长寿101：彼得的长寿框架基础指南，涵盖心血管疾病、癌症、神经退行性疾病、营养、运动、睡眠等领域的理解（重播）

来看最后一位'骑士'——神经退行性疾病，比如阿尔茨海默症，这是很多人经常询问我们的问题。

Looking at the last of a horsemen, neurodegenerative disease such as Alzheimer's, something we get asked about a lot.

从你讨论过的癌症、心血管疾病预防角度来看，这方面情况如何？

How does that look in terms of what you kind of discussed on cancer, cardiovascular disease as it relates to prevention?

嗯，我认为它处于中间位置。

Well I would say it's a little bit in the middle.

换句话说，我认为我们对某些病因确实有更清晰的认识（虽然并非所有病例），特别是对阿尔茨海默症，我们越来越清楚哪些人群易感，从遗传易感性角度来看哪些基因在起作用。

In other words, I think we actually have a slightly better sense of some of the causes, not in all cases, but certainly with Alzheimer's disease we're getting a much better sense of which people are susceptible, what genes play a role from a genetic susceptibility standpoint.

基因在这方面确实起着相当大的作用。

And genes do play a pretty big role there.

同时我们也了解其他影响因素。

And we also understand the other factors.

尼克，部分原因在于有个简单却惊人准确的格言：对心脏有益的就对大脑有益。

And part of the reason for this Nick is there's a very simple but surprisingly accurate adage which states, what's good for the heart is good for the brain.

大量研究反复证明了以下结论。

And study after study after study have demonstrated the following.

我们采取的每一项降低动脉粥样硬化性心血管疾病风险的干预措施，同时也降低了痴呆症的风险。

Every intervention that we take to lower the risk of atherosclerotic cardiovascular disease also reduces the risk of dementia.

这意味着阿尔茨海默病、血管性痴呆这两种主要类型，以及其他形式的痴呆症。

And that means Alzheimer's disease, vascular dementia, which are the two main ones but also other forms of dementia.

所以这意味着要保持更好的代谢健康，降低载脂蛋白B水平，降低血压，以及不吸烟。

So that means having better metabolic health, having lower ApoB, having lower blood pressure, not smoking.

这些措施能显著降低心血管疾病风险，同时也能显著降低阿尔茨海默病的患病风险。

Those things dramatically reduce your risk of cardiovascular disease and they dramatically reduce your risk of Alzheimer's disease.

在干预措施中，运动对痴呆症的积极影响甚至比心血管疾病更大。

Now, an area where dementia has an even bigger positive impact in intervention than cardiovascular disease is with that of exercise.

因此，运动能提高一个人避免或幸存于心血管疾病、癌症和痴呆症的几率并不令人意外。

So it's no surprise that exercise improves a person's odds of not getting and or surviving cardiovascular disease, cancer, dementia.

但我认为，就预防神经退行性疾病而言，运动带来的益处无论在程度还是确定性上都更为显著。

But I would say that the evidence for the benefits of exercise are both greater in magnitude and greater in confidence when it comes to the prevention of neurodegenerative disease.

这很有趣，因为我确实认为许多人最害怕的就是痴呆症，这背后有着非常明显的原因。

So it's interesting because I do think that many people fear dementia more than any other condition and there are very obvious reasons why that would be the case.

在我们的实践中，基于我们所做工作的性质以及接触的人群类型，我们可能比大多数人更为乐观——这些人群真正研究预防措施，密切关注痴呆症的早期征兆，并探索特定干预措施如何能带来改变。

And it might be that in our practice we're a bit more optimistic than most based on just the nature of what we do and the types of people that are in our practice, meaning like people who really study prevention and really look at these early early signs of dementia and look at how specific interventions can make a difference.

但遗憾的是，另一方面，在所有慢性疾病中，痴呆症和神经退行性疾病是目前我们几乎没有任何可行治疗方案的疾病。

But unfortunately, the flip side of that is that of all the chronic diseases, the dementing and neurodegenerative diseases are the ones for which we have at this time virtually no viable therapeutic options.

因此，神经退行性疾病（特别是痴呆类疾病）的真正关键点——这里我只简要提及帕金森病，因为它是最高发的运动障碍类疾病——在于预防是第一、第二也是第三优先事项。

So the real name of the game with neurodegenerative diseases, specifically the dementing diseases, and the only other one I'll really mention here briefly is Parkinson's disease because it's the most prevalent movement disorder, is that avoiding them is the first, second and third priority on a list of three priorities.

一旦进入治疗阶段，至少就目前而言，前景并不乐观。

Once we get into treatment land, at least at this point in time it's not very promising.

因此这两种疾病中，尽可能保持较高的储备能力会产生重大影响。

So these are both diseases where having as higher reserve as you can make a big difference.

你的认知储备和运动储备越高，对这些病症影响的抵抗力就越强。

So the higher your cognitive reserve and the higher your movement reserve, the more resilient you are to the effects of these conditions.

我认为这里应该直接陈述结论：我们不应忽视第四骑士，即代谢疾病谱系。

I think I should just state the conclusion here that we shouldn't ignore the fourth horseman, which is of course the spectrum of metabolic diseases.

正如我一开始所说，我认为与心血管疾病一样，我们在机制上对这些驱动因素已有相当清晰的认识。

As I said kind of at the outset, mean I think along with cardiovascular disease we really have a pretty clear sense mechanistically of what's driving this.

我的意思是，这似乎主要是营养过剩的后果。

I mean this appears to be primarily a consequence of overnutrition.

因此，能量失衡确实是胰岛素抵抗的驱动因素，而胰岛素抵抗又是导致从脂肪肝到二型糖尿病等一系列下游效应的根本原因。

So energy imbalance is really the driving factor of insulin resistance and insulin resistance is really the driving factor of the downstream effects that ultimately lead to everything from fatty liver disease, type two diabetes.

再次强调，这些疾病本身具有相当大的危害性和破坏性。

And again, these diseases in their own right are quite harmful and devastating.

但它们真正的危险在于对其他三大健康威胁的推波助澜。

But the real danger of them is the effect that they're having on the other three horsemen.

它们会将你的患病风险提高25%至50%。

Where they're increasing your risk by twenty five to fifty percent.

它们确实像是其他疾病的助燃剂。

So they really are gasoline on the fire of the other diseases.

在进入具体策略讨论前，最后一个基础性问题就是：我们如此强调预防的重要性——这对年轻听众来说应该能激励他们做长远规划

The last kind of foundational question before we get into tactics would be, we just talk so much about prevention and the importance of it which if anyone who is younger listening, hopefully encourages them to kind of play that longer game.

但对于年长者该怎么办呢？

But what about someone who's older?

所以他们刚听完你谈论预防的重要性，可能正在想：现在开始考虑长寿是否已经太晚了。

So they just heard you talk about prevention, the importance of it and they might be thinking themselves, I wonder if it's too late for me to start thinking about my longevity.

对此你会怎么回应？

What would you say to that?

嗯，我觉得这个问题可以从理论层面和实际层面来回答，对吧？

Well, mean I think there's like the theoretical answer and the practical answer, right?

理论层面的回答是：只要一息尚存，开始行动就永远不晚。

I mean I think the theoretical answer is look, while you still have breath in your lungs, it's not too late to do something.

但我也认为我们就像坐在一辆冲向悬崖的车上。

But I also think that we're all in a car driving towards the edge of a cliff.

如果在到达悬崖前就开始减速，要完全避开悬崖或大幅延缓坠落会容易得多。

It's a lot easier to slow the car down and make sure that you either avoid the cliff altogether or at a minimum slow your route to the cliff's edge dramatically if you begin the slowing process before you get there.

换句话说，所有人都明白看到红灯时必须在到达前就开始刹车。

In other words, everybody understands that when you see a red light, you have to be applying the brakes before you reach the actual light.

