Dr. Sara Gottfried: How to Optimize Female Hormone Health for Vitality & Longevity
Andrew Huberman:
安德鲁·休伯曼：
Welcome to the Huberman Lab podcast, where we discuss science and science-based tools for everyday life.
欢迎来到休伯曼实验室播客，我们在这里讨论科学和基于科学的日常生活工具。
I'm Andrew Huberman, and I'm a professor of neurobiology and ophthalmology at Stanford School of Medicine.
我是安德鲁·胡伯曼，斯坦福大学医学院神经生物学和眼科教授。
Today, my guest is Dr. Sara Gottfried.
今天，我的嘉宾是萨拉·戈特弗里德博士。
Dr. Sara Gottfried is an obstetrician gynecologist who did her undergraduate training in bioengineering at the University of Washington in Seattle.
Sara Gottfried 博士是一位妇产科医生，她在西雅图华盛顿大学接受了生物工程本科培训。
She then completed her medical training at Harvard Medical School, and she currently is a clinical professor of integrative medicine and nutritional sciences at Thomas Jefferson University.
随后，她在哈佛医学院完成了医学培训，目前是托马斯杰斐逊大学综合医学和营养科学的临床教授。
She has also been a clinician treating men and women in various aspects of hormone health and longevity for more than 20 years.
20 多年来，她一直是一名临床医生，在激素健康和长寿的各个方面为男性和女性提供治疗。
She is an expert in not just traditional medicine as it relates to hormones and fertility, but also nutritional practices, supplementation, and behavioral practices, and combining all of that expertise in order to help women navigate every aspect and dimension of their hormones, longevity, and vitality, ranging from puberty to young adulthood, adulthood, perimenopause, and menopause.
她不仅是与荷尔蒙和生育能力相关的传统医学方面的专家，而且还是营养实践、补充剂和行为实践方面的专家，她结合所有这些专业知识，帮助女性驾驭荷尔蒙、长寿和活力的各个方面和维度，从青春期到成年早期、成年、围绝经期和更年期。
And nowadays, she's also treating men across the lifespan in terms of longevity, vitality, and hormone health.
如今，她还为男性提供长寿、活力和荷尔蒙健康方面的治疗。
During today's discussion, Dr. Gottfried shares an enormous amount of information and tools that women can apply toward their hormone health, fertility, vitality, and longevity.
在今天的讨论中，戈特弗里德博士分享了大量信息和工具，女性可以利用这些信息和工具来改善荷尔蒙健康、生育能力、活力和长寿。
We discuss the gut microbiome, which many people have heard about, but Dr. Gottfried points out the specific needs that women have in terms of managing their gut microbiome and the ways that that influences things like estrogen levels and metabolism, testosterone, thyroid, and growth hormone, and much more.
我们讨论了许多人都听说过的肠道微生物组，但戈特弗里德博士指出了女性在管理肠道微生物组方面的具体需求，以及影响雌激素水平和新陈代谢、睾酮、甲状腺和生长激素等的方式。
We also discuss nutrition and exercise.
我们还讨论营养和运动。
We touch on how the omega-3 fatty acids play a particularly important role in managing female hormone health.
我们探讨了 omega-3 脂肪酸如何在管理女性荷尔蒙健康方面发挥特别重要的作用。
Dr. Gottfried points out why women have particular needs when it comes to essential fatty acids and how best to obtain those essential fatty acids for hormone health.
Gottfried 博士指出了为什么女性对必需脂肪酸有特殊的需求，以及如何最好地获取这些必需脂肪酸以维持荷尔蒙健康。
We also discuss exercise, and she offers some surprising information about the types and ratios of resistance training to cardiovascular training that women ought to use in order to maximize their hormone health.
我们还讨论了运动，她提供了一些令人惊讶的信息，关于女性应该使用的阻力训练与心血管训练的类型和比例，以最大限度地提高荷尔蒙健康。
We also talk a lot about the digestive system.
我们还谈论了很多关于消化系统的内容。
This was a surprising aspect of the conversation I did not anticipate.
这是我没有预料到的谈话中令人惊讶的方面。
Dr. Gottfried shared with us, for instance, that women suffer from digestive issues at more than 10 times the frequency that do men, and fortunately, that there are tools specific to women that they can use in order to overcome those digestive issues, and that in overcoming those digestive issues, they can overcome many of the related hormone issues that so many women face.
例如，戈特弗里德博士与我们分享，女性遭受消化问题的频率是男性的 10 倍以上，幸运的是，有一些专门针对女性的工具可以帮助她们克服这些消化问题，并且在克服这些消化问题的过程中，她们可以克服许多女性面临的许多相关的激素问题。
Dr. Gottfried also shares with you tremendous knowledge about the specific types of tests, not just blood tests, but also urine and microbiome tests that women can use in order to really get a clear understanding of their hormone status, not just of present, but also where the trajectory of their hormones is taking them.
Gottfried 博士还与您分享有关特定类型测试的丰富知识，不仅是血液测试，还有尿液和微生物组测试，女性可以使用这些测试来真正清楚地了解自己的激素状态，不仅是目前的激素状态，还包括激素的变化轨迹。
So we have an avid discussion about puberty, about young adulthood, adulthood, perimenopause, and how best to manage and navigate perimenopause and menopause, including a discussion about hormone replacement therapy.
因此，我们对青春期、青年期、成年期、围绝经期以及如何最好地管理和应对围绝经期和更年期进行了热烈的讨论，包括关于激素替代疗法的讨论。
In addition to her academic and clinical expertise, Dr. Gottfried has authored many important books on nutrition, hormones, and supplementation as it relates to women and to people generally.
除了她的学术和临床专业知识外，戈特弗里德博士还撰写了许多与女性和一般人有关的营养、激素和补充剂方面的重要书籍。
The two books that I'd like to highlight and that we've provided links to in the show note captions are Women, Food, and Hormones and The Hormone Cure.
我想强调的两本书是《女性、食物和激素》和《激素治疗》，我们在节目注释标题中提供了链接。
I read The Hormone Cure and found it to be tremendously interesting and informative, not just in terms of teaching me about female hormone health and various treatments for female hormone health, but also as a man, trying to understand how the endocrine system interacts with mindset, nutrition, and supplementation more generally.
我读了《激素疗法》，发现它非常有趣且内容丰富，不仅教我有关女性激素健康和女性激素健康的各种治疗方法，而且作为一个男人，试图了解内分泌系统如何与心态、营养和更广泛的补充相互作用。
So I highly recommend The Hormone Cure for anybody interested in hormones and hormone health, and Women, Food, and Hormones in particular for women.
因此，我强烈推荐《激素疗法》给所有对激素和激素健康感兴趣的人，特别是对女性感兴趣的《女性、食物和激素》。
Although, again, both books are going to be strongly informative for women wishing to optimize their hormone health, vitality, and longevity.
尽管如此，这两本书都将为那些希望优化荷尔蒙健康、活力和寿命的女性提供大量信息。
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。
And now for my discussion with Dr. Sara Gottfried.
现在我与萨拉·戈特弗里德博士进行讨论。
Dr. Gottfried, Sara, welcome.
戈特弗里德博士、萨拉，欢迎光临。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Thank you.
谢谢你。
So happy to be here.
很高兴来到这里。
Andrew Huberman:
安德鲁·休伯曼：
Yeah, I'm delighted and very excited to ask you about an enormous number of topics.
是的，我很高兴也很兴奋地向您询问大量的话题。
You are expert in so, so many things.
你在很多事情上都是专家。
So, the challenge for me is going to be to constrain this walk, as it were.
所以，对我来说，挑战就是限制这次步行。
But, I'm hoping that we can touch on a great number of things today.
但是，我希望我们今天能够讨论很多事情。
The first of which is really about hormones and female hormones in particular.
第一个实际上是关于荷尔蒙，特别是女性荷尔蒙。
And I have a question which is: Is it ever informative for a woman, regardless of age, to know something about her mother's, perhaps even her grandmother's experience, vis-à-vis hormones?
我有一个问题是：对于一个女人来说，无论年龄大小，了解她母亲，甚至她祖母关于荷尔蒙的经历，是否能提供一些信息？
Not just pregnancy challenges with or ease with pregnancy and child rearing, childbirth, this sort of thing, but what sorts of conversations should women be having with themselves and with family members to get a window into what their specific needs might be?
不仅仅是怀孕、育儿、分娩等事情带来的挑战或轻松，而且女性应该与自己和家人进行什么样的对话，以了解她们的具体需求可能是什么？
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Love this question.
喜欢这个问题。
So my work is really at the interface between genetics and environment.
所以我的工作实际上是在遗传学和环境之间的交界处。
So your question gets to both, and I think it's essential that you understand what your grandmother went through.
所以你的问题涉及到两者，我认为你必须了解你祖母经历过的事情。
I'd even say your great-grandmother, depending on longevity in your family.
我什至会说你的曾祖母，这取决于你家族的寿命。
So I grew up with my great-grandmother.
所以我是跟着曾祖母长大的。
I get that.
我明白了。
And especially your mother.
尤其是你的母亲。
So I would probably start first with trauma and intergenerational trauma, because I think that affects the endocrine system so hugely, especially cortisol signaling, but the broader PINE system, psycho immuno neuro endocrine system.
所以我可能会首先从创伤和代际创伤开始，因为我认为这对内分泌系统影响很大，尤其是皮质醇信号传导，但更广泛的 PINE 系统，心理免疫神经内分泌系统。
And then there's, if I think about the stages, the life cycle that a woman goes through If you think about puberty, I don't know how genetically determined the age of puberty is.
然后，如果我考虑一下女性经历的各个阶段，即生命周期。如果考虑到青春期，我不知道青春期的年龄是如何由基因决定的。
Certainly, there's a lot of environmental influences, like toxins can affect it.
当然，有很多环境影响，比如毒素会影响它。
But pregnancy, the age at which you start to go through perimenopause, menopause, many of those have a genetic component.
但是怀孕，也就是你开始经历围绝经期、更年期的年龄，其中许多都有遗传因素。
So with pregnancy, you can certainly think the shape of the pelvis, your ability to have a vaginal birth.
因此，在怀孕期间，您当然可以考虑骨盆的形状以及阴道分娩的能力。
Some of that is genetically determined.
其中一些是由基因决定的。
You do have the sperm donor affecting some of that.
精子捐献者确实会影响其中一些。
But, in my family, for instance, we have no cesarean sections.
但是，例如在我的家庭中，我们没有剖腹产。
So everyone goes through this process of a relatively easy vaginal birth.
所以每个人都会经历这个相对容易的阴道分娩过程。
I was a forceps baby, but for the most part, you can find out about that.
我是一个产钳婴儿，但在大多数情况下，你可以了解这一点。
And then there's certain female conditions that have a very strong component genetically, most of which run in my family.
另外，某些女性疾病具有很强的遗传因素，其中大部分是我家族遗传的。
So that includes endometriosis, fibroids.
这包括子宫内膜异位症、子宫肌瘤。
I just had a hysterectomy.
我刚刚做了子宫切除术。
I had 50 plus fibroids.
我有 50 多个肌瘤。
And polycystic ovarian syndrome.
还有多囊卵巢综合症。
Andrew Huberman:
安德鲁·休伯曼：
And of those three, how frequent are those?
这三个中，出现的频率有多高？
And maybe I can constrain the question a little bit by saying today's discussion, I imagine, is going to be heard by men and women of all sorts of ages.
也许我可以稍微限制一下这个问题，我想今天的讨论将被各个年龄段的男人和女人听到。
So maybe I'll direct the question a little bit toward at what age should these discussions start?
所以也许我会把问题稍微转向这些讨论应该在什么年龄开始？
We always imagine that women in their 30s and 40s and 50s and onward should be getting certain tests and addressing things like ovarian reserve and other sorts of things.
我们总是认为 30 多岁、40 多岁、50 多岁及以后的女性应该接受某些检查并解决卵巢储备等问题。
But maybe we could march through and just say, for a woman in her teens who's already hit puberty, what sorts of biomarkers, whether or not they're blood-based or phenotyping, the outward appearance of, should those young women be paying attention to?
但也许我们可以继续说，对于一个已经进入青春期的十几岁的女性来说，那些年轻女性应该关注什么样的生物标志物，无论它们是基于血液的还是表型的，以及外观？
Likewise, for women in their 20s, 30s.
同样，对于20多岁、30多岁的女性来说。
Maybe we could take it more or less by decade, starting at puberty.
也许我们可以或多或少地经历十年，从青春期开始。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Yeah.
是的。
Andrew Huberman:
安德鲁·休伯曼：
Assuming that woman hits puberty sometime, what, between, what is it now?
假设那个女人在某个时候进入青春期，那么，现在是什么？
The average in the US is somewhere between 12 and 16 years old.
美国的平均年龄在 12 至 16 岁之间。
Do I have that right?
我有这个权利吗？
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
No, you do not.
不，你没有。
Andrew Huberman:
安德鲁·休伯曼：
Oh, great.
哦，太好了。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
So that is-
那么那就是——
Andrew Huberman:
安德鲁·休伯曼：
I love to be wrong.
我喜欢犯错。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
So it used to be 12 to 16, I would say, 50 years ago.
所以我想说，50 年前，它曾经是 12 到 16 岁。
It's been moving younger, and we think some of that is related to toxin exposure, as I mentioned.
正如我提到的，它正在变得年轻化，我们认为其中一些与毒素暴露有关。
But I was 10 when I went through puberty, well, I should say menarche, and I started growing breasts much before that.
但我十岁的时候就进入了青春期，好吧，我应该说初潮，在那之前我的乳房就开始生长了。
So I think now I'm going to step away from the science for a moment.
所以我想现在我要暂时远离科学。
I'm going to do that pretty fluidly, and I'll try to call it out.
我会非常流畅地做到这一点，并且我会尝试把它说出来。
I think there's also a huge influence from stress and the development of the adrenal glands.
我认为压力和肾上腺的发育也有巨大的影响。
So going back to the science, the issue in teenage years is that the hypothalamic pituitary adrenal axis, and I like to think of it broader, so stay with me.
回到科学上来，青少年时期的问题是下丘脑垂体肾上腺轴，我喜欢把它想得更广泛，所以请听我说。
Hypothalamic pituitary adrenal, gonadal, ovaries in women, testes in men, thyroid, gut axis.
下丘脑、垂体、肾上腺、性腺、女性卵巢、男性睾丸、甲状腺、肠轴。
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
So that to me is the control system.
对我来说这就是控制系统。
So I'm kind of expressing my bioengineering side here.
所以我想在这里表达我的生物工程方面的观点。
Andrew Huberman:
安德鲁·休伯曼：
Well, I think it's great to include the other organs and tissue systems of the body because, as we both know that the narrow definition of just hypothalamic pituitary adrenal, it can't be just that, right?
嗯，我认为将身体的其他器官和组织系统包括在内是很好的，因为我们都知道下丘脑垂体肾上腺的狭义定义不可能只是这样，对吗？
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
No.
不。
Andrew Huberman:
安德鲁·休伯曼：
It can't, right?
不可能吧？
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
No.
不。
Andrew Huberman:
安德鲁·休伯曼：
Yeah.
是的。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
It doesn't tell the whole story.
它并没有讲述整个故事。
So if you look at the main sex hormones in a young woman who's in her teenage years, the hypothalamic pituitary adrenal gonadal part of that is not fully mature.
因此，如果你观察一个十几岁的年轻女性的主要性激素，就会发现其中的下丘脑、垂体、肾上腺、性腺部分还没有完全成熟。
So they're more likely to skip periods, especially under stress.
因此，她们更有可能跳过月经，尤其是在压力下。
They have a lot of influences.
他们有很多影响力。
It really doesn't get well established until you're done with adolescence.
直到你过了青春期，它才真正建立起来。
And I'm told that adolescence now is till age 25 to 26.
我听说现在的青春期是25岁到26岁。
I heard that, and I was like, "I've got two daughters." And I was thinking that's a really long time.
我听到这个消息后就想：“我有两个女儿。”我想这真的是很长一段时间了。
Andrew Huberman:
安德鲁·休伯曼：
And not just psychologically defined or biopsychosocial?
不仅仅是心理定义或生物心理社会？
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
So mostly psychologically defined.
所以主要是心理上的定义。
I heard that from a psychologist.
我是从一位心理学家那里听来的。
So biomarkers you asked about.
所以你问的生物标志物。
In your teenage years, what I think what is really interesting is to look at cortisol.
在你十几岁的时候，我认为真正有趣的是观察皮质醇。
To look at the dance between estrogen and progesterone in those years is less helpful because I think there's a lot of variability due to the immaturity of the system.
观察那些年雌激素和黄体酮之间的舞蹈没有多大帮助，因为我认为由于系统的不成熟，存在很多变化。
If you've got someone who's got really regular periods, it's probably better to do some benchmarking at that age.
如果你身边有人月经非常规律，那么最好在那个年龄做一些基准测试。
But generally, I find that benchmarking is best performed in your 20s or 30s.
但一般来说，我发现基准测试最好在 20 多岁或 30 多岁时进行。
Andrew Huberman:
安德鲁·休伯曼：
Are periods not that regular in terms of duration of the menstrual cycle when the menstrual cycle first sets in?
当月经周期开始时，月经周期的持续时间是否不那么规律？
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
It depends.
这取决于。
So I was like clockwork every 28 days until I had my hysterectomy in August.
所以我每 28 天就像发条一样准时，直到 8 月份我接受了子宫切除术。
Same thing with my daughters.
我的女儿们也是如此。
I've got two daughters, one's 17, the other's 23.
我有两个女儿，一个17岁，另一个23岁。
For a lot of women, they're not regular.
对于很多女性来说，她们的表现并不规律。
And then there's the whole piece of oral contraceptives and other forms of contraception where you have no idea what the normal cycle is.
然后还有整套口服避孕药和其他形式的避孕方法，您不知道正常周期是什么。
And I hope we'll have some time to talk a little bit about oral contraceptives because I think it is-- This is now opinion again and not science.
我希望我们有一些时间来讨论一下口服避孕药，因为我认为这又是一种观点，而不是科学。
I think it is the number one endocrinopathy that is iatrogenic for women.
我认为这是女性医源性排名第一的内分泌疾病。
Andrew Huberman:
安德鲁·休伯曼：
We will definitely talk about it.
我们一定会谈论它。
I get a lot of questions about oral contraceptives in the social media space and also questions about IUDs quite a lot.
我在社交媒体上收到了很多关于口服避孕药的问题，还有很多关于宫内节育器的问题。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Totally.
完全可以。
Andrew Huberman:
安德鲁·休伯曼：
In particular, copper IUDs-
特别是含铜宫内节育器 -
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Yeah
是啊
Andrew Huberman:
安德鲁·休伯曼：
...
...
non-hormonal IUDs.
非激素宫内节育器。
So we will definitely touch on that.
所以我们肯定会谈到这一点。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
I'm an IUD crusader, so I just want to give you that warning.
我是宫内节育器的斗士，所以我只想给你这个警告。
Andrew Huberman:
安德鲁·休伯曼：
You're a fan, do I have that right?
你是粉丝，我有这个权利吗？
Or you're anti-IUD?
或者你反对宫内节育器？
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
I am a huge fan.
我是一个超级粉丝。
Andrew Huberman:
安德鲁·休伯曼：
Uh-huh.
嗯嗯。
Which IUDs in particular?
特别是哪些宫内节育器？
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
So I like copper because it's non-hormonal.
所以我喜欢铜，因为它不含激素。
It's as effective as getting your tubes tied.
这和结扎管子一样有效。
Andrew Huberman:
安德鲁·休伯曼：
Who would've thought?
谁会想到呢？
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Right.
对。
Andrew Huberman:
安德鲁·休伯曼：
It's that toxic to the sperm mobility?
它对精子的活动能力有那么大的毒性吗？
Is that how it works?
是这样的吗？
That's my understanding of it-
我的理解是这样的——
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Probably
大概
Andrew Huberman:
安德鲁·休伯曼：
...
...
is that it basically, it's more or less an electric fence to the sperm cap, and just that's it.
基本上，它或多或少是精子帽的电围栏，仅此而已。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Electric fence is a bit of a harsh analogy, but I'll work with that.
电围栏是一个有点苛刻的类比，但我会用它。
But to have something that can last for 10 years so that you really have complete autonomy and sovereignty over your sexual life, that's profound.
但拥有一个可以持续10年的东西，让你真正对自己的性生活拥有完全的自主权和主权，这意义深远。
And to not get all those downstream risks that are associated with the birth control pill.
并且避免遭受与避孕药相关的所有下游风险。
The other thing that's important to know about it, I know this is a sidebar, women who use the copper IUD have the highest satisfaction rate of anyone on contraceptives.
另一件重要的事情是，我知道这是一个侧边栏，使用铜宫内节育器的女性在避孕方面的满意度是最高的。
The highest satisfaction rate, and yet it is the least used of all forms of contraception.
满意度最高，但它是所有避孕形式中使用最少的。
Now, my favorite is vasectomy.
现在，我最喜欢的是输精管结扎术。
But short of vasectomy, I think the IUD is a really great choice.
但除了输精管结扎术之外，我认为宫内节育器确实是一个不错的选择。
There are some risks associated with it.
存在一些与之相关的风险。
I'm not saying it's risk-free, but I love the IUD.
我并不是说它没有风险，但我喜欢宫内节育器。
And I love it for younger women, too.
我也喜欢年轻女性。
Because it used to be that when I went through my training, which was 30 years ago, we were told, "Don't put it in someone who hasn't had a baby." And that is patriarchal messaging.
因为30年前，当我接受培训时，我们被告知，“不要把它放在没有生过孩子的人身上。”这就是父权制的信息。
But getting back to your original question, which is about biomarkers per decade.
但回到你最初的问题，这是关于每十年的生物标志物。
In your 20s, that's when you want to do some base casing with estrogen, progesterone, and testosterone.
在你 20 多岁的时候，你会想要用雌激素、黄体酮和睾酮进行一些基础锻炼。
So I think it's really helpful to know about this tango.
所以我认为了解探戈确实很有帮助。
You're from Argentina, or your father is.
你来自阿根廷，或者你的父亲来自阿根廷。
Andrew Huberman:
安德鲁·休伯曼：
I have Argentine lineage.
我有阿根廷血统。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Yes.
是的。
Andrew Huberman:
安德鲁·休伯曼：
Yeah.
是的。
My grandparents did tango into their late 80s.
我的祖父母一直跳探戈直到八十多岁。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Well-
嗯-
Andrew Huberman:
安德鲁·休伯曼：
I'm in my late 40s, and I still haven't started, so I suppose there's time
我已经四十多岁了，还没有开始，所以我想还有时间
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
It might be time for you to look that up.
您可能是时候查一下了。
Andrew Huberman:
安德鲁·休伯曼：
Okay.
好的。
Will do.
会做。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
And it might be a factor in their longevity.
这可能是他们长寿的一个因素。
Andrew Huberman:
安德鲁·休伯曼：
Hmm.
嗯。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Did they have good health span, not just life span?
他们是否拥有良好的健康寿命，而不仅仅是寿命？
Andrew Huberman:
安德鲁·休伯曼：
They did.
他们做到了。
And my grandfather smoked cigarettes daily, remained mentally sharp until he died in his late 90s, but almost burned down their apartment several times falling asleep with a cigarette in his mouth.
我的祖父每天都抽烟，直到90多岁去世时仍然精神敏锐，但有几次在嘴里含着烟睡着时差点烧毁他们的公寓。
So I don't recommend anyone smoke, by the way.
所以顺便说一句，我不建议任何人吸烟。
But it was coffee, maté, red meat, and cigarettes, and they lived into their 90s.
但就是咖啡、马黛茶、红肉和香烟，他们活到了 90 多岁。
So that side of my family has the genetic advantage.
所以我的家族那边有遗传优势。
The other side, less so.
另一边则不然。
But in any event, tango-
但无论如何，探戈——
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Tango
探戈
Andrew Huberman:
安德鲁·休伯曼：
...
...
is a 2023 goal.
是2023年的目标。
It has been every year.
每年都是如此。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
I'm going to hold you accountable to that.
我会让你对此负责的。
Andrew Huberman:
安德鲁·休伯曼：
Okay.
好的。
Will do.
会做。
And no, there will be no YouTube video of me doing tango.
不，YouTube 上不会有我跳探戈的视频。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
At least not initially.
至少一开始不是。
Andrew Huberman:
安德鲁·休伯曼：
Tim Ferriss, actually, a phenomenal podcaster, as we know, is a-
事实上，正如我们所知，蒂姆·费里斯是一位杰出的播客，他是——
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
He's a badass tango
他是个棒极了的探戈
Andrew Huberman:
安德鲁·休伯曼：
...
...
he's a badass tango dancer.
他是一位出色的探戈舞者。
I know this through various sources.
我通过各种渠道了解到这一点。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Yes.
是的。
Andrew Huberman:
安德鲁·休伯曼：
Yeah.
是的。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
I've seen.
我见过。
Yeah, so this tango between estrogen and progesterone is incredibly important.
是的，雌激素和黄体酮之间的这种探戈非常重要。
You want to have the right lead, you want to have the right follow between the two hormones.
你想要有正确的引导，你想要在两种激素之间有正确的跟随。
Again, I'm stepping away from my science hat.
我再次摆脱我的科学帽子。
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
But what happens a lot of the time is that estrogen dominates in that tango.
但很多时候，雌激素在探戈中占主导地位。
And when that happens, it sets you up for greater risk of fibroids, endometriosis, breast pain, probably in association with the microbiome and the estrobolome.
当这种情况发生时，你会面临更大的肌瘤、子宫内膜异位症、乳房疼痛的风险，这可能与微生物组和雌曲醇组有关。
Andrew Huberman:
安德鲁·休伯曼：
Oh, can you familiarize me with the estrobolome?
哦，你能让我熟悉一下雌激素吗？
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Yeah.
是的。
Andrew Huberman:
安德鲁·休伯曼：
I'm delighted to know that I don't recognize the term.
我很高兴知道我不认识这个词。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Yeah.
是的。
So the estrobolome is the set of microbes, and their DNA, mostly, in the gut microbiome, that set of microbes and their DNA.
因此，雌激素组是一组微生物及其 DNA，主要存在于肠道微生物组中，即一组微生物及其 DNA。
If you look at the totality, the subset of particular bacteria modulate estrogen levels.
如果你从整体上看，就会发现特定细菌的子集调节雌激素水平。
So a lot of this work was spearheaded by Martin Glazer.
因此，这项工作的大部分工作都是由马丁·格雷泽（Martin Glazer）带头开展的。
And what we know is that there are some women who have an estrobolome that makes them have a greater risk of certain estrogen-mediated conditions like breast cancer, endometrial cancer, and in men, prostate cancer.
我们知道，有些女性体内含有雌激素，这使得她们患某些雌激素介导的疾病的风险更大，如乳腺癌、子宫内膜癌，而男性则患前列腺癌。
Andrew Huberman:
安德鲁·休伯曼：
Mm.
嗯。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
So the estrobolome is incredibly important.
因此雌曲醇极其重要。
There's not a lot of attention paid to it, but I always think in terms of my patients, could this be someone who's got a faulty estrobolome?
对此并没有太多关注，但我总是从我的患者角度思考，这可能是一个雌曲醇组有问题的人吗？
And we need to adjust it with some of the microbiome modulating nutrients, nutraceuticals that we have, so that they're less likely to have that tango that's not working with estrogen and progesterone.
我们需要用我们拥有的一些微生物组调节营养素和营养保健品来调整它，这样他们就不太可能出现与雌激素和黄体酮不起作用的探戈。
So getting back to the biomarkers.
回到生物标志物。
If you gave me an unlimited budget, which I kind of have with some of my clients that I work with now, what I would want to know is estrogen, progesterone, testosterone, and I'd want the timing right for that.
如果你给我无限的预算，就像我现在与我合作的一些客户一样，我想知道的是雌激素、黄体酮、睾酮，我希望有合适的时机。
I'd want to know about DHEA and sort of the whole androgen pathway.
我想了解 DHEA 和整个雄激素途径。
I'd want to know about the metabolites of estrogen because some of them are protective and very helpful.
我想了解雌激素的代谢物，因为其中一些具有保护作用并且非常有帮助。
Others are a bit like Homer Simpson.
其他人有点像荷马·辛普森。
They are just causing all kinds of problems in your body, increasing the risk of quinones like DNA damage, and potentially an increased risk of breast cancer.
它们只会给你的身体带来各种问题，增加 DNA 损伤等醌的风险，并可能增加患乳腺癌的风险。
Although, that data, I think, is mixed.
不过，我认为这些数据好坏参半。
I'd also like to know about their stool, so I want to know about the microbiome.
我还想了解他们的粪便，所以我想了解微生物组。
So the best that we have right now is to look, when we do stool testing, and I do a lot of stool testing, we can look at things like beta-glucuronidase Are you familiar with BG?
因此，我们现在最好的办法就是，当我们进行粪便检测时，我做了很多粪便检测，我们可以查看诸如 β-葡萄糖醛酸酶之类的东西，您熟悉 BG 吗？
Andrew Huberman:
安德鲁·休伯曼：
I'm familiar with it as a term, and so for those listening, very often, not always, when you hear an ase, A-S-E, you're dealing with an enzyme.
我很熟悉这个术语，所以对于那些听的人来说，很多时候，但并非总是，当你听到 ase、A-S-E 时，你正在处理一种酶。
So we can take a stab there, and it sounds like it's somehow involved in glucose metabolism of some sort, or is it-
所以我们可以在那里尝试一下，听起来它似乎与某种葡萄糖代谢有关，或者是-
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Glucuronidation.
葡萄糖醛酸化。
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
So it's involved in when you produce estrogen in the body, this is the simplified version, but when you produce estrogen, you are meant to use it, send it to the receptors where it's meant to go, and then lose it.
因此，当你在体内产生雌激素时，它会参与其中，这是简化版本，但是当你产生雌激素时，你就应该使用它，将其发送到它应该去的受体，然后失去它。
You don't want to keep recirculating the estrogen like bad karma, and that's what happens with people who have high beta-glucuronidase.
你不想像恶业一样继续循环雌激素，而这就是β-葡萄糖醛酸酶高的人会发生的事情。
So it's this enzyme that's produced by three bacteria in particular in the gut.
因此，这种酶是由三种细菌产生的，特别是在肠道中。
And I see a lot of men and women who have elevated beta-glucuronidase, and then they have some estrogen dominance related to that.
我看到很多男性和女性的β-葡萄糖醛酸酶升高，然后他们有一些与此相关的雌激素优势。
Is that the total reason?
这是全部原因吗？
We don't really know.
我们真的不知道。
But it's one of the drivers, it's one of the levers.
但它是驱动因素之一，是杠杆之一。
Andrew Huberman:
安德鲁·休伯曼：
And it can be detected from a microbiome, AKA stool sample.
它可以从微生物组（又称粪便样本）中检测到。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
That's right.
没错。
Andrew Huberman:
安德鲁·休伯曼：
And in terms of blood testing or various tests for these other biomarkers, getting estrogen, testosterone, and other ratios, I realize people have different means, financial means, but in general, people wanting to do a blood test, it sounds like women will need to do it at different stages of their menstrual cycle.
