Essentials: Healthy Eating & Eating Disorders - Anorexia, Bulimia, Binging

Welcome to Huberman Lab Essentials, where we revisit past episodes for the most potent and actionable science-based tools for mental health, physical health, and performance.

欢迎来到 Huberman Lab Essentials，在这里我们回顾过去的剧集，寻找针对心理健康、身体健康和表现的最有效、最可操作的基于科学的工具。

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, we are going to talk all about healthy and disordered eating, and indeed, we are going to talk about clinical eating disorders such as anorexia, bulimia, and binge eating disorder, as well as some other related eating disorders.

今天，我们将讨论健康和饮食失调，事实上，我们将讨论临床饮食失调，如厌食症、暴食症和暴食症，以及其他一些相关的饮食失调。

However, before we get into this material, I want to emphasize that today's discussion will include what it is to have a healthy relationship with food.

然而，在我们讨论这些材料之前，我想强调今天的讨论将包括什么是与食物建立健康的关系。

We're going to talk about metabolism.

我们要谈谈新陈代谢。

We are going to talk about how eating frequency and what one eats influences things like appetite and satiety, as well as whether or not we have a healthy psychological relationship to food and our body weight and so-called body composition, the ratio of muscle to fat to bone, et cetera.

我们将讨论饮食频率和吃什么如何影响食欲和饱腹感等，以及我们与食物和体重以及所谓的身体成分、肌肉与脂肪与骨骼的比例等是否有健康的心理关系。

So as we march into this conversation, I'd like to share with you some interesting and what I believe are important findings in the realm of nutrition and human behavior.

因此，当我们进入这次对话时，我想与大家分享一些有趣的、我认为是营养和人类行为领域的重要发现。

I know these days many people are excited about or curious about so-called intermittent fasting.

我知道现在很多人对所谓的间歇性禁食感到兴奋或好奇。

Intermittent fasting is, as the name implies, simply restricting one's feeding behavior, eating, to a particular phase of the 24-hour or so-called circadian cycle.

间歇性禁食，顾名思义，就是将一个人的进食行为（进食）限制在 24 小时或所谓的昼夜节律周期的特定阶段。

Other forms of intermittent fasting involve not eating for extended periods of time, for entire days, or some people will extend to two days or three days.

其他形式的间歇性禁食包括长时间不吃东西，甚至一整天不吃东西，有些人甚至会延长到两天或三天。

Typically, and hopefully, they will drink water during those times, sometimes referred to as water fasting, which means that they are ingesting fluids and hopefully they are ingesting electrolytes such as salt, potassium, and magnesium as well.

通常，希望他们在这段时间内会喝水，有时被称为水禁食，这意味着他们正在摄入液体，并且希望他们也摄入电解质，例如盐、钾和镁。

Because while one can survive for some period of time without ingesting calories, it is extremely important to continue to ingest plenty of fluids and electrolytes.

因为虽然一个人可以在不摄入卡路里的情况下生存一段时间，但继续摄入大量的液体和电解质是极其重要的。

And the reason for that is that the neurons of your brain and body that control your movements, your thoughts, clarity of thinking in general, et cetera, is critically dependent on the presence of adequate levels of sodium, potassium, and magnesium, the electrolytes, and that's because neurons can only be electrically active by way of movement of particular ions, which include things like sodium, potassium, and magnesium.

其原因是，控制你的运动、思想、思维清晰度等的大脑和身体神经元，很大程度上依赖于是否存在足够水平的钠、钾和镁（电解质），这是因为神经元只能通过特定离子（包括钠、钾和镁等离子）的运动来产生电活性。

So without those, you can't think, you can't function, and it actually can be quite dangerous.

因此，如果没有这些，你就无法思考，就无法发挥作用，而且实际上可能非常危险。

So why all the excitement about intermittent fasting?

那么，为什么间歇性禁食如此令人兴奋呢？

Well, a lot of the excitement relates to work that was done by a former colleague of mine down at the Salk Institute for Biological Studies in San Diego named Satchin Panda.

嗯，很多令人兴奋的事情都与我在圣地亚哥索尔克生物研究所的一位前同事所做的工作有关，他的名字叫 Satchin Panda。

Satchin's lab identified some very important and impactful health benefits of restricting one's feeding window to particular times within the 24-hour cycle, or even to having extended fasts that go for a day or two days or maybe even three days.

Satchin 的实验室发现，将进食窗口限制在 24 小时周期内的特定时间，甚至延长一天、两天甚至三天的禁食时间，对健康有一些非常重要且有影响力的好处。

What they saw was an improvement in liver enzymes, an improvement in insulin sensitivity, which is something that is good.

他们看到的是肝酶的改善，胰岛素敏感性的改善，这是好事。

It means that you can utilize the calories and the blood sugar that you happen to have.

这意味着您可以利用您恰好拥有的卡路里和血糖。

Being insulin insensitive is not good and is actually a form of diabetes.

胰岛素不敏感是不好的，实际上是糖尿病的一种形式。

What Satchin's lab, and subsequently other labs showed, was that restricting one's feeding window to anywhere from four to eight or even 12 hours during each 24-hour cycle was beneficial in mice, and some studies in humans have also shown that it can be beneficial for various health parameters.

Satchin 的实验室以及随后其他实验室的研究表明，将每个 24 小时周期内的进食时间限制在 4 到 8 小时甚至 12 小时对小鼠来说是有益的，一些针对人类的研究也表明，这对各种健康参数也有益。

However, the excitement about intermittent fasting seems to be related to the foundational truth about metabolism and weight loss and weight maintenance and weight gain, which is that regardless of whether or not you intermittent fast or whether or not you eat small meals all day long or you eat one meal in the evening and snack up until then, it really doesn't matter in the sense that the calories that you ingest from whatever source are going to be filtered through the calories that you burn by way of exercise, basal metabolic rate, which is just the calories that you happen to burn just being alive and thinking and breathing and your heart beating, et cetera.

然而，间歇性禁食的兴奋似乎与新陈代谢、减肥、体重维持和体重增加的基本事实有关，即无论你是否间歇性禁食，也无论你是否全天吃小餐，或者你在晚上吃一顿饭，然后再吃零食，从某种意义上说，你从任何来源摄入的卡路里都将通过你通过运动燃烧的卡路里进行过滤，基础代谢率，这只是你碰巧燃烧的卡路里活着、思考、呼吸、心跳等等。

And the reason why many people prefer intermittent fasting to other forms of, let's just call it what it is, diet or nutritional framework, is that many people find it easier to not eat than to limit their portion size.

许多人更喜欢间歇性禁食而不是其他形式的饮食或营养框架，我们就这么称呼它是什么，是因为许多人发现不吃东西比限制进食量更容易。

And here I'm not talking necessarily about eating disorders.

在这里我不一定谈论饮食失调。

I'm talking about the general population.

我说的是一般人群。

So why are we talking about this?

那么我们为什么要谈论这个呢？

And in particular, why are we talking about this during an episode that includes a discussion about eating disorders?

特别是，为什么我们要在一集讨论饮食失调的节目中谈论这个？

The reason is nobody, not the government, no nutritionist, no individual, no matter how knowledgeable they are about food and nutrition and food intake, can define the best plan for eating for any one individual.

原因是没有人，不是政府，没有营养师，没有个人，无论他们对食物、营养和食物摄入有多么了解，都可以为任何人制定最佳饮食计划。

I'm going to repeat that.

我要重复一遍。

Nobody knows what truly healthy eating is.

没有人知道什么是真正的健康饮食。

We only know the measurements we can take.

我们只知道我们可以进行的测量。

Liver enzymes, blood lipid profiles, body weight, athletic performance, mental performance, whether or not you're cranky all day, whether or not you're feeling relaxed.

肝酶、血脂、体重、运动表现、精神表现，无论你是否整天胡思乱想，无论你是否感到放松。

Nobody knows how to define these, and these have strong cultural and familial and socio-societal influence.

没有人知道如何定义这些，而这些具有强大的文化、家庭和社会影响力。

So if you hang out with people that intermittent fast all day, that will seem normal.

因此，如果你和整天间歇性禁食的人一起出去玩，这看起来很正常。

If you spend time with people that have never heard of intermittent fasting, intermittent fasting is going to seem very abnormal.

如果你和从未听说过间歇性禁食的人在一起，间歇性禁食会显得非常不正常。

Now, we are going to talk about eating disorders that really fall into the category of clinically diagnosable eating disorders for which there's actually serious health hazards and even the serious risk of death.

