美国头号心脏风险及预防之道

你认为有人会因为心碎而死吗？

Do you think someone can die from a broken heart?

简单来说，是的。真的吗？而且确实有一种实际存在的综合征，叫做心碎综合征。真的？这确实存在。

The short answer is yes. Really? And there is an actual syndrome, broken heart syndrome. Really? It is a thing.

百分之五十的美国人患有高血压。真的吗？而大多数人甚至不知道自己有这个问题。如果你问大多数人，你最害怕死于什么疾病？他们都会说是癌症，但事实并非如此。

Fifty percent of Americans have high blood pressure. Really? And the majority don't even know they have it. Most people, if you ask them, you know, what are you afraid of dying of? They all say cancer, but it's really not the case.

其实是心脏病。他是一位获得认证的心血管外科医生。他在YouTube上分享的关于健康生活以及保护我们唯一心脏的建议，已经获得了将近5000万次的观看量。

It's heart disease. He is a board certified cardiovascular surgeon. His tips for living well and protecting your one and only heart have racked up nearly 50,000,000 views on YouTube.

我非常激动向你们介绍杰里米·伦敦医生。导致我们出现心脏病、心脏病发作以及心脏疾病的主要原因是什么？

I am super excited to introduce you to doctor Jeremy London. What is the main cause of us having heart disease, heart attacks, heart conditions?

在我们的身体里，任何事情都不是孤立发生的。它们都是相互关联的，一切都息息相关。

Nothing happens in a vacuum in our body. It's all connected. Everything is connected.

电子烟对Z世代的心脏健康有多大影响？

How much does vaping affect the heart health for Gen Z?

我有没有见过因电子烟导致的危及生命的情况？百分之百有。你见过什么情况？关于电子烟的简短故事是

Have I seen really life threatening situations from vaping? A 100%. What have you seen? The short story with vaping is

我看到一个统计数据，说美国每年有805,000人发生心脏病发作。每40秒就有一人发作，这让我觉得太疯狂了。对我们美国人来说，这是一个非常严重的问题，听起来全球情况也差不多。所以我很想知道，导致我们出现心脏病、心脏病发作以及影响我们健康生活或导致死亡的心脏疾病的主要原因到底是什么？

I read a stat that said eight hundred five thousand people have heart attacks each year in The US. One heart attack every forty seconds, which seems crazy to me Mhmm. That this is such a big issue for us as Americans. And it sounds like around the world as well. So I'm curious then, what is the main cause of us having heart disease, heart attacks, heart conditions that affect us living a healthy life or dying.

为了更全面地看待这个问题，我们可以把它放在全球视角来看。是的，每年有两千万人死亡。因此，心脏病是全球男女死亡的首要原因。如果你问大多数人，你最害怕死于什么疾病？

To zoom out just a little bit further to put the perspective on this worldwide. Yeah. It's twenty million deaths a year. So it's the leading cause of death of men and women worldwide. And most people, if you ask them, you know, what are you afraid of dying of?

或者你认为最大的病因是什么？大家都说是癌症，但实际上并不是这样，全球范围内真正最大的原因是心脏病。而在心脏病中，最常见的原因是心脏动脉的阻塞。

Or what do you think the biggest cause? They all say cancer. But it's really not the case. It's it's heart disease worldwide. Now, of that group, the most common reason is blockages in the heart arteries.

而这也正是导致心脏病发作的原因。我们的心脏表面有动脉，这些动脉为心肌提供营养，心肌本质上就是一个泵。它需要能量，在我们身体中这种能量就是营养和氧气。如果动脉中逐渐出现阻塞，通常是由胆固醇堆积引起的，这就会在下方的心肌供血路径上形成一个障碍。如果这种阻塞变得足够严重甚至完全堵塞，就会导致心脏病发作。

And that's what causes heart attacks. We have arteries that are on the surface of our heart that bring nourishment to the heart muscle, which is just a pump. It's just, you know, that pump requires energy and in our bodies that's nutrition and oxygen. Well, if you get a blockage in there over time, usually from cholesterol buildup, that then creates a basically a roadblock to the heart muscle below. If that gets tight enough or completely blocks, that's when you have heart attacks.

这是那两千多万人中占比最高的一个类别。但人们患心脏病的原因还有很多种，比如心脏瓣膜问题、电气系统问题等。这三类是目前最常见的。

That's the single biggest bucket in that twenty million. But there are a lot of different reasons why people get heart disease. You can have valve problems within the heart. You can have electrical problems. Those are the three most common buckets.

此外当然还有先天性心脏病，有些人出生时心脏就有异常，这些也都统计在内。但大多数情况下，还是因为动脉阻塞引起的。

And then there's of course congenital heart disease. People are born with abnormalities and they all go in those numbers too. The majority of it is because people are getting blockages.

压力对心脏健康有多大影响？如果一个人总是感到压力山大、筋疲力尽、精神上长期处于紧张状态，这种情况会影响心脏健康吗？

How much does stress affect heart health? If someone's just feeling like overwhelmed, burnt out, mentally in their head constantly. Sure. Can that affect heart health or hurt you?

我认为这个问题的方式是：任何事情都不是孤立发生的。

So the way I would look at this is nothing happens in a vacuum

在我们的身体里，一切都是相互关联的。

in our bodies. It's all connected.

一切都息息相关。我们的大脑、神经系统、血管、心脏等都是相互连接的。压力是主要风险因素吗？不一定，但它确实对心脏病的发生有一定影响。

Everything is Our mind, our nervous system, all connected to our blood vessels, our heart, etcetera. Is that a major risk factor? No, it's not necessarily a major risk factor, but it definitely plays a role in heart disease.

它确实会产生影响，百分之百会影响。它会让你的身体感觉不适，而身体不适会给心脏带来负担，这当然可能产生影响。那么，你认为心脏病的三大主要因素是什么？

It influences it. 100%. It influences your body feeling sick. If your body feels sick, it puts stress on the heart and that could, yeah. So what would you say then are the three biggest factors of heart disease?

当然。

Sure.

首先是肥胖。真的吗？是的。与之相关的还有饮食不健康、胰岛素抵抗、高血压、糖尿病、高胆固醇、久坐不动的生活方式，我们也不能忽视吸烟。真的吗？

The first would be obesity. Really? Yep. And along with that, you know, comes poor diet and insulin resistance, high blood pressure, diabetes, high cholesterol, sedentary lifestyle, and we cannot leave out smoking. Really?

因为吸烟是你对身体能做的最糟糕的事情。再想想，这就像是在真空中一样。吸烟会影响肺部，也会影响所有的动脉。它其实是心脏病最主要的风险因素。

Because that is the single worst thing you can do for your body. Again, thinking about it like a vacuum. Smoking affects the lungs. It affects all the arteries. And it's the leading risk factor really for heart disease.

真的吗？哦，是的。那么接下来这个问题，大多数人可能都不会喜欢它的答案。电子烟对Z世代的心脏健康有多大影响？

Really? Oh, yes. So here's a question that most people are not going to like the answer to probably. How much does vaping affect the heart health for Gen Z?

是的。关于电子烟的简要情况是，与吸烟不同，我们还没有多年的数据。因此很难确切地说出它的影响。虽然有很多数据表明它比传统香烟危害小，但我们并不知道它的长期影响到底是什么。我们知道的是，很多人在使用电子烟，而且使用频率很高，因为与香烟不同，你不需要走到室外去抽。

Yeah. So the short story with vaping is unlike tobacco use, we don't have the years of data. So it's hard to really say, you know, there's all the data of, oh, it's better than We don't know what the long term implications are. What we do know is there's a lot of people doing it. They're doing it all the time because unlike cigarettes, you don't have to go outside.

你随时都在抽，对吧？没错，五次，是的。

You're smoking every Right. Five Yeah.

你总是能看到蓝色的灯光。你不再需要去机场那种专门的吸烟室了，现在这些吸烟室已经被彻底取消了。所以问题在于，我们根本不知道它的长期影响。而且这些电子烟产品中的尼古丁含量基本上是缺乏监管的。因此，它们的尼古丁含量可能比香烟高出很多倍。再加上你可以随时随地使用，所以尼古丁的暴露是全天候的。

You constantly see the blue lights all the time. You don't have to go to the room at the airport anymore that now they've actually taken those out altogether. So the issue is we just don't know the long term, but the nicotine content in those vaping formulations is essentially unregulated. So they can have just multitudes higher levels of nicotine than cigarettes. And again, because you can do it all the time, the exposure is all day long.

尼古丁本身是一种血管收缩剂。

So nicotine in and of itself is a vasoconstrictor.

所以它会收缩……所以它收缩的是心脏瓣膜吗？

So it constricts So it the valves,

不是瓣膜，而是实际的血管本身会收缩。

not the valves, the actual blood vessels themselves to constrict.

那当它流经心脏时，会产生什么影响呢？

And what does that do when it's pumping through the heart?

对。所以你可以再想想，把心脏看作是一个泵。

Right. So if you think about it again, as the heart as a pump.

你这里有一个小例子。

You got a little example here.

没错。所以这里下方的大心腔，你有左右两个心腔。左边的心腔是主要的泵血心腔，它将血液通过主动脉泵送到全身。这就是为什么它是红色的，因为它含有大量氧气，供给身体其他部位。那么如果所有这些血管都在收缩，而这个泵还在努力对这个系统做功，你觉得会导致什么情况？

Absolutely. So the big chambers down here, you have the right and the left chamber. The left chamber here is the main pumping chamber and it's pushing blood out through the aorta. That's why it's red because it's got lots of oxygen in it to the rest of the body. So if all of these blood vessels are clamping down and this pump is trying to work against that system, what do you think that causes?

高血压。有意思。

High blood pressure. Interesting.

这正是主要原因之一，没错。

And that's one of the main causes of Exactly.

因为长期的高血压会造成两个主要影响。第一，血管的弹性会下降，也就是我们常说的弹性减弱。血管变得僵硬，无法随着每一次心跳而扩张。当它们变得僵硬后，就容易受到损伤。

Because high blood pressure over time does two major things. One, you get decreased what we call elasticity of the blood vessels. They become stiff. So they don't flex with each heartbeat. As they become stiff, they can then become damaged.

