糖尿病医生警告：80%的成年人正走向慢性病！生酮饮食对大脑的惊人影响！

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You win? Details at yamabah.com. Must be 21 to enter. Please gamble responsibly.

关于这个你能告诉我些什么？

What can you tell me about this?

从科学角度看，它确实能增强认知能力。我们发现受试者在阅读吸收信息、提升决策能力方面有50%的改善。我们还通过研究证实它能延缓转移性癌症的进展。过去十五年我深耕科研领域，自身也患有多重慢性疾病（其中一种已被我逆转），因此我多次亲身体验过这种疗法。但当初我去诊所就诊时，医生从未告知我这类最有效的治疗方案。

Well, if you look at the science, it's enhancing cognition. We've seen a fifty percent improvement in how individuals were able to read and absorb information, have better decision making. And also we did a study and showed that it delayed the progression of metastatic cancer. And I've actually taken this a number of times because having been in research for the last fifteen years and having lived with multiple chronic diseases, one which I reversed. Some of the most powerful strategies like this were not being told to me when I went to the doctor's office.

让我们深入探讨。

So let's dig deeper.

安德鲁·库蒂尼克博士是研究科学家，参与过100多项关于代谢健康、糖尿病和生酮饮食的研究。基于这些发现，他正帮助人们预防慢性疾病、提升认知能力并优化身体机能。

Doctor. Andrew Kutinik is a research scientist who's worked on over 100 studies on metabolic health, diabetes, and the keto diet. And through his findings, he's helping people prevent chronic diseases, improve cognition, and optimize performance.

我的童年经历过相当戏剧性的时刻。你看，我完全遵医嘱行事：坚持运动、规范饮食，却依然患上了肥胖症。

I went through some pretty dramatic moments in my childhood. You know, I did everything I was told. Right? I exercised all the time. I ate what I was supposed to eat, but I still became obese.

你当时体重约255磅？是的。

You weighed about two hundred and fifty five pounds? Yep.

当时我完全不知道这对身体的危害有多大——我想绝大多数人也不清楚。如今超过20%的儿童患有肥胖症，这个数字在过去三十年翻了两番。关键问题在于：那些看似健康的食品，往往并不健康。

And I had no idea how damaging that actually was to my body. And I think the vast majority of people also don't. But over twenty percent of children have obesity. That's quadrupled over the last thirty years. And a big part of that is when it comes to food, what looks healthy isn't always healthy.

这绝非偶然。不久后我就被诊断出肥胖引发的慢性不可逆疾病，从此踏上了探索健康之道的旅程。约十年前我接触到生酮饮食，深入研究其科学原理后，发现它对糖尿病、肥胖症、阿尔茨海默病、严重精神疾病等慢性病都有积极影响。

And it's not by accident. And it wasn't soon after that I ended up getting diagnosed with a chronic irreversible disease that obesity puts you at risk for. And that immediately turned into a journey to understand how to be healthy. And I came across this diet a little over a decade ago called the ketogenic diet. So then I went into the science of this diet and found positive impacts on things like diabetes, obesity, Alzheimer's, serious mental illness, chronic diseases.

我当时就想，哇哦。因为很多人没意识到，这些疾病不仅可预防，很多还是可逆的。

And I was like, Oh, wow. Because a lot of people don't realize that many of these are not just preventable, but also reversible.

你进行了同类研究中历时最长的实验，研究生酮饮食对1型糖尿病患者的影响。

And you did the longest study ever done of its kind on the impact of the ketogenic diet on a patient that had type one diabetes.

没错。让我详细讲讲这件事。

Yes. Let me let me tell you all about it.

请给我三十秒时间说两件事。首先衷心感谢大家每周收听我们的节目，这对我们意义重大——这个梦想我们过去从未敢想，更没料到能走到今天。其次，我们感觉这个梦想才刚刚启航。

Just give me thirty seconds of your time. Two things I wanted to say. The first thing is a huge thank you for listening and tuning into the show week after week. It means the world to all of us and this really is a dream that we absolutely never had and couldn't have imagined getting to this place. But secondly, it's a dream where we feel like we're only just getting started.

如果喜欢我们的节目，请加入24%的定期收听用户，在这个应用上关注我们。我承诺会竭尽全力让节目现在和未来都保持高质量。我们会邀请你们想见的嘉宾，持续呈现你们喜爱的内容。谢谢。

And if you enjoy what we do here, please join the 24% of people that listen to this podcast regularly and follow us on this app. Here's a promise I'm gonna make to you. I'm gonna do everything in my power to make this show as good as I can now and into the future. We're gonna deliver the guests that you want me to speak to and we're gonna continue to keep doing all of the things you love about this show. Thank you.

Andrew Kutnik医生，如果用最概括的方式总结你过去二十年的研究重点和终极目标——你试图证明、理解的核心究竟是什么？

Doctor Andrew Kutnik. If you had to try and sort of summarize and encapsulate what you spent the last couple of decades of your life focused on and really trying to accomplish, prove, understand from the highest level, what exactly is that?

Steven，我的核心使命是赋予人们掌控自身健康的能力。通过科学赋能，将科研成果转化为实际行动。科学很复杂，解读不易。但经过十五年研究，加之亲身经历多种慢性病（其中一种已逆转，另一种不可逆），我的使命就是让患者获得我曾用过的工具和策略，让他们能自主优化健康与机能。

The core of my mission, Steven, is really to empower individuals to take control of their own health. It's empowering them with science, bridging science to actual action. Science is very complex. It's very hard to break it down. But having been in research for the last fifteen years and having lived with multiple chronic diseases, one of which I reversed and one of which is irreversible, my mission is to empower patients with the same tools and strategies that I had access to so they can take control to maximize their health and performance.

对于健康知识储备不足的普通人，你过去十五年主要研究哪些健康领域？

For the average person who may not be as knowledgeable about health and fitness, What are the areas of health that you've spent the last fifteen years researching and trying to understand?

广义上可称为新陈代谢研究。具体来说，就是理解身体如何代谢利用营养物质。比如这些橙子——食物中的成分是什么？摄入后身体会如何反应？从葡萄糖水平（大家耳熟能详）到胰岛素反应等细微变化。

I would call it, Steven, like metabolism in broad terms. Now I would say to break that down further for people to understand that, metabolism is trying to understand how the body metabolizes or utilizes things like nutrients or food. So you have oranges here. What's in that food? How when you ingest it will your body respond to it both from glucose levels, which I'm sure many have heard of, to insulin responses, to all this different nuance.

这很大程度上关乎营养，但也涉及运动。运动对新陈代谢影响巨大，对整体健康至关重要。但坦白说，这段研究旅程对我很自私——最初只想为自己找到最佳健康方案。但我很快发现，某些最有效的策略并非医生诊室里给出的建议，毕竟我在早期应对健康挑战时经历过相当戏剧性的时刻。

A lot of that comes down to nutrition, but it also is things like exercise. Exercise is such a powerful impact on metabolism, incredibly important for overall health. But from a personal perspective, this journey has been very honestly selfish for me. I wanted to understand how to get the best performance, the best for health for myself. And I very quickly realized that some of the most powerful strategies out there were actually not necessarily the ones that were being told to me when I went to the doctor's office because I went through some pretty dramatic moments early on in my journey with trying to overcome some of these challenges.

那么请带我回到你故事的最初，从最早的相关背景开始，让我理解你为何成为今天的你。我这里有一些你童年的照片，确实非常、非常能说明问题。要知道，我们的一些听众可能仅通过音频收听，他们可能无法看到屏幕上这些画面。

So take me back to the the start of your story in the earliest context that's relevant to understand why you became the person you became. I mean, I've got some photos here from your from your childhood, which are Yeah. Very, very telling. And, you know, some of our listeners might be listening on the audio alone, they might not be able to see these these visuals on the screen. Yeah.

所以能否请你为我描述其中一些照片。

So if you could describe some of these these pictures for me.

这些照片确实唤起了我关于肥胖挑战的强烈记忆。右边那张是我们家庭冒险时拍的，那时我经常和父亲去钓鱼。照片里的我非常胖，处于肥胖状态。而右边这张尤其触动我，因为我当时完全遵循了所有建议，对吧？

When yeah. It brings back some powerful memories of the challenges with obesity for me. You know, the the picture on the right is just a picture with on a family adventure, where we went to the we go I go fishing with my dad a lot. You know, I'm very heavy at the time. I was, you know, obese and the picture on the right here, this really gets me because, you did everything I was told, right?

我坚持锻炼，按照医生和健身杂志推荐的方式饮食，但脂肪组织却不断堆积。我完全没意识到这对身体的伤害有多大——我想绝大多数人也同样不了解。如今美国有超过68%的人口处于肥胖状态。

I exercised all the time. I ate what I was supposed to eat or what my doctor recommended, what the fitness magazines recommended, but I was just constantly challenged with gaining more and more fat tissue. And I had no idea how damaging that actually was to my body. And I think the vast majority of people also don't. Over sixty eight percent of America right now is obese.

这意味着在美国街头，每十个人中就有七个肥胖者。我们知道，当身体开始堆积更多脂肪组织时，胰岛素水平几乎会立即翻倍上升——远早于出现肥胖症状、组织损伤或器官损伤等迹象。这几乎会立即降低胰岛素敏感性，这种强效的脂肪储存激素本应将血液中的营养输送到组织。

Okay. That means seven out of ten people walking around the street in The United States Of America have obesity. And we know that the second you start building more and more fat tissue on your body, insulin levels rise almost double immediately before you even have symptoms of obesity or tissue damage or organ damage or anything along those lines. We know that that almost immediately reduces insulin sensitivity. So how well insulin is very powerful fat storage hormone is able to actually bring nutrients from the blood into tissues.

在肥胖初期，这种输送效率会下降约34%到35%。

That goes down around thirty four percent to thirty five percent, in early stages of obesity.

请用外行话帮我总结：胰岛素本质上就像优步司机，把物质从血液运送到需要的地方？

And just to summarize for a muggle like me, insulin is basically the Uber which takes things out of your blood and puts them where they need to be?

它本质上像是血糖的恒温器——这是大众最熟悉的比喻。当血糖升高时，它就像释放冷气来降温那样释放胰岛素使血糖回归正常范围；当血糖降低时，胰岛素分泌就会停止。

It's essentially like a thermostat for blood glucose. That's how most people know it. So as blood glucose levels rise, it works as a thermostat to, let's say release cool air to bring it back down. In this case releases insulin to bring blood glucose back into range. As blood glucose drops, insulin is stopped.

这些被称为β细胞的细胞会停止释放胰岛素。人体最终目的是维持血液中那一茶匙糖分的精确平衡——这对生命至关重要。糖分过高会造成损伤，过低则会危及生命，必须严格控制在极窄范围内。

It stops releasing insulin out of these cells called the beta cells. And ultimately what your body's trying to do is keep the one teaspoon of sugar that's in your blood that is critical for your life. If it goes up, it can cause damage. If it goes low, it can be life threatening. In this very, very tight range.

人体建立了多种机制来确保不超出这个范围。但想象一下，如果失去直接调控这个系统的关键分子会怎样。

And it builds a number of mechanisms to ultimately make sure and ensure that you don't go outside of that range. But imagine losing the one molecule that directly controls it.

我相信你现在身上戴着两个设备。所以你有了这个。

You're wearing two devices I believe on you at the moment. So you've got this.

是的。你手臂上的设备是什么？是胰岛素泵。对。史蒂文，你的身体会分泌胰岛素。

Yeah. What is the device on your arm? It's an insulin pump. Yeah. So Steven, your body produces insulin.

大多数正在听这个节目的人，他们的身体可能也会分泌胰岛素，除非他们患有1型糖尿病。所以当我的身体不再分泌这种分子时，必须有一种获取它的方式。它24小时都戴在我的手臂上，因为这本质上是一种将我不再拥有的胰腺打包并放在手臂上的方式，以此获取同样类型的胰岛素。

Most people who are probably listening to this, their body probably also produces insulin unless they have type one diabetes. And so when my body no longer produces this molecule anymore, there's got to be a way to get it. It sits on my arm 20 fourseven because it's a way of essentially packaging a pancreas that I don't have anymore and putting it on my arm and and a way of getting that same type of insulin.

你还有一个连续血糖监测仪吗？

And you have a CGM as well?

是的。在我的腹部这里，有一个连续血糖监测仪。

Yeah. So on my stomach here, so on my stomach here is a CGM.

也就是持续监测血糖水平的设备。

Which is a continuous glucose monitor.

连续血糖监测仪是用来追踪血糖或葡萄糖水平的。

CGM is a way of tracking sugar levels or glucose levels.

这两个设备都连接到你面前的手机上。我会把它投到屏幕上让大家看看

And both of those devices link to your phone which is in front of you. I'll throw that up on the screen so people can see

好的。

Yes.

大概是什么样子。

What that kind of looks like.

在这台设备上，绿色线条代表血糖水平。好的，我的血糖显示现在是109，这意味着组织间液的葡萄糖信号——组织间液指的是血管外、组织内的液体。是的，就是血管周围组织外的葡萄糖含量。这个信号反映了血液中的葡萄糖含量。

So on this device you have a green line that is glucose levels. Okay. My blood sugar says that it's 109 right now, which means that the interstitial signal of glucose is Interstitial meaning within, not in the blood but in the tissues. Yeah, so the amount of glucose right outside the blood around the tissues. And that signal is an indication of the amount of glucose in the blood.

就是这条绿线。目前显示是109。以毫克/分升为单位的平均血糖正常范围是70到120。

That's the green line. Okay. It says that I'm 109 right now. So average blood sugar levels using milligrams per deciliter is 70 to 120. That's considered normal.

下方的蓝色线条，类似方块和三角形的图案，表示胰岛素注射记录。但这些设备并不完美。尽管它们是市场上最先进的高端产品，仍存在重大局限性。

Below that is blue lines, almost like squares and triangles. Those are illustrations of insulin being administered. But they're not perfect devices. Despite them being premier and the most advanced technology on the market, there are significant limitations to them.

其实我之前看过你的一个视频片段，你说长期高血糖是导致慢性健康问题的最大原因。

I have actually I saw a clip of yours that I was watching earlier that said you think having high blood sugar over a long time is the biggest cause of long term health problems.

当你专注于改善整体健康时，必须明确什么最重要，对吧？健康问题的优先级一二三四五是什么？我们可以通过观察未来疾病的危险因素来分析。在美国和世界许多地区，心血管疾病是头号死因。

When you're focused on improving your overall health, you have to find out what matters most, right? So what's the hierarchy in the health one, two, three, four, five? What matters most on that? And we can look at that by looking at risk factors for future disease. Well, number one cause of death in The United States and across many parts of the world is cardiovascular disease.

它同时也是糖尿病患者的主要死因。在预测心血管疾病的各项指标中，糖化血红蛋白（HbA1c）高居榜首。HbA1c反映两到三个月内的平均血糖水平，对预测未来眼部疾病、肾脏疾病乃至心血管疾病风险具有极强的指示作用。因此在改善常见慢性病健康时，血糖控制处于金字塔顶端。

Well, it's also the number one cause of death in people with diabetes. And when you look at what are the strongest predictors of developing some form of cardiovascular disease, a measure called HbA1c comes up at the top. HbA1c is a average measurement of your blood glucose over a two to three month period of time. And that is incredibly powerful at predicting future risk for, let's say, diseases of the eye, diseases of the kidney, or even cardiovascular disease. And so when I think about how do we tackle improving health or in particularly in these common, much more common diseases, glucose control sits at the very top of that pyramid.