在血液测试或对这些其他生物标志物的各种测试方面，获得雌激素、睾酮和其他比率，我意识到人们有不同的手段、经济手段，但总的来说，想要进行血液测试的人，听起来女性需要在月经周期的不同阶段进行测试。
If they had to pick one, either in the follicular phase or in the luteal stage of their ovarian menstrual cycle-- excuse me, ovulatory menstrual cycle, when would you suggest they do that, if they had to pick one?
如果他们必须选择一个，无论是在卵巢月经周期的卵泡期还是黄体期——请问，排卵期月经周期，如果他们必须选择一个，你会建议他们什么时候这样做？
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
So if you forced me to pick one, I would say probably day 21 to 22 for someone in her 20s.
所以如果你强迫我选一个，我会说对于 20 多岁的人来说可能是第 21 到 22 天。
So we're focused right now on that decade.
所以我们现在关注的是那个十年。
So for most women, they've got a menstrual cycle date that averages out at 28 days.
因此，对于大多数女性来说，她们的月经周期平均为 28 天。
So this is about a week before they start their period.
所以这大约是她们月经开始前一周。
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
For women who are more irregular, it's harder to do that.
对于性格比较不规律的女性来说，做到这一点比较困难。
As women get older, and we'll talk about this in a moment, usually the cycle gets a little shorter.
随着女性年龄的增长，我们稍后会讨论这个问题，通常周期会变得更短。
So as they start to decline in their progesterone production, their period gets a little closer together.
因此，当她们的黄体酮分泌量开始下降时，她们的经期就会变得更加接近。
Like mine before August was about every 26 days.
就像我在八月之前的情况一样，大约每 26 天一次。
So at that point, you want to test sooner, like day 19, 20.
所以到了那个时候，你想早点测试，比如第 19 天、第 20 天。
And I'm not talking about a blood test.
我不是在谈论验血。
So a blood test is the cheapest thing.
所以验血是最便宜的事情。
It's usually what's covered by insurance.
通常是保险承保的范围。
But my preference would be to do dried urine.
但我更喜欢做干尿。
I like to use saliva for cortisol.
我喜欢用唾液来获取皮质醇。
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
I like to use dried urine so that I get metabolomics in addition to the levels of these hormones.
我喜欢使用干燥的尿液，这样除了这些激素的水平之外，我还可以获得代谢组学数据。
And if I'm forced to, I'll use blood testing, and that's certainly the gold standard for all of these hormones that we're talking about.
如果被迫的话，我会使用血液检测，这无疑是我们正在谈论的所有这些激素的黄金标准。
But it's not as comprehensive, and as you know, it's a quick little snapshot while the needle's in your vein for 30 seconds.
但它并不那么全面，而且如您所知，它只是针在您静脉中停留 30 秒时的快速小快照。
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Yeah.
是的。
The salivary cortisol makes sense to me because my understanding is that you get free cortisol, which is the active cortisol.
唾液皮质醇对我来说很有意义，因为我的理解是你会得到游离皮质醇，即活性皮质醇。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
That's right.
没错。
Andrew Huberman:
安德鲁·休伯曼：
You said with urine, you're also getting the metabolites.
你说通过尿液，你也会得到代谢物。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
That's right.
没错。
Andrew Huberman:
安德鲁·休伯曼：
And then for blood testing, you're getting sort of a crude window into the averages.
然后进行血液测试，您将获得平均值的粗略窗口。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
A static-
静态-
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm
嗯嗯
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
...
...
total level.
总水平。
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
So let me go back and say one other thing about biomarkers.
让我回过头来谈谈关于生物标志物的另一件事。
A big part of the testing that I do in phenotyping my patients, I practice precision medicine, so I like to almost start with nutritional testing.
我在对患者进行表型分析时所做的测试的很大一部分是进行精准医学，所以我喜欢从营养测试开始。
I don't think I've ever had a teenager.
我不认为我曾经有过青少年。
I've got some NBA players that are 19, 20, 21, so maybe those count.
我有一些 19 岁、20 岁、21 岁的 NBA 球员，所以也许这些也算在内。
But those are men, obviously.
但显然，这些都是男人。
But for nutritional testing, that would be potentially a helpful thing to do in your 20s.
但对于营养测试来说，这可能对你 20 多岁的人很有帮助。
Becomes less important as you get older and you develop more micronutrient deficiencies, but micronutrients play a huge role in terms of hormone production.
随着年龄的增长和微量营养素缺乏的增多，微量营养素变得不那么重要，但微量营养素在激素的产生方面发挥着巨大的作用。
Magnesium.
镁。
Magnesium is hugely involved in the way that you get rid of estrogen, as an example.
例如，镁与消除雌激素的方式密切相关。
So micronutrient testing, what I usually do is a combination of blood and urine.
所以微量营养素检测，我通常做的是血液和尿液的结合。
And so I'm looking at all of the micronutrients that we can measure that have some clinical scientific basis behind them.
因此，我正在研究我们可以测量的所有微量营养素，这些营养素背后有一些临床科学依据。
If I could do that for a teenager, I think it might be helpful because I recently gave a lecture on breast cancer risk reduction.
如果我能为青少年做到这一点，我认为这可能会有所帮助，因为我最近做了一个关于降低乳腺癌风险的讲座。
Another quick sidebar.
另一个快速侧边栏。
And I was sad to find that intake of vegetables, polyphenols, is such an important predictor of future risk of breast cancer, like when you're 50, 60 plus.
我很遗憾地发现蔬菜多酚的摄入量是未来患乳腺癌风险的重要预测因素，例如当您 50 岁、60 岁以上时。
And the most important time is when you're a teenager.
最重要的时期是青少年时期。
Now, I have one daughter that eats vegetables.
现在，我有一个吃蔬菜的女儿。
She loves them.
她爱他们。
And I have another daughter who eats food that's beige.
我还有另一个女儿，她吃米色的食物。
And it's very hard to get her to eat the volume of vegetables, five colors a day, which is what I do.
让她每天吃五种颜色的蔬菜是非常困难的，而这正是我所做的。
And if you have evidence that you could show a 17-year-old that they've got micronutrient gaps, I think that would be a motivator for them to eat differently at a time when it's so critical, even though it's 25 years in the future, that it's going to potentially change this arc that they're on.
如果你有证据表明你可以向 17 岁的孩子展示他们存在微量营养素缺口，我认为这将成为他们在关键时刻采取不同饮食方式的动力，即使是在未来 25 年，这也有可能改变他们目前所处的这条弧线。
Andrew Huberman:
安德鲁·休伯曼：
What do you do for a young woman who doesn't like vegetables, or is not somehow able or willing to get those five colors a day of vegetable to help support the microbiome?
对于不喜欢蔬菜，或者无法或不愿意每天摄入这五种颜色的蔬菜来帮助支持微生物组的年轻女性，您该怎么办？
Are supplements a useful tool in that case?
在这种情况下，补充剂是一个有用的工具吗？
What other sorts of tools, behavioral or otherwise, are useful?
还有哪些其他有用的工具（行为工具或其他工具）？
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Such a good question.
这是个好问题。
So here I'm going to invoke Rob Knight at UCSD.
所以在这里我要引用加州大学圣地亚哥分校的罗布·奈特(Rob Knight)。
So I think his gut project has really been helpful in terms of understanding what kind of modulators are going to be important.
所以我认为他的直觉项目对于理解什么样的调制器将是重要的非常有帮助。
So what I try to get that person to do, and I don't see many teens anymore other than NBA players, what I try to get them to do is to have a smoothie.
所以我试图让那个人做的就是喝一杯冰沙，除了 NBA 球员之外，我再也见不到很多青少年了。
Very hard to get them to have a smoothie every day, but if I could get them to have a smoothie three times a week and to throw some of these vegetables in, that makes a huge difference.
让他们每天喝一杯冰沙很难，但如果我能让他们每周喝三次冰沙并加入一些蔬菜，那就会有很大的不同。
Andrew Huberman:
安德鲁·休伯曼：
Mm.
嗯。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
We know that makes a difference in terms of microbiome change.
我们知道这会对微生物组的变化产生影响。
Andrew Huberman:
安德鲁·休伯曼：
So you're blending up broccoli or kale.
所以你正在混合西兰花或羽衣甘蓝。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Cauliflower.
花椰菜。
So cauliflower is great.
所以花椰菜很棒。
Andrew Huberman:
安德鲁·休伯曼：
Jalapenos even.
甚至是墨西哥胡椒。
They're putting things into the smoothie.
他们正在把东西放进冰沙里。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Yeah.
是的。
I don't know if you can get a teenager to do that, but they often will use-- I have them do steamed broccoli that's in the freezer because it's got very little taste.
我不知道你是否可以让青少年这样做，但他们经常会用——我让他们做冰箱里的蒸西兰花，因为它的味道很少。
So that they could do that in a chocolate smoothie.
这样他们就可以在巧克力冰沙中做到这一点。
They could add some greens.
他们可以添加一些蔬菜。
I like greens powders are super convenient.
我喜欢绿色粉末超级方便。
So that with, kind of a taste that they like, whether that's chocolate, which is what most of my clients want, or vanilla with berries and that sort of thing.
因此，他们喜欢某种口味，无论是巧克力（这是我的大多数客户想要的），还是香草加浆果之类的东西。
So that can go a long way if you don't like vegetables.
所以如果你不喜欢蔬菜的话，这会有很大帮助。
And short of that, I would say some supplements, but I would say that's a distant second to making a smoothie.
除此之外，我会说一些补充剂，但我想说这与制作冰沙相比还相差甚远。
I've got one patient that I have to mention because he took this to the extreme.
我必须提到一位病人，因为他把这件事做到了极端。
So he is a retired physicist professor at UCSD.
所以他是加州大学圣地亚哥分校的退休物理学家教授。
He found out that his microbiome was a hot mess and developed autoimmune disease.
他发现他的微生物组一团糟，并患上了自身免疫性疾病。
And so he became hellbent, like only a physicist could, on changing his microbiome.
因此，他像物理学家一样，一心想要改变自己的微生物组。
And he dramatically shifted it by having a smoothie every day with 57 vegetables and fruits in it.
他戏剧性地改变了这一现状，每天喝一杯含有 57 种蔬菜和水果的冰沙。
Andrew Huberman:
安德鲁·休伯曼：
57 independent-
57 独立-
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
57 independent.
57 独立。
So, this just warms my heart the way that he did this.
所以，他这样做的方式让我感到温暖。
But he would go to the farmers market, he would just get a bunch of this, a bunch of that, and he would go home, make the smoothie, and then stick it in the freezer, so he'd have a serving every day.
但他会去农贸市场，买一堆这个，一堆那个，然后回家，做冰沙，然后把它放进冰箱，这样他每天都会吃一份。
And he became a completely different person based on this microbiome change.
由于这种微生物组的变化，他变成了一个完全不同的人。
His autoimmune disease is in remission.
他的自身免疫性疾病已得到缓解。
He dropped a huge amount of weight.
他减轻了很多重量。
He went from being kind of this phenotype that I know you know well, of a professor, high-performing, traveling around the world on so many boards, so much innovation, so many great ideas, super computer guy, to being someone who gets up in the morning, gets in his hot tub, exercises for one to two hours a day, and then does a little work.
他从我知道你很熟悉的那种表型，一个教授，表现出色，在这么多的董事会上环游世界，这么多的创新，这么多伟大的想法，超级计算机专家，变成了一个早上起床，泡在热水浴缸里，每天锻炼一到两个小时，然后做一点工作的人。
He completely shifted the way that he lives.
他彻底改变了他的生活方式。
And his microbiome shift, who knows what's the chicken and what's the egg there?
还有他的微生物组变化，谁知道先有鸡、先有蛋呢？
But he had a huge change in his physiology.
但他的生理发生了巨大的变化。
Glucose went from being quite high.
血糖从相当高开始。
And he tracks all of this, of course.
当然，他追踪了这一切。
It's like on a computer.
就像在电脑上一样。
Andrew Huberman:
安德鲁·休伯曼：
Scientist after all.
毕竟是科学家。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Right.
对。
Yeah.
是的。
Andrew Huberman:
安德鲁·休伯曼：
And retired, I suppose, might have had some time on his hands.
我想，退休后他可能还有一些闲暇时间。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
And he's retired, but he's got the longest time series of anyone I know, and he's tracked his glucose and insulin going back 20 years.
他已经退休了，但他的时间序列记录是我认识的人中最长的，他的血糖和胰岛素记录可以追溯到 20 年前。
So he can show you, "Okay, here's where I started having my smoothie, and here's how my glucose and insulin changed as a result of that."
所以他可以向你展示，“好吧，这就是我开始喝冰沙的地方，这就是我的葡萄糖和胰岛素因此而发生的变化。”
Andrew Huberman:
安德鲁·休伯曼：
Is there a case for, I'll say young women, but young women and men using over-the-counter probiotics as a way to enhance the microbiome?
我会说年轻女性，但年轻女性和男性是否有理由使用非处方益生菌来增强微生物组？
This is something I hear about a lot.
这是我经常听到的事情。
I've heard that excessive doses of capsule probiotics can give a brain fog-like condition.
我听说过量服用胶囊益生菌会导致脑雾样症状。
I personally don't use capsule probiotics unless I feel like my system is under a significant amount of stress, in which case, I might add that in for brief periods of time, or if I've just taken antibiotics for a period of time.
我个人不会使用胶囊益生菌，除非我觉得我的系统承受很大的压力，在这种情况下，我可能会在短时间内添加益生菌，或者如果我刚刚服用抗生素一段时间。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Right.
对。
Andrew Huberman:
安德鲁·休伯曼：
Do you ever recommend that the college student or the high school student that she or he take capsule probiotics, assuming that they're getting, let's say, three to five servings of vegetables per day, either in smoothie form or some other form?
您是否曾经建议大学生或高中生服用益生菌胶囊，假设他们每天摄入三到五份蔬菜，无论是冰沙形式还是其他形式？
What are your thoughts on supplementing probiotics?
您对于补充益生菌有何看法？
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
It sounds like such a simple question.
这听起来是一个很简单的问题。
It is such a complex answer, and I don't think we really have the answer.
这是一个如此复杂的答案，我认为我们还没有真正的答案。
So I'll tell you the way that I approach it.
所以我会告诉你我的处理方法。
I look for randomized trials to support my use of probiotics, and frankly, I'm underwhelmed.
我寻找随机试验来支持我对益生菌的使用，坦率地说，我对此感到不知所措。
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
So I've seen some data, if I invoke my NBA players for a moment.
如果我暂时引用一下我的 NBA 球员的话，我已经看到了一些数据。
Almost every player I've tested has increased intestinal permeability.
我测试过的几乎每个球员的肠道通透性都增加了。
They just have such a high training load, probably mediated by cortisol, very high glucoses when they drain, that they have increased intestinal permeability.
他们只是有如此高的训练负荷，可能是由皮质醇介导的，排出时葡萄糖非常高，导致肠道通透性增加。
So those tight junctions in their intestine become loose.
因此肠道中那些紧密的连接变得松散。
They develop a lot of inflammation as a result of that.
因此他们会产生很多炎症。
And when you're a professional NBA player and you're making $20 million a year, you don't want a lot of inflammation.
当你是一名职业 NBA 球员并且年薪达到 2000 万美元时，你不会想要太多的炎症。
You want a little bit to help your muscles recover, but you don't want it to be adding to problems when you develop an injury.
您想要一点帮助您的肌肉恢复，但您不希望它在您受伤时增加问题。
Andrew Huberman:
安德鲁·休伯曼：
So this is leaky gut, essentially.
所以这本质上是肠漏。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Leaky gut.
肠漏。
Andrew Huberman:
安德鲁·休伯曼：
Yeah.
是的。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
I don't love that term, but yeah, we'll use it here.
我不喜欢这个词，但是，是的，我们会在这里使用它。
So there's a particular probiotic that is helpful in athletes with leaky gut.
因此，有一种特殊的益生菌对肠漏的运动员有帮助。
So that's the kind of specificity and randomized trial that I'm looking for.
这就是我正在寻找的特异性和随机试验。
The rest of it, I think there's support if you find help from it.
其余的，我认为如果您从中找到帮助，就会得到支持。
As you described, if you take a course of antibiotics, first of all, I would question whether you need them, but there's a time and place.
正如你所描述的，如果你服用一个疗程的抗生素，首先，我会问你是否需要它们，但有时间和地点。
Andrew Huberman:
安德鲁·休伯曼：
Yeah, I try and avoid them.
是的，我试着避开他们。
There have been instances where they've been prescribed, and I took them mostly in the past.
曾经有过开处方的情况，我过去大多服用过它们。
It was in college, they seemed like they kind of gave them out.
那是在大学里，他们似乎把它们给了出来。
You had a sinus infection-
您患有鼻窦感染 -
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
They totally did
他们完全做到了
Andrew Huberman:
安德鲁·休伯曼：
...
...
they give you antibiotics usually called like-
他们给你服用抗生素，通常称为-
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Yeah, the worst-
是的，最糟糕的是——
Andrew Huberman:
安德鲁·休伯曼：
Like M&As
比如并购
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
...
...
treatment ever.
治疗过。
Yeah.
是的。
So if you're coming off of antibiotics, I think that's a good time to do what we call replacement dose probiotics.
因此，如果您正在停止使用抗生素，我认为这是服用我们所说的替代剂量益生菌的好时机。
I think what's far more interesting is prebiotics.
我认为更有趣的是益生元。
I think the data is much better for prebiotics and the selective use of polyphenols
我认为益生元和多酚的选择性使用的数据要好得多
Andrew Huberman:
安德鲁·休伯曼：
How would a person in their teens and 20s, or any age for that matter, know whether or not they have nutritional deficiencies?
一个十几岁、二十多岁的人，或者任何年龄的人，如何知道自己是否营养缺乏？
What is the best way to analyze if one is getting enough magnesium?
分析一个人是否摄入足够镁的最佳方法是什么？
And for that matter, what is going to be the best way to test the microbiome?
就此而言，测试微生物组的最佳方法是什么？
You said stool sample, and I'll come right back with the same question I asked about a blood test.
你说的是粪便样本，我会立即回答我关于血液检查的相同问题。
What time of day, when during the month, to establish a baseline?
一天中的什么时间、一个月中的什么时间建立基线？
So this would be prior to embarking on a 97 vegetables or however many- ...
所以这将是在开始 97 种蔬菜或无论多少种蔬菜之前......
you wrote per day.
你每天都写。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
I was only 57.
我当时才57岁。
Andrew Huberman:
安德鲁·休伯曼：
Well, I love the idea that you're telling us, if I'm gathering correctly, is that, yes, there's a case for probiotics, but for the typical person, regardless of age, eating more vegetables or drinking more vegetables, as the case may be, is going to be beneficial for the gut microbiome, perhaps without the need to go test whether or not one is making a certain number of estrogen-related metabolites or not.
好吧，我喜欢你告诉我们的想法，如果我没记错的话，是的，益生菌是有道理的，但对于一般人来说，无论年龄大小，多吃蔬菜或喝更多蔬菜（视情况而定）将对肠道微生物群有益，也许不需要去测试一个人是否正在产生一定数量的雌激素相关代谢物。
Just that's a great starting place.
这是一个很好的起点。
Eat or consume more vegetables.
多吃或多吃蔬菜。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Totally.
完全可以。
Andrew Huberman:
安德鲁·休伯曼：
But if one wants to analyze their gut microbiome, are there good tests available to the general public?
但如果一个人想分析他们的肠道微生物组，是否有适合公众的良好测试？
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Hmm.
嗯。
Andrew Huberman:
安德鲁·休伯曼：
I'm not going to name companies, but I've been tracking this over the years, and it's never been clear to me that we know what constituents of the gut microbiome are best.
我不会说出公司的名字，但多年来我一直在跟踪这一点，但我一直不清楚我们是否知道肠道微生物组的哪些成分最好。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Yeah.
是的。
Andrew Huberman:
安德鲁·休伯曼：
We know that dysbiosis is bad.
我们知道生态失调是不好的。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Yep.
是的。
Andrew Huberman:
安德鲁·休伯曼：
And we know that diversity of the microbiome is good.
我们知道微生物组的多样性是有好处的。
We hear this.
我们听到这个。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Yep.
是的。
Andrew Huberman:
安德鲁·休伯曼：
But no one's ever told me that you want a particular ratio of one microbiota to another-
但没有人告诉我你想要一种微生物群与另一种微生物群的特定比例——
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Right
右
Andrew Huberman:
安德鲁·休伯曼：
...
...
in a way that has made any sense to me, at least.
至少在某种程度上对我来说是有意义的。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Totally.
完全可以。
Andrew Huberman:
安德鲁·休伯曼：
I'm not a microbiologist, but whereas with testosterone in men, we hear, okay, you want your free testosterone to be about 2% of your total, perhaps.
我不是微生物学家，但考虑到男性睾酮水平，我们听说，好吧，你可能希望你的游离睾酮水平约为总水平的 2%。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Yeah.
是的。
Andrew Huberman:
安德鲁·休伯曼：
With women, women are going to have more testosterone than estrogen on average, but still less than men when you look at testosterone, et cetera.
对于女性来说，平均而言，女性的睾酮水平高于雌激素，但如果考虑睾酮等因素，女性的睾酮水平仍然低于男性。
But you can get some crude measures.
但你可以得到一些粗略的措施。
But for the microbiome, it just seems like long lists of microbiota for which I just get dizzy.
但对于微生物组来说，它似乎只是一长串微生物组，让我感到头晕。
If you just wrote out a bunch of Is and Ls and Ss, you'd kind of halfway-
如果你只是写了一堆 Is、Ls 和 Ss，你就半途而废了——
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Totally
完全
Andrew Huberman:
安德鲁·休伯曼：
...
...
you're getting a bit the same information.
你得到的信息有点相同。
I'm not trying to poke at that field.
我并不是想涉足那个领域。
It's a beautiful field, but they haven't told me what my microbiota ought to look like.
这是一个美丽的领域，但他们没有告诉我我的微生物群应该是什么样子。
What's a healthy microbiome chart?
什么是健康的微生物组图表？
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Well, that's because we don't know.
嗯，那是因为我们不知道。
The best we have is Rob Knight's work.
我们最好的作品是 Rob Knight 的作品。
But even that is limited in terms of can I tell you that a woman in her 20s should have this particular pattern with her microbiome?
但即便如此，我能告诉你，20 多岁的女性应该有这种特殊的微生物组模式吗？
No, I can't.
不，我不能。
So let me go to your first question because I think you just asked about six.
让我回答你的第一个问题，因为我认为你刚刚问了大约六个问题。
Your first question is about nutritional testing.
你的第一个问题是关于营养测试的。
What I like to do with nutritional testing is run a panel that's looking at antioxidants, so like vitamin A, vitamin C, alpha-lipoic acid, plant-based antioxidants, because you can measure that in the blood.
我喜欢做的营养测试是通过一个小组来观察抗氧化剂，比如维生素 A、维生素 C、α-硫辛酸、植物性抗氧化剂，因为你可以在血液中测量它们。
I like to look at some of the key vitamins, especially the B vitamin range, because as you probably know, if you've got particular genetic polymorphisms, you might be less likely to be absorbing the right level of vitamin B9, folate, vitamin B12, et cetera.
我喜欢研究一些关键维生素，尤其是 B 族维生素系列，因为您可能知道，如果您有特定的基因多态性，您可能不太可能吸收适当水平的维生素 B9、叶酸、维生素 B12 等。
I'm also looking, going back to the antioxidants, at glutathione because I think that's such an important lever when it comes to detoxification, which we haven't talked about yet.
我也在寻找，回到抗氧化剂，谷胱甘肽，因为我认为这是一个非常重要的杠杆，当谈到排毒时，我们还没有讨论过。
And then I'm looking at some of the minerals.
然后我正在研究一些矿物质。
Magnesium is really the most important, and we know that somewhere around 70 to 80% of Americans are deficient in magnesium.
镁确实是最重要的，我们知道大约 70% 到 80% 的美国人缺乏镁。
That's like the lowest hanging fruit.
这就像是最容易实现的目标。
Andrew Huberman:
安德鲁·休伯曼：
I would be curious, for instance, with magnesium, if that number of people are deficient, does that mean that that number of people should be targeting their nutrition towards foods that contain magnesium and/or supplementing with magnesium?
例如，我很好奇，如果有那么多人缺乏镁，这是否意味着那么多人应该将营养目标转向含镁食物和/或补充镁？
And if so, what forms of magnesium?
如果是的话，镁有哪些形式？
We've talked about MAG 3 and 8 for sleep.
我们已经讨论过 MAG 3 和 8 用于睡眠。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Yep.
是的。
Andrew Huberman:
安德鲁·休伯曼：
There's MAG citrate.
有 MAG 柠檬酸盐。
There's so many forms.
有很多形式啊
It can be a little bit overwhelming to people.
这对人们来说可能有点难以承受。
So any detail in sourcing, I would appreciate it.
因此，如果有任何采购细节，我将不胜感激。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Great.
太棒了。
So first, in terms of testing, what I prefer to do is to mention more than one lab and more than one brand.
因此，首先，在测试方面，我更喜欢提及多个实验室和多个品牌。
I'm speaking mostly from experience.
我主要是根据经验发言。
So for testing, I do a lot of Genova, NutrEvols.
因此，为了进行测试，我做了很多 Genova、NutrEvols。
During the pandemic, they developed an at-home test.
在大流行期间，他们开发了一种家庭测试。
Normally with a NutrEval, you have to get your blood drawn, and you have to do a urine sample.
通常使用 NutrEval，您必须抽血，并且必须采集尿液样本。
So a lot of people can't do that.
所以很多人都做不到。
The great thing about this test is your insurance usually pays for most of it, and so the copay is about $150.
这项测试的好处是您的保险通常会支付大部分费用，因此共付额约为 150 美元。
So during the pandemic, they developed another test called Metabolomics, which does much of the same testing, but it's a finger prick.
因此，在大流行期间，他们开发了另一种名为“代谢组学”的测试，该测试进行了大部分相同的测试，但只是扎手指而已。
So most of my patients prefer that.
所以我的大多数病人都喜欢这样。
In fact, they haven't gone back to the NutrEval.
事实上，他们还没有回到 NutrEval。
Second lab is SpectraCell.
第二个实验室是 SpectraCell。
I use SpectraCell occasionally.
我偶尔使用 SpectraCell。
I find it not quite as easy in terms of fitting into my practice, but I've got friends and mentors like Mark Houston, who does a lot of precision cardiometabolic health.
我发现它不太容易融入我的实践，但我有像马克·休斯顿这样的朋友和导师，他做了很多精确的心脏代谢健康方面的工作。
He thinks SpectraCell is the best test out there.
他认为 SpectraCell 是目前最好的测试。
So you asked about magnesium.
所以你问的是镁。
You have to measure red blood cell magnesium, like whole blood.
您必须测量红细胞镁，就像全血一样。
And with deficiency, it's interesting with supplementation.
有了缺乏，补充就很有趣了。
For my patients who tend toward constipation, and that's frankly about 80% of the women that I take care of.
对于我的患者来说，他们有便秘倾向，坦率地说，这大约占我照顾的女性的 80%。
Andrew Huberman:
安德鲁·休伯曼：
Really?
真的吗？
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Yes.
是的。
Andrew Huberman:
安德鲁·休伯曼：
Wow.
哇。
I'd be curious as to why that is.
我很好奇这是为什么。
I can guess.
我能猜到。
Diet, stress.
饮食、压力。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Patriarchy, rage.
父权制，愤怒。
Andrew Huberman:
安德鲁·休伯曼：
So psycho-
所以心理-
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
That they may not know about
他们可能不知道
Andrew Huberman:
安德鲁·休伯曼：
So PINE, the-
所以 PINE，-
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
The PINE system.
松树系统。
Andrew Huberman:
安德鲁·休伯曼：
Right.
对。
Psychology, immunology, neural, and endocrine factors combined.
心理学、免疫学、神经学和内分泌因素相结合。
Is that-
难道是——
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Yes.
是的。
And then I would say there's another factor, which is being female is a health hazard.
然后我想说还有另一个因素，那就是女性对健康有害。
So we have twice the rate of depression, insomnia We've got three to four X increased risk of multiple sclerosis.
因此，我们的抑郁症、失眠症发病率是原来的两倍，多发性硬化症的风险增加了三到四倍。
We've got five to eight times the risk of thyroid dysfunction.
我们患甲状腺功能障碍的风险是原来的五到八倍。
So if you just look at that, and you look at subtle preclinical thyroid dysfunction, a huge number of the women that I take care of-- Well, let me back off.
因此，如果你看看这个，看看微妙的临床前甲状腺功能障碍，我照顾的大量女性——好吧，让我退后一步。
A large number of the women that I take care of have thyroid dysfunction that's contributing to constipation.
我照顾的许多女性都患有导致便秘的甲状腺功能障碍。
And if we go back to that control system, the hypothalamic pituitary adrenal thyroid gonadal gut axis, and they have a lot of perceived stress together with this borderline thyroid function that no mainstream medicine doctor has told her is a problem, and then she's got a problem with the tango between estrogen and progesterone, she's going to tend toward constipation.
如果我们回到那个控制系统，下丘脑、垂体、肾上腺、甲状腺、性腺、肠道轴，他们有很多感知到的压力，再加上这种临界甲状腺功能，主流医学医生都没有告诉她这是一个问题，然后她的雌激素和孕激素之间的关系出现了问题，她就会倾向于便秘。
Women have a lot more constipation than men.
女性比男性更容易发生便秘。
The gut is about 10 feet longer in women compared to men.
与男性相比，女性的肠道长约 10 英尺。
Andrew Huberman:
安德鲁·休伯曼：
Hmm.
嗯。
Yeah.
是的。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
We should talk about some sex and gender differences and define those.
我们应该讨论一些性别差异并对其进行定义。
Andrew Huberman:
安德鲁·休伯曼：
Sure.
当然。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
And they are much more likely to have a torturous colon.
而且他们更有可能患有折磨人的结肠。
And the way you know that is you get a colonoscopy, and they tell you, "Yeah, it was really hard to get in there and do what we need to do."
你知道的方式是你接受结肠镜检查，他们告诉你，“是的，真的很难进入那里做我们需要做的事情。”
Andrew Huberman:
安德鲁·休伯曼：
As a brief tangent, but I think this is the time to ask.
作为一个简短的切线，但我认为现在是时候问了。
At what age now do physicians insist their female patients get colonoscopies?
现在医生坚持让女性患者在多大年龄进行结肠镜检查？
For men, I think the age used to be 50.
对于男性来说，我认为过去的年龄是50岁。
Now it's getting ratcheted back to 45 or 40.
现在它又回到了45或40。
Again, these are recommendations, not requirements, but they're pretty strong recommendations from depending on where you live, et cetera.
再次强调，这些是建议，而不是要求，但它们是非常强烈的建议，具体取决于您居住的地方等。
For women, how early do you think they should get a colonoscopy to explore for possible polyps and/or colon cancer?
对于女性，您认为她们应该多久进行结肠镜检查以探查可能的息肉和/或结肠癌？
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Yeah, it's a really good question.
是的，这是一个非常好的问题。
I don't know the answer.
我不知道答案。
So what I've always operated with is 50.
所以我一直用的是50。
The way that I answer that is to go to the US Preventive Task Force rating to determine, based on their synthesis of the data, what age is the most appropriate.
我回答的方式是去美国预防工作组的评级，根据他们对数据的综合，确定什么年龄是最合适的。
Has it changed, as you just described, for men from 50 to younger?
