#104 Ben Bikman博士：如何通过饮食、运动和睡眠逆转胰岛素抵抗

那么膳食碳水化合物、精制碳水化合物与复合饱和脂肪各自扮演什么角色呢？

And so what role do dietary carbs, refined versus maybe complex saturated fats play?

然后这一切是在热量过剩的背景下发生的，还是在热量不足的情况下发生的？

And then is this all in the the background of caloric excess or or, you know, being in a deficit?

这一点也很重要吗？

Does that matter as well?

两者的混合有点像，因为这里存在细微差别。

The mixture of the two sort of like because there's nuance here.

哦，是的。

Oh, yeah.

确实有。

There is.

差不多要深入探讨了。

Kinda get into it.

事实上，一个重要的细微差别在于卡路里，这正是我需要谨慎的地方，因为关于你所暗示的这些干预措施的研究程度——我现在会进一步谈及——在低卡路里或高卡路里情况下，尚未完全阐明。

In fact, the big a big nuance is the calories, and this is where I need to be careful because the the degree of studies that have looked at these interventions that you're alluding to, and I'll touch on more now, in low calorie or hypercalorie, it's not been fully fleshed out.

但我认为可以安全地说，如果存在热量缺口，那么饱和脂肪与精制碳水的比例就变得不那么重要了。

But I would think it's safe to say if there's a caloric deficit, then it becomes less relevant, which of the the balance of saturated fats to refined carbs.

这时有人会说，那我们就一直保持热量缺口状态好了。

Now then someone would say, well, let's just always live in a caloric deficit.

是啊。

Yeah.

祝你好运。

Good luck with that.

我是说，如果真那么容易，人们早就耸耸肩说‘好吧’了。

I mean, it were if it were that easy, then people would just shrug their shoulders and say, okay.

‘我这辈子就吃低热量饮食了’。

I'm just gonna be on a low calorie diet for the rest of my life.

所以

So

所以如果你处于热量缺口状态，同时摄入一些精制碳水，那么

So if you're on a if you're on a caloric deficit and you're eating, you know, some refined carbs, then

这并不一定意味着有回旋余地。

it's not necessarily wiggle room.

你有

You have

更多回旋余地

more wiggle room

对于胰岛素抵抗来说。

for for insulin resistance.

是的。

Yeah.

没错。

Yeah.

我...我很有把握这么说。

I I'm I'm comfortable saying that.

但话又说回来，我必须补充说明，长期来看这其实不太可行。

And then, again, I just have to counter that by saying that's not really feasible long term.

要知道，人们会感到饥饿的。

You know, people get hungry.

或者说健康。

Or healthy.

饥饿感总是会占上风。

Hunger always wins.

是啊。

Yeah.

你得吃东西。

You gotta you gotta eat.

要有营养。

Nutritious.

必须给身体补充能量。

Gotta You gotta fuel the body.

所以你不能长期处于那种低热量状态。

So you can't be in that kind of chronic low calorie state.

关于饱和脂肪的观点是更具争议性的话题之一，我很乐意讨论这个问题，因为我整个博士后研究期间都在研究——我不该说整个。

So my view on so saturated fats is one of the more polarizing topics, and I'm very comfortable talking about it because my entire postdoctoral fellowship was looking at I shouldn't say entire.

我发表过最重要的论文就是研究不同脂肪酸通过转化为神经酰胺导致胰岛素抵抗的程度。

My biggest paper ever published was looking at the degree to which different fatty acids are capable of causing insulin resistance through the conversion into ceramides.

我可能会得罪一些人，但在细胞培养实验中，如果用棕榈酸酯（体内主要饱和脂肪）处理细胞，很快就会产生胰岛素抵抗。

And I'm going to upset some people, but in cell cultures, if you treat cells with saturated fat palmitate, which is the main saturated fat in the body, you get insulin resistance very quickly.

如果阻断神经酰胺，就能消除这种胰岛素抵抗。

Now if you block ceramides, you resolve that insulin resistance.

如果用单不饱和脂肪酸处理这些细胞，则不会产生胰岛素抵抗。

If you treat those cells with monounsaturated fatty acid, no insulin resistance.

如果用多不饱和脂肪酸处理这些细胞，同样不会产生胰岛素抵抗。

If you treat those cells with polyunsaturated fatty acid, no insulin resistance.

尽管目前对种子油的关注度很高——我认为这种关注是合理的，我也支持这种关注。

So as much as there is, and I believe it's justified, a very heavy focus on seed oils, I I approve of that focus.

我认为它们具有致病性，但当人们将其作为胰岛素抵抗的主要原因时，我会感到不适，因为数据并不支持这一观点。

I think they're pathogenic, but I grimace when people invoke them as a primary cause of insulin resistance because the data do not support it.

再次强调，我认为它们非常有害，但在胰岛素抵抗方面并非如此，因为我们实际上可以用棕榈酸酯处理细胞引发胰岛素抵抗，再同时用油酸或亚油酸共同培养细胞，就能逆转这种胰岛素抵抗。

Again, I think they're very harmful, but not when it comes to insulin resistance because you can in fact, we would treat cells with palmitate, cause insulin resistance, co treat them, co incubate the cells with either oleic acid or linoleic acid, and we would reverse the insulin resistance.

我并不是说种子油没有问题。

Now I do not mean to give seed oils a pass.

我认为它们具有高度致病性，但与胰岛素无关。

I think they're highly pathogenic, but not with insulin.

那么，亚油酸的其他膳食来源呢？

Well, other dietary sources of linoleic acid.

确实存在。

There are.

而且你甚至无法——我是说真的。

And there you can't even I avoid mean Really.

嗯。

Yeah.

对。

Yeah.

还有肉类。

And and meat.

我是说，实际上任何动物脂肪来源，任何动物性食品都含有一定量的亚油酸。

I mean, literally any animal source of of fat, any animal food has some linoleic acid in it.

它无处不在。

It's ubiquitous.

我想你只需要控制它的摄入量。

You would just want to control it, I guess.

关于饱和脂肪，我自己在2010年发表那篇论文时，可能带着'饱和脂肪会导致胰岛素抵抗'的观点结束了那个项目。

So with regards to saturated fat, my own work, when I published that paper in 2010, maybe, I left that project with this idea that saturated fats are thus a cause of insulin resistance.

当我看到杰夫·沃莱克博士的研究成果时，不得不重新审视自己的假设。

And I had to challenge my own assumptions when I saw the work of Doctor.

他是低碳水化合物研究领域的挚友和传奇人物。

Jeff Volick, a friend and legend in the realm of low carbohydrate studies.

他发表了几篇极具说服力的论文。

He published some incredibly compelling papers over a few papers.

他发现我必须重新审视我之前建立的模型，我当时想，好吧。

He found that I had to sort of challenge the model where I thought, alright.

我当时是用饱和脂肪处理细胞。

I was treating cells with saturated fat.

但这和人类摄入饱和脂肪是一回事吗？

Is that the same as a human eating it?

当然不是。

And of course, it's not.

现在谈到他的研究，你会发现当碳水化合物摄入量降低时，人类可以摄入比高碳水组多两到四倍的饱和脂肪，而他们血液中的饱和脂肪水平。

And now to touch on his work, you can have, humans that if if the carbohydrate levels are going down, they can eat two or three or four times more saturated fat than a high carb group, and then they're circulating levels of saturated fat.

因此血浆中的某些饱和脂肪含量明显更低。

So the saturated fat in some in the plasma is significantly lower.

这是因为我们血管中流动的大部分饱和脂肪都来自肝脏。

That's because most of the saturated fat that's flowing through our veins is coming from the liver.

当肝脏通过新生脂肪生成被指令制造脂肪时，它产生的脂肪就是棕榈酸酯。

When the liver is told to make fat through de novo lipogenesis, the fat that it makes is palmitate.

所以我们血液中流动的大部分饱和脂肪将来自肝脏制造，而非我们摄入的食物。

So most of the saturated fat we have flowing through our blood that's going to get to a cell is going to be coming from what the liver's making, not from what we're eating.