如果失控，就像我常打的比方：你开着车却只关心轮毂款式，但引擎根本坏了，或者连底盘车轴都没有。在糖尿病等疾病中，最重要的就是控制HbA1c。

And if unregulated, it's equivalent to analogy I often use, which is you're driving a car and you're focused on what type of rims you have, but you don't even have an engine in the car. Like your engine doesn't work. Or you don't have a chassis or an axis, but yet you're focused on rims or a sound system. And so the number one factor, particularly in diseases like diabetes, that matters most is HbA1c.

这是否意味着我们应该少吃糖？

So does that just mean that we should be eating less sugar?

要控制糖尿病最危险的因素，就需要了解如何调控它。从科学角度看，碳水化合物是每日每餐影响血糖升高的最强因素。大多数人每天进食三到四餐以上，所以首先应该关注饮食。

So if we wanted to control the most powerful risk factor in diabetes, we would need to understand how to regulate it, right? So then let's look at the science of this. Well, science says that carbohydrates, food, is the most potent factor in regulating elevations in glucose at every single meal of the day. Well, most people are eating three to four plus meals every single day. And so the very first logical thing to look at is food.

因为摄入的食物对血糖控制影响最大，而血糖控制不仅影响当下健康，更关乎未来。注重营养合情合理，这并非新发现——我们早就知道营养可能挽救生命。

Because what you're consuming has the most potent impact on glucose control. And glucose control has the most potent impact on your health not only today but in the future. And so focusing on nutrition makes sense. But this isn't like a new phenomenon. We've known that nutrition could be potentially lifesaving for people.

有一种叫做生酮饮食的疗法，如果有人之前听说过的话。这是一种大幅减少食物中碳水化合物含量的饮食方式。据我所知，最早关于通过大幅减少碳水化合物来挽救一型和二型糖尿病患者生命的记载，可以追溯到1796年，由一位名叫约翰·罗洛的医生发表。他报告了两例通过基本采用低碳水化合物饮食治愈糖尿病的案例。但事实上，在1921年我们发现这种饮食还能帮助治疗癫痫等神经系统疾病之前，许多顶尖的糖尿病专家——即研究或治疗糖尿病的人——已经使用这种策略超过一百年了。

There's something called a ketogenic diet, if someone's heard this before. It's a diet that dramatically reduces the amount of carbohydrates in the food. And the dramatic reduction in carbohydrates in the food was used to save lives of patients with type one and type two diabetes since there was the first report ever known, to my knowledge, is in 1796 by a gentleman named a physician called John Rollo. He published a report on two cases of diabetes mellitus using basically a carbohydrate replete or reduced diet to resolve the disease. But we know that some of the most premier diabetologists, meaning people who study diabetes or treat people with diabetes, were utilizing these strategies for over one hundred years before we then discovered in 1921 that this diet could also help neurological disorders like seizures and beyond.

因此，营养对整体健康的影响并非新发现。实际上，直到最近由于科学研究的爆发式发展，我们才重新认识到这种已有百年历史的营养智慧，这引发了公众对这种独特饮食策略的浓厚兴趣。

And so the phenomenon of nutrition playing a role in overall health is certainly not new. It's actually only recently that we're rediscovering century old wisdom of what nutrition can do for overall health due to the emergence of an explosion in science that has really drove a ton of public interest into this kind of unique dietary strategy.

说到生酮饮食，我很熟悉，因为我每年都会间歇性地采用这种饮食方式。大概一年有三四次会进入生酮状态。我会用酮体检测仪来测量血液中的酮体水平。对于不熟悉生酮饮食的人，我算是它的倡导者，所以相当了解。

So the ketogenic diet then. It's a diet that I'm familiar with because it's a diet that I cycle in and out of throughout the year. Probably I'm in a ketogenic state three or four times a year. Yeah. And I use the little keto reader just to check my What blood ketone is the for anyone that's unfamiliar with the ketogenic diet, I'm a bit of an advocate for it, so I'm fairly familiar.

但这让我意识到人们对它有多陌生——我和朋友们聊起时发现很多误解。如果你在进行生酮饮食，你主要吃些什么呢？

But that's also taught me how unfamiliar people are with it because I talk to my friends about it and there's a lot of misconceptions. If you're on a ketogenic diet, what are you eating?

通常人们对生酮饮食的想象存在很多错误信息，以为就是牛排培根。对某些人可能是这样。但科学配方的生酮饮食实际上包含我们通常认为健康的绿叶蔬菜——比如沙拉、西兰花、芦笋、花椰菜这类富含纤维和植物营养素的深色蔬菜。

So typically when someone visualizes a ketogenic diet, I think there's a lot of misinformation. They think it's just steak and bacon. And I guess for some people it might be that. But it's actually if we're talking about a well formulated ketogenic diet, we're talking about green leafy vegetables, things that we typically associate with health. Know, salads, broccoli, asparagus, cauliflower, these kind of nutrient dense green leafy vegetables that are high in fiber and phytonutrients.

蛋白质也是重要组成部分，可以来自肉类、三文鱼等鱼类、鸡蛋、奶酪。坚果也提供少量蛋白质。其余部分则由脂肪构成，这些脂肪通常来自植物源，比如橄榄油、牛油果油等。

Then you also have protein as a component of that. That can come from meat, that can come from fish in the form of salmon, eggs, cheeses. A little bit comes along for the ride in things like nuts. And then you also have the rest of the diet which is made up of fat and this can come a lot of times from various plant forms. This can come from like olive oil, avocado oil.

那么需要戒除哪些食物？

And what are you removing then?

高糖高淀粉的碳水化合物。比如贝果、甜甜圈、白米饭、意大利面这类食物。它们被排除在外是因为会迅速升高血糖水平，而血糖快速上升又会刺激胰岛素分泌。

Sugary starchy carbohydrates. So you're not having bagels. You're not having donuts. White rice, pastas, these type of foods, the reason they're not a part of this diet is because these foods rapidly elevate blood sugar levels. And a rapid elevation in blood sugar also spikes insulin.

胰岛素会抑制脂肪分解及向肝脏输送脂肪的能力。肝脏演化出将脂肪转化为酮体的精妙机制——因为长链脂肪酸（食物脂肪和体脂的主要形式）无法直接通过血脑屏障。虽然葡萄糖是大脑燃料，但在禁食或低碳水饮食导致胰岛素水平低下时，由于饮食中减少碳水化合物导致葡萄糖供应下降，脂肪就成为主要能量来源。

Insulin shuts down fat breakdown and the ability to take that fat to the liver. The liver built this amazing mechanism to be able to convert fat to ketone bodies because ketone bodies, fat can't actually long chain fatty acids, which is the primary form of fat that you consume in the food you eat and also the type that's broken down from your own fat tissue, can't readily cross the blood brain barrier. And we know that glucose is a fuel for the brain, but what happens if you fast or you don't consume a lot of carbohydrates and you have low insulin levels? And you can't transport the fat, which is now your primary fuel source on a ketogenic diet because you reduce glucose or carbohydrates in the diet which causes a reduction in glucose. The reduction in glucose lowers insulin.

胰岛素水平降低促使脂肪快速分解，从而成为你的主要能量来源。

The reduction in insulin causes fat to be rapidly broken down and now becomes your primary fuel source.

因此这存在进化基础，对吧？因为在远古时期，我们可能长时间无法进食。于是身体会转向内部，开始利用脂肪储备作为能量来源。这就是产生酮体的原因。

And so there's an evolutionary basis for this, right? Because once upon a time we might have gone long periods of time without eating something. And so our body turns inwards and starts using our fat stores as a mechanism to fuel our body. And that's why it produces ketones.

基本上，这种饮食方式的进化被认为是周期性的，即在人类历史中交替出现。因为如果经历食物丰沛期，我们可能会在短时间内尽可能多吃，然后寻找下一餐。在两次进食的间隔期会发生什么？如果像现代食物环境这样24/7完全依赖进食，从进化角度几天都活不下去。

Basically, the evolution of this diet was believed to be a cyclical, meaning on and off pattern in human history. Because if we were to go through bouts of abundance in food, we'd probably consume it as much as we can in one moment and then we're seeking the next meal. Seeking the next meal. What happens in that in between time? If you're 100% reliant on having food 20 fourseven like we do in our current food environment, you would never survive evolutionarily beyond a few days.

通过从碳水化合物代谢切换到脂肪代谢的能力，我们储存了数月之久的脂肪能量以备营养匮乏。这是人类最强大的生存机制之一，能帮我们度过饥荒。但自圣经时代我们就知道，禁食具有治疗潜力——最显著的是能缓解癫痫发作。完全断绝食物时会出现抽搐症状。

With the ability to switch from a carbohydrate based metabolism over to a fat based metabolism, we store months and months and months of fat energy in the event that we don't have nutrients. So it's one of the most powerful survival mechanisms we have to survive moments of famine. But we also have known since times of biblical texts that fasting has therapeutic potential. Most potently the ability to what would be described as attenuate seizures. Convulsion like behavior was described when you just completely eliminate food.

这其实是许多宗教实践的常见策略，因其所谓的'治疗特性'。事实上我们知道禁食会诱导酮症状态，而酮症在许多情况下（如癫痫）确实具有治疗效果。自192年梅奥诊所就发现，生酮饮食不仅能模拟禁食生理状态，还能减轻癫痫儿童的发作。这项研究后来在约翰霍普金斯等机构得到验证，证实其对癫痫、肥胖、1型和2型糖尿病都是有效的疗法，沿用至今已有数百年历史。

It's actually a common strategy in many religious practices because of its quote unquote healing properties. Well, we actually know that fasting induces a state of ketosis. We know that ketosis is actually shown to, in many of these cases, have a therapeutic impact in many of these environments, like seizures. We've known since 1921 out of the Mayo Clinic that ketogenic diets not only mimic the physiology of fasting but also attenuate the seizures in children with epilepsy. And that work has subsequently gone on to John Hopkins and other research institutes to show that this is a very verified strategy for not just epilepsy, but it has been used for obesity, type one diabetes, type two diabetes for centuries at this point.

而这一切都始于饮食中碳水化合物的减少。

And it all starts with the reduction of carbohydrates in the diet.

对我最有益的一点——Joe Rogan也讨论过——作为需要长时间说话的播客主，我明显注意到血酮水平和整体饮食（特别是血酮含量）会极大影响持续思考和表达的能力。为什么采用生酮饮食或补充外源酮时，我的沟通和思维效率比高碳水的标准西方饮食更高？

One of the things that's been most beneficial to me, but also I know Joe Rogan has talked about this before, is as a sort of a podcaster that spends a lot of time talking, you notice high variance in your ability to think, articulate yourself for long periods of time based on my blood ketone levels and my diet broadly, but specifically the amount of ketones that are in my blood. Why is that? Why is it that I feel like I'm more effective in communication and thinking when I'm on the ketogenic diet or taking exogenous ketones versus when I'm having a normal Western high higher carb diet?

如果人们拥有1型糖尿病患者那样的监测工具就会明白——当采用高碳水饮食时，血糖水平会不断起伏波动。这种高低变化直接关联能量水平变化。搜索'高血糖'或'低血糖症状'就能看到清单：疲劳、易怒、注意力涣散、颤抖...这些正是你描述的症状。

A lot of people would know why this is if they had the same tools and insight that type one diabetes gives. Because when you're consuming that diet, what is often happening is near constant elevations and dips, elevations and dips, highs and lows in blood sugar levels that we know are ascribed to changes in energy levels. So we know that high blood sugar levels, someone can Google if they're so interested to look at the term high blood sugar hyperglycemia or low blood sugar or hypoglycemia and just type in symptoms. And you'll see a laundry list of things like fatigue, irritability, lack of concentration, shakiness. These are all symptoms of a lot of what you're describing, right?

你的专注力和能量水平变化显然与葡萄糖水平相关。我们还知道这种变化...

Which is change in your ability to concentrate, your energy levels. It's very clear that glucose levels are linked to that. We also know that the change

明确一下，是指我处于血糖高峰还是低谷时？比如现在吃个这个...这些是橙子？柑橘？

Just to be clear, so is that when I'm at the high or the low in the glucose? If I, you know, if you ate one of these right now. Yep. What are these oranges? Tangerines?

是橙子。没错。

Oranges. Yep.

如果你现在吃一个这个，你的血糖水平大概会上升吧？

If you ate one of these right now, your blood glucose levels are going to go up presumably?

是的，因为这些橙子由结合在一起的糖分子构成。大多数水果都有结构性成分，所以你能看到它有实体，对吧？它不仅仅是液体。这些结构性成分会结合成多糖。

Yes, because these oranges are composed of bound sugar molecules together. So most fruit has a structural component to it, which is why you see it has mass to it, right? It's not just a liquid. And then that structural component binds together as a part of it, sugar that's bound together. They're called polysaccharides.

当你摄入这些多糖时，肠道会将其分解为单个葡萄糖分子吸收进血液。这时胰岛素开始释放，将葡萄糖储存到肌肉和肝脏等组织中供未来需求。因此像橙子这类高糖水果，以及面食、米饭都会升高血糖，同时伴随胰岛素水平上升。

And those polysaccharides, when you consume them, your gut actually takes those, breaks them down into individual glucose molecules to then be absorbed into the bloodstream. That's when the insulin's released. That's when insulin takes that glucose and stores it into tissues like the muscle and the liver for future glucose needs. And so yes, we would presume that with this high or oranges or even most fruits, pastas, rices would all elevate blood sugar levels. But then that accompanies with a high insulin level, right?

橙子吃得越多，所需胰岛素就越多。尽管这些食物被认为非常健康，但代谢疾病患者可能对所谓健康食物更敏感。一型糖尿病就是个典型例子。

So the more the oranges, the more insulin that you would need. And despite many of these foods being considered very healthy, those with metabolic disease or metabolic dysfunction may not may be more vulnerable to even what would typically be considered healthy foods. And type one diabetes is powerful example of that.

你说过愿意吃一个。我们会把你的血糖和胰岛素数据展示给观众，看看这个被多数人视为健康食品的橙子会如何快速影响你的指标。

So you said you'd be open to eating one of these. We've got your blood glucose and insulin levels, which we're going to put on screen for people that are watching. And it'll be interesting to see how quickly we see that orange, which is considered a health food by many people, have an impact on your glucose and insulin levels.

没错。我平时绝不会这样做，但让大众——尤其慢性病患者或糖尿病儿童——了解实际影响很重要。美国糖尿病协会将橙子列为超级食品，几乎所有机构都推荐食用。

So yes. So what I'm going to do is normally I would never do this. But I think it's very important for people to understand, especially those at home who either have a chronic disease, which is most Americans at this point, or kids who have a disease like diabetes, what the impact really could be. So let's say oranges are considered a superfood, by the American Diabetes Association. So it's a fruit highly recommended by almost every organization USDA or USDA, American Diabetes Association and beyond.

三个橙子约含70-90克碳水化合物。按我每日3000卡路里需求计算，若遵循USDA建议的55%碳水比例分四餐摄入，这相当于我单日一半的碳水摄入量。正好可以观察其对一型糖尿病患者血糖的实际影响。

The amount of orange is three oranges. Three oranges is probably going to make up around 70 to 90 grams of carbohydrates. For me, my energy needs is around calculated at around 3,000 calories per day. Now the activity I'm consuming, if I were to eat the amount of carbohydrates recommended per day which is around 55% by let's say the USDA guidelines that I would need to consume at least or more than this at if I split up all my calories over four meals. And so this is an opportunity to see what this will actually do to blood sugar levels and type one IVs, if you consume, will be a near equivalent to about a 50 amount of carbohydrates that I would consume per day if I was

生酮饮食要求每日碳水控制在50克以下对吧？

on a standard diet. The ketogenic diet, they typically say that to stay within it you need to be below, is it roughly 50 grams of carbohydrates a day?