正如您刚才所描述的那样，对于 50 岁以下的男性来说，情况是否发生了变化？
I don't know.
我不知道。
So we should fact-check that.
所以我们应该对此进行事实核查。
Andrew Huberman:
安德鲁·休伯曼：
All these additional health hazards for women.
所有这些对女性的健康都有额外的危害。
You broadly mentioned psychological impact, right?
您广泛地提到了心理影响，对吗？
And of course, these things are all related, psychology, immunology.
当然，这些东西都是相关的，心理学、免疫学。
And one of the, I think, wonderful things about neuroscience and science in general and medicine is that there's now an understanding that all the organs are connected to one another.
我认为，神经科学、一般科学和医学的奇妙之处之一是，现在人们已经认识到所有器官都是相互联系的。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
It's a network.
这是一个网络。
Andrew Huberman:
安德鲁·休伯曼：
It's a network.
这是一个网络。
And that the microbiome sits at a key node within that network.
微生物组位于该网络内的关键节点。
And I think most people accept that now.
我认为现在大多数人都接受了这一点。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Yes.
是的。
Andrew Huberman:
安德鲁·休伯曼：
Yeah.
是的。
That seems to be a theme that, at least in the last 10 years, is really wonderful because, certainly for neuroscience, it was thought that unless it's in the cranial vault, it's not neural, which is ridiculous because there's lots of nervous system outside the skull.
至少在过去十年里，这似乎是一个非常精彩的主题，因为，当然对于神经科学来说，人们认为，除非它在颅顶，否则它不是神经的，这是荒谬的，因为头骨之外有很多神经系统。
But in any case, for-
但无论如何，为了——
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Can I interrupt for a second?
我可以打扰一下吗？
Andrew Huberman:
安德鲁·休伯曼：
Yes, please.
是的，请。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
So I think you're right that there's an understanding about the network effect.
所以我认为你对网络效应的理解是正确的。
But I think that as much as I love mainstream medicine, and I trained in it, and I'm so grateful for my education, I still think it is a silo-based way of taking care of patients.
但我认为，尽管我非常热爱主流医学，并且接受过主流医学的培训，并且非常感谢自己所受的教育，但我仍然认为这是一种孤立的照顾患者的方式。
So even if there's an understanding of the network effect more at the science level, or as you described in neuroscience, if you are a woman who has constipation, fatigue, maybe an autoimmune condition, feel stressed out all the time, feel like your hormones are out of whack, you get sent to the gastroenterologist for the constipation.
因此，即使在科学层面上对网络效应有更多的了解，或者正如您在神经科学中所描述的那样，如果您是一名患有便秘、疲劳、可能患有自身免疫性疾病、一直感到压力、感觉荷尔蒙失调的女性，您就会因便秘而被送往胃肠病专家处。
You get sent to the rheumatologist for your autoimmune issues.
由于自身免疫问题，您会被送往风湿病专家处。
You maybe get sent to an endocrinologist if you've got thyroid problems.
如果您有甲状腺问题，您可能会被送往内分泌科医生处。
And there's very little collaboration between these groups.
这些团体之间的合作很少。
So even though there's an understanding of the network effect, in real life, it's not happening.
因此，即使人们了解网络效应，但在现实生活中，它并没有发生。
Andrew Huberman:
安德鲁·休伯曼：
Let's go deeper down that path because you point out something really important, and you've mentioned constipation a few times.
让我们更深入地探讨这条道路，因为您指出了一些非常重要的事情，并且您多次提到了便秘。
Can we view constipation as a serious enough symptom that it warrants an immediate intervention?
我们是否可以将便秘视为一种足够严重的症状，需要立即干预？
That is, does it flag or signal problems that are severe enough that that should be the issue that's dealt with for anybody that's experiencing it?
也就是说，它是否标记或发出信号，问题是否足够严重，以至于应该成为遇到该问题的任何人处理的问题？
Sort of an odd topic for many people because they think, oh, bowel movements, and there's that kind of preadolescent humor around this.
对于很多人来说，这是一个奇怪的话题，因为他们认为，哦，排便，并且有一种青春期前的幽默。
But I think it's so important.
但我认为这非常重要。
What I'm hearing you say is that constipation is far more common in women, and it signals many problems occurring.
我听到你说的是，便秘在女性中更为常见，它预示着许多问题的出现。
Does that mean that women should address constipation?
这是否意味着女性应该解决便秘问题？
And if so, what's the best way to address constipation?
如果是这样，解决便秘的最佳方法是什么？
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Yeah, I love this question because you're doing-- Can we have a quick little meta conversation?
是的，我喜欢这个问题，因为你在做——我们可以进行一次简短的元对话吗？
So you're doing something that I knew you would do, which is you're teaching me something, and you're changing-- There's this social genomics thing happening where you're changing my thought about this.
所以你正在做一些我知道你会做的事情，那就是你在教我一些东西，并且你正在改变——社会基因组学的事情正在发生，你正在改变我对此的想法。
So I just wanted to acknowledge that.
所以我只是想承认这一点。
Thank you.
谢谢。
Andrew Huberman:
安德鲁·休伯曼：
Thank you.
谢谢你。
Well, I think for me, when I hear that there's a kind of-- You're talking about a phenotype.
嗯，我认为对我来说，当我听说有一种——你在谈论一种表型。
Constipation is a phenotype.
便秘是一种表型。
It's one that people generally don't wear a T-shirt explaining it to people.
人们通常不会穿着 T 恤向人们解释这一点。
But that I'm guessing anything to do with sexual health, bowel health, urology, people just don't talk about.
但我猜测与性健康、肠道健康、泌尿科有关的任何事情，人们只是不谈论。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Right.
对。
Andrew Huberman:
安德鲁·休伯曼：
For all sorts of reasons, and those reasons are probably so obvious that they're not even worth discussing.
出于各种各样的原因，这些原因可能非常明显，甚至不值得讨论。
And also because we won't change them except by talking about them.
还因为除了谈论它们之外，我们不会改变它们。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Yep.
是的。
Andrew Huberman:
安德鲁·休伯曼：
So if you say women are far more constipated and that's signaling a larger set of problems-
所以，如果你说女性便秘的情况要严重得多，那就预示着一系列更大的问题——
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Yes
是的
Andrew Huberman:
安德鲁·休伯曼：
...
...
then my immediate thought is, well, will relieving constipation, pun intended retroactively- ...
然后我立即想到的是，好吧，会缓解便秘，双关语意为追溯-......
will that assist in a great number of issues and/or will it get them down the road of thinking about those other issues more specifically?
这会有助于解决很多问题和/或会让他们更具体地思考其他问题吗？
Like, do I need more magnesium-
比如，我需要更多的镁吗？
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Yeah
是啊
Andrew Huberman:
安德鲁·休伯曼：
...
...
or should I be putting vegetables in my smoothie?
或者我应该在冰沙中加入蔬菜？
So I'm curious about constipation as a target-
所以我很好奇以便秘为目标-
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Yeah
是啊
Andrew Huberman:
安德鲁·休伯曼：
...
...
for intervention that then opens up a bunch of other discussions because there are these certain nodes in the mental health, physical health space that when someone-- We talk a lot Deliberate cold exposure.
干预措施随后引发了一系列其他讨论，因为心理健康、身体健康领域存在某些节点，当有人——我们谈论很多故意的寒冷暴露时。
Do I think it's magic?
我觉得这很神奇吗？
No. But I think that if someone's getting themselves into a cold shower once a day, it opens up a number of questions about themselves and reveals a number of things to themselves, like how do I buffer stress?
不会。但我认为，如果有人每天洗一次冷水澡，就会引发许多关于自己的问题，并向自己揭示许多事情，比如我如何缓解压力？
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Yeah.
是的。
Andrew Huberman:
安德鲁·休伯曼：
What sorts of levels of control do I actually have?
我实际上拥有什么级别的控制权？
And on and on.
不断地。
So perhaps not the best example, but-
所以也许不是最好的例子，但是-
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Some of us hate cold exposure.
我们中的一些人讨厌寒冷的环境。
Andrew Huberman:
安德鲁·休伯曼：
Right.
对。
Which is prob-
这是有可能的
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
And we have a gene that makes us stress out like you-
我们有一种基因会让我们像你一样感到压力——
Andrew Huberman:
安德鲁·休伯曼：
Right
右
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
...
...
wouldn't believe-
不会相信-
Andrew Huberman:
安德鲁·休伯曼：
Which-
其中——
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
...
...
with cold exposure
受冷暴露
Andrew Huberman:
安德鲁·休伯曼：
...
...
which I would argue makes it very likely that even 10 seconds of cold exposure gets you the effect that you want.
我认为即使是 10 秒的寒冷暴露也很可能让你达到你想要的效果。
As opposed to someone who adores cold exposure like a penguin, needs a lot more cold exposure for it to have the adaptive response.
与像企鹅一样喜欢寒冷的人相反，它需要更多的寒冷暴露才能产生适应性反应。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Maybe.
也许吧。
Andrew Huberman:
安德鲁·休伯曼：
Anyway, that's my way-
无论如何，这就是我的方式——
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Maybe
也许
Andrew Huberman:
安德鲁·休伯曼：
...
...
of gumming through that.
坚持下去。
You're quite correct.
你说得很对。
So-
所以——
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
So let's answer this question
那么我们来回答这个问题
Andrew Huberman:
安德鲁·休伯曼：
...
...
the constipation issue.
便秘问题。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Yeah.
是的。
Andrew Huberman:
安德鲁·休伯曼：
Yeah.
是的。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
So this is how you're changing the way I think about this.
这就是你改变我对此问题的看法的方式。
So you're asking, okay, instead of looking at constipation as a constellation of symptoms, what about if you just used it on its own as sort of a key indicator or signal of dysfunction with my network or maybe something broader?
所以你会问，好吧，与其将便秘视为一系列症状，不如将其单独用作我的网络功能障碍的关键指标或信号或更广泛的东西呢？
And I think that's right.
我认为这是对的。
So it makes me think of a few things.
所以这让我想到了一些事情。
You're also changing this book that I'm writing on autoimmunity and trauma, so thank you for that.
您还修改了我正在写的关于自身免疫和创伤的书，所以谢谢您。
So women experience more trauma than men.
因此，女性比男性经历更多的创伤。
This is well established.
这是众所周知的。
If you look at the ACE studies that were done by the CDC and Kaiser in 1998, we know that men, for the most part, middle-aged men, about 50% of them experience significant trauma as defined by the ACE questionnaire.
如果你看看 CDC 和 Kaiser 在 1998 年进行的 ACE 研究，我们就会知道，男性，大部分是中年男性，其中大约 50% 经历过 ACE 调查问卷所定义的严重创伤。
Women are at 60%, and that's pretty durable since 1998.
女性比例为 60%，自 1998 年以来这一比例相当稳定。
So women have more, they have different forms of abuse, much more likely to have sexual abuse.
因此，女性遭受的虐待更多，她们遭受不同形式的虐待，更有可能遭受性虐待。
They have a different HPA response than men.
她们的 HPA 反应与男性不同。
Their perceived stress tends to be higher, and I'm generalizing for a population.
他们感受到的压力往往更高，这是我针对人群进行的概括。
Side note, in precision medicine, we don't do that.
旁注，在精准医学中，我们不这样做。
We do medicine for the individual, not the population, not medicine for the average.
我们为个人而不是大众、也不是普通人提供医疗服务。
And so if you look at the physiology of a female, I think that constipation and that need to control and restrain and hold things in, tighten the anal sphincter, I think that's part of the physiology.
因此，如果你观察女性的生理机能，我认为便秘以及需要控制、抑制和控制事物，收紧肛门括约肌，我认为这是生理机能的一部分。
So I'm veering away from the science, but I do think that it is a really important signal to pay a lot of attention to.
所以我偏离了科学，但我确实认为这是一个非常重要的信号，值得高度关注。
Now, you also asked about microbiome testing.
现在，您还询问了微生物组测试。
Should we do that, or do you-
我们应该这样做，还是你——
Andrew Huberman:
安德鲁·休伯曼：
Yeah.
是的。
Well, I have a couple more questions about constipation.
嗯，我还有几个关于便秘的问题。
I never thought I'd ask this many questions about constipation- ...
我从来没想过我会问这么多关于便秘的问题-...
but now I'm fascinated.
但现在我着迷了。
By the way, also this morning, I taught medical students at Stanford about the fact that we are basically a series of tubes, so that you talked about the anal sphincter.
顺便说一句，也是在今天早上，我在斯坦福大学向医学院的学生讲授我们基本上是一系列管子的事实，所以你们谈到了肛门括约肌。
We are a set of sphincters from one end to the other.
我们是一组从一端到另一端的括约肌。
I mean, we are-
我的意思是，我们是——
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Totally
完全
Andrew Huberman:
安德鲁·休伯曼：
...
...
a set of tubes, our nervous system being one of those tubes.
一组管子，我们的神经系统就是其中一个。
And I think in Eastern medicine, they talk about the various locks between those tubes and chambers, and it's not without coincidence.
我认为在东方医学中，他们谈论这些管子和腔室之间的各种锁，这并非没有巧合。
There's some real wisdom there, of course.
当然，这里面有一些真正的智慧。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Wait, did you just talk about energetic anatomy?
等等，你刚刚谈论的是能量解剖学吗？
Andrew Huberman:
安德鲁·休伯曼：
More or less.
或多或少。
I didn't say the word chakras, but- ...
我没有说脉轮这个词，但是——
I might in passing.
我可能顺便说一下。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Well, it's the bandhas that you work with.
嗯，这就是你所使用的收束法。
Andrew Huberman:
安德鲁·休伯曼：
Exactly.
正是如此。
The bandhas, right, are the sphincters, right?
收束法，对吧，是括约肌，对吧？
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Yes.
是的。
Andrew Huberman:
安德鲁·休伯曼：
Yes, that's right.
是的，没错。
Thank you for that.
谢谢你。
So what defines constipation?
那么便秘的定义是什么？
In other words- ...
换句话说——...
let's think about the healthy rather than think about the unhealthy.
让我们考虑健康的事情，而不是考虑不健康的事情。
How many bowel movements should a woman or a man have per day, assuming, and this is where it gets tricky, because some people are doing time-restricted feeding-
假设一个女人或一个男人每天应该有多少次排便，这就是棘手的地方，因为有些人正在进行限时喂食——
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Yeah
是啊
Andrew Huberman:
安德鲁·休伯曼：
...
...
some people are eating more, some people are eating more fiber-
有些人吃得更多，有些人吃得更多纤维-
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Yeah
是啊
Andrew Huberman:
安德鲁·休伯曼：
...
...
more bulk, larger meal at the end of the day, a larger meal at the beginning of the day.
在一天结束时吃更多的食物，在一天开始时吃更多的食物。
We will never be able to sort out all those variables.
我们永远无法理清所有这些变量。
But on average, how many bowel movements, and is timing during the day for bowel movements at all informative?
但平均来说，有多少次排便以及一天中排便的时间是否能提供信息呢？
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
What works for you?
什么对你有用？
Andrew Huberman:
安德鲁·休伯曼：
Well, when I'm asleep, generally I don't want a bowel movement.
嗯，当我睡着的时候，我通常不想排便。
So I'm going to be-
所以我会——
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Good
好
Andrew Huberman:
安德鲁·休伯曼：
...
...
like most people, right?
像大多数人一样，对吧？
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Well, sleep is primary for you.
嗯，睡眠对你来说是最重要的。
Andrew Huberman:
安德鲁·休伯曼：
Right, exactly.
对，完全正确。
I always assumed that morning time-
我一直以为早上的时候——
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Yeah
是啊
Andrew Huberman:
安德鲁·休伯曼：
...
...
was a healthy time for-
是一段健康的时光——
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Yes
是的
Andrew Huberman:
安德鲁·休伯曼：
...
...
bowel movements.
排便。
And I think almost everybody, babies included, recognize the feeling of being lighter and more energetic when they've evacuated-
我想几乎每个人，包括婴儿，都体会到撤离后变得更轻松、更有活力的感觉——
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Totally
完全
Andrew Huberman:
安德鲁·休伯曼：
...
...
their colon.
他们的冒号。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Totally.
完全可以。
Andrew Huberman:
安德鲁·休伯曼：
In fact, so much so that I'm obsessed with Jungian and Freudian psychology, that the first thing we learn when we come into this world is that we want something, we feel some sort of autonomic arousal stress-
事实上，以至于我对荣格和弗洛伊德心理学很着迷，当我们来到这个世界时，我们学到的第一件事就是我们想要某种东西，我们感受到某种自主唤醒压力——
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Yes
是的
Andrew Huberman:
安德鲁·休伯曼：
...
...
whether or not it's food or warmth or the need to have a bowel movement, and one of the first things that parents learn is how to recognize that not by the odor coming from the diaper, but by the look on the baby's face-
无论是食物、温暖还是需要排便，父母首先要学会的一件事就是如何识别这一点，不是通过尿布的气味，而是通过婴儿脸上的表情——
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Absolutely
绝对
Andrew Huberman:
安德鲁·休伯曼：
...
...
or their agitation.
或他们的激动。
Agitation signals the need for some sort of relief, right?
焦虑表明需要某种缓解，对吧？
Temperature relief, food relief, evacuating the bowel relief.
温解，消食，通便解。
So my understanding is that as autonomic arousal increases in the early part of the day, ideally after a good night's sleep, that bowel movements become more likely, unless that arousal becomes so great that then people feel so, quote-unquote, "locked up"-
所以我的理解是，随着自主神经的唤醒在一天的早些时候增加，最好是在睡个好觉之后，排便的可能性就会变得更大，除非这种唤醒变得如此强烈，以至于人们感觉如此，引用不引用，“被锁住了”——
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Right
右
Andrew Huberman:
安德鲁·休伯曼：
...
...
because of the balance of the autonomics of features.
因为功能的自主性的平衡。
So early day, I'm guessing, and again in the second half of the day, and here I'm totally guessing, and certainly not having to wake in the middle of the night.
我猜是在清晨，然后是在后半天，这里我完全是猜测，当然不必在半夜醒来。
Yeah, those are my best guesses.
是的，这些是我最好的猜测。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
That's great.
太好了。
So I would agree with that.
所以我同意这一点。
When I was at Harvard Medical School and UCSF for residency, I was taught that constipation is having a bowel movement less frequently than once every three days.
当我在哈佛医学院和加州大学旧金山分校实习时，我被告知便秘是指排便频率低于每三天一次。
Andrew Huberman:
安德鲁·休伯曼：
Sorry, I don't think I've ever laughed out loud on this podcast as a consequence of textbook medical knowledge.
抱歉，我想我从来没有因为教科书上的医学知识而在这个播客上大笑过。
Are you kidding me?
你在开玩笑吧？
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Is that ridiculous?
这很可笑吗？
Andrew Huberman:
安德鲁·休伯曼：
Well, that sounds like, and here pun intended, that sounds like the conclusion of some very-
嗯，这听起来像是，这里是双关语，听起来像是一些非常-
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Constipated person?
便秘的人？
Andrew Huberman:
安德鲁·休伯曼：
...
...
emotionally and in other ways constipated individuals.
情感上和其他方面便秘的人。
And again, this might seem like an odd conversation, but the discussion around constipation is present in psychological literature-
再说一遍，这似乎是一次奇怪的对话，但关于便秘的讨论存在于心理学文献中——
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Yes
是的
Andrew Huberman:
安德鲁·休伯曼：
...
...
because of this relationship to the autonomic system.
因为与自主系统的这种关系。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Well, it's a metaphor in literature.
嗯，这是文学中的一个比喻。
It's crucial.
这很关键。
So you spoke to a number of different threads that I think are important here.
所以你谈到了一些我认为在这里很重要的不同主题。
So that's the definition that I learned, and I heard that and I was like, "Hell no. That doesn't work for me, doesn't work for anyone I know." And I spent a lot of time, especially in medical school and in my internship where you rotate on medicine, dis-impacting women, like older women who come in who haven't had a bowel movement in a month.
这就是我学到的定义，当我听到这个定义时，我想，“天哪，不。这对我不起作用，对我认识的任何人都不起作用。”我花了很多时间，特别是在医学院和实习期间，轮流从事医学工作，以消除对女性的影响，比如进来一个月没有排便的老年女性。
Andrew Huberman:
安德鲁·休伯曼：
Whoa.
哇哦。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
And let me tell you, that is not nice for anybody.
让我告诉你，这对任何人都不好。
Andrew Huberman:
安德鲁·休伯曼：
Yeah.
是的。
Believe me, I became a scientist, not a physician, for a number of reasons.
相信我，出于多种原因，我成为一名科学家，而不是一名医生。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
That's one of them.
这是其中之一。
Andrew Huberman:
安德鲁·休伯曼：
Both positive and negative.
既有积极的也有消极的。
That's one of them.
这是其中之一。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Yeah.
是的。
So my definition of constipation as a Western, mostly white girl, is that if you're not having a bowel movement every single morning and you have a feeling of complete evacuation, anything less than that is constipation.
因此，作为一个西方（主要是白人）女孩，我对便秘的定义是，如果您每天早上没有排便并且有一种完全排空的感觉，那么任何低于此的感觉都是便秘。
So that's how I define it.
这就是我的定义。
If you're in India and you're eating food that's got a fair amount of microbes in it, it's less sanitary, I'm using that word as carefully as I can.
如果你在印度，吃的食物中含有大量微生物，那就不太卫生，我会尽可能谨慎地使用这个词。
Generally, they have a bowel movement after every meal, but they've got a different microbiome.
一般来说，他们每顿饭后都会排便，但他们的微生物群不同。
They're exposed to different microbes.
他们接触不同的微生物。
Here in the US, I would say once a day.
在美国，我会说每天一次。
You also spoke to something very important, which is the balance between the parasympathetic nervous system, rest and digest and poop, versus the sympathetic nervous system, kind of the on button, fight, flight, freeze, fawn.
您还谈到了一些非常重要的事情，即副交感神经系统（休息、消化和便便）与交感神经系统（类似于启动按钮、战斗、飞行、冻结、小鹿）之间的平衡。
So I think for those of us who've got issues with autonomic balance, it can lead to constipation, and I like that constipation could be pulled out and kind of writ larger as an important signal.
所以我认为对于我们这些有自主神经平衡问题的人来说，它可能会导致便秘，我喜欢便秘可以被拉出来，并且可以作为一个重要的信号。
Andrew Huberman:
安德鲁·休伯曼：
What sorts of tools do you recommend people use to relieve constipation?
您建议人们使用哪些工具来缓解便秘？
In eating more fiber, sounds like reducing stress is going to be a huge one.
吃更多的纤维，听起来对减轻压力有很大的帮助。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Yes.
是的。
Andrew Huberman:
安德鲁·休伯曼：
What are your favorite stress reduction tools?
您最喜欢的减压工具是什么？
I like to divide these into real-time tools, so big proponent of physiological sighing, real time, these sorts of things, but things that can really lower the baseline on stress overall to facilitate constipation and other broad indicators of health.
我喜欢将这些工具分为实时工具，生理叹息的大力支持者，实时的诸如此类的东西，但真正可以降低整体压力基线以促进便秘和其他广泛的健康指标的东西。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
So I'm not a fan of lowering stress.
所以我不喜欢减轻压力。
I'm a fan of lowering perceived stress, and I think the distinction is really important.
我热衷于降低感知压力，我认为这种区别非常重要。
I learned when I was in my 30s that I was a massive stress case, and I didn't know it.
当我 30 多岁的时候，我发现自己压力很大，但我自己并不知道。
It was just sort of, I think through residency, through working 120 hours a week, I just was so accustomed and sort of-
我想，通过实习，通过每周工作 120 个小时，我已经习惯了，而且有点——
Andrew Huberman:
安德鲁·休伯曼：
That was 120-
那是120-
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
...
...
and trained
并训练有素
Andrew Huberman:
安德鲁·休伯曼：
...
...
not under 20, folks.
不低于20岁，伙计们。
Yeah.
是的。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Yeah.
是的。
This was before-
这是之前的——
Andrew Huberman:
安德鲁·休伯曼：
Not unusual in medicine
在医学上并不罕见
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Well, they've changed training so that you work no more than 80 hours a week now, but that was before my time.
嗯，他们改变了培训方式，现在每周工作时间不超过 80 小时，但那是在我之前。
So I became accustomed to a massive amount of cortisol.
所以我习惯了大量的皮质醇。
Massive.
大量的。
And I would say I've spent the past 20 years really working on perceived stress to find, I think all of us need an à la carte menu of what is most effective.
我想说，在过去的 20 年里，我一直致力于研究感知压力，以找到最有效的方法，我认为我们所有人都需要一份菜单。
So what works for me now at my age is different than the TM I did as a college student, transcendental meditation.
所以现在对我这个年纪有效的方法与我在大学时所做的TM不同，那就是超验冥想。
It's different than the...
它不同于...
I became a certified yoga teacher when I was in my 30s.
我在30多岁的时候成为了一名经过认证的瑜伽老师。
That is very effective for a lot of people.
这对很多人来说非常有效。
It wasn't enough for my matrix.
这对于我的矩阵来说还不够。
I do holotropic breathwork.
我做全息呼吸。
I didn't read it, but I saw that you just had a paper in Cell on your sighing, and it made me think like, "Teach me how to sigh.
我没读过，但我看到你刚刚在《细胞》杂志上发表了一篇关于你叹息的论文，这让我想，“教我如何叹息。
Teach me how to sigh." Can you say a little bit about that?
教我如何叹息。”你能简单说一下吗？
Andrew Huberman:
安德鲁·休伯曼：
Sure.
当然。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
How do you do it?
你怎么做？
Andrew Huberman:
安德鲁·休伯曼：
Yeah.
是的。
Very briefly, that study was we wanted to find a minimal effective dose intervention.
简而言之，该研究是我们想要找到最小有效剂量干预。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Yeah, five minutes.
是的，五分钟。
Andrew Huberman:
安德鲁·休伯曼：
So I just wanted-
所以我只是想——
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Five minutes.
五分钟。
Andrew Huberman:
安德鲁·休伯曼：
Yeah.
是的。
So five minutes a day.
所以每天五分钟。
We needed to figure out what people do every day.
我们需要弄清楚人们每天都在做什么。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Yeah.
是的。
Andrew Huberman:
安德鲁·休伯曼：
And we were monitoring subjective mood, et cetera, but also biometrics remotely.
我们不仅监控主观情绪等，还远程监控生物识别。
So it's kind of a nice study.
所以这是一项很好的研究。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Which biometrics?
哪种生物识别技术？
HRV?
心率变异性？
Andrew Huberman:
安德鲁·休伯曼：
HRV, nighttime sleep.
HRV，夜间睡眠。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Cortisol?
皮质醇？
Andrew Huberman:
安德鲁·休伯曼：
I wish.
我希望。
So this was done during the pandemic, more than 100 subjects.
这是在疫情期间完成的，有 100 多个受试者。
The advantage was that we got data 24 hours a day because they're pinging us in their data, wearing these whoop bands.
这样做的好处是我们每天 24 小时都能获取数据，因为他们戴着这些百日带，在数据中向我们发出 ping 信号。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
HRV 24?
心率变异性24？
Andrew Huberman:
安德鲁·休伯曼：
Yeah.
是的。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Nice.
不错。
Andrew Huberman:
安德鲁·休伯曼：
So that was nice.
所以那很好。
Resting heart rate, subjective mood.
静息心率、主观情绪。
We would get in touch with them daily.
我们每天都会与他们联系。
So when people were swapped between groups, like any good study, but five minutes a day of sort of standard, if you will, forgive me, meditation.
因此，当人们在小组之间交换时，就像任何好的学习一样，但每天五分钟的标准冥想，如果你愿意的话，请原谅我。
So just sitting, no instructions about how to breathe, just closing their eyes and focusing on focusing.
所以只是坐着，没有关于如何呼吸的指导，只是闭上眼睛，集中精力。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Yep.
是的。
Andrew Huberman:
安德鲁·休伯曼：
Another group did box breathing.
另一组则进行箱式呼吸。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Yep.
是的。
Andrew Huberman:
安德鲁·休伯曼：
Inhale hold, exhale hold for equal durations.
吸气保持，呼气保持相同的时间。
The duration of each of those inhales and holds was set by their carbon dioxide tolerance.
每次吸气和保持的持续时间由他们的二氧化碳耐受性决定。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Hmm.
嗯。
Andrew Huberman:
安德鲁·休伯曼：
So somewhere between three and eight seconds-
所以大约在三到八秒之间——
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Yep
是的
Andrew Huberman:
安德鲁·休伯曼：
...
...
depending on how well they regulate carbon dioxide.
取决于它们调节二氧化碳的程度。
Another group did cyclic sighing, so this would be double inhale through the nose.
另一组则进行循环叹气，因此这将是通过鼻子进行两次吸气。
So big inhale through the nose followed by a two lungs empty exhale.
通过鼻子深深吸气，然后两肺空呼。
That second inhale after the first big lung inhale through the nose is really important because it makes sure that all the collapsed alveoli of the lungs-
通过鼻子第一次大肺吸气后的第二次吸气非常重要，因为它确保所有塌陷的肺泡 -
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Totally
完全
Andrew Huberman:
安德鲁·休伯曼：
...
...
snap open, and then the exhale, you offload a lot of the carbon dioxide.
猛地打开，然后呼气，你就会排出大量的二氧化碳。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
That's very similar to holotropic breathwork.
这与全息呼吸非常相似。
Andrew Huberman:
安德鲁·休伯曼：
Yes.
是的。
Not unlike holotropic breathwork.
与全息呼吸没什么不同。
A little bit pranayama-ish.
有点调息。
But the exhale is rather passive as opposed to active.
但呼气是被动的而不是主动的。
And then the fourth category was cyclic hyperventilation, which is a lot like Tummo, AKA Wim Hof-ish breathing.
第四类是周期性过度换气，这很像 Tummo，又名 Wim Hof 式呼吸。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Yeah.
是的。
Andrew Huberman:
安德鲁·休伯曼：
Different than Wim Hof breathing.
与 Wim Hof 的呼吸不同。
So this would be So very active inhales and exhales every 25 cycles of inhale, exhale, that'll be one cycle.
所以这将是非常活跃的吸气和呼气，每 25 个吸气、呼气周期，这将是一个周期。
Long exhale, hold lungs empty 15 to 30 seconds, then repeat for about five minutes.
长时间呼气，保持肺部排空 15 至 30 秒，然后重复约五分钟。
Everyone did that for five minutes.
每个人都这样做了五分钟。
And what we found was that the cyclic sighing led to the greatest improvements in mood around the clock, not just around the practice or during the practice, as well as lowered resting heart rate, improvements in sleep, et cetera.
我们发现，周期性叹息可以带来全天候的最大情绪改善，而不仅仅是在练习期间或练习期间，以及降低静息心率、改善睡眠等等。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
And you got it published in Cell.
你把它发表在《细胞》杂志上。
Andrew Huberman:
安德鲁·休伯曼：
Yeah, we were very fortunate.
是的，我们非常幸运。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
It's so amazing.
太神奇了。
Andrew Huberman:
安德鲁·休伯曼：
Yeah, very fortunate.
是啊，非常幸运。
I think thankfully, the reviewers and editors understood that these minimal intervention things hopefully are going to be of use to people.
我认为值得庆幸的是，审稿人和编辑明白这些最小的干预措施有望对人们有用。
So-
所以——
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
So useful to people.
对人们如此有用。
Andrew Huberman:
安德鲁·休伯曼：
Thank you.