他对此展示得非常非常清楚。

And he showed this very, very well.

但这仅适用于低碳水化合物背景下。

But that's only in the background of low carb.

确实如此。

Exactly.

是的。

Yeah.

事实上，如果这一点已经明确，我就不再赘述了。

So in fact, I won't even elaborate more on that if that point's clear.

所以碳水化合物摄入越低，你能吃的饱和脂肪就越多，且看似没有任何不良影响。

So the lower carbs are getting, the more you can eat saturated fat and appear to have no deficit.

我对这一点感到非常放心。

I'm very comfortable with that.

没有赤字

No deficit in

胰岛素抵抗没有问题。

No problem with insulin resistance.

抵抗。

Resistance.

好的。

Okay.

确实

And indeed

但在那种情况下，卡路里真的不是问题。

But calories aren't an issue in that in that context, really.

我不记得他们是否在低卡路里环境下进行过研究。

I don't recall whether they had it in a low calorie context or not.

我猜想因为胰岛素水平低，你可能会有更多的代谢调整空间。好的。

I would suspect because insulin is low, once again, you probably have a little more of that metabolic wiggle room Okay.

在代谢率较高和酮体流失的情况下，事情开始变得有点模糊不清

With the higher metabolic rate and then the ketone wasting, so it starts to get a little cloudy as to

饱和脂肪的情况是，确实存在一条通向胰岛素抵抗的路径

The saturated fat scenario is they that there is definitely a pathway to insulin resistance.

嗯

Mhmm.

然而，如果你更倾向于生酮饮食方式，低碳水生酮饮食的话，是的

However, it seems as though if you're more of a ketogenic type of eater, low carb ketogenic Yep.

对于这类饮食者，那条通路似乎并不相关。

Type of eater, that pathway doesn't seem to be Relevant.

相关。

Relevant.

我对此感到非常放心。

I I'm very comfortable with that.

是的。

Yeah.

事实上，这种表述非常精妙：碳水摄入越低，膳食饱和脂肪的影响就越小。

In fact, that's a great way of stating The lower the carbs are getting, the less the dietary saturated fat matters.

现在在高碳水饮食的背景下，尽管我作为饱和脂肪的坚定捍卫者不愿承认，但确实有几项研究做得非常出色。

Now in the context of a higher carb diet, as much as it pains me to admit because I'm such a defender of saturated fats, there are a couple studies that are very well done.

如果我没记错的话，是欧洲的一些研究团队，发表在《欧洲临床营养学杂志》上，他们在高碳水饮食背景下调整脂肪饱和度进行实验。

If I recall, it was some groups in Europe, in the European Journal of Clinical Nutrition, where they had in the context of a high carb diet and then manipulating the saturation of fats.

高碳水与高饱和脂肪的组合对胰岛素抵抗和胰岛素信号传导的影响最为不利。

The high carb and high saturated fat was the worst for insulin resistance and insulin signaling.

所以当再次谈到高碳水背景时，尽管我作为天然来源饱和脂肪的坚定捍卫者很难承认这一点，但这确实开始成为问题。

And so when it comes to, again, the background of high carb, then I as much as it pains me to admit because I'm such a defender of of saturated fats from natural sources, I I which is where they come from, that begins to be problematic.

我认为这确实存在问题，不仅对代谢健康，对心脏代谢健康也是如此。

I I think it's problematic and not just, you know, for for for metabolic health, but cardiometabolic health.

我的意思是，这会导致小而密的低密度脂蛋白颗粒形成。

I mean, that's where you get small dense LDL particles.

重申一次，问题在于饱和脂肪与精制碳水的组合。

Again, it's the combination of the saturated fat and the refined carbohydrates.

现在，是的。

Now Yeah.

我们是在讨论当你同时摄入高饱和脂肪饮食和你所说的高碳水化合物时的情况吗？

Are we talking about when you're having, you know, high saturated fat diet in combination with what you call carbohydrate high carb?

我是说，如果你吃的是水果、蔬菜，也许还有一些燕麦呢？

I mean, is this what if you're eating, you know, fruits and vegetables and, you know, maybe some oats?

这和吃饼干和加工食品是一样的吗？

Is that the same as eating cookies and processed foods?

是的。

Yeah.

不。

No.

当然，简单的回答会是否定的，但我记不清那项研究的具体细节了。每当我无法引用研究时，回答都会格外谨慎。

Of course, the easy answer would be no, but but I can't recall the specific the specifics of that study, and anytime I can't cite a study, I wanna be careful in the answer.

但我的观点是：这些碳水化合物的潜在胰岛素效应是什么？

But my view would be what is the underlying insulin effect of those carbs?

那么如果这些是低血糖负荷类型的碳水化合物，胰岛素反应会非常温和

So if these are low glycemic load type carbs where the insulin response is going to be very modest

对。

Right.

胰岛素本身会导致胰岛素抵抗，而且速度很快。

Insulin itself causes insulin resistance, and again, rapidly.

因此我认为，如果在摄入饱和脂肪的同时出现胰岛素峰值，这对胰岛素抵抗具有独特的危害性。

And and so what I think is if you take the context of an insulin spike with a saturated fat load, that's uniquely harmful with regards to insulin resistance.

回到关于碳水化合物类型的问题，我认为如果是低血糖负荷的碳水化合物，比如十字花科蔬菜、浆果和柑橘类水果，几乎不会有什么问题。

So back to the idea of what are the carbs, I think if you're talking about the low glycemic load carbs, like cruciferous vegetables and berries and citrus fruits, for example, now there's almost nothing.

然后你再配上一勺地球上饱和脂肪浓度最高的椰子油，我觉得完全没问题。

And then you chase that down with a tablespoon of coconut oil, the most the most concentrated form of saturated fat on the planet, I think you're fine.

不过椰子油有点特殊，因为它含有大量中链甘油三酯（MCT），不会形成神经酰胺底物，所以不太符合这个情况。

Well, coconut oil is a bit of a an outlier because so much of it's MCT, which doesn't follow which is not a substrate for ceramides, so it doesn't quite fit.

但在那种情况下，不，我认为完全没问题。

But in that case, no, I think that's would be perfectly fine.

但你触及了在我看来显而易见的罪魁祸首。

But you are touching on what is, to me, the obvious villain.

尽管我们越来越有两派人马在争论：不。

As much as we have increasingly two camps of people saying, no.

是那些种子油的问题。

It's the seed oils.

而我个人更倾向于——因为我是研究胰岛素抵抗的——关注精制淀粉和糖类。

And I'm generally more just because I'm an insulin resistance guy in the notes for refined starches and sugars.

事实上它们总是相伴出现。

The fact is they always come together.

所以一个人的饮食理念越是基于'不要从带条形码的袋装盒装食品中获取碳水化合物或食物'这种简单原则，

And so the more a person has a dietary ideology that's just simply based on the idea of don't get your carbs or don't get your food from bags and boxes with barcodes.

你就同时避开了精制淀粉、糖类和精炼油。

You're getting rid of both the refined starches and sugars and the refined oils.

除此之外的食物对大多数人来说基本都没问题。

Anything else is gonna be fine for the average for most people.

只是

Just

少买带条形码的袋装盒装食品，多吃天然食物，就没问题。

less bags and boxes with barcodes, more whole foods, you're fine.

那果糖和葡萄糖相比呢？

And but what about, like, fructose versus glucose?

如果从水果中摄入更多果糖，真的会和精制糖引发同样的胰岛素反应吗？

If you're having more fructose in the fruit, is that really causing the same insulin response as a refined

不会。

No.

确实不会。

It's not.

蔗糖也是。

Or sucrose.

不会。

No.

这绝对不是。

It absolutely is not.

不是。

No.

果糖根本不会引发胰岛素反应。

Fructose will not elicit an insulin response whatsoever.

身体会将部分果糖转化为葡萄糖，这就是为什么低血糖的糖尿病患者可以喝一杯橙汁。

Now the body will convert some of that fructose to glucose, which is why the diabetic who's gone hypoglycemic can just drink a cup of orange juice.

