huge proliferation of papers, most of which you find on Twitter, in which the study design is beyond bad.
免费访问听起来很棒，但当它是付费期刊时，就会出现大量论文，其中大部分你可以在 Twitter 上找到，其中的研究设计非常糟糕。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Awful.
太糟糕了。
Andrew Huberman:
安德鲁·休伯曼：
Like a ninth grader who woke up late for school and was partying all weekend could design a better study than most of these studies.
就像一个九年级学生上学迟到并且整个周末都在聚会一样，他可以设计出比大多数研究更好的研究。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah.
是的。
There-
那里——
Andrew Huberman:
安德鲁·休伯曼：
And there's some excellent studies out there as well, of course, presumably and eventually on hyperbaric chamber too.
当然，也有一些出色的研究，大概并且最终也是关于高压舱的。
So I'm not picking on hyperbaric chamber per se, but the proliferation of truly terrible science that's published in peer-reviewed journals is just overwhelming.
所以我并不是在挑剔高压舱本身，而是在同行评审期刊上发表的真正可怕的科学的扩散是压倒性的。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah, it's insane.
是的，这太疯狂了。
And all of that is to say, I think there are places where hyperbaric oxygen makes sense.
所有这些就是说，我认为高压氧在某些地方是有意义的。
Clearly in wound healing it does.
显然，在伤口愈合方面确实如此。
It's a miracle treatment for wound healing.
这是伤口愈合的奇迹疗法。
And I would absolutely use hyperbaric oxygen if I suffered a concussion.
如果我遭受脑震荡，我绝对会使用高压氧。
But beyond that, I think it's pretty tough to make the case.
但除此之外，我认为要证明这一点非常困难。
Andrew Huberman:
安德鲁·休伯曼：
Where do people go for that?
人们去哪里寻找这个？
There are clinics around?
周围有诊所吗？
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah, there are clinics you basically go to and-
是的，有些诊所你基本上都会去——
Andrew Huberman:
安德鲁·休伯曼：
Because the protocols have to be very precise.
因为协议必须非常精确。
Dr. Peter Attia:
彼得·阿蒂亚博士：
They do.
他们确实这么做了。
Andrew Huberman:
安德鲁·休伯曼：
This isn't something to cowboy at home.
这不是牛仔在家的事。
Dr. Peter Attia:
彼得·阿蒂亚博士：
No. You have to go into a real chamber.
不，你必须进入一个真正的房间。
I think the TBI protocol that's most commonly used is God, I want to say it's pretty intense.
我认为最常用的 TBI 协议是 God，我想说它非常激烈。
It's five 60-minute sessions a week at two atmospheres.
每周有五次每次 60 分钟的课程，气氛为两种。
Andrew Huberman:
安德鲁·休伯曼：
Oh, boy.
哦，男孩。
Dr. Peter Attia:
彼得·阿蒂亚博士：
It's no joke.
这不是玩笑。
Andrew Huberman:
安德鲁·休伯曼：
Okay.
好的。
Dr. Peter Attia:
彼得·阿蒂亚博士：
So from a cost and time perspective, it's enormous.
因此，从成本和时间的角度来看，这是巨大的。
And the time and cost are reasons why I think when I see people doing hyperbaric oxygen just because they think it's going to help them live longer, I'm like, "Dude, do you know what you could do with five hours a week plus the commuting time that you put into that?
时间和成本是为什么我认为当我看到人们仅仅因为他们认为这会帮助他们活得更长而使用高压氧时，我会想，“伙计，你知道你每周五个小时加上你投入的通勤时间可以做什么吗？
Put that into exercise, and I promise you, you'll get a bigger benefit than you're getting out of hyperbaric oxygen." But there's a lot of other stuff that I just think is maybe helpful.
把它投入到锻炼中，我向你保证，你会得到比高压氧更大的好处。”但我认为还有很多其他的东西可能会有帮助。
There's tons of supplements that I think about when it comes to brain health.
当谈到大脑健康时，我想到了很多补充剂。
What about curcumin?
姜黄素呢？
What about magnesium with L-threonate, the transporter?
镁与 L-苏糖酸盐（转运蛋白）怎么样？
What about methylated vitamins that lower homocysteine?
降低同型半胱氨酸的甲基化维生素怎么样？
What about EPA and DHA?
EPA和DHA怎么样？
And we've gone through all of the literature on that stuff, and many of these things we still are recommending through a kind of basically like the potential benefits outweigh the potential costs, but the evidence is really unimpressive for most of those other interventions.
我们已经浏览了所有关于这些东西的文献，我们仍然通过一种基本上类似于潜在收益大于潜在成本的方式推荐许多这些东西，但对于大多数其他干预措施来说，证据确实并不令人印象深刻。
So when you think about the big four or big five, if you include not getting head injury, everything else is probably a rounding error compared to those big ones.
因此，当您考虑四大或五大时，如果您没有头部受伤，那么与那些大的相比，其他一切可能都是四舍五入的错误。
Andrew Huberman:
安德鲁·休伯曼：
Maybe just for sake of thoroughness, we could just list off those four again.
也许只是为了彻底起见，我们可以再次列出这四个。
Exercise-
锻炼-
Dr. Peter Attia:
彼得·阿蒂亚博士：
Exercise, sleep, insulin sensitivity, and lipid management.
运动、睡眠、胰岛素敏感性和血脂管理。
Andrew Huberman:
安德鲁·休伯曼：
Great.
太棒了。
Well, along the lines of head injuries, we should probably move to the next category of how not to die is to avoid accidental death.
好吧，沿着头部受伤的思路，我们可能应该转向下一个类别，即如何不死是为了避免意外死亡。
How common is accidental death, and what are these accidental deaths?
意外死亡有多常见？这些意外死亡是什么？
Because we are separating this out from automotive death.
因为我们将其与汽车死亡分开。
So is this people falling while hiking, selfies gone bad?
那么这个人是不是在徒步旅行时摔倒了，自拍也坏了？
What are we talking about here?
我们在这里谈论什么？
I'm not chuckling because I like it, it's just it seems like there's a near infinite ways to die accidentally.
我笑不是因为我喜欢它，只是似乎有近乎无限的意外死亡方式。
And wouldn't use your imagination.
并且不会发挥你的想象力。
Dr. Peter Attia:
彼得·阿蒂亚博士：
So I think there's two ways to look at this.
所以我认为有两种方式来看待这个问题。
And so here I kind of merge two categories.
所以在这里我合并了两个类别。
So I would call it-- That overlap in the way that they're characterized by the CDC, but we'll talk about them separately and bring them together.
所以我会称之为——疾病预防控制中心对它们的描述方式的重叠，但我们将分别讨论它们并将它们放在一起。
So if you talk about true accidental deaths, automotive, and falls, and overdoses are the three.
因此，如果你谈论真正的意外死亡，车祸、跌倒和服药过量就是三者。
That's basically what it comes down to.
基本上就是这样。
So, in our death bar analysis, we list all this stuff out.
因此，在我们的死亡栏分析中，我们列出了所有这些内容。
In fact, I think that's actually one of the figures in the book is I have the accidental death figure that we've put together where we've adjusted by population.
事实上，我认为这实际上是书中的数字之一，我有一个意外死亡数字，我们将其按人口调整后放在一起。
And you'll see a couple of things.
你会看到一些事情。
If you look at it in absolute terms, it's basically a pretty constant.
如果你从绝对角度来看，它基本上是一个相当恒定的值。
So regardless of what decade of life you're in, once you're above 20, accidental deaths are a pretty sizable number of deaths.
因此，无论你处于人生的哪个十年，一旦你超过20岁，意外死亡的死亡人数就相当可观了。
Now, car accidents seem to be pretty constant throughout life.
现在，车祸似乎在一生中经常发生。
Little more common if you're under 60 than over 60, but they never go away.
60 岁以下的人比 60 岁以上的人更常见，但它们永远不会消失。
Andrew Huberman:
安德鲁·休伯曼：
I was told that in teenage and boys in their early 20s, alcohol-induced automotive fatalities place them at an astronomic risk.
有人告诉我，在青少年和 20 岁出头的男孩中，酒精引起的车祸死亡使他们面临天文数字的风险。
Is that just not true?
难道这不是真的吗？
Dr. Peter Attia:
彼得·阿蒂亚博士：
It's not true anymore compared to overdoses.
与服药过量相比，这不再是事实。
Andrew Huberman:
安德鲁·休伯曼：
Is that because young people now aren't getting their driver's licenses?
是因为现在年轻人拿不到驾照吗？
I've also heard that.
我也听说过。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah.
是的。
Well, I think it's also because we're seeing such an uptick in the deaths that come from fentanyl.
嗯，我认为这也是因为我们看到芬太尼导致的死亡人数大幅上升。
Andrew Huberman:
安德鲁·休伯曼：
Got it.
明白了。
Dr. Peter Attia:
彼得·阿蒂亚博士：
So fentanyl-related deaths have basically squashed all other deaths below 65 on the accidental front.
因此，与芬太尼相关的死亡人数基本上已将所有其他意外死亡人数压至 65 岁以下。
Andrew Huberman:
安德鲁·休伯曼：
Really?
真的吗？
Dr. Peter Attia:
彼得·阿蒂亚博士：
Oh, it's not even close.
噢，还差得远呢。
Andrew Huberman:
安德鲁·休伯曼：
Because of the number of different substances that fentanyl is being woven into?
因为芬太尼被编织成多种不同的物质？
Dr. Peter Attia:
彼得·阿蒂亚博士：
It's winding its way into everything.
它正在蜿蜒地渗透到一切事物中。
Andrew Huberman:
安德鲁·休伯曼：
All right.
好吧。
Can you give us-
你能给我们-
Dr. Peter Attia:
彼得·阿蒂亚博士：
So all counterfeit drugs, all illicit drugs.
所以所有的假药，所有的非法药物。
And look, most of the time you're not getting a lethal dose.
你看，大多数时候你并没有得到致命剂量。
But you're getting lethal doses so often now that-- Well, I did a little analysis actually the other day when I looked at how are deaths of despair increasing over the last five years.
但现在你经常得到致命剂量——嗯，前几天我实际上做了一些分析，当时我研究了过去五年里因绝望而死亡的人数是如何增加的。
So what did I define as a death of despair?
那么我将什么定义为绝望之死呢？
Suicide, alcohol-related death, or overdose, accidental overdose.
自杀、与酒精有关的死亡，或服药过量、意外服药过量。
So we differentiate that from suicide, where suicide is obviously deliberate and accidental is not.
因此，我们将其与自杀区分开来，自杀显然是故意的，而意外则不是。
So if you just look at those three things, so accidental overdoses, suicides, and alcohol use or alcohol-related death.
所以，如果你只看这三件事，那么意外服药过量、自杀、饮酒或与酒精相关的死亡。
Not including driving, by the way.
顺便说一句，不包括开车。
This is like cirrhosis of the liver that comes from...
这就像肝硬化一样，来自...
That number is going up at almost 20% per year since 2019.
自 2019 年以来，这一数字每年以近 20% 的速度增长。
So I couldn't get 2022 numbers yet.
所以我还无法获得 2022 年的数字。
So at the time I did this analysis, which was last week, the 2021 numbers was about 210,000 Americans.
因此，在我上周进行这项分析时，2021 年的美国人数量约为 21 万。
Andrew Huberman:
安德鲁·休伯曼：
Goodness.
善良。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Up from 180,000 in 2020, up from like 150,000 in 2019.
高于 2020 年的 18 万，高于 2019 年的约 15 万。
Andrew Huberman:
安德鲁·休伯曼：
So is this-
这也是——
Dr. Peter Attia:
彼得·阿蒂亚博士：
And that is driven almost entirely by fentanyl use.
这几乎完全是由芬太尼的使用驱动的。
Andrew Huberman:
安德鲁·休伯曼：
So I'm trying to get a sense of how this would happen.
所以我试图了解这是如何发生的。
A while back, there was an article in "The New York Times" that some photographs of people that died of fentanyl overdose, and it said they went out to buy cocaine and died of fentanyl.
前段时间，《纽约时报》有一篇文章，刊登了一些因芬太尼过量死亡的人的照片，说他们出去买可卡因，死于芬太尼。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Went out to buy cocaine.
出去买可卡因。
That's right.
这是正确的。
Andrew Huberman:
安德鲁·休伯曼：
And I thought to myself, this is a really kind of odd sociobiological phenomenon, right?
我心想，这真是一种奇怪的社会生物学现象，对吧？
Because here they're not demonizing these cocaine user.
因为在这里他们并没有妖魔化这些可卡因使用者。
They went out to buy cocaine, right?
他们出去买可卡因，对吗？
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah.
是的。
Andrew Huberman:
安德鲁·休伯曼：
I know cocaine has one narrow clinical use as a prescription drug, but in general, when people buy cocaine, they're quote unquote partying with it or using it to work longer hours or something like that.
我知道可卡因作为处方药的临床用途有限，但总的来说，当人们购买可卡因时，他们会用它来参加派对或用它来延长工作时间或类似的事情。
So the whole nature of the article was a bit strange to me.
所以这篇文章的整体性质对我来说有点奇怪。
But- It clearly pointed the fact that people are using cocaine.
但是——它清楚地指出了人们正在使用可卡因的事实。
Okay, that's no surprise.
好吧，这并不奇怪。
But people are going out and buying cocaine.
但人们正在出去购买可卡因。
They're presumably buying Valium.
他们可能正在购买安定。
They're presumably buying-
他们大概是在买——
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah, this is where it's really killing kids.
是的，这就是真正杀死孩子的地方。
Andrew Huberman:
安德鲁·休伯曼：
But this is online, this is in person.
但这是在线的，这是面对面的。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah.