大致如此。50克是个经验值，能使多数人的胰岛素水平低到足以产生酮体。

And it's roughly because 50 grams of carbohydrates per day is a rough number that we suspect most people will be able to get carbohydrates low enough to where insulin would be sufficiently low to produce ketone bodies.

明白了。具体数值会因胰岛素敏感性、反应速度和体重等因素有所变化。

Okay. Yeah. So there's variants depending on your insulin sensitivity and insulin response and I guess body weight is what's going be a factor.

重要因素。主要因素是因为每当讨论到像葡萄糖胰岛素这类话题时，每个人的反应都是高度个体化的。

Big factor. Major factor because anytime you're talking about things like, glucose insulin is always very individualized responses to each individual person.

我不相信，我...最近我都尽量避开水果。不知道。我会吃些莓果、覆盆子之类的，因为人们告诉我这些含有多酚和蓝黑莓成分。

I don't believe, I don't, I try and stay away from fruit these days. I don't know. I I, I have berries and raspberries and stuff like that and because people tell me there's like polyphenols and blue black blackberries.

但这些完全符合生酮饮食。对。因为它们纤维含量高，所以你看，你摄入的差不多一半——不是一半，但很大比例是纤维。关键要看净碳水化合物含量，也就是食物对血糖代谢的实际影响。

But those are totally, cohesive with the ketogenic diet. Yeah. Because they're higher in fiber so like, you know, half of what you're consuming, not half, but a large portion of it's fiber. So it's more about the net carbohydrates. It's the glycemic metabolic impact of the food.

如果纤维是不可消化的——水果里的纤维就是这样——那就不应该计入，对吧？高纤维的生酮饮食蔬菜大多如此，因为真正重要的是总碳水化合物与纤维的比例。净碳水化合物才是关键，那才是真正的代谢影响。

So if the fiber is non digestible, which in fruit it isn't, then it shouldn't, it doesn't count, right? So higher fiber content, most of the vegetables on a ketogenic diet are higher fiber, you know, because, you know, it's the total carbohydrate to fiber ratio. So the net carbohydrates that really matter because that's the amount of, that's the metabolic, real metabolic impact Okay. Of Yeah.

很多标榜生酮友好的食品写着净碳水1克什么的，但仔细一看他妈的写着28克。

A lot of keto friendly foods say like net carbs or one gram or something, but then you look at it and you go fucking, it says 28 grams.

纯属扯淡，老兄。

It's total bullshit, man.

是吗

Is

？百分百是。我测试过两种标签写着生酮友好的食品，热量、脂肪、蛋白质甚至纤维含量都相同，但代谢反应完全不同。现在进超市简直需要营养学或生物化学博士学位才能看懂标签。

it? So, oh, a 100%. So I've tested two different foods that are keto friendly on the label, same as like calories, same as like fat, protein, even fiber. And they can produce completely different responses. Mean the food environment nowadays you essentially need almost a PhD in nutrition or biochemistry to walk into a grocery store and be able to understand what the hell is on the label.

就是这样。我不想说他们不懂——他们心知肚明。那些大公司有充足资源，养着大批食品科学家，却在标签上写'零糖''生酮友好'作为营销把戏，因为这和健康效益挂钩。生酮饮食有益健康的研究满天飞，他们就想蹭这个标签。

It's, it is, and I don't want to sit here and say like, oh, they don't know. Like, no, they know. I mean, there's a companies who have tons of resources, food scientists galore and they're putting zero sugar on the label and keto friendly as a trick because it's associated with health benefits, right? There's all these studies on ketogenic diets that can show to improve health. And so they want to have that on their label.

但如果你看成分表，他们会用100种替代糖分的原料——麦芽糖醇、麦芽糊精等等，这些和糖有着完全相同的代谢效果。换了这些就能在标签上标榜零糖。

But what is often happening if you look on the back of the label there's about a 100 different ingredients they can swap sugar for for something that has the same exact metabolic effect as sugar. So maltitol, maltodextrin, all these different ingredients that are going to cause glucose to go up rapidly, they'll just swap it. And now you can put on your label zero sugar. If you've been

自从你被诊断出糖尿病后采用生酮饮食，你自己有没有间歇性地执行这种饮食方式？如果有，你注意到在执行和不执行这种饮食时有哪些不同？

in the ketogenic diet since you were diagnosed with diabetes, have you cycled in and out of it yourself? And if so, what have you noticed in terms of when you are in that diet and when you're not?

实际上我在十多年前就接触到了这种饮食方式。当时还没有连续血糖监测仪（CGM），我每天要采血6到10次来监测血糖，发现自己的血糖值很少超出正常范围，也不再经历血糖的剧烈波动。当我转向生酮饮食后，几乎立即就发现胰岛素需求量大幅下降了约40%多。

So I actually came across this diet a little over a decade ago. What I found is that almost every blood meter that I was taking this is before CGMs were present. I had to just prick my blood six to 10 times a day to see what my blood sugars were, I was finding that I was very rarely outside of the normal range. And I was also finding that I wasn't feeling these extreme highs and lows anymore. When I transitioned to a ketogenic diet, almost immediately, my insulin requirements dropped substantially, around 40, a little over 40%.

我需要注射的胰岛素量急剧减少。但由于没有连续血糖监测仪，无法实时查看血糖变化，只能确定胰岛素用量明显减少。于是我去见了当时的医生。

So the amount of insulin I needed to take dropped dramatically. But I didn't have continuous glucose monitor. I didn't have this instant feedback of like what is my blood sugar doing? I just know I needed a heck of a lot less insulin. And so what happened was I went into my doctor's office at the time.

那位医生恰好是美国糖尿病协会的主席。他说从未见过1型糖尿病患者的血糖能维持在正常范围内，问我究竟是怎么做到的。从那一刻起，这对我来说就转变成了一个终身的探索旅程——原来营养对我的肥胖减重有巨大影响。

He happened to be the American Diabetes Association president at the time. He's like, I've never seen a blood sugar level in the normal range with someone with type one diabetes before. He said, what are you doing? From that point forward, that's when for me it like transitioned, Steven, into like a lifelong journey of like, wow. Obviously nutrition had a huge impact on me losing weight when I had obesity.

现在它直接调控着这个强大的疾病——几乎所有患者在确诊后终生都会面临血糖偏高且波动的问题。99%的患者余生都无法再实现正常代谢控制，100%预计会出现胰岛素抵抗。在确诊三年内，我们就能在儿童患者大脑中观察到神经解剖结构的变化。

Now it was directly regulating this very powerful disease where upon diagnosis nearly all patients are going to have high and variable glucose levels for the rest of their life. Ninety nine percent of patients will never see normal metabolic control again for their life. One hundred percent of them are expected to get insulin resistance. And within three years we see neuroanatomical changes within the brain of children who are diagnosed.

这意味着什么？

What does that mean?

这意味着通过脑部核磁共振扫描，我们发现患有1型糖尿病且血糖偏高波动的儿童，其大脑白质和灰质会发生改变。与正常儿童大脑发育相关的区域，他们的发育方式出现了差异。这种现象在三年内就会出现，且与血糖控制不良直接相关。四年内我们还能在儿童身上观察到动脉粥样硬化进程的早期迹象。

So it means that when we look at MRI scans of the brain, we see that children with high and variable glucose levels with this disease with type one diabetes, they have shifts in the type of white and gray matter. The sections of the brain that are associated with normal brain development in childhood, they're not developing the same way. And we see this within three years. And it's directly linked to the poor glucose control. We also know that we see signs of the early signals of atherosclerotic progression in children within four years.

动脉粥样硬化进程是什么？

Atherosclerotic progression, what's that?

心血管疾病是全球人口主要死因之一。其最初表现就是血管功能与结构的变化——这最终会形成血管斑块或阻塞，导致心脏病发作或中风。对于遵循标准治疗的1型糖尿病儿童，99%的患者余生都将持续血糖偏高波动，他们的血管会从柔软顺滑状态逐渐变得僵硬，开始沉积胶原蛋白，就像捏住水管导致水流加速一样——我们可以通过血流速度来测量这种变化。

So one of the primary causes of death in individuals across the world is cardiovascular disease. And how do we get that? Well, have changes in your blood vessel and how it functions is the first and earliest signal of future what will ultimately be plaque or this kind of blockages within the blood vessel which ultimately cause things like heart attacks or strokes. Well, in type one diabetes we see that children who have high and variable glucose levels, again, ninety nine percent of patients are expected to just live this way for the rest of their life if they follow standard of care, if they follow the doctor's orders. They're going to see changes in how their blood vessels literally, functionally and structurally change.

他们的血管会从原本富有弹性的平滑状态逐渐变得非常僵硬。血管周围会积累越来越多的胶原蛋白，变得越来越硬。这就像打开水管后捏住管身——当血管变硬且管径缩小时，血流速度会加快。我们可以通过体内血流速度来测量这种变化。

Their blood vessels will now shift from being this very compliant, almost like a smooth wave to that blood vessel now becomes very rigid. It starts to build collagen, more and more collagen around it becomes stiffer and stiffer. It's almost like taking a hose and turning on a hose and pinching the hose. When you pinch the hose, as it becomes stiffer and as you shrink the size of the blood vessel it goes faster. And so we can measure that by the speed of the blood in the body.

另一个明确信号——血管开始变化的最强烈征兆之一——早在斑块形成或血管堵塞前数十年就已出现。顺便说一句，这些变化其实始于儿童时期。那些10至14岁被诊断出1型糖尿病的患儿，他们的血管无法对所谓的剪切应力做出反应。史蒂文，这意味着假设你今早去跑步时，随着心率加快，血流速度增加，血管壁承受的压力增大，你的血压最初会上升。

Another clear signal, one of the most powerful signals that the blood vessel is starting to change before you see plaque, before you see blockages, I mean decades prior. These are all happening in childhood, by the way. 10 to 14 year olds diagnosed with type one diabetes. We see that the blood vessel isn't able to respond to what they call sheer stress, Steven. So that means, let's say you go for a run this morning, Steven, and your blood pressure initially increases because as your heart rate increases, the speed of the blood increases, the amount of pressure on the vascular wall increases.

当血液在血管中快速流动时会产生应力现象，这并非坏事。实际上这是血管释放一氧化氮的信号。一氧化氮是强效血管扩张剂，能使血管舒张。

A phenomenon when the blood moves fast through blood vessels, it causes stress against the blood vessels. That's not a bad thing. It's actually a signal for the blood vessel to release something called nitric oxide. Nitric oxide is a potent called vasodilator. It causes the blood vessels to open up.

这是身体对压力的正常反应机制。运动时血管先收缩后舒张，都是身体的正常调节。但1型糖尿病早期就会削弱一氧化氮的生成能力，导致无法应对高压负荷。

And this is how your body responds normally to stress. Okay, you go for an exercise, vasodilation, or vasoconstriction, then vasodilation. And these are normal responses the body has. Well, what happens in type one diabetes very early on is that the ability to produce nitric oxide is diminished. You're not able to respond to high stress loads.

因此血管不仅逐渐硬化，更丧失应激能力。长期观察会发现动脉粥样硬化的早期征兆。过去认为所有1型糖尿病患者在确诊20年内都会出现视网膜病变——这种导致视力衰退甚至失明的眼损伤。多数患者10-14岁确诊，意味着30-34岁时就会出现视功能损伤或失明。虽然现在病程有所延长，但现有医疗技术下，所有患者因血糖剧烈波动都难免出现至少一种并发症。

So not only are the blood vessels becoming stiffer, but now the blood vessels aren't able to even respond as well to the stress. And so as you're looking at this and you're looking over time, you see these early signals of atherosclerotic progression. You also see very early on that it was once expected that all patients with type one diabetes would have eye damage, some form of eye damage called retinopathy, where you start to lose vision, eventually can go blind within twenty years of diagnosis. So most people are diagnosed in 10 to 14 years of age, which means by 30 34 years of age, you're going see a lot of patients who have altered eye function and or some who are blind. Now that has extended out over time, but we know that all patients with this disease, because of high and variable glucose levels, are expected to get at least one complication in their lifetime if they follow standard of care advice today even with the best technologies out there.

目前没有任何药物或技术能根治此病。高血糖波动及伴随的胰岛素抵抗具有累积性、剂量依赖性且不可完全逆转。确诊那一刻起，生命倒计时就已启动——就像吸烟，越早开始量越大，健康损害就越早越严重。

There is no pharmaceutical intervention. There is no technology that normalizes this disease. And the effects of these high and variable glucose levels and insulin resistance that accompanies it is cumulative, dose dependent and not completely reversible. Which means that once you're diagnosed the clock starts ticking. Just like smoking, the more you do, the earlier you do it, the earlier the impact and the more lost life you probably will get.

《精准营养》期刊有项326人研究显示生酮饮食能改善糖尿病患者血糖控制。这里说的'血糖控制改善'是否就是我们讨论的机制？

And there was a study done with three twenty six participants that found that the keto diet can increase glycemic control of patients with diabetes. That was in the Precision Nutrition publication. When it says it can increase glycemic control, what does that mean? Is that what we were talking about there?

生酮饮食通过减少碳水化合物摄入起效。碳水化合物会升高血糖水平，大幅削减其摄入量自然能减少血糖波动——毕竟碳水化合物是生活中最强的升糖因素。所谓血糖控制改善，是指通过持续监测全天候血糖水平，评估其稳定在健康范围内的程度。

So if you, when you do a diet known as the ketogenic diet, you're reducing carbohydrates. Well, when carbohydrates are consumed, they elevate glucose levels. Well, if you dramatically reduce the amount of carbohydrates consumed, you're not having those same type of glucose elevations and fluctuations because you're not consuming the most potent glucose elevating factor in our life, which is carbohydrates. And so when they talk about improvements in glycemic control, it is the measure of twenty four hour over multiple day levels of glucose in the circulation and how well is that being controlled within a normal healthy range.

所以您的目标是建议人们限制碳水摄入吗？毕竟碳水化合物和糖类总被妖魔化——几乎听不到关于糖的正面评价。您究竟想给听众什么建议？是要他们严格限制...

And so is your goal then to encourage people to restrict carbohydrates in their diet? Because carbohydrates and sugar have been somewhat, I guess, demonized because you never really hear many good things about sugar. So what is your goal here? What is the advice to the listener? Is it to restrict their

碳水化合物？必须清醒认识饮食对健康的重大影响。对占人口绝大多数的慢性病患者而言，限制碳水化合物确实能显著改善2型糖尿病等疾病。美国糖尿病协会2019共识报告将低碳水饮食列为2型糖尿病最循证营养策略，研究还显示其对阿尔茨海默病等有潜在益处。

carbohydrates? To be very conscious of what they're consuming because nutrition has a powerful potent impact on overall health. And for those patients who have chronic disease, which is unfortunately the overwhelming majority of us, yes, carbohydrates can be a very, restricting carbohydrates can have a powerful therapeutic effect on diseases like type two diabetes. The American Diabetes Association and their twenty nineteen consensus report described type two diabetes as the most evidence based nutritional strategy. We know that it can have potential positive impacts on things like Alzheimer's disease.