几分钟内，它就会开始，你知道，如此高浓度的果糖负荷会导致血糖波动。

And within minutes, it'll start to you know, that's such a concentrated load of fructose that they will see a glycemic excursion.

但不一样，果糖是不同的。

But no, fructose isn't the same.

但即便如此，也要因人而异，像你我这样体型匀称的健康人群，可以偶尔为之。

But even still, depending on the person, you and I were two lean healthy people, we could get away with it.

如果是对超重的二型糖尿病患者，我会说：好吧，那些含糖量最高的水果，比如芒果或香蕉，就要格外注意了。

If I'm talking to an overweight type two diabetic, then I say, alright, well the most sugary of the fruits, just be more careful with, like say, mango or banana.

那么我会说，好吧，你可能需要更小心一点，因为你的问题是你不擅长代谢葡萄糖，不擅长代谢糖分，所以对含糖量最高的水果要谨慎，但其他水果可以尽情享用。

Then I would say, alright, you maybe wanna be a little more careful because your disorder is you don't burn glucose, you don't burn sugar very well, and so you just be careful with the most sugary of the fruits, but then everything else enjoy liberally.

所以关于胰岛素抵抗和体重

So with respect to insulin resistance and weight

减轻、肥胖以及导致这些问题的原因。

loss and obesity and what's causing, like, the cause of these things.

对吧？

Right?

我是说，这就涉及到饱和脂肪与高碳水化合物饮食之间的某种争论，哪一种能让你更有效地减重？

I mean, this is where we get into there's also this sort of war between saturated fat versus sort of a high carb diet, and can you lose weight on one or the other better?

这就是为什么凯文·霍尔的研究有点意思。

And that's where Kevin Hall's study was kind of interesting.

我很想听听你的看法，因为他在2021年发表了一项研究。

I'd love to get your thoughts because so he's published a study back in 2021.

美国国立卫生研究院进行了一项控制得相当好的研究，让参与者分别采用高碳水饮食或生酮饮食。

NIH did a pretty well controlled study where people were on a high higher carb diet or they were on a ketogenic diet.

两组饮食的热量是相同的，即等热量。

They were isocaloric, so same calories.

但据我回忆，

But if I recall, the

不是。

No.

实际上，他们采用的是自由进食模式，结果发现植物基组自然而然地吃得较少。

In fact, they were they were able it was ad libetum, and then they found they found that the plant based group just spontaneously ate less.

确实如此。

So yeah.

2021年的这项研究，其优势之一（虽然研究并不完美，这点我可以详述）就是允许受试者自由进食。

So the 2021 study, they one of the powers of that study, and it's not a perfect one, which I can articulate, was that they allowed them to just eat freely.

但你必须遵循这种平衡模式，遵循这种饮食结构。

But you gotta follow these kind of balance, you follow this pattern, you follow that pattern.

如果我没记错的话，植物基饮食让他欣喜的是它挑战了肥胖的碳水化合物-胰岛素理论（这点我稍后可以详述），因为他们发现高碳水组每天自发少摄入约700卡路里。

And if I recall, the plant based, he rejoiced in the fact that it challenged the carbohydrate insulin theory of obesity, which I can articulate in a moment, because they found that the higher carb group spontaneously ate about 700 calories a day less.

听起来对吗？

Does that sound right?

我觉得是对的。

I think that's right.

所以他们只是自然而然地吃得少了，因为他们可以自由进食。

So they they just spontaneously were eating less because they could eat freely.

他们只是进食，每天少摄入700卡路里是个不小的数字。

They just ate and 700 calories a day is a meaningful amount to just spontaneously eat less of.

这确实挑战了那个观点，因为有一种看法——其实我并不喜欢但是

That did challenge the idea, because one view, I actually don't like But

他们减掉的脂肪也更多吗？

did they lose more fat as well?

是的，确实如此，没错。

Yeah, they did, they did, yeah.

但这个效果是适度的。

But this is modest.

公平地说，这项研究在控制方面做得很好。

To be fair to the study, they did a good job controlling it.

稍微批评一下这项研究，其发现极其有限。

To be a little critical of the study, the findings were exceptionally modest.

这类研究的结果就像是一磅对两磅的差别，而且只持续了两周，样本量也非常小。

This is the kind of thing where it was like one pound versus two pounds, and it was two weeks, and it was a very small study.

凯文所做的很多工作都是基于数学模型的结果，他们在数据基础上进行推测或外推。

And A lot of what Kevin has done is a lot of these mathematical modeling outcomes where they speculate or extrapolate beyond the data they get.

他们发现每天自发少摄入了700卡路里。

They found that they spontaneously ate 700 calories a day less.

这挑战了碳水化合物胰岛素模型的核心观点之一，即胰岛素升高会引发饥饿感。

That challenged one of the central ideas of the carbohydrate insulin model, which is if you spike insulin, you get hungry.

他当时说，这些人摄入了大量碳水化合物。

And he was saying, well, they ate all these carbs.

请注意，这些食物主要是植物性的。

Mind you, it was mostly plant based.

复合碳水化合物

Complex carbs.

没错，正是如此

So that's right.

所以这几乎有点不公平，因为现在大多数人并不是这样获取碳水化合物的

And so it's almost it's a little unfair because that's not how most people are getting their carbs these days.

更准确地说，全球约70%的热量摄入（美国约为60%）来自碳水化合物，而这些并非来自绿叶蔬菜、浆果或柑橘类水果

And and just to put a fine point on that point, 70% of all calories consumed globally, it's about 60% in The US, are carbohydrates, and they're not coming from leafy greens and berries and and, you know, citrus fruits.

它们来自印有条形码的袋装和盒装食品

It's coming from bags and boxes with barcodes.

不过，这仍然是个有趣的发现

But nevertheless, that's an interesting finding.

我的批评意见是：首先，这是一项极其短期的研究，我们应该强调一些更长期的研究来平衡这项短期研究

My my criticism of that is, one, it's it's an extremely short term study, and there are longer studies that we ought to highlight just to offset this very short study.

但与此同时，当你摄入大量水果蔬菜时，你的胃里会堆积很多体积

But at the same time, when you're eating so much fruits and vegetables, you're putting a lot of bulk in your stomach.

这并不让我感到惊讶，这些人可能在开始这种饮食后的短短两周内，就因为突然大量食用植物性食物而出现腹胀和排气问题——毕竟他们在开始节食前可能根本没吃那么多蔬菜。

And it didn't surprise me that these may be people who, within just two weeks on this diet, were just probably having a lot of bloating and gas, from eating a lot of plants when they probably weren't eating that many plants before they started the diet.

所以他们自发地减少了进食量，这完全在我的预料之中。

So it didn't entirely surprise me that they were spontaneously eating less.

就我个人而言，比起大量绿叶蔬菜和其他水果蔬菜，我更愿意多吃些肉，所以我可能会摄入更多卡路里。

I would personally enjoy eating more meat than I would big leafy greens and and other fruits and vegetables, so I would probably eat more calories.

实际上，两周后最有趣的是——我看了研究结果后心想：'低碳水组每天多摄入700卡路里，而你告诉我他们只多长了1磅脂肪？'

The fact at the end of the two weeks in fact, what's funny is I looked at the outcome and thought, okay, the low carb group was eating 700 calories more per day, and you're telling me they only gained, like, one more?

他们只增加了1磅脂肪？

They only had one more pound of fat?

如果有什么结论的话，你本可以说：'哇，低碳水饮食确实有代谢优势。'

If anything, you could have looked at all that data and said, Wow, there is a metabolic advantage to a low carb diet.

事实上，凯文·霍尔自己的研究中就发现，当人体处于生酮状态时，基础代谢率会显著提高。

In fact, some of the studies Kevin Hall of his own work that he's trying to distance himself from is finding that in a ketogenic state, people have a significantly higher metabolic rate.