是的。
Both
两者都
Andrew Huberman:
安德鲁·休伯曼：
The reason I'm so baffled by this is, let me re-contextualize what I've said so far about this question.
我对此感到如此困惑的原因是，让我重新回顾一下我到目前为止就这个问题所说的话。
I was surprised that the "Times" would write a paper about the tragedy of cocaine users dying of fentanyl.
我很惊讶《泰晤士报》会写一篇关于可卡因吸食者死于芬太尼悲剧的论文。
And I think they did it to highlight this fentanyl problem, because people have been using cocaine for a long time, and typically those are not the members of the population that we're really focused on since the mid-'80s, the so-called cocaine and crack epidemic.
我认为他们这样做是为了强调芬太尼问题，因为人们长期以来一直在使用可卡因，而且通常这些人并不是我们自 80 年代中期以来真正关注的人群，即所谓的可卡因和快克流行病。
So basically, it tells me that people, like you said, illicit drugs, so cocaine, but also, what other sorts of drugs are people buying?
所以基本上，它告诉我人们，就像你说的，非法药物，可卡因，而且，人们还购买哪些其他种类的药物？
Dr. Peter Attia:
彼得·阿蒂亚博士：
No. So where the majority of people are dying from fentanyl poisoning, and I had a guy on my podcast recently named Anthony Hipolito, and if anybody's interested in this topic, they really need to go listen to that.
不。所以，大多数人死于芬太尼中毒，最近我的播客上有一个叫安东尼·伊波利托的人，如果有人对这个话题感兴趣，他们真的需要去听听。
So Anthony-
所以安东尼-
Andrew Huberman:
安德鲁·休伯曼：
Yeah, I watched the YouTube version-
是的，我看过 YouTube 版本 -
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah
是啊
Andrew Huberman:
安德鲁·休伯曼：
...
...
of this, and your podcasts are excellent.
这一点，你的播客非常棒。
So if you're interested in this, and I think everyone should be interested in this-
所以如果你对此感兴趣，我认为每个人都应该对此感兴趣-
Dr. Peter Attia:
彼得·阿蒂亚博士：
If you have a child-
如果你有一个孩子——
Andrew Huberman:
安德鲁·休伯曼：
Please do.
请这样做。
Mm-hmm
嗯嗯
Dr. Peter Attia:
彼得·阿蒂亚博士：
...
...
or know somebody who has a child, you just got to get this podcast into their hands because it's the most important public service announcement I'll probably ever do in terms of saving more lives, potentially.
或者认识有孩子的人，你只需要把这个播客交给他们，因为这是我可能会在拯救更多生命方面所做的最重要的公共服务公告。
Where the majority of this is making its way into the accidental poisonings is through illicit counterfeit pills.
其中大部分是通过非法假药造成的意外中毒。
So it's when kids are out there buying oxy.
所以当孩子们出去购买氧气时。
They want oxy.
他们想要氧气。
Well, they can't get real oxy, right?
好吧，他们无法获得真正的氧气，对吧？
Because they're not going to go to a doctor and get real oxy.
因为他们不会去看医生并获得真正的氧气。
So they're going to buy it through Snapchat.
所以他们会通过 Snapchat 购买。
They're going to buy it through some drug dealer that they're finding on social media.
他们将通过在社交媒体上找到的毒贩购买它。
They're buying sleeping pills.
他们正在买安眠药。
They're buying all sorts of counterfeit stuff like Adderall.
他们购买各种假冒产品，例如阿得拉（Adderall）。
Any of these things are being laced with fentanyl.
这些东西中的任何一个都含有芬太尼。
Andrew Huberman:
安德鲁·休伯曼：
Adderall?
阿得拉？
Dr. Peter Attia:
彼得·阿蒂亚博士：
Absolutely.
绝对的。
Andrew Huberman:
安德鲁·休伯曼：
Wow.
哇。
I assumed the fentanyl-
我以为芬太尼-
Dr. Peter Attia:
彼得·阿蒂亚博士：
And again, the reasons are it's insanely cheap to use synthetic fentanyl.
再说一次，原因是使用合成芬太尼极其便宜。
And secondly, and again, I-
其次，再一次，我——
Andrew Huberman:
安德鲁·休伯曼：
But the effects of fentanyl are nothing like-
但芬太尼的效果并不像——
Dr. Peter Attia:
彼得·阿蒂亚博士：
I know
我知道
Andrew Huberman:
安德鲁·休伯曼：
...
...
the effects of Adderall.
阿得拉的作用。
So cocaine doesn't make sense for that reason either.
因此，可卡因也没有意义。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Cocaine doesn't make sense either.
可卡因也没有意义。
Yep.
是的。
And yet it's still showing up in cocaine.
但它仍然出现在可卡因中。
Again, I don't think that's the dominant place it's showing up.
再说一遍，我不认为这是它出现的主导位置。
I would guess that the dominant place it's showing up is in counterfeit opioids.
我猜想它出现的主要地方是假冒阿片类药物。
Andrew Huberman:
安德鲁·休伯曼：
So any opioid, barbiturate, any sedative, depressant.
所以任何阿片类药物、巴比妥类药物、任何镇静剂、抑制剂。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah.
是的。
But let me tell you what I'm telling my daughter.
但让我告诉你我对我女儿说的话。
Because this is, to me, it's a frontline problem.
因为对我来说，这是一个前沿问题。
I have a 14-year-old daughter.
我有一个 14 岁的女儿。
I'm like, "Listen, I don't care which friend of yours it is.
我说：“听着，我不在乎那是你的哪个朋友。
I don't care how much she's amazing.
我不在乎她有多出色。
If she tells you to try this sleeping pill because she took it the night before and it was really helpful, or this'll help you study better, or this'll help you do anything," I'm like, "Just come to us.
如果她告诉你尝试这种安眠药，因为她前一天晚上服用了它，这确实很有帮助，或者这会帮助你更好地学习，或者这会帮助你做任何事情，”我想，“来找我们吧。
We got a better pill for you." Right?
我们为你准备了更好的药丸。”正确的？
In other words, you can't trust anything because you don't know where she got it.
换句话说，你不能相信任何事情，因为你不知道她从哪里得到的。
She has the best of intentions, I'm sure, when she's given it to you.
我确信，当她把它交给你时，她是出于好意。
And by the way, she probably took it the night before and was just fine.
顺便说一句，她可能是前一天晚上服用的，而且效果很好。
But the people who are making these pills are not exactly up to GMP standards.
但制造这些药丸的人并不完全符合 GMP 标准。
So you just have no idea which pill is getting what dose of fentanyl.
所以你只是不知道哪种药丸含有多少剂量的芬太尼。
One thing that Anthony Hipolito told me that I simply couldn't believe, I had to ask him six times, was that some of these pills have one milligram of fentanyl in them.
安东尼·伊波利托告诉我的一件事让我简直不敢相信，我不得不问他六次，其中一些药丸中含有一毫克芬太尼。
Now, I made the point on the podcast that 100 milligrams of fentanyl, for most people, is a hit.
现在，我在播客上指出，对于大多数人来说，100 毫克芬太尼很受欢迎。
I've had fentanyl before.
我以前吃过芬太尼。
I've been in the hospital, and I've had fentanyl.
我住过医院，服用过芬太尼。
100 milligrams is like, wow, that is such a trip.
100 毫克就像，哇，这真是一次旅行。
And why-
以及为什么-
Andrew Huberman:
安德鲁·休伯曼：
Why are people dying from one milligram intake?
为什么人们摄入一毫克就会死亡？
Dr. Peter Attia:
彼得·阿蒂亚博士：
Respiratory inhibition.
呼吸抑制。
You can't breathe.
你无法呼吸。
That shuts the brain stem off.
这会关闭脑干。
Andrew Huberman:
安德鲁·休伯曼：
Well, I don't think we can highlight this enough.
嗯，我认为我们还不能充分强调这一点。
Adults are dying, kids are dying.
大人都会死，孩子也会死。
I met someone just earlier this week who told me her 35-year-old son died of an accidental fentanyl overdose.
本周早些时候，我遇到了一个人，她告诉我她 35 岁的儿子因意外服用芬太尼过量而死亡。
And he wasn't, at least by her description, a drug addict or anything of that sort.
至少根据她的描述，他不是吸毒者或类似的人。
I think-
我认为——
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah.
是的。
We're talking about a different game now.
我们现在谈论的是另一个游戏。
So it's like these are kids that have anxiety.
所以这些孩子就像患有焦虑症一样。
These are kids that are sort of addressing another issue with these pills, and that's why I think this whole concept of deaths of despair is a really important one.
这些孩子正在用这些药丸解决另一个问题，这就是为什么我认为绝望死亡的整个概念非常重要。
But back to your question, what do accidental deaths primarily amount to for the aging population?
但回到你的问题，对于人口老龄化来说，意外死亡主要意味着什么？
Again, it is so clear that it is fall related.
再次，很明显它与跌倒有关。
This is where once you hit 60, 65, the risk of a fall that results either immediately in death, you hit your head and die, going back to cerebral hemorrhage, or it is the straw that basically leads you down the path to death within the next 12 months, is astonishingly high.
一旦你到了 60 岁、65 岁，摔倒的风险就会高得惊人，要么立即导致死亡，要么撞到头而死，要么再次脑溢血，要么在接下来的 12 个月内成为压垮你的最后一根稻草。
It's so high that it's sort of hard to wrap your head around.
它太高了，以至于你的头都很难转过来。
But if you're over 65 and you fall and break your femur or hip, so you either crack the femoral neck or the femur itself, your 12-month mortality, the probability you will be dead in 12 months after that break if you're 65 or older, depending on the study, is about 15% to 30%.
但如果您超过 65 岁，摔倒并折断股骨或髋部，导致股骨颈或股骨本身折断，那么您的 12 个月死亡率（如果您年满 65 岁或以上），在折断后 12 个月内死亡的可能性约为 15% 至 30%（具体取决于研究）。
Andrew Huberman:
安德鲁·休伯曼：
Wow.
哇。
So in terms of offsetting the probability of falls, you talked a little bit about this before, but you and I have talked a little bit about this before, but maybe we could go a little bit deeper.
所以在抵消跌倒的可能性方面，你之前谈过一点，但你和我之前也谈过一点，但也许我们可以更深入一点。
People's ability to jump and land seems to be highly correlated with one's ability to not fall, or at least fall and control the fall in a way that leads to no or less severe injury.
人们的跳跃和着陆能力似乎与一个人不摔倒的能力高度相关，或者至少是摔倒并以不造成或较轻伤害的方式控制摔倒的能力。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah.
是的。
So Andy Galpin talked about this on your podcast.
安迪·加尔平在你的播客上谈到了这个问题。
He talked about it on my podcast.
他在我的播客上谈到了这件事。
What is the hallmark of aging on the muscle?
肌肉衰老的标志是什么？
It is atrophy of the type 2 muscle fiber.
这是2型肌纤维的萎缩。
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Dr. Peter Attia:
彼得·阿蒂亚博士：
That's the hallmark.
这就是标志。
Andrew Huberman:
安德鲁·休伯曼：
Fast twitch.
快速抽搐。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Fast twitch muscle fiber.
快肌纤维。
So if you want to understand what looks different in 50-year-old Peter versus 18-year-old Peter, it's not my type 1 fibers It's my type 2 fibers, it's my fast-twitch fibers, it's my explosive fibers.
所以，如果你想了解 50 岁的彼得和 18 岁的彼得有什么不同，那就不是我的 1 型纤维，而是我的 2 型纤维，这是我的快肌纤维，这是我的爆炸性纤维。
When I was 18 years old, I could vertical jump over 30 inches.
当我18岁的时候，我可以垂直跳跃超过30英寸。
Today, I'm lucky if I can vertical jump 24 inches.
今天，如果我能垂直跳24英寸，我就很幸运了。
And when I'm 60, boy, my goal is to be able to vertical jump 20 inches when I'm 60, and I don't know if I'm going to be able to do it.
当我60岁的时候，我的目标是当我60岁的时候能够垂直跳20英寸，我不知道我是否能够做到。
Andrew Huberman:
安德鲁·休伯曼：
I've seen some videos of some 80-year-old sprinters that are pretty impressive, and certainly 80-year-old gymnasts-
我看过一些80岁短跑运动员的视频，令人印象深刻，当然还有80岁体操运动员——
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah
是啊
Andrew Huberman:
安德鲁·休伯曼：
...
...
that are impressive.
令人印象深刻。
I've not seen very many videos of 80-year-olds dunking basketballs, for instance.
例如，我没看过太多 80 岁老人扣篮的视频。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah.
是的。
It's-
这是——
Andrew Huberman:
安德鲁·休伯曼：
Who are not taller than six feet, five inches.
身高不超过六英尺五英寸的人。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah.
是的。
So again, if you just think about size, strength, speed, we lose speed first.
再说一次，如果你只考虑尺寸、力量、速度，我们首先会失去速度。
We lose speed, then strength, and the last thing you lose is size.
我们失去了速度，然后失去了力量，最后失去的是体型。
So again, size is agnostic to fiber, right?
再说一遍，尺寸与纤维无关，对吗？
You could have big type 1 fibers and still have lots of size.
您可以拥有较大的 1 型光纤，但仍然具有很大的尺寸。
They're not going to be that strong, and they're certainly not going to be fast.
他们不会那么强，当然也不会那么快。
So we could spend hours on this particular topic, but I think the most important thing that people need to understand is you cannot age well if you are not doing the type of training that is there to strengthen and delay or minimize the hypertrophy of your type 2 fibers.
因此，我们可以花几个小时讨论这个特定的主题，但我认为人们需要理解的最重要的事情是，如果您不进行旨在加强、延迟或最小化 2 型纤维肥大的训练，那么您就无法很好地变老。
So everything matters, right?