现在，我们要讨论的饮食失调确实属于临床可诊断的饮食失调类别，实际上存在严重的健康危害，甚至有严重的死亡风险。

There are clear criteria in the psychiatric and psychological communities to define things like anorexia, bulimia, binge eating disorder, all of which we will talk about.

精神病学和心理学界有明确的标准来定义厌食症、暴食症、暴食症等疾病，所有这些我们都会讨论。

But as we have that discussion, I want to emphasize that self-diagnosis can be both a terrific but also a very precarious thing.

但在我们进行讨论时，我想强调的是，自我诊断既是一件很棒的事情，但也是一件非常不稳定的事情。

There's always a temptation as one learns about the symptomology of a given disorder, doesn't really matter what the disorder is, to ask the question, well, do I have that?

当人们了解某种特定疾病的症状时，总会有一种诱惑，不管这种疾病是什么，都会问这样的问题：嗯，我有这种病吗？

Does so-and-so that I know have that?

我认识的某某有这个吗？

It's tempting to diagnose them and/or ourselves as either having or not having a particular disorder.

人们很容易诊断他们和/或我们自己是否患有某种特定疾病。

However, diagnoses really need to be carried out by people who are trained in that particular field and that have deep expertise in recognizing the symptomology, including some of the more subtle symptomology of eating disorders.

然而，诊断确实需要由在该特定领域接受过培训并且在识别症状学方面具有深厚专业知识的人员进行，包括饮食失调的一些更微妙的症状学。

So if any of the symptoms resonate with you by way of you thinking that you have this particular disorder or someone that you know has this disorder, I would take that seriously, but I would take that information to a qualified healthcare professional that could diagnose or rule out any of these possible disorders.

因此，如果任何症状让您产生共鸣，认为自己患有这种特定的疾病或您认识的人患有这种疾病，我会认真对待，但我会将这些信息带给合格的医疗保健专业人员，他们可以诊断或排除任何这些可能的疾病。

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

我想稍微休息一下并感谢我们的赞助商之一 LMNT。

LMNT is an electrolyte drink that has everything you need and nothing you don't.

LMNT 是一种电解质饮料，拥有您需要的一切，没有您不需要的东西。

That means the electrolytes, sodium, magnesium, and potassium in the correct amounts, but no sugar.

这意味着电解质、钠、镁和钾的含量正确，但不含糖。

Proper hydration is critical for optimal brain and body function.

适当的水合作用对于大脑和身体的最佳功能至关重要。

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

即使是轻微程度的脱水也会降低认知和身体表现。

It's also important that you get adequate electrolytes.

获得充足的电解质也很重要。

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

电解质（钠、镁和钾）对于体内所有细胞（尤其是神经元或神经细胞）的功能至关重要。

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

饮用溶解在水中的 LMNT 可以很容易地确保您获得足够的水分和电解质。

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

为了确保我获得适量的水合作用和电解质，当我早上第一次醒来时，我将一包 LMNT 溶解在大约 16 至 32 盎司的水中，并且我基本上早上第一件事就是喝它。

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

我还会在进行任何体育锻炼时饮用溶解在水中的 LMNT，尤其是在炎热的日子里，当我大量出汗并失去水和电解质时。

LMNT has a bunch of great-tasting flavors.

LMNT 有很多美味的口味。

I love the raspberry, I love the citrus flavor.

我喜欢覆盆子，我喜欢柑橘味。

Right now, LMNT has a limited edition lemonade flavor that is absolutely delicious.

现在LMNT推出了限量版柠檬水口味，绝对美味。

I hate to say that I love one more than all the others, but this lemonade flavor is right up there with my favorite other one, which is raspberry or watermelon.

我不想说我比其他所有口味都更喜欢其中一种，但这种柠檬水口味与我最喜欢的另一种口味（覆盆子或西瓜）不相上下。

Again, I can't pick just one flavor.

再说一次，我不能只选择一种口味。

I love them all.

我爱他们所有人。

If you'd like to try LMNT, you can go to drinklmnt.com/huberman, spelled drinklmnt.com/huberman, to claim a free LMNT sample pack with a purchase of any LMNT drink mix.

如果您想尝试 LMNT，可以访问 Drinklmnt.com/huberman（拼写为 Drinklmnt.com/huberman），购买任意 LMNT 混合饮料即可领取免费 LMNT 样品包。

Again, that's drinklmnt.com/huberman to claim a free sample pack.

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

So what is an eating disorder?

那么什么是饮食失调呢？

Well, we have to take a step back and confess to the fact that every society, every culture, every family, and every individual has a different relationship to food.

好吧，我们必须退一步承认这样一个事实：每个社会、每种文化、每个家庭、每个人都与食物有着不同的关系。

Eating disorders, however, have particular criteria that allow us to define them and to think about different modes of treatment as it relates to the particular symptoms, in particular the psychological and biological symptoms of those disorders.

然而，饮食失调有特定的标准，使我们能够定义它们并考虑与特定症状（特别是这些疾病的心理和生物学症状）相关的不同治疗模式。

What are the major eating disorders?

主要的饮食失调有哪些？

Anorexia nervosa, most commonly referred to as anorexia, is perhaps the most prevalent and the most dangerous of all eating disorders.

神经性厌食症，最常被称为厌食症，可能是所有饮食失调中最普遍和最危险的。

In fact, anorexia is the most dangerous psychiatric disorder of all, even more than depression.

事实上，厌食症是最危险的精神疾病，甚至比抑郁症还要严重。

The probability of death for untreated anorexia is very high, and sadly, the prevalence of anorexia is very high.

未经治疗的厌食症死亡的可能性非常高，可悲的是，厌食症的患病率非常高。

If you look it up online or you talk to a qualified professional, it's essentially a failure to eat enough to maintain a healthy weight.

如果您在网上查找或咨询合格的专业人士，这本质上是没有吃足够的食物来保持健康的体重。

You can see all sorts of very troubling symptoms of somebody who's been anorexic for some period of time.

你可以看到患有厌食症一段时间的人出现各种非常令人不安的症状。

A general loss of muscle mass because they're ingesting fewer calories than they burn.

由于摄入的卡路里少于燃烧的卡路里，肌肉质量普遍下降。

They will have a low heart rate.

他们的心率会很低。

This is the body and brain's attempt to lower energy output.

这是身体和大脑试图降低能量输出。

They will have low blood pressure.

他们会有低血压。

They'll sometimes have symptoms like fainting, loss of bone density, osteoporosis, loss of periods in girls and women, and all sorts of disrupted gut and immune functions.

他们有时会出现晕厥、骨密度下降、骨质疏松、女孩和女性月经减少以及各种肠道和免疫功能紊乱等症状。

So there are just tons of terrible symptoms of anorexia that really place the anorexic into a very risky state, which is why mortality from anorexia gone untreated is extremely high.

因此，厌食症有很多可怕的症状，确实使厌食症患者处于非常危险的状态，这就是为什么未经治疗的厌食症死亡率极高的原因。

Now, one of the misconceptions about anorexia is that it stems from an overemphasis on perfectionism, or that because of all the images in social media and in advertising of extremely thin and fit or muscular people, that individuals are looking at themselves and comparing themselves to those images and thinking that they don't match up and developing anorexia.

现在，关于厌食症的误解之一是，它源于对完美主义的过分强调，或者由于社交媒体和广告中的所有极瘦、健康或肌肉发达的人的图像，人们正在审视自己并将自己与这些图像进行比较，并认为他们不匹配并发展厌食症。

That turns out to not be the case.

事实证明并非如此。

If you look at the prevalence or the rates of anorexia in the last 10 years or 20 years, and you compare that to when anorexia was first identified, which was in the 1600s and perhaps even earlier, what you find is that rates of anorexia are not going up.

如果你观察过去 10 年或 20 年厌食症的患病率或发病率，并将其与首次发现厌食症的时间（1600 年代甚至更早）进行比较，你会发现厌食症的发病率并没有上升。

Classically defined anorexia has existed at essentially the same prevalence for the last 100, 200, 300, and 400 years, which is incredible and really speaks to the likelihood that there's a strong biological contribution to what we call anorexia nervosa.

在过去的 100 年、200 年、300 年和 400 年里，经典定义的厌食症的患病率基本相同，这令人难以置信，也确实说明了我们所说的神经性厌食症可能有很强的生物学因素。

Anorexia nervosa is extremely common.