所以某种程度上，我认为要扭转局面确实非常困难。

So at some point, I think it is very difficult to back out of a situation.

但我也认为那只是罕见的例外，而非普遍规律。

But I also think that that's the rare exception and not the rule.

所以我在书中甚至写到过一些70多岁才首次真正开始关注健康的人。

So I've even in the book written about individuals who are in their 70s before they take their first committed step towards health.

这些人现在80多岁了，从健康水平和行动能力来看，状态比他们60多岁时还要好。

And these are individuals that in their 80s now are doing better than they were in their 60s from a health perspective, from a movement perspective.

因此我衷心希望那些已届暮年、正在收听我们节目并想着'真希望我早点行动，现在是否太迟'的人们——

So I would absolutely hope that a person listening to us in what might be thought of as their twilight years who's thinking, man, I wish I did something about this sooner, is it too late?

我想告诉他们：为时未晚。

I would say it's not too late.

当然需要有所妥协，要循序渐进，确保不会受伤。

You'll have to make concessions, you need to start slower, you need to make sure you're not getting injured.

我们为此专门准备了全套方案，甚至做过一期关于'老年人锻炼计划该是什么样'的播客节目。

I mean there's an entire playbook and we actually have a podcast around this topic specifically around what would an exercise program for the elderly look like.

但如果有人认为我在传达'过了某个年龄就彻底没希望'的观点，那我真的会非常失望。

But I definitely would be very disappointed if anyone thought I was communicating that once you reach a certain age, it's sort of all bets are off.

那么从健康寿命、寿命长度，我们现在来谈谈具体策略。

So moving from health span, lifespan to now the tactics.

我想我们会逐一讨论，但一开始如果你能先列出你所谓的'长寿工具箱'中的五个策略会很有帮助。

I think we'll go through each of them but I think it'd be helpful at the outset if you just kind of list what the five tactics in your quote unquote longevity toolkit are.

嗯。

Yeah.

我只是习惯性地把事物分类归纳。

I just kind of list things into buckets.

我不会说这个分类是穷尽的，还有其他我认为重要但不足以单独分类的事项，或许我应该设立第六个分类来容纳这些，我们也可以讨论这个问题。

I wouldn't say this is collectively exhaustive, there are other things that I think matter that don't warrant a bucket in my view or maybe I should come up with a sixth bucket that I would put every other thing into and we could talk about that as well.

但最主要的五大分类是：营养、运动、睡眠、药物学和情绪健康。

But the big five buckets are nutrition, exercise, sleep, pharmacology and emotional health.

当然也可以讨论第六个分类，包括污染、极端温度暴露、避免意外事故等。

Again, could talk about a sixth bucket which would be pollution, radical temperature exposure, accident avoidance.

也就是避免有害事故的行为，如机动车事故等这类事项。

So behaviors to avoid harmful accidents, automotive accidents, things like that.

所以确实还有第六个杂项类别，如果你想纳入的话。

So there's definitely also like a grab bag sixth column that you could include if you wanted to.

但我主要讨论前五个方面。

But I mostly talk about the first five.

我们就从你最喜欢的运动开始——这句话不是讽刺，它确实是你最钟爱的部分。

We'll start with your favorite, which is not ironic in that statement, it is actually your favorite, which is exercise.

我觉得如果能先说明下百岁十项全能这个框架会很有帮助，你愿意简单介绍下吗？

I think what would be helpful is, you've talked about this before but this framework of the centenarian decathlon, do you wanna just quickly state what that is?

因为这个概念能奠定基础，体现你与他人不同的运动思考方式。

Because I think it kind of gives some grounding and foundation to how you think about exercise compared to how others may talk about it.

关于这点我有很多想说的。

So there's so much I could say about this.

我原以为你会按惯例从营养学开始——当然这不是我的最爱，不过我们稍后也会讨论。

I really thought you were gonna throw me a usual ball and start with nutrition, which of course is not my favorite but we will talk about it.

但你说得对，运动确实是我的最爱，因为数据明确显示：如果充分发挥作用，运动对延长寿命的影响最为显著。

But you're right, exercise is my favorite and it is my favorite because I think the data are very clear that exercise, if leveraged to its capacity, has a greater impact on your lifespan.

请记住，这关乎你寿命的长短——即生存期，以及健康寿命——即生活质量，这两者比其他任何因素都更重要。

Remember that's the how long you live peace and your health span, that's the how well you live peace, than any of the others.

唯一的例外可能是情绪健康。

With the only exception potentially being emotional health.

显然存在这样的情况：当一个人的情绪健康处于极度糟糕状态时，在解决这个问题之前，任何身体健康都无济于事，实际上其他任何干预都只是在延长痛苦。

There's clearly going to be the case of the individual whose emotional health is in such ruins that until that is addressed, no amount of physical health matters and in fact anything else is just prolongation of agony.

但如果你排除这种情况——我并非要轻视这种情况，因为我知道很多人曾处于这种困境中。

But if you exclude that case, which is I don't want to minimize that case because I think there are many people who have been in that situation.

运动确实是干预措施中的王者。

Exercise really is the king of interventions.

你提到了我最喜欢的话题之一——百岁老人十项全能。

So you alluded to something that is one of my favorite topics, which is called the centenarian decathlon.

我意识到有些人读过这本书，他们理解这个概念，或者听过我谈论它。

So I realized that some people have read the book and they understand what this means or they've heard me talk about it.

但重申一下，我认为这个播客的目的是确保新听众能快速理解这个概念，或者为老听众提供一个复习的机会。

But again, the purpose of this podcast I think is to make sure that someone who's new maybe gets up to speed on this or it's a refresher for someone.

百岁十项全能这个概念是我在2018年想到的。

So the centenarian decathlon is an idea that came to me in the 2018.

这个想法虽然是一瞬间产生的，但其实是多年——准确说是四年煎熬的结果。

And it's an idea that occurred in an instant but it was really the result of many years, probably four years of suffering, so to speak.

这种煎熬始于2014年，当时我决定退出竞技自行车运动。

So the suffering started at the 2014 when I decided to stop competitively cycling.

我不仅停止了自行车运动，也不打算回归任何其他体育项目。

And not only did I stop cycling but I was not gonna go back to any other sport.

我不再参加大师级游泳、自行车等比赛。

So I was not gonna be competing anymore in masters swimming, cycling.

显然我也没兴趣重返拳击或武术之类的竞技项目。

Obviously I had no desire to go back and compete in boxing or martial arts or anything like that.

基本上，我已经彻底告别竞技，只想为了锻炼而锻炼。

Basically, I was done competing and all I wanted to do was exercise for the sake of exercise.

至少对我而言，这是个非常陌生的概念。

And this for me at least was a bizarre foreign idea.

因为从13岁开始直到那一刻——那时我41或42岁——我从未进行过没有特定目标的训练。

Because from the age of 13 until that point in time, which was 41 or 42, I had never trained without a specific purpose.

每一次重复动作、每一圈跑道、每一次踩踏踏板，我做的每件事都始终服务于某个目标。

Every single rep, every single lap, every single pedal stroke, everything I ever did was always geared towards a purpose.

而现在有生以来第一次，我有点迷茫：今天该做些什么呢？

And now for the first time ever, I was kind of like, what should I do today?

我想我应该去跑个步。

I guess I should go for a run.

好吧。

Okay.

我猜明天该练举重了。

I guess I'll lift weights tomorrow.

我在健身房举铁，可这是为了什么呢？

I'm in the gym lifting, what am I lifting for?

呃，我以前常做这个，大概现在也该继续做吧。

Well, I used to do this, I guess I should still do this.