所以一切都很重要，对吧？
You have to be doing your zone 2, you have to be doing all of these other things, but some component of your training needs to be stressing the type 2 fibers.
你必须做你的 2 区，你必须做所有这些其他的事情，但你的训练的某些部分需要强调 2 型纤维。
You have to be doing strength training that taxes those fibers.
你必须进行力量训练来消耗这些纤维。
You have to be doing reactivity training.
你必须进行反应训练。
You have to be doing explosive training.
你必须进行爆发力训练。
Andrew Huberman:
安德鲁·休伯曼：
And ideally, some training that involves jumping and landing.
理想情况下，进行一些涉及跳跃和着陆的训练。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Well, jumping is a very big part of it, and landing is a very big part of another one of what I think of as my four pillars of strength training.
嗯，跳跃是其中非常重要的一部分，而落地是我认为的力量训练四大支柱的另一个非常重要的部分。
So one of the pillars of strength training is eccentric strength, which is brakes.
所以力量训练的支柱之一是偏心力量，也就是刹车。
So you're going to hurt yourself 10 times more likely-- I'm making that number up, by the way.
所以你受伤的可能性会增加 10 倍——顺便说一句，这个数字是我编的。
I don't know if it's 10 times, but experientially, it seems to be.
我不知道是不是10倍，但从经验来看，似乎是。
You are 10 times more likely to hurt yourself stepping off something than stepping onto something, right?
踩下某物时受伤的可能性比踩上某物时受伤的可能性高 10 倍，对吗？
Stepping down versus stepping up.
下台与上台。
Because when you step up onto something, you are concentrically controlling a muscle.
因为当你踏上某物时，你正在集中控制一块肌肉。
When you step down, you have to apply the brakes, and that's where most people falter.
当你下台时，你必须踩刹车，而这正是大多数人犹豫不决的地方。
Much harder to walk downhill than uphill.
下坡比上坡难走多了。
Uphill is taxing your cardiovascular system, but if you slow down enough, you're fine.
上坡会给你的心血管系统带来负担，但如果你放慢速度，就没事。
But a lot of people don't have the ability to slow themselves down when they're walking downhill.
但很多人在下坡时没有能力放慢速度。
And so when an older person steps off a curb and can't fully stop themselves, and that results in a fall.
因此，当老年人走下路边并且无法完全阻止自己时，就会导致跌倒。
So I like doing things like a broad jump.
所以我喜欢做跳远之类的事情。
Broad jump's a fun little test that I like to do every once in a while.
跳远是一项有趣的小测试，我喜欢偶尔做一次。
I always want to make sure I can broad jump six feet.
我一直想确保我能跳六英尺。
That's kind of my arbitrary number that I've chosen.
这是我任意选择的数字。
And the reason is on the takeoff, that's a very explosive movement, but the landing is just as important.
原因是在起飞时，这是一个非常具有爆炸性的运动，但着陆也同样重要。
If I can't stick that landing, it means I don't have the brakes.
如果我不能坚持着陆，就意味着我没有刹车。
So those are some of the tests I want to be able to do to make sure that I'm utilizing that system.
这些是我希望能够进行的一些测试，以确保我正在利用该系统。
Because I do think, look, I've watched my mom.
因为我确实认为，看，我观察过我的妈妈。
My mom fell, gosh, probably been about four months ago, just fell in a typical way that people fall.
我妈妈摔倒了，天哪，可能是大约四个月前，只是以人们摔倒的典型方式摔倒。
By the way, it could've happened to anybody.
顺便说一句，这可能发生在任何人身上。
My mom walks around and moves around just fine.
我妈妈走路、走动都很好。
But on this particular day, she just tripped on a uneven stone and fell and landed and broke her hand.
但在这一天，她被一块不平坦的石头绊倒，摔倒了，摔断了手。
And she's really lucky she didn't break her hip, and I told her that because my mom is probably in her mid-70s, and I said, "Look, if that was your femur, I'd give you a 30% chance of dying in the next year." Those are such difficult to recover from injuries because first of all, you're dealing with the immobility of the hospitalization and immobility that follows that.
她真的很幸运，没有摔断臀部，我告诉她，因为我妈妈可能已经 70 多岁了，我说，“看，如果那是你的股骨，我会给你 30% 的机会在明年死亡。”这些伤势很难从伤病中恢复，因为首先，你要面对的是住院期间的瘫痪以及随之而来的瘫痪。
And the amount of muscle loss that occurs could easily be four or five pounds of lean tissue lost, that for most people that age becomes almost impossible to get back.
而且肌肉损失量很容易就损失了四到五磅的瘦肉组织，对于大多数人来说，这个年龄几乎不可能恢复。
And that says nothing about sort of the acute causes of death, like a fat embolism that results from a broken femur, a blood clot from laying in bed.
这并没有提到一些急性死亡原因，比如股骨骨折导致的脂肪栓塞、躺在床上形成的血栓。
Those things are also catastrophic.
这些事情也是灾难性的。
But what happens is a lot of these patients just never get back to the same level of mobility.
但实际情况是，很多患者再也无法恢复到原来的活动能力。
And now I think in many ways, we're kind of pivoting from what kills you to what ruins your quality of life.
现在我认为，从很多方面来说，我们正在从致命的事物转向破坏生活质量的事物。
And we've spent so much time talking about what kills you, but I think you might as well be dead in some ways if you can't do the things you want to do.
我们花了很多时间谈论什么会杀死你，但我认为如果你不能做你想做的事情，从某些方面来说你可能已经死了。
And if playing with your grandkids or gardening or playing golf or going for a walk with your spouse, or think of any of the things that we all do today and take for granted.
如果和你的孙子们一起玩耍，或者园艺，或者打高尔夫球，或者与你的配偶一起散步，或者想想我们今天所做的任何事情，并认为这是理所当然的。
If you can't do those things, I don't know, you sort of lose the reason to be around.
如果你做不到这些事情，我不知道，你就失去了存在的理由。
Andrew Huberman:
安德鲁·休伯曼：
And oftentimes, the inability to do those things is associated with pain.
通常，无法做这些事情会带来痛苦。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Mm-hmm.
嗯嗯。
Andrew Huberman:
安德鲁·休伯曼：
Which is psychologically and obviously physiologically so distressing.
这在心理上和生理上都是如此令人痛苦。
You mentioned the four pillars of health.
您提到了健康的四大支柱。
Maybe just list those off for people.
也许只是为人们列出这些。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Of lifting?
起重？
Andrew Huberman:
安德鲁·休伯曼：
Well, the four pillars of longevity through physical-
那么，通过身体健康长寿的四大支柱——
Dr. Peter Attia:
彼得·阿蒂亚博士：
Oh, yeah.
哦，是的。
Sort of the exercise pieces of them.
排序其中的练习部分。
Andrew Huberman:
安德鲁·休伯曼：
Yes.
是的。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah.
是的。
So strength, stability, aerobic efficiency, and aerobic peak output.
所以力量、稳定性、有氧效率和有氧峰值输出。
Andrew Huberman:
安德鲁·休伯曼：
Okay, so aerobic peak would be sort of like VO2 max.
好的，有氧峰值有点像最大摄氧量。
Dr. Peter Attia:
彼得·阿蒂亚博士：
VO2 max-
最大摄氧量-
Andrew Huberman:
安德鲁·休伯曼：
Yep
是的
Dr. Peter Attia:
彼得·阿蒂亚博士：
...
...
and zone 2.
和2区。
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Dr. Peter Attia:
彼得·阿蒂亚博士：
In my analogy, your zone 2 is how wide the base of your pyramid is.
在我的类比中，区域 2 是金字塔底部的宽度。
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Dr. Peter Attia:
彼得·阿蒂亚博士：
And your VO2 max is how tall the peak of the pyramid is.
你的最大摄氧量是金字塔顶峰的高度。
Andrew Huberman:
安德鲁·休伯曼：
Oh, okay.
哦，好吧。
Dr. Peter Attia:
彼得·阿蒂亚博士：
So the best pyramid has a wide base and a high peak.
所以最好的金字塔有宽底和高顶。
So you could have a reasonably wide base and a shallow peak.
所以你可以有一个相当宽的底部和一个浅的顶部。
If you just did zone 2 training, you're going to get a reasonable peak, but it's not going to be that high.
如果您刚刚进行了 2 区训练，您将获得一个合理的峰值，但不会那么高。
You have to do some of that specific training.
您必须进行一些特定的培训。
If you just focus on high intensity, you might drive up that VO2 max, but you're actually going to have a relatively narrow aerobic base.
如果您只专注于高强度，您可能会提高最大摄氧量，但实际上您的有氧基础相对较窄。
So you think about just maximizing the area of that triangle, widest, tallest.
所以你考虑最大化那个三角形的面积，最宽，最高。
Stability and strength.
稳定性和强度。
Stability, of course, encompasses everything we're talking about in terms of reactivity.
当然，稳定性涵盖了我们在反应性方面所讨论的一切。
I dedicate a chapter in the book to this concept because it is so foreign to most people, and for understandable reasons.
我在书中专门用了一章来讨论这个概念，因为它对大多数人来说都很陌生，而且出于可以理解的原因。
It's not sexy.
这不性感。
It's the hardest one to train, it's the hardest one to understand, but it's so important because it's the thing that I think differentiates people who age well and people who don't age well.
这是最难训练的，也是最难理解的，但它非常重要，因为我认为这是区分老化的人和老化的人的关键。
Andrew Huberman:
安德鲁·休伯曼：
And I should perhaps throw in there, please correct me if I'm wrong, but also most of the machines that are in typical commercial gyms that allow people who are not very experienced to start doing some resistance training don't really tap into the stability factor terribly much.
也许我应该补充一下，如果我错了，请纠正我，而且典型的商业健身房中的大多数机器允许经验不足的人开始进行一些阻力训练，但并没有真正充分利用稳定性因素。
So while there's value to leg extensions and leg curls and chest presses and shoulder presses done with machines, certainly, for a number of reasons, and can often be safer than free weights, especially for people who are approaching at a later time or are new to the whole thing, they don't really lend themselves to real-life stability.
因此，虽然用机器进行腿部伸展、腿弯举、胸部推举和肩部推举很有价值，当然，出于多种原因，而且通常比自由重量更安全，特别是对于后来接触或刚接触整个训练的人来说，但它们并不真正有助于现实生活中的稳定性。
As you mentioned, walking down stairs in the absence of a handrail.
正如您提到的，在没有扶手的情况下走下楼梯。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Right.
对。
Andrew Huberman:
安德鲁·休伯曼：
Or movements in kind of odd planes.
或者在某种奇怪的平面上移动。
Having to step aside to avoid a bicycle-
不得不靠边躲避自行车——
Dr. Peter Attia:
彼得·阿蒂亚博士：
Right
右
Andrew Huberman:
安德鲁·休伯曼：
...
...
at an angle as opposed to just moving linearly.
以一定角度移动，而不是仅线性移动。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah.
是的。
And by the way, a lot of things that don't involve machines still don't give you that, right?
顺便说一句，很多不涉及机器的事情仍然无法给你带来这些，对吧？
Doing a deadlift, you have to be stable to lift a heavy weight like you would a deadlift without hurting yourself.
进行硬拉时，您必须保持稳定才能像硬拉一样举起重物而不伤害自己。
That requires an unbelievable capacity to harness intra-abdominal pressure and to be connected.
这需要令人难以置信的驾驭腹内压力和连接的能力。
If you're going to lift 500 pounds off the ground, you're stable, but that still doesn't prepare you for what you just described.
如果您要从地面举起 500 磅的重物，您就可以保持稳定，但这仍然无法让您为刚才所描述的情况做好准备。
So stability is multifaceted, and it involves doing a lot of things.
所以稳定是多方面的，需要做很多事情。
Today, for example, today was a cardio zone two day, so I did my cardio zone two, and I had an extra 10 minutes before I needed to get moving.
例如，今天是有氧运动区两天，所以我做了有氧运动区二，在我需要开始运动之前我还有额外的 10 分钟时间。
And so all I did was step ups for 10 minutes.
所以我所做的就是 10 分钟的上台阶。
I just did single leg, very slow step up, and insanely slow step downs off a box in a gym.
我只是做了单腿，非常缓慢地向上迈出，然后从健身房的箱子上极其缓慢地向下迈出。
So two-second up, four-second down.
所以向上两秒，向下四秒。
Two-second up, four-second down.
向上两秒，向下四秒。
And I would do them with ipsilateral loads, contralateral loads, all sorts of different things.
我会用同侧负载、对侧负载以及各种不同的东西来完成它们。
And basically, that's just a stability game for me.
基本上，这对我来说只是一个稳定游戏。
It's like I'm building that concentric strength in a movement where it's easy to cheat, but can I do it without cheating?
这就像我在一个很容易作弊的运动中建立同心力量，但我可以在不作弊的情况下做到这一点吗？
Andrew Huberman:
安德鲁·休伯曼：
That's terrific, and it's terrific that you cover all of that in the book in addition to these other topics.
这太棒了，除了这些其他主题之外，您还涵盖了书中的所有内容，这真是太棒了。
So several times during our conversation today, you alluded to quality of life.
因此，在今天的谈话中，您多次提到了生活质量。
And one of my favorite segments in your book, indeed, the segment in your book that I believe could be its own entire book of tremendous value, is the section on emotional health.
在你的书中我最喜欢的部分之一，事实上，我相信你书中的部分可能成为整本书中具有巨大价值的部分，那就是关于情绪健康的部分。
If you could just share with us a bit of what inspired you to include that section.
如果您能与我们分享一些启发您加入该部分的内容的话。
Was this, for instance, based on communication with your patients?
例如，这是基于与患者的沟通吗？
To what extent it was based on your own life experience?
它在多大程度上是基于你自己的生活经历？
And then maybe we can drill a little bit deeper into what's contained in those chapters and what really constitutes emotional health.