而这种损伤后的修复过程就会导致动脉粥样硬化，也就是动脉硬化。因此，高压会直接造成损伤，而随着时间的推移，左心室或者说这个泵血心腔本质上是一块肌肉，当任何一块肌肉长时间处于张力之下，它就会增长、变厚。当肌肉变厚时，就会减小心腔的容积，也就是血液的来源空间变小了。因此，心脏泵出的血液就会减少。而最终的结果就是，在对抗阻力的情况下工作久了，最终导致心力衰竭。

And the repair process from that damage is what causes atherosclerosis or hardening of the arteries. So you've got direct damage from the higher pressure and then over time because the left ventricle or that pumping chamber is just a muscle, what happens if you put any muscle time under tension, it's going to grow, it's going to get thick. Well, when the muscle gets thick, it decreases the size of the cavity where the blood comes from. So less blood is getting ejected from the heart. And then the end result of that as it works against resistance is eventual heart failure.

有意思。所以这是一个连续的过程，随着时间推移发展而来。这也是为什么高血压是一个非常重要的风险因素。你知道吗，50%的美国人都有高血压。真的吗？

Interesting. And so it's really a continuum timeline. And that's why high blood pressure is such an important risk factor. And you know, fifty percent of Americans have high blood pressure. Really?

而且大多数人甚至不知道自己有高血压。这是我们能够控制的最重要的单一风险因素之一。

And the majority don't even know they have it. And it's one of the single most modifiable risk factors that we can have.

如果我们有高血压，该如何降低它呢？

How can we lower our high blood pressure if we have it?

嗯，我们一直提到的几个关键点，你知道的，均衡的营养

Well, the pillars that we talk about all the time, you know, solid nutrition,

低压力。

low stress.

没错。规律的运动，包括有氧运动和阻力训练。所有这些因素都非常非常重要。通过单纯改变生活方式，你就可以显著地控制血压。当然，很多人确实需要药物治疗，但这并不是失败，控制血压对于预防心脏病来说真的非常关键。

That's right. Regular exercise, both, you know, with aerobic training as well as resistance training. All of those things are really, really important. And you can modify your blood pressure significantly with just lifestyle changes. Now many people do need medications and that's not a failure, you know, but getting your blood pressure under control is really important from a heart disease standpoint.

作为一名心脏外科医生，在过去25年里，你估计自己做过多少例心脏手术？

How many heart surgeries do you feel like you've done in the last twenty five years as a heart surgeon?

你知道，我们多次估算过这个问题，因为在我职业生涯的初期，我做的手术数量非常惊人，大概在六千五到七千例左右。哇，大概就是这个数量级。

You know, we've estimated this on multiple different times because the beginning of my career I was doing, you know, crazy, crazy numbers, probably somewhere around six thousand five hundred to seven thousand. Wow. Somewhere

好的，也就是说在25年里做了六千到七千例心脏手术或者心脏手术操作。那么在这些病人中，有哪三个共同的因素导致他们最终躺在你的手术台上，出现某种心脏问题？

in Okay, that six thousand to seven thousand heart surgeries in twenty five years or heart operations in twenty five years. What are the three things that all those people had in common that got them on your operating table with some type of heart failure?

其实并不是所有病人都有心脏衰竭的问题。我认为

So they don't have all have heart failure. I think

是的，但至少是某种心脏疾病。

that's yeah, some heart condition.

没错，明白了。他们来到手术台的原因主要分为三类：动脉阻塞、瓣膜问题，或者心脏电系统的问题。这就是他们需要手术的主要原因。我们先从最常见的说起吧，那就是心脏动脉的阻塞。

Exactly. Gotcha. And depending on why they're there again, the three buckets either blockages in the arteries, problems with the valves, or problems with the electrical system. That's why they get there. So let's let's go with the most common, which is blockages in the heart artery.

这确实是当你

That's really the most common when you

看到，这是我们最喜欢做的最常见的手术。

see That's the most common operation that we Like

百分之六十，七十？

sixty, seventy percent?

可能吧，是的，大概是百分之六十。

Probably. Yeah, probably sixty percent

会

would

是的，Block 就是堵塞。这会是动脉中的阻塞，这种阻塞通常会被发现，要么是因为病人出现了症状，要么是因为他们属于高风险人群，然后他们的内科医生或心脏病专家能够识别并提前进行干预，从而避免问题的发生。

be a Block is a blockage. Yes. It would be a blockage in the artery that would be picked up either because patients were having symptoms or because they were in a high risk category and their internist or cardiologist recognize that and intervene before there was a problem.

如果有人出现这种限制，主要的症状有哪些呢？当然，所以

What are the main symptoms someone might have if they're in with they have you know that restriction? Sure. So

心脏阻塞引起的心脏症状经常被称为伟大的伪装者，因为不是每个人都会表现出我所说的电视上那种典型的心脏病发作症状，比如捂着胸口、疼痛蔓延到下巴或手臂等。的确有很多人会出现这些症状，但有时候症状可能非常轻微，甚至在心脏病发作前的阶段也会出现一些预警信号。例如，如果你的一条主要动脉出现阻塞，而这条动脉正是为心脏泵血提供营养的，当你进行体力活动时，阻塞严重到一定程度，就会导致心肌得不到足够的营养和氧气。当这种情况发生在你的小腿时，你就会出现抽筋的现象。

heart symptoms from blockages are as frequently referred to as the great masquerader because not everybody presents with what I call the TV heart attack, where it's clutching the chest, pain into the jaw pain down. Now many people do, but the symptoms can be very subtle. Even in that pre heart attack phase, are warning signs. Well, if you have a blockage in one of the main arteries that's supplying again the pump and that blockage gets significant enough as you exert yourself, you outstrip the amount of nutrients and oxygen that can get to that portion of the heart. What happens in your calf when that happens, when that occurs, you get a Charlie horse.

当这种情况发生在心肌时，你可能会感到胸部发紧，或者出现气短，甚至腹痛等症状。这些症状可能非常轻微。关键在于，这些症状在活动时出现，而在你坐下休息后就会缓解，这被称为稳定性心绞痛或稳定性胸痛。换句话说，这是某种潜在更严重问题的预警信号。

Happens in your heart muscle is you have tightness in your chest, or it can be shortness of breath, or it can be abdominal pain even. And the symptoms can be very subtle. The key is that the symptoms come on with activity and then when you sit down, it's relieved with rest. That's referred to as stable angina or stable chest pain. In other words, warning signs of something potentially bigger

即将到来。如果某人出现了这类预警信号，他们应该怎么做？应该

to come. If someone's having that type of a warning sign, what should they do? Should they

这是一个危险信号，你应该尽快接受专业医疗人员的评估。比如立刻拨打急救电话，还是不一定需要打112？如果疼痛消失了，那就不一定需要拨打急救电话。明白了，但如果疼痛持续存在，那拨打急救电话就是正确的选择。

That is a red flag and you should be evaluated by a qualified healthcare provider. Like call 911 right away or is it not? Not necessarily 911 as long as the pain goes away. Got it. If the pain continues, absolutely 911 is the answer.

但如果是那种你会注意到的情况，比如说，每次我去倒垃圾的时候，我都会感到胸口有点发紧，必须停下来休息一分钟。疼痛会消失，然后我走回房子里，它又会再次出现。但每次休息后症状就会缓解。这种稳定型心绞痛确实需要进行评估，但不一定属于紧急情况。不过，如果你有任何担忧，及时就医是最安全的选择。

But if it's the kind of thing where you notice, for example, every time I take the garbage out, I get this little tightness in my chest and I have to stop for a minute. The pain goes away and I go walk back in the house and it kind of comes back. But every time I rest, relieved. That stable angina, it is definitely something that needs to be evaluated, but not necessarily an emergency. However, if you're ever concerned, that's the safest route

哇。好的，再说一遍，我一开始听到你说，肥胖和饮食不良是导致人们出现心脏问题、心脏病、高血压以及糖尿病的主要原因之一，而糖尿病对心脏状况或心脏衰竭的影响也非常大，久坐不动的生活方式也是一个因素。你还提到了吸烟，我们稍微谈到了电子烟，听起来目前我们还没有这方面的完整数据，还不清楚它到底对心脏有什么影响。不过，你是否已经观察或注意到一些有心脏问题的病人，他们恰好也在使用电子烟？

to Wow. Okay, so again, heard you in the beginning say obesity with poor diet is one of the main causes or the main reasons why people have heart conditions, heart diseases, high blood pressure, and diabetes also influences heart conditions or failures in a big way, sedentary lifestyle. And you also mentioned smoking. We're talking about vaping a little bit, which we don't have the data, it sounds like yet, of how it actually influences the heart. But are you seeing or noticing signs or patterns of people coming in who also vape that are just happen to also be vaping that have heart conditions?

我们可以想想主要使用电子烟的人群特征。通常来说，使用者比较年轻。是的，是的，是的。也就是说，40岁以下、没有家族病史、不是糖尿病患者的人群，他们患心脏病的风险本来就是比较低的。那么，我有没有见过因为使用电子烟而导致的严重危及生命的情况呢？

So think about the demographic of people that are vaping primarily. It's usually younger. Yeah, yeah, yeah. So folks under the age of 40 that don't have a family history, they're not diabetic, you know, the risk of heart disease there is certainly lower. Now, have I seen really life threatening situations from vaping?

当然见过。这就是为什么我说……百分之百确定。

Absolutely. Which is why Okay. 100%. Is What why I

你见过什么情况？

have you seen?

有一种综合征叫做电子烟相关急性肺损伤（EVALI），这是一种与电子烟使用相关的急性肺损伤。这种损伤甚至可能在只吸一次电子烟后就发生，是由于肺部出现炎症反应导致的。这些年轻人被送到医院时病情非常严重，连呼吸机和插管都无法为身体提供足够的氧气。我们必须使用一种叫做ECMO（体外膜肺氧合）的设备，把他们的血液从体内抽出，进行体外氧合后再输回体内。这些患者可能是18岁、21岁、23岁的年轻人。

Well, there is a syndrome called EVOLI, which is e cigarette vaping associated acute lung injury. And this is an injury that can occur from vaping one time from an inflammatory process that happens in the lungs in these really young folks. They come in the hospital, they're so sick that even the ventilator, the breathing tube is not adequate to nourish their body with oxygen. And we have to put them on something called ECMO, which is an external lung circuit where we take blood out of the body, blood back, oxygen back into the blood and return it to the body. And these can be 18, 21 year old, 23 year old individuals.

不幸的是，我们已经遇到过好几个没能抢救回来的病例。

And unfortunately, we've had several that haven't survived.

真的吗？确实是这样。所以这些患者都使用过电子烟，而且病因就是电子烟？百分之百确定吗？

Really? Absolutely. So these are all patients who have vaped. It was caused from the vaping? Absolutely.

你遇到过最年轻的需要手术的患者有多大？

What's the youngest patient you've had to operate on?