所以这项研究的一个启示或许是：当人体进入生酮状态后，每天即使多摄入700卡路里，也能比对照组少增加1磅

And so perhaps one outcome of that study is that when a person gets to ketosis, they were able to eat 700 calories more per day and only had one more pound of fat than the other group did.

这在我看来是个相当大的胜利。

That to me is a pretty big win.

这触及了已成为我实验室主题的某件事——如果你允许我简短说明的话，我会尽量简洁（虽然我不太擅长这个）。一百多年前，两位著名的传奇科学家弗朗西斯·本尼迪克特（你可能记得他创建了至今仍用于根据体型评估代谢率的本尼迪克特方程）与埃利奥特·P·乔斯林进行了合作。

And that touches on something that's become a theme for my lab, where, if you'll allow me very briefly, I will try to be brief, I'm not very good at that, but over a hundred years ago, two famous legendary scientists, Francis Benedict, who you and I may recall created what's called the Benedict equation, which is an equation that is still used to this day to try to assess metabolic rate based on someone's body size.

这位能量消耗研究领域的传奇人物本尼迪克特，曾与埃利奥特·P·

So the Benedict equation, this legend of energy expenditure, he collaborated with Elliot P.

乔斯林合作——后者拥有全球最著名的内分泌诊所，即以他命名的乔斯林糖尿病中心。

Joslin, the most famous endocrinology clinic in the world, the Joslin Diabetes Center, named after him.

这两位各自领域的传奇人物试图研究他们所称的严重糖尿病（即我们现在所说的一型糖尿病）患者的新陈代谢。

You had these two legends in their own realm who tried to understand the metabolism of people in what they called severe diabetes, which we would call type one.

他们发现这些患者的新陈代谢率比正常高出约20%。

They found that their metabolic rate was about 20% too high.

多年后，当胰岛素开始成为治疗手段时，明尼苏达的一个研究团队（第一作者是Nair，拼写为N A I R）不仅证实了六七十年前的发现——即一型糖尿病患者的新陈代谢率过高。

And then years later, when insulin began to be a therapy, a group at Minnesota, the first author is Nair, N A I R, they not only confirmed the findings from sixty or seventy years earlier that in type one diabetes, the metabolic rate is too high.

就像是某种机能出现了故障。

Like, something's broken.

他们代谢过于旺盛。

They're burning too hot.

但当你给他们注射胰岛素后，几分钟内代谢率就开始下降。

But when you gave them insulin, within minutes, the metabolic rate began to slow down.

所有这些都回到2021年的那项研究，我之所以提起这些，是因为在我看来这进一步证明了胰岛素水平越低——就像低碳水化合物饮食那样——人体拥有的代谢调节空间就越大。

And so all of this back to that study from 2021, the reason I even brought all of this up is to me that's further evidence of the lower insulin gets, like with a low carb diet, the more metabolic wiggle room a person has.

当每日能量消耗增加数百卡路里时，我们在人体研究中发现部分原因是脂肪组织在胰岛素水平下降时代谢率显著提高。

Where energy expenditure is up by several 100 calories a day, and and we found in human work that part of it is because the fat tissue starts having a much higher metabolic rate when insulin comes down.

线粒体解偶联作用大幅增强。

There's much more mitochondrial uncoupling.

就像引擎不断加速运转，燃烧能量只为了产生热量。

So the engine is just revving and revving and burning energy just to create heat.

但与此同时，你产生的酮体越多，排出的酮体就越多，而酮体本身就是卡路里。

But at the same time, the more you're making ketones, the more you're expelling those ketones, and ketones are calories.

因此低碳水化合物组每天多摄入的700卡路里，他们只多长了1磅脂肪的原因，可能就是由于这些代谢优势让他们把其余热量都燃烧掉了。

And so maybe those 700 calories a day that the low carb group was eating in excess, the fact that they only had one other pound of fat could be that they were just burning the rest off because of these metabolic advantages.

说到灵活空间，我们讨论的是人们可能拥有灵活空间的各种情况。

Well, speaking of wiggle room, I mean, we're talking about a variety of scenarios here where people can have wiggle room.

我们谈到了处于热量赤字状态。

We talked about, you know, being in caloric deficit.

这给你更多一些灵活空间。

It gives you a little more wiggle room.

是的。

Yep.

处于生酮或接近生酮状态似乎能提供更多灵活空间。

Being in a ketogenic or, you know, close to a ketogenic state seems to give you more wiggle room.

但如果是高强度体力活动呢？

But what about being, like, highly physically active?

完全正确。

Absolutely.

没错。

Yeah.

好的。

Good.

我很喜欢你用这种背景和‘弹性空间’的主题来构建这个讨论。

I love how you're framing that with this context, these themes of wiggle room.

你在哪些方面还有一点可操作的空间呢？

Where do you have a little bit of margin to work with?

是的。

Yeah.

绝对如此。

Absolutely.

运动可以说是另一个释放途径，如果你需要消耗能量，运动将是个绝佳方式。

Exercise is one of those other outlet, if you will, where if you have energy that you need to account for, exercise is gonna be a wonderful way to do it.

我通常不太强调运动，因为我不想让人们误以为运动能替代饮食控制。

I I often don't focus so much on exercise because I don't want to convey to people that it can outdo the diet.

有篇针对女性的研究论文显示，他们对比了高强度结构化运动方案与单纯低碳饮食，结果低碳饮食带来的代谢改善优于力量训练。

There was a paper published in women where they looked at a very structured and intense exercise program with just think it was just a low carb diet, and the low carb diet had better metabolic improvements than the strength training did.

因此，明智执行的饮食方案——即改变营养结构——通常会对代谢健康产生更好的长期益处。

And so diet is going to generally smart, smartly done diet, so changing nutrition is going to yield better long term benefits with metabolic health.

不过，我本人是运动的强烈倡导者。在我看来，代谢健康且苗条是一回事，但苗条却体弱多病则是另一回事。

However, the exercise I'm an enormous advocate of exercise, and to me, you are not going to go it's one thing to be metabolically healthy and lean, but then it's something else to be lean and sick or or or or weak or frail.

这就是我认为运动发挥作用的地方。

And that's where to me the exercise comes in.

所以我的观点是：通过智慧饮食保持苗条和代谢健康。

So my view is you eat smart to be lean and metabolically sound.

通过运动保持强壮有力且代谢健康。

You exercise to be strong and capable and metabolically sound.

当然，肌肉是消耗葡萄糖的主力军。

So muscle, of course, is the great glucose consumer.

当佩戴持续血糖监测仪的人看到血糖波动时，其中80%的下降都是为肌肉提供能量所致。

When if someone's wearing their CGM and they see the glucose come up and down, 80% of that coming down is what's going in to fuel the muscle.

肌肉因其庞大的质量而具有极高需求——肌肉量越大，你拥有的这种缓冲空间（我们称之为'回旋余地'）就越大，清除葡萄糖的速度就会快得多。

The muscle is just by mass so big and so hungry that the more muscle you have, the more you're going to have this big buffer or what we're calling wiggle room where you're going to clear, you're gonna clear that glucose much, much faster.

假设有两个体重相同的人，一个脂肪更多，一个肌肉更多，但其他条件相同——不过这可是个重大差异。

So if you had two people of equal body mass, but one having more fat, one having more muscle, But otherwise, the same, and that's a big difference, though.

我知道。

I know.

他们摄入相同量的碳水化合物。

They eat the same amount of carbs.

肌肉更发达的人，其血糖曲线会快速升降，可能在一小时或九十分钟内就恢复正常。

The guy with more muscle is gonna have his glucose curve come up and down, and it'll be back down to normal in an hour, maybe ninety minutes.

肌肉较少的人（即使脂肪更多，但总体重相同），他们的血糖下降需要更长时间，胰岛素水平回落也因此更慢——因为肌肉是胰岛素引导葡萄糖的主要去向，且效率极高。

The person who has less muscle, even more fat, so same body mass, they're it's gonna take much, much longer for that glucose to come down, and thus, it take longer for the insulin to come down because muscle is the main place where insulin's gonna escort the glucose to, and it does so very well.