神经性厌食症极为常见。

It's anywhere from 1% to 2% of women And the typical onset is in adolescence, close to puberty, but it can show up later in life as well.

1% 到 2% 的女性患有此病，典型的发病时间是青春期，接近青春期，但也可能出现在晚年。

In fact, the identification and diagnosis of anorexia tends to be in the early 20s.

事实上，厌食症的识别和诊断往往在20岁出头。

But if you look back at the history of those individuals, there were typically signs of anorexia that stem back into their early teens, or maybe even before that.

但如果你回顾这些人的历史，就会发现厌食症的迹象通常可以追溯到他们十几岁的时候，甚至可能更早。

Now, of course, men can be anorexic as well, but anorexia nervosa does seem to occur at 10 times the rate in women and young girls than it does in men and young boys.

当然，现在男性也可能患有厌食症，但女性和年轻女孩的神经性厌食症发病率似乎是男性和男孩的 10 倍。

So what is hunger and what is satiety?

那么什么是饥饿，什么是饱足呢？

Satiety, of course, being sated or feeling like we've had enough food.

饱腹感，当然是吃饱了或者感觉我们已经吃够了。

I want to remind people of the basic mechanisms by which the brain and body communicate.

我想提醒人们大脑和身体交流的基本机制。

The body is communicating two types of information to the brain on a regular basis, but in particular around feeding.

身体定期向大脑传达两种类型的信息，特别是在进食方面。

And those two types of information are mechanical information and chemical information.

这两类信息是机械信息和化学信息。

When your stomach is full, it sends signals to your brain that are purely based on this mechanical fullness, has nothing to do with nutrients, that says, "I'm full, and therefore don't be as hungry.

当你的胃吃饱时，它会向你的大脑发送纯粹基于机械饱腹感的信号，与营养无关，即“我已经吃饱了，因此不会那么饿。

Don't motivate to find or ingest food." Whereas when our gut is empty, even if we have plenty of nutrients or plenty of body fat stores, we tend to focus on food a bit more.

不要主动去寻找或摄取食物。”而当我们的肠道空虚时，即使我们有充足的营养或体内脂肪储存，我们也会倾向于更多地关注食物。

So volume and mechanical influences have a profound effect on how we think and what we consider doing or not doing.

因此，体积和机械的影响对我们的思维方式以及我们考虑做什么或不做什么有着深远的影响。

Likewise, chemical effects.

同样，化学效应。

When we ingest food, our blood glucose goes up.

当我们摄入食物时，我们的血糖会升高。

That information is signaled to the brain via neuronal pathways and hormonal pathways.

该信息通过神经元通路和激素通路向大脑发出信号。

And in particular, there are neurons within our gut that signal to areas of our brain stem that are involved in satiety and our sense of having enough, that there's food in our system.

特别是，我们肠道内的神经元会向脑干区域发出信号，这些区域与饱腹感和我们的饱腹感有关，我们的系统中有食物。

So that's chemical information.

这就是化学信息。

So how are hunger and feeding and satiety regulated?

那么饥饿、进食和饱腹感是如何调节的呢？

By way of mechanical and chemical signaling.

通过机械和化学信号的方式。

You have, I have, we all have neurons in our hypothalamus that trigger eating and neurons that trigger cessation or stopping of eating.

你有，我有，我们的下丘脑中都有触发进食的神经元，以及触发停止或停止进食的神经元。

Your hypothalamus at the base of your forebrain sits more or less above the roof of your mouth.

位于前脑底部的下丘脑或多或少位于上颚上方。

The hypothalamus contains lots of different kinds of neurons, including neurons that stimulate sexual activity and desire, regulate your body temperature, and control appetite and ceasing of eating and appetite.

下丘脑含有许多不同类型的神经元，包括刺激性活动和性欲、调节体温、控制食欲以及停止进食和食欲的神经元。

There are two types of neurons within a particular area of your hypothalamus that are relevant here.

下丘脑特定区域内有两种类型的神经元与此相关。

There are the so-called POMC neurons, okay?

有所谓的 POMC 神经元，好吗？

Pro-opio melanocortin neurons that tend to act as more of a brake on appetite by way of another hormone called melanocyte-stimulating hormone.

阿片原黑皮质素神经元往往通过另一种称为黑素细胞刺激激素的激素来抑制食欲。

And you have a class of neurons called the AgRP neurons.

一类神经元称为 AgRP 神经元。

The AgRP neurons are the ones that stimulate feeding, and they create a sort of anxiety or excitement about food.

AgRP 神经元是刺激进食的神经元，它们会产生一种对食物的焦虑或兴奋。

And if you eliminate or kill these neurons, which has been done in experimental mouse models in the laboratory, but also there are humans that have lesions or neurotoxic effects on these AgRP neurons, and what you find is that they don't want to eat.

如果你消除或杀死这些神经元，这已经在实验室的实验小鼠模型中完成了，但也有人对这些 AgRP 神经元产生了损伤或神经毒性作用，你会发现他们不想吃东西。

They have no appetite for food whatsoever.

他们对任何食物都没有胃口。

Whereas if you stimulate these AgRP neurons, or in humans that have, say, a small tumor near these AgRP neurons, they become hyperphagic.

然而，如果你刺激这些 AgRP 神经元，或者在这些 AgRP 神经元附近有一个小肿瘤的人类中，它们就会变得贪食。

They will eat to the point of bursting.

他们会吃到爆裂的程度。

Now, there are signals coming back from the body to inform the brain about presence of different levels of nutrients, and that generally comes from three sources.

现在，身体会返回信号，通知大脑存在不同水平的营养物质，这些信号通常来自三个来源。

First of all is body fat.

首先是身体脂肪。

The more body fat we have, the more we secrete a hormone called leptin, L-E-P-T-I-N, leptin from body fat.

我们体内的脂肪越多，我们从体内脂肪中分泌的一种叫做瘦素（L-E-P-T-I-N）的激素就越多。

Leptin goes to the brain and suppresses appetite.

瘦素进入大脑并抑制食欲。

Not incidentally, leptin signaling is disrupted in people that have bulimia and obesity and certain forms of binge eating disorder.

并非偶然，患有贪食症、肥胖症以及某些形式的暴食症的人的瘦素信号传导受到干扰。

The body fat is doing something else really interesting that relates to anorexia.

身体脂肪正在做一些与厌食症相关的非常有趣的事情。

When there's sufficient levels of body fat and leptin circulating in the blood, and that leptin signal gets to the brain, the hypothalamus and the pituitary gland register that signal and, in a completely subconscious way, trigger the deployment of eggs in females and the production of sperm in males.

当血液中循环的身体脂肪和瘦素水平足够时，瘦素信号到达大脑，下丘脑和垂体就会记录该信号，并以完全潜意识的方式触发女性卵子的部署和男性精子的产生。

So when body fat stores are very low, the reason why periods shut off or sperm production is reduced or even shut off is because there's not enough leptin getting to the hypothalamus and to the pituitary, and they shut off the signals, the hormones, things like gonadotropin-releasing hormone, luteinizing hormone, follicle-stimulating hormone, that travel to the ovary or to the testes and cause the ovary and testes to ovulate or to produce more sperm.

因此，当体内脂肪储存量非常低时，月经停止或精子产生减少甚至停止的原因是没有足够的瘦素到达下丘脑和垂体，它们会关闭信号、激素，如促性腺激素释放激素、黄体生成素、卵泡刺激素，这些激素会前往卵巢或睾丸，导致卵巢和睾丸排卵或产生更多精子。

So you've got two categories of neurons, one that acts as an accelerator, the AgRP neuron, saying, "Eat, eat," and gets you excited to eat.

因此，你有两类神经元，一类充当加速器，即 AgRP 神经元，它会说“吃，吃”，让你对吃东西感到兴奋。

And then you have a category of neurons, the POMC neurons, that are suppressing hunger.

然后有一类神经元，POMC 神经元，可以抑制饥饿。

They're acting like a brake.

它们的作用就像刹车一样。

And the body is informing the brain all the time about the status of the body and whether or not it needs more food.

而身体也时刻在向大脑通报身体的状态以及是否需要更多的食物。

So you might ask, why is it that people who are overweight and have a lot of body fat, why they would continue to eat a lot?

那么你可能会问，为什么超重、体内脂肪多的人，为什么还要继续吃很多东西呢？

It seems like that just shouldn't happen.