是为了给他们上ECMO（体外膜肺氧合）设备吗？

To place them on ECMO for

就像心力衰竭、心脏病一样。

the Just as like a heart failure, heart disease.

对于心脏病来说，23岁是我做搭桥手术患者中最年轻的，那是由于动脉阻塞引起的。这名患者才23岁。他的家族有非常强烈的心脏病遗传史，并且由于基因因素导致胆固醇水平非常高，这种情况虽然不常见，但确实会发生，他的胆固醇水平达到了几千。而正常情况下，我们知道，你希望胆固醇水平在90到100左右，而他的却达到了几千。

So for heart disease, 23 years old is the youngest patient I've ever operated on for bypass surgery, for blockages in the arteries. 23 years old. Had a very strong family history of heart disease and they had a genetic propensity for very high cholesterol, which is not common, but it does occur and their cholesterol was in the thousands. Whereas normally, you know, you want it around 90 to a 100, theirs was in the thousands.

这个人总体来说健康吗？还是说他本身也比较肥胖，或者饮食习惯也不好？

Was this person healthy in general or were they not, they were more obese or more poor diet as well? Absolutely. So they weren't influencing the reversal of that.

他确实不健康。他们需要通过药物来帮助控制，因为他们体内存在强烈的遗传因素导致这种情况。此外，他们自己也没有好好照顾自己的健康。

They were not. And they would have needed medication to help do that because they had all of the genetic force behind them then to get to that spot. And then they didn't take care of themselves on top of it.

我听到的意思是，目前我们还没有太多关于电子烟如何导致心脏病的数据或研究结果。但是你已经不得不为很多因为使用电子烟而出现问题的人做过手术，对吗？

So we don't have a lot of the data yet I'm hearing or the research around how vaping causes heart disease yet is what I'm hearing. But you've had to operate on many people who have come in because of vaping. Is that correct?

是的。我想说，数量不算很多。是的。我认为只是少数几个。是的，没错。

Yeah. It's not many, I would say. Yeah. I don't think that A handful. Yeah, for sure.

但我想说的是，当你看到三四个年轻人因为成瘾而丧命，而电子烟在我们当今社会已经成为一种常态，这让我感触很深。我自己有三个儿子。这对我来说真的非常贴近现实。我正在个人努力传播关于电子烟的信息。归根结底，你即将制定自己的规则。我理解这一点。但至少要知道事实，至少要明白我们真的不知道电子烟的后果，所有关于电子烟是安全替代品的说法都只是传言而已。

But I mean, you see three, four, five young adults not survive from an addiction and something that has become normative in our society today, you know, and I have three boys. Wow. And so it hits really close to home for me. Am really on a personal quest to get the information out about vaping and look in the end, you're about to your rules. Like I get it, But at least know the facts, at least understand that we really don't know the implications of this, that all of the, all of the chatter about this is a safe alternative.

我们并不知道这些说法是否属实。

We don't know that.

你觉得那些来看病的人，如果他们没有使用电子烟或者没有吸烟，你觉得他们是否也会因为其他生活方式的选择而来看病？还是说你认为电子烟或吸烟对心力衰竭起了很大的作用？

Do you think those people that came in, if they weren't vaping or weren't smoking, do you think they would have also been there because of other lifestyle choices? Or do you think the vaping or smoking heavily influenced the heart failure?

对于心脏病人来说，百分之百是吸烟导致的。如果你在吸烟，那风险因素就是十倍、十二倍甚至十五倍。真的吗？哇。是的，当然。我的意思是，如果你要审视一下，如果我们暂时退一步，问问自己：我现在健康吗？

So for sure, the cardiac patients a hundred percent. It's like a, you know, ten, twelve, 15 X factor when people are smoking cigarettes in Really? Wow. Yeah, for sure. I mean, if you're going to examine, if we're going to take a step back for a second and say, am I healthy right now?

你知道，你会怎么做到这一点呢？首先，你会吸烟吗？我们先从这里开始。接下来是酒精或者好吧，是的，我们可以暂时不谈这个。甚至可以更广泛一些。

You know, how would you do that? Number one would be, do you smoke? Let's start there. The next on the list would be Alcohol or Well, yeah, we can we can leave that one off for just a minute. It can even be broader than that.

有一个非常有效的工具，就是将自己归类，比如我有多健康？非常好、好，你知道的。一般，信不信由你，研究中就是这么用的，它能帮你大致确定自己的位置。

There's a real powerful tool just to put yourself in a category like how healthy am I? Excellent, good, you know. Average, Believe it or not, they use that in research and it just kind of puts you in the mindset of where do I fall?

有意思。

Interesting.

那么你接下来要做什么？你要称一下体重，对吧？身体

Then what are you going to do next? You're going to weigh yourself, right? Body

质量指数。

mass index.

并不是衡量长寿的好指标。我们可以谈谈更好的方法，但这是一个不错的起点，对吧？然后只需测量你的腹部周长和身高的比例，这个比例非常有意义。再说一次，我们谈到肥胖，这种过度消费的问题。好吧，我们知道内脏脂肪或者说堆积在你腹部器官周围的脂肪，是炎症疾病的引擎，尤其是是的。

Is not a great indicator of longevity. Can talk about the better ways to do it's a good place to start, right? Then just measuring your abdominal girth to your height, that ratio is very meaningful. Again, we talked about obesity, this over consumption problem. Well, we know that visceral fat or the fat that's in your belly around your organs is the engine for inflammatory diseases, particularly Yeah.

心脏

Heart

如果你有很多多余的腹部脂肪，那么我猜你的心脏周围也可能有脂肪。

if you have a lot of excess belly fat, then you probably have fat around your heart too, I'm assuming.

确实如此，但尤其是这种腹部脂肪。

You do, but it's this fat in particular.

外部脂肪，内脏脂肪。

The external fat, the visceral.

你器官周围的内脏脂肪，不是皮下那种脂肪，你知道的，在里面夹层之间的脂肪

The visceral around your organs, not the fat that's in, you know, under your skin in Inside between

那个你

that you

你真的无法，真的无法

can't that you really can't Not

腹部脂肪。

belly fat.

就是啤酒肚。

It's the beer belly.

明白。

Gotcha.

我会这么来形容它。它确实会影响你身体的整体炎症过程。并且它是代谢综合征和2型糖尿病的已知风险因素。接下来还有什么？心率过快。

Is really how I would describe it. That really influences the overall inflammatory process in your body. And it's a known risk factor for metabolic syndrome and type two diabetes. What would be next on the list? Breasting heart rate.

你知道，我在那个标准上处于什么位置，先从这些事情开始。然后你开始具体地审视生活方式。你看看饮食，看看饮酒情况，你知道自己在标准上处于什么位置，还要看看你的睡眠。睡眠方面的一些简单问题。我是否每晚都在同一时间上床睡觉？

You know, kind of where am I on that scale and start with those things. Then you start to look specifically at lifestyle. You look at diet, you look at alcohol, you know, where I'm on the scale, you look at your sleep. Simple things with sleep. Am I going to bed at the same time every night?

我有没有，比如说，每天睡够六到八小时？我是否在同一时间醒来？然后就像你之前提到的，我的心理健康状况如何？我在哪一方面？这可能有点困难，但网上有一些非常好的问卷可以帮你完成。

Am I getting, you know, six to eight hours? Am I waking up at the same time? And then as you mentioned earlier, like what is my mental health status? Where am I with that? And that can be tough, but there's some great online questionnaires that you can do.

这是一个很好的起点，比如我有多健康？不仅从心脏的角度来看，而是整体来看。有时候，了解自己目前的状况，就能打开这扇机会之门。我的意思是，我们是

And that's a great place to start, like how healthy am I? Not just from cardiac standpoint, but in general. And sometimes just kind of knowing where you are currently as an opportunity opens that door. I mean, we're

在当今社会，人们会赞扬那些身材偏大或者不因体型大小而羞辱他人的人。我完全支持不去羞辱或评判他人。但当涉及到人们的心脏健康或整体生活质量时，如果一个人极度肥胖，却不对自己的生活方式选择负责，他们可能会对自己的身体造成很大伤害，未来也会带来更多的医疗费用和药物开销，同时也会给他们身边的人带来压力和负担，仅仅是因为他们没有照顾好自己的健康。

in a society right now that people praise those who are, you know, plus sizes or don't shame someone for how big they are or things like that. And I'm all for not shaming or judging people. But when it comes to people's heart health or just overall quality of life Yeah. If they're extremely obese and they're not taking accountability for their lifestyle decisions, they might be causing a lot of physical harm to themselves, more medical bills, medications in the future, and also putting strain and stress on the people around them Mhmm. By not taking care of their health.

我不是说你必须拥有六块腹肌，或者必须完美无瑕。这不是重点。但作为一个医生，你会怎么跟社会说：这个社会在庆祝人们无论想多胖都可以，还认为这是件好事，说我们不要羞辱任何人。

I'm not saying you have to have a six pack and be perfect. That's not what this is about. But what do you say as a doctor to society that says, you know, celebrate anyone for how big they wanna be. It's a good thing. You know, let's not shame anyone.

你如何在这其中找到平衡？既要支持人们的情绪、感受以及他们在生活中自己的个人经历，又要引导他们对自己的生活负责，对自己的健康负责？不是要你变得完美，不是要你成为封面模特，而是要确保你对自己的健康负责，为了你的未来、你未来可能有的家庭、你身边的人负责。你如何在人们的情绪和现实之间找到平衡？

How do you navigate that to to support people's emotions and feelings and how they feel or their their own personal experience in life versus leading them to take accountability in their life and take responsibility for their health? Not being perfect, not being a cover model or something like that, but like making sure you're responsible for your health, for your future, the family you have in the future, the people around you. How do you navigate that? People's emotions versus practicality?

你提到了很多方面的问题，我们先从第一个棘手的问题开始讨论吧。你是如何进入这类对话，并可能改变这种观念的呢？我同意你的观点，我认为支持一种从数据来看在很多方面都不健康的生活方式是危险的。那么当你面对一个病人，开始这样的对话时，你是怎么做的呢？

You've touched on so many things there, but let's let's let's try to slide down the first slippery slope. Yeah, yeah. Which is, you know, how do you enter that conversation and potentially change that narrative? Because I agree with you that I think that that it's dangerous to validate a lifestyle that we know from the data is not healthy on so many on so many fronts. So how do I do it personally when you know, when a patient comes in and you start that conversation, right?