多项研究证实这点。我更倾向于称之为'治疗性碳水化合物限制'，因其核心是获得健康收益。许多人采用此法只为减重或提升认知敏锐度——但这本质上是通过改善代谢健康来实现的。

There are studies that have looked at this. We also know that for Carbohydrate restriction we're talking Yes, yep. So, and I like to term this therapeutic carbohydrate restriction because it's the therapeutic outcome of a carbohydrate reduction. And that's really the goal of this is can you improve your overall health? Many people would just do this simply to improve, to lose weight, to feel like you say, to feel more cognitively alert.

但就我而言，当你处于代谢谱系中伴随糖尿病等疾病时，它对自我感受的影响更为强烈，对整体健康的影响也更为深远。不幸的是，多项研究和多个研究团队指出，约93%的美国人都存在某种形式的代谢紊乱。

But in my case where you're along the metabolic spectrum with diseases like diabetes, it has an even more potent impact on how you feel, even more potent impact on your overall health. But unfortunately about ninety three percent of Americans have some form of metabolic derangement as cited by multiple studies and multiple research groups.

你们曾对一名1型糖尿病患者进行了为期十年的生酮饮食影响研究。这无疑是同类研究中历时最长的——你们用十年时间对个体患者的饮食进行了控制？

You did a ten year study on the impact of the ketogenic diet on a patient that had type one diabetes. I think this is most certainly the longest study ever done of its type, where you took one individual and over ten years you, I guess, controlled their diet?

我们有机会监测一位特殊的1型糖尿病患者。确诊后六年里，患者遵循美国糖尿病协会推荐的健康饮食，2013年转为生酮饮食。开始饮食干预后，他们接受了DEXA扫描，控制卡路里摄入和体成分。

So we had access to the ability to monitor a unique patient who had type one diabetes. And they were diagnosed and had followed the American Diabetes Association diet, a healthy diet, for six years. And then switched over in 2013 to a ketogenic diet. Upon the initiation of the diet in post, they had DEXA scans. They controlled their calorie intake, their body composition.

患者未服用任何额外药物。我们能在十年间控制所有变量并监测影响。这之所以重要，是因为生酮饮食常被质疑可能增加心血管疾病风险——这种假设源于伴随膳食饱和脂肪增加的LDL升高现象。饱和脂肪主要来自动物蛋白。

They weren't taking any additional medications. And we were able to monitor the impact over a ten year period while controlling all those variables. And why that's so important is because one of the common concerns of a ketogenic diet is the hypothetical risk it can increase cardiovascular disease. And the reason that they think that it can increase cardiovascular disease or it's hypothesized that it will is because of the elevation in LDL that often accompanies an increase in saturated fat in the diet. Now saturated fat comes from things like animal proteins.

椰子也含饱和脂肪。我们发现：尽管该饮食使LDL胆固醇近乎翻倍（理论上应恶化心血管健康），但通过高级心血管评估显示，患者血糖控制完全正常——这恰恰是最关键的致病风险因素。患者胰岛素负荷降低超40%，其心血管健康不仅优于同龄同性别1型糖尿病患者平均水平...

It's in coconuts as well. What we found is that despite a near doubling in LDL cholesterol on this diet, which again should be associated with worsening cardiovascular health, we did an advanced cardiovascular assessment in this patient and found that despite doubling LDL, they had maintained completely normal glycemic control. Which again, based on all the data, says the number one risk factor. They reduced their insulin load over 40%. And their cardiovascular health was not only better than the average patient of similar age and sex with type one diabetes.

甚至在几乎所有指标上都优于非糖尿病患者——尽管LDL翻倍。十年追踪显示，不仅未见心血管疾病迹象，反而呈现显著的心血管健康状态。后续我们对46,000多名1型糖尿病患者开展史上最大规模营养（尤其是碳水化合物）影响分析，发现70%以上的极低碳水生酮饮食报告显示患者能完全实现血糖正常化——这是1型糖尿病最关键的致病风险因素。

It was better in almost every single category than people even without type one diabetes, despite the doubling of LDL cholesterol. It illustrated that over a ten year period, it maintained not only no sign of cardiovascular disease, but remarkable cardiovascular health. And in fact, we actually followed on that study with the largest ever analysis of the impact of nutrition, particularly carbohydrates, in over forty six thousand patients with type one diabetes. We showed that in over seventy percent of all reports of very low carbohydrate ketogenic diets that patients were completely able to normalize their glucose control, normalize the most potent risk factor for the disease of type one diabetes.

这是否属于某种谱系？我可以在屏幕上展示从正常、糖尿病前期到糖尿病不同阶段的分级标准吧？

And is this this is a sort of a spectrum of I'll put that on the screen for people to see the different sort of stages and categorizations of being normal, pre diabetic and diabetic, right?

完全正确。正常值为HbA1c低于5.7%，糖尿病前期介于5.7%-6.4%，糖尿病则为6.5%及以上——理论上这个数值没有上限。

Correct, yes. So normal is anything less than 5.7% HbA1c. Pre diabetic is that five point seven percent number up to six point four percent. And then diabetic is anywhere between six point five percent all the way up into essentially, there's no cap on how high that number can go.

我注意到你的血糖水平急剧上升了。是的。所以...

I mean, noticed your blood sugar levels have risen quite dramatically. Yes. So

你最初看到的可能只是第一阶段反应。起始平均值约100毫克/分升。食物摄入后需要时间分解为葡萄糖，葡萄糖进入血液再转移至细胞间质液。现在我们看到的只是摄入了约五分之一推荐量的超级食物碳水化合物的直接影响——美国糖尿病协会将橙子这类柑橘水果视为糖尿病患者的超级食物。

what you see initially is probably only the first phase of this, right? So started at an average of around one hundred milligrams per deciliter on average. And once the food is then consumed, because once you consume the food, it takes some time to break down into glucose, That glucose then goes in the blood and then the blood moves glucose into this compartment around the cells, which called the interstitial fluid. And now we're starting to see the direct impact of just consuming probably a fifth of the amount of carbohydrates I should consume from a superfood. You know, oranges are considered both a citrus in a fruit and is considered like a superfood by the American Diabetes Association in the context of diabetes.

所以当血糖飙升时，比如你刚吃了一些橙子，血糖正在上升。是的。人会有什么感觉？然后当它骤降并低于基准值时，又会有什么感觉？因为最初大约是从100开始的。

So when the glucose spike is high, so you've just eaten some oranges, the spike is going up. Yeah. What does someone feel? And then what do they feel when it's then crashes down and goes below? Because it started at about 100.

所以我推测它会上升到某个峰值，然后不会回落到100。在正常的非糖尿病患者身上，通常会降到100以下，对吧？

So I imagine that it's going to go up to whatever it goes up to. And then it's not going to drop back down to 100. It's going to drop below 100 typically in a normal non diabetic person, right?

100左右是正常值。理想情况下，血糖只会轻微上升。胰岛素会迅速响应。如果你的代谢功能完全健康，血糖会回落到正常水平。但再次强调，我们绝大多数人都做不到。

So 100 is right around the normal. So what you'd hope would happen is that you're going to go up just a little bit. Insulin is going to respond quickly. And you're going to come back down to normal if you have total healthy metabolic function. Again, the vast majority of us do not.

但在这个案例中，预期会发生的是：随着血糖升高和胰岛素响应，血糖会升至食物中的葡萄糖含量对应的峰值。与此同时，我的胰岛素泵也在立即响应，试图将血糖维持在正常范围内。你可以看到屏幕上蓝线（代表胰岛素初始响应）随着血糖升高而急剧上升。

But in this case, what would be predicted to happen is that as blood sugar elevates and insulin responds, it's going to go as high as the amount of glucose that's present in the food. But at the same time, my pod is also, which is holding my insulin, is immediately trying to respond. It's immediately trying to say, Okay, oh no, we need to bring this and keep this into a normal range. And so it's trying to release insulin. And so you can see on the screen that there's this massive uptick in the blue line, which is the initial response in insulin immediately to the elevation in glucose.

这正是正常生理状态下发生的情形，只是没人能测量到。但在这里你可以亲眼看见。

This is exactly what happens in normal physiology, yet no one can measure it. But you can see it here.

那么当血糖飙升时我会有什么感觉？会精力充沛吗？注意力集中？还是感到疲倦？

So how would I feel when the glucose spike is high? Do I feel energetic? Do I feel focused? Or do I feel tired?

根据我的个人经验，Steven，当血糖过高时，我的专注力会下降，感到疲劳。我妻子还说我会变得易怒。这些都可以查到——高血糖的症状是什么？

My personal experience here, Steven, is that as blood sugar becomes very high, I become my focus reduces. I become fatigued. I can also, according to my wife, become irritable. But you can even look this up. You can look up what are the symptoms of hyperglycemia?

当血糖水平超过正常范围（70-120）时会出现什么症状？长期证据非常清楚地表明，这不仅影响你的身体感受，还会影响心理健康状态。

What are the symptoms of elevated glucose levels above the normal range, which is normal 70 to 120? That's when you can start to see very clearly that the evidence over time has shown a very clear impact on not only how you feel physically, but also your mental health status as well.

我刚查了症状，上面说高血糖的常见即时症状包括：口渴、口干、尿频、头痛、脑雾、疲劳、倦怠、视力模糊。那么当血糖骤降或真的低于正常范围时，通常又会有什么感觉？

I've just looked up the symptoms here and it says the common immediate symptoms of having a high glucose spike is you feel thirsty, dry mouth, frequent urination, headache, brain fog, fatigue, sluggishness, blurry vision. And then once you go down and you crash, or your glucose really drops below the normal range, what do you feel then, typically?

我喜欢这样比喻：想象你在户外阳光明媚的日子和朋友畅谈，突然乌云密布，人群散去，开始下雨。我们知道血糖水平会直接影响大脑的神经生物学机制——即大脑的运作方式。

So a lot of how I like to describe this is almost like imagine you're outside and sunny outside. And you're having a great day, great conversation with other friends. And then all of a sudden, very rapidly, clouds come over top. Everyone kind of dissipates and it starts to rain. It's almost like we know that glucose levels have a direct impact on the neurobiology of the brain, meaning how the brain functions, how it operates.

尤其在血糖水平极高时（通常超过180毫克/分升），你会开始看到炎症信号和压力信号，比如身体内的氧化应激（如果人们之前听说过这个术语）。这会对组织造成损害并引发应激反应。但问题在于，史蒂文，大多数患者长期处于这种状态。

And particularly at very high glucose levels, typically above 180 milligrams per deciliter, you start to see signals of inflammation, signals of stress like oxidative stress in the body if people have heard of that before. And that can start to cause damage on tissues and cause a stress response. But the problem here, Steven, is that most patients are living there 20 fourseven.

我查看了部分症状描述，上面说血糖骤升后的短期崩溃是由于胰岛素过量分泌导致的反应性低血糖（即血糖崩溃）。在崩溃时你可能会感到颤抖、饥饿（通常渴望碳水化合物和糖分）、易怒、焦虑、虚弱或头晕。我第一次尝试Replit那晚熬到凌晨三点，它彻底震撼了我——作为本期播客赞助商的Replit，是我见过最强大的人工智能平台之一。

I was looking at some of the symptoms here, and it says the short term crash you get after a spike, after a rapid rise, is a bit of an insulin overshoot. So it's reactive hypoglycemia, which is sugar crash. And then you might feel in that crash jittery or shaky, hungry, often craving carbs, and sugar again, irritable, anxious, weak, or lightheaded. I stayed up until 3AM the night I first tried Replit, and it blew my mind. Replit, our sponsor of this podcast, are one of the most powerful AI platforms I've come across.

它们允许你用简单英语在几分钟内将任何想法转化为实际可用的应用程序。只需描述你想创建的内容，Replit的AI代理就会为你实现。你完全不需要编程经验就能开始使用。我让Replit的AI代理根据我理想中的待办清单标准，为我创建了一个全新版本，它仅用几分钟就完成了构建。

They allow you to turn any idea you have into real working apps in minutes using plain English. Just describe what you want to create and Replitz AI agents will create it for you. And you don't need any coding experience to get started. I asked Replitz AI agent to create a brand new to do list for me based on exactly how I wanted my perfect to do list to be. And it built it for me in minutes.

我无需懂编程就能创建它，现在这就是我正在使用的待办清单。成本极低、速度极快，且完全按照我的需求个性化定制。现在我不但是该公司的投资者，他们还是品牌赞助商。Replit可连接Stripe等支付系统或OpenAI等服务，并内置数据库和用户认证系统。

And I didn't need to know how to code to create it. That is now the to do list that I'm using. Super cheap, super fast, and completely personalized to exactly what I wanted it to do. And now I'm an investor in the company, as well as them being a brand sponsor. And Replit connects to payment systems like Stripe or services like OpenAI and has a built in database and user authentication system.

无论你是创业者、自由职业者，还是正在寻找程序员的人，都可以用Replit构建下一个应用。访问replit.com并使用代码STEPHEN，即可享受首月核心套餐五折优惠。你曾在2025年做过一项研究，我记得...

If you're a founder or a freelancer or anyone who's been searching for someone who can code, you can build your next app with Replit. Head to replit.com and use code STEPHEN to get 50% off your first month of Replit's core plan. You did a study in 2025, I believe,

是关于生酮饮食对运动表现的影响？如果生酮饮食具有这些可追溯至两个多世纪前的治疗潜力，那它对运动表现的真实影响是什么？因为这是人们走进诊所时最常提出的质疑：'听说这会降低我的运动表现'。

on the impact of the ketogenic diet on physical performance? If a ketogenic diet has all these therapeutic potentials, going back for over two centuries, what is truly the impact it of on performance? Because that's one of the primary reasons where at least someone were to walk into a clinical setting and say, well, yeah, you can do this, but I've heard it's going to decrease my performance. Physical performance. Physical performance.

我们对此非常关注，因为当前运动营养学推荐碳水化合物的依据是：自1921年以来研究显示其能提升表现。当年哈佛和波士顿的医生观察波士顿马拉松选手时发现，半数人甚至无法完赛——他们面色苍白、言语含糊、身体颤抖，有些人直接退赛。血液检测显示这些选手都出现了低血糖症状。

And so we were very, very interested in this because we thought, Okay, when we look at why carbohydrates are currently being recommended as sports nutrition is because since 1921 they've been shown to improve performance. And how they showed that in 1921 was that physicians out of Harvard and Boston actually watched Boston marathoners, half of which wouldn't even finish the race, slurred words. They would have like almost pale skin, shaky, weren't able to articulate their words, or some wouldn't finish at all. And what they were finding was that these when they tested the blood of these individuals, that they were finding that glucose levels were low. Basically, they reached what they call hypoglycemia.

这是个描述极低血糖水平的医学术语。次年他们为波士顿马拉松选手提供碳水化合物后，所有人的表现都有提升。实际上自1925年起，我们就知道碳水化合物能增强表现。但到了1960年代，伯格斯特龙检测法通过肌肉活检发现：肌肉中储存着葡萄糖。

It's a medical term to describe very low blood sugar levels. And then next year they provided carbohydrates. And these marathoners in the Boston Marathon, and all of them improved their performance. And so since 1925 actually, we've known that carbohydrates can improve performance. But what has happened though over time is that in 1960s there was a measurement technique called the Bergstrom method where you actually did a muscle biopsy, pulled out muscle tissue and found that, oh wow, there's actually glucose stored in the muscle.