但那段时间我完全处于一种没有方向的生活状态，这种状态一直持续到2018年——当时我参加了一位挚友父母的葬礼。

But it was this totally rudderless existence that I had and it stayed that way until the 2018 when I was at the funeral of the parent of one of my best friends.

抱歉要重复这个故事，因为我在书里也写过这件事。

And apologies for repeating this because I do write about this in the book.

但基本上在那个葬礼上我意识到，虽然朋友的母亲去世时年事已高（大约89岁），但她的身体机能其实在过去十年里已经严重衰退，以至于实际死亡几乎只是走个形式。

But basically at that funeral I realized that while my friend's mom had died at a relatively old age, I think about 89, her physical life had basically demised so significantly in the past decade that her actual death was almost just a matter of formality.

早在那之前十年，她就已经失去了做那些对她最重要的事情的能力。

But she had lost the ability to do the things that mattered to her most a decade earlier.

因为肩膀问题，她再也不能打高尔夫了。

So she couldn't play golf anymore because of her shoulder.

因为膝盖、髋关节和背部问题，她无法再打理花园。

She couldn't garden because of her knees and hips and back.

她甚至无法和孙辈们玩耍。

She couldn't even play with her grandkids.

因此她人生最后十年的大部分时间，基本上都无法参与任何活动。

And so she spent most of the last decade of her life largely uninvolved in anything.

她在生命的最后一年患上了痴呆症，这最终夺走了她的生命。

And did come down with dementia in the final year of her life and that's what ultimately took her life.

但我被这位曾经充满活力的人彻底震撼了，她失去了一切，在这种状态下度过了最后一年。

But I was just totally blown away by this person that I once remembered as being completely vibrant, losing everything and spending this last year in this state.

那一刻我意识到，当我坐在教堂长椅上时，首先这种情况其实很普遍。

And I realized in that moment, as I literally sat in a church pew, first of all this is really common.

其次，这就是我想要为之训练的目标。

And secondly, this is what I want to train for.

四年来第一次意识到，我想要训练的目的就是为了避免这种情况。

For the first time in four years realized, the thing I want to train for is to avoid this.

我想设计一项体育活动，一项在我生命终点时完成的活动，从现在到那时的一切都将是为它进行的训练。

I want to come up with an event, an athletic event that will be done at the end of my life and everything between now and then will be training for it.

于是我就想出了这个叫做'百岁十项全能'的主意。

And so I just came up with this idea called the centenarian decathlon.

并非因为它暗示必须活到100岁才能参赛，甚至也不意味着必须包含10个项目，而是作为一种思维模型，思考哪些是我生命终点时仍想做到的最重要活动——既包括日常生活活动，也包括表现性活动——以及我能多清晰地定义它们。

Not because it implies that one has to live to a 100 to compete or not even to imply that it has to have 10 events But simply as a mental model to say what are the most important activities, both activities of daily living and activities of performance that I want to be able to do at the end of my life And how well can I define them?

我能在多大程度上理解执行这些活动所需的体能特质？

How well can I understand the physical traits that will be necessary to execute them?

然后我能从中倒推出多少内容？

And then how much can I reverse from there or back cast from there?

我今天需要做什么，才能最大限度地提高明天完成那些事情的概率。

What I need to be doing today to increase the probability of doing those things tomorrow to the highest level.

显然，这已经成为了我的一大执念，如你所知。

And that has become obviously a huge obsession of mine as you know.

我和另外几个人围绕这个理念创办了一家公司，名为'十的平方'，专门致力于培训人们实现这一目标。

I along with a couple of other folks have started a company around this called ten squared, which is just geared towards training people to do this.

我认为，至少在有人提出更好的想法之前，这是针对非具体目标训练的最佳模式。

And I think that it is at least until someone shows me a better idea, the best model for how to train if your goal is not something very specific.

所以，如果你 再次强调, 如果你来找我说, 我知道你多么热爱柔术, 如果你说, 看, 20 6个月后有一场锦标赛, 我真的很想参加。

So again, if you came to me and said, I know how much you love jujitsu, if you're like look, there's this tournament coming up in six months and I really wanna compete for it.

那不是百岁十项全能。

That's not the centenarian decathlon.

这是你需要进行的非常特定类型的柔术训练，以便参加比赛。

That's a very specific type of training you need to be doing in jujitsu to go and compete there.

比如，我妻子明年要参加波士顿马拉松，她想跑出某个成绩，这与她的百岁十项全能训练完全无关。

If you know, my wife is running the Boston Marathon next year and she wants to run a certain time, she will have nothing to do with training her centenarian decathlon.

她将进行非常非常特定的跑步训练，以确保达成目标。

She is going to be doing very very specific running workouts to make sure she hits her goals.

因此训练方式有很多种，但我想说的是大多数人训练的目的并非为了成为本地柔术比赛的最佳选手，也不是为了在波士顿马拉松创造个人纪录。

So there are lots of other ways to train but my point is that most people aren't training to be the best at their local jujitsu tournament or to run their PR at the Boston Marathon.

即使他们确实在做这些事，通常也是短暂的。人们真正应该训练的目标，是让自己在人生最后十年成为最出色的自己。

And even if they do those things, they're usually fleeting and ultimately what people really wanna be training for is to be the most kick ass versions of themselves in the last decade of their life.

再说一次，如果这意味着你80到90岁时身体机能像70岁一样好，那将与大多数人的经历完全不同。

And again, if that means your 80 to 90 years are functioning like you're a really good 70 year old, that's a totally different experience from what most people go through.

假设有人在为百岁十项全能训练，他们认同这个理念并表示‘我要把全部精力投入其中，如何成为专注生活的运动员？’

Let's say someone is training for the centenary decathlon, so they kind of agree and they say, I wanna put all my focus into this which is how do I become an athlete focused on life?

我们不必详细讨论这些，因为在节目说明中会链接到我们多次讨论过这些内容的地方。

And we don't have to get into these in detail because in the show notes, we'll link to the multiple multiple places we've talked about them.

但对于有兴趣参加百岁十项全能训练的人，你认为哪四个要素最重要？

But what are the four components that you think are important for someone who is interested in training for the Centenary Decathlon?

一切始于基础。

It starts on the foundation.

你必须具备稳定性。

You have to have stability.

你必须拥有底盘。

You have to have the chassis.

基本上，我会说是底盘和轮胎。

Basically, I'd say the chassis and the tires.

你需要掌握运动控制的每个方面：协调性、力量释放能力、力量承受能力以及平衡能力。

You have to have every aspect of the motor control, coordination, ability to dissipate force, ability to receive force, ability to balance.

稳定性包含的内容如此丰富，我认为值得用半章篇幅来阐述，虽然解释起来最为复杂，但一旦缺失却显而易见。

There's so much that goes into stability that it I think got a full half chapter in the book and it's far and away the most complicated to explain but it's really obvious to see it when it's not there.

我们每个人都存在稳定性不足的问题，这是我转向这种训练方式时最大的认知重塑。

So every one of us is lacking in stability and it was the biggest re education for me as I pivoted to this way of training.

这包括从学习如何正确加压腹腔空间，到如何解锁肋骨、保持适当重心，再到如何根据需要等长收缩肌肉，如何在控制下完成动作，以及如何保持良好的足部力学，对吧？

So it's everything from learning how to appropriately pressurize your intra abdominal space to how to unlock your ribs, maintain an appropriate center of gravity, how to be able to isometrically contract muscles as necessary, how to be able to do it under control, how to have good foot mechanics, right?

我的意思是，我们曾为这些内容做过专门的播客，因为稳定性训练的每个组成部分都相当微妙。

I mean all of these things we've done dedicated podcasts on because each component of this stability game is quite nuanced.

好消息是，虽然我们大多数人在中年时在这方面存在巨大缺陷，但它们都是可以重新训练的。

And the good news is while most of us show up to the middle part of our life with enormous deficits here, they're all retrainable.