谢谢你。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
How often do you read a paper like that, that could offer a behavior change that is so easy to implement?
您多久读一次这样的论文，它可以提供如此容易实施的行为改变？
I love that question.
我喜欢这个问题。
Andrew Huberman:
安德鲁·休伯曼：
Thank you.
谢谢你。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
So what about, did you tell them not to drink?
那你有没有告诉他们不要喝酒呢？
Because alcohol has such a huge effect on HRV.
因为酒精对 HRV 的影响非常大。
Andrew Huberman:
安德鲁·休伯曼：
Yeah.
是的。
So in this case, we didn't tell them to alter anything else about their behavior.
因此，在这种情况下，我们没有告诉他们改变任何其他行为。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Just hoping it was background kind of across this-
只是希望这是背景——
Andrew Huberman:
安德鲁·休伯曼：
That's right
没错
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
...
...
all grids.
所有网格。
Andrew Huberman:
安德鲁·休伯曼：
Yes, and some were Stanford students, others were from the general population.
是的，有些是斯坦福大学的学生，其他的是普通民众。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Any frat boys that were drinking heavily?
有没有酗酒的兄弟会男孩？
Andrew Huberman:
安德鲁·休伯曼：
Probably not.
可能不会。
Well, during the pandemic, I think alcohol intake went way up across the board.
嗯，在大流行期间，我认为酒精摄入量全面上升。
Listen, if I had a magic wand, I would ask that people either not drink or drink two drinks per week maximum.
听着，如果我有一根魔杖，我会要求人们要么不喝酒，要么每周最多喝两杯。
At least that's my understanding of the literature.
至少这是我对文学的理解。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Are you familiar with the WHOOP data with alcohol?
您熟悉 WHOOP 的酒精数据吗？
Andrew Huberman:
安德鲁·休伯曼：
No, but we have a collaboration with WHOOP through that paper.
不，但我们通过那篇论文与 WHOOP 进行了合作。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Yeah.
是的。
Andrew Huberman:
安德鲁·休伯曼：
And it certainly disrupts patterns of nighttime sleep, in particular, from my understanding, that first phase of sleep that's related to the massive growth hormone release-
它肯定会扰乱夜间睡眠模式，特别是根据我的理解，睡眠的第一阶段与大量生长激素的释放有关-
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Yes
是的
Andrew Huberman:
安德鲁·休伯曼：
...
...
that we all really need and want in the first-
我们首先真正需要和想要的-
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
And you didn't measure growth hormone?
你没测生长激素吗？
Andrew Huberman:
安德鲁·休伯曼：
We did not.
我们没有。
No. The second iteration of this study will certainly include free cortisol by saliva.
不会。这项研究的第二次迭代肯定会包括唾液中的游离皮质醇。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
A hormone panel?
激素面板？
Andrew Huberman:
安德鲁·休伯曼：
Yeah, hormone panels.
是的，激素面板。
Well, I'm beginning to think that we should also be asking people how often they're going to the bathroom and what time of day.
嗯，我开始认为我们还应该询问人们去洗手间的频率以及一天中的什么时间。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Yes.
是的。
Andrew Huberman:
安德鲁·休伯曼：
This thing around constipation is super interesting, and I think that plus blood markers, and then I'm very excited to learn that urine contains additional markers that could be informative.
关于便秘的事情非常有趣，我认为加上血液标记物，然后我很高兴得知尿液中含有其他可以提供信息的标记物。
So yeah, it was a fun study.
是的，这是一项有趣的研究。
Not an easy study to do with that number of subjects.
对如此多的受试者进行研究并不容易。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Takes a lot of training for your research assistants.
需要对你的研究助理进行大量培训。
Andrew Huberman:
安德鲁·休伯曼：
Yeah, it was a big group.
是的，那是一个大团体。
It was nine people in our group and three clinicians, and a lot of phone calls, and a lot of back and forth.
我们小组有九个人和三名临床医生，打了很多电话，也进行了很多来回。
And thank you to the subjects who served as the-
感谢你们担任-
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Yay
耶
Andrew Huberman:
安德鲁·休伯曼：
...
...
the real-life guinea pigs.
现实生活中的豚鼠。
So yeah, I think people are starting to appreciate that there are ways that they can relieve their stress that don't only fall under the categories of vacation-
所以，是的，我认为人们开始意识到，有一些方法可以缓解压力，而这些方法不仅仅属于假期——
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Right
右
Andrew Huberman:
安德鲁·休伯曼：
...
...
and meditation.
和冥想。
But I want to say that meditation is obviously a wonderful tool.
但我想说，冥想显然是一个很棒的工具。
It's just it's a tool not unlike any other tool that it is great for some people and less great for others.
它只是一个工具，与任何其他工具没有什么不同，它对某些人来说很好，但对其他人来说不太好。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Well, certainly it's a great tool, and it's got such a scientific basis behind it.
嗯，当然这是一个很棒的工具，而且它背后有这样的科学基础。
But there's so many things on this à la carte menu.
但这个点菜菜单上有很多东西。
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Sex, orgasm, connection, feeling heard and seen and loved.
性、性高潮、联系、被听到、被看到和被爱的感觉。
Andrew Huberman:
安德鲁·休伯曼：
Yeah, let's talk about that.
是的，我们来谈谈这个吧。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Yeah.
是的。
Andrew Huberman:
安德鲁·休伯曼：
You mentioned earlier that all these stress factors, you said patriarchy, right?
你之前提到所有这些压力因素，你说父权制，对吗？
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Yeah.
是的。
Andrew Huberman:
安德鲁·休伯曼：
But I think, if I may, at risk of just strengthening that statement, that to me is signaling a bunch of other factors around, as you said-
但我认为，如果可以的话，冒着强化这一声明的风险，对我来说，这表明了周围的一系列其他因素，正如你所说的-
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Yes
是的
Andrew Huberman:
安德鲁·休伯曼：
...
...
keeping things in.
把东西放进去。
What do you think explains...
你觉得怎么解释...
Let's talk about that, because I think that's likely to have raised a certain flag in people's minds, like, what exactly is she talking about?
让我们来谈谈这个，因为我认为这可能会在人们的脑海中升起某种旗帜，比如，她到底在说什么？
Are you talking about less opportunity?
你是说机会少吗？
Are you talking about less opportunity to vocalize?
您是在谈论发声的机会减少吗？
Are you talking about less opportunity to vocalize and be heard?
您是在谈论发声和被听到的机会减少吗？
I realize that there are an infinite number of variables, but given that it sounds like a really strong input to the system, what I mean by that is that psychology is influencing biology, and you're saying that these power dynamics, structures and dynamics, are impacting it.
我意识到变量有无数个，但考虑到这听起来像是对系统的一个非常强大的输入，我的意思是心理学正在影响生物学，而你是说这些权力动态、结构和动态正在影响它。
Let's hear your thoughts on that, because I hate to let a flag like that go by without fleshing it out.
让我们听听你对此的想法，因为我讨厌让这样的旗帜在没有充实它的情况下就过去。
And let's-
让我们-
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Never waste a good flag.
永远不要浪费一面好旗帜。
Andrew Huberman:
安德鲁·休伯曼：
Well, and let's preface it by just saying that people will have different opinions on this, and I think that's healthy, and like with the discussion about constipation, let's talk about what people aren't willing to talk about when it comes to health.
好吧，让我们先说一下，人们对此会有不同的看法，我认为这是健康的，就像讨论便秘一样，让我们谈谈人们在健康方面不愿意谈论的事情。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Love it.
喜欢它。
So we might need to talk about patriarchy on part two, but I'll give you some material that I've been working with.
所以我们可能需要在第二部分讨论父权制，但我会给你一些我一直在研究的材料。
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
I did not even understand the existence of patriarchy until I was a bioengineering undergraduate at-
我什至不明白父权制的存在，直到我成为一名生物工程本科生。
Andrew Huberman:
安德鲁·休伯曼：
At MIT, I should mention, which has always had a bit of a skewed male in terms of-
我应该提一下，在麻省理工学院，在以下方面一直有一些偏向男性的现象——
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
You think so?
你这么认为吗？
Andrew Huberman:
安德鲁·休伯曼：
...
...
faculty numbers.
教员人数。
Well, my-
好吧，我的——
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Well, that's true at most universities.
嗯，大多数大学都是如此。
Andrew Huberman:
安德鲁·休伯曼：
True.
确实如此。
Well, my postdoc advisor was the late Ben Barres, who was a female to male transition transgender.
嗯，我的博士后导师是已故的本·巴雷斯（Ben Barres），他是一位女性向男性过渡的跨性别者。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Interesting.
有趣。
Andrew Huberman:
安德鲁·休伯曼：
First transgender member of the National Academy of Sciences, one of my closest friends.
美国国家科学院第一位变性人成员，我最亲密的朋友之一。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
That's awesome.
太棒了。
Andrew Huberman:
安德鲁·休伯曼：
Unfortunately, he died of pancreatic cancer.
不幸的是，他死于胰腺癌。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Mm.
嗯。
Andrew Huberman:
安德鲁·休伯曼：
But we were very close.
但我们非常接近。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Yeah.
是的。
Andrew Huberman:
安德鲁·休伯曼：
They're actually making a documentary about Ben.
他们实际上正在制作一部关于本的纪录片。
But Ben, this is interesting, Ben went to MIT-
但是本，这很有趣，本去了麻省理工学院-
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Mm
毫米
Andrew Huberman:
安德鲁·休伯曼：
...
...
because he wanted to be around a lot of men.
因为他想和很多男人在一起。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Yeah.
是的。
Andrew Huberman:
安德鲁·休伯曼：
That's a lesser-known fact.
这是一个鲜为人知的事实。
But then he was a very strong advocate for women.
但后来他是女性的坚定拥护者。
He went as Barbara when he was Barbara, and by the way, he's given me permission to share all this.
当他还是芭芭拉时，他就以芭芭拉的身份去了，顺便说一句，他允许我分享这一切。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Amazing.
太棒了。
Andrew Huberman:
安德鲁·休伯曼：
Prior to his death, I recorded a lot of conversations with Ben.
在他去世之前，我录制了很多与本的对话。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Yeah.
是的。
Andrew Huberman:
安德鲁·休伯曼：
I only ever knew him as Ben, by the way.
顺便说一句，我只知道他叫本。
But when he was at MIT, he was identified female, and he later talked about the intense suppression, oppression, literally is how he described it, especially given that he was performing so well.
但当他在麻省理工学院时，他被认定为女性，后来他谈到了强烈的压制，压迫，字面意思就是他所描述的，特别是考虑到他表现得那么好。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Yes.
是的。
So you just defined patriarchy.
所以你刚刚定义了父权制。
You did it yourself.
你自己做的。
A couple things.
有几件事。
When I was in bioengineering, I took a women's studies class, and it was all about ...
当我在生物工程专业时，我参加了女性研究课程，这都是关于......
teaching undergraduates about the existence of patriarchy, which I would define maybe at its simplest as power over.
向本科生讲授父权制的存在，我将其最简单的定义为权力之上。
I'm not saying men are patriarchy, I'm saying something very different, which is power over.
我并不是说男人是父权制，我说的是非常不同的东西，那就是权力之上。
Let me correct one thing that you said.
让我纠正你说的一件事。
I didn't go to MIT as an undergraduate.
我本科时没有去麻省理工学院。
So I was in Alaska, and I went to the University of Washington for bioengineering.
所以我在阿拉斯加，去了华盛顿大学学习生物工程。
Andrew Huberman:
安德鲁·休伯曼：
In Seattle.
在西雅图。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
In Seattle.
在西雅图。
Andrew Huberman:
安德鲁·休伯曼：
Okay.
好的。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
I dropped out of a graduate program in bioengineering to go to the Harvard MIT program for Health Sciences and Technology in Boston.
我从生物工程研究生课程中退学，前往波士顿的哈佛大学麻省理工学院健康科学与技术项目。
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Thanks for that clarification.
感谢您的澄清。
University of Washington, also a wonderful place.
华盛顿大学，也是一个美妙的地方。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Yeah.
是的。
It's a great place.
这是一个很棒的地方。
Andrew Huberman:
安德鲁·休伯曼：
I have many, many, many, many, many wonderful close colleagues there.
我在那里有很多很多很多优秀的亲密同事。
It's an incredible place, especially for vision science.
这是一个令人难以置信的地方，尤其是对于视觉科学而言。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
It's especially good for engineering-
这对工程特别有好处——
Andrew Huberman:
安德鲁·休伯曼：
Mm
毫米
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
...
...
bioengineering.
生物工程。
But, yeah, so my MD is jointly between MIT and Harvard, and it's the oldest, maybe largest, although Harvard says this a lot, program for biomedical engineers and MD/PhDs, physician scientist training program.
但是，是的，我的医学博士是麻省理工学院和哈佛大学联合设立的，它是最古老的，也许是最大的，尽管哈佛大学说了很多，针对生物医学工程师和医学博士/博士的项目，医师科学家培训项目。
Andrew Huberman:
安德鲁·休伯曼：
Great.
太棒了。
Thanks for that clarification.
感谢您的澄清。
I'm going to blame the internet for this one.
我要把这件事归咎于互联网。
I am.
我是。
I think we need to send our Wikipedia editors out-
我认为我们需要派我们的维基百科编辑出去-
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
I think LinkedIn is correct.
我认为 LinkedIn 是正确的。
Andrew Huberman:
安德鲁·休伯曼：
Okay, great.
好的，太好了。
Well, Wikipedia editors, note.
好吧，维基百科编辑们，请注意。
Get out there and make the correction now you heard it.
你听到了就赶紧出去纠正吧。
So what you're really talking about is systemic stress in the body as a consequence of systemic stress of environment.
所以你真正谈论的是身体的系统压力，这是环境系统压力的结果。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
That's right.
没错。
But there's particular forms of it.
但它有特定的形式。
I would say this also relates to white privilege, it relates to racism, and when you look at the way that systems, including my beloved MIT, the way that they're set up is that might makes right, and generally, the people that are the strongest, big men, strong men, they're the ones who tend to be the most successful.
我想说这也与白人特权有关，与种族主义有关，当你看看这些系统的方式时，包括我心爱的麻省理工学院，它们的设置方式是强权即正义，一般来说，最强大的人，大人物，强人，他们往往是最成功的人。
So for people who are BIPOC, for people who don't have white privilege, for women, it's a different experience.
因此，对于 BIPOC 的人、没有白人特权的人、对于女性来说，这是一种不同的体验。
And so I'm using patriarchy as kind of an umbrella here, but it connects to many other things.
所以我在这里使用父权制作为保护伞，但它与许多其他事物有关。
Andrew Huberman:
安德鲁·休伯曼：
I want to use this as an opportunity to, A, keep this in mind as we turn to a question that I didn't close the hatch on earlier, and it's my fault, which is I'm now clear on the fact that a woman in her late teens, early 20s ought to know something about her testosterone, estrogen, thyroid, cortisol levels, should start at least thinking about her microbiome, should be thinking about how many bowel movements and the timing of those bowel movements per day, really.
我想以此为契机，A，在我们转向一个我没有早点解决的问题时牢记这一点，这是我的错，我现在清楚地认识到这样一个事实：一个十几岁、二十岁出头的女性应该了解她的睾酮、雌激素、甲状腺、皮质醇水平，至少应该开始考虑她的微生物组，应该考虑每次排便次数和排便时间。一天，真的。
And I'm assuming that what I just described is also true for women in their 20s, 30s, 40s, 50s, on up to 100s.
我假设我刚才描述的情况也适用于 20 多岁、30 多岁、40 多岁、50 多岁、甚至 100 多岁的女性。
Is that correct?
这是正确的吗？
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
That's correct, but I would say that there are differential opportunities by decade.
这是正确的，但我想说的是，十年间机会有所不同。
So I'm glad you circled it back to teenagers and testosterone, because I think if you know, for instance, in your teenage years that you have high androgens and that you've got this potential phenotype way into the future that you may not even notice.
所以我很高兴你把它带回青少年和睾丸激素，因为我认为，如果你知道，例如，在你十几岁的时候，你的雄激素水平很高，并且你在未来可能不会注意到这种潜在的表型。
Maybe you notice you've got a few extra hairs on your chin or something.
也许您注意到下巴或其他地方有一些多余的毛发。
If you know that your testosterone is elevated or some other androgen, it might change the arc of how you take care of yourself.
如果您知道您的睾酮或其他雄激素升高，它可能会改变您照顾自己的方式。
So I think that could be very helpful in your teenage years.
所以我认为这对你的青少年时期非常有帮助。
In your 20s, for people who are a stress case like me, so age 27 on the words at UCSF, if I had known that I was such a high cortisol person, I think I would've done things differently.
在你 20 多岁的时候，对于像我这样有压力的人来说，27 岁就在加州大学旧金山分校的话，如果我知道我是一个皮质醇如此高的人，我想我会做不同的事情。
I would've changed my behavior.
我会改变我的行为。
And I don't know because I didn't base case these, but your testosterone can decline starting in your 20s, kind of depending on how much stress your matrix is under.
我不知道，因为我没有对这些进行基本假设，但你的睾酮激素会从 20 多岁开始下降，这取决于你的基质承受的压力有多大。
So for women, that can start as early as 28.
所以对于女性来说，最早可以从 28 岁开始。
Usually, your testosterone declines by about 1% per year.
通常，您的睾酮激素每年下降约 1%。
Andrew Huberman:
安德鲁·休伯曼：
What level of testosterone do you like to see in a woman, let's say after age 25?
您希望女性 25 岁之后的睾丸激素水平达到什么水平？
What kind of range is healthy?
什么样的范围才是健康的？
I know what the reference range is, only because I know one could look it up.
我知道参考范围是多少，只是因为我知道人们可以查到它。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Yeah.
是的。
Andrew Huberman:
安德鲁·休伯曼：
I don't know it off the top of my head, admittedly.
诚然，我根本不知道这一点。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Yeah.
是的。
Andrew Huberman:
安德鲁·休伯曼：
But what's a kind of a nice reference point there?
但是那里有什么好的参考点呢？
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
So the way I tend to describe this on podcasts is the top half of the normal range.
因此，我倾向于在播客上描述这一点的方式是正常范围的上半部分。
Andrew Huberman:
安德鲁·休伯曼：
Great.
太棒了。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
So that I think is a good benchmark.
所以我认为这是一个很好的基准。
For PCOS, generally, it's much higher than that.
对于 PCOS，一般来说，这个数字要高得多。
I've seen patients with PCOS where their total testosterone is 100 to 200.
我见过 PCOS 患者的总睾酮水平为 100 到 200。
But-
但是——
Andrew Huberman:
安德鲁·休伯曼：
Do they always have peripheral manifestations of that?
他们总是有这种外围表现吗？
A little bit of hair, the skin plaques I've heard about, so darkened skin plaques-
一点头发，我听说过的皮肤斑块，所以变黑的皮肤斑块-
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Irregular periods
经期不规律
Andrew Huberman:
安德鲁·休伯曼：
...
...
irregular periods.
不规律的经期。
I get a lot of questions about PCOS.
我收到很多关于多囊卵巢综合症的问题。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Yeah.
是的。
Andrew Huberman:
安德鲁·休伯曼：
And you're the first person we've had on this podcast that's really qualified to talk about PCOS in a real way.
你是我们这个播客中第一个真正有资格真正谈论多囊卵巢综合症的人。
So here we're talking about too many androgens, cysts on the ovary, irregular ovarian men- sla- oh, excuse me, I keep saying that, ovulatory/menstrual cycle.
所以这里我们谈论的是雄激素过多、卵巢囊肿、卵巢月经不规律——哦，对不起，我一直在说，排卵/月经周期。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Right.
对。
Andrew Huberman:
安德鲁·休伯曼：
What are some other indicators, and do you recommend that women start taking androgen blockers?
还有哪些其他指标？您是否建议女性开始服用雄激素阻滞剂？
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Mm-hmm.
嗯嗯。
Andrew Huberman:
安德鲁·休伯曼：
There seems to be a lot of PCOS out there.
那里似乎有很多多囊卵巢综合症。
I'm hearing about it a lot.
我经常听到这件事。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
So glad you asked about this.
很高兴你问到这个问题。
So PCOS is one of those really poorly understood conditions that kind of flies below the radar until a woman wants to get pregnant, or she's got some other issue that drives her to a physician.
因此，多囊卵巢综合症是人们真正知之甚少的疾病之一，直到女性想要怀孕，或者有其他问题促使她去看医生之前，这种疾病才被人们所忽视。
The problem is that it is a syndrome.
问题是它是一种综合症。
So polycystic ovary syndrome, sometimes polycystic ovarian syndrome, and syndromes don't necessarily fit together into a really clear diagnostic criteria.
因此，多囊卵巢综合征（有时是多囊卵巢综合征）和综合征不一定符合真正明确的诊断标准。
So in this instance, there are three different criteria that we look for.
因此，在这种情况下，我们需要寻找三个不同的标准。
So cysts on the ovaries, having clinical manifestations of hyperandrogenism, so that could be hirsutism, acne, other things.
因此，卵巢上的囊肿具有雄激素过多症的临床表现，因此可能是多毛症、痤疮或其他疾病。
And then usually irregular periods.
然后通常是不规律的月经。
And the way that that's defined, at least by the latest criteria, is having a period every 35 days or less.
至少按照最新标准，其定义是每 35 天或更短时间来一次月经。
So typical cycle length, 28 days, 35 days.
所以典型的周期长度是28天、35天。
You're skipping a period here and there.
你在这里或那里跳过了一个句点。
So those are the criteria that we use to diagnose PCOS.
这些就是我们用来诊断多囊卵巢综合症的标准。
There are about four different systems out there in the literature for diagnosing PCOS, which is where it starts to get confusing.
文献中大约有四种不同的系统用于诊断多囊卵巢综合症，这就是它开始变得令人困惑的地方。
So there's some women who have no cysts on their ovaries, but they've got hirsutism and they've got irregular periods.
有些女性的卵巢没有囊肿，但她们却患有多毛症并且月经不调。
Andrew Huberman:
安德鲁·休伯曼：
Could you define hirsutism?
你能定义多毛症吗？
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Hirsutism is increased hair growth, usually in places that you don't want it.
多毛症是指毛发生长增多，通常是在您不想要的地方。
So for women, it can be kind of male pattern.
所以对于女性来说，它可以是一种男性模式。
They might notice it on their breasts, on their chest.
他们可能会在他们的乳房上、胸部上注意到它。
And then there's, of course, a familial quality to that.
当然，还有家庭品质。
I was just looking at a paper last night looking at Israelis and how much hirsutism they have, and whether this is related to CAG repeats on the androgen receptor.
昨晚我刚刚看一篇论文，研究以色列人的多毛症程度，以及这是否与雄激素受体上的 CAG 重复有关。
Andrew Huberman:
安德鲁·休伯曼：
Do they get, not Israelis, but do women who might have PCOS experience androgenic alopecia?
他们，不是以色列人，而是可能患有多囊卵巢综合症的女性，都会经历雄激素性脱发吗？
So hair loss that's sort of the "male pattern baldness".
因此，脱发属于“男性型秃发”。
Of course, it's androgen pattern baldness as opposed to male, that we're talking about testosterone, DHT related.
当然，我们谈论的睾丸激素与双氢睾酮相关，是与男性相反的雄激素型秃发。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Sometimes.
有时。
This is where I'm going to invoke clinical experience rather than what I've seen in the literature.
这就是我将援引临床经验而不是我在文献中看到的内容的地方。
Women definitely can have some androgenic alopecia.
女性肯定会出现一些雄激素性脱发。
I tend to see it later in life.
我倾向于在以后的生活中看到它。
But this is an important point because we think of PCOS as, I was just talking about it in teenage years, like wouldn't it be nice to know that you have this phenotype and you're at risk for all the things that people are at risk for?
但这很重要，因为我们认为多囊卵巢综合症，我只是在青少年时期谈论它，如果知道你有这种表型并且你面临着人们面临的所有风险，这不是很好吗？
And we haven't talked about glucose and insulin yet.
我们还没有讨论葡萄糖和胰岛素。
We should.
我们应该。
What we know is that PCOS is not just a problem in terms of irregular periods and then difficulty getting pregnant.
我们知道，多囊卵巢综合症不仅仅是月经不调和怀孕困难的问题。
So those are mostly problems in your 20s, 30s, early 40s.
所以这些问题大多出现在你20多岁、30多岁、40岁出头的时候。
But it is a massive risk factor for cardiometabolic disease as you get older.
但随着年龄的增长，它是心脏代谢疾病的一个巨大危险因素。
So many people tend to pigeonhole PCOS as a problem of reproductive age.
很多人倾向于将多囊卵巢综合症归为生育年龄问题。
We have to be thinking of it over the entire female life cycle.
我们必须在整个女性生命周期中考虑这一点。
And I would say it's even more important to consider it over the age of 50, average age of menopause is 51 to 52, because we know that that elevated testosterone, the high androgens, are probably the greatest cardiometabolic driver of disease for women with PCOS.
我想说，更重要的是考虑到 50 岁以上，更年期的平均年龄是 51 至 52 岁，因为我们知道，升高的睾酮、高雄激素可能是 PCOS 女性疾病的最大心脏代谢驱动因素。
Andrew Huberman:
安德鲁·休伯曼：
Wow.
哇。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Now, one other thing I want to mention, and I still have my notes that we're going to talk about microbiome testing-
现在，我想提另一件事，我仍然保留着我们将要讨论微生物组测试的笔记 -
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm
嗯嗯
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
...
...
because that's such a fun subject.
因为那是一个非常有趣的话题。
What I was taught to do, again, saying this with so much love for the people who have taught me how to do medicine.
我再次被教导要做什么，带着对那些教我如何行医的人的极大爱说这句话。
What I was taught to do is that if you have a woman with PCOS, you make the diagnosis, you measure her testosterone, you see if she has acne, blah, blah, blah.
我被教导要做的是，如果你有一位患有多囊卵巢综合症的女性，你就做出诊断，测量她的睾酮水平，看看她是否有痤疮，等等，等等。
You ask that woman one question, "Do you want to get pregnant or not?" So then you have these women with PCOS who get started on a birth control pill if they don't want to get pregnant.
你问那个女人一个问题：“你想不想怀孕吗？”因此，这些患有多囊卵巢综合症的女性如果不想怀孕，就会开始服用避孕药。
If they want to get pregnant, then you help them get pregnant by addressing some of these PCOS issues, like maybe you give them Clomid or you do something to make them ovulate more frequently.
如果他们想怀孕，那么你可以通过解决一些 PCOS 问题来帮助他们怀孕，比如你给他们服用克罗米芬 (Clomid) 或者做一些事情来让他们更频繁地排卵。
That is the way that most conventional medicine approaches this, and it does women a gigantic disservice.
这就是大多数传统医学处理这个问题的方式，这给女性带来了巨大的伤害。
So one of the things I'm speaking into is the gender gap that exists.
所以我要谈的一件事是存在的性别差距。
So my feeling is that the research money that goes into women's health is abysmal compared to what goes into men's health.
所以我的感觉是，与男性健康相比，用于女性健康的研究资金是非常少的。
Andrew Huberman:
安德鲁·休伯曼：
Really?
真的吗？
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
And I think that's changing, but there's also a huge lack of awareness of sex and gender differences when it comes to the way that we construct clinical trials and other experiments.
我认为这种情况正在发生变化，但在我们构建临床试验和其他实验的方式方面，我们还严重缺乏对性别和性别差异的认识。
Andrew Huberman:
安德鲁·休伯曼：
Well, that's absolutely true.
嗯，这绝对是真的。
I've sat on NIH review panels for more than a decade now.
我已经在 NIH 审查小组中任职十多年了。
I'm a regular standing member, which is only to say that I see the research as it's being proposed.
我是一名常务会员，这只是说我看到了这项研究的提议。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Yes.
是的。
Andrew Huberman:
安德鲁·休伯曼：
And now it's required, no grant will get funded without sex as a biological variable.
现在要求的是，如果没有性别作为生物变量，任何拨款都不会获得资助。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Amen.
阿门。
Andrew Huberman:
安德鲁·休伯曼：
And here I'm-- By the way, folks, this is biological sex the noun, not sex the verb.
我在这里——顺便说一句，朋友们，这是名词性的生理性别，而不是动词性的性别。
Both are super interesting, obviously.
显然，两者都非常有趣。
But when we say sex as a biological variable, meaning even if it's a study on mice, there had to be-
但当我们说性别是一个生物变量时，意味着即使这是一项针对老鼠的研究，也必须有——
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
When did that start, though?
但这是从什么时候开始的呢？
Andrew Huberman:
安德鲁·休伯曼：
That didn't start that long ago.
这并不是很久以前就开始的。
I don't want to misattribute here.
我不想在这里误判。
I think we can thank Francis Collins for insisting on this.
我想我们应该感谢弗朗西斯·柯林斯坚持这一点。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Amen, Francis.
阿门，弗朗西斯。
Andrew Huberman:
安德鲁·休伯曼：
So it's going to be sometime in the last-
所以这将是最后的某个时候——
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
And Bernadine Healy.
还有伯纳丁·希利。
Bernadine Healy has done so much to help us.
伯纳丁·希利为我们提供了很多帮助。
But she made the Women's Health Initiative, which I hope we'll get to, which is a hot mess, so confusing, the data that came out of that.
但她发起了“妇女健康倡议”，我希望我们能够参与其中，但从中得出的数据却是一团糟，令人困惑。
But it's nice-
但这样挺好的——
Andrew Huberman:
安德鲁·休伯曼：
And these trials are long, and so the data are only now starting to emerge.
这些试验时间很长，因此数据现在才开始出现。
So just to be clear.
所以要明确一点。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Right.
对。
Andrew Huberman:
安德鲁·休伯曼：
I have a question that I don't think is going to take us off track, but I'm going to pose this question as a hypothesis because I think it's likely to be a little bit of a, not a barbed wire question, but maybe a prickly question when people first hear it, but it's posed as a hypothesis.
我有一个问题，我认为这不会让我们偏离正轨，但我将把这个问题作为一个假设提出，因为我认为这可能不是一个铁丝网问题，而是当人们第一次听到它时可能是一个棘手的问题，但它是作为一个假设提出的。
You mentioned some of the psychosocial stress issues based on at the organizational level, institutional level, societal level, maybe right down to the family-
您提到了一些基于组织层面、机构层面、社会层面甚至家庭层面的社会心理压力问题——
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Mm-hmm
嗯嗯
Andrew Huberman:
安德鲁·休伯曼：
...
...
and just life, that are biasing health outcomes for the worse in female populations.
就生活而言，这使得女性群体的健康结果变得更糟。
Okay?
好的？
You referred to it as the patriarchy.
您将其称为父权制。
I'm just trying to make sure that we're both talking about the same thing, and that's non-exhaustive, I realize.
我只是想确保我们谈论的是同一件事，我意识到这并不详尽。
That's just a subset of the issues.
这只是问题的一小部分。
I'm also hearing there's a lot more PCOS-
我还听说多囊卵巢综合症（PCOS）越来越多——
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Mm-hmm.
嗯嗯。
Oh
噢
Andrew Huberman:
安德鲁·休伯曼：
...
...
which is hyperandrogenization of the ovary.
这是卵巢雄激素过多症。
We're talking about, you mentioned excess testosterone, which females naturally have more testosterone than they do estrogen anyway.