看来这不应该发生。

From an evolutionary standpoint, it makes sense that we should eat as often as we can, as much as we can, and as fast as we can.

从进化的角度来看，我们应该尽可能多地、尽可能多地、尽可能快地吃东西，这是有道理的。

There are circuits in the brain to reward eating often, eating fast, and cramming as much food into you as possible.

大脑中有一些回路可以奖励经常进食、快速进食以及尽可能多地塞进食物。

Because from a purely evolutionary standpoint, food was scarce and seeking food was dangerous, whether or not it was from animal sources or not, and it's always been competitive.

因为从纯粹进化的角度来看，食物是稀缺的，寻找食物是危险的，无论它是否来自动物，而且它总是充满竞争。

Every animal, including humans, has a hardwired circuit that we were born with that pays attention to how much food is available How much we are getting now and how much we are likely to get in the future.

每一种动物，包括人类，都有我们与生俱来的硬连线电路，它关注有多少食物可用、我们现在得到多少以及我们将来可能得到多少。

And without going down the rabbit hole of arcuate nucleus biology, in two sentences, you have a hypothalamic area called the arcuate nucleus.

不用深入了解弓状核生物学的兔子洞，用两句话就能知道，你有一个称为弓状核的下丘脑区域。

It's actually the area that houses these POMC neurons and these other types of neurons that regulate hunger and satiety.

它实际上是容纳这些 POMC 神经元和调节饥饿和饱腹感的其他类型神经元的区域。

And these neurons in the arcuate nucleus start getting active when we see food and think about food, and they drive hunger in a way that's responsive to what the food looks like, what it smells like, but also our prior history of interactions with that food, and it takes into account social context.

当我们看到食物并想到食物时，弓状核中的这些神经元开始活跃，它们以一种对食物的外观、气味以及我们之前与食物相互作用的历史做出反应的方式驱动饥饿，并且它考虑了社会背景。

What's the pathway?

途径是什么？

How does this work?

这是如何运作的？

Well, you can frame all of behavior, good decision-making and bad decision-making, in a pretty simple box diagram model.

好吧，您可以在一个非常简单的框图模型中构建所有行为，包括好的决策和坏的决策。

We have knowledge of what we should do in one box.

我们知道我们应该在一个盒子里做什么。

Okay?

好的？

We should eat that.

我们应该吃那个。

We shouldn't eat that.

我们不应该吃那个。

We should wait for dinner.

我们该等晚饭了。

We shouldn't wait for dinner.

我们不应该等待晚餐。

And then we have what we actually do in another box.

然后我们在另一个盒子里实际做的事情。

In between those two boxes are two intervening forces, and those intervening forces are critically important.

在这两个盒子之间有两个干预力量，而这些干预力量至关重要。

Those intervening forces are homeostatic processes that regulate the balance of different systems in your body, hot and cold, awake or asleep, dopamine and the desire to pursue things, serotonin and the desire to just relax and chill.

这些干预力量是体内平衡过程，调节体内不同系统的平衡，热和冷，清醒或睡眠，多巴胺和追求事物的欲望，血清素和放松和放松的欲望。

So homeostatic processes and reward systems.

所以稳态过程和奖励系统。

And as we now move into discussion about anorexia and bulimia specifically, what you'll see is that anorexia and bulimia are not a breaking of the mindset of what one should do or shouldn't do.

当我们现在具体讨论厌食症和贪食症时，您会看到厌食症和贪食症并没有打破一个人应该做什么或不应该做什么的心态。

It's a disruption of these homeostatic and reward processes such that decision-making is completely disrupted and in many cases is not available to the anorexic or bulimic.

这是对这些稳态和奖励过程的破坏，使得决策完全被打乱，并且在许多情况下厌食症或暴食症患者无法做出决策。

Now, I don't want to be abstract here.

现在，我不想在这里变得抽象。

What I'm saying is that the person who starves themselves to the point where they might die, and in some cases sadly do die, they can know perfectly well that their behavior is leading to bad outcomes and possibly even death, and yet they are not able to intervene unless they get particular clinical help because the homeostatic processes, the signals from the body and brain that say, "You need food," those aren't registering in the same way that they are for other individuals.

我想说的是，那些把自己饿死到可能会死的人，在某些情况下不幸地确实死了，他们可以完全清楚自己的行为会导致不良结果，甚至可能死亡，但他们无法干预，除非他们得到特定的临床帮助，因为稳态过程，来自身体和大脑的信号说“你需要食物”，这些信号的记录方式与其他人不同。

And just as a little teaser of where we're headed, anorexics have a sort of switch that's been flipped such that their decision-making is actually pretty darn good.

就像我们前进方向的一个小预告一样，厌食症患者有一种被翻转的开关，这样他们的决策实际上非常好。

It might even be better than yours in terms of evaluating food nutritional content, but their habits are disrupted, so they're not even consciously aware of the fact that they're making terrible, and in some cases, very dangerous food choices.

在评估食物营养成分方面，它甚至可能比你的更好，但他们的习惯被打乱了，所以他们甚至没有意识到自己正在做出糟糕的、在某些情况下甚至是非常危险的食物选择。

It turns out habits and the way that we build and break and rebuild new habits is one of the most effective treatments for anorexia.

事实证明，习惯以及我们建立、打破和重建新习惯的方式是治疗厌食症最有效的方法之一。

I'd like to take a quick break and acknowledge our sponsor, AG1.

我想稍微休息一下并感谢我们的赞助商 AG1。

AG1 is a vitamin mineral probiotic drink that also includes prebiotics and adaptogens.

AG1 是一种维生素矿物质益生菌饮料，还包含益生元和适应原。

As somebody who's been involved in research science for almost three decades and in health and fitness for equally as long, I'm constantly looking for the best tools to improve my mental health, physical health, and performance.

作为一个从事科学研究近三十年以及同样长期从事健康和健身工作的人，我一直在寻找最好的工具来改善我的心理健康、身体健康和表现。

I discovered AG1 back in 2012, long before I ever had a podcast, and I've been taking it every day since.

我早在 2012 年就发现了 AG1，那时我还没有播客，从那时起我就每天都在服用它。

I find it improves all aspects of my health, my energy, my focus, and I simply feel much better when I take it.

我发现它改善了我的健康、精力、注意力的各个方面，而且服用它后我感觉好多了。

AG1 uses the highest quality ingredients in the right combinations, and they're constantly improving their formulas without increasing the cost.

AG1 使用最优质的成分进行正确的组合，并且在不增加成本的情况下不断改进其配方。

In fact, AG1 just launched their latest formula upgrade.

事实上，AG1刚刚推出了他们最新的配方升级。

This next-gen formula is based on exciting new research on the effects of probiotics on the gut microbiome, and it now includes several clinically studied probiotic strains shown to support both digestive health and immune system health, as well as to improve bowel regularity and to reduce bloating.

这种下一代配方基于关于益生菌对肠道微生物组影响的令人兴奋的新研究，它现在包含几种经过临床研究的益生菌菌株，这些益生菌菌株显示出支持消化健康和免疫系统健康，以及改善肠道规律性和减少腹胀。

Whenever I'm asked if I could take just one supplement, what that supplement would be, I always say AG1.

每当我被问到是否可以只服用一种补充剂时，我总是说 AG1。

If you'd like to try AG1, you can go to drinkag1.com/huberman.

如果您想尝试 AG1，可以访问 Drinkag1.com/huberman。

For a limited time, AG1 is giving away a free one-month supply of omega-3 fish oil, along with a bottle of vitamin D3 plus K2.

AG1 限时免费赠送一个月的 omega-3 鱼油，以及一瓶维生素 D3 加 K2。

As I've highlighted before on this podcast, omega-3 fish oil and vitamin D3 K2 have been shown to help with everything from mood and brain health to heart health to healthy hormone status and much more.

正如我之前在此播客中强调的那样，omega-3 鱼油和维生素 D3 K2 已被证明对改善情绪和大脑健康、心脏健康、健康激素状态等各个方面都有帮助。

Again, that's drinkag1.com/huberman to get a free one-month supply of omega-3 fish oil plus a bottle of vitamin D3 plus K2 with your subscription.

再次强调，通过 Drinkag1.com/huberman 订阅，即可免费获得一个月的 omega-3 鱼油以及一瓶维生素 D3 和 K2。

So now let's talk about anorexia, this failure to consume enough energy such that the individual is at risk of death, and if not death, then severe metabolic disorders, lack of bone density, et cetera.