然后也许我们可以更深入地研究这些章节中包含的内容以及真正构成情绪健康的内容。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Well, I think that chapter of the book, which is a pretty long chapter, it's the final chapter as well, is certainly different from all of the others in that there's no confusion about expertise, right?
嗯，我认为这本书的这一章很长，也是最后一章，它肯定与其他所有章节不同，因为在专业知识方面没有混淆，对吧？
I think in the other chapters, I at least try to come across as having some knowledge on the subject matter, and I'm writing them most often as, quote unquote, the doctor, right?
我认为在其他章节中，我至少试图给人留下对这个主题有一些了解的印象，而且我最常以医生的身份来写它们，引用不引用，对吧？
Whereas I think that last chapter is much more about an experiential side of my knowledge acquisition, and therefore, really it comes across more as a patient.
然而我认为最后一章更多地是关于我获取知识的经验方面，因此，实际上它更多地表现为一个病人。
And I think you're right.
我认为你是对的。
I think that that's a chapter that initially was resisted by all other parties involved in the book.
我认为这一章最初遭到了本书中所有其他各方的抵制。
So my coauthor, my editor, everybody else sort of felt like, "This is interesting, but it's a separate topic.
所以我的合著者、我的编辑和其他人都觉得，“这很有趣，但这是一个单独的话题。
If you want to write about this, you should write another book about it.
如果你想写这个，你应该写另一本书。
But it doesn't really belong in this book." I disagreed for two reasons, and ultimately, I guess my opinion prevailed.
但它并不真正属于这本书。”我有两个原因不同意，最终我想我的意见占了上风。
The first is I didn't want to write another book, so not including this in this book to then write about it in another book was not something I was interested in doing.
首先，我不想再写一本书，所以我不想把它包含在这本书中，然后在另一本书中写到它。
But I think more importantly, I do think that this book is about much more than how long you live.
但我认为更重要的是，我确实认为这本书的意义远不止于你的寿命。
And while we have talked about, and will talk about in the book that is, how cognitive and physical health are just as germane to quality of life as they are to length of life, this other piece of emotional health, it's potentially the most important of them all.
虽然我们已经讨论并将在书中讨论认知和身体健康如何与生活质量和寿命长度密切相关，但情绪健康的另一部分可能是其中最重要的。
It's also the hardest to define, but without it, none of this other stuff matters, right?
它也是最难定义的，但如果没有它，其他的东西都不重要，对吧？
So there's infinite lifespan, if you're miserable, means nothing.
所以说，寿命是无限的，如果你痛苦的话，那就毫无意义了。
Andrew Huberman:
安德鲁·休伯曼：
May even be worse.
甚至可能更糟。
Dr. Peter Attia:
彼得·阿蒂亚博士：
That would be a curse, right?
那将是一个诅咒，对吗？
You could argue, how could you punish somebody the most?
你可能会争辩说，你怎样才能惩罚某人最严重呢？
Allow them to live forever and be miserable.
让他们永远活着，痛苦不堪。
Andrew Huberman:
安德鲁·休伯曼：
Is there a Greek myth?
有希腊神话吗？
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah, there's a Greek god.
是的，有一个希腊神。
Andrew Huberman:
安德鲁·休伯曼：
Which is?
哪个是？
Dr. Peter Attia:
彼得·阿蒂亚博士：
Tithonus.
提托努斯。
Yeah.
是的。
Andrew Huberman:
安德鲁·休伯曼：
Tithonus?
提托努斯？
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah.
是的。
Andrew Huberman:
安德鲁·休伯曼：
Okay.
好的。
Dr. Peter Attia:
彼得·阿蒂亚博士：
He was granted immortality.
他被授予永生。
It's a bit different.
有点不同。
He was granted immortality, but without a health span, basically.
他被授予永生，但基本上没有健康期限。
So he aged forever.
于是他就永远老了。
Andrew Huberman:
安德鲁·休伯曼：
Dreadful.
太可怕了。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah.
是的。
And this would be dreadful, too, right?
这也会很可怕，对吧？
And then I feel like, why did I need to write about this?
然后我想，为什么我需要写这个？
Well, I think that this is probably my greatest struggle, I think.
好吧，我想这可能是我最大的挣扎。
Way at the outset of the podcast, you asked me kind of like, what are the obstacles to longevity?
在播客一开始，你就问我，长寿的障碍是什么？
And that got us down a path of Some very black and white things.
这让我们走上了一条非黑即白的道路。
But when I look at a patient, I create a dashboard.
但当我观察病人时，我会创建一个仪表板。
And the dashboard is what are all the things that are a threat to every component of your longevity, both lifespan and health span?
仪表板显示了哪些因素对您的长寿（寿命和健康寿命）的各个组成部分构成威胁？
We talked about a bunch of those things.
我们讨论了很多这样的事情。
So what is your risk for atherosclerosis and what are we doing about it?
那么，您患动脉粥样硬化的风险是多少？我们正在采取什么措施呢？
What is your risk for cancer?
您患癌症的风险有多大？
What are we doing about it?
我们正在做什么呢？
What is your risk for neurodegeneration?
您患神经退行性疾病的风险有多大？
What are we doing about it?
我们正在做什么呢？
What is your risk for accidental death?
您意外死亡的风险有多大？
What are we doing about it?
我们正在做什么呢？
What is your risk for physical decline?
您身体衰退的风险有多大？
What are we doing about it?
我们正在做什么呢？
And one of those things is what is your risk of emotional health or poor emotional health, and what are we doing about it?
其中一件事是您情绪健康或情绪健康不佳的风险是什么，我们正在采取什么措施？
So when I do that exercise for me, which I do, right?
那么当我为自己做这个练习时，我就会这么做，对吗？
I have that spreadsheet laid out for me and I know where my factors line up.
我已经为我准备好了电子表格，我知道我的因素在哪里。
And interestingly, despite my family history being horrible for atherosclerosis, it's sixth on my list because basically I intervened early, I have a clear understanding of the pathophysiology, and I'm doing everything to the maximum.
有趣的是，尽管我的动脉粥样硬化家族史很可怕，但它在我的名单上排名第六，因为基本上我很早就进行了干预，我对病理生理学有清楚的了解，而且我正在尽最大努力做一切。
So I'm actually very confident I will die with and not from atherosclerosis.
所以我实际上非常有信心我会死于动脉粥样硬化而不是死于动脉粥样硬化。
But the top thing on my list is actually emotional health.
但我清单上最重要的实际上是情绪健康。
That's the one that is the hardest for me to manage, and it's the easiest to get out of balance, and it creates the most pain in my life.
这是我最难管理的，也是最容易失去平衡的，也是我一生中最痛苦的。
So that's a long answer to why I felt this needed to be in here.
这是一个很长的答案，解释了为什么我觉得这个需要放在这里。
Andrew Huberman:
安德鲁·休伯曼：
Well, in the book, you go into very honest detail about some of your journeys through and challenges with emotional health and paths to overcoming those.
嗯，在书中，您非常诚实地详细介绍了您在情绪健康方面的一些经历和挑战以及克服这些挑战的途径。
Maybe we'll get into those a bit, but before we do, how should we define emotional health?
也许我们会稍微讨论一下这些问题，但在此之前，我们应该如何定义情绪健康？
This, to me, seems like one of the most difficult areas to calibrate oneself.
对我来说，这似乎是最难自我校准的领域之一。
Even just measuring emotion is tricky.
即使只是测量情绪也是很棘手的。
Language is the dissection tool for psychologists, psychiatrists, and indeed for all of us.
语言是心理学家、精神病学家乃至我们所有人的剖析工具。
"How are you doing today?" "Great," or, "I'm miserable," or, "I'm depressed." It means such different things to different people.
“你今天怎么样？” “太好了”，或者“我很痛苦”，或者“我很沮丧”。这对不同的人来说意味着不同的事情。
Obviously, suicide being the far end of, we presume, misery.
显然，我们认为自杀是痛苦的尽头。
There are instances of manic suicide, but-
确实有躁狂自杀的例子，但是——
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah
是啊
Andrew Huberman:
安德鲁·休伯曼：
...
...
depressive misery.
抑郁的痛苦。
But setting that aside, how should we evaluate, think about, and communicate emotional health to ourselves and to the relevant people that could potentially help us if we need it?
但抛开这一点，我们应该如何评估、思考和向自己以及在我们需要时可能帮助我们的相关人员传达情绪健康？
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah, well, you're right.
是的，嗯，你是对的。
It's very difficult, right?
这非常困难，对吧？
And so much of what goes into this book is about things that are much easier to quantify.
本书中的大部分内容都是关于更容易量化的事情。
I could sit here and talk for days about all the ways we quantify from the histologic to the gross of each of these diseases, genetically, all of these other things.
我可以坐在这里好几天谈论我们从组织学到总体上对每种疾病、遗传以及所有其他事物进行量化的所有方法。
With emotional health, it's far more vague, and I don't even attempt to come up with a definition, right?
对于情绪健康来说，它要模糊得多，我什至没有试图给出一个定义，对吧？
I can tell you things that make up components of it.
我可以告诉你它的组成部分。
So connectivity with others just seems to be an inescapable part of this.
因此，与他人的联系似乎是其中不可避免的一部分。
So the ability to maintain healthy relationships and attachments to other people.
因此，有能力与他人保持健康的关系和依恋。
And by the way, these are in no particular order.
顺便说一句，这些没有特定的顺序。
Having a sense of purpose.
有目标感。
Being able to regulate your emotions.
能够调节自己的情绪。
Experiencing fulfillment.
体验成就感。
Experiencing satisfaction.
体验满足感。
All of these things matter, and I think that for many of us, if we're taking an honest appraisal of ourselves, we'll notice that we have deficits in these areas.
所有这些事情都很重要，我认为对于我们许多人来说，如果我们诚实地评估自己，我们会注意到我们在这些领域存在缺陷。
Being present.
存在。
By the way, that's something that may have been less of an issue 100 years ago than it is today.
顺便说一句，这在 100 年前可能比今天还不是一个问题。
So I think, certainly for me, being present is very difficult.
所以我认为，对我来说，存在于当下是非常困难的。
It's not my default state.
这不是我的默认状态。
I don't know that it's the default state for most people, truthfully.
说实话，我不知道这是否是大多数人的默认状态。
But I'm very often predisposed with thoughts about the future.
But I'm very often predisposed with thoughts about the future.
Occasionally thoughts about the past, but it's much more often kind of thoughts about the future and planning and thinking about what I need to do and what do I want to do next, and never really being satisfied with anything that's happening in the moment.
偶尔会想到过去，但更常见的是对未来的想法，以及计划和思考我需要做什么以及下一步想要做什么，并且永远不会真正满足于当下发生的任何事情。
So I have to work hard to overcome those things.
所以我必须努力去克服这些事情。
And I'm sure you can appreciate this, but when you are present, you generally are in a much better frame of mind.
And I'm sure you can appreciate this, but when you are present, you generally are in a much better frame of mind.
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Yeah.
是的。
There's an interesting study, I think it was initially published by Dan Gilbert's lab, one of these long-term happiness studies, that was published in "Science" magazine, that pinged people for their level of happiness, unhappiness, presence, or lack of presence multiple times throughout the day.
有一项有趣的研究，我认为它最初是由 Dan Gilbert 的实验室发表的，这是一项长期幸福研究，发表在《科学》杂志上，该研究在一天中多次检测人们的幸福程度、不幸福程度、在场或缺席程度。
This was in the early years of smartphones.
这是智能手机出现的早期。
So this is around 2010, 2011.
所以这是2010年、2011年左右。
So the technology wasn't as good as it is now, but it was good enough to do this in a very large number of people.
So the technology wasn't as good as it is now, but it was good enough to do this in a very large number of people.
I forget how many, but certainly more than 10,000, and that number I'm stating it intentionally low.
I forget how many, but certainly more than 10,000, and that number I'm stating it intentionally low.
And what they found was regardless of whether or not people were doing something they enjoyed or not, boring to them or not, the degree of presence to what they were doing was a stronger predictor of their happiness in that moment and overall than was anything else.
他们发现，无论人们是否在做自己喜欢的事情，是否无聊，他们所做的事情的存在程度比其他任何因素都更能预测他们在那一刻和整体上的幸福感。
And also a fairly rare feature for most people.
对于大多数人来说，这也是一个相当罕见的功能。
So seems like it's something that we do need to work at, perhaps nowadays, as you point out, more than we perhaps do in our ancestral past.
因此，这似乎是我们确实需要努力的事情，也许现在，正如您所指出的，比我们祖先所做的更多。
I'm a little bit surprised that you say that you find it hard to be present because you strike me as somebody that is not just willing, but has a strong almost reflex toward observing the contour of something and then really drilling into it and really getting to the guts of most everything that interests you.
我有点惊讶你说你发现很难在场，因为你给我的印象是，你不仅愿意，而且对观察某物的轮廓有强烈的近乎本能的反应，然后真正深入其中，真正深入了解你感兴趣的大多数事物的本质。
So you strike me as somebody who's very present, and I guess maybe this gets back to this, the vagueness
So you strike me as somebody who's very present, and I guess maybe this gets back to this, the vagueness
Dr. Peter Attia:
彼得·阿蒂亚博士：
But they're not mutually exclusive, right?
但它们并不相互排斥，对吗？
So for example, I'll notice that sometimes if I'm playing with my kids, especially my boys because they're younger, and playing with them is really being in their world.
例如，我会注意到，有时如果我和我的孩子们一起玩，尤其是我的儿子们，因为他们还小，和他们一起玩真的是在他们的世界里。
If I'm with my daughter, we can be doing things that are kind of mutually, we'll do things together that I would probably do by myself or she would do by herself.