所以肌肉量越大，人体代谢葡萄糖的缓冲空间就越大，能承受的碳水摄入量也越多。尽管我确实认为碳水化合物是主要问题，但肌肉多的人确实能摄入更多。

So the more muscle mass a person has, the more sort of metabolic wiggle room they have to clear that glucose, and then the more carbs they can eat, as much as I really point the finger at carbs as a primary problem, the more they can eat.

甚至到了这种程度：有个备战马拉松的人，每天摄入超过200克碳水，第二天早晨仍处于深度酮症状态。

And even to the point where if a person's very active, I knew a guy who was training for a marathon, he would eat over 200 grams of carbs per day and still be in deep ketosis the next morning.

你可能觉得这不可能。

You would think, well, no.

通常，生酮饮食的碳水化合物摄入不超过50克。

Normally, a ketogenic diet's no more than 50 grams.

除非你正在消耗那些葡萄糖。

Well, unless you're just burning that glucose.

对。

Right.

而且你还提到这项比较力量训练与...的研究。

And and also you you mentioned this this study that was comparing strength training to Yes.

与低碳水饮食相比。

To the, you know, low carb.

对。

Right.

我认为高强度间歇训练也很重要，当你进行...你知道，这方面有很多研究，我们在讨论运动如何改善代谢健康。

Well, I think also high intensity interval training when you're doing you know, there's there's a lot of work on so we're talking about how exercise can improve metabolic health.

我认为这是一个非常重要的调节手段，因为你激活了这些GLUT4转运蛋白，它确实有效。

And I think it is a really important lever to pull here because you you're you're activating these GLUT four transporters, and it does that.

这种激活是通过乳酸的产生实现的，当你真正高强度运动时就会产生乳酸。

Like, that activation happens through lactate, the generation of lactate, which is happening when you're really pushing yourself hard.

对。

Yeah.

所以在那个时候，你也正在变得对胰岛素敏感。

And and so at that point, you know, you're you're becoming insulin sensitive too.

对吧？

Right?

你是。

You are.

所以在某种程度上你确实改变了情境。

So you're you're really kind of changing the the the scenario in some ways.

我个人认为这不应该成为人们用来...的理由

It doesn't I don't personally think it should give people the, justification to

放纵饮食。

go and eat Indulge.

一大堆披萨，还有冰淇淋之类的

Bunch of pizzas and, you know, ice cream and

是啊

Yeah.

所有这些东西

All all that stuff.

偶尔放纵一下也没关系

All you know, cheating once in a while is fine.

但是，我觉得人们不能——你绝对无法通过运动抵消暴饮暴食

But, like, I I I think that peep you can't you definitely can you can't out you can out eat exercise,

换句话说

in other words.

但你可以通过运动改善睡眠

So But you can out exercise bedtime.

没错

Right.

没错。

Exactly.

你可以通过锻炼来弥补熬夜。

You can out exercise bedtime.

是啊。

Yeah.

但我确实认为锻炼极其重要，特别是考虑到有不同类型的锻炼方式。

But I do think exercise is extremely important, especially, like, there's different types of exercises.

那其实是另一个问题了。

That that was kind of another question.

你知道的，力量训练与那种高强度训练或长时间耐力训练之间的区别。

You know, the strength training versus, like, really going hard or or the long endurance training.

对吧？

Right?

所以像高强度间歇训练这种，你可以用更短时间完成，但强度会非常大。

So high intensity interval training, you can kinda get away with doing less time, but you're going really hard.

对吧？

Right?

你在推动这个

You're pushing that

而我毫不掩饰地支持这种做法

And I am unapologetically an advocate of that.

尽管人们可能会看着自己的日程说只有一小时，但我要说每个人——无论男女老少——都应该进行力量训练

As much as people may look at their day and say, I have one hour, I would say everyone, man, woman, old, young, strength train.

力量训练

Strength train.

我有时会质疑自己的动机，会想如果处于危机中，我逃避挑战的能力是否真比直面挑战的能力更重要

I sometimes question my own motivations, where I just think if I were in a crisis situation, would my ability to run away from the challenge be better than my ability to face the challenge?

不，我不这么认为，因为我要和妻儿在一起，能跑得比他们快并不能解决问题

No, don't think so because I'm gonna be with my wife and kids, the fact that I can outrun them isn't going to solve the problem.

所以我希望自己随时能采取行动

And so I wanna be ready to do something if I need to.

但即便抛开那个夸张的戏剧性场景不谈，肌肉越发达，其代谢需求就越高，考虑到大多数人面临的时间限制。

But even beyond that silly, dramatic scenario, the bigger the muscle, the hungrier the muscle, and given the time constraints that most people have.

但即便如此，有研究表明，在较短时间范围内（比如每天30分钟的力量训练），力量训练组在胰岛素敏感性方面的改善要优于有氧训练组。

But even then, there are studies to show that minute for minute at that shorter end, if a person spending, I think it was like thirty minutes a day, the strength training group had better improvements in insulin sensitivity than the aerobic training group.

所以如果你的时间有限，而且说实话，每个人最终都会选择力量训练。

So if you have constrained time, and let's face it, everybody does default to strength training.

无论你能进行何种程度的力量训练，就强度而言，只需尽力做到力竭。

Whatever degree of strength training you can get, and just your to touch on your point about intensity, just try to go to failure.

至少在某个肌肉群或动作的训练过程中，做到力竭，不必追求高强度低强度。

At least at some point during that overall muscle or that movement, get to it doesn't have to be a high weight, low rep.

即使你采用较轻重量、较高次数，也要做到力竭。

Even if you're doing a lower weight, higher rep, just get to failure.

把自己练到精疲力竭。

Fatigue yourself.

没错。

Yeah.

让自己疲劳。

Fatigue yourself.

对。

Yeah.

对。

Yeah.

对。

Yeah.

这就是在说有氧训练时，我觉得这也有个程度问题。

And that's where, like, if you're in the context of aerobic training, I think that's also like there's a spectrum.

对吧？

Right?

比如，他们当时在做什么？

Like, what were they doing?

他们当时还能说话吗？

Were they were they able to talk?

对。

Right.

你知道，如果他们真的全力以赴

You know, if they're really going hard

他们处于哪个强度区间？

Which zone are they in?

没错。

Right.

是的。

Yeah.

要知道，这确实会影响你如何推动那个杠杆——关于胰岛素敏感性和你的葡萄糖转运蛋白，以及它们向肌肉的转移

You know, it really it it does make a difference with respect to your how you're pushing that lever for for, you know, insulin sensitivity and your glute transporters and them sort of translocating up to

是的。

Yeah.

打开肌肉的闸门。

The muscle and opening the floodgates.

所以，是的，知道这个很好。

And so, yeah, it's it's nice to know.

换句话说，条条大路通罗马。

In other words, there's there's many roads to Rome.

所以我只是想说，你知道，现在有很多饮食争议，我认为重要的是要记住生物学是很复杂的。

And and so I do I I'm just trying to you know, there's there's definitely a lot of diet wars out there, and I do think it's important to keep in mind that biology is complicated.

这里有很多因素在起作用。

There's a lot of things going on here.

而且，是的，采用低碳水化合物饮食对胰岛素敏感性非常有益

And, yes, having a low carb diet can be very beneficial for insulin sensitivity

嗯。

Mhmm.

可以预防胰岛素抵抗。

For staving off insulin resistance.

但也有人不会选择低碳水化合物饮食。

But there's also people that are not gonna eat a low carb diet.

是的。

Yeah.

他们仍然可以保持非常健康的新陈代谢，尤其是当他们避免摄入精制碳水化合物时。

And they can still be very metabolically healthy, particularly if they're avoiding refined carbohydrates.

他们在运动。

They're exercising.

他们没有暴饮暴食。

They're not overeating.

他们没有处于热量过剩状态。

They're not in a caloric surplus.

还有些人听说饱和脂肪没问题，但没有完全理解其完整背景，于是会同时摄入大量碳水化合物。

And then there's people that hear saturated fat's okay, and they don't quite understand the whole context of it, and they'll eat a lot of carbs with it.