既然用于身体运动的肌肉组织中含有葡萄糖，那它必然对运动表现至关重要。随后研究发现肌肉中葡萄糖（即糖原）水平低下与疲劳存在关联。1980年代的研究进一步显示：人们维持高强度运动的能力与其碳水化合物燃烧量成正比。

So it must be really important for physical performance. If the muscle which is used to contract and move the body during physical performance, that if glucose is in that tissue, it must be essential for performance. And then after they discovered that, there was all these associations between low glucose levels in the muscle called glycogen, low glycogen, and fatigue. Then after that, in the 1980s, they were able to look at the amount of sugar, carbohydrates, and fat that the body was burning during exercise. And what they found at that stage is that, oh, wow, it looks like the amount that people are able to sustain intense exercise is proportional to how many carbohydrates they're burning.

后来有几项建模研究（史蒂文）分析了运动强度与燃料类型（脂肪或碳水化合物）的关系，结论是：低强度运动主要燃烧脂肪，而高强度运动必须依赖碳水化合物。2017至2020年间三项针对生酮饮食（持续5天至3周）的研究显示，受试者运动表现平均下降了约2%。

And then there was a few modeling studies, Stephen, that then looked at, okay, what's the relationship between, let's say, the intensity of exercise and what type of fuel you use, whether it be fat or carbohydrates. And they modeled it and said, Okay, well at lower intensities you must burn almost all fat. And at very high intensities you must burn carbs. And there was a number of studies in 2017 to 2020, three different studies that looked at the ketogenic diet over a five day to three week period. And they saw that in those studies that there was a decline in performance by around 2%.

如果你采用生酮饮食。

If you were on the ketogenic diet.

没错。与高碳水饮食相比。是的。那么这向研究人员揭示了什么？他们说，好吧，显然生酮饮食必然会损害运动表现。

Correct. Compared to a high carb diet. Yeah. And so what did that tell these researchers? Well, they said, okay, well obviously the ketogenic diet must impair performance.

自20世纪20年代以来就有大量证据表明，碳水化合物、糖原的摄入量对运动表现至关重要。但关键在于，长期以来我们都知道适应生酮饮食不是一周、两周，甚至三周就能完成的，而是需要四周或更长时间。你所说的适应，是指身体转变为能高效燃烧利用酮体的状态吗？

And there's all this evidence since 1921s that the amount of carbohydrates, glycogen, how much carbs you're consuming is essential for performance. But here's the kicker, is that one major confounder of all this is that we've known for quite a long period of time that the adaptation to a ketogenic diet is not one week. It's not two weeks, not even three. It's four weeks or more. And when you say adaptation, mean your body's transition to being in a state where it's efficient at burning using ketones?

由于摄入碳水化合物减少，身体降低葡萄糖氧化（燃烧碳水化合物供能）的能力会增强，脂肪供能的比例会急剧上升。随后酮体产量大幅增加，酮类物质不仅作为肌肉组织的能量底物，还能为大脑供能。这是个渐进的过程。但人们研究这些数据时，只关注了减少碳水后身体变化的某些指标。我们想探讨的是：如果生酮饮食真有这些健康益处，那固然很好——

So the body's ability to lower its glucose oxidation, the amount of carbohydrates it's burning for fuel because you're giving your body less of it, the amount of fat that's being utilized for fuel goes up dramatically. And then you produce way more ketone bodies and ketones are now being used as not only a body tissue substrate, meaning energy for the muscle, but also for the brain. And so it's this transition over. But when people were looking at these studies, they were just looking at some of the metrics of what happens when your body transforms when you reduce carbohydrates. So what we wanted to do is say, okay, if there's all these health promoting benefits of a ketogenic diet, that sounds great.

但所有研究和运动理论都认为这会损害表现。于是我们决定验证这点：让运动员严格执行生酮饮食四周。我们不仅控制其卡路里摄入，还控制体成分、活动水平等关键变量——这些是前人研究常忽略的——从而真正测试宏量营养素（即从碳水转向脂肪）对表现的影响。

But all these studies and sports dogma would say that's going to impair performance. Okay. So let's test that. Let's actually put athletes on a ketogenic diet for four weeks. We are going to control not only their calories, we're going to control their body composition, we're going to control their activity level, we're going to control all these key confounders that many of these prior studies never controlled so that we could truly test the diet induced, so the macronutrient, meaning the shift from carbs to fat, effect on performance.

而且我们在同一批受试者身上进行测试，这样就控制了遗传和环境变量。完成这些后，史蒂芬，我们测试了公认极度依赖葡萄糖的运动形式：让他们完成6组800米冲刺。

But we're going do it in the same person. So now we're going to control their genetics. We're going to control their environment. Once we did that, Steven, we tested what most people think is a very glucose dependent form of exercise. We asked them to do six by 800 meter sprints.

他们先采用高碳水饮食，后转为低碳水饮食。整个过程随机对照。结果显示，转换饮食四周后，他们的运动表现没有任何下降。

They were on a high carb diet. And then they switched to a low carb diet. Now what happened is it was all randomized and controlled. When they switched over, they had no deterioration in performance. At four weeks.

在理论上应该极度依赖葡萄糖、依赖碳水化合物的运动形式中，四周时间节点下的表现依然如此。

At the four week mark in a form of exercise that we would expect would be extremely glucose dependent, extremely carbohydrate dependent.

但在四周之前，运动表现是否有受损？

But before four weeks, was there an impairment in that performance?

斯蒂芬，我们重点研究的是最终结果。没有观察中间过程，只关注了终点时间。因为核心问题是：坚持这种饮食后是否存在差异？毕竟采用这种饮食的人，理想状态下是会长期维持的。

So what we were interested in, Stephen, is studying at the end. So we didn't look intermediately. We exclusively look at the end time point. Because the question was, well, is there a difference once you stick to this diet? Because if you go on this diet, ideally you're sticking with it over time.

因此，如果确实需要碳水化合物，我们还测量了他们在运动期间燃烧了多少碳水化合物和脂肪。这是在超过他们最大摄氧量85%的情况下进行的，即运动时总最大耗氧量的85%。此时我们预期几乎不会有脂肪被氧化或燃烧，几乎完全依赖碳水化合物。然而，我们发现这些运动员记录的运动期间脂肪燃烧水平是文献中报道的最高值，这表明当这些运动员采用生酮饮食时——

And so if it is true that you require carbohydrates, we then also measured how many carbohydrates and fat they were burning during exercise. And it was over what we call 85% of their VO2 max, which means 85% of their total maximum oxygen consumption during exercise. That is when we would expect almost no fat to be oxidized or to be burned and almost exclusively carbohydrates. Well, we found that these athletes recorded the highest levels of fat burning during exercise ever reported in the literature, illustrating that when these athletes The ketogenic. Ketogenic diet.

当这些运动员长期适应生酮饮食后，即使在极高强度运动下，他们的脂肪氧化水平也达到了创纪录的水平。这意味着脂肪能够在极高强度运动中提供营养和能量，而在这种情况下我们通常认为只有碳水化合物才是相关且可利用的。

That when these diets adapted to the diet for sufficiently long, they had record levels of fat oxidation even at very high intensity levels. Which means that fat was able to provide nutrients and fuel at very, very intense form of exercise when we would expect only carbohydrates would be relevant and utilizable.

我有很多从事耐力运动或自行车等项目的朋友都在谈论外源性酮体。我是一家生产外源性酮体公司的联合创始人，这是我的免责声明。我手头就有这个产品。关于这类外源性酮体产品，你能告诉我些什么？

So many of my friends that are endurance athletes or that are involved in things like cycling talk about exogenous ketones. I'm a co owner of a company that produces exogenous ketones. That's my disclaimer. I've got the product here. What can you tell me about products like this, exogenous ketone products?

外源性指的是外部补充的，我猜。

Exogenous meaning externally supplemented I guess.

没错，采用生酮饮食时你的肝脏会自行产生酮体。而外源性酮体则是通过摄入获得。那么为什么要摄入呢？为什么不直接采用生酮饮食？因为我们知道适应生酮饮食需要时间。

Right, so with a ketogenic diet you produce them, your liver produces them for you. With exogenous you're consuming these. Well, why would you consume them? Why not just do a ketogenic diet? Well, we know that a ketogenic diet takes time to adapt.

我们刚才讨论过运动表现需要长达四周或更久才能看到完整效果。假设你是一名战士或需要立即进入战场的人，或者想快速进入这种状态怎么办？除非有一种分子能在摄入后数分钟内迅速提升循环中的酮体水平——这就是外源性酮体的作用。自1960年代起我们就知道，麻省理工学院航空航天部门研究过一种名为1,3-丁二醇的物质。

We just talked about that with physical performance that we see that, you know, up to four weeks to see the full effect on performance or more. Well, what happens if you're, let's say, a war fighter or someone who's going out into the field or immediately wants to flip into this state? You can't do that unless there was a molecule that you could consume that could rapidly elevate ketone bodies in circulation within minutes. Insert exogenous ketone bodies. We have known since the 1960s that the product in there was studied by MIT, in the aerospace department called thirteen Butanediol.

它能被摄入并快速提升循环中的酮体水平。2016年有一项名为'代谢优化'的研究，这是DARPA耗资1000万美元的项目。

That it was able to be consumed and rapidly elevate ketone bodies in circulation. There was a study in 2016 called the Metabolic Optimization. It's a $10,000,000 program from DARPA.

DARPA是指

DARPA being the

DARPA是美国政府下属的先进研究机构，资助高风险高回报项目。其中之一就是酮体的应用测试。他们测试的分子与现有产品中的分子相同，只是稍作配方调整。研究表明——这个分子也是如此——摄入后能快速改变新陈代谢，虽不完全等同于生酮饮食的效果，但几乎能产生直接影响。

DARPA is an advanced research organization from The United States Government where they fund very high risk, high reward programs. And one of which was the use and testing of ketone bodies. And so that molecule that they tested was utilized the same molecules in there and they kind of tweaked some of the formulations a bit. And they showed that, and we know that this is the same for this molecule as well, that when you consume them it rapidly changes metabolism. Almost not identical to what happens with the ketogenic diet, but it has an almost direct impact.

它具有降血糖作用，能直接结合GPR109A等关键受体来影响炎症，直接阻断NLRP3炎症小体（一种导致炎症增加的分子）。我们还知道它能改变基因在体内的使用方式（即表观遗传信号）。因此摄入酮体实际上可以改变基因上的分子标记及其最终表达方式。

It has a blood glucose lowering effect. It directly binds to receptors like the, they call it GPR109A or some other key receptors that directly impact inflammation. So it directly blocks something called N O R P three inflammasome, which is a molecule that leads to increases in inflammation. We also know that it changes the way that our genes are used in the body called epigenetic signaling. And so the consumption of ketone bodies can actually change the molecules on our genes and how those molecules are ultimately manifested.

这提升了我们的抗氧化能力，即身体抵抗氧化应激的能力。我们观察到所有这些强大的效应，体内代谢的快速变化。2016年的这项研究表明，仅通过口服摄入这些分子就能迅速改变代谢。但它还与体能表现的提升相关。但如果你看得更远，就像这类研究一样，因为我们在运动员、健康个体以及军事环境中都进行了观察。

That increases our antioxidant capacity, meaning our ability to block oxidative stress in the body. We see all these powerful effects, these rapid shifts in metabolism within the body. And this 2016 study showed that just orally consuming these molecules could rapidly shift metabolism. But it was also linked to improvement in physical performance. But if you look beyond that and just like these kind of studies, because we looked at them in athletes, we looked at them in healthy individuals and then also in military settings.

但我们也发现，有研究在认知衰退风险患者中对此进行了探讨，比如阿尔茨海默病患者。他们在一项为期六个月的研究中表明，补充外源性酮体能够减缓我们已知随年龄增长而出现的认知能力下降。

But we've also, there's studies looking at this in patients at risk for cognitive decline. So patients at risk for Alzheimer's disease. They've shown that in a six month study administering exogenous ketone bodies was able to attenuate the decline in cognition that we know happens with advanced age.

不过为了明确起见，你是说它减缓了衰退速度，并不能治愈或修复阿尔茨海默病，只是延迟了病情发展？

And just to be clear though, you're saying it reduces the decline. It doesn't cure Alzheimer's or fix Alzheimer's It just delays?

准确。是的。我们知道随着年龄增长，人的大脑功能会急剧或稳步下降。因此我们的目标是抵消或阻止这种衰退。

Accurate. Yes. We know that as individuals age, you're on a precipitous or steady decline in brain function. And so the goal is to offset or to stop the decline. That's our goal.

我们希望维持正常的大脑功能，保持清晰的思维和理解能力，比如阅读、解题和解决问题。精神病学领域也涌现了相关研究，目前约有11项正在进行的临床试验，探讨酮基疗法对脑健康的影响，特别是严重精神疾病。美国实际上超过四分之一的成年人患有严重精神疾病。事实上，我相信有超过20%的成年人正在服用某种精神类药物。

We want to maintain normal brain function and our ability to think clearly and to understand things clearly like reading and doing problems and solving problems. There have also been these emergence of studies in the world of psychiatry. I think there's around 11 ongoing active clinical trials looking at the impact and interaction of ketone based therapies and brain health, particularly serious mental illness. One in four adults in The United States, actually over one in four adults in The United States has serious mental illness. In fact, I believe the numbers are over twenty percent of adults are taking some type of psycho altering medication.

本质上，我们发现基础代谢与心理健康状态之间存在诸多关联。这种独特饮食方式的应用——已知能提升酮体水平，而酮体似乎对大脑有直接影响——现在似乎与改善严重精神疾病相关。这将如何发展会很有趣。但光是想象营养（而非药物或技术），仅仅通过改变超市购物选择就能对各种病症产生强大疗效，就非常引人入胜。

At its core, we see all these relationships between underlying metabolism being a key factor contributing to mental health status. And the application of this unique diet, which we know increases ketone bodies, which appear to have direct impacts on the brain, now seems to be linked to improved serious mental illness. And it'll be interesting to see where that evolves. But it's just a fascinating world to imagine that nutrition, not a medication, not a technology, but simply going to the grocery store and swapping the things you choose in there can lead to these powerful, powerful therapeutic effects in people of all sorts of different conditions or disorders.

我读过一项2020年关于外源性酮体对脑网络稳定性影响的研究。他们探究了脑网络稳定性对两种主要脑能量（葡萄糖或酮体）的反应。参与者两次到实验室饮用外源性酮体或葡萄糖，随后接受核磁共振扫描。引人注目的是，研究表明酮体增加了脑网络稳定性，而葡萄糖则降低了网络稳定性。

On one of the studies that I read about the administration of exogenous ketones and the impact it has on brain network stability was from 2020, where they investigated if brain network stability responds to two major brain fuels, either glucose or ketones. And participants came to the laboratory on two occasions and drank exogenous ketones or glucose. And after consuming these drinks, they underwent an MRI scan. Strikingly, the study showed that ketones increased the stability of brain networks. In contrast, glucose decreased the stability of the network.

酮体摄入后的网络稳定性比葡萄糖摄入后高出87%。这项发表在PubMed上的研究摘要最后一行写道：'导致酮体利用的饮食干预增加了可用能量，因此可能在保护大脑衰老方面显示出潜力'，这非常有趣。

Network stability was 87% greater after ketone consumption than stability measured after glucose consumption. And in that study, which is on PubMed, the last line of the abstract says, dietary interventions resulting in ketone utilization increase available energy and thus may show potential in protecting the aging of the brain, which is super interesting.