现在我们来谈谈厌食症，即无法消耗足够的能量，导致个体面临死亡的风险，如果不是死亡，那么就会出现严重的代谢紊乱、骨密度缺乏等。

A careful analysis through medical epidemiology has shown that you find anorexia even in cultures and societies where food is scarce.

通过医学流行病学的仔细分析表明，即使在食物匮乏的文化和社会中，也会出现厌食症。

So that really speaks to biological mechanism.

所以这确实说明了生物机制。

Typically, anorexia starts in adolescence right around puberty.

通常，厌食症开始于青春期，即青春期左右。

Puberty, at a very broad level, is the most significant and dramatic developmental step anyone goes through in their lifespan.

从广义上讲，青春期是任何人一生中经历的最重要、最戏剧性的发展阶段。

The body changes, the brain changes, perceptions change, one's own self-perception changes, and most of those changes are driven by changes in circuitry within the hypothalamus.

身体变化、大脑变化、感知变化、自我感知变化，而这些变化大部分是由下丘脑内电路的变化驱动的。

So neurons that are controlling the production of the so-called sex steroid hormones, things like testosterone, estrogen, and related hormones, prolactin, et cetera, those are all changing at very rapid rates.

因此，控制所谓性类固醇激素（例如睾酮、雌激素和相关激素、催乳素等）产生的神经元都在以非常快的速度发生变化。

Let's look under the hood.

让我们看看幕后情况。

Let's look at what's known about the neural circuitry and the sorts of perceptions and behaviors of the neural circuitry is driving in order to understand what they are truly suffering from at the level of cause, not just symptoms.

让我们看看对神经回路的了解，以及神经回路驱动的感知和行为的种类，以便了解他们在原因层面上真正遭受的痛苦，而不仅仅是症状。

First of all There's a challenge in studying anorexia because in anorexia, what you're essentially studying is the absence of a behavior.

首先，研究厌食症是一个挑战，因为在厌食症中，你本质上研究的是行为的缺失。

It's very hard to study the absence of a behavior as opposed to a behavior.

研究一种行为的缺失而不是一种行为是非常困难的。

So they did some experiments with anorexics, giving them a gallery of pictures of different foods and allowing those anorexic patients to arrange those foods according to preference about what they would select, about food nutrient content, about caloric content.

因此，他们对厌食症患者做了一些实验，给他们一系列不同食物的图片，并让厌食症患者根据他们对食物营养成分、热量含量的偏好来排列这些食物。

They essentially asked these anorexics to evaluate food.

他们本质上是要求这些厌食症患者评估食物。

And in doing so, they were able to identify something that's very unique to anorexics at the level of their perception of food.

通过这样做，他们能够在厌食症患者对食物的感知层面上识别出一些非常独特的东西。

Anorexics, rather than being anxious in the presence of food, have a hyperacuity, a hyper-awareness of the fat content of foods, almost to the point of being sort of fat content savants.

厌食症患者并不是在食物面前感到焦虑，而是对食物的脂肪含量有高度的敏锐度和高度的认识，几乎达到了某种脂肪含量专家的程度。

Now, it's a well-known symptom of anorexia, especially young anorexics, that they have kind of an obsession with food, caloric contents, macronutrient ratios, meaning fat, protein, and carbohydrate ratios.

现在，这是厌食症的一个众所周知的症状，尤其是年轻的厌食症患者，他们对食物、热量含量、常量营养素比例（即脂肪、蛋白质和碳水化合物的比例）有某种痴迷。

They are actively avoiding high-fat content foods, calorie-rich foods, and defaulting towards very low-calorie foods if they have to eat.

他们积极避免高脂肪含量的食物、高热量的食物，如果必须吃的话，默认选择低热量的食物。

And that's very important because what that means is that we need to look at the areas of the brain that drive habit formation and habit execution.

这非常重要，因为这意味着我们需要研究驱动习惯形成和习惯执行的大脑区域。

In the case of the anorexic, those habits are exactly the place where things start to go awry and that drive this very dysfunctional undereating behavior that sadly often leads to death or certainly bad medical outcomes.

就厌食症患者而言，这些习惯正是事情开始出错的地方，并导致这种非常不正常的饮食不足行为，不幸的是，这种行为常常导致死亡或肯定会导致不良的医疗结果。

And it turns out that the brain areas associated with habit formation and execution are the best point of intervention.

事实证明，与习惯形成和执行相关的大脑区域是最佳干预点。

So, you have reflexes and you have neural processes that include what are called duration path and outcome-type processes.

所以，你有反射，你有神经过程，包括所谓的持续时间路径和结果类型过程。

A duration, path, outcome-type process, we can shorten with DPO.

我们可以通过 DPO 缩短持续时间、路径、结果类型的流程。

DPO is for all types of goal-related behaviors.

DPO 适用于所有类型的目标相关行为。

So for instance, if you want to go to the grocery store and pick some stuff up and then head home, you're going to think duration.

例如，如果您想去杂货店买一些东​​西然后回家，您就会考虑持续时间。

How long do I have?

我还有多长时间？

Okay, do I have 45 minutes to get to the store?

好的，我有 45 分钟时间去商店吗？

How long does it take to get to the store?

到达商店需要多长时间？

Path, which way am I going to drive there?

路径，我要走哪条路去那里？

Which way am I going to navigate through the grocery store?

我要在杂货店里走哪条路？

Outcome, was I able to get in, get the items I need, and get home in time?

结果是，我能进去、拿到我需要的物品并及时回家吗？

Okay.

好的。

DPO, duration, path, outcome.

DPO、持续时间、路径、结果。

It's a very conscious process that requires decision-making and it's reward-based.

这是一个非常有意识的过程，需要决策并且基于奖励。

You use these DPO-type processes in the short term to pick up groceries and pick a line at the grocery store and decide which trajectory to take home, and you use them for navigating long, extended processes in life, trying to get a degree or raise children or get through a particularly challenging year, et cetera.

您可以在短期内使用这些 DPO 类型的流程来取货、在杂货店排队并决定带回家的轨迹，并且您可以使用它们来导航生活中长期、延伸的流程，尝试获得学位或抚养孩子或度过特别具有挑战性的一年等等。

So duration, path, outcome, and that entire process relies on your forebrain, this prefrontal cortex.

因此，持续时间、路径、结果以及整个过程都依赖于你的前脑，即前额叶皮层。

The prefrontal cortex is what allows you to take information from memory, combine it with information about what's happening in the present context, and then to direct your behavior, your speech, et cetera, toward particular outcomes.

前额叶皮层可以让你从记忆中获取信息，将其与当前环境中发生的事情的信息结合起来，然后指导你的行为、言语等，以达到特定的结果。

Reflexes, on the other hand, don't involve the prefrontal cortex in the same way.

另一方面，反射并不以同样的方式涉及前额皮质。

Habits and reflexes, like once you know how to walk, that doesn't rely on prefrontal cortex.

习惯和反应，就像一旦你知道如何走路，就不再依赖于前额叶皮层。

It's subconscious as it's sometimes called, but basically you don't have to use the parts of the brain that are involved in duration, path, and outcome-type analyses.

它有时被称为潜意识，但基本上你不必使用大脑中涉及持续时间、路径和结果类型分析的部分。

But basically, you have a brain area and anorexics have a brain area that's involved in evaluating and decision-making around food, and then another brain area that's involved in the reflexive consumption of particular foods and the reflexive avoidance of other foods.

但基本上，你有一个大脑区域，厌食症患者有一个大脑区域参与对食物的评估和决策，然后另一个大脑区域参与反射性消费特定食物和反射性避免其他食物。

There are always homeostatic and reward systems influencing this kind of thing.

总是有稳态和奖励系统影响这种事情。

Well, in the brain of the anorexic, it turns out that the reward systems have been attached to the execution of habits in a way that is unhealthy for body weight, but at least from a purely neural circuit perspective, the reward is now given, this chemical reward in the brain is given for avoiding particular foods and only approaching these very low-calorie, low-fat foods.

好吧，在厌食症患者的大脑中，事实证明，奖励系统以一种对体重不健康的方式与习惯的执行联系在一起，但至少从纯粹的神经回路的角度来看，现在给予了奖励，大脑中的这种化学奖励是为了避免特定食物而只接近这些低热量、低脂肪的食物。

So there really does seem to be a flip in the switch in the anorexic brain that rewards them internally.

因此，厌食症患者的大脑中的开关似乎确实发生了翻转，从而在内部奖励了他们。

They feel good when they avoid certain foods and they approach others.