比如，他们告诉你自己没有任何风险因素，但他们却超重了七十磅。你就会想，好吧，我们得先退一步。很多时候，我们需要让人们明白，他们过去的生活方式并不一定决定他们未来的道路。当你给他们一个新的起点，告诉他们：你已经走了一段路，这段路把你带到了现在这个位置，而现在你可能已经面临问题了（如果你来看我，很可能就是如此）。那么你想象一下自己五年、十年后会是什么样子？

Like, they tell you, don't have any risk factors and they're seventy pounds overweight. You're like, okay, let's let's take a step back. I think many times allowing people to understand that that the life they've lived to getting to that point doesn't necessarily define what their path is forward. And when you when you kind of give them a new set point of, okay, you've take you've gone down a road and it's gotten you to a place where now you're potentially in trouble or if you're seeing me, you probably are. How do you picture yourself five years, ten years?

你想成为什么样的人？几乎可以肯定，那不是你现在这个样子。每个人的情况都不一样，所以你和他们对话的方式也会不同。但我确实认为，这种整体的观念是有危险的，因为它在某种程度上形成了一种保护，让你忽视了可能非常不健康的情况。因此，我认为应该从这个角度出发，用一种非情绪化、非评判性的方式来讨论这个问题，然后把刚才你提到的那些问题分解成一个个小步骤，让每个人都能逐步接受。

Who's the person you want to be? And almost invariably, it's not who they are at that point. And each individual person is so different on how you have that conversation, But I do think that that overall narrative is dangerous because it creates an insulation in a way that that you're really abdicating a potentially very unhealthy scenario. And so I think that backing into it from that perspective, a non emotional way, not totally non judgmental and then break down each of those things that you just talked about into really small steps for people. Yeah.

因为大多数时候，人们感到非常不知所措。他们真的不知道从哪里开始。他们感到害怕，害怕自己已经落后了，担心自己会失败。

Because most of the time folks are really overwhelmed. They don't really know where to start. They're scared. They're scared that they're already at a deficit. They're worried they're going to fail.

他们已经感到羞愧了，百分之百是这样。很多时候，食物能缓解一部分这种羞愧感。

They're already in shame. 100%. And food relieves some of the shame feeling in Many the times.

是的，很多时候。我不知道是谁说的，但我特别喜欢那句话：恐惧像一片广阔的海洋，但实际上只有寸深。我认为如果你能帮助人们迈出第一步，哪怕是一些很简单的事情，比如散步，也会很有帮助。是的。很多人只是对走进健身房感到非常不自在，你能理解这一点。

Yeah, Many times. And I don't know who said it, but I love that quote, you know, that fear is an ocean wide, but only an inch deep. And I think that if you can help folks take that first step, and it can be simple stuff, just walking. Yeah. Like many of those folks are just really uncomfortable walking into a gym and you can appreciate that.

是的。所有那些‘你要接纳自己的身体’的说法其实并不起作用。现在，我是否认为重点是找到你自己的健康体重，就像你指出的那样？这并不意味着你必须成为泳装模特。所以你必须设定合适的目标。

Yeah. And all of the you need to be comfortable with the body that you are, that doesn't help. Now, do I think it's about finding as you point out the healthy weight for you? That doesn't mean that you're a swimsuit model necessarily. And so you have to set appropriate goals.

因此，我认为让人们明确他们目前所处的位置以及他们想成为什么样的人，然后帮助他们将目标分解成非常小的步骤，这种方法在我的实践中效果非常好。

So I think allowing people to identify where they are and the person they want to be, and then helping them break that down into really small steps has worked really well for me in the practice.

是的。

Yeah.

确实是这样的。

It really has.

我想这之所以具有挑战性，是因为如果一个人超重了70磅、100磅甚至150磅，导致他们变成这样的原因并不仅仅是一个身体上的实际问题。其中还包含某些情感或心理上的创伤或障碍。当然，不只是心脏方面的阻塞，而是一种情感或心理上的障碍，使他们以某种特定的方式忽视了自身的健康。也许他们是非常优秀的人，善于帮助他人，聪明又有才华，但某些情感或心理上的障碍却阻止了他们为自己做出改变。

I guess it's challenging because if someone is seventy, a hundred, a hundred fifty pounds overweight, it's not just a, you know, physical practical thing for them that got them there. There's some type of emotional or mental trauma or blockage also. Sure. Not just a heart blockage, but an emotional or mental blockage that has allowed them to get to that place of not taking care of themselves in a certain way around health. Maybe they're like amazing people and they're good for other people and they're smart and they're talented, but something has been blocking them emotionally or mentally to want to create that for themselves.

我能想象要扭转这种情况有多难，尤其是如果这种生活方式已经持续多年。所以这一定非常困难。但我们该如何做？观看这段对话的人，如何帮助他们生活中极度肥胖的人，那些每年都在不断增重十到二十磅、年复一年却毫无改变的人。这几乎就像是你需要彻底地专注于重塑一种全新的身份和生活方式。如果你要减掉100磅或70磅，你几乎必须改变思维方式，开始修复和疗愈导致这种行为的某些情感或心理问题。但我好奇的是，观看这段对话的人，他们身边可能有自己关心的人正在面临这样的问题，他们担心对方的心脏健康。

And I can imagine how hard it is to reverse it, especially if it's been years of living in a familiar pattern. So it must be extremely hard, but how do we, how does someone watching this get through to someone in their life who is extremely obese and is just allowed year after year, ten, twenty pounds a year to pack on every year, and they're not making any changes. It's almost like you need to be completely obsessed for a whole new identity and lifestyle. If you're going to reverse a 100 pounds, 70 pounds, it's almost like you have to think a different way and you have to start healing and mending certain things that caused those actions to get there, I'm assuming. But how does someone who's watching this, who has someone in their life they care about, who's struggling with this, that's afraid for their heart health.

当然。他们如何以一种不评判对方的方式，与他们所爱的人沟通，同时又能促使对方开始采取行动？

Sure. How can they communicate to the person they love in a way that doesn't judge them, but holds them accountable to start taking action?

是的。我认为这确实是一个挑战。

Yeah. And I think that that certainly is

这可能不是你的专业领域。

That may not be your expertise.

你问的这个问题有点超出我的专业范围，但也不是完全不相关。从我的角度来看，我的优势在于，如果他们来到我的办公室，说明他们生活中出现了一个新的转折点。是的。这让我能够利用这个机会，因为人生就是由一系列选择组成的，对吧？很多时候我们明明知道应该怎么做，但就是做不到。

You're stretching out outside of my wheelhouse, but not entirely. I mean, from my perspective, I have the benefit that if they're in my office, they're having a touch point in their life that we are at a new crossroads. Yeah. And so it enables me to utilize that as life is a series of choices, right? There's many times where we know better, but we don't do better.

是的。现在你有了一个真正的理由去做得更好。是的，这就是原因，以下是我建议的做法。有时候，正如你所描述的那样，人们陷入了一种安逸的状态，要打破这种模式真的很难。

Yes. You now have a real reason to do better. Yes. And here's why, and here are the things that I recommend. And sometimes when folks fall into a level of complacency, as you've described, to break that pattern can be really tough.

并且

And

因此，我认为从支持性的角度出发总是最有意义的，但如果有疑问，就回归数据本身。

so I think that obviously from a supportive place always makes the most sense, but when in doubt, fall back into the data.

分享一下这些数据。

Share the data.

我们就是从这个话题开始谈话的。如果你继续沿着这条路走下去，最可能不会是癌症导致你的健康问题。是的。我们知道男性和女性的第一号杀手是什么。我们需要做什么才能让你避免走到那一步？

How we started this conversation. It's not cancer that's going to take you most likely if you continue down this road. Yeah. We know what the number one killer is of men and women. What do we need to do so that you don't get there?

是的，那么酒精对心脏病的影响有多大？

Yeah. And how much does alcohol affect heart disease?

显然，这一直是一个备受争议的话题。当我们开始谈论营养或酒精时，这种讨论的激烈程度几乎可以与宗教话题相提并论，人们在情感上对此非常投入。

So obviously this has been a hotly debated topic that, you know, when we start talking about nutrition or alcohol, it rivals religious conversations with many with the emotional embodiment of how people step into this.

但仅从数据本身来看，不考虑文化因素。

But just on the data alone, not Let's the culture of

那我们来看看喝酒时会发生什么。酒精会被分解成两种物质：乙醛和乙酸盐。我不是要给你讲一堆化学名词，但乙醛会让你在喝酒时感到愉悦，如果你觉得这种感觉不错的话。

talk about what happens when you drink. Okay. Alcohol is broken down into two things. Acetyl Aldehyde and Acetate. Not to give you a bunch of chemical names, but Acetyl Aldehyde is what makes you feel good when you're drinking if you find that to be good.

它同时也是对你体内每一个细胞都有毒的物质。没错，就是毒药，100%。这是一个不可否认的事实。而乙酸盐基本上就是空热量。

It's also what's toxic to every single cell in your body. So poison. 100%. And that is an undeniable fact. And acetate is basically empty calories.

如果你不消耗这些乙酸盐，你基本上会把它转化为脂肪。所以这两个是主要的成分。因此，从逐步的角度来看，第一，它对细胞有直接毒性；第二，多余的乙酸盐会变成脂肪。这些脂肪会储存在哪里？

If you don't burn the acetate, you're going to turn that into fat essentially. So those are the two major components. So when we look at this from a stepwise fashion, number one, it's directly toxic to cells. Number two, additional acetate goes to fat. Where does that fat go?

是内脏脂肪和腹部脂肪在推动这种影响。更不用说，通常来说，当你摄入额外热量的时候，比如你在喝酒的时候，往往不会在意自己到底摄入了多少。我们可能都曾有过这样的经历，这种过度消费就变得更加严重。所以，酒精会带来很多方面的影响，但最终，酒精消费是一个个人选择的问题。最近，即使是适度饮酒也受到了越来越多的质疑，我认为在未来两到三年内，相关的数据会非常明确地证明这一点。

It's visceral fat, abdominal fat driving this engine. Not to mention the fallout is typically speaking when you're taking an extra calories, when you're drinking, you're not mindful of what you're putting in your mouth. We've all been guilty of such, you know, so your your over consumption then becomes more of an issue. So there's a lot of ramifications to alcohol, but in the end, you know, alcohol is a personal choice. Of recent, even moderate alcohol use has really been questioned, questioned and I think that data is going to come out very strong in the next two to three years.

我个人认为，在未来五到十年内，酒精将会像香烟一样受到关注。我估计酒精产品上会出现类似香烟那样的健康警示标签。

Personally, I think alcohol is going to be the new cigarettes in the next five to ten years. I think there's going be warning labels on alcohol very similar to cigarettes.