如果我和我的女儿在一起，我们可以做一些相互的事情，我们会一起做一些我可能自己做或她自己做的事情。
But with my boys, it's generally doing something I wouldn't otherwise be doing.
But with my boys, it's generally doing something I wouldn't otherwise be doing.
And if I'm paying attention to it, I'm constantly amazed at how after five minutes of searching through a bin for just the right Lego piece that we want to do to build this one little thing, my mind will start thinking about something else.
如果我注意它，我会不断惊讶地发现，在花了五分钟的时间在一个垃圾箱中寻找我们想要用来建造这个小东西的正确乐高积木之后，我的大脑会开始思考其他事情。
Like, "Oh my God, I got to go.
就像，“天哪，我得走了。
Ugh, I didn't email that dude back, and I got to do this, and I got to do this, and I got to do this, and I got to do this." And I just get into the, I got to do, I got to do, I got to do.
Ugh, I didn't email that dude back, and I got to do this, and I got to do this, and I got to do this, and I got to do this." And I just get into the, I got to do, I got to do, I got to do.
And it's like, dude, you've only been here for five minutes.
And it's like, dude, you've only been here for five minutes.
Why don't you just find the Lego piece that you need to finish building that thing over there that is this beautiful moment that you're not going to have many of, right?
你为什么不去那里找到你需要的乐高积木来完成建造那个东西，那是你不会有很多的美好时刻，对吧？
There's a very finite number of these moments you're going to have, so you want to savor every one of them.
你所拥有的这些时刻的数量非常有限，所以你想要细细品味每一个时刻。
So, and again, I don't think I'm alone in that.
所以，再一次，我认为我并不孤单。
I think a lot of parents, for example, can relate to that, and that's literally just one of many different things.
I think a lot of parents, for example, can relate to that, and that's literally just one of many different things.
And by the way, I wouldn't have said that that was my greatest challenge either, but it's something that requires, I think, deliberate attention.
顺便说一句，我也不会说这是我最大的挑战，但我认为这是需要刻意关注的事情。
Andrew Huberman:
安德鲁·休伯曼：
What you're alluding to is a challenge with holding a single time perception or perception of time.
What you're alluding to is a challenge with holding a single time perception or perception of time.
One of the most remarkable things to me about the human brain is our ability to be present or think about the past or the future, or the present and the future, and we can occupy different time bins.
对我来说，人类大脑最引人注目的事情之一是我们能够活在当下或思考过去或未来，或者现在和未来，并且我们可以占据不同的时间段。
And in a recent non-recorded conversation of ours, you showed me something that I've seen before, but for some reason, this time it had a profound impact on me, which was that you have a chart of the number of weeks that you're going to live, and you mark them off one week at a time.
在我们最近一次没有录音的谈话中，你向我展示了一些我以前见过的东西，但出于某种原因，这一次对我产生了深远的影响，那就是你有一张你将活多少周的图表，你一次把它们标记为一周。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Mm-hmm.
嗯嗯。
Andrew Huberman:
安德鲁·休伯曼：
We were talking about this in the context of major life decisions.
我们在重大人生决定的背景下讨论这个问题。
And it illustrates the fact that we need such a chart, that we can't really move through our day being present to the beauty of working on a Lego with our kid while also paying attention to the fact that, wow, this is week number whatever, 600 in the or X number of weeks of one's life.
它说明了这样一个事实，即我们需要这样一个图表，我们无法一边享受与孩子一起拼搭乐高的美妙，一边真正度过一天，同时还要注意这样一个事实：哇，这已经是第几周了，一个人生命中的 600 周或 X 周。
So that ability to contract and dilate our time perception is marvelous, but it's also a double-edged sword because it's what takes us out of what's meaningful in the moment.
因此，收缩和扩张我们的时间感知的能力是奇妙的，但它也是一把双刃剑，因为它会让我们脱离当下有意义的事情。
One sort of has to wonder, then, whether or not our challenges in being present, I guess the psychoanalyst maybe we need to or psychiatrist maybe we need to ask our Paul Conti who you know and I know, and respect greatly, whether or not this is some subconscious refusal of our own mortality or something, right?
那么，我们必须想知道，我们是否面临着存在的挑战，我想我们可能需要精神分析师，或者精神科医生，也许我们需要问我们的保罗·康蒂，你认识我，并且非常尊重，这是否是对我们自己的死亡或其他什么的潜意识拒绝，对吗？
That if we were to really contemplate our mortality on a regular basis, not just when we're marking off the weeks of the poster, we wouldn't be able to be present because it's kind of overwhelming, right?
如果我们真正定期思考我们的死亡率，而不仅仅是在我们标记海报的几周时，我们就无法在场，因为这有点令人难以承受，对吗？
Dr. Peter Attia:
彼得·阿蒂亚博士：
I don't know.
我不知道。
I feel like the literature says that people who spend more time contemplating their own mortality are actually more at peace, kind of a little bit of the exposure therapy idea.
我觉得文献说，花更多时间思考自己死亡的人实际上更平静，有点像暴露疗法的想法。
So I'm not sure it's an unhealthy thing to be aware of your mortality.
So I'm not sure it's an unhealthy thing to be aware of your mortality.
I suspect it's helpful in as much as you accept it, right?
我怀疑只要你接受它就会有帮助，对吗？
And you feel like you have some agency over parts of it, right?
And you feel like you have some agency over parts of it, right?
I don't think I have nearly enough agency over the length of my life.
我认为我一生中没有足够的代理权。
I think I've got five to 10 years of wiggle room that I can extract.
我认为我还有五到十年的回旋余地。
If I do all of the things that I've written about in that book, I bet I can stretch my life out 10 to 15 years at the maximum.
If I do all of the things that I've written about in that book, I bet I can stretch my life out 10 to 15 years at the maximum.
Call it 10 over what would've happened if I didn't do those things.
Call it 10 over what would've happened if I didn't do those things.
Maybe it's more, but it depends on what we're comparing it to, right?
也许更多，但这取决于我们将其与什么进行比较，对吗？
From being reasonable to maybe being a little bit hyper-functioning.
从理性到可能有点功能亢进。
Maybe it's 10 years.
也许是10年了。
But where I know I have a much greater agency is in quality, and for me now, a big part of that is in terms of quality of relationships.
但我知道我在质量方面拥有更大的能动性，而现在对我来说，其中很大一部分是在关系质量方面。
I think that's a big thing.
我认为这是一件大事。
And I think for most people, that's what I hope this chapter does, is it sort of allows more people to take an appraisal of that and ask that question, which is before it's too late, am I living my life more for my resume virtues or for my eulogy virtues to borrow from David Brooks' work, "The Road to Character," which I talk about as being kind of one of the many aha moments that I had during this journey.
我认为，对于大多数人来说，这就是我希望本章所做的，是让更多的人对此进行评估，并在为时已晚之前提出这个问题，我的生活更多是为了我的简历美德，还是为了我的悼词美德，借用大卫·布鲁克斯的著作《品格之路》，我认为这是我在这段旅程中经历的众多顿悟时刻之一。
Andrew Huberman:
安德鲁·休伯曼：
Yeah.
是的。
And there again, thank you.
再次谢谢您。
You recommended "The Road to Character" to me.
你向我推荐了《品格之路》。
I do an annual solo wilderness trip, and I listen to it during the drive to that trip and on that trip, and I would just say it's a truly important book for everyone to listen to.
我每年都会进行一次单独的荒野旅行，我在开车去那次旅行的途中和在那次旅行中都会听这本书，我只想说这对每个人来说都是一本非常重要的书。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah.
是的。
Andrew Huberman:
安德鲁·休伯曼：
It's really quite impressive.
这确实令人印象深刻。
What are the things that you do on a regular b- let's say on a daily basis to try and enforce forgive the word, but enforce emotional wellbeing and health in terms of relationships.
你每天都会做哪些事情来尝试强制原谅这个词，但在人际关系方面加强情感健康和健康。
Because as you point out, it's not reflexive for everybody, and that doesn't make them bad people.
因为正如你所指出的，这并不是每个人都会条件反射的，这并不意味着他们就是坏人。
I think it does have to do with this challenge in balancing expectations of work and other things, and for some people, a more inherent selfishness, and for some people, they aren't selfish enough.
我认为这确实与平衡工作和其他事情的期望方面的挑战有关，对于某些人来说，这是一种更内在的自私，而对于某些人来说，他们不够自私。
I know plenty of people that are running around trying to serve everybody, and then their health is crashing or their mental health is crashing.
我知道很多人到处奔波，试图为所有人服务，但他们的健康状况却崩溃了，或者他们的心理健康状况崩溃了。
So it can cut any which way or all ways.
因此它可以任意方向或所有方向进行切割。
What sorts of practices do you incorporate or just even thoughts within your own mind?
你会采取什么样的实践，或者只是在你自己的头脑中思考？
Do you use charts and lists?
您使用图表和列表吗？
You're very regimented about your workouts, building grip strength, eccentric training zone two, et cetera.
你对锻炼、增强握力、第二区离心训练等等都非常严格。
Why wouldn't we also script out the things to pay attention to each morning and day as a list of to-dos?
为什么我们不把每天早上和每天要注意的事情写成待办事项列表呢？
Dr. Peter Attia:
彼得·阿蒂亚博士：
Well, I have done those things, right?
嗯，我已经做过这些事情了，对吗？
So certainly, and I write about it in the book, I've gone away a couple of times.
所以当然，我在书中写到了这一点，我已经离开过几次了。
So in 2017, I spent two weeks at a facility in Kentucky.
因此，2017 年，我在肯塔基州的一家工厂呆了两周。
In 2020, I spent three weeks at a facility in Arizona.
2020 年，我在亚利桑那州的一家工厂待了三周。
And on the back end of that facility three years ago when I got out, I had a very clear list of daily things I needed to do.
三年前，当我离开该设施时，我有一个非常清晰的日常需要做的事情清单。
And so at that point, for about six months following getting out of that stint of rehab, God, the list of behaviors I was doing every single day.
所以在那一点上，在结束康复期后的大约六个月里，上帝，我每天都在做的行为清单。
Twice a day, standing in front of the mirror, reading my list of affirmations, writing in my journal every single day.
每天两次，站在镜子前，阅读我的肯定清单，每天在日记中写下。
I had therapy every single day.
我每天都接受治疗。
All of that stuff was highly regimented.
所有这些东西都受到严格管制。
Today, I would say there's no one single behavior that is quote unquote mandated as part of my recovery.
今天，我想说，没有任何一种行为是我康复过程中强制要求的。
But perhaps the most important thing that does come up every day is being mindful of and acting on as quickly as possible every time I do something damaging to a relationship.
但也许每天都会出现的最重要的事情是，每当我做了一些有损于人际关系的事情时，要尽快意识到并采取行动。
So, I would say that if you compare Formula One, one of my favorite sports by far.
所以，我想说，如果你比较一级方程式赛车，这是迄今为止我最喜欢的运动之一。
If you compare Formula One 40 years ago to Formula One today, the difference is not in the number of accidents that takes place.
如果将 40 年前的一级方程式赛车与今天的一级方程式赛车进行比较，差异并不在于发生的事故数量。
The difference is in the fatality of those accidents.
区别在于这些事故的死亡人数。
There are just as many, if not more accidents in Formula One today.
如今，一级方程式赛车中发生的事故即使不是更多，也同样多。
The difference is nobody dies in those accidents.
不同的是，没有人在这些事故中死亡。
The cars are so much safer.
汽车安全得多。
They're engineered first for safety, second for performance.
它们的设计首先是为了安全，其次是为了性能。
It used to be the reverse.
过去情况恰恰相反。
And that's why there was a day when every second or third weekend, a driver was killed.
这就是为什么每隔两个或第三个周末就会有一天，一名司机被杀。
It's catastrophic to imagine what took place between the mid-60s and about the mid-80s in Formula One.
It's catastrophic to imagine what took place between the mid-60s and about the mid-80s in Formula One.
And similarly, I would say that the frequency with which I have an interaction with a person who matters to me that is not the best interaction it could be is only slightly less than what it was five years ago.
同样，我想说的是，我与对我重要的人进行互动的频率，虽然不是最好的互动，但只比五年前略少了一点。
The difference is the severity of that is much lower, and more importantly, and most importantly, the length of time between when I screw up and when I make amends is infinitely shorter.
不同的是，事情的严重性要低得多，更重要的是，最重要的是，从我搞砸到我弥补的时间间隔要短得多。
Right?
正确的？
It went from being, I would never make amends, to if I'm a dick to my wife, I usually am trying to rectify it within a few minutes, or at most a couple of hours.
它从“我永远不会弥补”，变成“如果我对我妻子来说是个混蛋，我通常会试图在几分钟内，或者最多几个小时内纠正它”。
One thing I learned throughout this journey was if you hold yourself up to this goal of I have to be perfect, I have to be the perfect dad, I have to be the perfect husband, I have to be the perfect friend, you're going to set yourself up for failure because you're just not going to be perfect.
我在整个旅程中学到的一件事是，如果你坚持自己的目标：我必须是完美的，我必须是完美的父亲，我必须是完美的丈夫，我必须是完美的朋友，你就会让自己陷入失败，因为你不会完美。
But if instead you can say, what I'm going to be perfect about is repairing damage when I cause it, that's what matters.
但如果你可以说，我要做的就是在造成伤害时修复伤害，这才是最重要的。
The other day, I yelled at my son for something.
有一天，我因为某事对儿子大喊大叫。
It was a while ago, actually, because it was before I lost my voice.
事实上，那是不久前的事了，因为那是在我失声之前。
So, I don't know.
所以，我不知道。
He was just doing something, and he was wrong.
他只是在做某事，但他错了。
He did something I told him 150 times not to do.
他做了我告诉过他 150 遍不要做的事。
And I yelled at him and punished him.