实际上即使到了老年，我们的身体仍然具有相当的可塑性。

We're actually still quite plastic in our old age.

第二个组成部分是力量。

Second component is strength.

我认为力量的子成分是爆发力。

And I would say a sub component of strength is power.

尽管随着年龄增长我们会很快丧失爆发力，但保持得越多越好。

So even though we lose power very quickly as we age, the more we can maintain it the better.

没有力量和稳定性，就不可能有爆发力。

And you can't have power without strength and stability.

第三个要素，这更像是一个连续体，第三和第四要素共同构成心肺适能的连续谱系。

The third component, and this is really more of a continuum, the third and fourth are part of a continuum of cardiorespiratory fitness.

我将其比喻为一个三角形。

I talk about this as being a triangle.

三角形的底边代表有氧效率。

So the base of the triangle is the aerobic efficiency.

也就是最大脂肪氧化能力。

So this is the maximum fat oxidation.

这是你全天候的基础代谢节奏。

This is your all day pace.

我们希望这个数值尽可能高。

We want that to be as high as possible.

而三角形的顶点则代表最大摄氧量（VO2 max）。

And then the peak of the triangle is the vo two max.

最贴切的比喻就是发动机的排量大小。

That's most adequately thought of as the engine size.

这就是有氧运动的峰值输出。

So that's the peak aerobic output.

这就是四个组成部分，我们与患者和十平方客户一起做的练习之一就是，一旦确定了某人的百年目标和十项全能目标，就将它们分解为具体需求。

Those are the four components and one of the exercises we do with both our patients and obviously the clients in 10 squared is once you have a person's centenary and decathlon goals, you break them down into what is required.

所以如果你给我你的清单，我们可以拿这份清单说，哦，这需要每分钟每公斤31毫升的最大摄氧量。

So if you give me your list, we can take that list and we can say oh this requires a VO2 max of 31 milliliters per kilogram per minute.

这需要能够这样坐着，或者在这个领域需要达到这样的力量水平。

This requires an ability to sit this way or this requires this much strength in this domain.

这需要这种类型的髋关节负荷等等。

This requires this type of hip loading etcetera etcetera.

然后我们可以评估一个人目前的状态，然后说，哦，显然你现在能做所有这些事，但这是每项能力未来衰退的预测轨迹，四十年后你会在基准线之上还是之下？

And then we can evaluate where a person is today and then say, oh okay, well obviously today you can do all of those things but here's the predicted trajectory of decline on each of those things and will you be above your benchmarks in forty years or will you be below them?

对我们大多数人来说，包括我自己，至少在部分指标上，你实际上远低于目标水平，因此必须现在提升表现，以确保未来能达到目标。

And for most of us, myself included, at least on some of those dimensions, you're actually considerably below them at your target and therefore you have to raise the performance currently to make sure you hit the targets in the future.

就像我们提到的，对于任何想进一步了解运动相关内容的听众，我们会在节目笔记中链接多个播客文章等资料，方便大家深入阅读。

And like we mentioned for anyone who is interested in further on anything exercise in the show notes, we'll link to the multiple podcast articles etcetera so people can dive in.

但从运动转向你第二喜欢的营养话题，你的思考框架是什么？因为你不一定像某些人那样谈论营养，他们总说说这种饮食最好或那种饮食最好。

But moving from exercise to your second favorite, nutrition, what's your framework for how you think about nutrition because you don't necessarily think about nutrition as some people talk about it which is this diet's best or this diet's best.

你以一种不同的方式看待它，所以你想带大家了解你的框架吗？你如何评估营养状况以及一个人的营养状态？

You kind of look at it a little bit of a different way and so do you want to walk people through your framework and how you assess nutrition and where someone is at in their nutritional state?

是的。

Yeah.

我想说的是，营养是一个非常复杂的研究领域。

I mean I would say that nutrition is a very complicated thing to study.

我认为这是所有支柱中最混乱的研究领域，可能比情绪健康还要混乱，尽管这一点或许有争议。

I would say it's the messiest of all the pillars to study, probably even messier than emotional health, although maybe that's debatable.

但原因显而易见且无需重申。正因如此，这个领域中很少有能高度确定的事情。

But the reasons for it are obvious and not worth restating But it's for that reason that there were very few things that can be stated in this field with a high, high degree of certainty.

不幸的是，营养学的挑战在于，有很多人说话时带着疯狂的自信，他们谈论某些事情时仿佛绝对正确，即使你给他们的陈述加上误差范围，那误差也会大过他们说的内容。

So unfortunately, the challenge in nutrition is you have a lot of people that speak with such insane conviction and they talk about something as though it is absolutely correct even though if you were putting an error bar on their statement, it would dwarf anything they're saying.

说实话，我自己也曾犯过这样的错误。

And truthfully, I have been guilty of this.

我认为十二年前，我谈论营养学时的那种确定性其实是没有依据的。

I think twelve years ago, I was talking about nutrition with a level of certainty that I don't think was warranted.

正如那句老话所说，离岸越远，海水越深。

And so as the adage goes, the further you get from the shore, the deeper the water.

随着年龄增长，我发现自己其实已经离岸很远，意识到这里的海水深不可测，很少有事情能确定到值得你盲目相信的程度。

And I think in my older age, I'm actually quite far out from the shore and I realized the water is awfully deep out here and there aren't a lot of things that can be stated at a high enough degree of certainty that you should act on them with almost blind faith.

所以这里有两件事我可以非常非常确定地告诉你。

So here are the two that I can tell you with a very very high degree of certainty.

第一点是，营养对人体整体健康最重要的单一输入因素是能量平衡。

The first is that the single most important input from nutrition to a person's overall health is energy balance.

换句话说，食物能量输入是健康的第一决定因素。

Stated another way, the energy input of food is the first order determinant of health.

再换个说法，你摄入的总热量是最重要的因素。

Maybe stated another way, the total calories you consume would be the most important thing.

当然不是唯一因素，我并不是说一千卡路里的薄荷糖和一千卡路里的西兰花效果相同，它们显然不同。

Not the only thing, I do not want to suggest that a thousand calories of tic tacs is the same as a thousand calories of broccoli, it is not.

但我是从常识的角度来讨论这个问题。

But I'm also talking about this through the lens of common sense.

事实是，如果你靠吃薄荷糖度日，你摄入的热量会远超一千卡路里，因为它们既不饱腹又毫无营养。

And the truth of it is, if you subside on a diet of tic tacs, you're gonna eat a lot more than a thousand calories of them because they're not satiating and they're junk and they're hollow.

所以我要明确说明，首要因素是总热量摄入，但它也受许多其他因素影响，包括饮食质量、加工方式和宏量营养素分配。

So I wanna be very clear that the primary input is total energy but it is also impacted by many other things including diet quality, processing and macronutrient distribution.

第二点非常明确的是，蛋白质是我们最不应该妥协的宏量营养素。

The second thing that is abundantly clear is that protein is the macronutrient we should be least flexible on.

换句话说，我们可以相当灵活地调整碳水化合物和脂肪的摄入量来满足能量需求。

Stated another way, we can be quite flexible on how much carbohydrate and fat we consume to fill our energy needs.

但由于蛋白质的摄入目的不是产生ATP（这是我们摄入碳水与脂肪的主要原因，尽管脂肪也承担某些结构功能），我们对蛋白质需求不能太过灵活或妥协。

But because protein is not consumed for the purpose of ATP generation, which is the principal reason we consume carbohydrates and fats, although fats are also essential for some structural purposes, We cannot be too flexible or compromising in our protein requirements.

换句话说，如果非要给出一个具体数值，我会说平均每人每天应摄入每公斤体重1.6克蛋白质。

In other words, if you really wanted to just come up with a single number to give people, I would say on average about 1.6 grams of protein per kilogram of body weight should be consumed by everybody.