天啊，我希望如此。

Gosh, I hope so.

我

I

我的意思是，我知道肯定有很多从事酒类生意或餐饮行业的人可能不喜欢我这么说，但我不明白喝酒到底有什么好处。一定还有其他方式可以销售人们喜欢的产品而不会伤害到他们，对吧？你明白我的意思吗？社会一定能想出其他类似的方式来让人们聚集在一起享受生活。

mean, I'm sure there's a lot of people in business who run alcohol businesses or restaurants that probably don't like me saying that, but I just don't know the benefit. There's got to be another way to sell product that people can enjoy that doesn't hurt them. Yeah. You know what I mean? There's gotta be something else like that society can come up with.

但我这辈子从未喝醉过。所以我从来不知道那种感觉是什么样的。我尝过一点点酒精饮料，但我从没完整地喝完过一杯啤酒。我也没试过像那样喝一杯葡萄酒。

But I've never been drunk in my life. So I've never known what that feeling is. I've had sips of alcohol, but I've never been had a full beer. I've never had like Wow. A glass of wine.

我只在一次场合下喝过一口葡萄酒，那是和Gary Vaynerchuk一起，因为我十年前跟他说过我会尝试一次。我当时就说了，这是唯一一次我会这么做。我从未喝醉过，也不觉得我错过了什么，因为我了解酒精对身体的影响。

I have only had one sip of wine one time. It was with Gary Vaynerchuk because I told him I'd do it like ten years ago. And I was like, this is the one and only time I'm doing this. And I've never been drunk. And I don't feel like I'm missing out because I just, I know what it does to the body.

我知道酒精对大脑的影响，也知道和喝得烂醉的人在一起的感觉，与和稍微喝一点的人在一起是完全不同的。当你身边的人喝得非常醉，而你自己却清醒时，那感觉并不愉快。但如果只是喝一两杯葡萄酒，那还可以，我能够接受。但如果一个人已经无法清晰思考了，那我们就根本无法享受这个过程。

I know how it impacts the mind and how being around people who are extremely drunk is different than being around people that just drink a little bit. When you're around really drunk people and you're not drunk, it's not enjoyable. It's different if it's like, I'm having a glass or two, it's like, I can be around that. It's fine. But it's like, if you're just unable to think clearly, we're not having fun.

是的，而且你看起来在接下来的几天里身体也不舒服。那这到底有什么好处呢？我理解在文化上、宗教上，某些宗教或社会层面，喝酒有它聚集人群的作用，但我们也可以通过其他方式来聚在一起玩桌游、聚在一起开心地聊天、敞开心扉，而不是需要依靠酒精来鼓起勇气才能说出真心话。对吧。

Yeah. And it, you don't look like your body is having fun the next couple of days either. So how is there a benefit to this? You know, I get it culturally, religiously for some religions, societally, there's benefit for bringing people together, but you can come together and play board You can come together and you have fun and talk and open up vulnerability versus needing the courage of alcohol to start sharing the truth. Yeah.

既然知道它的危害远远大于好处。也许我将来可能会因为某种随机的疾病去世，别人会说，哦，你是死于这种病的。你可能一辈子都在喝酒，但不管怎样，我个人真的不觉得喝酒有什么好处。

Knowing that the damages are way stronger. Now I might die of some random thing and be like, oh, you died of this. You could have been drinking your whole life and whatever. But I just don't think there's benefit to it personally.

那样做没有任何好处，而且它会伤害你的心脏。

There's there's not benefit. And it hurts your heart.

听起来像是……它

It sounds like. It

它会伤害你身体的每一个细胞。所以我和你的经历有些不同。你以前喝酒吗？我喝过。但我想要表示理解。

hurts every cell of your body. So I had a little different path than you. Didn't you used to drink? I did. But I want to validate.

你曾经像是一个典型的南方好男孩，喜欢每隔几天就喝一次酒，对吧。嗯。跟说说你的饮酒经历吧。

You were like a good Southern boy who was like, let's drink every few nights and, know. Well. Tell me your drinking experience.

我不打算承认太多。

I'm not gonna admit to too much.

我不会评判你，我从不评判别人，我只是……

No judge. I don't judge. I'm just.

我确实喜欢过酒精，我喜欢葡萄酒，喜欢将葡萄酒与食物搭配，你刚才说的那种体验我也很喜欢。

I enjoyed, I enjoyed alcohol. I enjoyed wines. I enjoyed pairing wines with food. I enjoyed the whole experience like you discussed.

是的。

Yes.

我确实喜欢过，它是我生活方式的重要组成部分，毫无疑问。而当我开始感觉不适，就在我心脏出现问题之前，我就对自己说：‘至少你可以做的一件事就是戒酒。’

I did. It was it was very much part of my lifestyle. No question about it. And when I started to not feel well prior to my own cardiac situation. I said to myself, well, I mean, the one thing you can do at least is quit drinking.

至少从生活中去掉这个因素，确保自己清楚，因为我当时并不知道到底是什么原因。

At least remove that from your life and make sure because I didn't really know what was

继续吧，看看会发生什么。

going on. See what happens.

看看会发生什么。你那时多大年纪？我当时是55岁。

See what happens. How old were you? I was 55 at the time.

好的。这是一年前的事情吗，还是什么时候？

Okay. Was like a year ago or what was this?

不，谢谢你。那是三年前的事了。其实也没什么太大区别，因为当时我还有其他事情在处理。没错。

No. Thank you. That was three years ago. And it didn't really make a lot of difference because I had something else going on. Yes.

当然多少还是有些改变的。但是一旦我知道了病情，也装了支架，感觉好多了。我妻子对我说的第一句话居然是，顺便说一下，她自己是不喝酒的。她问我：“你是不是打算重新开始喝酒？”我说：“到现在已经一年了。”我说：“绝对不可能了。”

It made some difference for sure. But once I knew what was happening and I got a stent and I felt much better, the first thing my wife said to me, she's like, and she doesn't drink by the way. She said to me, Are you gonna start drinking again? I said, This has been a year at this point. I said, No way.

我甚至都不想碰酒了，就是因为你说的这些原因。我喜欢顺其自然地生活。好时光就是好时光，遇到坏时光我也能妥善应对。而酒精，人们却在两种情况下都会去喝。

I don't even want to because of all the things that you just mentioned. I like to live my life untampered. You know, the good times are the good times. I deal with the bad times accordingly. And with alcohol, people drink it both times.

是啊，开心的时候要喝，难过的时候也会喝。当你难过的时候也喝酒。而且酒精是唯一一种你的朋友还会鼓励你继续使用的东西。

Yeah. To celebrate. And they're sad. And when you're sad. And it's the one drug that your friends will encourage you to continue to do.

来喝杯啤酒吧。好啊。

Let's have a beer. Yeah.

是啊。你刚才说的另一件让我特别注意的事情是，和一群醉汉待在一起其实一点都不好玩。

Yeah. And one of the other things that really got my attention that you said is that it's really not fun to be around a bunch of drunk people.

如果你是清醒的。

If you're sober.

我当时并没有意识到这一点。

And I didn't realize

很长时间都是这样。挺有意思的。

that for a long time. Interesting.

我可以告诉你，戒酒可能是我成年后做出的最具变革性的决定。那真的很好。不，毫无疑问。你知道吗，我最近在一个播客里听到兰斯·阿姆斯特朗谈到这件事，他说他最近一两年也戒酒了。他说，我从未听过任何人说后悔戒酒。

And it I can tell you that removing alcohol for my life was probably the single most transformative decision I've made as an adult. That's great. No, there's no question about it. And you know, heard Lance Armstrong say on a podcast not long ago when he was talking about, I guess he's removed alcohol recently or in the last year or two. He said, I've never heard anyone say I regret moving alcohol for my life.

我希望自己没有戒掉。我当时就觉得他说得太对了。对我来说，戒酒就像是每天的魔法秘诀，让每一天都变得一样，变得可预测。是的。

I wish I hadn't quit. And I was like, that's so true. And for me it is like this magic sauce of every day is the same. Every day is predictable. I'm Yes.

当然，我知道当我这样谈论这件事时，听起来可能有点评判别人的感觉。但我其实一点也不评判。就像我说的，你的身体，你的规则，你想怎么做就怎么做。我没有资格评判别人，我也不想评判别人。

And you know, feel like I'm very judgmental when I talk about it this way. I'm not at all. Like when I say your body, your rules, like go for it. Live your life. Don't have any room to be judgmental nor nor do I want to be.

这有点像你读了一本好书或者看了一部好电影，你会想要分享那种体验。我觉得你分享自己戒酒后的经历时，也是这种感觉。我亲身经历了这种对比，也清楚地感受到这种改变对我有多么强大。所以，你的生活确实变得更好了。毫无疑问。

But it's kind of like when you read a good book or go see a good movie, you want to, like, share that experience. And that's kind of the sense I got from you when you were sharing, you know, your experience without alcohol. I have seen the contrast of that and just how powerful that change has been for me. And so Life has gotten better for you. No question.

是的，在各个方面。

Yeah. On all fronts.

是的，健康方面、人际关系方面，你还帮我省了钱。所有这些方面都变好了。

Yeah. Health wise, relationship wise, you've saved me money. Like all these things here like

完全正确。没错。

Absolutely. Yeah.

你现在是否希望当初早点戒酒？还是你觉得，好吧，这五十年来酒对我是有意义的，现在是时候放下了？

Yeah. Now do you wish you could go back and quit sooner or do you feel like, okay, it served a purpose for fifty years of my life and now

嗯，对的。我的确这么觉得，因为它实在太强大了

Well, yeah. I mean, I do because it's been so powerful

有意思。

Interesting.

我真希望我早些意识到这一点，但这并不是我当初的路

That I I I do wish I had realized it sooner, but it just wasn't my

是的，没错。

Yeah, exactly.

那不是我的路，但我对此感到坦然。是的，当然。你知道的，我现在很享受这一切。

Wasn't my path. And I'm okay with that. Yeah, of course. You know, I'm enjoying it now.

是的。我对这个很感兴趣。你已经完成了超过6500例心脏手术。那么你亲手捧过多少颗心脏呢？嗯，所有这些手术中都有。

Yeah. I'm curious about this. You've done over 6,500 plus heart operations, heart surgeries. How many hearts have you held in your hand? Well, all of those.