当他们避免某些食物并接近其他食物时，他们会感觉良好。

So it's not a deprivation-based model where they are flagellating themselves or masochistic or actively avoiding food in order to punish themselves, which is interesting because a lot of psychological theories support that idea.

所以这不是一个基于剥夺的模型，在这种模型中，他们鞭打自己或受虐狂或主动避免食物以惩罚自己，这很有趣，因为很多心理学理论都支持这个想法。

Rather, once this transitions into a set of habits, they are actually getting a sense of reward.

相反，一旦这转变为一系列习惯，他们实际上就会获得一种奖励感。

They feel good, presumably from the release of a different neuromodulator called dopamine, by approaching foods that are low-fat, low-calorie content.

他们感觉良好，大概是由于接触低脂肪、低热量的食物时释放了一种叫做多巴胺的不同神经调节剂。

And so their whole brain circuitry is skewed toward avoiding particular things, and they actually are rewarded for that, and they feel good.

因此，他们的整个大脑回路都倾向于避免特定的事情，他们实际上因此得到了奖励，而且感觉很好。

They feel better than if they were eating in a healthy, weight-supporting way.

他们感觉比以健康、支持体重的方式饮食要好。

So how do you break a habit?

那么如何改掉一个习惯呢？

How do you rewire the brain circuitry that's literally causing a reflex, and in this case, causing a reflex that is killing the individual, or at least leading to very bad health outcomes?

如何重新连接真正引起反射的大脑回路，在这种情况下，引起致命的反射，或者至少导致非常糟糕的健康结果？

The way that you do that is through a cognitive mechanism where you teach the individual what is leading up to the habit.

这样做的方式是通过一种认知机制，告诉个体是什么导致了这种习惯。

So let's talk about what those things are that lead into a habit, because those turn out to be the exact points of entry for changing and eliminating and rewiring habits toward more healthy behaviors.

因此，让我们来谈谈那些导致习惯的因素是什么，因为事实证明，这些因素正是改变、消除和重新调整习惯以实现更健康行为的切入点。

There are two main features of thinking that go into the sorts of habits that anorexics execute.

厌食症患者的习惯有两个主要的思维特征。

The first is something called weak central coherence.

第一个是所谓的弱中心一致性。

Weak central coherence is essentially an inability to see the forest through the trees.

中心相干性弱本质上是无法透过树木看到森林。

It's a hyperacuity and focus on details within a given environment.

这是一种超敏锐度，注重特定环境中的细节。

You miss the big picture.

你错过了大局。

The other is a challenge in set shifting that once you identify something that's of particular interest and that's driving some sort of reward, for the anorexic, that would be identifying the high-fat foods or identifying the one food on the table that one could eat without anyone hopefully noticing that they're eating just the green beans and not touching any of the other food.

另一个是设置转换的挑战，一旦你确定了一些特别感兴趣的东西，并且为厌食症患者带来了某种奖励，那就是确定高脂肪食物或确定桌子上人们可以吃的一种食物，而没有人希望注意到他们只吃绿豆而没有接触任何其他食物。

If you ever had a meal with an anorexic, they become masterful actually at trying to keep people's awareness away from what they're doing, which is to home in on these low-fat, low-calorie foods.

如果你曾经和厌食症患者一起进餐，他们实际上会非常擅长让人们的注意力远离他们正在做的事情，那就是专注于这些低脂肪、低热量的食物。

What's amazing, and frankly also important, are these findings that once you teach anorexics what's happening to them, that they're doing this, they are able to intervene.

令人惊奇且坦率地说也很重要的是，这些发现表明，一旦你教厌食症患者发生了什么，他们正在这样做，他们就能够进行干预。

Now, they need support, right?

现在，他们需要支持，对吗？

And another form of therapy that seems to work well for anorexics that ideally is combined with this habit rewiring is a family-based model.

另一种似乎对厌食症有效的治疗形式是基于家庭的模式，它最好与这种习惯重塑相结合。

Family-based models are starting to surface a lot now in various therapy settings.

基于家庭的模式现在开始在各种治疗环境中大量出现。

Therapy-based models, in short, are basically where the entire family is made aware of the individual's challenges with a particular eating disorder or other disorder.

简而言之，基于治疗的模型基本上是让整个家庭都意识到个人因特定饮食失调或其他疾病而面临的挑战。

And in understanding some of the biology and psychology around it, they stop condemning the individual.

在了解了与之相关的一些生物学和心理学后，他们不再谴责个人。

They start to support that individual through cuing them towards their own habits that they observe.

他们开始通过引导他们养成自己观察到的习惯来支持那个人。

They give them some autonomy.

他们给予他们一些自主权。

They realize that none of this changes overnight.

他们意识到这一切都不是一朝一夕就能改变的。

But they're taught about things like neuroplasticity and the ability to change one's brain in response to experience.

但他们被教导诸如神经可塑性以及根据经验改变大脑的能力等知识。

And so there's a whole internal support network.

所以有一个完整的内部支持网络。

All of these things fall under the umbrella of cognitive behavioral therapy.

所有这些都属于认知行为疗法的范畴。

And I should mention that cognitive behavioral therapies are often done in conjunction with pharmacologic therapies.

我应该提到，认知行为疗法通常与药物疗法结合使用。

Before we move on to talking about bulimia and some related disorders, I want to talk about an aspect of anorexia that's very interesting, quite troubling in fact, but that has received a lot of attention, and that's the distorted self-image.

在我们继续讨论贪食症和一些相关疾病之前，我想谈谈厌食症的一个方面，它非常有趣，事实上也很令人不安，但它已经受到了很多关注，那就是扭曲的自我形象。

Now, in the episode on depression, we talked about a very powerful aspect of major depression, which is this anti-self confabulation, that people who are depressed seem to genuinely believe and even confabulate about the fact that they are performing poorly in life and that they are no good or worthless, et cetera.

现在，在抑郁症这一集中，我们谈到了重度抑郁症的一个非常强大的方面，那就是这种反自我的虚构，抑郁症患者似乎真诚地相信甚至虚构他们在生活中表现不佳、他们一无是处或毫无价值等等的事实。

It's literally a lie that they believe and their statements and their feelings and their behaviors start to reflect that lie.

这实际上是他们相信的谎言，他们的言论、感受和行为开始反映出这个谎言。

They're not conscious of it.

他们没有意识到这一点。

That's why we call it confabulation.

这就是为什么我们称之为虚构。

Anorexics often will see themselves as overweight or imperfect in ways that are of an obsession for them.

厌食症患者常常会认为自己超重或不完美，这对他们来说是一种痴迷。

In the case of the anorexic, the problem seems to be that they have a genuine distortion of their self-image, so much so that they don't actually see themselves accurately.

就厌食症患者而言，问题似乎在于他们的自我形象存在真正的扭曲，以至于他们实际上无法准确地看待自己。

Their visual perceptions are off.

他们的视觉感知发生了变化。

And the reason we know this is because of some really important and beautiful studies that were done in my colleague Jeremy Bailenson's lab at Stanford.

我们之所以知道这一点，是因为我的同事杰里米·拜伦森 (Jeremy Bailenson) 在斯坦福大学的实验室进行了一些非常重要且精彩的研究。

What's really interesting about these studies is they give us a window into the perceptual defect that anorexics have.

这些研究真正有趣的是它们为我们提供了了解厌食症患者感知缺陷的窗口。

I've actually done one of these experiments.

我实际上已经做过其中一项实验。

I'm fortunate to not be anorexic, but I've done some work with the VR lab over there.

我很幸运没有厌食症，但我在那边的 VR 实验室做了一些工作。

And what you get to do is you get to adjust this avatar of yourself to the point where you think it's as accurate as it could possibly be.

你要做的就是将自己的化身调整到你认为尽可能准确的程度。

And anorexics really distort this avatar.

厌食症患者确实扭曲了这个化身。

In other words, they create this serious mismatch between their perception of themselves and the reality.

换句话说，他们对自己的看法与现实之间存在严重的不匹配。

So indeed, it does seem to be the case.

确实如此，情况似乎确实如此。

Now, what's relieving, or I should say what's encouraging about some of the therapies that we talked about before, the family-based model, the cognitive behavioral treatments, yes, and the drug treatments as well, but this habit intervention model, is that as one starts to shift those things, it does appear that the perception of self seems to follow, that the perception of self seems to shift along with the change in habits.