我们正在谈论，你提到了过量的睾酮，无论如何，女性体内的睾酮自然比雌激素更多。
But we're talking about elevated levels.
但我们谈论的是升高的水平。
Here's a hypothesis.
这是一个假设。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Mm-hmm.
嗯嗯。
Andrew Huberman:
安德鲁·休伯曼：
One hypothesis would be that the increased androgens and the PCOS are a consequence of the psychosocial conditions that-
一种假设是雄激素增加和多囊卵巢综合征是心理社会状况的结果，即：
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Mm-hmm
嗯嗯
Andrew Huberman:
安德鲁·休伯曼：
...
...
are, I don't want to say forcing, but are biasing the need for females to think, behave, react, act in certain ways to survive, let alone thrive.
我不想说强迫，而是偏向女性为了生存而以某种方式思考、行为、反应、行动的需要，更不用说茁壮成长了。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Mm.
嗯。
Andrew Huberman:
安德鲁·休伯曼：
I don't say this for any kind of political correctness hypothesis.
我这么说并不是为了任何政治正确性假设。
This would be a fun, interesting, and I think important study to run, right?
这将是一项有趣的、有趣的、我认为很重要的研究，对吗？
Depending on stress and the conditions, the specific type of stress, do females underproduce or overproduce androgens, or is it a neutral effect?
根据压力和条件、压力的具体类型，女性是否会产生雄激素不足或过多，还是中性效应？
Does that make sense?
这有道理吗？
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
I love this question.
我喜欢这个问题。
So let me just paraphrase the last part of it to make sure I got it.
因此，让我解释一下它的最后一部分，以确保我明白了。
It sounds like what you're asking is, could PCOS, or at least some phenotypes of PCOS, be a response to what I'm calling patriarchy?
听起来你想问的是，PCOS，或者至少是 PCOS 的某些表型，是否是对我所说的父权制的回应？
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
And then you add a second part to it, which is, do healthy women, what is their production of testosterone like?
然后你添加第二部分，那就是，健康的女性，她们产生的睾丸激素是怎样的？
Is that right?
是这样吗？
Andrew Huberman:
安德鲁·休伯曼：
Yes.
是的。
And with the acknowledgement, you're the expert here.
得到认可后，您就是这里的专家了。
You're the physician, clinician, and expert in hormones, and I'm not, but with the understanding that absolute levels of hormones are interesting, but perhaps not as interesting as the ratios of testosterone to estrogen.
您是激素方面的医生、临床医生和专家，而我不是，但您知道激素的绝对水平很有趣，但可能不如睾酮与雌激素的比率那么有趣。
So when we're talking about excess testosterone, we're really not talking about, oh, women making a lot of testosterone because frankly, they already make a lot.
因此，当我们谈论过量的睾酮时，我们实际上并不是在谈论女性产生大量睾酮，因为坦率地说，她们已经产生了很多。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Mm-hmm.
嗯嗯。
Andrew Huberman:
安德鲁·休伯曼：
Most people weren't aware of that.
大多数人都没有意识到这一点。
I wasn't aware that women make more testosterone than estrogen.
我不知道女性产生的睾丸激素比雌激素更多。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
And we need it.
我们需要它。
Andrew Huberman:
安德鲁·休伯曼：
Right.
对。
And so it's not saying that testosterone in women is bad or is always a reaction to the environment.
因此，这并不是说女性体内的睾酮不好，或者总是对环境的反应。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Yes.
是的。
Andrew Huberman:
安德鲁·休伯曼：
But when it becomes super physiological or hyper-elevated, I could imagine all sorts of social conditions that would create that.
但当它变得超级生理或高度升高时，我可以想象会产生这种情况的各种社会条件。
So in males and females, but here we're talking about PCOS in females in particular.
男性和女性都有，但这里我们特别讨论女性的多囊卵巢综合症。
So I'd love for you to speculate.
所以我很乐意让你推测。
Should we run the study?
我们应该进行这项研究吗？
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
We should totally run the study because I don't know the answer.
我们应该完全进行这项研究，因为我不知道答案。
I suspect that you're onto something.
我怀疑你正在做某事。
It may not explain all of the women with PCOS, because as I mentioned, there's a lot of different phenotypes, but I think it could explain a significant portion.
它可能无法解释所有患有多囊卵巢综合症的女性，因为正如我提到的，有很多不同的表型，但我认为它可以解释很大一部分。
And you're saying if we look at the gene environment interface, this environmental influence of being someone who's got power over you, if PCOS was a response to that, the way that we treat it would be completely different.
你是说，如果我们看看基因环境界面，这种环境对你有权力的人的影响，如果多囊卵巢综合症是对此的反应，我们对待它的方式就会完全不同。
Andrew Huberman:
安德鲁·休伯曼：
Mm.
嗯。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
So on the one hand, I want to be careful not to dismiss the suffering and experience of women with PCOS.
因此，一方面，我要小心，不要忽视患有多囊卵巢综合症的女性所遭受的痛苦和经历。
I've got a lot of women with PCOS in my family, and there's so much pain and suffering, especially if you want to have a baby, and you try for years, and you just can't ovulate.
我家里有很多患有多囊卵巢综合症的女性，有很多痛苦和折磨，特别是如果你想生孩子，你尝试了很多年，但你就是无法排卵。
On the other hand, I read a paper recently, and maybe we could cite this, that compares the phenotype of a woman with PCOS to a man who is hypoandrogenic.
另一方面，我最近读了一篇论文，也许我们可以引用这篇论文，该论文将患有多囊卵巢综合症的女性与低雄激素男性的表型进行了比较。
And I think that's a really interesting way to look at this because the thread we haven't talked about with PCOS is the role of insulin and glucose.
我认为这是一种非常有趣的看待这个问题的方式，因为我们还没有讨论多囊卵巢综合症的主题是胰岛素和葡萄糖的作用。
So for some of the phenotypes of PCOS, the problem is hyperinsulinemia, high insulin in the blood, is driving those theca cells in the ovaries to overproduce testosterone.
因此，对于多囊卵巢综合症的某些表型，问题是高胰岛素血症，即血液中的高胰岛素，正在驱使卵巢中的卵泡膜细胞过度产生睾酮。
Andrew Huberman:
安德鲁·休伯曼：
These women are insulin insensitive, so more insulin's being cranked out, and these cells in the ovary are therefore making more androgen.
这些女性对胰岛素不敏感，因此会产生更多的胰岛素，因此卵巢中的这些细胞会产生更多的雄激素。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
You don't like to say insulin resistant?
你不喜欢说胰岛素抵抗吗？
Andrew Huberman:
安德鲁·休伯曼：
Oh, I don't have a problem saying insulin resistance.
哦，我对胰岛素抵抗没有意见。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Okay.
好的。
I like the way that you-
我喜欢你的方式——
Andrew Huberman:
安德鲁·休伯曼：
I'm just a little bit outside the lane lines of my expertise, so I was trying to use it.
我只是有点超出了我的专业知识范围，所以我试图利用它。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Sure.
当然。
Andrew Huberman:
安德鲁·休伯曼：
What is the correct nomenclature so that we can make sure everyone understands?
正确的命名法是什么才能确保每个人都理解？
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Well, what I like about insulin insensitive, the way that you just said it, is that I think that offers people a way in, and I love to do that in terms of messaging.
嗯，我喜欢胰岛素不敏感的地方，就像你刚才所说的那样，我认为这为人们提供了一种进入的方式，而且我喜欢在信息传递方面这样做。
Insulin resistance starts to lose people because they don't really get what that means at a receptor level.
胰岛素抵抗开始失去人们，因为他们并没有真正理解这在受体水平上意味着什么。
Andrew Huberman:
安德鲁·休伯曼：
I think I say insulin insensitive because when people hear insulin sensitive, it almost sounds like a bad thing, but that's actually what you want.
我想我说胰岛素不敏感是因为当人们听到胰岛素敏感时，这听起来几乎是一件坏事，但这实际上就是你想要的。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Right.
对。
It's what you want.
这就是你想要的。
Andrew Huberman:
安德鲁·休伯曼：
So I think that's how I defaulted to insulin insensitive.
所以我想这就是我默认胰岛素不敏感的原因。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
What's your insulin?
你的胰岛素是什么？
Andrew Huberman:
安德鲁·休伯曼：
I don't know.
我不知道。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
What?
什么？
Andrew Huberman:
安德鲁·休伯曼：
I'm due for a blood test.
我要去验血了
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Yes, you are.
是的，你是。
Andrew Huberman:
安德鲁·休伯曼：
I'm due for a blood test.
我要去验血了
I had blood work done about eight months-
我做了大约八个月的血液检查-
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Can I interpret it?
我可以解释一下吗？
Andrew Huberman:
安德鲁·休伯曼：
Sure.
当然。
That'd be great.
那太好了。
I'm always experimenting with different supplements and different behavioral regimens, and I've kept charts since I was 19.
我一直在尝试不同的补充剂和不同的行为疗法，并且从 19 岁起我就一直保存图表。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Oh, you're like my patient.
哦，你就像我的病人。
Andrew Huberman:
安德鲁·休伯曼：
I've been sort of obsessed by this, and I would say, everybody, if you can afford it, and at the time, actually, I had to save up, insurance wouldn't cover it, get some basic blood work done so that you have a reference point.
我对此有点着迷，我想说，大家，如果你能负担得起的话，当时，实际上，我必须存钱，保险不承保，做一些基本的血液检查，这样你就有一个参考点。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Do it as soon as possible because we've been talking about these women over the life cycle.
尽快这样做，因为我们一直在谈论这些女性的整个生命周期。
I wish I knew what my insulin was when I was a teenager.
我希望我十几岁的时候就知道我的胰岛素是什么。
I wish I knew what my fasting insulin was.
我希望我知道我的空腹胰岛素是多少。
I really wish I knew my postprandial insulin in my teenage years, in my 20s, in my 30s.
我真希望我在十几岁、20多岁、30多岁的时候就知道我的餐后胰岛素。
Well, I knew it in my 30s, starting at 35.
嗯，我在 30 多岁的时候就知道了，从 35 岁开始。
Andrew Huberman:
安德鲁·休伯曼：
Are you a fan of continuous glucose monitors?
您是连续血糖监测仪的粉丝吗？
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
The hugest, most gigantic fan of CGMs.
CGM 的最大、最大的粉丝。
I've never seen any tool that I've ever used in medicine change behavior the way that CGMs do.
我从未见过任何我在医学中使用过的工具能够像连续血糖监测那样改变行为。
Andrew Huberman:
安德鲁·休伯曼：
Wow.
哇。
Why do you think they are so effective at changing behavior?
您认为为什么他们在改变行为方面如此有效？
I've tried one, and I really liked it.
我尝试过一个，我真的很喜欢它。
I learned that in the sauna, my blood glucose goes up, probably by a bit of dehydration.
我了解到，在蒸桑拿时，我的血糖会升高，可能是由于脱水所致。
I learned what kind of foods work for me, which don't.
我了解了哪些食物对我有效，哪些对我无效。
I thought it was fascinating.
我觉得这很有趣。
I learned how every behavior you could possibly imagine, use your imagination, impacts blood glucose.
我了解了你可以想象的每一种行为，发挥你的想象力，如何影响血糖。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Totally.
完全可以。
Andrew Huberman:
安德鲁·休伯曼：
It was totally fascinating to me, including how a Two wake-ups during the middle of the night versus one, versus none impacted blood glucose the next morning.
这对我来说非常着迷，包括半夜两次醒来与一次醒来与没有醒来对第二天早上的血糖有何影响。
Fascinating.
迷人。
For a data junkie like me, it was like I was in heaven.
对于像我这样的数据迷来说，就像在天堂一样。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Right.
对。
Andrew Huberman:
安德鲁·休伯曼：
Why do you think they are so effective in changing behavior?
您认为为什么它们在改变行为方面如此有效？
Is it because of that, that people can see that real-time control, like scan in and like, "Oh, that's the sandwich glucose?"
是因为这个，人们可以看到实时控制，就像扫描一样，“哦，那是三明治葡萄糖？”
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
I think it's many things.
我认为有很多事情。
I think it's generally the enchantment of learning about your own chemistry and biology.
我认为这通常是学习自己的化学和生物学的魅力。
Andrew Huberman:
安德鲁·休伯曼：
I love that.
我喜欢那个。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
And I think for me, what I've seen, I feel like doctors are basically marketers, like sacred marketing.
我认为对我来说，我所看到的，我觉得医生基本上是营销人员，就像神圣的营销一样。
Our job as a physician is to convince people to do something that we think is good for them based on the best science, but we can't just say, "Here, why don't you fill this prescription for a CGM?" You have to market it.
作为一名医生，我们的工作是说服人们做一些我们认为基于最好的科学对他们有益的事情，但我们不能只是说，“在这里，你为什么不按照这个处方进行 CGM 呢？”你必须推销它。
You have to say, "I think this completely changes the way that you approach your pre-diabetes.
你必须说：“我认为这完全改变了你应对糖尿病前期的方式。
I think this could dramatically affect your risk of Alzheimer's disease that you're so worried about, that your mother has." So our job as physicians is to be that sacred marketer.
我认为这可能会极大地影响你患阿尔茨海默病的风险，你非常担心你的母亲患有这种病。”因此，作为医生，我们的工作就是成为神圣的营销人员。
So CGMs are one of my tools that I think are so crucial.
所以 CGM 是我认为非常重要的工具之一。
So enchantment number two, yeah, it's the real-time effect.
所以第二个魅力，是的，它是实时效果。
So if you go get your glucose and insulin measured, or maybe you do a two-hour glucose challenge test where you look at glucose and insulin at the fasting point one hour later, two hours later, or more frequently, that does not have the same kind of behavior effect as having continuous data where you can say, "Okay, I drove to see you, Andrew, from my place in Berkeley, and it was stressful.
因此，如果你去测量你的血糖和胰岛素，或者也许你做了一个两小时的葡萄糖激发测试，在一小时后、两小时后或更频繁地观察空腹点的血糖和胰岛素，这不会产生与连续数据相同的行为效果，你可以说，“好吧，安德鲁，我从伯克利的地方开车去看你，压力很大。
It was torrentially raining, and I know my glucose was elevated." I think really understanding what the mediators are of your glucose control is essential.
当时正下着倾盆大雨，我知道我的血糖升高了。”我认为真正了解血糖控制的调节因素至关重要。
Now, that said, it's also kind of a later effect.
也就是说，这也是一种后期效应。
I'd rather know your insulin, and we know from the Whitehall study that insulin, especially postprandial insulin, fasting insulin too, can change years and years before you get a change in glucose.
我更想知道你的胰岛素，我们从白厅研究中知道，胰岛素，特别是餐后胰岛素，空腹胰岛素也可以在你的血糖发生变化之前多年发生变化。
So that's more for pre-diabetes and diabetes.
这对于糖尿病前期和糖尿病来说更是如此。
So I think those are the main reasons why I think it's such an important tool.
所以我认为这些是我认为它如此重要的工具的主要原因。
Third thing is it democratizes data, which you do, too.
第三件事是它使数据民主化，你也这样做。
Incredible how you do that with your podcast.
令人难以置信的是你如何在你的播客上做到这一点。
But I think one of the most hopeful and exciting things that I'm seeing right now in the health space is that we're going from this patriarchal relationship where doctors hold the power and are the gatekeepers of data, to patients and clients having much more access to that enchantment about their own chemistry and their own biology.
但我认为我现在在健康领域看到的最有希望和最令人兴奋的事情之一是，我们正在摆脱这种父权关系，即医生掌握权力并且是数据的看门人，患者和客户可以更多地接触到他们自己的化学和生物学的魅力。
So to me, that is so exciting.
所以对我来说，这太令人兴奋了。
I've got probably 100 patients that are in a data stream with me where we're looking at their glucose, and I can-- I'm on sabbatical, so I'm not doing this so much anymore, but I can call a patient and be like, "Why is your glucose so high?
我可能有 100 名患者在我的数据流中，我们正在查看他们的血糖，我可以——我正在休假，所以我不再这样做了，但我可以打电话给患者并说，“为什么你的血糖这么高？
What did you do?" "Oh, it was my birthday.
你做了什么？” “哦，那天是我的生日。
I had a piece of birthday cake." That kind of collaboration that also is teaching the patient to be their own clinician, to me, that is a loop of benevolence and integrity that I think is essential to creating health.
我吃了一块生日蛋糕。”这种合作也教会患者成为自己的临床医生，对我来说，这是仁慈和正直的循环，我认为这对于创造健康至关重要。
We've got a disease care system.
我们有一个疾病护理系统。
We need the democratization of data to become a health-based system.
我们需要数据民主化，成为一个基于健康的系统。
Andrew Huberman:
安德鲁·休伯曼：
Amen to that a million times over.
阿门一百万遍。
We share that sentiment, I can tell, at a deep level.
我可以看出，我们在深层次上有着同样的感受。
I think the pandemic actually assisted in, well, it harmed many things, but it assisted in people's understanding that no magic fairy, nor the government, nor anyone was going to arrive at their door with a kit of things to make them healthy.
我认为大流行实际上帮助了，嗯，它伤害了很多东西，但它帮助人们理解，没有魔法仙女，也没有政府，也没有任何人会带着一套让他们健康的东西来到他们家门口。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Right.
对。
Andrew Huberman:
安德鲁·休伯曼：
That provide sunlight, movement, sleep, and all the various aspects of nutrition.
它们提供阳光、运动、睡眠和各个方面的营养。
No, nothing.
不，没什么。
Nothing.
没有什么。
That everyone has to have access to first and foremost, and then implement those things as best they can.
每个人都必须首先获得这些东西，然后尽其所能地实施这些东西。
Speaking of which, and kind of circling back to this idea of people in their late teens, 20s, 30s, and onward, if you had a magic wand and you could give two or three don'ts.
说到这里，我们又回到了十几岁、二十多岁、三十多岁以及以后的人们的想法，如果你有一根魔杖，你可以给出两三个“不要”。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Mm.
嗯。
Andrew Huberman:
安德鲁·休伯曼：
Or to make it personal, if you could go back in time and erase certain behaviors, what would the don'ts category be?
或者说，如果你能回到过去并消除某些行为，那么“不该做”的行为会是什么？
You can tell us more than two or three.
你可以告诉我们不止两三个。
But if the goal is to maximize vitality and longevity, and those are not always parallel to one another.
但如果目标是最大限度地提高活力和寿命，那么这些并不总是相互平行的。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Right.
对。
Andrew Huberman:
安德鲁·休伯曼：
They're certainly not the same thing, sometimes orthogonal.
它们当然不是同一件事，有时甚至是正交的。
But let's just say fertility being a proxy for vitality and longevity.
但我们只能说，生育能力是活力和长寿的代表。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Mm.
嗯。
Andrew Huberman:
安德鲁·休伯曼：
I think people will sometimes forget this, that fertility isn't just about people who want to conceive children, it can serve as a proxy for vitality and longevity.
我认为人们有时会忘记这一点，生育力不仅仅与想要怀孕的人有关，它还可以作为活力和长寿的代表。
So what would you like to see patients, let's focus first on female patients, but if it extends to male patients as well, what would you like to see them not do?
那么您希望看到患者做什么，我们首先关注女性患者，但如果也扩展到男性患者，您希望看到他们不做什么？
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Yeah.
是的。
Andrew Huberman:
安德鲁·休伯曼：
Or do far less of?
或者做得少得多？
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
I really like that.
我真的很喜欢这样。
So I would say a few things.
所以我想说几句话。
I'll just headline them and then we can go into detail.
我将只列出标题，然后我们可以详细讨论。
Number one, sleep.
第一，睡觉。
I do want to diverge from you a little bit on some things, but sleep is probably not one of them.
我确实想在一些事情上与你有一点分歧，但睡眠可能不是其中之一。
Andrew Huberman:
安德鲁·休伯曼：
Oh, well, feel free.
哦，好吧，随意吧。
You're the one that worked 100 and- ...
你是那个工作了 100 次的人，而且——...
you're the one that worked 120 hours a week.
你是那个每周工作 120 小时的人。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
I was not sleeping much then, let's just put it that way.
那时我睡得不多，这么说吧。
Andrew Huberman:
安德鲁·休伯曼：
I can't imagine, unless you lived in a different reality than I do.
我无法想象，除非你生活在与我不同的现实中。
And there are times in my career where I was pulling all-nighters and sleep-deprived.
在我的职业生涯中，有时我会通宵达旦、睡眠不足。
I don't recommend it, but I did it.
我不推荐这样做，但我做到了。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Yeah, I hope you don't do that anymore.
是的，我希望你不要再这样做了。
Andrew Huberman:
安德鲁·休伯曼：
No longer if I can avoid it.
如果我能避免的话，就不再这样了。
But there were years, many years, where it was like, "All right, here we go." And I'm quite adept at it for one cycle.
但有很多年，很多年，我的感觉就像是，“好吧，我们开始吧。”我对一个周期已经很熟练了。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Yeah.
是的。
Andrew Huberman:
安德鲁·休伯曼：
By two nights, I kind of start to fall apart.
到了两个晚上，我开始崩溃了。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Totally.
完全可以。
Andrew Huberman:
安德鲁·休伯曼：
Yeah.
是的。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
So I would say sleep, alcohol, high perceived stress And I'd love to talk about maybe the data on telomeres and what we know.
所以我想说的是睡眠、酒精、高感知压力，我想谈谈端粒的数据以及我们所知道的。
Andrew Huberman:
安德鲁·休伯曼：
So you'd like to see people get enough sleep.
所以你希望看到人们有足够的睡眠。
So don't dis-
所以不要dis-
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Yeah, not all of these are concordant.
是的，并非所有这些都是一致的。
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
So, not enough sleep, too much alcohol, too much perceived stress, eating the wrong foods, toxic relationships, and isolation.
因此，睡眠不足、酗酒、压力过大、吃错食物、有毒的人际关系和孤立。
And then number six, not moving enough or not moving and exercising in a way that really fits with your body.
第六，运动量不够或没有以真正适合您身体的方式运动和锻炼。
Andrew Huberman:
安德鲁·休伯曼：
Hmm.
嗯。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
So those-
所以那些-
Andrew Huberman:
安德鲁·休伯曼：
Can we start with that one, actually?
实际上我们可以从那个开始吗？
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Sure.
当然。
Andrew Huberman:
安德鲁·休伯曼：
Just because it's such a-- and then work backwards.
只是因为它是这样的——然后倒推。
That's interesting.
那很有意思。
I think nowadays people appreciate the need for quote unquote cardio.
我认为现在人们意识到有氧运动的必要性。
I know that the exercise physiologists cringe and dissolve into a puddle of tears when I say that.
我知道当我这么说时，运动生理学家们会感到畏缩并泪流满面。
But getting the heart rate up over some period of time longer than 10 minutes in order to generate cardiovascular health circulation.
但要在10分钟以上的时间内提高心率，以促进心血管健康循环。
So, and resistance training of some kind, maybe flexibility.
所以，还有某种阻力训练，也许是灵活性训练。
What do you mean by body phenotype and exercise?
身体表型和运动是什么意思？
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
I'll speak from personal experience.
我将从个人经历来谈谈。
So what I did through-- I gave up my 20s to medicine.
所以我所做的就是——我放弃了20多岁的医学。
And during that time, I occasionally got to the gym.
在那段时间里，我偶尔会去健身房。
At UCSF on Parnassus, you could go to the gym, and then as soon as your beeper went off, you're back into the hospital.
在加州大学旧金山分校帕纳塞斯分校，你可以去健身房，然后当你的传呼机一响，你就又回到了医院。
But I didn't exercise much.
但我没怎么运动。
Do you remember NordicTracks?
你还记得北欧轨道吗？
I had a NordicTrack in my house, and that was like it.
我家里有一个 NordicTrack，就是这样。
What I believe, because for me, the primary outcome that I'm interested in is cardiometabolic health.
我相信什么，因为对我来说，我感兴趣的主要结果是心脏代谢健康。
So when it comes to exercise, what I really feel, if we're going to be at a population level, I feel that about a third cardio, two-thirds resistance training is based on my synthesis of the literature, the best combination.
因此，说到锻炼，我的真实感受是，如果我们要达到人口水平，我认为大约三分之一的有氧运动、三分之二的阻力训练是基于我对文献的综合，这是最佳组合。
And I think there's, as you described with your sign study, I think there's a minimal effective dose, which for a population is about 150 minutes.
我认为，正如您在体征研究中所描述的那样，我认为有一个最小有效剂量，对于人群来说大约是 150 分钟。
I think most of us need a lot more than that as-
我认为我们大多数人需要的远不止这些——
Andrew Huberman:
安德鲁·休伯曼：
Per week of
每周
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
...
...
per week.
每周。
But I think, for me, because I have a phenotype that produces a lot of insulin, kind of depending on how I'm on my game, I have a lot of glucose, so I have to exercise a lot more to dispose that glucose.
但我认为，对我来说，因为我的表型会产生大量胰岛素，这取决于我在比赛中的表现，所以我有大量的葡萄糖，所以我必须进行更多的锻炼来处理这些葡萄糖。
So I think you then have to move from medicine for the population or prescriptions for the population to what works for the individual.
所以我认为你必须从针对人群的药物或针对人群的处方转向对个人有效的药物。
Andrew Huberman:
安德鲁·休伯曼：
I think that recommendation is fantastic.
我认为这个建议非常棒。
I think resistance training-- well, let me put it this way.
我认为阻力训练——好吧，让我这样说。
I'm neither a trainer nor a physician, but I've seen in family members that were doing, I wouldn't say a lot of cardio, but just cardio, that when they add resistance training, everything in terms, including their biomarkers, have improved dramatically.
我既不是教练也不是医生，但我在家庭成员中看到，我不会说很多有氧运动，而只是有氧运动，当他们增加阻力训练时，一切方面，包括他们的生物标志物，都得到了显着改善。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Yes.
是的。
Andrew Huberman:
安德鲁·休伯曼：
This is in particular for female members of my family.
这对于我家的女性成员来说尤其如此。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Well, one of the mediators that I think is important, especially for people who do what I call chronic cardio, which is what I did, is cortisol.
嗯，我认为重要的调节因素之一是皮质醇，特别是对于那些进行我所说的慢性有氧运动的人来说，这就是我所做的。
So we know that runners, especially marathon runners, people who do a lot of cardio and don't do much resistance training, they tend to have much high cortisol levels.
所以我们知道，跑步者，尤其是马拉松运动员，进行大量有氧运动但不进行太多阻力训练的人，他们的皮质醇水平往往很高。
And you can buffer that with vitamin C.
你可以用维生素 C 来缓冲它。
Vitamin C can decrease the effect.
维生素C会减弱这种作用。
But chronic cardio doesn't always serve people.
但慢性有氧运动并不总是适合人们。
So quick personal example.
这么快的个人例子。
When I first started measuring hormone panels in myself, I went to my physician and I said, "I'm 35.
当我第一次开始测量自己的激素水平时，我去找我的医生，我说：“我 35 岁了。
I've had one kid.
我已经有一个孩子了
I want to have another kid.
我想再要一个孩子。
I've never been so exhausted in my life.
我一生中从未如此疲惫过。
I just feel like I'm pushing a rock up a hill.
我只觉得自己就像是在把一块石头推上山。
I've got this belly fat that I don't like.
我有我不喜欢的腹部脂肪。
And I don't want to have sex with my husband.
而且我不想和我丈夫发生性关系。
So what do you think?
那么你觉得怎么样？
What could we do about this?" And he offered a birth control pill and an antidepressant.
对此我们能做些什么呢？”他还提供了避孕药和抗抑郁药。
Andrew Huberman:
安德鲁·休伯曼：
Oh, goodness.
哦，天哪。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
So I left him, and I went to the lab, and I ran a hormone panel, and my cortisol was three times what it should've been.
所以我离开了他，去了实验室，进行了激素检查，发现我的皮质醇含量是应有水平的三倍。
My insulin was in the 20s.
我的胰岛素是20多岁。
I was fasting.
我当时正在禁食。
My glucose was 105.
我的血糖是105。
My thyroid was mildly abnormal.
我的甲状腺轻度异常。
My progesterone was low.
我的黄体酮很低。
And that set me on this course of realizing that what I was doing as a physician, taking care especially of women, was not getting to some of these root causes that are so essential.
这让我意识到，作为一名医生，我所做的事情，尤其是照顾女性，并没有找到其中一些至关重要的根本原因。
And I would say I had to start first with cortisol.
我想说我必须首先从皮质醇开始。
At that time, I was running four miles, three times a week, four times a week.
那时，我跑四英里，每周跑三次，每周跑四次。
That was just raising my cortisol further.
这只会进一步提高我的皮质醇。
So that was not the right exercise for me.
所以这对我来说不是正确的练习。
I needed more adaptive exercise.
我需要更多的适应性锻炼。
I started doing Pilates, more yoga.
我开始做普拉提，更多的是瑜伽。
That helped to lower my cortisol.
这有助于降低我的皮质醇。
It started me on changing the way I was managing perceived stress, and it also changed my supplement regimen.
它开始改变我管理感知压力的方式，它也改变了我的补充方案。
Andrew Huberman:
安德鲁·休伯曼：
And could we talk about that?
我们可以谈谈这个吗？
The moment you said lowering cortisol, thought of the two supplements that come to mind are ashwagandha, which I think can potently reduce cortisol, but I've heard some recommendations about cycling it.
当你说到降低皮质醇时，我想到的两种补充剂是南非醉茄，我认为它可以有效降低皮质醇，但我听说过一些关于循环使用它的建议。
And I've always wondered about time of day for ashwagandha intake because you sort of, quote unquote, "want cortisol elevated" in the early part of the day.
我一直想知道一天中什么时间摄入南非醉茄，因为你会在一天的早些时候“想要升高皮质醇”。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Yes.
是的。
Andrew Huberman:
安德鲁·休伯曼：
And we know this.
我们知道这一点。
We know you do not want cortisol peaking later in the day.
我们知道您不希望皮质醇在当天晚些时候达到峰值。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
No, you do not.
不，你没有。
Interferes with sleep.
干扰睡眠。
Andrew Huberman:
安德鲁·休伯曼：
Interferes with sleep.
干扰睡眠。
And then the other supplement is rhodiola rosea.
另一种补充剂是红景天。
Am I pronouncing that correctly?
我的发音正确吗？
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Yeah.
是的。
So rhodiola is very effective.
所以红景天是非常有效的。
It's been shown in multiple randomized trials to lower cortisol, so that could be very effective.
多项随机试验表明它可以降低皮质醇，因此可能非常有效。
Andrew Huberman:
安德鲁·休伯曼：
What sort of dose?
什么样的剂量？
I've started taking it recently, by the way, and I made a huge mistake.
顺便说一句，我最近开始服用它，但我犯了一个巨大的错误。
I like to make the mistakes first so then my audiences don't make them.
我喜欢先犯错误，这样我的观众就不会犯错误。
As I was taking it, I heard it was an adaptogen, so I thought, "Oh, I'll take it before resistance training." But of course, you want the cortisol peak during resistance training-
当我服用它时，我听说它是一种适应原，所以我想，“哦，我会在阻力训练之前服用它。”但当然，你希望在阻力训练期间皮质醇达到峰值-
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Yes, you do
是的，你知道
Andrew Huberman:
安德鲁·休伯曼：
...
...
because that's going to set in motion the adaptive response.
因为这将启动适应性反应。
So I started taking it later in the day, and it's really improved, I would say my late day, second half of the day cognition- This is subjective, to be fair.