重申一次，我讨厌这种笼统说法，因为确实不存在放之四海皆准的标准。

Now again, I hate saying that because there's truly nothing that you can say across the board.

显然，根据饮食情况，有些人需要更多蛋白质，而有些人可能可以稍微少摄入一些。

There are clearly people who based on what they're eating will need more protein and there are probably people who can get away with a little bit less.

如果一个人摄入的是PDCAS评分完美1.0的高质量蛋白质，且活动量不大，他们可能只需1.2克甚至1克就够了。

If you took a perfectly high quality PDCAS one point zero protein in a person who's not over the moon active, they could probably get away with 1.2 grams or even one gram.

但如果低于这个量，你就真的开始亏待自己了。

But boy, anything below that and you're starting to really miss out.

顺便说一句，随着年龄增长，由于合成代谢抵抗，这些需求会增加。

And by the way, as you age, those requirements go up due to anabolic resistance.

所以我们可以整天讨论各种饮食方式、各种信仰体系，以及每个饮食阵营里的各种分支。

So again, we can talk all day about every diet under the sun and every religion and every faction of every religion around every dietary tribe.

但事实是，要找到一个真正的营养科学家真的很难。

But the truth of it is, it's really hard to find a scientist, an actual nutrition scientist.

我说的不是那些网红。

I'm not talking about an influencer.

我说的也不是健康博客。

I'm not talking about a health blog.

我指的是那些真正在实验室从事营养研究工作的人，他们会反对这种说法。

I'm talking about actual people who work in labs doing nutrition who will disagree with that statement.

确实有少数人持不同意见，但他们是极少数，而且有趣的是他们在讨论这些问题时往往回避使用人类数据。

There are some, but they are in the huge minority and interestingly they tend to avoid using human data when they talk about those things.

但当你将研究对象限定为人类而非啮齿动物，并结合实验数据与其他观察结果时，这两点似乎最为关键。

But when you limit yourself to the species of interest, which is humans, not rodents and you talk about experimental data coupled with other insights, those two things seem to matter the most.

你摄入了多少卡路里？

How many calories are you getting?

既不过多，也不过少。

Not too much, not too little.

你摄入的蛋白质足够吗？

Are you getting enough protein?

当然还有其他考量因素。

Obviously there are other terms.

我们当然也要确保你摄入足够的微量营养素，并避免毒素摄入。

We certainly want to make sure you're getting enough micronutrients as well and that you're avoiding toxins.

如今这个问题已经比一百年前要少见得多了

That tends to be less of an issue today than it was a hundred years ago.

不过当然这本身也很有意思

But of course that's also really interesting.

但尼克提到的很多其他内容都是细节

But a lot of the other stuff Nick is details.

所以当我面对病人时，考虑到这些因素的重要性，我认为从一开始就评估这些指标是合理的

So when I'm looking at a patient, given how important those things are, to me it makes sense to be evaluating those things at the outset.

当我们第一天为某人做DEXA扫描时，就能看到他们的皮下脂肪含量、内脏脂肪含量、肌肉量，还能通过高级血液检测了解他们的代谢健康状况、葡萄糖代谢能力等各项指标

So when we do a DEXA scan on somebody on day one and we can see how much subcutaneous fat they have, how much visceral fat they have, how much muscle mass they have and we can do a lot of advanced blood work and see how metabolically healthy they are, how well they dispose of glucose, all these other things.

我可以迅速回答三个关键问题

I can very quickly answer three questions.

实际上在初次接触时就能完成

Literally on first contact.

你是营养过剩还是营养不良？

Are you overnourished or undernourished?

这归根结底是能量平衡的问题。

And that really comes down to energy balance.

你体内有多少脂肪？这些脂肪在体内的分布状况如何？

How much fat do you have on your body and how well is it distributed throughout your body?

具体分布在哪些部位？

Where is it distributed?

第二个问题：你的肌肉量充足还是不足？

Second question, are you adequately muscled or are you under muscled?

第三个问题：你的代谢功能是否健康？

Third question: Are you metabolically healthy or not?

当你能回答这三个问题——通过少量数据在短时间内就能得出结论——就能判断这个人需要增加、减少还是维持现有总能量摄入，蛋白质该增减多少，以及应该进行何种运动来强化我们的发现。

And when you can answer those three questions, which you can in a very short period of time with a relatively small amount of data, that tells you does this person need to eat more, less or the same total energy, the same amount of protein or less and how important and what type of exercise should they be doing to augment our findings.

既然讨论的是营养问题，我最后补充一点：大多数人做完检测后都会略高于营养过剩的阈值。

Because we're talking about nutrition, I'll close this out by saying most people when they do this come out slightly in the overnourished category.

这其实就是说大多数人都超重或肥胖的另一种表述方式。

That's just another way of saying most people are overweight or obese.

我认为这个数字可能显示70%的人口处于营养过剩或严重营养过剩状态。

I think the numbers are probably seventy percent of the population are overnourished or significantly overnourished.

因此，当大多数人走完整个治疗流程后，最终都会归入'我需要少吃'的阵营。

Therefore, most people when you go through that whole treatment algorithm are going to be in the I need to eat less camp.

如果你属于'我需要少吃'阵营，现在有三种方法可以实现。

If you are in the I need to eat less camp, you now have three ways to do that.

可以说是三种策略。

Three strategies if you will.

第一种是直接减少热量摄入。

The first is directly reducing caloric intake.

也就是说，不考虑吃什么或何时吃，我只需要简单减少进食量。

So, that says, agnostic to what or when I eat, I will simply eat less.

这是最直接的方式。

This is the most direct way to do it.

这种方式有很多优缺点，我们在其他播客中已经详细讨论过，稍后会附上链接。

It has lots of pluses and minuses which we have discussed in so much detail in other podcasts that we'll link to.

第二种方法是，我会找出饮食中某些或某类食物并将其从饮食中剔除。

The second method is I will identify something or some set of things in the diet that I will remove from the diet.

我会限制这些食物。

I will restrict them.

这被称为饮食限制。

This is called dietary restriction.

而且饮食限制的元素越严格，这种方法的成效就越显著。

And the more restrictive the elements of your diet, the more effective this technique is.

所以，如果你只限制生菜的摄入，这将毫无效果。

So, if you only choose to restrict lettuce, this will have no effect.

但如果你限制除土豆外的所有食物——即只允许自己吃土豆——这将产生巨大效果。

If you restrict everything but potatoes, meaning if the only thing you allow yourself to eat is potatoes, this will have an enormous effect.

因此，限制得越多，效果就越好。

So, the more you restrict the better that works.

第三种策略是时间限制，即缩短进食的时间窗口，这个窗口越窄，总体上造成热量不足的可能性就越大。

And then the third strategy is time restriction where you limit the window in which you eat and the narrower and narrower that window, the greater the likelihood that you will overall induce a caloric deficit.

关于营养学我还有很多可以说的。

So there's a lot more I can say about nutrition.

我们可以深入探讨哪种脂肪更好——饱和脂肪、单不饱和脂肪还是多不饱和脂肪。

We could get into the nuances of which type of fats are better, saturated fats, monounsaturated, polyunsaturated fats.

地中海饮食是否比低碳水化合物饮食或低脂饮食更有效这类问题。

Is a Mediterranean diet more efficacious than a low carb diet or a low fat diet and all of those things.

重申一下，这些内容我都写过也讲过，但从最重要的角度来看，我想你已经掌握了要点。

Again, I've written about, I've spoken about but I think from the standpoint of what are the most important things, think you've got it.

你想起中午吃了什么吗？

Have you remembered what you ate for lunch yet?

我觉得这是营养讨论中唯一遗漏的部分。

That's I think the only thing from the nutrition conversation that's missing.