我们曾针对一种极具侵袭性的转移性癌症开展研究，应用外源性酮体。我在研究生阶段的工作中发现，仅使用外源性酮体就能延缓转移癌的进展。同时，在观察体重时发现，它减缓了癌症患者常见的体重急剧下降现象——这种被称为恶病质的病症，特指疾病导致的机体组织快速消耗。在转移性癌症这种最常见的情境中，其侵袭性尤为突出。当我们观察到体重未下降时，我进一步研究了体重的来源。

So we did a study looking at cancer and applying exogenous ketones in a very aggressive form of metastatic cancer. And what we saw in my work in graduate school is that when applying just exogenous ketones that it delayed the progression of the metastatic cancer. But it also, when looking at body weight, reduced the rapid decline in body weight we sometimes see with cancer, a phenomenon called cachexia, which is a a term to describe the rapid wasting of body tissue with disease. And it is no more aggressive than the context of cancer, particularly metastatic cancers where it's most common. And when we saw the lack of decline in body weight, I then looked at where the body weight was coming from.

显然，体重未下降是由于肌肉量得以保持。多项临床生理学研究表明（这些研究直接通过分子测试对人体肌肉组织功能进行干预），外源性酮体的补充能显著减少肌肉组织分解，本质上说明它可能是促进健康肌肉量的有力机制。

And it was clear that the lack of body weight decline was because of the preservation in muscle mass. So it also appeared, and there's been a number of what they call clinical physiology studies, so studies that actually directly manipulate human beings with molecules and tests, know, like muscle tissues and how they function, we see that exogenous ketone administration can dramatically reduce the amount of muscle breakdown breakdown of muscle tissue, essentially illustrating it may be a powerful mechanism in promoting healthy muscle mass as well.

关于生酮饮食，我一直很担心的一点是，如果采用生酮饮食，我还能增加肌肉量吗？因为当我开始生酮饮食并停止摄入碳水化合物时，体重往往会迅速下降，体脂减少。是的，脂肪减少了，我变得非常精瘦，但更显瘦弱。

In terms of being in a ketogenic diet, one of the things I'm always quite concerned about is, am I still able to gain muscle mass if I'm in a ketogenic diet? Because I when I go into a ketogenic diet and I stop having carbohydrates, I tend to lose weight rapidly and shred. Yeah. The fat falls off and I get very lean but more skinny.

你笑了，也许是因为你喜欢更精瘦的体型。关于生酮饮食的一个现象是，它不会导致肌肉量减少。已有大量研究表明，你能够保持肌肉量。

You smile though because maybe you like to be more shredded. So a phenomenon with the ketogenic diet, so there's no deterioration in muscle mass with the ketogenic diet. There have been plenty of studies that have shown that you're able to maintain muscle mass.

还能增肌吗？

And build it?

是的，还能增肌。研究也证明了这一点。俄亥俄州立大学的杰夫·沃里克在这方面做了多项研究，观察那些实际处于减少摄入饮食的人群。他们减少了热量摄入，饮食中能量较低，同时也在进行生酮饮食。这实际上是一项军事研究。

Yes, and build it. So they've shown that as well. So Jeff Volick out of Ohio State University has done a number of studies in this area looking at individuals who were actually on a reduced intake diet. So they're reducing less calories, so they had less energy in the diet, and they were also doing the ketogenic diet. It was actually a military study.

研究表明，在热量限制下，他们能够保持肌肉量，与高碳水饮食的人一样。或者换句话说，类似于半饥饿状态。因此，这些饮食对肌肉量没有负面影响。然而，就你的个人例子而言，开始生酮饮食时首先发生的一件事是利尿效应或自然的排水效果。基本上，你减少了体内的钠含量，所以你会排出更多的水分。

And they showed that they were able to maintain muscle mass just as much as if someone was on a high carb diet while under a caloric restriction or another way of describing it is like a semi state. So there's no impact, negative impact that we see with these diets on muscle mass. However, to your personal example, one of the first things that happens when you go into ketogenic diet is there's a naturatic effect or a natural ease of effect. Basically you reduce the amount of sodium in the body. So you piss it out basically.

你保持的水分重量减少了。这就是为什么人们在开始生酮饮食时最初会看到体重快速变化的原因之一。对许多人来说，这很棒，因为如果他们是为了减肥而这样做，这就像是即时的正向反馈。但有时这只是水分重量。水分存在于脂肪和肌肉中。所以并不一定是你失去了肌肉量，而可能只是水分重量减少的现象。

And you hold less water weight. And that's one of the first things that's why people see this rapid shift in body weight initially when they're on a ketogenic diet, which for many people is great because if they're trying to do it to lose weight, that's like immediate reinforcement. But sometimes it's water weight. Well, water is in both the fat and the muscle. So it's not necessarily that you're losing any muscle mass per se, but it just might be in a phenomenon of less water weight.

在某些情况下，这可能是有益的，对吧？如果你从事一项需要功率与体重比的运动，但你能够通过调整水分在更低的体重下保持相同的功率，那就很棒。只要你能保持相同的功能表现。

And in some context that might be beneficial, right? If you're in a sport where you have a power to weight ratio, but you're able to maintain the same power at a lower weight simply by shifting water, that's great. As long as you're able to function equivalently.

在饮食方面，我是否需要考虑什么

Is there anything I do need to be thinking about in terms

以确保我仍在增重，我想是为了保持我的蛋白质水平高？在尝试增加肌肉量时，饮食方面最重要的事情是进行高强度的抗阻训练。这是最关键的一点。在饮食方面，为了增强这一效果，蛋白质是你摄入的最强大的营养素之一，可以增强这种反应。另一个是确保你有足够的热量，对吧？

of my diet to make sure I'm still gaining weight just to, I guess, keep my protein levels high? So the most important thing related to your diet when it comes to trying to build muscle mass is to exercise hard and with resistance exercise. That's the most important thing. When it comes to your diet, to enhance that effect, protein is one of the most powerful nutrients you can consume to augment that response. Another is to ensure you're having sufficient calories, right?

如果你处于热量不足的状态，你说你倾向于摄入更少的热量，因为你可能不那么饿。嗯，这是不仅减少脂肪，还会减少肌肉的最有效方法之一，就是不吃食物或

So if you're in a caloric deficit, so you said that you tend to eat less calories because you're probably not as hungry. Well, that's one of the most powerful ways to lose not only fat but also muscle is to just not eat food or

我想就是这样。因为我...是的，在进行生酮饮食时我会失去食欲。当我服用这些外源性酮体如酮智商时，食欲也会稍微下降。

I think that's it. Because I Yeah. I lose my appetite when I when I'm in the ketogenic diet. I also lose my appetite a little bit when I take these exogenous ketones like ketone IQ. Yeah.

我读过一些研究显示，根据其中一项研究，服用外源性酮体时食欲大约会降低20%。但在生酮饮食期间，情况像是——我会感到饥饿，但一开始进食就会很快停下。是的，这非常奇怪。比如我在开普敦待了十天或两周写书时...

And I've I've seen some of the studies that show that there's roughly 20% decrease in appetite when you take exogenous ketones according to one particular study that I read. But when I'm in the ketogenic diet, it's like food is, I get hungry, but then I start eating and I stop very quickly. Yeah. And it's really bizarre. Like I was I was in Cape Town for ten days or two weeks writing my book.

那里有厨师为我烹饪美味佳肴。我明明很饿，看着食物觉得'太棒了'，但吃五六口就饱了。只有在生酮饮食时，我体内会发生某种变化，让我不会像平时那样暴饮暴食。

And so I had the chef there and the chef cooks me my food and makes this amazing food. I'm so hungry, I look at it and like, oh, amazing. I start eating it, I have like five or six bites and I'm done. And only when I'm in the ketogenic diet, there's something going on in my body which just doesn't just doesn't wanna binge eat like I sometimes

这里涉及两个要点：一是生酮饮食中摄入的食物类型，二是饮食期间身体代谢的变化。David Ludwig医生（内分泌学家）在《永远饥饿》一书中提出了'碳水化合物-胰岛素模型'，虽然存在争议，但其中关于饥饿的关键观点是——如果能在生酮饮食中获得持续稳定的能量来源...

So there's two things to talk about. One is the type of foods you're consuming on a ketogenic diet and the other is what is happening in your body, in your metabolism on the diet. So there's a book called Always Hungry by a physician, endocrinologist named David Ludwig. And he's kind of coined this carbohydrate insulin model. And it's somewhat controversial, but the reality is that there's some important notes in it, one related to hunger, which is if you're able to have a fuel source on a ketogenic diet that's sustained over time.

就不会出现葡萄糖和胰岛素的剧烈波动。而生酮饮食能提供持续的能量输入，血液中营养物质供应稳定，葡萄糖和胰岛素水平都更加平稳，避免了这些分子的剧烈波动——这可能是原因之一。

So you don't have the up and downs of glucose and up and downs of insulin, these constant swings. Whereas on a ketogenic diet, have this sustained level of fuel influx, right? So you have this nutrient availability in the blood. So glucose levels are much more stabilized, insulin is much more stabilized, and you don't have those fluctuations in those specific molecules. That might be one potential reason.

另一个潜在原因是生酮饮食通常不包含那些引发饥饿的食物。就像我们在超市讨论过的——70%的货架商品，特别是中央区域高度加工的食品，它们将碳水化合物与盐、脂肪等混合，制造出极佳口感，刺激多巴胺分泌，形成正向强化反馈，驱使人们追求更多愉悦体验。

But the other potential reason is that when you're on a ketogenic diet, you tend to not consume the type of foods that drive hunger. So again, we talked about in the grocery store, the 70% of the grocery store, and particularly in the center of the grocery store that is highly processed where they combine carbohydrates with salt or fat or some combination there and that makes it highly palatable or very, very tasty, you know, increase the dopamine response, this positive reinforcement response of the food, that drives people to seek more of that pleasure response. And as a result, they want to consume more. So everyone has probably felt this example where you're in a restaurant, you've eaten enough food to where you feel physically full. You're like, oh, I'm totally full.

比如在餐厅吃饱后说'我真的吃不下了'，但当看到最爱的甜点经过时又会说'这个我能吃'——明明生理上已经饱了，却仍想继续进食。

Like, I don't want eat anymore food. Someone walks by with your favorite dessert. And you're like, oh, well, I could eat that. You're literally physically full. But yet you want to consume more food.

这种现象已成为美国和全球面临的难题，食品环境不断诱导人们过量摄入。这绝非偶然，而是食品工业精心设计的策略，旨在激发这种愉悦反应。

This is a phenomenon that has been the struggle in America and the rest of the world essentially now, where the food environment often drives people to over consume. And it's not by accident. These are like well conducted strategies in the food industry to lead to these positive pleasure responses.

这让我想到餐厅先上面包的做法。

I have to talk about this with bread in the restaurant. They give you bread first.

这是个高明策略，Stephen。从面包开始，引导你享用完整套餐直到甜点。多力多滋和品客薯片也采用同样策略——通过特定分子组合让你觉得'太美味了'而持续食用。

It's a good, it's a solid strategy, Stephen, to cause you to want to consume, start to finish, not only the bread, get a big meal, and follow on with dessert. You know, it is a great strategy for ensuring that. But it's also the same strategy that Doritos is using, where like you combine this mixture of molecules in the food that you consume it and you get, oh, this tastes great. Pringles. Same exact thing.

当你将这些不同成分组合在一起时，它会迫使你产生‘哦，这个味道太棒了，我还想再吃’的感觉，而你永远不会感到饱腹。食品行业在这种环境下最常用的伎俩之一就是，他们当然深知这一点，对吧？所以当你同时摄入这类食物时，他们知道你会吃得更多。

Where you combine these different components and it forces you this like, Oh, this tastes great. I need more. And you never feel full. One of the most common tricks that the food industry utilizes in these environments is that one, they certainly are aware of this, right? And so when you consume these type of foods together, they know they consume more of it.

但有时人们甚至没有意识到这一点。最好的例子就是去看看超市货架上大多数培根产品的背面标签，看看大多数花生酱、杏仁酱、坚果酱的成分表。它们大多添加了盐和糖，甚至达到你尝不出来的程度。

But sometimes people aren't even aware of it. And a best example of this, go look at the back of most of the bacon on the grocery store aisle. Go look at the back of most peanut butters, almond butters, nut butters in the grocery store. Most of them have added salt and added sugar. Even to levels where you don't even taste it.

但仔细看标签。添加这些成分的目的是为了增强风味层次，引发大脑对食物的积极反应，从而让你摄入更多。这就是为什么在当今食品环境中人们总是感到饥饿的重要原因——他们不断寻求更多食物，却无法摆脱这种恶性循环。

But go look at the label. The reason those are added is to increase the flavor profile, the positive brain response to the food, so that you consume more of it. And this is a huge part in why people always feel hungry in today's food environment. They're always seeking more food. And they can't get off that hamster wheel.

他们总是过量摄入，或持续受到这种现在被称为‘食物噪音’的影响——总是有进食冲动却永不饱足。这都归咎于糖和盐的添加，食品被刻意设计成能让大脑发出‘不要只吃一口，尽量多吃’信号的风味组合。因为我们始终在追求这种愉悦反应，不仅限于食物，生活中方方面面都是如此。

They're always over consuming or always referring to this for now on called food noise, where they always feel the drive to consume foods or they never feel full. And it's because of the sugar and the salt. It is because the food is composed and made in such a way to have a flavor profile that your brain says not just eat one bite, eat as much as possible. Because we're always seeking these pleasure responses, right, in our lives, in our world. This is even independent of food.

那么我们该如何应对？对于大多数人来说，解决方案首先是避免液态卡路里。这简直是自投罗网的错误选择，因为大量液态热量会促使人们过度摄入，激发大脑的愉悦反应。

So what do we do about this? So the solution for most people in this situation is to try to focus, number one, don't consume liquid calories. That's like a dead giveaway bad move because those are abundance of calories will drive people often to over consume them and drive this pleasure response in the brain.

液态卡路里？具体指什么？

Liquid calories. What's a liquid calorie?

比如汽水或可乐——基本不含任何营养素却热量极高，会让血糖和胰岛素水平飙升，喝完反而更饿。橙汁也是典型例子，还有人们常喝的那些水果奶昔。

So let's say you have a soda or a Coke. So basically completely void of any nutrients and really high in calories, spikes your glucose through the roof, insulin through the roof, and then often makes you hungrier afterwards, not less hungry, by having it. Like orange juice. Another great example. Smoothies, those fruit smoothies people have.

没错。事实上，将水果打碎搅拌反而会加速吸收速度，改变激素反应，对多数人造成更糟的代谢后果。

Exactly. In fact, just taking fruit and then blending it up actually increases the speed by which it's absorbed, changes the hormonal response and leads to a worse outcome for most people.

可大多数人都认为水果奶昔很健康啊。

Most people think a fruit smoothie is a healthy thing.

是啊，这个认知有待商榷。水果本身多数情况下不算糟糕，毕竟是营养密集的食物。如果人们能适量食用当然没问题。但若患有代谢性疾病，可能就要更警惕血糖升高的问题了。

Yeah, don't know about that. I think that when you take fruit, which for most reasons isn't terrible, right? It's not, these are nutrient dense foods. If people can consume them and get away from them, great. If you have a metabolic disease you might be more vulnerable to, let's say, glucose elevations.

但当你摄入这类食物时——可能是任何食物，比如把土豆做成土豆泥——仅仅通过改变或搅碎食物，你就破坏了那些需要身体花时间消化的结构成分。这就像把原本细水长流的小水管突然开到最大，营养物质进入身体的速度急剧加快，完全改变了GLP-1等分子的激素反应，体内正常的GLP-1水平会被彻底打乱。

But when you then take foods like that, it could be any foods. It could be taking potatoes and then making mashed potatoes. By simply changing or blending that food up, you are now taking a lot of these structural components that your body would take time to digest and you're removing them. And you basically almost are almost turning on like a small hose that's just giving it a little bit of water at a time and is turning it on all the way. You know, you're rapidly increasing the speed of how the nutrients enter the body and it completely changes the hormonal response of molecules like GLP-one and normal levels of GLP-one in the body are completely altered.