所以我开始在当天晚些时候服用它，它确实得到了改善，我会说我的晚间、后半天的认知——公平地说，这是主观的。
I just feel like I'm in a more even plane of attention in the second half of the day.
我只是觉得在后半天我的注意力更加均匀。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
So you're describing an N of one experiment-
所以你描述的是一个实验中的N个-
Andrew Huberman:
安德鲁·休伯曼：
Right
右
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
...
...
which is-
这是-
Andrew Huberman:
安德鲁·休伯曼：
Anecdota.
轶事。
Yeah
是啊
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Well, it is not anecdotal.
嗯，这不是轶事。
So I was taught at Harvard Medical School that the hierarchy of evidence starts at the lowest with expert opinion, case studies, then you've got cohort studies, then you've got observational data that's prospective, then you have randomized trial.
所以我在哈佛医学院学到的是，证据的层次从最低的专家意见、案例研究开始，然后是队列研究，然后是前瞻性的观察数据，然后是随机试验。
But the highest quality evidence of all is the N of one experiment-
但最高质量的证据是一个实验的 N 个——
Andrew Huberman:
安德鲁·休伯曼：
Hmm
嗯
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
...
...
where you serve as your own control.
您可以自行控制。
So what you're describing with rhodiola, I would frame that as an N of one experiment, where you have a washout period and you compare before and after, and I'd like to measure some other metrics to see if there's an effect, including your cortisol.
所以你所描述的红景天，我会把它作为一个实验的N个，你有一个清除期，然后比较之前和之后，我想测量一些其他指标，看看是否有效果，包括你的皮质醇。
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
So rhodiola has been shown in multiple randomized trials to reduce cortisol.
因此，多项随机试验表明红景天可以减少皮质醇。
The other thing that I think is super effective is phosphatidylserine, PS for short.
我认为超级有效的另一件事是磷脂酰丝氨酸，简称PS。
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Fish oil also more modestly reduces cortisol.
鱼油还能更适度地降低皮质醇。
Ashwagandha is interesting.
阿什瓦甘达很有趣。
So in my first book, "The Hormone Cure"-
所以在我的第一本书《激素疗法》中——
Andrew Huberman:
安德鲁·休伯曼：
Which I read, by the way.
顺便说一下，我读过。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
You did?
你做到了吗？
Andrew Huberman:
安德鲁·休伯曼：
I did.
我做到了。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
I was hoping that was the one you read.
我希望那是你读到的那一篇。
Andrew Huberman:
安德鲁·休伯曼：
I did.
我做到了。
I read it, and it's spectacular, and I thought going into it, I had this, let's just call it what it was, this kind of male bias like, "Is there going to be anything in here for me?"
我读了它，它很壮观，我想进入它，我有这个，我们就这样称呼它吧，这种男性偏见就像，“这里有什么东西适合我吗？”
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Right.
对。
Andrew Huberman:
安德鲁·休伯曼：
"Because I don't have ovaries and is this going to be...
“因为我没有卵巢，这会是......
" And it was immensely informative.
“而且它的信息量非常大。
So thank you.
所以谢谢你。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
So glad.
很高兴。
Andrew Huberman:
安德鲁·休伯曼：
Yeah.
是的。
I have very fond recollections of the walks I took listening to it, and then I own the print version too.
我对听它散步的经历有非常美好的回忆，然后我也拥有了印刷版。
So I like to switch back and forth.
所以我喜欢来回切换。
So thank you for that.
所以谢谢你。
It's a superb book for anyone to read.
这是一本适合任何人阅读的好书。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Thank you.
谢谢你。
Andrew Huberman:
安德鲁·休伯曼：
Yeah.
是的。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
I so appreciate that.
我非常欣赏这一点。
So in chapter four, you may or may not remember that ashwagandha, at least the time that I wrote that book, ashwagandha's data is not great, but lack of proof is not proof against.
所以在第四章中，你可能记得也可能不记得阿什瓦甘达，至少在我写那本书的时候，阿什瓦甘达的数据不是很好，但缺乏证据并不构成反驳。
So with ashwagandha, most of the data comes from thousands of years of using it in Ayurvedic medicine, and it's considered, again, not my science hat.
因此，对于南非醉茄，大部分数据来自于它在阿育吠陀医学中数千年的使用，而且它再次被认为不是我的科学帽子。
It's considered a double adaptogen so that it's potentially helpful when you are a high cortisol phenotype, like I was, like I sometimes still am, or low cortisol.
它被认为是一种双重适应原，因此当您具有高皮质醇表型（就像我以前，有时仍然如此）或低皮质醇表型时，它可能会有所帮助。
I haven't found that in my patients, although I'll give you one exception.
我还没有在我的病人身上发现这一点，不过我会给你一个例外。
So ashwagandha is mostly based on animal studies.
所以南非醉茄主要基于动物研究。
There's not as much human data, but it is used a ton in integrative medicine.
人类数据并不多，但它在综合医学中被大量使用。
There's one supplement that I've found to be incredibly helpful for people who tend to have high cortisol at night, and that's called a Cortisol Manager.
我发现有一种补充剂对于那些在夜间皮质醇水平较高的人非常有帮助，这就是所谓的皮质醇管理器。
It's by Integrative Therapeutics.
这是综合疗法的。
I don't have a second supplement manufacturer that makes something similar.
我没有第二家生产类似产品的补充剂制造商。
It's their number one selling supplement because it's so effective.
这是他们销量第一的补充剂，因为它非常有效。
Andrew Huberman:
安德鲁·休伯曼：
Is it a cocktail of several things?
它是几种东西的鸡尾酒吗？
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
It's a combination of phosphatidylserine and ashwagandha.
它是磷脂酰丝氨酸和南非醉茄的组合。
Andrew Huberman:
安德鲁·休伯曼：
Tell me more about phosphatidylserine.
告诉我更多有关磷脂酰丝氨酸的信息。
I am familiar with it, for it's been mentioned by some guests that were on the Tim Ferriss podcast long ago for other reasons, I think related to sleep.
我对此很熟悉，因为很久以前蒂姆·费里斯播客上的一些嘉宾就因为其他原因提到过它，我认为与睡眠有关。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Yes.
是的。
Andrew Huberman:
安德鲁·休伯曼：
And maybe that's another reason why you like it.
也许这就是你喜欢它的另一个原因。
But before we move on from rhodiola, is there a dosage of rhodiola roseacea that you-
但在我们继续讨论红景天之前，有没有一种剂量的红景天可以让您-
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
So I would refer people to my book because-
所以我会推荐人们阅读我的书，因为-
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Sure
当然可以
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
...
...
the randomized trials and the doses that were used are in there.
随机试验和使用的剂量都在那里。
So I can't remember with rhodiola, although I took it this morning to prepare to be with you.
所以我不记得红景天了，尽管我今天早上服用它是为了准备和你在一起。
Andrew Huberman:
安德鲁·休伯曼：
Yeah.
是的。
We can look it up and put a-
我们可以查一下并放一个-
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Yeah
是啊
Andrew Huberman:
安德鲁·休伯曼：
...
...
show note caption so people can link it.
显示注释标题，以便人们可以链接它。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
I can remember the dose with phosphatidylserine-
我记得磷脂酰丝氨酸的剂量-
Andrew Huberman:
安德鲁·休伯曼：
Great
太棒了
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
...
...
because I take that regularly.
因为我经常服用。
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
So 400 to 800 milligrams is the typical dose for PS, and what's interesting is that in the randomized trials that were done, 400 milligrams was more effective than 800 milligrams.
因此，400 至 800 毫克是 PS 的典型剂量，有趣的是，在进行的随机试验中，400 毫克比 800 毫克更有效。
Andrew Huberman:
安德鲁·休伯曼：
Interesting.
有趣。
I've found that for several supplements that the lower dose was more effective.
我发现对于几种补充剂来说，较低剂量更有效。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Yes.
是的。
Andrew Huberman:
安德鲁·休伯曼：
Yeah.
是的。
It doesn't matter what those were.
那些是什么并不重要。
And so when you say PS, you were referring to, by the way, folks, not PCOS, just because- ...
所以，顺便说一句，当你说 PS 时，你指的是人们，而不是 PCOS，只是因为 -...
scientists and clinicians are familiar with, and military, very familiar with acronyms.
科学家和临床医生都很熟悉，而军事人员则非常熟悉缩写词。
Phosphatidylserine, PS, so 400 to 800 milligrams, 400 being more effective.
磷脂酰丝氨酸，PS，400至800毫克，400毫克更有效。
Taken later in the day or early day?
是在当天晚些时候还是早些时候拍摄的？
Does it matter?
有关系吗？
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
It depends on when your cortisol is high.
这取决于您的皮质醇何时处于高水平。
Andrew Huberman:
安德鲁·休伯曼：
Hmm.
嗯。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
So for me, what's the pattern for cortisol?
那么对我来说，皮质醇的模式是什么？
Typically, it rises to its peak 30 to 60 minutes after you get up.
通常，它会在起床后 30 至 60 分钟达到顶峰。
Then it has this gradual kind of asymptotic decline until you go to bed.
然后它会逐渐渐近下降，直到你上床睡觉。
So if you're someone like me who peaks way crazy high, I don't do that anymore, but that's what I used to do, I need a phosphatidylserine in the morning.
所以，如果你是像我这样的人，峰值非常高，我不再这样做了，但那是我以前所做的，我早上需要磷脂酰丝氨酸。
For people who are high at night, who have what's known as a flat cortisol pattern or a inverted pattern, you want to take it at night.
对于夜间兴奋的人来说，他们有所谓的扁平皮质醇模式或倒置模式，你应该在晚上服用。
And the flat pattern, just quick sidebar, is that that's associated with a number of conditions that most mainstream physicians don't know about.
扁平化模式，即快速侧边栏，与大多数主流医生不了解的许多情况相关。
Andrew Huberman:
安德鲁·休伯曼：
Hmm.
嗯。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
So a flat pattern where it's low in the morning and it's high at night is associated with anxiety, depression, decreased survival from breast cancer.
因此，早上低、晚上高的扁平模式与焦虑、抑郁和乳腺癌生存率降低有关。
That was studied at Stanford by David Spiegel.
大卫·斯皮格尔在斯坦福大学对此进行了研究。
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
He was my close, even collaborator, even on the breathwork study that we just did.
他是我亲密的、甚至是合作者，甚至在我们刚刚进行的呼吸研究中也是如此。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Oh, interesting.
哦，有趣。
Andrew Huberman:
安德鲁·休伯曼：
Yeah.
是的。
He's our-
他是我们的——
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Yeah
是啊
Andrew Huberman:
安德鲁·休伯曼：
...
...
associate chair of psychiatry now.
现任精神病学副主任。
So a wonderful human being, has-
所以一个了不起的人，拥有——
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Amazing
太棒了
Andrew Huberman:
安德鲁·休伯曼：
...
...
been a guest on this podcast, and I'm now fantasizing about a conversation that includes a panel of incredible minds like you and David from the clinical side.
我是这个播客的嘉宾，我现在幻想着一场对话，其中包括一群像你和大卫这样来自临床方面的令人难以置信的头脑。
So in any case, yeah, the late shifted cortisol, not good.
所以无论如何，是的，皮质醇的晚期转移并不好。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Not good.
不好。
Andrew Huberman:
安德鲁·休伯曼：
Not good.
不好。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
And it seems to have the worst immune downstream issues of any of the cortisol patterns.
它似乎具有所有皮质醇模式中最糟糕的免疫下游问题。
So that's really important to know about because it then maps to things like, it's related to PTSD.
所以了解这一点非常重要，因为它会映射到与创伤后应激障碍 (PTSD) 相关的事物。
So that's the pattern we see like in vets who've got PTSD as well as others.
这就是我们在患有创伤后应激障碍（PTSD）的兽医和其他人身上看到的模式。
It maps to autoimmunity.
它映射到自身免疫。
It maps to fibromyalgia.
它对应于纤维肌痛。
Andrew Huberman:
安德鲁·休伯曼：
I was told that one in 12 people have are heterozygous, so one mutant copy or hypomorphic for some mutation in adrenal related genes, so congenital adrenal hyperplasia.
有人告诉我，每 12 个人中就有 1 人是杂合子，因此肾上腺相关基因中的某些突变会出现突变拷贝或低等态，因此是先天性肾上腺增生。
Is that true?
这是真的吗？
And if so, that means that one in 12 people walking around are cranking out far too much cortisol or not enough cortisol, or the cortisol system is already skewed in a direction that makes life more challenging at the levels we're talking about.
如果是这样，那就意味着每 12 个人中就有一个会产生过多或不足的皮质醇，或者皮质醇系统已经朝着使生活在我们所说的水平上更具挑战性的方向倾斜。
Did I hear that correctly?
我没听错吗？
Because one in 12 is not a small number.
因为十二分之一并不是一个小数字。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
It's not a small number.
这可不是一个小数目。
It fits with what I see clinically.
这与我在临床上看到的情况相符。
I want to see that data just to see what does that mean, and could you modulate it with environmental influences?
我想查看这些数据只是为了看看这意味着什么，你能根据环境影响来调节它吗？
But it certainly fits with what I see.
但这确实符合我所看到的。
I was taught, once again, in mainstream medicine that in terms of adrenal function, it's very binary how most clinicians think about it.
主流医学再次告诉我，就肾上腺功能而言，大多数临床医生对它的看法是非常二元的。
You either have Addison's disease and you don't make enough cortisol, or you've got Cushing's or Cushingoid pattern and you make too much cortisol, and anything in the middle is normal.
您要么患有阿迪森氏病，但皮质醇分泌不足；要么您患有库欣病或库欣样模式，但皮质醇分泌过多，介于两者之间的任何情况都是正常的。
And my experience is that, hell no. There are those of us like me who make a lot of cortisol.
我的经验是，绝对不。我们中的一些人像我一样会产生大量皮质醇。
I don't have Cushing's.
我没有库欣的。
Maybe I've got one of these, I wouldn't call it a mutant gene, I would call it more of a vulnerable gene.
也许我有其中一个，我不会称其为突变基因，我更愿意称其为脆弱基因。
So maybe I have one of those.
所以也许我有其中之一。
Maybe that's part of the reason why I make two to three times what I should be.
也许这就是我的收入是应有收入的两到三倍的部分原因。
Andrew Huberman:
安德鲁·休伯曼：
I'm aware of certain groups of individuals from within the military sector that there's a more frequent occurrence of some mutation in CAH, congenital adrenal hypertension.
我知道军事部门内的某些人群更频繁地出现 CAH（先天性肾上腺高血压）的某些突变。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Yep.
是的。
Andrew Huberman:
安德鲁·休伯曼：
Not necessarily two copies, which if people look that up, they're going to go, "Oh, wow, there's all these phenotypes" but sort of hypomorphic type things, so less than or too much cortisol, and they are very good at staying up multiple days per night.
不一定是两个副本，如果人们查一下，他们会说，“哦，哇，有所有这些表型”，而是某种亚同型的东西，所以皮质醇少于或太多，而且他们非常擅长每晚熬多天。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Right.
对。
Andrew Huberman:
安德鲁·休伯曼：
Multiple nights in series.
连续多个夜晚。
So they can pull all-nighters very easily.
所以他们可以很轻松地通宵达旦。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Yep.
是的。
Andrew Huberman:
安德鲁·休伯曼：
They can push harder when most people would quit.
当大多数人放弃时，他们可以更加努力。
And everyone thinks, well, that's a great phenotype to have.
每个人都认为，这是一个很好的表型。
But guess what?
但你猜怎么着？
It's because they hyper produce cortisol.
这是因为它们过度产生皮质醇。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Yep.
是的。
Andrew Huberman:
安德鲁·休伯曼：
And so that's interesting.
这很有趣。
And I think if we were to panel medical students and graduate students, and you were to look at who's pulling excessively long hours, who's stressed out a lot, even outside of academia and medicine, and pushing really hard.
我认为，如果我们对医学生和研究生进行小组调查，你会看到谁的工作时间过长，谁的压力很大，甚至在学术界和医学界之外，而且工作非常努力。
I think the ability to push and not crash, we think of it as adaptive, but in some sense, it's maladaptive over a series of years, which is sort of what you described earlier.
我认为推动而不崩溃的能力，我们认为它是适应性的，但从某种意义上说，它在一系列的时间里是不适应的，这有点像你之前描述的那样。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Yeah.
是的。
It's such a good point because, in some ways, you'd want to select for that in certain professions, like in the military, like in medicine.
这是一个很好的观点，因为在某些方面，你会想选择某些职业，比如军队，比如医学。
But I would wonder for those folks about the downstream consequences of producing so much cortisol.
但我想为那些人想知道产生如此多皮质醇的下游后果。
Andrew Huberman:
安德鲁·休伯曼：
Oh, it's got to be detrimental for their health-
哦，这肯定对他们的健康有害——
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
It's got to be
一定是
Andrew Huberman:
安德鲁·休伯曼：
...
...
in the long run, and you see that.
从长远来看，你会看到这一点。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
But even the data shows that if you're someone like me who makes a lot of cortisol, higher rates of depression, like 50% of people with major depression have high cortisol levels, higher rates of suicide, much more metabolic dysfunction.
但即使是数据也显示，如果你像我一样产生大量皮质醇，那么患抑郁症的几率就会更高，比如 50% 的重度抑郁症患者皮质醇水平很高，自杀率也会更高，代谢功能障碍也会更多。
We know that trauma, as an example, maps to an increased risk of glucose metabolism issues, and certainly high cortisol does that because it's one of the jobs of cortisol is to manage glucose.
例如，我们知道创伤会增加葡萄糖代谢问题的风险，而高皮质醇肯定会造成这种情况，因为皮质醇的工作之一就是管理血糖。
And it kind of sets you up for this one, number five, which is toxic relationships.
这会让你为第五种有毒关系做好准备。
Someone who hyper produces cortisol, it's hard to live with someone like that.
皮质醇分泌过多的人很难与这样的人一起生活。
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
It's also, I would say, people that have this, let's just call it biological resilience, it's not always adaptive because you can stay in bad circumstances longer.
我想说的是，具有这种能力的人，我们称之为生物适应力，它并不总是具有适应性，因为你可以在恶劣的环境中停留更长时间。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Yep.
是的。
Andrew Huberman:
安德鲁·休伯曼：
The ability to crash, provided it's not suicide or life destroying or long arc of pause and the requirement to take two years off from work or school or something.
崩溃的能力，只要它不是自杀或生命毁灭或长时间的停顿，并且需要停止工作或学校或其他什么的两年。
The ability to keep pressing on is a double-edged sword.
继续前进的能力是一把双刃剑。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Yes, it is.
是的，确实如此。
Andrew Huberman:
安德鲁·休伯曼：
Let's put it that way.
这么说吧。
I want to make sure in staying within this conversation, because you mentioned phosphatidylserine, we talked about rhodiola rosea, we talked a bit about ashwagandha.
我想确保留在这次谈话中，因为你提到了磷脂酰丝氨酸，我们谈到了红景天，我们谈到了南非醉茄。
You've also talked about omega-3s and fish oil in particular.
您还特别谈到了 omega-3 和鱼油。
I'd love to know your favorite sources of these.
我很想知道你最喜欢的这些来源。
I think nowadays there's more general acceptance that getting these essential fatty acids is important.
我认为现在人们越来越普遍地认识到获取这些必需脂肪酸很重要。
Do you have a threshold level of sort of grams?
你有克级的阈值吗？
I've encouraged podcast listeners to consider, depending on what they're eating, to try and get a gram of EPA or more per day.
我鼓励播客听众考虑，根据他们吃的东西，尝试每天摄入一克或更多的 EPA。
Does that seem excessive?
这看起来是不是太过分了？
And what are the real data on EPAs?
持久授权书的真实数据是什么？
Because then the cardiovascular experts always hit back and say, "Oh, no, it's not good for cardiovascular health." And then you go, "Well, it's better than antidepressants in other studies," and they go, "No." So I feel like if you really want to make your life difficult, if you want to raise your cortisol, you go on Twitter, and you say something positive about omega-3s or fish oil.
因为心血管专家总是回击说：“哦，不，这对心血管健康不利。”然后你说，“嗯，在其他研究中它比抗抑郁药更好，”他们说，“不。”所以我觉得如果你真的想让你的生活变得困难，如果你想提高你的皮质醇，你就可以在推特上说一些关于 omega-3 或鱼油的积极言论。
And you learn a lot.
你会学到很多东西。
What are your thoughts on omega-3s?
您对 omega-3 有何看法？
I take a lot of them.
我拿了很多。
I've always been a big fan.
我一直是它的忠实粉丝。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Yeah.
是的。
So this is where I personalize.
所以这就是我个性化的地方。
I think some people need more than others.
我认为有些人比其他人需要更多。
And what I do is I measure your level.
我所做的就是衡量你的水平。
So this gets back to nutritional testing.
所以这又回到了营养测试。
So for you, I would suggest an OmegaQuant, or one of my favorite cardiometabolic panels is to do a Cleveland HeartLab.
因此，对于您来说，我建议使用 OmegaQuant，或者我最喜欢的心脏代谢面板之一是进行克利夫兰心脏实验室。
So I think they give me the most reliable information, not just for lipids and subclasses and NMR fractionation, but it also gives me an insulin resistance score.
因此，我认为它们为我提供了最可靠的信息，不仅涉及脂质和亚类以及 NMR 分级，而且还为我提供了胰岛素抵抗评分。
It gives me levels of omega-3s.
它为我提供了 omega-3 水平。
Andrew Huberman:
安德鲁·休伯曼：
Great.
太棒了。
We'll provide links to these different-
我们将提供这些不同的链接 -
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Great
太棒了
Andrew Huberman:
安德鲁·休伯曼：
...
...
sites so that people can look at them.
网站，以便人们可以查看它们。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
But one quick thing about that.
但有一点要注意。
The whole story is not omega-3s and taking fish oil.
整个故事并不是omega-3和服用鱼油。
So the work of Charlie Serhan at the Brigham is showing that the way that we resolve inflammation Our understanding of it is really, I think, in the learning to crawl stage.
因此，布里格姆医院的查理·瑟汉 (Charlie Serhan) 的工作表明，我们解决炎症的方式我认为，我们对炎症的理解实际上是在学习爬行阶段。
And so if you look at the omega-3, 6 pathway in the body, fish oils can help kind of push the reactions in a particular direction.
因此，如果您观察体内的 omega-3、6 通路，就会发现鱼油可以帮助将反应推向特定方向。
But typically, they're not enough for the resolution of inflammation.
但通常情况下，它们不足以解决炎症。
Now, what most people do, including my NBA players, is they pop an ibuprofen or something like that when they've got inflammation that's got lots of other side effects that are not so good for you.
现在，大多数人，包括我的 NBA 球员，都会在出现炎症时服用布洛芬或类似药物，而炎症会带来许多其他副作用，对你来说不太好。
And we know in terms of the resolution of inflammation, that taking something like ibuprofen reduces the amplitude of inflammation by about 50%, but then it potentially blocks the complete resolution of inflammation.
我们知道，就炎症的消退而言，服用布洛芬等药物可以将炎症的幅度降低约 50%，但它可能会阻碍炎症的完全消退。
So there's these new supplements that you may have heard of called specialized pro-resolving mediators.
您可能听说过这些新的补充剂，称为专门的促解决调解剂。
There's a lot of different supplement companies that make them.
有很多不同的补充剂公司生产它们。
And that combined with fish oil seems to be the best combination.
与鱼油结合似乎是最好的组合。
And what I do for athletes who've got kind of the normal aches and pains of the training load they have, is I'll combine a little aspirin, small dose, just like 81 milligrams or-
对于那些因训练负荷而出现正常疼痛的运动员，我会做的就是混合一点阿司匹林，小剂量，就像 81 毫克或-
Andrew Huberman:
安德鲁·休伯曼：
Baby aspirin
婴儿阿司匹林
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
...
...
two of those baby aspirin together with fish oil plus specialized pro-resolving mediators.
其中两种婴儿阿司匹林与鱼油以及专门的促解决介质一起使用。
And there's some that are NSF, they're certified for sports.
还有一些是 NSF 的，它们获得了运动认证。
But the dose, I would say with my patients, some of them only need 1,000 milligrams, your gram that you mentioned for the population.
但我会对我的病人说，他们中的一些人只需要 1,000 毫克，也就是你提到的针对人群的克剂量。
Some of them need six grams together with ATMs.
其中一些与 ATM 机一起需要 6 克。
So I think it has to be personalized.
所以我认为它必须是个性化的。
Andrew Huberman:
安德鲁·休伯曼：
How young is it okay for people to start taking omega-3s?
几岁开始服用 omega-3 合适？
For instance, young women in their teens, people in their 20s and their 30s, young guys in their 20s and 30s, should they take fish oil?
例如，十几岁的年轻女性、20多岁、30多岁的人、20多岁、30多岁的年轻人，是否应该服用鱼油？
Assuming they're not going to get anything tested.
假设他们不会接受任何测试。
I'm thinking about the college student who is really into biomarkers and that sort of thing will go do some of this.
我正在考虑那些真正热衷于生物标记物的大学生，他们会去做一些这样的事情。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Mm-hmm.
嗯嗯。
Andrew Huberman:
安德鲁·休伯曼：
But many people won't.
但很多人不会。
But they want to do the right thing.
但他们想做正确的事。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Mm-hmm.
嗯嗯。
Andrew Huberman:
安德鲁·休伯曼：
So they'll try and drink a little less hopefully.
所以他们会尽量少喝一点。
Hopefully, they won't smoke or vape.
希望他们不会吸烟或电子烟。
Please don't smoke or vape.
请不要吸烟或电子烟。
The idea that vaping is okay is like we had a whole episode.
电子烟没问题的想法就像我们有一整集一样。
It's so bad.
太糟糕了。
So bad for everything we're talking about.
对于我们正在谈论的一切来说都很糟糕。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Let's end that chapter.
让我们结束这一章吧。
Andrew Huberman:
安德鲁·休伯曼：
Exactly.
正是如此。
Hopefully, they'll try and avoid those things.
希望他们会尽力避免这些事情。
Hopefully, they'll avoid hard drugs.
希望他们能够避免使用硬性毒品。
Hopefully, they'll avoid getting any STIs.
希望他们能够避免感染任何性传播感染。
If they do, they'll resolve them quickly, hopefully.
如果他们这样做了，希望他们能很快解决这些问题。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Yes.
是的。
Andrew Huberman:
安德鲁·休伯曼：
But they might say, "Oh, well, okay, I'm willing to take some magnesium or take some phosphatidylserine, buffer my cortisol, eat some vegetables." Should they consider taking fish oil as a kind of across-the-board inoculatory thing?
但他们可能会说，“哦，好吧，好吧，我愿意服用一些镁或磷脂酰丝氨酸，缓冲我的皮质醇，吃一些蔬菜。”他们是否应该考虑将鱼油作为一种全面的疫苗？
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
So I'd like to rank order these.
所以我想对这些进行排序。
I would say fish oil, yes.
我想说鱼油，是的。
I think 1,000 milligrams as a general recommendation is good, but I also have a food first philosophy.
我认为 1,000 毫克作为一般建议是不错的，但我也有食物第一的理念。
So my preference would be that they're having salmon or some kind of smashed fish, and they're getting that as the primary source of their omega-3s.
所以我更喜欢他们吃鲑鱼或某种碎鱼，他们将其作为 omega-3 的主要来源。
And then the days that they don't have fish, I recommend it probably twice a week that they take fish oil.
然后在他们不吃鱼的日子里，我建议他们每周服用鱼油两次。
Then I would put magnesium next, since so many people are deficient.
接下来我会添加镁，因为很多人都缺乏镁。
Then I'd probably put vitamin D.
然后我可能会放维生素D。
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
How many IU of vitamin D per day?
每天多少国际单位的维生素 D？
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Well, you keep asking me this.
好吧，你一直问我这个。
Andrew Huberman:
安德鲁·休伯曼：
Yeah.
是的。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Like for the population.
就像对于人口一样。
Andrew Huberman:
安德鲁·休伯曼：
Yeah.
是的。
Well, let me put it this way.
好吧，让我这样说。
For the lazy person or, and this is an or not an and, or the person who just doesn't have the finances to go get levels measured.
对于懒惰的人或，这是一个或不是一个和，或者只是没有财力去测量水平的人。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Yeah.
是的。
Andrew Huberman:
安德鲁·休伯曼：
Because our audience is a huge range.
因为我们的受众范围很大。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Yeah.
是的。
Andrew Huberman:
安德鲁·休伯曼：
We've got people who can have tons of disposable income that listen to this pod.
我们有很多拥有大量可支配收入的人收听这个播客。
We have people with no disposable income.
我们有些人没有可支配收入。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
So 1,000 to 2,000 international units.
所以 1,000 到 2,000 个国际单位。
Andrew Huberman:
安德鲁·休伯曼：
Okay.
好的。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
What I do is I dose to a serum level that's between about 50 and 90.
我所做的就是将血清浓度控制在 50 到 90 之间。
Andrew Huberman:
安德鲁·休伯曼：
Great.
太棒了。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
And so I have a vitamin D receptor SNP, and so I need to take about 5,000 a day to get to what I need.
我有维生素 D 受体 SNP，所以我每天需要服用大约 5,000 颗才能达到我的需要。
A lot of people don't need that.
很多人不需要那个。
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
And there's some supplements that I don't know if they need.
还有一些补充品我不知道他们是否需要。
So you mentioned phosphatidylserine.
所以你提到了磷脂酰丝氨酸。
For someone who's a college student and their cortisol is completely normal, they're wasting their money on PS.
对于大学生来说，他们的皮质醇完全正常，他们在 PS 上浪费了钱。
They don't need it.
他们不需要它。
They might need it later, but they don't need it now.
他们以后可能需要它，但现在不需要。
Andrew Huberman:
安德鲁·休伯曼：
I'd like to make sure that we circle back to birth control, in particular oral contraceptive birth control.
我想确保我们回到节育问题，特别是口服避孕药节育问题。
And we should touch on IUDs perhaps a little bit more.
我们也许应该更多地谈论宫内节育器。
But what are your thoughts on sort of pure estrogen birth control?
但是您对纯雌激素避孕有何看法？
This is what I learned when I was in college is that birth control is basically tonic estrogen.
这是我在大学时了解到的，节育基本上就是补雌激素。
So constantly taking estrogen, estrogen.
所以不断的服用雌激素，雌激素。
Women are taking estrogen so that they don't get the estrogen priming of progesterone.
女性服用雌激素是为了避免雌激素对孕激素的影响。
You're not getting any ovulation.
你没有排卵。
And I've known women that took oral contraception as like estrogen pills basically for five, 10, 15 years.
我认识一些女性，她们服用口服避孕药就像服用雌激素药一样，基本上服用了五年、十年、十五年。
Are there long-term consequences of this as it relates to pregnancy, PCOS, menopause?
这是否会产生与怀孕、多囊卵巢综合症、更年期有关的长期后果？
If so, what are some of those consequences?
如果是这样，会产生哪些后果？
What are your concerns?
您有什么顾虑？
What do you like about oral contraceptives?
您喜欢口服避孕药的哪些方面？
What do you dislike about them?
你不喜欢他们什么？
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
I like how balanced you ask that question.
我喜欢你问这个问题的平衡性。
So women who take oral contraceptives, as long as you're describing, like 10 years or longer, we call those Olympic oral contraceptive users.