我狼吞虎咽地吃了昨天剩下的意大利面南瓜，还吃了什么来着？

I scarfed down some leftover spaghetti squash that we made yesterday and what else did I have?

哦，我还吃了一盒黑莓和一些鹿肉。

Oh, I had a container of blackberries and I had some venison.

就是这样。

There you go.

很好。

Great.

接下来谈谈睡眠。

Moving on to sleep.

睡眠是你曾撰文讨论过的话题，你现在比过去更加重视它了。

So sleep is something you've written about where you take it much more seriously now than maybe you used to in the past.

那么你想谈谈为什么你认为睡眠不仅是寿命长短，更是健康寿命的关键因素吗？

So do you wanna talk about why you think sleep is such an important component of not only lifespan but also health span.

嗯，我认为数据比我更有说服力地证明了这一点。

Well, I think the data really make the case more compellingly than I need to.

幸运的是，短期睡眠剥夺很容易研究，它明确显示出对认知能力、体能表现、胰岛素抵抗等健康指标以及食欲的显著负面影响。

Fortunately, short term sleep deprivation is easy to study and it unequivocally demonstrates a remarkable negative impact on cognition, on physical performance, on physical markers of health such as insulin resistance, on appetite.

当睡眠不足时，人体所有机能都会出现问题。

Everything that can go wrong in the human body goes wrong when you are sleep deprived.

再次强调，这其中的好处在于你无需进行长达五年的研究就能得出这些结论。

And again, what's nice about this is you don't need to do five year studies to figure this out.

只需进行两到三周的实验，将受试者的夜间睡眠时间缩减至四小时，就能在他们清醒状态下彻底摧毁各项生理指标。

You can do two week, three week studies where you take people down to four hours a night of sleep and you can absolutely destroy them in every physiologic measure during the wakeful period of their lives.

因此我们可以推断，如果每晚只睡五个半或六小时，可能不会产生那么严重的负面影响。

So we can then extrapolate from there that okay, well if you're only sleeping five and a half or six hours a night, you're probably not getting as much of the negative effects.

但当我们观测到其他负面效应虽然程度较轻，仍很容易将其归因于睡眠不足。

But when we see and measure other effects that are negative to a lesser extent, it seems pretty easy to attribute them to the reduction of sleep.

换句话说，当研究对象不像短期研究中那样严重缺觉时，他们也会出现类似问题，只是程度较轻。

So in other words, when you look at a person who's not sleeping as inadequately as people are typically studied in short term studies geared towards identifying the risks, they get many of the same problems but just not as extreme.

这表明睡眠减少存在剂量效应。

Suggesting there's a dose effect to sleep reduction.

说实话，我认为相比十年前，如今社会更愿意接受这个观点。

And truthfully, I think that this is something that I think society is far more willing to entertain today than ten years ago.

我认为我的挚友Matt Walker对此功不可没。

I think Matt Walker, who's also a very close personal friend, has had a lot to do with this.

阿丽安娜·赫芬顿让这个问题受到了广泛关注。

Ariana Huffington has brought a lot of attention to this.

所以我认为现在有很多人都在说，嘿，'等我死了再睡觉'这种我曾经奉为信条的想法，实际上如果你坚持这种信条，只会死得更快。

So I think there are many people out there that are saying, hey, this whole idea of I'll sleep when I'm dead, which used to be my mantra is like, you're gonna be dead quicker if you adopt that mantra.

所以，你确实会在死后长眠，而且死亡会比你所期望的更早到来。

So you will indeed sleep when you're dead and you'll be dead sooner than you wanna be.

所以，我认为这一点不需要太多说服。

So again, I think that this one doesn't require a lot of convincing.

但具体如何操作当然要复杂一些。

But how to do it of course is a little more complicated.

好消息是确实有很多很棒的行为疗法工具，而且对某些人来说，最终可能需要药物或机械辅助设备，比如如果患有呼吸暂停症，可以使用CPAP，这里确实有药物和其他技术可以提供帮助。

The good news is there's really a lot of wonderful behavioral tools and ultimately for some people pharmacology or mechanical assistance such as CPAP, if a person has apnea, there are technologies both pharmacologic and otherwise that can really help here.

但对大多数人来说，行为疗法就能解决问题。

But for most people the behavioral tools do the work.

这确实是那种极少需要看医生来解决睡眠问题或排查睡眠障碍的情况之一。

This is really one of those things where very few people need to see a physician to help them sleep or to troubleshoot a sleep problem.

幸运的是，当你需要时，有一整个医学分支专门研究睡眠生理学。

And when you do, fortunately there's an entire branch of medicine dedicated to sleep physiology.

确实有专门研究睡眠的医生，必要时我们当然会毫不犹豫地寻求他们的帮助。

There are actual physicians who specialize in this and we're certainly not afraid to use them when it's necessary.

还有一种行为疗法领域叫做失眠认知行为疗法，这是一整套专门针对失眠期间可用认知工具的方法体系。

There's also a field of behavioral therapy called cognitive behavioral therapy for insomnia that is an entire discipline that is dedicated towards the cognitive tools that you can use during periods of insomnia.

我们诊所经常遇到睡眠质量极其糟糕的患者，在所有问题中，这是我最乐观能在短期内帮助改善的。

So we always get patients in our practice who just have what can only be described as the most abjectly horrible sleep and of all the problems we face, this is the one that I tend to be most optimistic about our ability to help in a relatively short period of time.

我们有一整期AMA节目专门讨论睡眠问题，还有多期Matt Walker专题节目。

We have a whole AMA dedicated to sleep along with multiple Matt Walker episodes.

所以我觉得不需要深入细节，因为我们会在节目说明中附上相关链接。

So I don't think we needed to get into insane detail because we will link it in the show notes.

不过你提到了一些行为工具，如果有人表示'我需要更关注睡眠，需要采取措施改善睡眠'的话——

But you mentioned a few of the behavioral tools and so if someone says, okay, I need to take more awareness of my sleep, I need to do more to get better sleep.

他们可以关注和评估的具体事项有哪些？

What are some of the things that they can look at and evaluate?

如果我们在电梯里，从1楼到15楼的短暂时间里要我告诉你最重要的建议，我会说尽量每天固定时间上床和起床。

I would say if we were in an elevator and we had only between the 1st Floor and the 15th Floor for me to tell you everything that mattered, I would say try to go to bed at the same time and wake up at the same time every day.

确保在床上躺够八小时，让房间尽可能黑暗和凉爽，睡前两小时远离任何刺激性事物，尤其是令人烦躁的工作和社交媒体这类东西。

Give yourself about eight hours to be in bed, make the room as dark as possible, as cold as possible and detach yourself from anything stimulating, especially upsetting which is work, social media, that kind of stuff for two hours before bed.

如果电梯还没到15楼，我会补充说睡前三个小时内不要进食或饮酒。

And if we haven't hit the 15th Floor yet, I would say try to not eat or drink any alcohol for three hours before bed.

这些都是零风险、零后悔的改善睡眠措施。

Those would be the no risk, no regret moves to try to fix your sleep.

顺便说一句，这已经很多了。

And that's a lot by the way.

我并不是说这对一个什么都没做的人来说会很容易。

I'm not suggesting that would be easy to do for someone who's doing none of them.

但如果你给我100个抱怨睡眠不好或客观测量显示睡眠不佳的人，他们全都照做了，我认为其中80人会有所改善。

But if you gave me a 100 people who were complaining of poor sleep and or objectively had measurements of poor sleep and all a 100 of them did that, think 80 of them would get better.

现在谈谈药物和补充剂。

Moving to drugs and supplements.

如果你审视所有药物和补充剂，我们拥有海量的相关内容，这里不可能回答所有收到的提问。

This is something that if you look at all the different drugs, pharmacologic, if you look at all the supplements, we have an insane amount of content on, impossible to answer all the questions here that come in.