胰岛素反应也会随之改变。

The insulin response is also altered.

GLP-1是饥饿激素对吧？

And GLP-one is the hunger hormone.

它因与饥饿相关而闻名，因为进食时会释放这种激素。它能改变大脑的饥饿驱动力。大多数人通过Ozempic（诺和泰）知道它——像司美格鲁肽、Wegovy、替尔泽肽这些GLP-1受体激动剂，它们不是将GLP-1提升到正常水平，而是推高到远超生理水平的浓度，这是人体自然状态下永远达不到的。

It's known for being related to hunger because it's released in response to food. It changes the brain's hunger drive. And most people know of it because of Ozempic. Ozempic, semaglutide, Wegovy, tirzepatide, all these GLP-one receptor agonists that are increasing GLP-one levels not to normal levels. They're increasing them to super physiologic levels, levels that would never be observed or ever seen in normal settings of the body.

我刚刚投资数百万成为Ketone IQ公司的联合所有者。故事很有趣：我在播客谈到生酮状态，提到自己极低碳水、几乎零糖的饮食让身体产生酮体，这使我思维极度专注、耐力提升、情绪改善，工作表现更出色。节目播出几周后，伦敦总部办公室就收到了这些小瓶装的样品。

I've just invested millions into this and become a co owner of the company. It's a company called Ketone IQ. And the story is quite interesting. I started talking about ketosis on this podcast and the fact that I'm very low carb, very, very low sugar, and my body produces ketones which have made me incredibly focused, have improved my endurance, have improved my mood, and have made me more capable at doing what I do here. And because I was talking about it on the podcast, a couple of weeks later, these showed up on my desk in my HQ in London, these little shots.

天啊！它对我的语言表达、专注力、训练状态、情绪调节以及防止白天精力崩溃的效果如此惊人，我立即联系了公司创始人，现在已成为联合老板。强烈建议你了解这个产品背后的科学。如果想尝试，访问ketone.com/steven订阅可享7折，第二次发货还会附赠礼物。

And oh my god. The impact this had on my ability to articulate myself, on my focus, on my workouts, on my mood, on stopping me crashing throughout the day was so profound that I reached out to the founders of the company, and now I'm a co owner of this business. I highly, highly recommend you look into this. I highly recommend you look at the science behind the product. If you wanna try it for yourself, visit ketone.com/steven for 30% off your subscription order, and you'll also get a free gift with your second shipment.

网址ketone.com/steven。很荣幸我拥有的公司能再次赞助播客。用15秒说明如何在线上建立事业：成功者并非靠完美计划，而是迈出第一步后持续行动。

That's ketone.com/steven. And I'm so honored that once again, a company I own can sponsor my podcast. Just give me fifteen seconds to explain how you can build a viable business online. The people I see winning in life don't have a perfect plan. They just take the first step and then the next, and then they keep going.

他们保持痴迷与坚持。我联合创立的平台StandStor（本期赞助商）能帮你将知识变现——无需技术门槛，几分钟就能上线销售数字产品、 coaching服务、会员社区。成千上万创业者用它掌控未来，因为StandStor专为愿意拼搏的人打造。立即用14天免费试用开启你的事业：stephenbartlett.stan.store

They stay obsessed and they stay consistent. And StandStor, a platform I co own and one of our sponsors, is the best first step to help turn your knowledge into income. It only takes a couple of minutes to launch your business and start selling digital products, coaching, memberships, or communities online without any tech headaches or endless setup. Thousands of entrepreneurs, creators, and risk takers use to take control of their future because Stan is for entrepreneurs, for those willing to put in the work and bet on themselves. If you're ready to start building, join us.

现在我想给听众些改善生活的实用建议，帮大家应对当下的饮食环境。假设你有500万听众，你会给他们什么建议来提升生活质量和表现？

Launch your business today with a free fourteen day trial at stephenbartlett.stan.store. So I want to give the audience that are listening some practical ways that they can change their life to live a better life and to navigate the food environment we live in. But just to just generally, the advice that you would give if you had the ear of, I don't know, 5,000,000 people right now and you could say something to them to help them live better lives, to perform better, what advice would you give them?

第一，要有意识地关注每日饮食。食物的影响力堪比药物，有时甚至更强。注意饮品选择，摄入完整食物，避免液态热量。如果你特别需要稳定血糖、降低胰岛素水平（比如像我这样的代谢紊乱患者），减少碳水化合物往往是强效策略——事实上这已被证实能预防和逆转肥胖症、二型糖尿病，新兴证据表明它甚至可能缓解严重精神疾病。

Number one is I would say be conscious of the food you're consuming and what you're consuming on a daily basis. The impact of food is equivalent to medicine. It is sometimes more powerful than medicine. So what you drink, what you eat, focusing on whole foods, not consuming liquid calories. And if you're someone who could benefit uniquely from stable glucose levels, lower insulin levels, like someone who has some type of metabolic disorder like I do, reducing carbohydrates oftentimes can be a very powerful strategy, in fact known to prevent and reverse things like obesity and type two diabetes, with emergent evidence for its potential ability to put things like serious mental illness into remission.

但随着更多证据出现，我们会看得更清楚。定期锻炼。我们知道锻炼可能不是主要原因，缺乏锻炼或许并非导致某人肥胖与否的主要因素。但我们确实知道体育活动促进健康。我们确实知道体育活动对整体健康极为重要。

But we'll see as more evidence comes out. Exercise on a regular basis. We know that exercise might not be the primary, the lack of exercise might not be the primary driver for why someone is or isn't obese. But we do know that physical activity promotes health. We do know that physical activity is extremely important for overall well-being.

所以你练出了大块肌肉。好吧。这与1型糖尿病有任何关联吗？这是你策略的一部分吗？

So You've got big muscles. Oh, well. Is that somewhat linked to type one diabetes at all? Is that part of your strategy?

是的，我曾一度肥胖。自那以后，我变得痴迷于探索如何变得更强壮、更快速，优化我的代谢健康和表现。这成为了一场终身的自我实验之旅。但锻炼本身就很重要。对我而言，关键在于尝试各种锻炼实验和策略——无论是抗阻训练还是其他方式——来探索什么会影响我的身体、我的胰岛素，以及如何提升整体代谢健康。

Yeah, look, I was obese at one point. And so I've since that point taken a very I've become obsessed with trying to find out how to be bigger, stronger, faster, optimize my metabolic health, optimize my performance. And so it's been a lifelong kind of self experiment in that journey. But exercise is just important in general. But for me, it's about all the different experiments and strategies I can use with exercise, with resistance exercise, and beyond to kind of play around with what affects my body, what affects my insulin, how do I increase my overall metabolic health.

而我发现这些与我的表现直接相关。

And what I have seen is that that's directly linked to my performance.

你多久锻炼一次？

How often do you exercise?

我尽量每天都锻炼，尽我所能

I try to exercise every single day as much as I

每次锻炼多久？做哪些类型的运动？

How long for and what types of exercise?

目前我通常每周六天进行30分钟到1小时的举重训练。然后我会骑自行车去练习巴西柔术——这种独特的混合型高强度运动，可能五分钟极度激烈，接着休息一两分钟，如此循环。我每周大约练习五天。还会尽量抽时间做有氧运动，如果某天柔术或抗阻训练量不足，就额外增加跑步、骑行或上下肢联动的有氧器械训练。

So what I do right now is I typically do weightlifting for thirty minutes to an hour every or six days a week. And then I will go typically ride a bike to jujitsu, so Brazilian jujitsu, which can be uniquely almost like a mixed exercise, intense exercise, where it can be extremely intense for like five minutes and then you have a one or two minute break, extremely intense and then a break. And I do that typically around five days a week. I also try to purposely engage in some type of aerobic exercise when I can. If I wasn't able to do as much jujitsu one day or as much resistance exercise, I always try to add on some type of cardiovascular work, whether that be a run, a bike, or these aerodyne bikes where it's just lower and upper body.

我发现这些运动效果惊人，既能提升心血管健康又不会损伤肌肉组织。你的饮食是怎样的？我醒来通常不会立刻想吃东西——采用生酮饮食后不仅改善了血糖和胰岛素水平，还消除了饥饿感，所以早晨我不急于进食。

I find those to be incredibly effective and powerful tools and actually just not causing damage to muscle tissue, but also allowing you to improve your overall cardiovascular health. What does your diet look like? So I tend to wake up and not think about food. That's one thing that I've also experienced similar to you that when I switched to a ketogenic diet, not only improved my glucose and insulin, but I also found that with a ketogenic diet that I don't feel hungry. So I would wake up and I don't tend to eat food right away.

实际上，比起进食，我更喜欢不进食的状态——不是因为我不享受用餐时光（我非常喜欢），而是因为一天中22-23小时保持血糖胰岛素稳定的生活质量，远胜于因进食带来的波动和不确定性。简而言之，我不进食是因为不觉得饿，同时这让我更容易管理糖尿病。

In fact, I enjoy when I don't eat food more so than when I do eat food oftentimes just because not because I don't enjoy the feeling of sitting down and having food. I love that. But the experience and lived quality of life of not having high variable glucose levels, high insulin levels, and the uncertainty that comes with that in my daily life, I enjoy the twenty three hours or twenty two hours of my day where I have the stability, not the moments in time where I'm introducing uncertainty and variability. To dumb that down a little bit, what I'm saying is that when I don't eat, I wake up and I don't eat food because I find that I'm not hungry, but I also find that it makes managing diabetes easier. And so do

你一天吃一顿还是两顿？

you eat once a day or twice a day or?

我通常一天吃两到三顿，比如柔术或举重训练前后各一顿，睡前也会吃——虽然尽量避免临睡前进食，因为会影响睡眠质量。但我发现只要感到饥饿就会进食，并确保摄入足够蛋白质来配合运动需求。

I tend to eat two to three times a day, you know, sometimes right before jujitsu or weightlifting jujitsu, always afterwards and always before, sometime before bed. Try not to do it right before bed, because it tends to impact my sleep quality a little bit. But I find that I just eat whenever I feel hungry, and I try to give myself sufficient protein to be able to respond to the exercise that I'm doing.

第一个建议是关于有意识地选择食物，第二个是关于运动。还有其他建议吗？

So I've got the first one's about being intentional about your food choices. The second one is about exercise. Anything else?

睡眠非常重要。史蒂芬，这些建议虽然不算革命性，但营养定制、适量运动和优质睡眠确实是健康的三大支柱。如果这些基础没打好，其他努力都是徒劳。

Well, sleep's really important. These are Stephen, this isn't like, oh, like this is the most revolutionary advice of all time. But these core foundational components good nutrition tailored to your specific needs, exercising as much as you can, and getting good sleep are the pillars of health. If you don't have those corrected, then you're wasting your time everywhere else.

关于血糖监测数据，有什么让你意外的发现吗？你随身佩戴两种监测设备观察胰岛素和血糖反应，有没有哪些人们意想不到会显著影响血糖水平的事物？比如橙汁——我小时候还以为这是健康饮品。

And is there anything as it relates to glucose that surprised you? Because you're someone that sees a lot of this data. I mean, walk around with the two devices on that you've mentioned, and you're looking at the insulin and glucose response, is there anything that people don't understand as having a really pronounced impact on their glucose levels that they wouldn't expect? Like orange juice is one of the ones that growing up I thought, fuck, I thought this was a healthy thing.

曾经是

Used to

我以前喝阳光果汁时还以为在补充维生素，现在回想起来很后悔。并非要指责父母（养育孩子本就不易），但当我看到家长给孩子一大杯橙汁时，脑子里就会浮现孩子即将经历的血糖飙升。

drink Sunny Delight thinking I was putting all these amazing vitamins in my body. And now I actually look back and regret it. And I not to be judgmental over any parents because parenting is very hard. But sometimes I'll see parents giving their children a big glass of orange juice. And in my head I just see the glucose spike that that child's about to have.

说到育儿很有意思，我家有个三岁和六岁的孩子。当他们尝过这些高糖美味食品后，就会不停地索要——普通食物突然就不够好了。这正反映了我们成年人日常面临的挑战，但很多人根本没意识到这对代谢、饥饿感和未来健康的影响。

It's funny when you mention parenting because I a three and a six year old at home. And it's amazing when they try one of these foods, these very sugary foods, these very tasty foods, they it's almost like they become incessant on wanting it again. You know, like normal food isn't good enough anymore. And I think that's a great illustration of what many of us adults are challenged with on a daily basis. But yet many people are just unaware of the impact that it's having on their metabolism, impact that it's having on their hunger, the impact that that's going to lead to on their future health.

通过持续血糖监测仪和胰岛素设备，有没有发现人们必须避免的食物？除了液态卡路里，还有哪些会导致剧烈或意外的血糖反应？

And is there anything that you've spotted from your experiments with your CGM and your insulin device that people should most certainly avoid? So you said liquid calories. Is there anything else that causes a really pronounced or unexpected glucose response?

说实话史蒂芬，随着时间推移很难单独指出某一种。市面上很多食物——尤其是加工食品——对血糖和胰岛素水平的冲击往往超乎预期。当你食用这些产品时，其实是在赌食品公司添加的成分会与你的代谢系统和谐相处。

Yeah. You know, there's so many. Honestly, Stephen, over time that it's really hard to pinpoint any singular one. A lot of the foods that are out there are often surprisingly challenging on glucose levels, on insulin levels, particularly the processed foods. Because what happens when you make these food products is that you're trusting the food company to put ingredients in there that you're going to respond favorably to, that your metabolism will respond well to.

事实上这远非保证，在许多情况下可能性或许更低。所以，是的，史蒂文，我举不出具体例子。但我亲身经历过无数次这种情况。

And the truth is that that's far from a guarantee, and in many cases maybe less likely than it is likely. And so, yeah, I don't have a single example for you, Steven. I just but I've experienced it numerous times.

我这里有个简短的清单：含糖饮料、白面包和贝果、白米饭——这让我很惊讶，因为我曾经以为白米饭...

So I've got a small list here. Sugary drinks, white bread and bagels, white rice, that surprised me lot because I used to think white

哦，真的吗？

Oh, really?

我小时候一直以为米饭是健康食品。

I I thought growing up rice was like a health food.

好吧。既然说到这个，白米饭、土豆...

Okay. Well, so on that note, white rice, potatoes,

任何形式的土豆都不例外。

All potatoes in any form.

红薯的血糖反应通常较弱，但仍会产生显著的升糖效应。所以无论是土豆泥还是...

Sweet potatoes tend to have less of a glycemic response, but it's still going to have a potent glycemic response. So mashed or

烤土豆，当然还有薯条。

baked potatoes, obviously french fries.

没错，薯条绝对算。意大利面也是重灾区。麦片呢？精制谷物麦片？

Yeah. For sure french fries. Most of like pasta is a big one. Cereal? Refined cereals?