我就对他大喊大叫并惩罚他。
But I was way too harsh.
但我太严厉了。
Because basically, the first 27 times he did it, I didn't respond, and then when I finally did, it's like I blew a gasket, right?
因为基本上，前27次他这样做，我没有回应，然后当我最终回应时，就像我炸开了垫圈，对吧？
But what I realized is, you could say, well, maybe it hurts a child to do that, but I think it hurts them way less if you can immediately go and repair and say, "Hey, buddy.
但我意识到，你可以说，好吧，这样做可能会伤害孩子，但我认为如果你能立即去修复并说：“嘿，伙计，对他们的伤害会小得多。
Daddy was a little harsh in that.
爸爸在这方面有点严厉。
I'm sorry.
对不起。
I didn't mean to yell at you like that, but what you did is wrong, and you're not going to get to go out and play right now as a result of it.
我不是故意对你大喊大叫，但你的做法是错误的，因此你现在不能出去玩。
But I love you very much, and I want us to do better.
但我非常爱你，我希望我们做得更好。
I want you to do better in not doing this thing, and I want to do better in not yelling at you when you do this thing." This is not rocket science, right?
我希望你能做得更好，不要做这件事，我也希望你在做这件事时不要对你大喊大叫。”这不是火箭科学，对吧？
But I just think I used to live my life in a way where all I did was break shit and never fix it.
但我只是觉得我过去的生活方式就是把事情搞砸，从不修复它。
So you're living in a house where everything is broken.
所以你住在一个所有东西都坏了的房子里。
Whereas now, I still break things, but now I clean up the mess.
而现在，我仍然破坏东西，但现在我收拾残局。
And oh, all of a sudden, the house is better.
哦，突然间，房子好多了。
Andrew Huberman:
安德鲁·休伯曼：
What is your process for when there's a need for repair, but you feel that it wasn't you, it was somebody else's error or potential error?
当需要维修，但您觉得不是您造成的，而是其他人的错误或潜在错误时，您的流程是什么？
So you very humbly express how you go about repairing your errors But what about situations where a loved one, a coworker, you feel screwed up or wronged you, right?
所以你非常谦虚地表达了你如何修复你的错误，但是如果你的亲人、同事让你感觉自己被搞砸了或者冤枉了，那又怎样呢，对吧？
As many people do, we all do from time to time feel this way.
正如许多人所做的那样，我们都会时不时地有这种感觉。
Do you approach them, and try and repair the situation?
你会接近他们并尝试修复这种情况吗？
Because there's a little bit less or far less control when, than the situation you described.
因为与您描述的情况相比，控制力有点少或少得多。
And by the way, the situation you described, I think, is a perfect one because I think we all screw up.
顺便说一句，我认为你所描述的情况是完美的，因为我认为我们都搞砸了。
And so the answer to the second question is sort of the answer to the first, which is if everyone did what you were doing, the world would be truly a far better place.
因此，第二个问题的答案类似于第一个问题的答案，即如果每个人都做你正在做的事情，世界将真正变得更加美好。
But not everyone's doing what you're doing.
但并不是每个人都在做你正在做的事情。
So if you feel wronged, assuming that wrong wasn't sociopathically motivated, what is your process for going about repairing a relationship fracture like that?
因此，如果你感到委屈，假设这种错误不是出于反社会动机，那么你要采取什么步骤来修复这样的关系破裂呢？
Dr. Peter Attia:
彼得·阿蒂亚博士：
Again, this assumes that this is a relationship that matters, right?
同样，这假设这是一种重要的关系，对吧？
So in every interaction, you're only really able to optimize around one thing, and you have to decide, is this one thing that I'm optimizing around the relationship or is it the outcome?
因此，在每次交互中，你只能真正围绕一件事进行优化，并且你必须决定，这是我围绕关系优化的一件事还是结果？
There are other things to optimize around, but you understand that those are different, right?
还有其他事情需要优化，但您知道这些是不同的，对吗？
And-
还有——
Andrew Huberman:
安德鲁·休伯曼：
Maybe you could elaborate on that a little bit.
也许你可以详细说明一下。
I think I get it, but flesh it out a bit.
我想我明白了，但要充实一点。
Dr. Peter Attia:
彼得·阿蒂亚博士：
All right.
好吧。
If I'm at the market, or if I'm trying to buy a new car, and I'm sitting there talking to the car salesman, that's a relationship.
如果我在市场上，或者我想买一辆新车，而我坐在那里与汽车推销员交谈，那就是一种关系。
That's an interaction.
这就是一种互动。
Now, I want to buy this car for as little as possible, and he wants to sell the car for as much as possible.
现在，我想以尽可能低的价格买这辆车，而他想以尽可能高的价格卖掉这辆车。
Well, in that interaction, my relationship with him means nothing.
嗯，在那次互动中，我和他的关系毫无意义。
Let's assume I don't know this guy, and he's not my best friend.
假设我不认识这个人，而且他也不是我最好的朋友。
I'm optimizing everything around the outcome.
我正在围绕结果优化一切。
So everything I do in negotiating and in interacting with him personally is based on getting the best outcome for me.
因此，我在与他个人的谈判和互动中所做的一切都是基于为我获得最好的结果。
It's very selfish, right?
这是非常自私的，对吧？
Nothing wrong with that, by the way.
顺便说一句，这并没有什么问题。
He's doing the same thing.
他也在做同样的事情。
Andrew Huberman:
安德鲁·休伯曼：
Well, he's doing the same.
嗯，他也在做同样的事情。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Absolutely.
绝对的。
Andrew Huberman:
安德鲁·休伯曼：
Right, exactly.
对，完全正确。
Dr. Peter Attia:
彼得·阿蒂亚博士：
But now, for example, pretend that you are the car salesman, and you're one of my closest friends, and it's your dealership.
但现在，例如，假设你是汽车推销员，你是我最亲密的朋友之一，这是你的经销店。
It's your money.
这是你的钱。
You can't sell this thing to me at a loss.
这东西你不能亏本卖给我。
I don't want you to do that because I want you to be able to make money.
我不希望你这样做，因为我希望你能够赚钱。
And similarly, you care about me, and you don't want me to overpay for this.
同样，你关心我，也不希望我为此付出过高的代价。
So now we're negotiating, and we're both trying to optimize for an outcome, but our relationship also matters.
所以现在我们正在谈判，我们都在努力优化结果，但我们的关系也很重要。
It's a very different negotiation at that point.
那时这是一次非常不同的谈判。
And so I think I always try to ask myself this question when I'm having some interpersonal conflict, which is, what am I optimizing for?
所以我想，当我遇到一些人际冲突时，我总是尝试问自己这个问题，即我正在优化什么？
So, if I'm having a quarrel with my wife, I have to remind myself that the objective or outcome is not necessarily the top priority.
所以，如果我和妻子吵架，我必须提醒自己，目标或结果不一定是最重要的。
Being right all the time, which is my default state, it's just to be a bull in a china shop.
Being right all the time, which is my default state, it's just to be a bull in a china shop.
It's to be authoritarian instead of authoritative.
与其说是权威，不如说是独裁。
And that doesn't work if the relationship matters.
如果关系很重要，那就行不通了。
So to answer your question, the first thing I'm going to ask myself if I feel slighted is, what is the nature of the relationship?
因此，为了回答你的问题，如果我感到被轻视，我首先要问自己的是，这种关系的本质是什么？
Is it even worth trying to do something about this?
是否值得为此尝试做点什么？
And presumably, you're asking the question because the lens is yes.
想必，您问这个问题是因为镜头是肯定的。
This is someone who you care about more than in just a transactional way.
这是你不仅仅以交易方式关心的人。
Usually, what I've realized is I can't try to approach the situation without fully understanding myself, and that takes a while.
通常，我意识到，在没有完全了解自己的情况下，我无法尝试处理这种情况，而这需要一段时间。
So generally, and this is where I still one to two times a week, I'm still working with a therapist.
所以一般来说，我仍然每周一到两次与治疗师一起工作。
I have to kind of try to figure it out on my own and then usually bounce it off a therapist and say, "Well, I think this is why I'm upset about this.
我必须尝试自己解决这个问题，然后通常会向治疗师反馈并说：“嗯，我想这就是我对此感到不安的原因。
I think that when this person did this or said this, I felt this." First of all, am I correct in what I felt?
我想当这个人这样做或者说这个的时候，我就有这样的感觉。”首先，我的感受是否正确？
Because remember, sometimes you might, at least for me, this was the case, I would just feel anger in response to every interaction.
因为记住，有时你可能，至少对我来说是这样，我会对每一次互动感到愤怒。
But what I didn't realize was that anger was really just another emotion that was superimposed on top of hurt, or superimposed on top of fear, or superimposed on top of shame, or superimposed on top of something else.
但我没有意识到，愤怒实际上只是另一种情绪，叠加在伤害之上，或者叠加在恐惧之上，或者叠加在羞耻之上，或者叠加在其他东西之上。
But I didn't know how to articulate any of those other emotions, so the only thing I could really articulate was anger.
But I didn't know how to articulate any of those other emotions, so the only thing I could really articulate was anger.
So if anger is the only thing I know and anger is the only response I see, it's not very helpful.
因此，如果愤怒是我唯一知道的事情并且愤怒是我看到的唯一反应，那么这没有多大帮助。
It's not very insightful.
这不是很有洞察力。
So that's a big part of it, is being able to deconstruct what I'm feeling.
所以这是其中的一个重要部分，就是能够解构我的感受。
Oh, what I really feel is loss, or what I really feel is abandonment right now.
噢，我现在真正的感受是失落，或者说我现在真正的感受是被抛弃。
And that sometimes takes a while to figure out, at least for me.
And that sometimes takes a while to figure out, at least for me.
I'm only a few years into this journey, and maybe other people figured these things out when they were in their 20s, and so they're veterans.
我进入这个旅程才几年，也许其他人在 20 多岁时就明白了这些事情，所以他们是退伍军人。
They can do this more naturally.
他们可以更自然地做到这一点。
But that's step one.
但这是第一步。
If I don't really understand what's going on, I can't even begin to try to approach this person to say, "This is how I feel.
If I don't really understand what's going on, I can't even begin to try to approach this person to say, "This is how I feel.
How do you feel, and what are we optimizing for in this interaction?"
How do you feel, and what are we optimizing for in this interaction?"
Andrew Huberman:
安德鲁·休伯曼：
Well, I certainly know you are not alone in this sense that it's a process, and it takes a lot of time, and on a case-by-case basis can take a lot of time to figure out exactly what one is feeling.
嗯，我当然知道你并不孤单，因为这是一个过程，需要很多时间，并且根据具体情况可能需要很多时间才能准确地弄清楚一个人的感受。
I think it really goes back to the coarseness of language as a way to sort one's feelings.
I think it really goes back to the coarseness of language as a way to sort one's feelings.
It was actually your other, because we mentioned Paul Conti, who is one of your Stanford Medical School classmates, but another previous guest on this podcast who was also one of your medical school classmates Dr. Karl Deisseroth, right?
这实际上是你的另一个，因为我们提到了保罗·康蒂，他是你斯坦福医学院的同学之一，也是这个播客的另一位前嘉宾，也是你医学院的同学之一卡尔·戴瑟罗斯博士，对吧？
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yep.
是的。
Andrew Huberman:
安德鲁·休伯曼：
Psychiatrist and bioengineer of phenomenal stature and doing amazing things in the world, who said, "Most of the time we have no idea how other people feel, even though we think we do.
精神病学家和生物工程师，具有非凡的地位，在世界上做出了惊人的事情，他说：“大多数时候，我们不知道别人的感受，即使我们认为自己知道。
And most of the time, we don't even know how we feel." Our ability to really know what we're really feeling is terrible, and yet we recognize the broad bins.
And most of the time, we don't even know how we feel." Our ability to really know what we're really feeling is terrible, and yet we recognize the broad bins.
I'm pissed off.
我很生气。
I'm super happy.
我超级高兴。
I'm relaxed.
我很放松。
I'm tired.
我累了。
Just think about how coarse that language is for the-
Just think about how coarse that language is for the-
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yep
是的
Andrew Huberman:
安德鲁·休伯曼：
...
...
for all the nuance and all the underlying things, conscious and subconscious, that could be driving an emotional state.
for all the nuance and all the underlying things, conscious and subconscious, that could be driving an emotional state.
It's really quite unbelievable.
这实在是太令人难以置信了。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah.
是的。
Beyond the valence, positive versus negative, that was about the extent of my emotional language until somewhat recently.
Beyond the valence, positive versus negative, that was about the extent of my emotional language until somewhat recently.
Andrew Huberman:
安德鲁·休伯曼：
Well, it strikes me you've come a very long way.
嗯，我觉得你已经走了很长的路。
Maybe you could share with us a little bit about what you learned on these, what you called retreats.
Maybe you could share with us a little bit about what you learned on these, what you called retreats.
In the book chapter, you describe deliberately going off to a treatment center, multiple treatment centers over time, to really drill into this process of understanding oneself better and how one's current state of emotional processing and emotional stability are influencing relationships and the key importance of that.
在本书的章节中，您描述了随着时间的推移故意去一个治疗中心、多个治疗中心，以真正深入了解这个更好地了解自己的过程，以及一个人当前的情绪处理和情绪稳定性状态如何影响人际关系以及其关键重要性。
Was there any overriding theme for you?
对你来说有什么最重要的主题吗？
For instance, could you trace back to specific events or themes of childhood that made a lot of it make sense?
例如，你能否追溯到童年时期的特定事件或主题，这些事件或主题让很多事情变得有意义？
Or is it far more nuanced than that?
或者它比这更加微妙？
Dr. Peter Attia:
彼得·阿蒂亚博士：
Well, the first thing I would say is, I wish I could tell you that this was a very deliberate and wonderful choice, that I just decided I'm going to go on a little self-healing journey.