现在，令人欣慰的是，或者我应该说，我们之前讨论过的一些疗法，基于家庭的模型，认知行为治疗，是的，还有药物治疗，但令人鼓舞的是，这种习惯干预模型是，当一个人开始改变这些事情时，对自我的看法似乎确实随之而来，对自我的看法似乎随着习惯的改变而改变。

So it doesn't seem that trying to tell someone, "Oh my gosh, you're so thin, you really need to eat," that doesn't seem to work.

所以，试图告诉某人“天哪，你太瘦了，你真的需要吃东西”似乎并没有什么作用。

They just don't see themselves the same way that you see them.

他们只是不以你看待他们的方式看待自己。

And so I offer that as a point of consideration if you know someone that's anorexic or if you look at an anorexic and you think, how is it that they are still critical of the small, even nonexistent amount of body fat on their triceps or something.

因此，如果你认识某人患有厌食症，或者如果你看到一个厌食症患者，你会想，为什么他们仍然对三头肌或其他部位的少量甚至不存在的身体脂肪持批评态度，我提出这一点作为考虑因素。

How is that?

怎么样？

Well, it's literally that their brain, as it relates to perceptions, visual perceptions in particular, they're completely off.

嗯，从字面上看，他们的大脑，因为它涉及感知，特别是视觉感知，他们完全关闭了。

And fortunately, by changing habits, you rewire those circuits as well.

幸运的是，通过改变习惯，你也可以重新连接这些电路。

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

我想稍微休息一下并感谢我们的赞助商之一 Function。

Last year, I became a Function member after searching for the most comprehensive approach to lab testing.

去年，在寻找最全面的实验室测试方法后，我成为了 Function 成员。

Function provides over 100 advanced lab tests that give you a key snapshot of your entire bodily health.

Function 提供 100 多项高级实验室测试，为您提供整个身体健康状况的关键快照。

This snapshot offers you with insights on your heart health, hormone health, immune functioning, nutrient levels, and much more.

此快照为您提供有关心脏健康、激素健康、免疫功能、营养水平等方面的见解。

Function not only provides testing of over 100 biomarkers key to your physical and mental health, but it also analyzes these results and provides insights from top doctors who are expert in the relevant areas.

Function 不仅提供对您的身心健康至关重要的 100 多种生物标记物的测试，而且还分析这些结果并提供相关领域专家的顶级医生的见解。

For example, in one of my first tests with Function, I learned that I had elevated levels of mercury in my blood.

例如，在我第一次使用 Function 进行测试时，我发现我的血液中汞含量升高。

Function not only helped me detect that, but offered insights into how best to reduce my mercury levels, which included limiting my tuna consumption, I'd been eating a lot of tuna, while also making an effort to eat more leafy greens and supplementing with NAC, N-acetylcysteine, both of which can support glutathione production and detoxification.

功能不仅帮助我发现了这一点，还为我提供了如何最好地降低汞含量的见解，其中包括限制我的金枪鱼摄入量，我一直在吃大量金枪鱼​​，同时还努力多吃绿叶蔬菜并补充 NAC、N-乙酰半胱氨酸，这两者都可以支持谷胱甘肽的产生和解毒。

And I should say, by taking a second Function test, that approach worked.

我应该说，通过进行第二次功能测试，这种方法奏效了。

Comprehensive blood testing is vitally important.

全面的血液检测至关重要。

There are so many things related to your mental and physical health that can only be detected in a blood test.

有很多与您的心理和身体健康相关的事情只能通过血液检查来检测。

The problem is blood testing has always been very expensive and complicated.

问题是血液检测一直非常昂贵且复杂。

In contrast, I've been super impressed by Function's simplicity and at the level of cost.

相比之下，Function 的简单性和成本水平给我留下了深刻的印象。

It is very affordable.

这是非常实惠的。

As a consequence, I decided to join their scientific advisory board, and I'm thrilled that they're sponsoring the podcast.

因此，我决定加入他们的科学顾问委员会，我很高兴他们赞助了这个播客。

If you'd like to try Function, you can go to functionhealth.com/huberman Function currently has a wait list of over 250,000 people, but they're offering early access to Huberman Podcast listeners.

如果您想尝试 Function，可以访问 functionhealth.com/huberman Function 目前有超过 250,000 人的等待名单，但他们为 Huberman 播客听众提供了早期访问机会。

Again, that's functionhealth.com/huberman to get early access to Function.

同样，可以通过 functionhealth.com/huberman 提前访问 Function。

Okay, so let's talk about bulimia, which is overeating and then purging, typically by self-induced vomiting or by ingestion of laxatives.

好吧，我们来谈谈暴食症，它是指暴饮暴食，然后通过自我催吐或服用泻药来清除。

And then we'll also talk about binge eating disorder, which has a lot of the same features as bulimia, but typically no purging.

然后我们还将讨论暴食症，它与贪食症有很多相同的特征，但通常没有清除。

The criteria that were described to me is that if somebody's doing this at least once a month over a period of anywhere from two to three months, then it likely would qualify.

向我描述的标准是，如果有人在两到三个月的时间内每月至少这样做一次，那么它很可能符合资格。

They're not making the decision to overeat.

他们并没有做出暴饮暴食的决定。

They are driven from the inside to ingest far more food than they need, and in some cases, than they would want to eat.

他们从内部被迫摄入远远超过他们需要的食物，在某些情况下，甚至超过他们想要吃的食物。

So it's a lot like the habit that we described for anorexia.

所以这很像我们描述的厌食症的习惯。

It's almost like it's turned into a reflex once they get going.

一旦他们开始行动，这几乎就变成了一种条件反射。

All the homeostatic signals are being overridden.

所有的稳态信号都被覆盖。

All the signals from the body, the leptin, the insulin, the glucose, all that stuff is cosmically sky-high, and yet they're just what the nerds call hyperphagic.

来自身体的所有信号，瘦素、胰岛素、葡萄糖，所有这些东西都是宇宙级的高水平信号，但它们正是书呆子所说的贪食信号。

They're just eating like crazy.

他们只是疯狂地吃东西。

There's a lot of shame associated with bulimia, oftentimes because people are vomiting and it's hard to hide that vomiting behavior.

贪食症会带来很多耻辱，通常是因为人们呕吐，而很难隐藏这种呕吐行为。

People are aware of it.

人们都意识到了这一点。

The hallmark feature of bulimia that distinguishes it from anorexia, aside from the fact that it's overeating as opposed to undereating, is a lack of what they call inhibitory control.

暴食症与厌食症的区别除了暴食症是暴饮暴食而不是暴饮暴食这一事实之外，暴食症的一个显着特征是缺乏所谓的抑制控制。

And that might come as no surprise, but first of all, the bulimic, unlike the anorexic, is hyper-impulsive and oftentimes has other types of impulse behaviors.

这可能并不奇怪，但首先，暴食症患者与厌食症患者不同，是过度冲动的，并且常常有其他类型的冲动行为。

And for that reason, many of the treatments that you see for bulimia and binge eating disorder are the sorts of treatments that don't seem to work so well, or at least most of the time, for anorexia.

出于这个原因，你看到的许多治疗暴食症和暴食症的治疗方法似乎对厌食症效果不佳，或者至少在大多数时候效果不佳。

So the drugs that increase the neuromodulator serotonin, for instance, fluoxetine, also called Prozac, Paxil, et cetera, those things oftentimes can be effective in bulimia.

因此，增加神经调节剂血清素的药物，例如氟西汀，也称为百忧解、帕罗西汀等，这些药物通常可以有效治疗贪食症。

Some of the drugs that are used to treat attention-deficit hyperactivity disorder in ADD, some of those same drugs like Adderall, Vyvanse, and things of that sort, can also be used to treat bulimia and binge eating disorder.

一些用于治疗 ADD 中注意力缺陷多动障碍的药物，其中一些药物如 Adderall、Vyvanse 等，也可用于治疗贪食症和暴食症。

Why would that work?

为什么那会起作用？

Well, now you are familiar with the prefrontal cortex.

好了，现在您已经熟悉了前额皮质。

Prefrontal cortex is involved in this analysis of duration, path, and outcome.

前额叶皮层参与对持续时间、路径和结果的分析。

Duration, path, and outcome is how we avoid impulsivity.

持续时间、路径和结果是我们避免冲动的方法。

It's how we think, okay, if this, then that.

我们就是这样想的，好吧，如果这样，那就那样。

If that, then this.