你是把心脏取出体外，还是有些手术中会留在体内？不，

You put them, you like take it out of the body or some of them you leave? No,

所有操作都是在体内完成的，但你需要对心脏进行操作。所以我之前提到的位于心脏前部的动脉，就是那些红色的线条。如果我们是在心脏前部进行手术，心脏就可以处于这个位置。

it's every, everything remains in the body, but you have to manipulate the heart. So the arteries that I was talking about on the front of the heart are these red red lines. So if we're operating on the front of the heart, the heart can kind of sit here.

但如果是在后部呢。

But if it's on the back.

你说得对。在这种情况下，我们会在大多数手术中让心脏停止跳动。通过心肺机来实现心脏的停跳。

But if on the you're right. So we stop the heart for the majority of these operations. Stop it. Utilizing a heart lung machine.

天哪，那要怎么做呢

Holy cow. So how

血液继续在体内循环。

does So the blood continues to go around the body.

但血液不再经过心脏。

But not through the heart.

我们在这个地方放一个夹子。

We put a clamp here.

否则血液会到处流出来。没错。

Otherwise there's blood coming out everywhere. Exactly.

然后我们会向心脏注入一种含有高钾成分的冷溶液，让心肌进入冬眠状态。这样我们就可以操作心脏，打开它。我们就是通过这种方式完成所有操作的。然后我们再对心脏进行进一步操作。你在进行这些操作的时候，实际上就是在直接接触心脏。

And then we infuse the heart with a high potassium containing cold solution that puts the heart muscle in a hibernating state. Then we can actually maneuver the heart, open the heart. That's how we That's fix the how we do all of that. And then we maneuver the heart. So you're actually handling the heart when you're doing all those things.

但不要那样把它拿掉

But no, don't remove it like

是的，是的。但你确实在调整它。当然，在胸腔里面。当然。

Yeah, yeah. But you're kind of adjusting it. Absolutely. In the chest cavity. Sure.

是啊，握住一个人的心脏是什么感觉？

Yeah. What is that like holding the heart of a human being?

说实话，我一直认为我所做的是一种荣誉和特权。这种感觉从我进入手术室之前就开始了。那就是我和病人之间建立的关系。对我来说，这只是其中的一个部分。而对于病人来说，这就像你曾经握着我的心一样。

You know, I look at what I do as an honor and a privilege, honestly. And it starts well before I ever get into the Operating Room. And that's the relationships that I develop with my patients. And that is just one component of it for me. For the patients, it's like, you've had my heart in your hand.

我经常听到这样的评论。你知道，我不希望轻视或贬低他们提出的观点，但当你每天都在做同样的事情时，它就变成了日常的一部分。然而，能够建立起一种彼此信任的关系，让我有机会从事这样的工作，这才是对我真正有意义的地方。

I get that comment a lot. You know, I think it's and I don't want to deprioritize or belittle the comment that they're making, but when you're doing something every day, it becomes part of the routine. But again, to develop a relationship that there's enough trust that I'm given that opportunity to do that, that's what's meaningful for me.

是的，是的。这可能是一个非常敏感的话题。如果你不想谈，我们也可以不讨论。不过我猜你已经当了二十五年的外科医生，肯定也有病人没能从手术中挺过来，对吧？当然。

Yeah, yeah. Now this may be very sensitive topic. We don't have to talk about it if don't want to, but I'm assuming you've been a surgeon for twenty five years. There's been people that haven't made it from surgery, right? Sure.

你有没有和别人谈过这种经历？当你对一个病人投入了很多精力，你知道手术风险有多高，他们可能无论如何都挺不过去，但你还是必须进去动手术，结果他们最终没能活下来。这种情况对你在情感上、心理上、信心上都带来过什么样的影响？总的来说，你是怎么应对的？我知道很多医生都不幸面临过这样的情况。

Have you ever talked about that stuff of what that is like when you're invested in a person and you know how high risk it is? Like they may not make it either way and you've got to go in and operate and then they don't come out of that alive. How has that impact you either emotionally, mentally, confidence wise? Just kind of how do you deal with that in general? I know a lot of doctors have to face this unfortunately.

是的。你知道的，像脑外科医生、心脏外科医生，这种情况确实不幸会发生。当然。很明显，你当然希望这种情况不常发生，但对你来说，这种经历是什么样的呢？

Yeah. You know, brain surgeons, heart surgeons, this happens unfortunately. Sure. Obviously, you hope it doesn't happen that often, but what has that been like for you?

对于择期手术、风险最低的手术来说，病人死亡的风险是百分之一到百分之二，听起来这个数字很小，但当你把它放在六千名病人的背景下来看，就不一样了，对吧？没错。所以如果你问我，我工作中最困难的是什么，那就是病人的死亡。哇。这种情况到现在也一点没有变得更容易接受，和我25年前刚开始的时候一样难。

So for elective operations, lowest risk operations, the risk of patients dying is two percent, one to two percent, which sounds like a small number until you put it in the perspective of six thousand patients, right? Right. And so if you ask me what the single most difficult part of what I do is, it's patients dying. Wow. And that's no easier today than it was when I started 25 ago.

确实一点也没有变得更容易。你知道，你提到了那些风险非常高的病人，他们本来可能就活不下来。说实话，从心理准备的角度来说，如果这是一场孤注一掷的手术，病人和家属的期望值本来就很低。哦，天哪。但如果是择期手术，当某人走进医院时，她是一个母亲，或者他是一个丈夫，却落入了那1%到2%的死亡率范围。哦，天哪。

It is absolutely no easier. And, you know, you mentioned the patients that are really high risk and aren't going to make it, you know, honestly, from a mindset standpoint, if it's a real hail Mary operation, the expectations with that patient and the family are very low. Oh man. But for elective operations when someone walks into the hospital and they're a mother or a husband, you know, and they fall in that one to two percent. Oh my gosh.

这真的、真的、真的非常困难，直到今天依然如此。我仍然会在半夜醒来，想起这些年的一些失去。但你知道吗，最终，如果有一天我对此不再有感觉，我就会放弃我现在的工作。你这是什么意思？因为如果那种情感的联结，以及这件事的重要性，以及它对我的个人影响，完全消失了的话——是的，那就不对劲了。

It is really, really, really difficult and remains so to this day. And I still wake up in the middle of the night thinking about some of those losses over the years. But you know, in the end, with the when and if that were to ever go away, I would quit what I do. What do you mean? Because if that sense of attachment and the importance of that event occurring and the way it impacts me personally was never Yeah.

那么我认为我就不应该再继续做我现在的工作了。

Then I don't think I should be doing what I'm doing.

如果这些事情不再困扰你或影响你。

If it didn't bother you or affect you.

没错，没错。正如你提到的，你必须学会把情绪分隔开来，因为你不能把这些带回家，第二天你还得起床，还得回来继续工作。

Exactly, exactly. And you you do as you mentioned, have to compartmentalize because you can't take that home and you got to get up the next day and you got to come back.

你不能在第二天要做心脏手术的时候还在想着那件事。

You can't do it at heart surgery the next day and thinking about that.

没错。

Right.

我的意思是，很明显你在想着这件事，想要做到最好，确保自己采取了正确的行动，但我希望这种事不要再发生了。

I mean, obviously you're thinking about it and wanting to do the best job you can and make sure you're taking the right actions, but you can't I hope this doesn't happen again.

你不能带着那样的心态走进手术室，你必须把事情分门别类。

Cannot go into the Operating Room with that mindset and you have to compartmentalize.

有没有人教过你？我不知道医学院会不会教这个，但有没有人教过你当失去一位病人时该如何应对？比如在情感上如何处理？还是说只能靠自己把情绪分隔开来，专注于工作，几乎就像是把情绪压下去，这样才能在第二天展现出最好的状态？

How did did anyone teach you? I don't know if they teach you this in med school, but did anyone teach you how to navigate when you lose a patient? Like how to process that emotionally? Or is it more, you have to just compartmentalize, do the job and almost like not stuff it, but stuff the emotions so you can show up your best self the next day?

你问题的第一部分，这种东西能教吗？不能。而且这种情况通常要等到你完全结束培训之后才会真正遇到。

So the first part of your question, can you teach that? No. And it doesn't really happen until you're technically out of training entirely.

嗯。

Yeah.

而那份责任是百分之百压在你肩上的。

And the responsibility is a 110% on your shoulders.

所以当你当了十年医生，还在培训学生的时候，你会觉得自己已经做了无数次的练习。但其实并不是这样。

So you're like ten years in as a doctor training student. You're like, you've done so many reps. But you're not Yeah.

这才是真正的反应。但责任并不会完全落在你身上。

Truly the response. But the buck doesn't stop with you.

是的。

Yes.

在你亲身经历之前，这非常困难。就像是试图让一名员工产生主人翁意识，对吧？你真的无法做到这一点，直到他们加入你的公司，成为其中一员，参与其中的事务。他们要么有这种意识，要么就没有。这和医生、外科医生的情况是一样的，直到你亲自到场，所有的责任都压在你身上，你才会产生那种情感上的牵挂。

And until you get into that situation, it's very difficult. It's like trying to instill ownership into someone as an employee, right? Like you can't really do that until they're there and they're part of your business and what have you. And they either have that or they don't. Same thing as a physician, as a surgeon, you know, until you show up and all of that responsibility is on you, you don't have that emotional attachment.

即使你在培训期间看到并参与过类似的情况。

Even though you see it and are part of it in training.

因为你见过其他医生失去病人，而你曾经帮助或协助过那些病人。

Cause you've seen other doctors lose patients that you were helping or guiding.

没错。当然，在那种情况下你依然会感到难过，并不是说你毫无感情。但你不会像当事人那样

Absolutely. And you're still, of course, I mean, you feel badly in those situations. Not that you're non emotional. But you're not

亲自走进手术室完成手术的人，你没有

the one in there doing the job. You don't have

走出手术室去面对病人的家人，进行那种谈话。我不知道你是怎么做到的。是的，这并不容易，而且从来就没有变得更容易过。

to go out look and family in the have that conversation. I don't know how you do that. Yeah. It's it's not easy. It's and it's never gotten any easier.

天哪，是的。这种情况从来就没有变得更容易过。这从来就不是我工作中令人愉快的部分，确实不是。

Oh my goodness. Yeah. It's never gotten any easier. It has not. It is not the fun part of my job, but it's not.

有没有遇到过这样的病人，当你把他推进手术室的时候，你就觉得成功的希望非常渺茫，比如说只有百分之一的可能性手术会成功，或者类似的情况。但最终病人却奇迹般地康复了，并因此多活了很多年？

Has there ever been a patient that has come in on the Operating Table that you said this is the biggest long shot of success? Like there's a one percent chance this will work and or something like that. And they have somehow recovered and lived a longer life because of that operation?