这就是最糟糕的情况——你把两者结合起来了。

And that's the worst case scenario where you're combining the two.

没错。

Yeah.

嗯，对任何情况来说都是的。

Well, to any yeah.

对我来说，高脂肪高碳水组合对任何结果都是最糟糕的。

To me, high fat, high carb is the worst combination for every outcome.

你提到心脏代谢问题时说到了脂蛋白谱的负面变化。

You'd mentioned cardiometabolic with regards to adverse changes in lipoprotein profile.

完全正确。

Absolutely.

我同意这个观点。

I agree with that.

但回到脂肪细胞本身，高碳水高脂肪饮食会通过胰岛素刺激向脂肪细胞发出增大的信号——而脂肪细胞最便捷的增大方式就是吸收脂肪。如果你正在摄入脂肪，它会非常乐意吸收，但胰岛素水平低时就不会这样。

But high carb and high fat, just bringing it back to the fat cell, you are now giving it a stimulus of insulin, which is telling the fat cell to get big, and the fat cell wants to get big most easily just by pulling in fat, which if you're eating fat, it's going to pull in very happily, but it won't if insulin's low.

所以你看，这就是为什么你可以选择要调控哪个变量。

And so, you know, that's why you can sort of pick which variable you're going to play around with.

虽然你没问这个问题，但既然谈到了脂肪增长的诱因...

Not that you've asked this, but then having touched on what causes the growth of the fat.

这就自然引出了一个问题：什么能让脂肪细胞缩小？

So naturally, it begs the question, what shrinks the fat cell?

看看你的脸。也许你今天过得不好。

Well, you look at those two levers, the the high insulin and the high calorie.

你必须二选一。

You have to pick one.

我唯一担心的是，尽管人们如此热忱地捍卫卡路里观点已经持续了一个世纪，如果你只是减少卡路里而不解决某人潜在的高胰岛素问题，你会很快让他们感到饥饿。

My only worry is as much as people are so ardently defending the caloric view, which they have for a century now, If you just cut calories without addressing someone's underlying high insulin, you're going to make them hungry very quickly.

这就是为什么我既承认卡路里观点，又强调胰岛素观点的原因之一。

And that's one of the reasons why I speak to the insulin side as much as I acknowledge the calorie side.

我认为这是一个需要采取的步骤。

I think that is a step to take.

它不应该是第一步。

It just shouldn't be the first step.

我希望看到的第一步是控制你的胰岛素。

What I like to see is the first step is control your insulin.

好的。

Okay.

我该怎么做呢？

How do I do that?

减少精制碳水化合物的摄入。

Well, reduce your consumption of refined carbs.

确保摄入充足的优质蛋白质和脂肪，还有水果蔬菜，这有助于降低胰岛素水平。

So make sure you're getting a lot of good protein and fat, and then fruits and vegetables, that's gonna help your insulin come down.

暂时不用操心卡路里摄入。

Don't worry about your calories yet.

这个我们稍后再处理。

We'll get there later.

只需专注于降低胰岛素水平，就能获得代谢优势——代谢率提升，酮体排泄消耗的卡路里增加，体重自然开始下降。

And just by focusing on the lowering insulin aspect, you have the metabolic advantages come into place, which is metabolic rate goes up, calorie wasting through ketone excretion goes up, and so you're gonna start to lose weight.

当你达到下一个平台期时，再进行调整。

And then if you get when you get to that next sort of plateau, alright.

现在我们可以关注卡路里方面了。

Now we can look at that calorie side.

因为随着胰岛素水平降低，你的大脑现在更习惯使用酮体，你也更适应脂肪动员。

Because with lower insulin, your brain is more accustomed to using ketones now, and you're more accustomed to you mobilizing fat.

由于低胰岛素状态下燃烧更多脂肪，你的线粒体数量增加了。

You have more mitochondria because you've been burning more fat with low insulin.

现在你可以开始减少卡路里摄入，而不用担心饥饿感让你放弃。

Now you can start cutting calories and not have to worry about hunger kicking you out.

只关注卡路里而不解决高胰岛素问题最典型的例子可能就是《超级减肥王》节目，你从没见过那些可怜的参赛者重聚，因为他们全都反弹了。

The most obvious example of the problem with just going after calories without addressing a high insulin would be perhaps like The Biggest Loser, where you never see a reunion tour with those poor contestants because they gain everything back.

没错。

Right.

饥饿感总是会获胜。

Hunger always wins.

确实如此。

It's true.

我确实想更深入地探讨你提到的一些内容，但我还是想先完成这部分，多谈谈胰岛素抵抗的根本原因。

I definitely we're gonna I wanna get more into some of what you touched on, but I I kinda wanna just complete this, you know, talk about a little bit more about what's the underlying cause of insulin resistance.

我们已经讨论过饮食构成的问题。

We've talked about diet composition.

嗯。

Mhmm.

这是个重要因素。

That's a big one.

那么进餐频率呢？

What about meal frequency?

你多久吃一次？

So how often you're eating?

如果你是零食爱好者，或者习惯深夜进食，又或者你是轮班工作者。

If you're a snacker, if you're when you're eating, if you're late night eating, or if you're a shift worker.

是的。

Yeah.

这如何产生影响？

How does that play a role?

是啊。

Yeah.

我们确实同情轮班工作者，并感激他们为社区所做的一切，但这是最不健康的生活方式。

Well, we pity the the shift workers and bless them for everything they're doing for community, but that's the worst way to do it.

关于进餐频率，我认为自60年代非正式地、70年代末正式推行高碳水饮食建议以来，再到食物指南金字塔，进而演变成每天多餐少量——事实证明大多数人正是这样吃的。

So, with regards to meal frequency, I think that our the advice that we've been giving since the '19 unofficially since the nineteen sixties, officially since the late nineteen seventies of high carb diet, and then what transitioned into with the food guide pyramid, and then what transitioned into eating multiple small meals per day, I think the proof is in the pudding, which is that's how most people eat.

他们早餐摄入高淀粉高糖的糟糕食物，需要上午加餐，然后是午餐、下午茶、晚餐、宵夜——我们已看到后果：胰岛素抵抗和肥胖成为最普遍的问题。

They eat a starchy, sugary, terrible breakfast, and they need a mid morning snack, and then they need a lunch, and then need an afternoon snack, then dinner, an evening snack, we can see the consequences, which is insulin resistance and obesity are the most common problems.

即使在肥胖不普遍的地区，胰岛素抵抗仍然常见。

Even where obesity is not common, insulin resistance is still common.

虽然不想扯太远，但即便在日本或新加坡（我的第二故乡）这样的国家——

Not to go on a tangent too much, but even countries like Japan or Singapore, my second home.

我的一个孩子就出生在那里。

One of my kids was born there.

我在新加坡完成了我的研究项目。

I did my fellowship in Singapore.

为什么美丽的新加坡小岛会如此关注糖尿病，而普通新加坡人却非常苗条？

Why would the beautiful little island of Singapore care so much about diabetes when the average Singaporean is incredibly lean?

他们的糖尿病发病率比我们高很多。

Their rates of diabetes are higher than ours by a lot.

我们甚至算不上糖尿病最多的国家，这实际上与我们储存脂肪的方式有关。

We're not even close to the most diabetic country, and that actually comes back to how we store fat.

所以关于进餐频率和饮食内容，我认为高碳水饮食加上大量卡路里，并且每天多次进食是最糟糕的方式。

So with regards to meal frequency and what we eat, I think high carb diet with abundant calories, and eating multiple times a day is the worst way to do it.

因此我认为最好减少进餐次数，每天两到三餐，同时控制碳水化合物摄入，可以享用完整的水果和蔬菜。

So I would think it'd be better to have fewer meals, two to three meals a day, where you're controlling carbs, so whole fruits and vegetables, enjoy them.

优质蛋白质和脂肪则可以自由享用。

And then good proteins and fats, enjoy them liberally.