如果是这样，那么这个。

You can imagine how for the obsessive-compulsive or for the anorexic, these are circuits that are overactive.

你可以想象，对于强迫症患者或厌食症患者来说，这些回路是过度活跃的。

For the bulimic, this is the circuit that's going to essentially be underactive, so really the polar opposite of what you see in anorexia.

对于暴食症患者来说，这个回路本质上是不活跃的，所以与厌食症中看到的情况截然相反。

So this lack of impulsivity implies a lack of prefrontal control, what we call top-down control.

因此，缺乏冲动意味着缺乏前额叶控制，即我们所说的自上而下的控制。

They become more impulsive.

他们变得更加冲动。

So bulimics have an issue with impulsivity, and therefore drugs that can increase serotonin and sometimes these drugs that increase dopamine and norepinephrine levels in the brain allow for more top-down control, and that's also why they're used to treat ADHD and attention deficit disorder.

因此，暴食症患者存在冲动问题，因此可以增加血清素的药物，有时可以增加大脑中多巴胺和去甲肾上腺素水平的药物可以实现更多自上而下的控制，这也是它们被用来治疗多动症和注意力缺陷障碍的原因。

These drugs tend to create a hyperfocus and tend to push the brain and general mode of processing into one in which you think, if this, then that.

这些药物往往会造成高度集中，并倾向于将大脑和一般处理模式推入一种你思考的模式，如果这样，那就那样。

If this, then that.

如果这样，那就那样。

So anticipating outcomes.

所以期待结果。

Do behavioral interventions work for bulimia?

行为干预对贪食症有效吗？

In some cases, yes, provided that those interventions are done early enough.

在某些情况下，是的，只要这些干预措施做得足够早。

Regardless, behavioral interventions coupled with drug-based interventions are always more effective than either one alone.

无论如何，行为干预与药物干预相结合总是比单独使用任何一种干预更有效。

Fortunately, there is a decent-sized kit of drugs that can help with bulimia.

幸运的是，有一套相当大的药物可以帮助治疗贪食症。

We have on the one hand anorexia, which seems to be a disruption in habit and a coupling of unhealthy habits, in this case food restriction, to the reward pathway.

一方面，我们患有厌食症，这似乎是习惯的破坏以及不健康习惯（在本例中是食物限制）与奖励途径的结合。

And on the flip side, we have binge eating disorder and bulimia, where a very unhealthy habit of gorging oneself with food, sometimes followed by purging, is not necessarily coupled to reward.

另一方面，我们有暴食症和贪食症，这是一种非常不健康的习惯，暴饮暴食，有时随后进行净化，并不一定与奖励相关。

They feel terrible when they do that.

当他们这样做时，他们感觉很糟糕。

Right?

正确的？

The anorexic feels great about restricting their food intake.

厌食症患者对限制食物摄入量感觉很好。

They feel like they're winning some sort of game.

他们感觉自己正在赢得某种游戏。

The circuitry is flipped somehow that way.

电路以某种方式翻转。

With bulimia, they feel horrible about the fact that they're binging.

患有贪食症时，他们会对自己的暴饮暴食感到恐惧。

There's immense shame.

有一种莫大的耻辱。

They can't control themselves.

他们无法控制自己。

The reward is set up before the behavior.

奖励是在行为之前设置的。

The reward is set up in drawing them to food and in making food look like something that's incredibly appetizing and there's no impulse break.

奖励的目的是吸引他们去吃东西，让食物看起来非常美味，而且不会有冲动。

There's no way for them to stop that kind of behavior.

他们没有办法阻止这种行为。

I think for those of us that know anorexics or have observed anorexia, it's so hard to see somebody starve themselves to near death or to death.

我认为对于我们这些了解厌食症或观察到厌食症的人来说，很难看到有人将自己饿死或饿死。

Equally disturbing is somebody who has an abundance of food and is gorging themselves and then feels terrible about it.

同样令人不安的是，有人拥有丰富的食物，却狼吞虎咽，然后感觉很糟糕。

So these are heavy topics.

所以这些都是沉重的话题。

These are topics that frankly no one really wants to talk about unless they know someone who's suffering from them or they themselves suffer from them.

坦率地说，这些话题没有人真正愿意谈论，除非他们认识遭受这些痛苦的人或者他们自己也遭受这些痛苦。

What I've tried to do today is try and give you a window into what really underlies these things that we call eating disorders.

我今天试图做的就是尝试为您提供一个窗口，让您了解这些我们称为饮食失调的疾病的真正根源。

I hope I've done that at the level of biology, neurocircuitry, mechanism, endocrinology, and some of the psychology.

我希望我已经在生物学、神经回路、机制、内分泌学和一些心理学的层面上做到了这一点。

As with any episode of this podcast, but especially where we're talking about mental health issues and mental health disorders, behavioral disorders, there's no way that I can exhaustively cover all the different forms of treatment.

与本播客的任何一集一样，尤其是在我们谈论心理健康问题、心理健康障碍、行为障碍时，我无法详尽地涵盖所有不同形式的治疗。

The major takeaways today are we should all be asking the question, what is healthy eating for us?

今天的主要收获是我们都应该问一个问题：什么是我们的健康饮食？

How do we develop a relationship to food that we can enjoy food, hopefully both socially and on our own, but that we are not neurotic and compulsive about it?

我们如何与食物建立一种关系，我们可以享受食物，希望既可以在社交场合也可以在我们自己身上享受食物，但又不会对此感到神经质和强迫？

Today, we focused on the extremes of food-related behaviors that really qualify as genuine disorders.

今天，我们关注的是真正属于真正疾病的与食物相关的极端行为。

They are in the psychiatric manuals, and they are diagnosable, and they are serious health concerns.

它们出现在精神病学手册中，并且是可以诊断的，并且是严重的健康问题。

They're not just mentally troubling and concerning for the people suffering from them and the people around them, but they are genuine health concerns.

它们不仅给患者及其周围的人带来精神上的困扰和担忧，而且是真正的健康问题。

Just want to reiterate that anorexia nervosa is the most deadly psychiatric disorder by a huge margin.

只是想重申一下，神经性厌食症是最致命的精神疾病。

And if you look statistically at the number of people with eating disorders and that die of eating disorders, it's not far off from the number of people that die from automobile accidents.

如果你统计一下患有饮食失调症和死于饮食失调症的人数，就会发现它与死于车祸的人数相差不远。

I would love for you to take away this model that was handed off to me that I think is so powerful for thinking about all sorts of things, not just eating, but all kinds of behaviors and perceptions, that you have one box for what you think, one box for what you do, and what is intervening between those?

我希望你能拿走这个交给我的模型，我认为它对于思考各种各样的事情非常强大，不仅仅是饮食，还有各种行为和感知，你有一个盒子代表你的想法，一个盒子代表你所做的事情，以及介于这两者之间的是什么？

Why is it that you can know better and not do better?

为什么你可以知道得更好，却不能做得更好？

Well, it's because you also have to cope with the subconscious homeostatic processes and reward processes, and those oftentimes can be disrupted in ways that we find ourselves doing things that are not good for us, are not good for other people.

嗯，这是因为你还必须应对潜意识的稳态过程和奖励过程，而这些过程常常会被扰乱，因为我们发现自己正在做一些对我们不利、对其他人不利的事情。

But fortunately, there is this great gift, which is that knowledge of knowledge can allow you to do better without question, and that knowledge of knowledge allowing you to do better over time leads to this incredible phenomenon called neuroplasticity, which essentially is translated into doing better over time, even if difficult, eventually makes doing better reflexive.

但幸运的是，有一个伟大的礼物，那就是知识的知识可以让你毫无疑问地做得更好，而知识的知识让你随着时间的推移做得更好，这会导致这种令人难以置信的现象，称为神经可塑性，本质上转化为随着时间的推移做得更好，即使很困难，最终也会使你条件反射性地做得更好。

And last but not least, I want to thank you for your time and attention, and thank you for your interest in science.

最后但并非最不重要的一点是，我要感谢您的时间和关注，并感谢您对科学的兴趣。

"I didn't like what you said." Odin pauses.

“我不喜欢你说的话。”奥丁停了下来。

"About the future." This is the love story of real Hinge couple, Odin and Edward, written and read by me, Curtis Garner.

“关于未来。”这是真实的铰链夫妇奥丁和爱德华的爱情故事，由我柯蒂斯·加纳撰写和阅读。

Listen to the free audiobook now.

立即收听免费有声读物。