但我认为应该帮助人们理解药物和补充剂的正确关系——该如何看待它们，又该如何避免误区。当患者带着20种补充剂清单来就诊时，你该如何与他们沟通？

But I think helping people understand just what the relationship with drugs and supplements should be, how they should think about it, how they should not think about it, How do you talk to patients about that who come in to the practice and maybe have a list of 20 supplements that they show up with?

对，这确实是一种典型表现。

Yeah, that's definitely one phenotype.

我想说这需要同时应对两种极端情况。

I would say just to kind of address both extremes.

有些人认为药物和补充剂能解决一切问题，而另一些人则认为永远不该服用任何药物或补充剂。

You have some people who think everything is solved by drugs and supplements and then you have people who think you should never take a drug or a supplement.

所以我总是提醒人们：药物和补充剂只是工具。

And so I just always kind of try to remind people, drugs and supplements are just a tool.

说'我永远不想吃药'就像告诉承包商：'请好好盖我的房子，但永远别用锤子或十字螺丝刀'。

To say I never wanna take a drug is kind of like telling a contractor, hey, please do a good job building my house but just never use the hammer or never use the Phillips screwdriver.

你可以用方头螺丝刀，但不能用十字的。

You can use the Robertson but not the Phillips.

你只是需要工具。

You just wanna have tools.

我们只是需要工具，而最优秀的承包商、木匠和工匠会拥有最多的工具，并且最擅长知道何时以及如何使用它们。

We just wanna have tools and the best contractor and carpenter and tradesman is gonna have the most tools and the most facility with knowing how and when to use them.

因此，话虽如此，我们确实在补充剂方面有一个框架，因为正如你所说，补充剂的数量是无限的。

So, that said, we do kind of especially on the supplement side, have a framework because as you said, there's an infinite number of supplements.

受监管的药物数量有限，但补充剂的数量是无限的。

There's a finite number of regulated drugs but a non finite number of supplements.

所以你必须为此建立一个框架。

So you have to have a framework for this thing.

因此，对于任何外源性分子，我首先问自己的问题是：服用这种分子是为了延长寿命还是改善健康寿命？

And so the first question I'm always asking myself with any exogenous molecule is is this a molecule that is being taken to lengthen lifespan or improve health span?

你会惊讶于我询问服用补充剂的人他们是为了这两个目的中的哪一个而服用的次数。

You would be amazed at how many times I ask somebody who's taking a supplement which of those two they're taking it for.

通常你会得到一个非常茫然的表情。

Usually you get a very blank stare.

我服用它是因为网红推荐我用的。

I'm taking it because influencer told me to take it.

好吧。

Okay.

那么假设我们能确定你服用它是出于上述原因之一。

So let's say we can establish that you are taking this for one of those reasons.

它要么能让我活得更久，要么能改善我的身体、认知或情绪健康。

It's either gonna make me live longer and or it's going to improve my physical, cognitive or emotional health.

接下来我要问的是：如果这是一种延长寿命的增强剂，如果它能让你活得更久，它是通过针对特定疾病实现的，还是一种广泛的抗衰老分子？

The next question I would say is okay, if this is a lifespan enhancer, if this is gonna make you live longer, is it doing it by targeting a specific disease or is it a broad gero protective molecule?

同样地，如果你告诉我这是一种健康寿命增强剂，它是专门增强认知健康、身体机能、情绪健康，还是通过某种我们不了解的机制在起作用？

Similarly, if you're telling me this is a health span enhancer, is it specifically enhancing cognitive health, physical performance, emotional health or is it sort of acting through some mechanism we don't understand?

我会询问我们是否有关于这个的安全性数据。

I would ask if we have safety data on this.

我会询问我们是否有人体有效性数据，如果没有的话，是否有动物实验数据。

I would ask if we have efficacy data in humans and or in animals if not.

如果是在动物实验中，其相关性如何？

And if in animals, how relatable is it?

如果是补充剂，我会问我们如何控制纯度？

If it's a supplement, I would ask how can we control for purity?

我们怎么知道瓶子上标注的成分与实际内容一致，且没有不该存在的成分？

How do we know that what the bottle says is in it, is actually what's in it and that nothing that's not supposed to be in it isn't in it?

还有几个问题，但大致就是这些。

There are a few more questions but that's the long and short of it.

因此，我认为需要通过这类检验流程，对所有事物施加这种筛选，只有到那时我们才能考虑该使用哪些补充剂。

And so, I think one needs to go through that type of exercise and put that type of filter to everything and then and only then I think should we go down the path of okay, what supplements do we want to use?

我们何时需要考虑使用药理学手段、激素疗法这类方法。

Where do we want to turn to pharmacology, hormones, those things.

转到最后一个策略，你刚才也稍微提到了，因为情绪健康也属于健康寿命范畴。

Moving to the last tactic and you talked a little bit about this because emotional health fits in the health span bucket as well.

但当人们思考长寿时，情绪健康通常不是经常被提及的方面。

But when people think about longevity, emotional health is not something that usually comes up a lot.

那么对于已经在关注营养、运动、睡眠、药物和补剂，但尚未重视情绪健康的人，你会对他们说些什么？

And so what would you say to someone who maybe is taking the steps in their nutrition, their exercise, their sleep, drugs and supplements, but not necessarily focusing on their emotional health?

关于情绪健康的重要性——虽然你不一定总将其与长寿直接关联，但你认为这是关键因素——你会给他们什么建议？

What would your advice to them be on how emotional health, you don't necessarily correlate it all the time with longevity, but you find it to be an important aspect?

嗯，我认为有两个层面。

Well, mean, think there's two components.

尽管无法证实，但有充分证据表明：能更好管理压力、更快乐且拥有更健康人际关系的人，很可能也更长寿。

I think there is enough evidence, though you could never prove it, that a person who's managing their stress better, who's happier and who has better relationships, probably also lives longer.

流行病学数据无疑支持这一点，这是很明确的。

Certainly the epidemiology suggests all of that, that's not unclear.

但我必须承认，要证明其中的因果关系非常困难。

But I'm acknowledging that that would be very difficult to demonstrate causality.

人们可能因为健康状况更好而更快乐、拥有更好的人际关系等等。

People could be happier and have better relationships and all those things because their health is better.

所以这里可能存在反向因果关系。

So it could be reverse causality there.

但我认为实际上已有足够证据表明至少存在双向因果关系。

But I think there's actually enough evidence that there's at least bidirectional causality there.

但我觉得要帮助人们思考这个问题，我会说先别管那个。

But I think to help somebody think about this, would say just forget that.

我们假设痛苦、孤独和愤怒能让你活得更久。

Let's pretend that being miserable, lonely and angry helped you live longer.

而如果你快乐、拥有良好人际关系且内心和谐，反而会缩短寿命。

And that if you were happy and you had great relationships and you were in harmony, you would live shorter.

当这样表述时，谁会选择前者呢？

Who would choose the former when you frame it that way?

除了极端情况——比如快乐的人活不过30岁，痛苦的人能活到100岁。

Outside of extremes, like okay, happy people can't live past 30, miserable people can live to a 100.

我敢肯定很多人会说宁愿痛苦地活到100岁。

I'm sure a lot of people would say, well I'd rather be miserable at a 100.

但事实是，即便这样表述也显得很荒谬。

But the truth of it is, even framed that way it seems ridiculous.

综上所述，作为一个思想实验，暂且把寿命这部分忘掉。

So all of that is to say as a thought experiment, just forget the lifespan piece of this.

单纯从常识的角度来思考这个问题。

Just think of it through the lens of common sense.

你为什么会选择让自己不快乐呢？

Why would you ever choose to be unhappy?

这毫无道理。

It doesn't make sense.