虽然这在社交或家庭场合不太方便，但你能把更多餐食安排得越早越好。

But this isn't convenient in social or family situations, but the more you can stack your meals to be earlier in the day, the better.

研究表明，在人类进行间歇性断食或限时进食的实验中，一组人吃早餐和午餐，另一组人吃午餐和晚餐。

So studies that have looked at humans finding where they do the kind of intermittent fasting or time restricted eating of you have one group eat breakfast and lunch, one group eat lunch and supper.

吃午餐和晚餐的那组结果更差。

The lunch and supper group has worse outcomes.

并不是说他们没有改善。

Not that they're not better.

我是说，任何一种方式都比标准饮食要好。

I mean, any one of those is better than the standard.

但当你比较两者时，将主要进食时间安排在白天早些时候效果更好。

But when you compare the two, the outcomes are better for the meals being earlier in the day.

现在，我们都是有孩子的人。

Now, you and I are parents.

如果我回家后只是坐在餐桌旁，看着亲爱的妻子和孩子吃饭而自己不吃，那该有多尴尬？

How awkward would it be for me to come home and just sit around the dinner table and look at my darling wife and kids eat dinner while I'm not?

我可不会那么做。

I'm not gonna do that.

因此，尽管作为科学家的我知道早餐和午餐后禁食（包括晚餐）对我更有益，但我不会这么做。

And so as much as me as a scientist knowing that it would be better for me to have breakfast and lunch and fast through later part of the day, including supper, I'm not going to do that.

因为我更看重作为丈夫和父亲的角色，而不是追求六块腹肌之类的。

Because I care more about being a husband and father than I do about having a six pack or whatever.

所以我选择自己的方式——也许不需要详细解释我的情况，但我认为间歇性断食可以每天只吃一顿，或者至少保持三餐。

So I'm going to my own way of doing it is, well, maybe I without I don't need to explain my own situation, but I think that intermittent finding one meal of the day or at a minimum, have three meals a day.

并尽量让每餐间隔四小时左右。

And try to have about four hours between those meals.

最重要的是——这里我们要体谅轮班工作者并感谢他们——就是晚上。

And then the most important thing I would say, and this is where we pity the shift workers and thank them, it would be evening.

晚上不要吃零食。

Do not snack in the evening.

特别要指出的是，人们往往没有意识到：当他们监测睡眠并困惑于夜间糟糕的睡眠习惯时，失眠最常见的原因其实是体温过高。

Especially, one of the things I think that people don't appreciate is, as much as they're monitoring their sleep and they're wondering why they have after night terrible sleep habits, the most common cause of insomnia is elevated body temperature, so they're too hot.

而导致体温过高的最常见原因之一就是高血糖。

And one of the most common causes of being too hot is hyperglycemia.

大多数人没有意识到，当你的血糖水平飙升时，会激活交感神经系统。

Most people don't appreciate that when your blood glucose levels spike, activate your sympathetic nervous system.

在一天中所有可能激活交感神经系统的时刻，你最不希望它在你试图入睡时被触发。

And of all the times of the day when your sympathetic nervous system is activated, you don't want it to be turned on when you're trying to go to bed.

这时候你需要的是副交感神经占主导地位。

That's when you want the parasympathetic to dominate.

所以当有人吃了那些让血糖飙升的夜宵，然后在高血糖状态下入睡时，他们会表现出所有焦虑的体征和症状。

So when someone eats that evening snack of spiking their blood sugar, then they go to bed in a hyperglycemic state, they're going to have all of the signs and symptoms of anxiety.

他们会躺在床上感觉燥热。

They're gonna be laying there hot.

他们的心脏会剧烈快速跳动，他们会感受到那种脉搏的冲击并疑惑：我到底在焦虑什么？

Their heart is going to be beating hard and fast, and they're they're gonna feel that pulse pounding and wonder, what am I anxious about?

为什么我就是睡不着？

Why can't I just sleep?

其实并不是因为你患有焦虑症。

Well, it's not because you have anxiety.

这是因为你处于高血糖状态下入睡。

It's because you went to bed hyperglycemic.

但不幸的是，那正是一天中人们意志最薄弱的时刻，我对此深有同感，因为我也有相同感受。

But unfortunately, that is the one time of day where people are at their weakest, and I'm very sympathetic to that because I feel the same thing.

人们可以整天走过各种零食和垃圾食品而不为所动，明知这些对身体不好。

People can walk past treats and junk food all day and and and deny themselves that, knowing that it's not good for them.

但当下午六点或七点一到，诱惑突然就换了一副面孔，他们开始放纵自己——而这恰恰是最糟糕的时间点。

But the moment 06:00 comes around or 07:00, then all of a sudden, the temptation starts to take on a new form, and they can't they indulge, and that is the worst time.

举例来说，他们若在午餐时段放纵，情况会比在晚间好得多。

It would be better for them to indulge in that at lunch, for example, than it would be at that point of the day.

这不仅关乎新陈代谢和维持良好的胰岛素敏感性，更不用说对睡眠的影响了。

Not only metabolically and in maintaining good insulin sensitivity, but not to mention sleep.

而睡眠不佳带来的连锁反应，只会形成恶性循环。

And then the compounding consequences of poor sleep just creates this vicious cycle.

是啊。

Yeah.

好的。

Okay.

所以用餐频率听起来像是，每次进食都会引发胰岛素反应，而胰岛素反应会导致脂肪储存。

So the meal frequency, it sounds like, you know, the more you're each time you're elevating each time you're having an insulin response, that insulin is then you're you're getting into the fat storage.

是的。

Yeah.

而且你会感到饥饿。

And you will get hungry.

而你确实会这样。

And you will Yeah.

所以尽管我们强调了2021年的那项研究，我本该做的是重点介绍博士的工作。

So so as much as we highlighted that 2021 study, what I ought to have done is highlight the work of Doctor.

David Ludwig、Kara Ebeling等人在2012年《新英格兰医学杂志》上发表的研究（Shai等人）表明，尽管有研究显示高胰岛素组并未减少饥饿感，但数十年的证据恰恰相反。

David Ludwig, Kara Ebeling and others, Shai et al, in New England Journal of Medicine in 2012, where there are so many decades worth of evidence showing that as much as we had that one study suggesting while the insulin higher insulin group didn't have less hunger, yeah, there's a lot of evidence showing the opposite.

这样就会形成血糖与饥饿感的过山车效应——当人们摄入含淀粉和糖分的早餐时（坦白说现在大多数早餐都是如此）

So where you you end up creating this roller coaster of glycemia and hunger, where the person eats a starchy sugary breakfast, which let's face it, most breakfasts are these days.

血糖会急剧飙升，然后升高后必然又会降低，当血糖降低时，饥饿感就再次袭来。

They have this big spike, and then when you go high, you inevitably go low, and then when you go low, hunger comes again.

尽管你胃里可能还有食物，但大脑已经开始感知到饥饿，因为血液中的总能量下降了——即使胃里仍有大量食物，但这仍会刺激饥饿感。

Even though you may still literally have food in your stomach, and yet your brain is starting to sense, well, I'm hungry because the overall amount of energy in the blood has gone down even though there's plenty of stuff still in the stomach, but it stimulates hunger.

这就是David Ludwig的主要研究成果。

That's David Ludwig's main contributions.

总之，这让人陷入血糖过山车般的波动中，每次血糖下降，饥饿感就会推动它再次上升。

So anyway, it puts the person on this roller coaster of glycemia, and every time it comes down, hunger wants to push it back up again.

所以，虽然我打断了你，但这导致他们每天要吃六七顿饭。

And so, yeah, I cut you off though, but that puts them in a position to eat six or seven times a day.

如果不进食，他们就会喝含糖饮料，比如汽水或甜味果汁。

And if they're not eating, they're drinking something sugary, either a soda or sugary fruit juice.

对。

Right.

你提到的含糖类早餐与复合碳水化合物早餐的区别在于，后者中的纤维会延缓葡萄糖反应，同时也能产生饱腹感。

And and the difference between, you know, the sugary type of, like, breakfast you're talking about and perhaps, like, some something that's more of a complex carbohydrate would be the fiber slowing that glucose response and causing some satiety as well.