所以服用口服避孕药的女性，只要你描述的，像10年或更长时间，我们就称之为奥林匹克口服避孕药使用者。
In terms of benefit, I think that especially when they first came out and even now, it gives women reproductive choice, and that's essential.
就好处而言，我认为特别是在它们刚出现时甚至现在，它为女性提供了生育选择权，这是至关重要的。
As you may know, our reproductive choice has been declining recently.
如您所知，我们的生殖选择最近一直在下降。
So I'm a big fan in that regard, and we've got a lot of data to show both the risks and also the benefits of it.
所以我是这方面的忠实粉丝，我们有大量数据来展示它的风险和好处。
So I'll speak first into the benefits because I'm going to get on a soapbox a little bit about the risks.
因此，我将首先谈谈好处，因为我将就风险进行一些演讲。
So we know that it reduces the risk of ovarian cancer.
所以我们知道它可以降低患卵巢癌的风险。
So there's something about this idea of incessant ovulation That is not good for the female body.
因此，持续排卵的想法对女性身体不利。
So if you look at, for instance, women who are nuns who don't take oral contraceptives and they have a period every single month of their reproductive lives, they have a greater risk of ovarian cancer.
例如，如果你观察那些不服用口服避孕药的修女女性，她们在生育期间每个月都会来一次月经，那么她们患卵巢癌的风险就更大。
So if you look then at women who have several babies and they've got a period of time when they're pregnant that they're not ovulating, and then they breastfeed for some period of time, they have a lower risk of ovarian cancer.
因此，如果你观察一下生育多个孩子的女性，她们在怀孕期间有一段时间不排卵，然后母乳喂养一段时间，那么她们患卵巢癌的风险较低。
So oral contraceptives help with reducing ovulation and reducing risk.
因此，口服避孕药有助于减少排卵并降低风险。
We know that if you take the oral contraceptive for about five years, it reduces your risk of ovarian cancer by 50%.
我们知道，如果您服用口服避孕药大约五年，您患卵巢癌的风险就会降低 50%。
And that's significant because we're so poor at diagnosing ovarian cancer early.
这很重要，因为我们在早期诊断卵巢癌方面做得很差。
There's really no method that's really effective.
确实没有什么方法是真正有效的。
We use CA 125 and ultrasound screening, especially in women who are at greater genetic risk.
我们使用 CA 125 和超声波筛查，尤其是针对遗传风险较高的女性。
But even that, often we diagnose it in a later stage.
但即便如此，我们通常还是在后期才诊断出来。
Andrew Huberman:
安德鲁·休伯曼：
Maybe just because that statement is going to highlight for a number of people the question of what are some of the earliest symptoms that people can recognize without a blood test.
也许只是因为该声明将向许多人强调这样一个问题：人们无需验血即可识别的最早症状是什么。
So is ovarian cancer, is it going to be pain?
那么卵巢癌的话，会痛吗？
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
So the problem is the symptoms are so vague and they're so nonspecific.
所以问题是症状是如此模糊且不具体。
One of the most common symptoms is bloating.
最常见的症状之一是腹胀。
And we've already talked about constipation, we've talked about how women have this longer GI tract, and so bloating is a really common experience for most women.
我们已经讨论过便秘，我们讨论过女性如何拥有更长的胃肠道，因此腹胀对于大多数女性来说是一种非常常见的经历。
You can have bulk symptoms, feeling like your lower belly is kind of pressed out.
您可能会出现肿块症状，感觉下腹部有点受压。
So the way that we inform women in terms of watching for this is to get regular gynecologic exams.
因此，我们告诉女性注意这一点的方法是定期进行妇科检查。
For women who are at high risk where they have, for instance, an ultrasound for some reason, and it shows a mass that we're concerned about, there's a way to triage that in terms of what kind of evaluation that they need, and that's the situation where you might get a blood test called the CA 125.
对于处于高风险的女性，例如，由于某种原因进行了超声波检查，结果显示了我们担心的肿块，有一种方法可以根据她们需要的评估类型对其进行分类，在这种情况下，您可能会进行称为 CA 125 的血液检查。
The problem is the symptoms are so vague.
问题是症状太模糊了。
It depends on how big the tumor is, how much bulk you have, what it's pressing on.
这取决于肿瘤有多大、你的体积有多大、它压迫什么。
Andrew Huberman:
安德鲁·休伯曼：
So if taking estrogen and thereby reducing the frequency of ovulation lowers the risk of ovarian cancer, should even women who are not sexually active, so they're not actively trying to get pregnant or avoid getting pregnant.
因此，如果服用雌激素从而减少排卵频率可以降低患卵巢癌的风险，那么即使是性生活不活跃的女性也应该这样做，这样她们就不会积极尝试怀孕或避免怀孕。
But if they're not sexually active, then the probability of conceiving, unless they go through some IUI or some other route, is very low, as far as I know.
但据我所知，如果她们的性行为不活跃，那么受孕的可能性非常低，除非她们通过宫腔内人工授精或其他途径。
That's what I was taught in high school anyway.
无论如何，这就是我在高中时所教的。
Would they be wise to suppress ovulation for periodically using hormone-based contraception just so that they can offset the risk of ovarian cancer?
为了抵消卵巢癌的风险，定期使用激素避孕来抑制排卵是否明智？
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
That's a very rational question, and I would say that's what mainstream medicine has had at its back to recommend oral contraceptives, not just for women who are seeking contraception, but for acne, for painful periods.
这是一个非常理性的问题，我想说，这就是主流医学推荐口服避孕药的原因，不仅适用于寻求避孕的女性，也适用于治疗痤疮和经期疼痛。
For really kind of the drop of a hat, they're prescribing oral contraceptives.
他们确实开了口服避孕药。
That's what I was taught to do.
这就是我被教导要做的。
But there are so many consequences, and I think the issue here is more about consent.
但后果有很多，我认为这里的问题更多的是关于同意。
Because in OBGYN, and I started out as a board-certified OBGYN, and I now mostly see men, but I was taught as an OBGYN to convince women to go on the oral contraceptive, and I think a lot of that is pharmaceutical influence.
因为在妇产科，我一开始是一名经过委员会认证的妇产科医生，现在我主要看男性，但作为一名妇产科医生，我被教导要说服女性继续服用口服避孕药，我认为这很大程度上是药物的影响。
So maybe we could talk about the risks and why the answer is no to your question.
所以也许我们可以谈谈风险以及为什么对你的问题答案是否定的。
Andrew Huberman:
安德鲁·休伯曼：
As we do that, could I just ask, is the so-called ring, it used to be called the NuvaRing.
当我们这样做的时候，我能问一下，就是所谓的戒指吗，它曾经被称为 NuvaRing。
Maybe that's a brand name.
也许这就是一个品牌名称。
But when I was in college, there was all this discussion about the ring by both men and women for reasons that don't belong on the podcast.
但当我上大学时，男性和女性都对戒指进行了所有讨论，其原因不属于播客。
Use your imagination, folks.
发挥你的想象力，伙计们。
So the ring, obviously it's not oral hormone contraception, but it's hormone based, right?
所以戒指，显然不是口服激素避孕药，而是基于激素的，对吗？
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
It is.
是的。
Andrew Huberman:
安德鲁·休伯曼：
The ring is releasing estrogen locally as opposed to taking it orally.
该环在局部释放雌激素，而不是口服。
But would you slot it under what you're about to tell us in terms of the concerns?
但您能否将其放在您将要告诉我们的担忧的内容之下？
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
So we have less data about the ring.
所以我们关于戒指的数据较少。
So the oral contraceptive is two hormones.
所以口服避孕药是两种激素。
It's ethinyl estradiol, and it's a progestin.
它是乙炔雌二醇，它是一种孕激素。
So it's not the normal progesterone that your body makes, that your ovaries make, and your adrenals make.
因此，这不是您的身体、卵巢和肾上腺产生的正常黄体酮。
It is a synthetic form of progesterone.
它是黄体酮的合成形式。
And it is the same progestin, similar, same class that was shown to be dangerous and provocative in the Women's Health Initiative.
在妇女健康倡议中，它是被证明具有危险性和挑衅性的相同、相似、相同类别的孕激素。
So I'm not a fan of progestins.
所以我不喜欢孕激素。
I do not recommend them for any woman unless the consequence of not taking them is surgery or unless it gives them some freedom in some way.
我不向任何女性推荐它们，除非不服用它们的后果是手术，或者除非它以某种方式给她们一些自由。
So I don't like progestins.
所以我不喜欢孕激素。
The NuvaRing is estrogen plus progestin, but it's released transdermally through the vagina.
NuvaRing 是雌激素加孕激素，但它是通过阴道经皮释放的。
So given the way that it's delivered to the vagina, the doses are lower than what's taken orally.
因此，考虑到它输送到阴道的方式，剂量低于口服剂量。
But in terms of some of the risks that I'm about to talk about, we don't know about much of the data.
但就我即将讨论的一些风险而言，我们对大部分数据了解不多。
We think that it's similar.
我们认为这是相似的。
There's probably a spectrum of risk, and the NuvaRing is a little more towards the middle than what I'm talking about with oral contraceptives.
可能存在一系列风险，NuvaRing 比我所说的口服避孕药更接近中间一点。
Andrew Huberman:
安德鲁·休伯曼：
Okay.
好的。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Are you ready for that?
你准备好了吗？
Andrew Huberman:
安德鲁·休伯曼：
Yeah, I'm ready for the risks.
是的，我已经做好了应对风险的准备。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Okay.
好的。
So like with almost any pharmaceutical, the oral contraceptive depletes certain micronutrients.
因此，与几乎所有药物一样，口服避孕药会消耗某些微量营养素。
So magnesium, there's certain vitamin Bs that are depleted.
镁和某些维生素 B 都被耗尽了。
It also affects the microbiome.
它还会影响微生物组。
That data is not as strong, but there seems to be some effect.
这个数据虽然没有那么有力，但似乎也有一些效果。
And there's also an increased risk of inflammatory bowel disease, an autoimmune condition.
而且患炎症性肠病（一种自身免疫性疾病）的风险也会增加。
It increases inflammatory tone.
它增加炎症张力。
So the studies that I've seen increase one of the markers of inflammatory tone, high sensitivity CRP, by about 2 to 3 X.
因此，我看到的研究将炎症张力的标志物之一——高敏感性 CRP 增加了约 2 到 3 倍。
It seems to make the hypothalamic pituitary adrenal axis more rigid so that you can't kind of roll with the punches and wax and wane in terms of cortisol production the way that you can off the birth control pill.
它似乎使下丘脑、垂体、肾上腺轴变得更加坚硬，这样你就不能像戒掉避孕药那样，在皮质醇的产生方面随波逐流、起伏不定。
It can affect thyroid function.
它会影响甲状腺功能。
I'm thinking of the slide that I have that has 10 problems associated with the oral contraceptive, but that's what I can remember right now.
我正在思考我的幻灯片，其中有 10 个与口服避孕药相关的问题，但这就是我现在能记住的。
Andrew Huberman:
安德鲁·休伯曼：
That's very helpful, and it makes me wonder whether or not if on the one hand, oral contraceptives are protective in women against ovarian cancer, but then they have these other issues.
这非常有帮助，这让我想知道，一方面口服避孕药是否可以保护女性免受卵巢癌的侵害，但另一方面她们还有其他问题。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Yeah.
是的。
There's one other I want to mention.
我还想提一下另外一个。
Andrew Huberman:
安德鲁·休伯曼：
Please.
请。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Anytime you take oral estrogen, it raises sex hormone-binding globulin.
每当您口服雌激素时，它都会增加性激素结合球蛋白。
And you've talked to other podcast guests about this, Kyle, I think.
我想，凯尔，你已经和其他播客嘉宾谈论过这个问题了。
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Sex hormone-binding globulin, I think of as a sponge that soaks up free estrogen and free testosterone.
性激素结合球蛋白，我认为是吸收游离雌激素和游离睾酮的海绵。
So when you go on the birth control pill, you raise your sex hormone-binding globulin.
因此，当您服用避孕药时，您的性激素结合球蛋白会升高。
It soaks up especially free testosterone, and for some women, it's not a big deal.
它吸收特别是游离睾酮，对于一些女性来说，这不是什么大问题。
They don't notice much of a difference.
他们没有注意到太大的差异。
But then there's a phenotype, maybe related to CAG repeats on the androgen receptor, who are exquisitely sensitive to that decline in free testosterone.
但还有一种表型，可能与雄激素受体上的 CAG 重复有关，雄激素受体对游离睾酮的下降非常敏感。
So this then opens the portal of talking a little bit about testosterone in women.
因此，这就打开了谈论女性睾酮激素的大门。
So we've mentioned already that it's the most abundant, biologically the most abundant hormone in the female system.
所以我们已经提到，它是女性系统中最丰富、生物学上最丰富的激素。
Even though men make almost 10 times as much or even more than 10 times, it is so important for women.
尽管男性的收入几乎是男性的10倍甚至超过10倍，但这对女性来说却是如此重要。
It is essential to so many things, not just sex drive and muscle mass and seeing a response to resistance training, but also confidence and agency.
它对很多事情都很重要，不仅仅是性欲和肌肉质量以及对阻力训练的反应，还包括信心和能动性。
And so those women who are so sensitive to their testosterone level, they've got this high sex hormone-binding globulin, their testosterone declines.
因此，那些对睾酮水平非常敏感的女性，她们体内的性激素结合球蛋白很高，她们的睾酮水平就会下降。
What they describe is vaginal dryness, maybe a decline in sex drive, but there's also this bigger issue related to confidence and agency, even risk-taking from studies that we've done with MBA students that I think is a serious problem.
他们所描述的是阴道干燥，可能是性欲下降，但还有一个与信心和代理有关的更大问题，甚至是我们对 MBA 学生进行的研究中的冒险行为，我认为这是一个严重的问题。
Maybe the most important out of all of these things is that it can shrink the clitoris by up to 20%.
也许所有这些事情中最重要的是它可以使阴蒂缩小高达 20%。
20%.
20%。
Andrew Huberman:
安德鲁·休伯曼：
And that includes a regression of the nerves that innervate the clitoris?
这包括支配阴蒂的神经退化吗？
Is that...
难道是……
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
That's a very good question as a neuroscientist.
作为神经科学家，这是一个非常好的问题。
Andrew Huberman:
安德鲁·休伯曼：
Yeah.
是的。
I used to teach the neural side of reproductive health.
我曾经教授生殖健康的神经方面的知识。
We need to do a series on sexual health.
我们需要做一系列有关性健康的活动。
Maybe you would co-host that with me-
也许你会和我共同主持——
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Sure
当然可以
Andrew Huberman:
安德鲁·休伯曼：
...
...
because we could certainly use your expertise.
因为我们当然可以利用您的专业知识。
I think, yeah, that's a dramatic number.
我想，是的，这是一个戏剧性的数字。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
It's dramatic.
这是戏剧性的。
Yeah.
是的。
But then let's go back to the sacred marketing.
但接下来让我们回到神圣的营销。
If I've got a woman that I think should not be on the birth control pill, and maybe she's taking it for acne, or she's taking it because her periods were a little painful, what I'm going to do is say, "Let's leverage these other ways of making your period less painful.
如果我有一个我认为不应该服用避孕药的女性，也许她是因为痤疮而服用避孕药，或者她服用避孕药是因为她的经期有点疼痛，我要做的是说，“让我们利用这些其他方法来减轻经期疼痛。
Let's take the message of your painful periods and figure out, okay, it's at your inflammatory tone, and we give you some fish oil and ATMs, maybe a little aspirin when you've got your period.
让我们了解一下您经期疼痛的信息，然后弄清楚，好吧，这是您的炎症基调，我们会给您一些鱼油和自动提款机，也许在您经期时给您一点阿司匹林。
Let's find some other ways to deal with it than to take the oral contraceptive, which you have not received informed consent about, because it can shrink your clit by up to 20%." Now, that usually convinces most people to come off of it.
让我们找到一些其他方法来处理它，而不是服用口服避孕药，因为它可以使你的阴蒂缩小多达 20%。”现在，这通常会说服大多数人放弃它。
Andrew Huberman:
安德鲁·休伯曼：
Is that reversible?
这是可逆的吗？
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
The elevation in sex hormone-binding globulin does not seem to go away when you come off the birth control pill.
当您停止服用避孕药时，性激素结合球蛋白的升高似乎不会消失。
To me, that is the biggest problem with prescribing oral contraceptives.
对我来说，这是服用口服避孕药的最大问题。
Now, the data that we have is limited.
现在，我们拥有的数据是有限的。
There's one woman, Claudia something something, who looked at sex hormone-binding globulin a year out from stopping the birth control pill, and it was still elevated.
有一个女人，克劳迪娅什么的，在停止服用避孕药一年后，她检查了性激素结合球蛋白，发现它仍然升高。
It wasn't as high as it was when they were on the pill, but it was still elevated.
虽然没有服用避孕药时那么高，但仍然升高。
So your question about reversibility, I don't know if we know the answer to that.
所以你关于可逆性的问题，我不知道我们是否知道答案。
Andrew Huberman:
安德鲁·休伯曼：
Wow.
哇。
Okay.
好的。
Yeah, that's a significant statement and something for consideration.
是的，这是一个重要的声明，值得考虑。
Related to this, although this might seem not related, it is, how early do you recommend that women go get their follicle number assessed?
与此相关的是，尽管这看起来似乎无关，但您建议女性多早进行卵泡数量评估？
In other words, to get a sense of the size of the ovarian reserve and their AMH levels measured.
换句话说，了解卵巢储备的大小及其测量的 AMH 水平。
I'm an amateur outsider as I say this, but we have an episode on fertility where I just describe the ovulatory menstrual cycle.
正如我所说，我是一个业余局外人，但我们有一集关于生育的节目，我只是描述了排卵月经周期。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Yeah.
是的。
Andrew Huberman:
安德鲁·休伯曼：
And-
还有——
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
I'm not the best person to answer that.
我不是回答这个问题的最佳人选。
Andrew Huberman:
安德鲁·休伯曼：
Yeah.
是的。
Well, we can-
好吧，我们可以——
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
I'm too far out from it.
我离它太远了。
Andrew Huberman:
安德鲁·休伯曼：
Okay.
好的。
Well, I suppose then from taking the perspective of somebody who thinks about fertility in terms of at least congruent with vitality and longevity-
好吧，我想，从一个认为生育力至少与活力和长寿一致的人的角度来看——
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Yeah
是啊
Andrew Huberman:
安德鲁·休伯曼：
...
...
given that it's fairly non-invasive, it's an ultrasound or a blood draw for AMH or both, is there any reason why a woman would not want to get her follicle number assessed or her AMH levels assessed?
鉴于它是相当非侵入性的，它是超声检查或抽血检测 AMH，或者两者兼而有之，那么女性有什么理由不想评估她的卵泡数量或评估她的 AMH 水平呢？
Is there any reason why?
有什么理由吗？
Because I was shocked to learn that most women don't do this-
因为我很震惊地发现大多数女性不会这样做-
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Yeah
是啊
Andrew Huberman:
安德鲁·休伯曼：
...
...
until they're hitting their late 30s or early 40s, and they either haven't conceived or they suddenly decide that they want to conceive.
直到她们30岁末或40岁出头，她们要么没有怀孕，要么突然决定要怀孕。
And I thought, "Why doesn't every doctor insist that their female patients have their AMH level addressed so that if they need to-
我想，“为什么不是每个医生都坚持要求他们的女性患者解决 AMH 水平问题，以便在需要时——
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
It's cost
这是成本
Andrew Huberman:
安德鲁·休伯曼：
...
...
freeze eggs, they can?"
冷冻卵子，可以吗？”
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
It's cost.
这是成本。
Andrew Huberman:
安德鲁·休伯曼：
It's cost?
是成本吗？
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Yeah.
是的。
So I think if you've got the disposable income to do it, go for it.
所以我认为如果你有足够的可支配收入来做这件事，那就去做吧。
Andrew Huberman:
安德鲁·休伯曼：
It's not included in a standard blood panel?
它不包含在标准血液检测中吗？
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
No. The only women in my practice who've had AMHs done and have looked at their follicle count are women who want to freeze their eggs, and that requires disposable income, or they are having trouble getting pregnant, so they are in the reproductive endocrinology system, and they're getting an evaluation.
不会。在我的诊所中，唯一做过 AMH 并检查过卵泡计数的女性是想要冷冻卵子的女性，这需要可支配收入，或者她们在怀孕方面遇到困难，所以她们在生殖内分泌系统中接受评估。
And then there are also the women who have symptoms of early menopause.
还有一些女性会出现更年期提前的症状。
So premature ovarian insufficiency, which is before age 40.
所以卵巢早衰，也就是40岁之前。
Those are the women that I see getting it tested, and I think you're right that it should be offered more broadly.
我看到这些女性正在接受测试，我认为你认为应该更广泛地提供它是正确的。
It speaks to the democratization of data again, and I think most women don't know that.
它再次谈到了数据的民主化，我认为大多数女性并不知道这一点。
So you're doing a huge service, I think, to be speaking into this.
所以我认为你在谈论这个问题是做了很大的贡献。
One other point related to that is that what I see in conventional medicine is that when a woman asks for a hormone panel and she's not trying to get pregnant, she usually gets told that hormones vary too much, it's a waste of money, you don't need it.
与此相关的另一点是，我在传统医学中看到的是，当一位女性要求进行激素检查并且她不想怀孕时，她通常会被告知激素变化太大，这是浪费钱，你不需要它。
Or, "If you're feeling hormonal, why don't you go on a birth control pill?" Unless she's trying to get pregnant.
或者，“如果你感觉荷尔蒙分泌旺盛，为什么不服用避孕药呢？”除非她想怀孕。
If she's trying to get pregnant, suddenly those same tests are very reliable, and they get their testosterone, their free testosterone, their thyroid panel.
如果她想怀孕，突然间这些相同的测试就非常可靠，他们会得到睾酮、游离睾酮和甲状腺检查。
They get their estrogen and progesterone.
他们获得雌激素和黄体酮。
Maybe they get their cortisol.
也许他们得到了皮质醇。
They get their AMH.
他们得到了 AMH。
So there's a double standard between those who want to get pregnant and those who don't, and that needs to end.
因此，想要怀孕的人和不想怀孕的人之间存在双重标准，这种情况需要结束。
Andrew Huberman:
安德鲁·休伯曼：
Yeah, I totally agree.
是的，我完全同意。
As I've learned more about ovulatory cycle and AMH and the antral population of follicles, it's fascinating.
随着我对排卵周期、AMH 以及卵泡窦群的了解越来越多，这很有趣。
It just seems to me, wow, a relatively straightforward test.
在我看来，哇，这是一个相对简单的测试。
One definitely invasive ultrasound, but-
一种绝对有创的超声波，但是-
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
I don't consider that
我不这么认为
Andrew Huberman:
安德鲁·休伯曼：
...
...
yeah.
是的。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
That's not invasive.
这不是侵入性的。
Andrew Huberman:
安德鲁·休伯曼：
Not terribly invasive, but invasive at least.
不是非常具有侵入性，但至少具有侵入性。
But the other one, just pure blood test.
但另一项，只是纯血测试。
Just seems like why wouldn't this be offered or covered by insurance, or that anyone that wanted it?
似乎为什么保险不提供或承保这种情况，或者任何想要它的人？
But now I understand why.
但现在我明白为什么了。
You mentioned menopause.
你提到了更年期。
Huge topic.
巨大的话题。
Enormous topic.
话题浩大。
We had a guest on the podcast who's not a clinician, who said something in passing, so I'm likely to get this wrong, but what they said was that the results of the large-scale trials on hormone replacement therapy for women for menopause said something to the effect of if the hormone therapy was started early enough, it was very beneficial for-
我们的播客上有一位非临床医生的嘉宾，他顺便说了一些话，所以我可能会弄错，但他们说的是，针对更年期女性的激素替代疗法的大规模试验的结果表明，如果激素治疗足够早地开始，这对-
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Yes
是的
Andrew Huberman:
安德鲁·休伯曼：
...
...
vitality and health outcomes, whereas if women went through menopause and then initiated the hormone replacement therapy, that it could be detrimental to their health.
活力和健康结果，而如果女性经历更年期然后开始激素替代疗法，则可能对其健康有害。
So first of all, do I recall that statement correctly?
首先，我是否正确地记得那句话？
And then second of all, what sorts of hormones are being replaced?
其次，什么样的激素正在被取代？
Is it just estrogen?
只是雌激素吗？
And how is that done?
这是怎么做到的？
Is it done through birth control?
是通过节育来实现的吗？
So oral contraceptives, NuvaRings.
所以口服避孕药，NuvaRings。
What are your thoughts on menopause?
您对更年期有何看法？
When should people start thinking about it?
人们什么时候应该开始思考这个问题？
And what is the palette of things available so that we can do an entire episode with you on this topic in the future?
未来我们可以就这个主题与您一起制作一整集的可用内容是什么？
I get a lot of questions about this, and I'm guessing, based on everything you've told me today, that there are women in their 30s that while they may be 20 years out from menopause, probably should be doing things now in anticipation of that.
我收到了很多关于这个问题的问题，根据你今天告诉我的一切，我猜想，有些 30 多岁的女性虽然距离更年期可能还有 20 年，但现在可能应该做些事情来应对更年期。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Yes.
是的。
So we haven't talked about the 30-something, but I totally agree with you.
所以我们还没有讨论过 30 多岁的问题，但我完全同意你的观点。
The more you know about your phenotype, your hormonal phenotype when you're in your 30s, you're set up in terms of what to do in the future, especially things like your thyroid, your estrogen and progesterone levels, because you can replace to a state of euthyroid, whatever that is for you.
当你 30 多岁的时候，你对自己的表型、荷尔蒙表型了解得越多，你就会对未来做什么做好准备，尤其是你的甲状腺、雌激素和黄体酮水平，因为你可以恢复到甲状腺功能正常的状态，无论这对你来说是什么。
You can replace-- I don't usually go exactly back to where the estrogen and progesterone levels were, but we can get pretty close.
你可以替换——我通常不会完全回到雌激素和黄体酮水平的水平，但我们可以非常接近。
So in your 30s, having a base case, I think, is really essential.
因此，我认为，在 30 多岁的时候，拥有一个基本情况非常重要。
So you spoke to the Women's Health Initiative, which was published in 2002, and we went from a huge number of women taking hormone therapy to a very small percentage, like in the range of 5%.
所以你谈到了 2002 年发布的女性健康倡议，我们将接受激素治疗的女性人数从大量减少到很小的比例，比如 5% 左右。
And that means we've got millions and millions of women who are suffering needlessly with things like insomnia, difficulty with their mood, difficulty with sex drive, feeling like they are closing the store in terms of sex because they're not on hormone therapy.
这意味着我们有数以百万计的女性正在遭受不必要的痛苦，比如失眠、情绪低落、性欲困难，感觉自己在性方面要关门了，因为她们没有接受激素治疗。
I would agree with the statement that you made that hormone therapy, particular forms that are similar to what your body always made, when it's given judiciously at the right time, typically within five to 10 years of menopause, which is 51 to 52, that is incredibly safe.
我同意您所说的激素疗法，即与您的身体通常产生的激素类似的特殊形式，如果在正确的时间明智地给予，通常是在绝经后 5 到 10 年（即 51 到 52）内，那是非常安全的。
So it's a complicated study, the Women's Health Initiative, but it was the wrong study in the wrong patients with the wrong medications and with some of the wrong outcomes.
因此，这是一项复杂的研究，即妇女健康倡议，但这是一项错误的研究，针对的是错误的患者，使用了错误的药物，并且产生了一些错误的结果。
So it was powered to look at cardiovascular outcomes.
因此它有能力观察心血管结果。
It was not powered to look at breast cancer.
它没有能力检查乳腺癌。
It was stopped because of breast cancer risk.
由于乳腺癌风险，该计划被停止。
But what happened in the control arm of the study was that they had an incredibly low rate of breast cancer.
但在该研究的对照组中发生的情况是，她们的乳腺癌发病率极低。
And so as a result, they ended up having this increased risk of breast cancer at five years, and they stopped the study.
结果，他们在五年内患乳腺癌的风险增加了，他们停止了这项研究。
Now, the study was done with synthetics.
现在，这项研究是用合成物完成的。
It was done with conjugated equine estrogen, known as Premarin, and medroxyprogesterone acetate.
它是用结合的马雌激素（称为倍美力）和醋酸甲羟孕酮完成的。
Those were the so-called estrogen and progesterone.
这些就是所谓的雌激素和黄体酮。
Those are synthetic hormones.
这些是合成激素。
We think especially the progestin is associated with the greater risk of breast cancer, although the subsequent reevaluations of the data, now 18 years out, have shown that This problem with the control group and no increased risk of breast cancer.
我们认为，尤其是孕激素与乳腺癌的风险增加有关，尽管随后对数据的重新评估（现已过去 18 年）表明，对照组存在这一问题，并且乳腺癌风险并未增加。
And for the women who got estrogen only, those who had a hysterectomy, the Premarin, they actually had a decreased breast cancer risk and decreased breast cancer mortality.
对于只服用雌激素的女性，即接受子宫切除术的女性，服用倍美力后，她们患乳腺癌的风险和乳腺癌死亡率实际上都降低了。
So there's a lot to be said about this.
所以关于这一点有很多话要说。
I'm trying to keep it really brief.
我尽量保持简短。
But if you look at the women 50 to 60, so within 10 years of menopause, they're the ones who seem to have the greatest benefit.
但如果你观察 50 至 60 岁的女性，那么在绝经后 10 年内，她们似乎是受益最大的群体。
So they had a decreased subclinical atherosclerosis, so less cardiovascular disease.
所以他们的亚临床动脉粥样硬化减少了，因此心血管疾病也减少了。
They had an improvement in terms of bone health, less progression to diabetes.
他们的骨骼健康有所改善，糖尿病进展较少。
And then over the age of 60, they started to have greater risk of certain outcomes, such as cardiovascular disease, myocardial infarction, and so on.
超过 60 岁后，他们开始面临更大的某些后果的风险，例如心血管疾病、心肌梗塞等。
You asked about, what do I do?
你问我要做什么？
And to me, this problem is not just menopause.
对我来说，这个问题不仅仅是更年期。
What's more interesting is to talk about perimenopause.
更有趣的是谈论围绝经期。
So perimenopause is the period of time before your final menstrual cycle, and for most women, depending on how attuned you are to the symptoms, it can last for 10 years.
因此，围绝经期是最后一次月经周期之前的一段时间，对于大多数女性来说，根据您对症状的适应程度，围绝经期可以持续 10 年。
So I'm still in perimenopause.
所以我还处于围绝经期。
It's been 20 years because I've been tracking it so carefully.
20年过去了，因为我一直如此仔细地追踪它。
It usually gets kicked off by having your cycle get closer together.
它通常是在你的周期变得更接近时开始的。
So that can happen in your 30s or your 40s.
所以这可能会发生在你 30 多岁或 40 多岁的时候。
You go from 28 days to 25 days, that sort of thing.
你从 28 天到 25 天，诸如此类。
You may notice that you start sleeping more poorly because progesterone's so important.
您可能会注意到，由于黄体酮非常重要，您的睡眠质量开始变差。
You talked about that with Kyle.
你和凯尔谈过这个。
You may notice it as more anxiety, difficulty sleeping, and that probably is related to the estrogen receptor.