而我认为对我而言，一个深刻的领悟是：你可以对此采取行动。

And I think what maybe for me was a big insight late in life was you can do something about this.

每个人都有自己的故事、经历和背景，这些都是可以改变的。

Everybody's got a story, everybody's got a history, everybody's got a background that brings them to the table, but it's all modifiable.

所以关键点在于：软件是可以被修改的。

So the software can be modified is the point.

关于这点我们有太多内容可以探讨，显然无法在此详细展开。

And we've got so much content on this that I obviously couldn't go into it in any detail here.

但我认为本次讨论中最关键的是，这个领域整体上与其他领域同等重要，甚至可能更为重要，因为如果这一领域得不到控制，其他方面都无关紧要。

But I think the most important thing for the purpose of this discussion is that this entire area is as important, potentially more important than all of the others because without this one in check, the other ones don't matter.

彼得，我想这基本涵盖了我们希望讨论的内容。

Peter, I think that kinda wraps what we were hoping to cover.

正如我们一开始提到的，目的不是深入探讨所有细节，我们会提供相关链接，而是更侧重于概述长寿基础，为新人或需要复习的人讲解一些核心概念。

And again, as we kind of mentioned on the outset, the idea is not to get into the super intense details on everything, we'll link to that but more so cover high level longevity one zero one, how you think about some core aspects for people who are newer, people who need a refresher.

我认为最后应该以这个问题结束：如果有新人正在收听，可能对从何开始感到有些迷茫，对吧？

I think the last thing that we should end with is just if someone is new and they're listening to this and they maybe feel a little bit overwhelmed on where they should start, right?

我们谈到了很多关于寿命、健康寿命、不同疾病和各种策略的信息。

A lot of information came out of them on the lifespan, health span, different diseases, different tactics.

对于那些想更认真对待但不知从何开始的听众，你会给他们什么建议？

What advice would you give someone who is listening and they would say, I wanna take this more seriously but I'm a little overwhelmed on where to start?

我会说，先选一个方面入手。

I would say just pick one.

这不是竞赛，我认为找到你认为能取得成效的领域，就是最好的起点。

It's not a race and I think finding something that you think you're gonna be successful in would be the best first place to start.

听完我们刚才讨论的所有内容后，如果有什么特别触动你的地方？

So if after listening to everything we just talked about, you're kind of like, you know what really resonates with me?

我的睡眠可能很糟糕。

My sleep probably sucks.

那我建议，你可以先不要改变饮食习惯，不要调整运动计划，不要做其他任何事，也不要买补剂，就专注改善我们谈到的睡眠问题。

Then I would say, how about you change nothing in your nutrition, nothing in your exercise, Don't do anything else, don't buy a supplement, just work on implementing the stuff we talked about on sleep.

因为如果你能改善睡眠，将会带来双重效果。

Because if you get that better, it's gonna do two things.

这会让你更容易处理其他问题，同时给你信心和掌控感，让你觉得'嘿，我其实能掌控这件事'。

It's gonna make it easier for you to address the other things and it's going to give you the confidence and agency that says, hey, I actually have control over this thing.

这并非我无法掌控的事。

It's not out of my hands.

太棒了。

Awesome.

好的，Peter，希望听众喜欢这期特别节目，感谢你的时间，我们下期再见。

Well, Peter, hopefully people enjoyed this special episode, but thank you for your time and we'll see you on the next one.

听起来很棒。

Sounds great.

感谢收听本周的《The Drive》节目。

Thank you for listening to this week's episode of The Drive.

对我来说，能够不依赖付费广告来提供所有这些内容至关重要。

It's extremely important to me to provide all of this content without relying on paid ads.

为此，我们的工作完全依靠会员的支持才得以实现。

To do this, our work is made entirely possible by our members.

作为回报，我们为会员提供独家内容和远超免费用户的高级权益。

And in return, we offer exclusive member only content and benefits above and beyond what is available for free.

如果你想在这个领域的知识更上一层楼，我们的目标是确保会员获得的回报远超订阅价格。

So if you wanna take your knowledge of this space to the next level, it's our goal to ensure members get back much more than the price of the subscription.

高级会员享有多项权益。

Premium membership includes several benefits.

首先是详细的播客节目笔记，涵盖每期节目中讨论的每个话题、论文、人物和相关内容。

First, comprehensive podcast show notes that detail every topic, paper, person, and thing that we discuss in each episode.

坊间传闻我们的节目笔记无人能及。

And the word on the street is nobody's show notes rival ours.

第二，每月一期的'问我任何问题'（AMA）特别节目。

Second, monthly ask me anything or AMA episodes.

这些节目专门回答订阅者提问，通常聚焦单一主题，旨在为会员特别关注的话题提供详尽清晰的解答。

These episodes are comprised of detailed responses to subscriber questions, typically focused on a single topic and are designed to offer a great deal of clarity and detail on topics of special interest to our members.

当然，您也能获取这些节目的完整内容笔记。

You'll also get access to the show notes for these episodes, of course.

第三，您将收到由专业研究团队编写的付费版新闻简报。

Third, delivery of our premium newsletter, which is put together by our dedicated team of research analysts.

这份简报涵盖延长寿命领域的广泛话题，内容比免费周刊更为深入详尽。

This newsletter covers a wide range of topics related to longevity and provides much more detail than our free weekly newsletter.

第四，可访问专属播客频道，收听所有节目（包括精简版的AMA问答，不含您现在听到的这些介绍性内容）。

Fourth, access to our private podcast feed that provides you with access to every episode including AMA's sans the spiel you're listening to now and in your regular podcast feed.

第五，会员专享的《精华集》播客，精选本节目往期最佳片段混剪而成。

Fifth, the Qualys, an additional member only podcast we put together that serves as a highlight reel featuring the best excerpts from previous episodes of the drive.

这是回顾往期节目的绝佳方式，无需逐一回听每一集。

This is a great way to catch up on previous episodes without having to go back and listen to each one of them.

最后，还有沿途陆续添加的其他福利。

And finally, other benefits that are added along the way.

若想了解更多并获取这些会员专属福利，请访问peterateamd.com/subscribe。

If you want to learn more and access these member only benefits, you can head over to peterateamd.com forward slash subscribe.

您也可以在YouTube、Instagram和Twitter上找到我，用户名均为PeterAttiaMD。

You can also find me on YouTube, Instagram, and Twitter, all with the handle PeterAttiaMD.

您还可以在Apple播客或您使用的任何播客平台为我们留下评价。

You can also leave us review on Apple Podcasts or whatever podcast player you use.

本播客仅用于一般信息目的，不构成医疗、护理或其他专业医疗服务实践，包括提供医疗建议。

This podcast is for general informational purposes only and does not constitute the practice of medicine, nursing, or other professional healthcare services, including the giving of medical advice.

不构成医患关系。

No doctor patient relationship is formed.

使用本播客信息及相关资料的风险由用户自行承担。

The use of this information and the materials linked to this podcast is at the user's own risk.

本播客内容并非旨在替代专业医疗建议、诊断或治疗。

The content on this podcast is not intended to be a substitute for professional medical advice, diagnosis, or treatment.

用户不应因自身任何医疗状况而忽视或延迟获取医疗建议，并应就此类情况寻求医疗保健专业人员的帮助。

Users should not disregard or delay in obtaining medical advice from any medical condition they have, and they should seek the assistance of their health care professionals for any such conditions.

最后，我非常严肃对待所有利益冲突问题。

Finally, I take all conflicts of interest very seriously.

关于我的所有信息披露及我投资或顾问的公司，请访问peterateamd.com/about，我在那里保持了一份最新且活跃的所有披露清单。

For all of my disclosures and the companies I invest in or advise, please visit peterateamd.com/ about where I keep an up to date and active list of all disclosures.