当然有。是的，绝对有这种情况。我想大多数心脏外科医生都会有类似的体会，就像奇迹一样。是的。

Absolutely. I mean, yeah, absolutely. I think most cardiac surgeons would identify with that too. Just like miracles. Yeah.

我的意思是，你看，我们从不单独在手术室里操作。这是最基本的事实。我们只是在为人做手术。当然，你知道，我们总是尽最大的努力，但结果并不完全由我们掌控。最终的结果不是我们能决定的。但我们的确会接收一些病人，尤其是那些年纪较轻、病情非常严重的患者。

I mean, look, we never walk in the Operating Room alone. That's the bottom line. We're just people operating on people. And there's certainly, you know, we we always do the best we can but the end is not up to is not up to us. That's that ultimate the ultimate outcome is not up to us but we certainly have taken patients, particularly younger patients that come in with really grave problems.

即使成功率非常低，我们也会给他们一个机会，因为为什么不呢？当然。你知道，如果一个人已经过了很长的一生，已经九十多岁了，有多种健康问题，他们因为同样的问题被送来，那对话就完全不同了——是的，是的。哇。

We're going to give them an opportunity even if it's a very low percentage because why wouldn't we? Of course. You know, if somebody's lived a long life and they're in their 90s and they have multiple medical problems, they come in with that same problem. It's a different conversation with the Yeah, yeah. Wow.

但这种情况确实会发生。

But absolutely that does occur.

你在走进手术室之前有什么仪式吗？你和上帝之间有某种关系吗？你会把上帝带到手术室里吗？

Do you have a ritual before you go into surgery? And do you have a relationship with God where you bring God to the room with you?

我确实有一套非常明确的流程。这不一定是在手术前立刻发生，而可能是在手术前几天就开始准备了。有点像军队或体育训练那样，我会想象即将进行的手术过程。然后我会设想可能出现的三到四个最糟糕的情况。哇。

So I go through very much a process. It doesn't necessarily happen right before the operation, but days leading up potentially. And much like military or sports where I visualize the operation that I'm going to do. I then identify the three or four worst possible scenarios that I can get into. Wow.

以及我将如何应对这些问题。这很聪明。因为你知道，我们不会在关键时刻突然超常发挥，我们只会表现出平时训练的水平。是的。

And how I'm going to get out of it. That's smart. Because, know, we never rise to the occasion. We always fall to our level of training. Yes.

是的，这就是人性。军事训练的基本原则。没错。我是偶尔会愿意相信我们确实能在关键时刻表现得更好，但那是在压力之下，你不能指望每次都这样。

I mean, that's just human nature. Military 101. Exactly. I mean, I like to occasionally believe that we do rise to an occasion, but that's under duress. You can't count on that.

不。所以除非你为此训练过，

No. So Unless you train for it,

你只会表现出你平时训练的水平。时间。

going to fall to the level of your training. Time.

是的。这正是我所做的。然后我总会把这种准备带回手术当天的早晨，当我去看即将接受手术的病人时。因为在术前谈话中，我会告诉病人我们可能会遇到一些困难，但我可以向他们保证的是，我会始终如一地投入百分之百的注意力，并且会像对待自己家人一样照顾他们。

Yeah. And so that's absolutely what I do. And then I always bring it back the morning of when I see patients before surgery to the patients that we're actually going to be operating on that day. Because I tell patients in the pre op conversation that I can't guarantee them that we're not going to have bumps in the road. But what I can guarantee them is they're going to have a 110% of my attention at all times and I'm going to care for them like they're my own family.

哇，而且我确实是这个意思。这太好了。我认为这就是我向他们表达我真的会参与其中的方式。是的。

Wow. And that I truly mean. That's great. And I think that that's how I express to them that I'm truly gonna be a part of this. Yeah.

我全身心投入。

I'm fully engaged.

你会在你的仪式中引入上帝的概念吗，还是这部分并不包含在你的

Do you bring God into the, your, your ritual at all or is that not part I, of your

我不会特别这么做。有些

don't specifically. Some

医生是完全基于信仰的，而其他医生则完全不是。我只是必须

doctors are full faith based and other doctors Absolutely. I just gotta

我是一个非常有灵性的人，但我不是一个非常宗教化的人。

I am a very, I'm a very spiritual person. I'm not a very religious person.

嗯

And

我还发现，考虑到各种不同的宗教，有时候引入宗教是合适的，但有时候又会让病人感到不适。

I also find that with the breadth of religions that, you know there's times when it's appropriate and there's other times when it's uncomfortable for patients.

当然。

Of course.

因此，我的工作就是努力让他们尽可能感到舒适。我希望他们知道，我是以全身心投入的态度来到他们面前的，并且

And so my job is to try to make them as comfortable as possible. And so I want them to know that I'm coming to them fully engaged and

那是对的。

That's correct.

并且是开放且完全负责任的。

And open and fully responsible.

你知道，我们在这个Variness学校讨论的很多话题都与人际关系有关。我认为人际关系是过上充实的生活或在生活中受苦的关键之一，这取决于你人际关系的质量。我很好奇，从心脏外科医生的角度来看，你觉得有人会因为心碎而死吗？不是指字面上的意思，而是说心理和情绪是否会对心脏产生如此大的影响，比如因为失去亲人、悲伤、分手或离婚而感到极度崩溃，导致心脏无法继续跳动？

You know, a lot of the topics that we talk about on the School of Variness is around relationships. I think relationships is one of the keys to either living a fulfilling life or suffering in life based on the quality of your relationships. I'm curious from a heart surgeon standpoint, do you think someone can die from a broken heart based on relationships, not like, can the mind and the emotions impact the heart so much if they feel devastated from a loss, grief, a breakup, a divorce where the heart just cannot go on?

简短的回答是：会的。真的吗？确实有一种实际的综合征。那是什么？叫做Takotsubo心肌病，也就是心碎综合征。

The short answer is yes. Really? And there is an actual syndrome. What is that? Tokosobu's cardiomyopathy or broken heart syndrome.

真的吗？

Really?

确实存在这种病。

It is a thing.

得了吧。所以你可以是一个健康的人，没有任何这些锻炼，完全没有体脂。

Come on. So you can be a healthy human being. Have none of these, you know, workouts. Absolutely. No body fat.

这种病最常见于55到60岁以上的女性身上，但男性也会发生。

Now, it is most commonly occurs in women over the age of 55 or 60. Most commonly it happens in men too.

你见过这种病例。

You've seen this.

哦，当然见过。我们每年都会遇到好几次。通常如你所说，是在失去亲人、财务损失或重大情绪压力之后发生的。我们推测，但尚不完全清楚具体原因，认为这是自主神经系统过度刺激引起的，也就是所谓的战斗或逃跑反应，或者是休息和消化反应。这就像这些反应之间的失衡，从而导致急性心力衰竭，患者的表现就像他们刚刚经历了心脏病发作一样。

Oh, absolutely. We see it multiple times during the year. Typically, as you pointed out, it's after the death of a loved one, financial loss, major emotional stress. So we think and we don't truly know the cause that it is an over stimulation of the autonomic nervous system, is that fight or flight or the rest or digest. It's like an imbalance of that that then causes like acute heart failure and patients present just like they've had a heart attack.

很多时候，他们最终会被心脏科医生评估，医生会将染色剂注入动脉进行导管插入检查，结果却发现没有任何阻塞。但之前心脏功能是正常的，现在却下降到了大约20%。现在，这里有个好消息和坏消息。大多数患者只需通过支持性治疗就能好转，一些药物加上时间，心脏功能就会逐渐恢复。

And many times they end up being evaluated by a cardiologist actually having the dye put in the arteries, the catheterization, and they have no blockages. But the heart function that was before normal is now down to like 20%. Now here's the here's the good news and bad news. The majority of these patients get better just with support. Some medications support and time and it gets better.

这种病在女性中更为常见，但死亡率非常低，大约在1%到2%之间。男性则很少发生这种情况，但死亡率却高得多，真的，大约在5%到8%之间。早期曾有一些研究认为这可能与雌激素减少有关，这就是为什么我们更常见于围绝经期和绝经期女性，但男性也会得这种病。

Women, it's much more common but the death rate is very low somewhere around one to two percent. Men, it happens much less commonly but the death rate is much higher. Really? Five to eight percent. There was some research early on that this maybe has something to do with the decrease in estrogen which is why we're seeing it in perimenopausal and menopausal women more commonly, but men get it too.

所以，这些理论并不是在所有情况下都站得住脚。我们其实并不真正了解它。但确实，你可以因为心碎而死，我们见过这种情况，也看到这种综合征的发生。我曾经给一些病人做过手术，他们当时病情很重，两周后他们的家人因为心碎综合征也住进了医院，两个人同时在医院里。

So it's there's those those theories aren't holding water across the board. So we don't really understand it. But yes, you can die from a broken heart and we see it. And we see this syndrome. I have had patients that I have operated on that have been really sick and then their family member comes in two weeks later with broken heart syndrome and they're both in the hospital.

得了吧，哦，是的，太疯狂了。

Come on. Oh yeah, it's crazy.

但你不能通过手术治疗心碎综合征，是的，不需要做手术。

But you can't operate on broken heart syndrome. No, you don't have to.

没有阻塞，没有任何阻塞，瓣膜也运作正常。只是心脏的功能，原本强大的心脏泵血能力现在变弱了。但随着时间的推移和支持性治疗，幸运的是，大多数人最终都会恢复。

There's no blockages. There's no blockages and the valves are working fine. It's just that the heart function, that heart pump that normally is strong is now weak. And with time and support, thank goodness majority of them come back.

心碎的时候不要开始酗酒，也不要暴饮暴食，这是很好的建议，很好的建议。那有什么区别呢？

Don't start drinking when you have a broken heart. Don't start overeating and drinking. That's good advice. That's good advice. What is the difference?

你知道，我希望我自己永远不会经历这种情况，也希望没有人必须面对这种情况，但中风或类似中风症状的人，与心脏病发作或类似心脏病发作症状的人之间有什么区别呢？

You know, I hope I never witnessed this and I hope no one has to witness this, but what is the difference between someone having a stroke

嗯嗯。

Mhmm.

或者类似中风的症状，当然，与心脏病发作或类似心脏病发作的症状有什么不同？他们有什么表现？他们如何应对？两者之间有什么区别？

Or stroke like symptoms Sure. Versus a heart attack or heart attack like symptoms? What do they do? How do they respond? What are they saying between the two?