好吧，我要说的第一件事是，我希望我能告诉你，这是一个非常深思熟虑且美妙的选择，我只是决定要进行一次自我修复的旅程。
But unfortunately, that was not the case.
但不幸的是，事实并非如此。
In both cases, in 2017 and in 2020, I was as close to having no choice in the matter as one can have.
In both cases, in 2017 and in 2020, I was as close to having no choice in the matter as one can have.
So both of these experiences represented total rock bottom moments in my life.
So both of these experiences represented total rock bottom moments in my life.
So these would've been the two lowest points in my life, for different reasons, but they were nevertheless the two absolute low points in my life.
因此，由于不同的原因，这将是我生命中的两个最低点，但它们仍然是我生命中的两个绝对低点。
And I would say, in the first instance, I guess I could've chosen not to go, but I would've lost everything that mattered in my life at that point.
我想说，首先，我想我可以选择不去，但那时我会失去生命中重要的一切。
And I had our good friend, Paul Conti, basically telling me that I needed to do this, that I really needed to do this.
And I had our good friend, Paul Conti, basically telling me that I needed to do this, that I really needed to do this.
And in the second situation, though completely different circumstances, you might think, how can one person, in just a span of three years, find themselves in a situation where they, almost without having any choice in the matter, have to go away to a place where you're basically locked up without a phone for three weeks, and you're doing 12 to 13 hours of therapy a day?
在第二种情况下，尽管情况完全不同，你可能会想，一个人怎么可能在短短三年的时间里，发现自己陷入这样一种境地：他们几乎没有任何选择，不得不离开到一个基本上被关在没有电话的地方三周，而你每天要接受 12 到 13 个小时的治疗？
So nothing about this was something I wanted to do.
所以这不是我想做的事情。
Nothing about this was pleasant.
这件事没有什么令人愉快的。
I would describe these as the most difficult things I've ever done in my life, bar none.
我会把这些描述为我一生中做过的最困难的事情，没有之一。
And I've done some difficult things in my life, but they've always been physically difficult.
我一生中做过一些困难的事情，但它们总是在身体上很困难。
I love doing physically difficult things.
我喜欢做体力上困难的事情。
But this was emotionally the equivalent of, for me, climbing K2 and swimming the English Channel in the same month.
但对我来说，这在情感上相当于在同一个月内攀登乔戈里峰并游过英吉利海峡。
Something that just you couldn't fathom.
有些东西只是你无法理解的。
So with that said, yes, I learned a lot.
话虽如此，是的，我学到了很多东西。
And I learned that people like me can be overly analytical, and that hyperanalytical nature can lead you astray when you think that your intellect is giving you a fact-based explanation for a set of circumstances, and you rationalize them away.
我了解到，像我这样的人可能会过度分析，而当你认为自己的智力正在为一系列情况提供基于事实的解释时，过度分析的本性可能会让你误入歧途，然后你将它们合理化。
Well, this happened to me when I was a kid, but I get it, and it's not really a problem, and as a result of that, these are actually some positive things that came out of that experience.
嗯，这在我小时候发生过，但我明白了，这并不是一个真正的问题，因此，这些实际上是从那次经历中产生的一些积极的事情。
And I think the real aha moment in my journey, which occurred on a day that I remember very well, was the day I finally dropped that.
我认为我的旅程中真正的顿悟时刻发生在我记得很清楚的一天，就是我终于放弃了它的那一天。
I dropped that rationalization, and I allowed myself to experience what a child would experience in that moment, and then understood what the implications are for a child going through these things.
我放弃了这种合理化，我让自己体验孩子在那一刻会经历什么，然后理解对孩子经历这些事情意味着什么。
And I think that was really the first time in my life I ever accepted emotionally something that I had intellectually always said, "It doesn't really matter.
我认为这确实是我一生中第一次在情感上接受一些我在理智上总是说的东西：“这并不重要。
That's just life, and those things happen, and lots of worse things happen to lots of people, and that's okay." And I think it's not that once I emotionally accepted this, I became a victim.
这就是生活，那些事情会发生，很多更糟糕的事情发生在很多人身上，但这没关系。”我认为并不是一旦我在情感上接受了这一点，我就成为了受害者。
It wasn't at all.
根本不是。
It just finally allowed me to realize, oh, I can let that go now.
它终于让我意识到，哦，我现在可以放手了。
I don't have to be a slave to the adaptations that came from that.
我不必成为由此而来的适应的奴隶。
I can surrender.
我可以投降。
Andrew Huberman:
安德鲁·休伯曼：
That's beautiful and inspiring to me.
这对我来说很美丽并且鼓舞人心。
I think that, yeah, there's this incredible ability that the human brain has to script a story And to compare to other people's circumstances and, as you said, rationalize what are essentially emotional traumas or physical traumas from the perspective of the adult.
我认为，是的，人类大脑有一种令人难以置信的能力，可以编写一个故事，并与其他人的情况进行比较，正如你所说，从成年人的角度合理化本质上的情感创伤或身体创伤。
But if I know one thing for sure, and I'll make it very clear, I'm not a clinician, but is that the brain doesn't discard of any circuitry.
但如果我确实知道一件事，并且我会说得很清楚，我不是临床医生，而是大脑不会丢弃任何电路。
We repurpose the same circuitry we used as children, as adults.
我们重新利用我们在儿童时期和成人时期使用的相同电路。
And so the ability to go back to that and to parse it, but as you pointed out, not from an intellectual standpoint, but from an emotional standpoint, seems to be the really hard work.
因此，返回并解析它的能力，但正如你所指出的，不是从智力的角度，而是从情感的角度，似乎是真正艰苦的工作。
Do you do that on a regular basis?
你经常这样做吗？
Dr. Peter Attia:
彼得·阿蒂亚博士：
No, not at all.
不，一点也不。
It's been done a handful of times.
已经做过几次了。
It's been exhausting.
已经很累了。
It's very difficult.
这是非常困难的。
I don't know if this is the right word.
我不知道这个词是否正确。
I would almost describe it as emotionally violent.
我几乎会把它描述为情感上的暴力。
And it's not something I need to revisit often, truthfully.
老实说，这不是我需要经常重新审视的事情。
I think that, it's been done a finite number of times, and I think I've captured so much value from it that there are lots of other things I continue to do.
我认为，它已经完成了有限的次数，而且我认为我已经从中获得了如此多的价值，以至于我还有很多其他事情可以继续做。
I use a system called dialectical behavioral therapy that is a regular part of the therapy that I do.
我使用一种称为辩证行为疗法的系统，这是我所做的治疗的常规部分。
But I don't have to go back to my childhood.
但我不必回到童年。
I don't have to go back to uncovering and re-exploring a lot of that stuff.
我不必回去发现和重新探索很多这样的东西。
I've learned the lessons, and now it's really about practicing the skills.
我已经吸取了教训，现在真正要练习的是技能。
I know what I want now.
我现在知道我想要什么了。
You talk about plasticity.
你谈论的是可塑性。
I'll share one example, which I know I wrote about in the book, but just for folks listening, that you'll appreciate.
我将分享一个例子，我知道我在书中写过这个例子，但仅供大家聆听，您会欣赏的。
One of the hallmarks of my existence has always been just an insane amount of anger and rage.
我存在的标志之一就是疯狂的愤怒和愤怒。
It's been there as long as I've known.
从我知道以来它就一直在那里。
So I don't have a conscious memory of not having rage.
所以我没有有意识地记得没有愤怒。
Right?
正确的？
So earliest memories of life, when I'm five years old, I have rage like you can't believe.
生命中最早的记忆是，当我五岁的时候，我的愤怒程度让你难以置信。
And it's a problem all my life.
这也是我一生的问题。
So as a teenager, if I go more than two weeks without punching a hole in the wall of our house, it's a miracle.
所以，作为一个青少年，如果我两周多没有在我们家的墙上打洞，那就是一个奇迹。
I am so good at drywall.
我很擅长干墙。
You can't believe how good I am for all the stuff I have to repair around our house.
你简直不敢相信我对我们房子周围所有需要修理的东西有多擅长。
Like I'm breaking windows.
就像我打破窗户一样。
And of course, I rationalized how much boxing saved my life because I had this amazing outlet for my rage.
当然，我合理地解释了拳击救了我多少命，因为我有一个令人惊奇的发泄愤怒的渠道。
Right?
正确的？
I got to basically exercise six hours a day.
我基本上每天要锻炼六个小时。
I'm hitting punching bags and people all day long, and it's just a beautiful outlet that keeps me out of jail.
我整天都在打沙袋和人，这只是一个让我免于牢狱之灾的美丽出路。
And a big part of that rage was inward.
这种愤怒很大一部分是发自内心的。
Right?
正确的？
So it's not rocket science to understand that a person who has that much hatred for everyone has an enormous amount for themselves.
因此，理解一个对每个人都有如此多仇恨的人对自己也有巨大的仇恨并不是什么复杂的事情。
And so one of the things I didn't realize was happening was what my inner monologue was.
所以我没有意识到正在发生的一件事就是我的内心独白。
Because as you can appreciate, your inner monologue is so frequent and ubiquitous and present that it's easy to almost forget that it's there.
因为正如你所意识到的，你的内心独白如此频繁、无处不在、无处不在，以至于你很容易几乎忘记它的存在。
That's the sort of dangerous part about it, right?
这就是它的危险部分，对吧？
Is kind of the David Foster Wallace, this is water thing.
有点像大卫·福斯特·华莱士，这是水的东西。
The fish are swimming through water.
鱼儿在水中游动。
The water's everywhere.
水无处不在。
They don't even realize they're in water.
他们甚至没有意识到自己在水里。
You don't realize the subconscious stream of thoughts that constantly flow.
你没有意识到潜意识中不断流动的思想流。
But eventually, I became aware of just what that self-talk was.
但最终，我意识到自言自语是什么。
And it was, it's no longer the case, it was the angriest, the most violent self-talk you can imagine.
过去是，现在不再是这样，这是你能想象到的最愤怒、最暴力的自言自语。
It was like there is no mistake that I could make that was anything other than my perfect standard that didn't result in what I would call my inner Bobby Knight going ballistic.
就好像我不可能犯任何错误，除了我的完美标准之外，不会导致我所谓的内心鲍比·奈特（Bobby Knight）的爆发。
So it just didn't matter.
所以这并不重要。
It sounds silly, it didn't matter.
听起来很傻，但这并不重要。
If I didn't perfectly cook a steak, if I didn't perfectly nail something I was doing, if I didn't do anything that was perfect at what I described as match grade perfect, I would want to beat myself to a pulp, and I would scream at myself.
如果我没有完美地烹制牛排，如果我没有完美地完成我正在做的事情，如果我没有做任何事情达到我所描述的匹配级完美，我就会想把自己打得一团糟，我会对自己尖叫。
Again, it's hard to describe, and I hope that most people listening to this don't understand what that feels like.
再说一遍，这很难描述，我希望大多数听到这个的人都无法理解那是什么感觉。
Well, it became very clear that that had to change.
嗯，很明显，这种情况必须改变。
Because when you hate yourself that much, by definition, you are going to be an insufferable prick to everybody else.
因为当你如此讨厌自己时，根据定义，你将成为其他人难以忍受的混蛋。
That's going to spill into how you interact with the world.
这将影响你与世界互动的方式。
So I was working with a therapist who was one of the people who was sending me to this place in Arizona, and basically, it became clear that they proposed that I could shed this trait if I was willing to do a certain amount of work.
所以我正在和一位治疗师一起工作，他是派我去亚利桑那州这个地方的人之一，基本上，很明显，他们提出，如果我愿意做一定量的工作，我可以摆脱这种特质。
And I was like, "There's no chance." I'm 47 years old.
我当时想，“没有机会了。”我今年47岁了。
This is the only way I've ever interacted with myself.
这是我与自己互动的唯一方式。
How in the world could this be undone?
这到底怎么可能被撤销呢？
It would take another 40 years to undo this.
又需要 40 年才能消除这一点。
And they're like, "No, here's this exercise you're going to do." So the exercise was, every single time I did something where I would have that self-talk, I would have to immediately stop myself And pretend that it wasn't me that just did that, but it was one of my closest friends.
他们会说：“不，这是你要做的练习。”所以练习是，每当我做了一些我会自言自语的事情时，我就必须立即停止自己并假装不是我做了那件事，而是我最亲密的朋友之一。
And instead, I would audibly speak to that person, there was nobody else there, but speak to that person as though they are the one that made the mistake.
相反，我会大声地和那个人说话，那里没有其他人，但和那个人说话，就好像他们是犯了错误的人一样。
And I was to record that on my phone.
我要用手机记录下来。
So if I'm out there shooting my bow and arrow and I don't get a bullseye, instead of screaming at myself, I have to say, "Oh, imagine it's my buddy JR who just missed that shot.
因此，如果我在外面用弓箭射击而没有射中靶心，我不会对自己尖叫，而是必须说：“哦，想象一下是我的好友 JR 刚刚射中了那一枪。
What would I say to him?" Pick up the phone or pull out the phone and say, of course, something different.
我要对他说什么？”当然，拿起电话或拿出电话说一些不同的话。
And of course, what I would say in that situation was much kinder.
当然，在那种情况下我会说得更加友善。
I mean, infinitely kinder.
我的意思是，无限仁慈。
It's like if I'm saying it to my closest friend, I'm going to say it in a very kind way.
就像如果我对我最亲密的朋友说的话，我会以一种非常友善的方式说出来。
And I had to take a copy of that audio and text it to my therapist.
我必须复制该音频并将其发短信给我的治疗师。
Andrew Huberman:
安德鲁·休伯曼：
Oh, wow.
哦，哇。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah.
是的。
Andrew Huberman:
安德鲁·休伯曼：
Talk about vulnerability.