您可能会注意到它更加焦虑、睡眠困难，这可能与雌激素受体有关。
So ER alpha is estrogen receptor alpha is anxiogenic.
所以ERα是雌激素受体α，是致焦虑的。
It increases anxiety.
它会增加焦虑。
ER beta is associated with an anxiolytic activity.
ER beta 与抗焦虑活性相关。
And then there's a total of about six estrogen receptors now.
现在总共有大约六个雌激素受体。
There's the G protein-coupled estrogen receptors, and those are mixed anxiolytic, anxiogenic.
G 蛋白偶联雌激素受体具有混合抗焦虑和致焦虑作用。
So, there's this whole period of perimenopause, and what's most fascinating to me, and we've got to talk about this either today or another time, is that there is this massive, massive change that happens in the female brain that people are not talking about enough.
所以，整个围绝经期，对我来说最有趣的是，我们今天或其他时间都必须讨论这个问题，那就是女性大脑中发生了这种巨大的变化，而人们对它的谈论还不够。
And so looking at the work of Lisa Mosconi at Cornell, from starting around age 40, there is this massive change in cerebral metabolism.
因此，看看康奈尔大学丽莎·莫斯科尼 (Lisa Mosconi) 的工作，从 40 岁左右开始，大脑新陈代谢就发生了巨大的变化。
So you can do FDG PET scans, you can look at glucose uptake, and there's about, on average, a 20% decline from premenopause, up to age 35, to perimenopause, to post-menopause.
所以你可以做 FDG PET 扫描，你可以观察葡萄糖的摄取情况，从绝经前、35 岁之前、到围绝经期、到绝经后，平均大约下降 20%。
The women who are having the most symptoms in perimenopause to menopause, the hot flashes, the night sweats, the difficulty sleeping, those are the ones who have the most significant cerebral hypometabolism.
围绝经期至更年期症状最多的女性，潮热、盗汗、睡眠困难，是脑代谢低下最严重的人群。
Andrew Huberman:
安德鲁·休伯曼：
So it's almost like a, I don't want to scare people with this language, but it's a low level, or let's call it pseudo-dementia of sorts.
所以这几乎就像是，我不想用这种语言吓唬人们，但它的水平很低，或者让我们称之为伪痴呆症。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Yes.
是的。
It seems to be a phenotype that you can then map to Alzheimer's disease because that's Lisa Mosconi's work.
这似乎是一种可以映射到阿尔茨海默病的表型，因为这是丽莎·莫斯科尼的工作。
She's looking at, okay, Alzheimer's disease is not a disease of old age.
她看着，好吧，阿尔茨海默病不是老年病。
It is a disease of middle age.
这是一种中年病。
What are some of the biomarkers that we can define that can tell you what your risk is?
我们可以定义哪些生物标志物来告诉您您的风险是什么？
I've got a mother and a grandmother with Alzheimer's disease.
我的母亲和祖母都患有阿尔茨海默病。
You can believe I am all over this data.
你可以相信我对这些数据很了解。
Andrew Huberman:
安德鲁·休伯曼：
And insulin resistance-
还有胰岛素抵抗——
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Huge part of it
其中很大一部分
Andrew Huberman:
安德鲁·休伯曼：
...
...
insulin insensitivity, as we talked about before, seems to be somewhere in there.
正如我们之前谈到的，胰岛素不敏感似乎就在其中。
Which I think when that idea first surfaced, a few people were like, "Really?" But then, of course, the brain is this incredibly metabolically demanding organ.
我认为当这个想法第一次出现时，有些人会说，“真的吗？”当然，大脑是一个代谢要求极高的器官。
You deprive neurons of fuel sources, or you make them less sensitive to fuel sources, they start dying.
如果你剥夺神经元的燃料来源，或者降低它们对燃料来源的敏感度，它们就会开始死亡。
They certainly start firing less.
他们当然开始减少射击。
It makes perfect sense.
这是完全有道理的。
And I think now it's, thanks to Lisa's work, work that you've done and have talked about quite a lot in your books and elsewhere, I think has really highlighted for people that metabolism and metabolomics is going to be as important as genes and genomics when it comes to-
我认为现在，多亏了丽莎的工作，你所做的工作，以及你在书中和其他地方谈论过的很多工作，我认为这确实向人们强调了新陈代谢和代谢组学将与基因和基因组学一样重要——
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
That's right
没错
Andrew Huberman:
安德鲁·休伯曼：
...
...
dementia.
痴呆症。
Perhaps, especially in women.
也许，尤其是女性。
Is it safe to say that?
这样说安全吗？
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
I think so because we believe that the system is regulated by estrogen.
我这么认为是因为我们相信该系统是由雌激素调节的。
So the decline in estrogen starting around age 40, 43 is kind of the average, seems to be the driver behind cerebral hypometabolism.
因此，雌激素从 40 岁左右开始下降，43 岁是平均水平，似乎是脑代谢低下的驱动因素。
The way I describe it to my patients is it's like slow brain energy.
我向我的病人描述的方式是，这就像大脑能量缓慢。
So you walk into a room, you can't remember why.
所以你走进一个房间，你不记得为什么。
You just notice that you can't manage all the tasks the way that you once could.
您只是注意到您无法像以前那样管理所有任务。
Things are just a little slower.
事情进展得有点慢。
And I say that to women, and they're like, "I have that.
我对女性这么说，她们会说：“我有这个。
Help me." So this is then circling back to WHI, where women are scared to death of taking hormone therapy.
帮帮我。”那么这又回到了 WHI，那里的女性对接受激素治疗感到恐惧。
And we've got all of these women that are marching toward potentially a greater risk of Alzheimer's disease.
所有这些女性都可能面临更大的阿尔茨海默病风险。
And they have this opportunity in their 40s and their 50s to take hormone therapy, and they may not be offered it because the typical conventional approach based on WHI is to say, "Unless you're having hot flashes and night sweats that are severe, I'm not going to give you hormone therapy." And I just want to call that out.
他们在 40 多岁和 50 多岁的时候有机会接受激素治疗，但他们可能不会接受激素治疗，因为基于 WHI 的典型传统方法是说，“除非你有严重的潮热和盗汗，否则我不会给你激素治疗。”我只是想指出这一点。
I would say no. That is not the way to approach it.
我会说不。这不是解决问题的方法。
Further, the concept right now in conventional medicine is that hot flashes and night sweats are these nuisance symptoms that we will take care of temporarily, maybe with a little bit of estrogen and progesterone or a birth control pill because it's given a lot.
此外，传统医学目前的概念是，潮热和盗汗是这些令人讨厌的症状，我们将暂时处理这些症状，可能会用一点雌激素和黄体酮或避孕药，因为它的剂量很大。
Andrew Huberman:
安德鲁·休伯曼：
Or that they pass.
或者他们通过了。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Or that you just-
或者你只是——
Andrew Huberman:
安德鲁·休伯曼：
This idea like, yeah
这个想法就像，是的
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
...
...
suck it up.
吸干它。
Andrew Huberman:
安德鲁·休伯曼：
Right.
对。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Suck it up It doesn't matter that you're not sleeping anymore.
忍住吧，你不再睡觉也没关系。
Turn down the temperature in your room.
调低房间的温度。
And that's not right, because hot flashes and night sweats are a biomarker of cardiometabolic disease.
这是不对的，因为潮热和盗汗是心脏代谢疾病的生物标志物。
They are a biomarker of increased bone loss.
它们是骨质流失增加的生物标志物。
They are a biomarker of changes in the brain.
它们是大脑变化的生物标志物。
So many of these symptoms that occur in perimenopause are not driven by the ovaries.
围绝经期出现的许多症状并不是由卵巢引起的。
They are driven by the brain.
它们是由大脑驱动的。
Andrew Huberman:
安德鲁·休伯曼：
Yeah.
是的。
It's the bidirectional crosstalk between the body and the brain keeps-- I think is this resounding theme.
这是身体和大脑之间的双向串扰——我认为这是一个响亮的主题。
We had Chris Palmer on here, a psychiatrist-
我们这里有克里斯·帕尔默，一位精神病学家——
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Yes
是的
Andrew Huberman:
安德鲁·休伯曼：
...
...
who's talking about ketogenic diet for treatment-
谁在谈论生酮饮食治疗-
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Totally
完全
Andrew Huberman:
安德鲁·休伯曼：
...
...
of mental health.
的心理健康。
I know we could have a whole other discussion, and we will, I hope, if you'll agree to it, about nutrition and as it relates to hormones, specific diets and so forth.
我知道我们可以进行完全其他的讨论，我希望，如果您同意的话，我们将会讨论营养以及与激素、特定饮食等相关的问题。
But the-
但是——
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
And that's a question, too, whether this problem of cerebral hypometabolism, could we solve it with estrogen and/or increased metabolic flexibility?
这也是一个问题，我们是否可以通过雌激素和/或增加代谢灵活性来解决大脑代谢低下的问题？
So I just wanted to footnote that.
所以我只是想对此进行脚注。
Sorry to interrupt you.
抱歉打扰你了。
Andrew Huberman:
安德鲁·休伯曼：
No, please.
不，请。
Please interrupt.
请打断。
As long as we're there, I know you are a fan in some instances of intermittent fasting, time-restricted feeding, and/or ketogenic diet-
只要我们在那里，我就知道您在某些情况下是间歇性禁食、限时喂养和/或生酮饮食的粉丝——
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Yes
是的
Andrew Huberman:
安德鲁·休伯曼：
...
...
to get cells sensitive to insulin.
使细胞对胰岛素敏感。
If I understand correctly, which is not to say that women need to stay on the ketogenic diet for long periods of time or intermittent fast for only time-restricted feeding for eight hours or six hours a day, but that by increasing, you said metabolic flexibility, excuse me, but by increasing cells' sensitivity to insulin and then maybe returning to a more typical eating pattern and periodically switching back and forth, that might actually be beneficial.
如果我理解正确的话，这并不是说女性需要长期坚持生酮饮食或间歇性禁食，每天只进行八小时或六小时的限时喂养，而是说通过增加新陈代谢的灵活性，对不起，而是通过增加细胞对胰岛素的敏感性，然后可能回到更典型的饮食模式并定期来回切换，这实际上可能是有益的。
Do I have that right?
我有这个权利吗？
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Yeah, I love the pulse.
是的，我喜欢脉搏。
So I feel like it's much more physiologic than, say, going on a ketogenic diet and staying there for years.
所以我觉得这比采用生酮饮食并持续数年更具生理性。
All of the data that we have on the ketogenic diet, it's pretty limited in terms of duration.
我们掌握的关于生酮饮食的所有数据，其持续时间都非常有限。
The longest players that we have in terms of the data are the folks with epilepsy, and that's just a different phenotype.
从数据来看，我们拥有的最长的玩家是患有癫痫症的人，这只是一种不同的表型。
So I think in terms of microbiome effects, diversity, dysbiosis, some of those issues, we really don't know in terms of long-term effects.
所以我认为就微生物组影响、多样性、生态失调等一些问题而言，我们真的不知道长期影响。
So I prefer with a ketogenic diet that it's used as an N of 1 experiment, and that you do it for four weeks.
因此，我更喜欢将生酮饮食用作 N of 1 实验，并且进行四个星期。
Maybe you measure biomarkers before and afterwards.
也许您在之前和之后测量生物标志物。
Maybe you look at your stool before and afterwards, and we still haven't talked about stool tests yet.
也许你检查了之前和之后的大便，我们还没有讨论大便检查。
But you could measure your fasting insulin and your glucose.
但您可以测量空腹胰岛素和血糖。
You could just start there.
你可以从那里开始。
Do four weeks of keto, clean keto, including vegetables, doesn't have to be 57 a day, and then measure it again afterwards.
做四个星期的酮，干净的酮，包括蔬菜，不一定要每天57，然后再测量一次。
Andrew Huberman:
安德鲁·休伯曼：
Since you mentioned stool testing-
既然你提到了粪便测试-
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Yes
是的
Andrew Huberman:
安德鲁·休伯曼：
...
...
what is your recommendation about stool testing?
您对粪便检测有何建议？
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
So my recommendation, this is again in the field of if you have the disposable income.
所以我的建议是，如果你有可支配收入的话。
So I usually start with Genova because they've got a good copay system with insurance.
所以我通常从热那亚开始，因为他们有一个很好的自付费用系统和保险。
That's what I typically use.
这就是我通常使用的。
So I usually do their one-day stool test, where you have to go digging through your stool and send it off to this lab that's in North Carolina.
所以我通常会进行一日粪便测试，你必须挖掘你的粪便并将其送到北卡罗来纳州的这个实验室。
I usually do the one day, unless I'm concerned about parasites.
我通常有一天做，除非我担心寄生虫。
In that case, I tend to do three days.
在这种情况下，我倾向于做三天。
I do that for people who travel a fair amount and go to places where there's greater risk, or they just have gut symptoms.
我为那些经常旅行并去过风险更大的地方的人，或者他们只是有肠道症状的人这样做。
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Another test that I do a lot is, because I always like to mention two labs, is a test by Onegevity.
我经常做的另一个测试是 Onegevity 的测试，因为我总是喜欢提到两个实验室。
And this is much more of a data wonk type of test because it's powered by AI.
这更像是一种数据专家类型的测试，因为它是由人工智能提供支持的。
It was designed by a guy who's got inflammatory bowel disease, and he's a PhD, deep phenotyping bioinformatics guy who wanted to make this really easy.
它是由一位患有炎症性肠病的人设计的，他是一名博士，深度表型生物信息学专家，他想让这变得非常简单。
So the test is under the umbrella of Thorne, and they just call it GutBio.
因此，该测试是在 Thorne 的领导下进行的，他们只是将其称为 GutBio。
They might have another name for it.
他们可能有另一个名字。
And they just improved it so that it's this wipe instead of digging through your stool.
他们只是改进了它，这样它就变成了这种擦拭巾，而不是挖掘你的粪便。
And so my athletes will do it now.
所以我的运动员现在就会这么做。
They were not so into digging through their stool before.
他们以前不太热衷于挖凳子。
Andrew Huberman:
安德鲁·休伯曼：
Is anybody?
有人吗？
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Really, no one is.
真的，没有人是这样的。
Andrew Huberman:
安德鲁·休伯曼：
I don't want the answer to that.
我不想要这个问题的答案。
I know the answer.
我知道答案。
I refer to that question.
我指的是这个问题。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
But that's a super interesting test because you get much more dense data.
但这是一个非常有趣的测试，因为您可以获得更密集的数据。
The issue is, with apologies to my friends at Thorne, the issue is that their recommendations end up being Thorne supplements.
问题是，向我在索恩的朋友们道歉，问题是他们的建议最终变成了索恩补充剂。
So that can be very easy for people who want to connect the dots.
因此，对于那些想要将这些点联系起来的人来说，这可以非常容易。
That's not always the way that I like to do it.
这并不总是我喜欢的方式。
Andrew Huberman:
安德鲁·休伯曼：
First of all, three things.
首先，三件事。
You've shared with us an immense amount of knowledge.
您与我们分享了大量的知识。
And in that first statement, I also want to apologize because I threw at you the entire lifespan of-- female lifespan, reproductive health, contraception, diet, microbiome, so many things.
在第一份声明中，我还想道歉，因为我向你们提出了整个生命周期——女性寿命、生殖健康、避孕、饮食、微生物组，等等。
But I first, I just want to say you've taught me a tremendous amount-
但首先，我只想说你教会了我很多东西——
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Mm
毫米
Andrew Huberman:
安德鲁·休伯曼：
...
...
including, I think, something that most people, including myself, have not thought about enough, which is the psychosocial impact on things that we're all familiar with.
我认为，包括我自己在内的大多数人都没有充分考虑到这一点，那就是对我们都熟悉的事物的心理社会影响。
Constipation, bowel movements, what we eat, what we avoid.
便秘、排便、我们吃什么、我们避免什么。
I have to say really a huge thank you for that because it's not something that's been discussed on this podcast before.
我必须对此表示衷心的感谢，因为这个播客之前没有讨论过这个问题。
Sort of know that brain communicates with body, psychology and biology are linked, but I think this is the first time that anyone's ever directly linked circumstances and biology and psychology in such a concrete way.
有点知道大脑与身体沟通，心理学和生物学是相互联系的，但我认为这是第一次有人以如此具体的方式将环境与生物学和心理学直接联系起来。
So that's the first thing.
这是第一件事。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Thank you.
谢谢你。
Andrew Huberman:
安德鲁·休伯曼：
And I know I speak for many people on that.
我知道我在这方面代表了很多人。
Second of all We barely scratched the surface of your knowledge, which is both frustrating for me because I always want to learn more, and I know many other people do as well, but also very exciting because hopefully without much persuasion, we can have you back on to talk about things-
其次，我们仅仅触及了你知识的表面，这对我来说既令人沮丧，因为我总是想了解更多，而且我知道很多其他人也这样做，但也非常令人兴奋，因为希望在没有太多说服的情况下，我们可以让你回来谈论事情——
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
No persuasion at all.
根本没有说服力。
Andrew Huberman:
安德鲁·休伯曼：
I know you're working with men now.
我知道你现在正在和男人一起工作。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Yeah.
是的。
Andrew Huberman:
安德鲁·休伯曼：
Men's health.
男性健康。
I think there's more for us to explore in terms of PCOS, menopause, contraception, and all of the above.
我认为在多囊卵巢综合症、更年期、避孕等等方面还有更多值得我们探索的地方。
But then something that you and I were talking about off-camera before we started, which I think is a really important factor that ties back to this issue of trauma and stress and the bidirectional relationship between biology and psychology.
但在我们开始之前，你和我在镜头外谈论了一些事情，我认为这是一个非常重要的因素，与创伤和压力问题以及生物学和心理学之间的双向关系有关。
Hopefully, someday we won't even separate those two.
希望有一天我们不会将这两个人分开。
Which is the use of specific medicines, including plant medicines-
这是具体药物的使用，包括植物药——
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Yes
是的
Andrew Huberman:
安德鲁·休伯曼：
...
...
and how that can influence overall health, which no doubt will include hormone health.
以及这如何影响整体健康，这无疑包括激素健康。
So I say all of that for two reasons.
所以我说这一切有两个原因。
First of all, to queue up the, we won't even call it a part two, but a sequel to this, which I'm gratified to hear that you'll join us for that.
首先，要排队，我们甚至不会将其称为第二部分，而是其续集，我很高兴听到您将加入我们。
And then also to just really extend a huge thank you.
然后还要向您致以深深的谢意。
The amount of knowledge that you shared is immense and is going to be very, very useful and actionable for men in terms of their thinking and their actions, and for women in particular.
你们分享的知识量是巨大的，对于男性，尤其是女性，在他们的思想和行动方面将非常非常有用和可行。
Today's discussion in particular for women in terms of how to think about their health and biology, how to think about their psychology and the environment that all of that is embedded in.
今天的讨论特别针对女性，涉及如何思考她们的健康和生物学、如何思考她们的心理以及所有这些所嵌入的环境。
So I just want to say an enormous thank you.
所以我只想对你们表示衷心的感谢。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Thank you, Andrew.
谢谢你，安德鲁。
I so appreciate that, and I so appreciate what you offer to the world in terms of a way in, a way to understand physiology, and how to craft, architect a better life.
我非常欣赏这一点，也非常欣赏您为世界提供的一种了解生理学的方法，以及如何创造、构建更美好的生活。
Can I just add one last thing?
我可以添加最后一件事吗？
Andrew Huberman:
安德鲁·休伯曼：
Absolutely.
绝对的。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Because I didn't talk about it since we didn't get-
因为我没有谈论它，因为我们没有-
Andrew Huberman:
安德鲁·休伯曼：
Please
请
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
...
...
to the 40s and the 50s and this list of biomarkers.
到 40 年代和 50 年代以及这个生物标志物列表。
Andrew Huberman:
安德鲁·休伯曼：
Please do.
请这样做。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
So I feel like if women went away with one thing today, it would be to do a coronary artery calcium score by age 45, and sooner if you've got premature heart disease.
所以我觉得，如果今天的女性要做一件事，那就是在 45 岁时进行冠状动脉钙化评分，如果您患有过早心脏病，则更早进行。
Andrew Huberman:
安德鲁·休伯曼：
How is that taken?
这是怎么采取的？
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
So it's a CT scan of the chest.
这是胸部 CT 扫描。
You can self-order it.
您可以自行订购。
I think at Stanford Hospital, you can self-order it.
我想在斯坦福医院，你可以自行订购。
Last time a patient checked, it was $250.
上次病人检查的价格是 250 美元。
So again, disposable income.
再说一遍，可支配收入。
But it almost gives you this fork in the road in terms of how much you need to pay attention to cardiometabolic health as a woman.
但作为一名女性，您需要在多大程度上关注心脏代谢健康，这几乎给您带来了这个岔路口。
And it's 45 for men, too.
男性也是 45 岁。
So if you haven't had one.
所以如果你还没有的话。
Have you had one?
你有过吗？
Andrew Huberman:
安德鲁·休伯曼：
No.
不。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
You need one.
你需要一个。
Andrew Huberman:
安德鲁·休伯曼：
Okay.
好的。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Insulin, cortisol, CAC.
胰岛素、皮质醇、CAC。
Andrew Huberman:
安德鲁·休伯曼：
Great.
太棒了。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
So-
所以——
Andrew Huberman:
安德鲁·休伯曼：
I'll run all that by you
我将由你来处理这一切
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
...
...
it's really essential, and it's so fascinating because there's some women who have a zero, so my score is zero, and that's great.
这真的很重要，而且非常令人着迷，因为有些女性的得分是零，所以我的得分是零，这很棒。
So often you can just keep doing what you're doing.
很多时候你可以继续做你正在做的事情。
But if you're 45 and you're starting to be elevated, or maybe you've got PCOS, or you've got some other biomarkers tending you in this direction toward the number one killer, really it's nine out of the top 10 killers in the US, that allows you to really start to make changes, and I think it's essential to know that data.
但如果你已经 45 岁了，你的体重开始升高，或者你可能患有多囊卵巢综合症，或者你有一些其他生物标志物引导你朝着第一杀手的方向发展，实际上，美国十大杀手中有九个，这让你真正开始做出改变，我认为了解这些数据是至关重要的。
It's probably not going to be offered by your doctor.
您的医生可能不会提供该服务。
Certainly, Peter Attia is going to offer it, but most conventional doctors are not going to do it.
当然，彼得·阿提亚会提供这种服务，但大多数传统医生不会这样做。
And then the last thing I want to say-
然后我想说的最后一件事——
Andrew Huberman:
安德鲁·休伯曼：
Before you mention it, so if I were to go to my doctor, and I just say I want a cardiac calcium score.
在你提到它之前，如果我去看医生，我只是说我想要心脏钙分数。
That's what people should ask for?
这才是人们应该要求的？
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Coronary artery calcium score.
冠状动脉钙评分。
Andrew Huberman:
安德鲁·休伯曼：
Coronary-
冠状动脉-
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
CAC.
CAC。
Andrew Huberman:
安德鲁·休伯曼：
Okay.
好的。
So everyone hear that and know that.
所以每个人都听到并且知道这一点。
If you're 40 or older, and maybe if you're-
如果你已经 40 岁或以上，也许如果你——
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
45
45
Andrew Huberman:
安德鲁·休伯曼：
...
...
45 or older, get it.
45岁以上，买吧。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
So the last thing is, and this is for men and women, is your ACE score.
最后一件事是你的 ACE 分数，这对于男性和女性来说都是如此。
So adverse childhood experiences.
如此不利的童年经历。
Knowing your ACE score is so essential in terms of a baseline for how much trauma your system, your PINE system endured when you were a kid.
了解您的 ACE 分数对于确定您的系统（您的 PINE 系统）在您小时候遭受的创伤程度的基线非常重要。
And we know that childhood trauma, whether it's abuse or neglect or having an alcoholic parent, that maps to disease in middle age, and it can give you so much insight.
我们知道，童年的创伤，无论是虐待、忽视，还是父母酗酒，都会导致中年的疾病，它可以给你很多洞察力。
I'll give you an example.
我给你举个例子。
I've got a patient who had an elevated coronary artery calcium score, who does everything right with her food.
我有一位患者的冠状动脉钙化评分升高，但她的饮食习惯却很正确。
I think it was her trauma that elevated her CAC when she was 45.
我认为正是她的创伤在她 45 岁时提高了她的 CAC。
So I think an ACE score, knowing your ACE score, starting as a teenager, knowing it and knowing how to work with that is really essential.
所以我认为 ACE 分数，了解你的 ACE 分数，从青少年开始，了解它并知道如何使用它是非常重要的。
Andrew Huberman:
安德鲁·休伯曼：
There are certain people, they are exceedingly rare, but you are one such person that when they speak, knowledge just comes out of them, and it's incredibly useful and helpful knowledge.
有一些人，他们非常罕见，但你就是这样的人，当他们说话时，知识就从他们身上流露出来，而且是非常有用和有帮助的知识。
So thank you.
所以谢谢你。
I'm going to get both of those things.
我要得到这两样东西。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Good.
很好。
Andrew Huberman:
安德鲁·休伯曼：
And I highly recommend that everyone else pursue ways that they can get those, or if they can't get them, that they earmark those as things to get at the point where they can obtain sufficient disposable income.
我强烈建议其他人寻求能够获得这些的方法，或者如果他们无法获得这些，他们将这些指定为他们可以获得足够的可支配收入时需要获得的东西。
Sounds like the detriments to health that those can offset would be well worth the cost.
听起来这些可以抵消的对健康的损害是值得的。
Dr. Sara Gottfried:
萨拉·戈特弗里德博士：
Totally.
完全可以。
Speaker 3:
演讲者3：
Thank you.
谢谢你。
Andrew Huberman:
安德鲁·休伯曼：
Thank you for joining me for today's discussion all about female hormone health, vitality, and longevity with Dr. Sara Gottfried.
感谢您今天与 Sara Gottfried 博士一起参与有关女性荷尔蒙健康、活力和长寿的讨论。
If you'd like to learn more about Dr. Gottfried's work, please check out her social media channels.
如果您想了解更多有关 Gottfried 博士的工作，请查看她的社交媒体频道。
We've provided links to those in the show note captions.
我们在节目注释标题中提供了链接。
In addition, please check out one or all of Dr. Gottfried's excellent books that she's written about nutrition, supplementation, and various treatments for hormone health, longevity, and vitality.
此外，请查看 Gottfried 博士撰写的一本或全部优秀书籍，内容涉及营养、补充剂以及激素健康、长寿和活力的各种治疗方法。
We've linked to two of those, notably "Women, Food, and Hormones" and her book "The Hormone Cure" in our show note captions.
我们在节目注释中链接了其中的两个链接，特别是“女性、食物和激素”以及她的书“激素治疗”。
If you're learning from and/or enjoying this podcast, please subscribe to our YouTube channel.
如果您正在学习和/或喜欢此播客，请订阅我们的 YouTube 频道。
That's a terrific zero-cost way to support us.
这是支持我们的绝佳零成本方式。
In addition, please subscribe to the podcast on Spotify and Apple.
此外，请订阅 Spotify 和 Apple 上的播客。
And in addition, on both Spotify and Apple, you can give us up to a five-star review.
此外，在 Spotify 和 Apple 上，您都可以给我们五星级的评价。
If you have questions or comments or topics or guests that you'd like me to cover on the "Huberman Lab" podcast, please put those in the comments section on YouTube.
如果您希望我在“Huberman Lab”播客中介绍您的问题、评论、主题或嘉宾，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 of 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。
If you're not already following us on social media, we are hubermanlab on Instagram, Twitter, Facebook, and LinkedIn.
如果您还没有在社交媒体上关注我们，我们在 Instagram、Twitter、Facebook 和 LinkedIn 上是 hubermanlab。
And I should mention that on both Instagram and Twitter, I cover science and science-related tools for mental health, physical health, and performance, some of which overlap with the contents of the "Huberman Lab" podcast, but much of which is distinct from the contents of the "Huberman Lab" podcast.
我应该提到的是，在 Instagram 和 Twitter 上，我涵盖了有关心理健康、身体健康和表现的科学和与科学相关的工具，其中一些与“Huberman Lab”播客的内容重叠，但其中大部分与“Huberman Lab”播客的内容不同。
Again, it's hubermanlab on all social media channels.
再说一遍，所有社交媒体渠道上都是 hubermanlab。
And if you haven't already subscribed to the "Huberman Lab" podcast so-called Neural Network Newsletter, that's a monthly newsletter.
如果您还没有订阅“Huberman Lab”播客，即所谓的神经网络通讯，那么这是一份每月通讯。
It's completely zero cost, and we provide summaries of podcast episodes as well as summaries of tools for everything from optimizing sleep to hormone health, deliberate cold exposure, deliberate heat exposure, fitness, and so on.
它完全是零成本，我们提供播客剧集的摘要以及从优化睡眠到荷尔蒙健康、有意冷暴露、有意热暴露、健身等各个方面的工具摘要。
It's very easy to sign up for.
注册非常简单。
You go to hubermanlab.com, go to the menu, and scroll to Newsletter.
您访问 hubermanlab.com，进入菜单，然后滚动到新闻通讯。
You simply provide your email.
您只需提供您的电子邮件即可。
We do not share your email with anybody.
我们不会与任何人分享您的电子邮件。
As I mentioned before, it is completely zero cost.
正如我之前提到的，它完全是零成本。
Again, that's the Neural Network Newsletter, and you can find it at hubermanlab.com.
同样，这就是《神经网络通讯》，您可以在 hubermanlab.com 上找到它。
During today's episode and on many previous episodes of the "Huberman Lab" podcast, we discuss supplements.
在今天的节目以及“Huberman Lab”播客的许多以前的节目中，我们讨论了补充剂。
While supplements aren't necessary for everybody, many people derive tremendous benefit from them, for everything from sleep to focus to hormone regulation.
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，从睡眠到注意力集中到激素调节等各个方面。
The "Huberman Lab" podcast is happy to announce that we partnered with Momentous Supplements because Momentous Supplements are of the absolute highest quality.
“Huberman Lab”播客很高兴地宣布我们与 Momentous Supplements 合作，因为 Momentous Supplements 具有绝对最高的质量。
Also, they include many single-ingredient formulations, which is essential if you want to design a supplement regimen that is both cost-effective and the most biologically effective supplement regimen.
此外，它们还包括许多单一成分配方，如果您想设计既具有成本效益又最具生物有效性的补充方案，这一点至关重要。
That's very hard to do with blends of supplements.
对于混合补充剂来说这是很难做到的。
It's very straightforward to do with single-ingredient formulations.
使用单一成分配方非常简单。
Also, Momentous Supplements ship internationally, which is important because we realize that many of you reside outside of the United States.
此外，Momentous Supplements 还可以进行国际运输，这一点很重要，因为我们意识到你们中的许多人居住在美国境外。
If you'd like to see the supplements discussed on the "Huberman Lab" podcast, you can go to livemomentous, spelled O-U-S.
如果您想查看“Huberman Lab”播客中讨论的补充剂，您可以访问 livemomentous，拼写为 O-U-S。
So that's livemomentous.com/huberman.
这就是 livemomentous.com/huberman。
Thank you once again for joining me for today's discussion all about female hormone health, vitality, and longevity with Dr. Sara Gottfried.
再次感谢您今天与 Sara Gottfried 博士一起参与有关女性荷尔蒙健康、活力和长寿的讨论。
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。