所以这是你会进行对比的方面。

So that would be something that you would contrast.

更不用说

Not to mention even

2021年的那项研究，他们可能采用的是更复杂的碳水化合物，而非

that study in 2021, they probably were doing more complex carbohydrates and not

确实如此。

They were.

是的。

Yeah.

而且是基于植物的。

And it was it was plant based.

这再次说明我们需要谨慎对待。

And that that's again another reason why I thought we need to be careful.

我并非有意对这项研究过分苛责。

Not I don't mean to sound overly critical of the study.

我很感激。

I appreciate it.

但同时，我认为我们需要详细说明研究的局限性——大多数人早餐不会从一大份绿叶沙拉开始。

But at the same time, I think we need to, elaborate on the limitations, which is most people aren't starting with the breakfast of a big leafy green salad.

但有一个研究发现，当你吃早餐时（他们专门研究了早餐），那篇文章的标题类似'更快产生饥饿感'。

But there is an a group, that found that when you have a breakfast and they looked at breakfast, and the name of the article was something like, more rapid return of hunger.

他们说标题里提到了类似'回归饥饿感'的内容。

They said it was something like return to hunger was in the title.

如果早餐是等热量的，即卡路里相同、蛋白质固定，仅脂肪与碳水化合物的比例不同，那么高碳水组会更快感到饥饿，并在下一餐比低碳水组吃得更多。

And if the breakfast, isocaloric breakfast, so same number of calories, protein was clamped, and it just differed in the ratio of fats to carbs, the high carb group was hungrier much sooner and then ate more for their next meal than the low carb group.

因此我认为，尽管我们想对全植物食品保持公平态度，但如果早餐能搭配优质蛋白质和脂肪的全植物食品，那将是提升饱腹感的理想组合。

And so I would say, as much as we want to be sort of fair with whole plants, if that breakfast is a mix of whole plants with good proteins and fats, that's going to be a winning combination of satiety.

然后享用一顿丰盛的午餐。

And then have a nice lunch.

就我个人观点而言，如我之前所说，我不会详细阐述自己的方法，但我其实不怎么吃早餐。

And then my view, for me personally, I don't eat breakfast as much as I said I wouldn't elaborate on my own approach.

我午餐吃得很多。

I eat a big lunch.

那是我一天的主餐，因为我发现如果午餐吃得丰盛，晚餐就能轻松控制，晚上也容易避免吃零食。

That's my main meal of the day because I want and then I find if I have a big filling lunch, it's easy for me to taper through dinner and then easy to not snack in the evening.

但尽管我知道，作为一个代谢科学家却也是个会犯错的人类，有时会有坏习惯，最大的讽刺就是晚上仍然是我一天中最脆弱的时刻。

But as much as I know, one of the great ironies of being a metabolic scientist and yet a fallible human, with bad habits sometimes is that evening time is still my weakest time of the day.

我的孩子们认为我是世界上最好的爸爸，我希望他们健康，所以家里基本不买麦片。

And my kids think that I'm the best dad in the world, and I want them to be healthy, and I don't really bring a lot of cereal into the home.

大部分早晨我都会给孩子们做早餐，我会做各种不同的餐点。

I make breakfast for the kids every morning for the most part, and it's a mix of various meals that I make.

他们会想，哇，我爸爸真是太爱我了。

They think, wow, my dad just loves me so much.

是的，我确实很爱你们。

Yes, I do.

我爱你们，我亲爱的小宝贝们。

I love you all, my little darling babies.

但我这样做是因为我不想家里有麦片。

But I do it because I don't want cereal in the home.

因为如果家里有麦片，爸爸对麦片就像吸毒成瘾一样。

Because if there's cereal in the home, daddy is a meth addict when it comes to cereal.

只要有麦片在，尽管我心知肚明，我还是会像上瘾者一样——我几乎能预见到接下来的场景：我会先哄孩子们睡觉。

And if it's there, as much as I know, I will, like, go through this like, I can almost script it out where I'll put help get the kids to bed.

然后打扫房子、整理物品，当一切归于寂静时，我就会想：我现在需要立刻干掉六碗麦片。

I'll clean the house, straighten things up, and then everything's quiet, and then I think, I I need six bowls of cereal right now.

接着就会吃到自己反胃为止。

And so then I will eat myself sick.

像个真正的瘾君子那样，我会骗自己说'就吃一碗'。

And like a true addict, I will tell myself, I'll just have one bowl.

一碗能有什么问题呢？

What's the problem with one bowl?

但总有个小天使在我肩头低语：'你明明知道一碗根本停不下来'

And then yet there's this little shoulder angel telling me, oh, but you know you're not gonna stop at one bowl.

但这时我内心的瘾君子又在说，是啊，我

But then there's the addiction side of me saying, yeah, am.

就是想要这个

I want this.

我就吃一碗

I'm just gonna have one bowl.

我从来都做不到

I never.

但我妻子可以

My wife can, though.

我妻子有种外星人般的神奇能力，能像吃冰淇淋或麦片这类甜食时，只吃一点点就停下

My wife has this uncanny alien like ability to eat something like this, something sweet, like an ice cream or a cereal, and just have a little bit of it and be done.

我做不到这样

I can't do that.

在对待这类事情上，她是个节制者，而我却是个成瘾者——这也是为什么我不认同现代营养学最流行的那句'万事适度'的箴言

She is a moderator, and I am an addict when it comes to these kinds of things, which is one of the reasons why I don't love a lot of the modern the most popular modern mantra when it comes to nutrition is moderation in all things.

如果你无法做到适度怎么办？

What if you can't moderate?

那最好一开始就不要尝试。

Then it would be better not to even start.

对。

Right.

我想谈谈你刚才提到的内容，这与导致胰岛素抵抗的其他因素有关。

I wanna talk about you talked you sort of alluded to this, and this has to do with the other contributing factors to insulin resistance.

你是在说，如果你深夜进食，可能会干扰睡眠。

And you're talking about this in the context of if you're if you're late night eating, it can disrupt your sleep.

是的。

Yeah.

而且，你知道，出于多种原因，你还提到了一些我以前从未真正思考过的有趣观点。

And, you know, for many reasons, you're also you talked about some very interesting stuff that I hadn't really thought about before.

但同时你的消化系统也在工作，明白吗，当你所有系统都处于激活状态时。

But also you're digesting, you know, when your your systems are all activated.

有效的食物。

Effective food.

是的。

Yeah.

你很性感。

You're hot.

确实如此。

Exactly.

没错。

Yeah.

所以，我是说，这完全说得通。

So, I mean, it it makes it makes perfect sense.

事实上，我记得我朋友Sachin Panda医生，他在限时进食方面做了很多研究，还开发了一个叫'我的昼夜节律时钟'的应用，人们可以在上面上传餐食照片，自动打时间戳并添加评论。

And in fact, I remember a friend of mine, doctor Sachin Panda, he's done a lot of research on time restricted eating, and he's got this app, My Circadian Clock, where people were, you know, uploading pictures of their meals, and it was time stamped, and they're putting comments.

而他收到的最常见评论之一就是'这会扰乱睡眠'。

And, like, the most one of the most common comments he was getting was, is disrupting sleep.

较晚进食会干扰睡眠。

Eating later was disrupting sleep.

最后他就像是，我们必须研究这个问题。

And finally, it was like like he's like, we gotta look into this.

我是说，有几十个人都在讨论这个现象。

I mean, there's, you know, dozens of people talking about this.

当你看到数据时发现这种反向关联很有趣，然后突然又冒出其他线索。

And and it's kinda funny when you kinda get that reversed thing that you're looking at when you're when you get the data, and then something else kinda pops in.

是啊。

Yeah.

哇。

Wow.

深夜进食似乎确实会干扰人们的睡眠，这是真实存在的现象。

Eating late at night seems to be disrupting people's sleep, and that's that's that's a real thing.

我被说服了。

I'm convinced.