谈论脆弱性。
Dr. Peter Attia:
彼得·阿蒂亚博士：
So can you imagine-
那么你能想象吗——
Andrew Huberman:
安德鲁·休伯曼：
I was all on board this practice until you mentioned that, at which point, and I trust my therapist to a very deep level, but I thought, "Wow, that's a mountain."
我一直致力于这种做法，直到你提到这一点，此时我非常信任我的治疗师，但我想，“哇，那是一座山。”
Dr. Peter Attia:
彼得·阿蒂亚博士：
Well, this poor person got a lot of text messages, a lot of audio files.
好吧，这个可怜的人收到了很多短信，很多音频文件。
But here's the part that just blows my mind.
但这是让我大吃一惊的部分。
It only took, I don't know, I can't remember exactly.
只是花了，我不知道，我记不太清了。
I'd have to go back to look at my journals.
我得回去看看我的日记。
It only took about four months to get rid of Bobby Knight.
只用了大约四个月的时间就摆脱了鲍比·奈特。
Again, we had kind of a mental model for what this looked like, which was Bobby Knight was the chairman of the board.
同样，我们对这件事有一个心理模型，那就是鲍比·奈特（Bobby Knight）是董事会主席。
He sat in the boardroom, and nobody else got to talk.
他坐在会议室里，没有其他人可以说话。
Andrew Huberman:
安德鲁·休伯曼：
And for those that don't know, Bobby Knight had a terrible temper.
对于那些不知道的人来说，鲍比·奈特的脾气很糟糕。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah.
是的。
Andrew Huberman:
安德鲁·休伯曼：
Yeah.
是的。
The worst.
最糟糕的。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Right.
对。
This is the guy that was throwing chairs across the basketball court.
这是那个在篮球场上扔椅子的人。
Andrew Huberman:
安德鲁·休伯曼：
Level 11-
11级-
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yep
是的
Andrew Huberman:
安德鲁·休伯曼：
...
...
out of 10.
满分 10 分。
Dr. Peter Attia:
彼得·阿蒂亚博士：
And all of a sudden, we got to the point where Bobby Knight is not even in the boardroom anymore.
突然之间，鲍比·奈特 (Bobby Knight) 甚至不再出现在董事会中了。
In fact, as I say this today, I don't really remember what he sounded like.
事实上，当我今天这么说的时候，我真的不记得他听起来是什么样子了。
It's amazing to me.
这对我来说太神奇了。
And I've had some really amazing opportunities to bring him back.
我有过一些非常好的机会把他带回来。
It's not like I'm making fewer mistakes, right?
我的错误并没有减少，对吧？
It's not like I'm better today than I was three years ago at all the things that I do.
我今天所做的所有事情并不比三年前更好。
I'm not.
我不是。
I'm actually probably worse in many regards.
事实上，我在很多方面可能更糟糕。
But the difference is I can communicate with myself, I think I can say this, I think I can say lovingly, right?
但不同的是我可以和自己沟通，我想我可以这样说，我想我可以充满爱意地说，对吧？
And maybe not as lovingly as some people can.
也许不像某些人那样充满爱心。
I still think I'm probably maybe just a little higher standard with myself than maybe I need to be at times, but I'm just not beating myself up like I used to.
我仍然认为我对自己的标准可能比有时需要的要高一些，但我只是不再像以前那样折磨自己了。
And I think by extension, I'm beating other people up a lot less.
我认为推而广之，我殴打别人的次数要少得多。
Andrew Huberman:
安德鲁·休伯曼：
Well, I don't know the extent to which your internal narrative reflects the narrative that others have about you, but first of all, I want to thank you for sharing what you just shared.
好吧，我不知道你的内心叙述在多大程度上反映了其他人对你的叙述，但首先，我要感谢你分享你刚才分享的内容。
I think as a practical step, first of all, it's one I've never heard of before, but certainly represents this incredible phenomenon of neuroplasticity.
我认为作为一个实际的步骤，首先，这是我以前从未听说过的，但肯定代表了这种令人难以置信的神经可塑性现象。
Because four months sounds like a bit of time, and yet you were 47 years old.
因为四个月听起来有点长，但你已经47岁了。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Yeah.
是的。
Andrew Huberman:
安德鲁·休伯曼：
So that's 47 years of accumulated just absolutely berating self-talk is what it sounds like.
所以这就是 47 年积累的绝对谴责自言自语的感觉。
So it's something that people can think about for their own purposes and their own challenges.
因此，人们可以根据自己的目的和挑战来思考这一问题。
Also, I've read the book twice now and love it.
另外，我已经读了这本书两遍并且很喜欢它。
As I put in my endorsement of it, I think it's not just informative, but it's indeed important because it centers on so many of the key actionable items related to health span and lifespan, vitality, longevity, whatever people want to call these things that are essential.
正如我对它的认可一样，我认为它不仅提供了丰富的信息，而且确实很重要，因为它集中于许多与健康寿命、活力、长寿相关的关键可操作项目，无论人们如何称呼这些重要的东西。
But also this section on emotional health was absolutely profound for me.
但关于情绪健康的部分对我来说绝对是意义深远的。
It inspired a huge number of changes.
它激发了巨大的变化。
And the book as a whole represents a very important contribution to everybody.
整本书对每个人来说都是一个非常重要的贡献。
There are numerous points, and I would say every chapter is applicable to everybody, and there are very few books out there like that.
要点很多，而且每一章都适用于每个人，像这样的书很少。
So I want to thank you for that and especially for including the section on emotional health, and especially for sharing what you did today, because I think it doesn't just take a bit of vulnerability, but a ton of vulnerability and humility to be able to share what you just shared.
因此，我要感谢你们，特别是感谢你们纳入了关于情绪健康的部分，特别是分享了你们今天所做的事情，因为我认为，要分享你们刚刚分享的内容，不仅需要一点脆弱性，还需要大量的脆弱性和谦逊。
And my only request or wish is that you also hopefully internalize it, the tremendous gift that you're giving everybody through coming on podcasts like this, doing your own podcast, writing the book.
我唯一的请求或愿望是，你也希望能将它内在化，这是你通过参加这样的播客、做自己的播客、写这本书给每个人的巨大礼物。
I look out on the landscape of front-facing, public-facing health out there, and you sit, not alone, but in a unique stance as the medical doctor that I do believe that people trust the very most because of the fact that you have that intense rigor, I wouldn't even say your desire, your absolute obsession with measurement and precision.
我眺望着前方、面向公众的健康景观，你不是一个人坐着，而是以一种作为医生的独特立场，我相信人们最信任你，因为你有那么强烈的严谨性，我什至不会说你的愿望，你对测量和精度的绝对痴迷。
Many of the things that a moment ago you were pointing to as potentially hazards for your emotional life, but that serve all of us, the general public, so preciously and with just incalculable value.
刚才你指出的许多事情对你的情感生活有潜在的危害，但它们对我们所有人、广大公众来说是非常宝贵的，具有不可估量的价值。
So I hope that internalizes as well.
所以我希望这也能内化。
Maybe it'll even weave into your self-talk.
也许它甚至会融入你的自言自语中。
Maybe I need to send you a script every day.
也许我需要每天给你发一个剧本。
But in all seriousness, I also want to thank you for taking the time today.
但说实话，我还要感谢您今天抽出宝贵的时间。
And even though it's a personal thing, I really want to thank you for your being an amazing colleague to me in the podcast space, in the health and medicine space, whatever that is, and also just an incredible friend.
尽管这是个人的事情，但我真的想感谢你，在播客领域、健康和医学领域，无论是什么领域，你都是我的一位出色的同事，而且还是一位令人难以置信的朋友。
You've been a tremendous source of support and guidance in every one of the domains that we talked about today and many more And again, I just want to say that this emotional health component, I agree with you.
在我们今天讨论的每一个领域以及更多领域，您都为我们提供了巨大的支持和指导。我只想说，在情绪健康这一方面，我同意您的观点。
I think it's not just vital, I think it's the most vital of all of them.
我认为这不仅是至关重要的，而且是所有这些中最重要的。
So you've just made numerous important contributions, and I just want to thank you for sharing.
您刚刚做出了许多重要贡献，我只想感谢您的分享。
You clearly put everything you have into everything you do.
你清楚地将你拥有的一切投入到你所做的一切中。
So thank you, Peter.
所以谢谢你，彼得。
Dr. Peter Attia:
彼得·阿蒂亚博士：
Andrew, thank you.
安德鲁，谢谢你。
I really appreciate you making the time for us to sit down and talk in a long-form way, which I enjoy.
我真的很感谢您抽出时间让我们坐下来进行长时间的交谈，我很喜欢这种方式。
And yeah.
是的。
It's an honor, and it means a lot to me that you have read it twice, and that you've appreciated it, and praised it as you have.
这是一种荣幸，对我来说意义重大，您已经阅读了它两遍，并且您对它表示赞赏，并如您所愿地赞扬它。
Thank you.
谢谢。
Andrew Huberman:
安德鲁·休伯曼：
Thank you once again for joining me for today's discussion with Dr. Peter Attia.
再次感谢您参加今天与 Peter Attia 博士的讨论。
I hope you learned as much and enjoyed the conversation as much as I did.
我希望你能像我一样学到很多东西并享受这次谈话。
Please also check out Dr. Attia's new book, which is releasing on March 28th, 2023, entitled "Outlive: The Science and Art of Longevity." If you're learning from and/or enjoying this podcast, please subscribe to our YouTube channel.
另请查看 Attia 博士于 2023 年 3 月 28 日发行的新书，题为“Outlive：长寿的科学与艺术”。如果您正在学习和/或喜欢此播客，请订阅我们的 YouTube 频道。
That's a terrific, zero-cost way to support us.
这是支持我们的绝佳且零成本的方式。
In addition, please subscribe to the podcast on both Apple and Spotify.
此外，请订阅 Apple 和 Spotify 上的播客。
And on both Apple and Spotify, you can also leave us up to a five-star review.
在 Apple 和 Spotify 上，您还可以给我们留下五星级的评价。
If you have questions for us or comments about the podcast, or topics you'd like me to cover, or guests that you'd like me to include on the Huberman Lab podcast, please put those in the comment section on YouTube.
如果您对我们有疑问或对播客有意见，或者您希望我涵盖的主题，或者您希望我在 Huberman Lab 播客中加入的嘉宾，请将这些内容放入 YouTube 的评论部分。
I do read all the comments.
我确实阅读了所有评论。
In addition, please check out the sponsors mentioned at the beginning and throughout today's episode.
此外，请查看今天节目开头和整个节目中提到的赞助商。
That's the best way to support this podcast.
这是支持这个播客的最佳方式。
On various episodes of the Huberman Lab podcast, we discuss supplements.
在休伯曼实验室播客的各个剧集中，我们讨论了补充剂。
While supplements aren't necessary for everybody, many people derive tremendous benefit from them for things like improving sleep, supporting hormones, improving focus, and so on.
虽然补充剂并不是每个人都需要的，但许多人从它们中获得了巨大的好处，例如改善睡眠、支持荷尔蒙、提高注意力等等。
The Huberman Lab podcast is proud to have partnered with Momentous Supplements.
Huberman Lab 播客很荣幸与 Momentous Supplements 合作。
If you'd like to see the supplements discussed on the Huberman Lab podcast, you can go to Live Momentous, spelled O-U-S, livemomentous.com/huberman.
如果您想查看 Huberman Lab 播客上讨论的补充内容，可以访问 Live Momentous，拼写为 O-U-S，livemomentous.com/huberman。
If you're not already following me on social media, it's hubermanlab on Instagram, Twitter, Facebook, and LinkedIn.
如果您还没有在社交媒体上关注我，请关注 Instagram、Twitter、Facebook 和 LinkedIn 上的 hubermanlab。
And at all of those places, I cover science and science-based tools, some of which overlap with the contents of the Huberman Lab podcast, but much of which is distinct from the content covered on the Huberman Lab podcast.
在所有这些地方，我介绍了科学和基于科学的工具，其中一些与胡伯曼实验室播客的内容重叠，但其中大部分与胡伯曼实验室播客所涵盖的内容不同。
Again, it's hubermanlab on all social media platforms.
再说一遍，所有社交媒体平台上都是 hubermanlab。
If you haven't already subscribed to the Huberman Lab podcast Neural Network Newsletter, it's a monthly newsletter that includes free toolkits for things like toolkit for sleep, how to enhance the quality and duration of your sleep, toolkit for focus, toolkit for neuroplasticity, toolkit for deliberate cold exposure, heat exposure, and summaries of podcast episodes.
如果您还没有订阅 Huberman Lab 播客《神经网络通讯》，这是一份每月通讯，其中包括免费工具包，包括睡眠工具包、如何提高睡眠质量和持续时间、专注力工具包、神经可塑性工具包、故意冷暴露、热暴露工具包以及播客剧集摘要。
All of those toolkits can be found by going to hubermanlab.com.
所有这些工具包都可以通过访问 hubermanlab.com 找到。
Go to the menu, scroll down to Newsletter, and simply give us your email.
转到菜单，向下滚动到时事通讯，然后向我们提供您的电子邮件。
We do not share your email with anybody.
我们不会与任何人分享您的电子邮件。
And again, the newsletters and toolkits are completely zero cost.
再说一次，新闻通讯和工具包完全是零成本。
And you will also find some PDF examples of previous toolkits.
您还可以找到以前工具包的一些 PDF 示例。
Again, that's hubermanlab.com.
再说一遍，那就是 hubermanlab.com。
Thank you once again for joining me for today's discussion with Dr. Peter Attia.
再次感谢您参加今天与 Peter Attia 博士的讨论。
And last but certainly not least, thank you for your interest in science.
最后但并非最不重要的一点是，感谢您对科学的兴趣。