大多数麦片对血糖和胰岛素的影响实际上远比我刚提到的那些食物更糟糕。事实上，那些号称有益心脏健康的麦片，只要吃上建议分量，血糖就会飙升到离谱的程度。所以我个人会尽量避免这类食品。我认为当前健康科学领域的大多数从业者也会认同，这些并非最理想的饮食选择。我们更倾向于推荐升糖指数较低、对葡萄糖和胰岛素水平影响较小的食物。

Most cereals are actually worse than the foods that I just described on blood sugar and insulin by a long shot. In fact, most of the, you know, these heart healthy cereals, would never, blood sugar would just spike through the roof, portion of the amount I ate. So yeah, I wouldn't be consuming a lot of those. And I think most people at this stage in the health and science world would also generally align with that, that those aren't necessarily the best foods to consume. We would think, you know, more of the less glycemic or less foods that have less of an impact on glucose levels, less of an impact on insulin levels.

你知道，我经常听到一种说法，尤其是在研究和临床领域，他们说‘看，不是每个人都需要担心这个，因为很多人对这些食物反应良好’。我会回应说‘你说得对，但问题是超过一半的美国人处于糖尿病前期，90%以上的人有某种指标显示他们的代谢健康受损，而超过86%（或68%）的人患有肥胖症。’

You know, one thing I constantly hear, especially in the research and clinical community is like, well, look, you know, not everyone needs to be concerned about that because, you know, people can respond to a lot of these foods just fine. I say, well, you're right. Except that over half of America has prediabetes. And ninety plus percent have some form of measurement that indicates that their metabolic health is impaired. And over eighty six, sixty eight percent are obese.

现在连儿童也受到这些疾病的侵袭，约20%的儿童患有肥胖症和糖尿病前期。这事实表明，我们的健康状况比以往任何时候都更糟糕。

And now children are affected with these diseases, with obesity and prediabetes, at around twenty percent. So it's the fact that we are now less healthy than we've ever been.

我们缺乏支撑的基础。

We don't have the foundation to support.

没错。我认为，当我们谈论健康营养和运动时，常把它们比作药物。但实际上，这些只是你每天应该做的正常事情，因为我们的身体本就是为此设计的。当我们不这样做时，健康就会恶化，这就是在挑战身体维持正常健康的能力。

Correct. And I think, you know, when we think about healthy nutrition, we think about exercise, we describe them as medicine. But the reality is these are just normal aspects of things you should do every single day because that's what our bodies were made to do. And when we don't do those things, this is when health deteriorates. This is when we're challenging our body to maintain normal health.

让我惊讶的一个例子是干果。它提到，虽然水果含有天然糖分，但干燥过程会浓缩这些糖分。这去除了水分，使糖分更易被吸收，导致比新鲜水果更高的血糖飙升。通常人们也认为干果是健康食品。

One of the surprising ones for me was dried fruits. And it said, while fruit contains natural sugars, the process of drying it concentrates those sugars. This removes the water and can make the sugar more readily available for absorption, leading to a higher glucose spike compared to fresh fruit. Typically people think of dried fruit as being a health food as well.

是的，别碰那些。除非我身上没有葡萄糖，且由于某种原因我的血糖正在下降到危险的低水平，那时我才会吃那些食物。否则我不会食用它们，就因为它们会如此迅速地提高血糖水平。

Yeah, don't touch those because unless I don't have any glucose on me and my blood sugar is going down for some reason and it's in dangerously low levels, that's when I consume those foods. Otherwise I would not consume them just because of how quickly they raise blood sugar levels.

你认为每个人都应该尝试生酮饮食吗？

Do you think everybody should try the ketogenic diet?

哦，这是个好问题。我想说，哇。我要说的是，如果你不尝试，你永远不会知道它的潜在好处或缺乏好处。就像生活中的任何事情一样，我们只能假设其他人的情况。我们在这里多次讨论过生酮饮食。

Oh, that is a good question. I think, wow. What I would say is that you will never know the potential of its benefit or lack thereof if you don't try. Like anything in life, we're left to assume what everyone else is like. We've talked about the ketogenic diet numerous times here.

我们在这里也多次讨论过外源性酮体。但如果你不尝试，你就不知道它对你是否有效。在科学上，史蒂文，

We talked about exogenous ketones numerous times here. But if you don't try it, you don't know how it'll work for you. In science, Steven,

一

one

最值得重视的一点是，我们经常发布的条形图看起来像这样——一条代表群体平均结果的线。但人们往往忽略了，这条线或条形图是由无数个体数据平均而成的。如果你恰巧是那个位于最高点或最低点的数据点，即所谓的异常值，对干预措施反应极好或极差，却盲目遵循研究给出的平均建议会怎样？

of the most important things to appreciate is that we often publish bar graphs look like this. A line that illustrates the average outcome of a group of people. But what you don't appreciate is that that line or that bar graph is made up of numerous individuals who all average to that number. But what if you're the person who's at the very high dot or the very bottom dot, meaning that you're what they call an outlier or someone who responded negatively or positively to that? And then you just follow the average advice that that study showed.

比如有人会说：'看啊，我试了这种方法但无效，可既然研究这么说我就继续尝试吧'。不，你可能是研究中无反应的那类人，就像光谱另一端有强烈反应的人一样，最终都被平均化了。

Well, oh, look, I tried this approach and it didn't work for me. I'm just going keep trying because this study said that I should. Well, no. You might be the person who was in that study who didn't respond, just like the person on the opposite end of the spectrum who did, who averaged out to the metal.

就像那项关于外源性酮体对大脑稳定性影响的研究，可能有人获得了100%的改善，有人只有20%，经过群体平均后数据就中和了。如果你恰巧是获得100%改善的人，这对你而言就是极具价值的个体化工具。

So in that study that talked about the impact of exogenous ketones on brain stability, someone might have had 100% improvement in brain stability, and someone might have had 20% improvement or whatever, and they've averaged it out across a bigger group of people. So if you are that person that had 100% gain in brain stability, it's a pretty unbelievable tool for you to understand based on your body.

正是如此。科学实验永远存在这种情况。我们有时会区分'有反应者'和'无反应者'。但在我们使用AtriMin和Ketone IQ产品的SOCOM研究中，实际上几乎所有受试者的血氧饱和度(SpO2)都提升了，心率也有所增加。

Exactly. And that's always the case in science. I mean, there are sometimes we look at this as responders and non responders. But actually in the study where we gave the product from AtriMin and Ketone IQ, in the SOCOM study, we actually saw that nearly all of them saw an increase in SpO2. Nearly all of them saw an increase in heart rate.

这种情况很罕见。SpO2即血氧含量，这个指标能反映在低氧环境中人体获得氧气的能力强弱。

But that's rare. That is rare. SpO2. Ah, so the amount of oxygen in the blood. So the measure that would indicate whether someone in these low oxygen environments had more blood or less, more oxygen or less oxygen.

归根结底，尝试很重要。我认为应该对各种营养策略保持开放态度——我本人就尝试过不下15到20种饮食法。最终发现生酮饮食，特别是我作为曾患肥胖症的1型糖尿病患者，能显著提升我的生活质量，避免血糖剧烈波动和高胰岛素水平导致的并发症，这些并发症可能让人减寿10到20年。这就是我坚持生酮的原因。

Ultimately, it's important to try. I think it's, would always say yes, you should try because, or any nutrition strategy, because you should try different ones. I've probably tried over 10 plus different diets, honestly, like 15 or 20 at this point in my life. I've just come to find that the ketogenic diet, for all the reasons we described and because I have type one diabetes and I had or have type one diabetes but had obesity, find that a ketogenic diet is remarkably powerful at helping me live a dramatically improved quality of life, not have the increased risk for the high in variable glucose levels, high insulin levels that lead to a near guarantee of complications and ten to twenty years of lost life insurgency. That's why I do it.

本播客有个传统环节：每位嘉宾要为下一位未知嘉宾留下问题。现在有个相当刁钻的问题——虽然问题本身也很奇怪，但我还是要问：'模拟系统之外是什么？'

I have a closing tradition on this podcast where the next guest leaves a question for the next guest not knowing who they're leaving it for. And this is a really tough question. So it's a very strange question as well, but I'm gonna ask you anyway. Yeah. The question is, what is outside the simulation?

这取决于你的哲学观——考虑到人类对世界的认知完全受限于大脑的容量。我们对于'模拟系统'这类概念的诠释与表达，永远受制于大脑的理解与表述能力。

I think it depends on your philosophy on how our existence is with the limitations of understanding that our awareness of our world is completely limited to our brain's capacity. And our interpretation and then explanation of the world and the term of a simulation or however you want to frame it, I believe is always going to be limited by our brain's ability to understand and articulate that.

那你认为模拟系统之外究竟存在什么？

So what do you think is outside the simulation?

意识。

Consciousness.

你认为意识存在于模拟之外吗？

You think consciousness is outside the simulation?

我认为我们拥有的能力——不是意识本身，史蒂文，而是超越意识运作的能力。这问题把我难住了，老兄。这真是个...

I think that our ability to have, not consciousness, Steven, but our ability to operate beyond consciousness. Got me on that one, man. That was a that

是个棘手的问题。

was a Tough question.

是啊，确实棘手。这这这真是个烧脑的问题。我不知道。

Yeah. It is a tough question. That's that's that's a it's a burner right there. I don't know.

你...你认为在我们所见的一切之外存在上帝吗？

Do do you think there is do you think there is a God beyond beyond this all this stuff that we see here?

我要给你最真实坦诚的回答。是的。我认为我们永远无法准确回答这个问题。

I'm gonna give you the most real honest answer possible. Yeah. I don't think we ever can actually answer that question accurately.

所以你的答案其实就是不知道？

So your your answer therefore is you don't know?

我不知道。而且我觉得我永远都不会知道。

I don't know. And I don't think I'll ever know.

好的。非常感谢你所做的工作。真的很感激。

Yeah. Okay. Thank you. Thank you so much for doing the work that you do. Really appreciate it.

因为你知道，我这个领域的许多朋友，甚至包括我桌上这款酮类产品的创始人迈克尔，都把你视为酮类研究科学和思想领导力的黄金标准，更广泛地说，在葡萄糖及相关领域如胰岛素等方面也是如此。你以极其深刻的方式推动了这个领域的进步和思维发展。而你才34岁，这很了不起。我们基本同龄，但你对健康领域产生了巨大影响，这都源于你开头讲述的自身经历的那些复杂情况。

Because, you know, so many of my friends in this field and even Michael, the founder of the the ketone product on my on my table here, talk about you as being the sort of gold standard of research science and thought leadership on the subject of ketones and more broadly on the subject of glucose and all of the adjacent subjects like insulin. So you've really pushed the field forward and the thinking forward in this space in a really profound way. You're only just getting started at 34 years old, which is remarkable. We're basically the same age. And you've had such a tremendous impact on the field of health, that's borne out of the story that you told at the start through your own complications.

尽管在如此年轻的年纪得到这样的诊断是件极其不幸的事，但由此产生的结果对许多人来说却是美好的——他们将更了解自己、自己的疾病，以及与之相关的表现和其他一切，而这都归功于你。所以请继续你正在做的研究，并以你现有的方式传播这些信息，因为这是非常必要且重要的工作。非常感谢你，也谢谢你今天抽出时间与我交谈。

So although it's such a tragic thing to have such a diagnosis at such a young age, what's come from that is a beautiful thing for so many people that will better understand themselves and their illnesses, but also their performance and everything correlated to that because of you. So please keep doing the research you're doing and spreading the word in the way you're spreading it because it's much needed work and it's important work. So you so much, and thank you for giving me your time today.

Steven，这是我的荣幸。非常感谢，先生。

Steven, it was an honor. Appreciate it, sir.

请务必对我接下来要说的话保密。我将邀请一万名你们中的成员更深入地进入‘CEO日记’的世界。欢迎来到我的核心圈。这是我向全球推出的一个全新私人社区。我们有太多精彩的内容从未向你们展示过。

Make sure you keep what I'm about to say to yourself. I'm inviting 10,000 of you to come even deeper into the diary of a CEO. Welcome to my inner circle. This is a brand new private community that I'm launching to the world. We have so many incredible things that happen that you are never shown.

包括我录制对话时iPad上的简报、从未发布的片段、与嘉宾的幕后谈话，以及我们从未播出的节目内容等等。在这个圈子里，你将直接与我互动。你可以告诉我们你希望这档节目变成什么样，想让我们采访谁，以及你希望我们进行哪种类型的对话。

We have the briefs that are on my iPad when I'm recording the conversation. We have clips we've never released. We have behind the scenes conversations with the guests and also the episodes that we've never ever released and so much more. In the circle, you'll have direct access to me. You can tell us what you want this show to be, who you want us to interview, and the types of conversations you would love us to have.

但请记住，目前我们只邀请前一万名加入的成员，之后就会关闭通道。如果你想加入我们的私人封闭社区，请点击下方描述中的链接，或访问d0accircle.com。届时我会与你交流。如果你现在经营着一家企业，这意味着你可能处在一个瞬息万变的环境中——关税和贸易政策动态变化，

But remember, for now, we're only inviting the first 10,000 people that join before it closes. So if you wanna join our private close community, head to the link in the description below or go to d0accircle.com. I will speak to you then. If you're someone running a business today, that means you're probably operating in a world that doesn't sit still. Tariffs and trade policies are dynamic.

客户需求不断转变，创新步伐永不停歇。因此你的容错空间正变得越来越小。在缺乏全局视野的情况下做决策不仅风险高，而且必然会拖慢所有进程。我经常看到这样的情况：企业有好的想法，却因分散在五个互不连通的系统中而举步维艰。现在我多家公司都在使用我们的赞助商Oracle旗下的NetSuite，这个AI驱动的商业管理套件能让你更清晰地掌控业务。

Customer expectations shift constantly and the pace of innovation is relentless. So your margin of error is becoming increasingly smaller. Making decisions without full visibility across your business is not only risky, but it inevitably slows down everything. And I see it all the time businesses with the right ideas, but they're stuck because they're spread across five systems that don't talk to each other. Many of my companies now use our sponsor NetSuite by Oracle, which has an AI powered business management suite that allows you to see your business more clearly.

从财务到人力资源再到运营，所有数据都集中在一处，你不必再四处搜集信息，一切尽在眼前。它实时运作，让你能 confidently 进行预测，在问题萌芽前就发现它们，并 generally 更快速地行动，没有盲区。如果你的企业年收入达到七位数或更多，有一本值得你花时间阅读的免费电子书《领导者必备的三大洞察指南》，现在就可以从netsuite.com/bartlett下载。再次强调：netsuite.com/bartlett。

Everything from financials to HR to operations lives in one place, so instead of chasing information you've got it all in front of you. It operates in real time so you can forecast with assurance, spot problems before they even become problems and generally move faster without blind spots. If your business is generating 7 figures or more, there's a free ebook that's worth your time reading. It's called Navigating Three Insights for Leaders and you can download it now from netsuite.com/bartlett. That's netsuite.com/bartlett.

我会把链接放在下方。

I'll link it below.

Lowe's深知免费能让一切更美好。因此我们的会员从银钥匙等级起，每天都能获得所需商品的免费标准配送。会员的节省金额会快速累积，还等什么？今天就免费加入吧。Lowe's——

Lowe's knows that free makes everything better. That's why our rewards members get free standard shipping on the things they need and want, starting at silver key status every day. Savings for rewards members add up fast, so why wait? Join for free today. Lowe's.

我们助力，您省钱。阿拉斯加和夏威夷地区不可用。除外条款及其他条款适用。忠诚度计划受条款和条件约束。

We help. You save. Not available in Alaskan, Hawaii. Exclusions and more terms apply. Loyalty program subject to terms and conditions.

详情请访问 lowes.com/shippingterms。可能随时变更。

Details at lowes.com/shippingterms. Subject to change.