这是个好问题。我认为这种困惑并不少见，因为人们觉得这两者之间有很多重叠，有时候确实可能存在。但我们先从中风开始讲起，这样你能更好地理解发生了什么。基本上，中风是由于大脑某部分缺乏血液供应。

That's a good question. And I think that it's not an uncommon confusion because people think that there's a lot of overlap and sometimes there can be. But let's start with stroke first, okay, so that you understand what's happening. Basically with a stroke, it's lack of blood flow to a portion of the brain.

那么心脏会影响流向大脑的血液吗？

And does the heart influence the blood flow to the brain?

通常情况下，在典型的中风症状中不会。我不想深入探讨太复杂的细节。虽然有一些心脏来源的问题可能会导致中风，但大多数情况下并不是因为心脏本身的问题导致血流障碍。那么最常见的中风来源是哪里呢？是颈动脉中的阻塞，这些阻塞物会脱落，向上进入头部，造成大脑中的小动脉堵塞，从而导致大脑缺乏氧气和营养物质，就像心脏发生心肌梗死一样。

Not typically in standard stroke symptoms. And I don't want to get too far in the weeds. There are cardiac sources that It's can cause not a blood flow issue though from a heart problem most of the time. Where's the most common places that strokes come from? It's blockages in the carotid arteries that break off pieces, break off and go north and cause blockages in the small arteries in the head and then cause a lack of oxygen and nutrients to the brain just like a heart attack in the heart.

所以，根本问题是一样的，但症状却大不相同。

So the essential problem is the same. The symptoms are very different.

那么当有人中风时，你会看到或注意到哪些症状？

So when someone's having a stroke, what are symptoms that you'll see or notice?

你需要注意的症状包括：言语改变、嘴角下垂、通常身体的一侧出现无力（而不是两侧），当然也可能存在一些交叉影响，但通常是面部变化、言语含糊、视觉变化，以及身体一侧（比如上肢的手或腿，或下肢）无法正常活动或无力。

The things that you want to look for are changes in speech, drooping of the mouth, weakness typically on one side of the body and not on the other, but it can be, you know, there can be some crossover, but it's usually facial changes, slurred speech, visual changes, and one side of the body, meaning upper extremity hand and or leg not moving properly weakness.

明白了。

Okay.

所以这就是中风。这在现在就是需要拨打急救电话的医疗紧急情况。绝对如此。

So that's a stroke. And that is a medical emergency for 901 now. Absolutely.

立刻停下你正在做的事情。百分之百正确。拨打急救电话，把患者送到医院。

Stop what you're doing. 100%. Call the paramedics. Get them to the hospital.

没错。这绝对属于医疗紧急情况，就像心肌梗死一样。

Absolutely. That is that's a medical emergency as is a heart attack.

那么心脏病发作的主要症状是什么？

And what are the main symptoms of a heart attack?

主要症状通常包括压榨性的胸痛，通常被描述为像一头大象坐在胸口的感觉，还有气短，疼痛放射到手臂或下颌。话虽如此，正如我之前提到的，心脏病发作可能表现得非常不典型。有些患者会出现剧烈的腹痛，且疼痛不会消失。这种情况下可能难以判断，但一般来说，持续不缓解的压榨性胸痛、放射性疼痛，或者放射到手臂或下颌的疼痛，以及气短，这些症状都需要特别注意。911，快拨打911。

So the main symptoms are going to be crushing chest pain, typically described as like an elephant sitting on your chest, shortness of breath, radiation of pain into the arms or up into the jaw. That being said, as I mentioned earlier, can be the great masquerader. Patients can have intense abdominal pain that doesn't go away. It can be difficult to discern but those symptoms of crushing chest pain that does not go away, pain that radiates or into the jar, shortness of breath, nine eleven. Nine eleven.

911。我希望

Nine eleven. I hope

我从不希望亲眼见到这种情况，但了解这些信息很有用。所以你应该采取行动，而不是说‘你会没事的’或者‘你没事’之类的。

I never have to witness that, but that's good information to know. So you're taking action as opposed to, you'll be fine, or you And

当你不确定的时候，永远不要犹豫。拨打911并去医院检查，你永远不会因此受到批评。生命太宝贵了，不能冒这个险。

always when in doubt, you're never, you're never going to be, you know, you're never going to be criticized for calling 911 and going to the hospital there's a concern. The commodity is too great to not do that.

是的。是的。你得照顾好自己的生命。那么，你认为每个人为了心脏健康，最应该添加到生活中的是哪三件最重要的事情？同时，最应该从生活中去除的又是哪三件事情？

Yes. Yeah. You got to take care of your life. And what would you say are the three biggest things then everyone should be adding to their life to help their heart and the three biggest things people should be removing from their life to support their heart health. Okay.

我们已经谈过其中一些了。当然。你比如说，有哪些三件要添加的，三件要去除的，这样你的心脏健康状况会变得更好，你觉得这些事情分别是什么？

We talked about some of them already. Sure. You're like, here's the three things you need to add to your life and three things to remove, and you'll improve the quality of your heart health much better, what would you say those things are?

我们先谈谈你应该添加的事情吧，因为我觉得人们通常更愿意添加一些东西，而不是放弃他们已经习惯或喜欢的事物。首先，每天都要活动，不要久坐不动。这种活动可以有多种形式。理想情况下，如果我们参考研究数据，我们希望包括有氧运动，也就是每周至少两到三次显著地提高心率的锻炼，从而提升你的VO2最大摄氧量。

So let's talk about the things that you should add because I think people are much more willing to add things to their life than to remove things that they've gotten accustomed to or they've enjoyed. So I think the first is to move every day and not live a sedentary lifestyle. And that comes in a lot of forms. Ideally, like if we're following the data, what do we want that to include? We want that to include aerobic training, where you are getting your heart rate up at least two to three times a week significantly, so that you can move what's called your VO2 max.

又是一个听起来专业的术语。这是什么意思呢？简单来说，就是你的心血管系统的工作效率。你的VO2最大摄氧量越高，说明你的心脏工作效率越高，这会延长你的健康寿命和寿命。老实说，这可能是最重要的健康预测指标之一。

Again, a fancy term. What does it mean? It just simply means how efficient your cardiovascular system So the better your VO2 max, the more efficient your heart is working, that increases your health span and lifespan. Probably the single most important predictor honestly is VO2 max. Okay.

此外，还有阻力训练，也就是力量训练。对，非常重要。正如加布里埃尔·莱恩（Gabrielle Lyon）所说，肌肉是长寿的器官。她为什么这么说？

Then along with that is resistance training. Yep. So important. As Gabrielle Lyon says, muscle is the organ of longevity. Why does she say that?

嗯，很明显，随着年龄增长，拥有坚实的肌肉质量非常重要，因为我们在30岁之后就会开始流失肌肉，这种流失是非常明显的。拥有坚实的肌肉会让你更稳定，不容易跌倒，可以抱起孙子孙女、提起行李箱，保持正常的生活功能。此外，肌肉是我们身体里的葡萄糖储存库或者说糖分储存库。保持稳定的血糖水平不仅对心血管健康至关重要，对整体慢性疾病的预防也非常关键。

Well, obviously having a solid muscular mass as we age because we know we're going to be losing muscle mass after the age of 30. It's dramatic. Having that in place, you're more stable, you're less likely to fall, you're able to pick up your grandchildren and pick up suitcases and function, have a functional life. In addition, muscle is a glucose sink or a sugar sink in our bodies. And maintaining stable blood glucose levels is critical not just for cardiovascular health, but for chronic disease in general.

所以我认为锻炼是非常重要的一点。

So I think exercise is so important to add.

好的。

Okay.

我认为下一个是良好的睡眠卫生计划。没错，因为你知道，作为一名运动员，你应该明白最大的进步是在恢复期间实现的。是的。对于我们这些总是想更努力训练以获得更好效果的人来说，休息反而更难做到，对吧？

I think the next one would be a solid sleep hygiene program. Yep. Because, you know, you as an athlete understand that the biggest gains happen during recovery. Yes. And it's hard for guys like you and me that just want to go harder to get those results, right?

有时候，你越想更努力地推进，反而越需要退一步，真正让你的身体恢复。而这种恢复不仅仅是心脏和肌肉，也包括我们的大脑。我们在睡眠中，大脑会得到恢复，白天大脑中产生的各种废物会在睡眠中被清除出去。因此，从心血管健康和全身健康的角度来看，睡眠都是非常重要的。

Just push harder, harder sometimes to take the step back and actually allow your body to recover. And it's not just your heart and your muscles, it's our brain too. Our brain rejuvenates when we sleep. That's when all of the waste products that have occurred in the brain during the day get washed out. So sleep is important across the board, both from a cardiovascular standpoint and whole body.

然后我认为第三点就是你之前提到的。我认为人际关系对于长寿来说真的非常重要。你知道，我父亲这个月就快89岁了，他有一次打电话给我说，‘孩子，我给你一个建议，随着年龄增长，你要把朋友紧紧地留在身边。’他说，‘因为你不知道哪些朋友会渐渐失去联系，哪些还能继续沟通。’因为有人愿意拿起电话对你说一句，‘嘿，你在干嘛？’

And then I think the third is what you mentioned earlier. I think relationships are really, really important to longevity. You know, my dad's about to be 89 years old this month actually and he called me one time and said, you know, I'm going to give you one piece of advice as you age. He said, keep your friends really close to you. He goes, because you're not sure which ones you're going to lose, which ones are going to be able to communicate because having someone pick up the phone and just say, hey, what you doing?

是的，或者问一句‘你最近怎么样？’他说，‘不一定非要安排什么大事，但这种联系，我认为是非常重要的因素。’这真的很棒，这是我们每天早上起床的动力之一。

Yeah. Or how are you doing? He goes, Not that you have to make any great plans, but just that connection, I think is a really, really important factor. That's cool. In the reasons we get up every morning.

他当时说的那句话让我印象非常深刻，那是在他即将迎来80岁生日的前夕。而且他其实是在很多年前说的，不是最近才说的。哇。

And that really stuck with me when he made that comment. That's good wisdom. Particularly on the eve of his 80 birthday. And he said this actually years ago, it wasn't recently. Wow.

所以，为了改善心脏健康，可以添加的三件事是：每天运动，包括有氧运动和抗阻训练；建立更健康、更良好的睡眠卫生习惯，保证每晚都有高质量的睡眠；改善人际关系的质量。那么

So three things to add to increase your heart health is to move every day, aerobic and resistance training, have a healthier, better sleep hygiene program, you know, get quality sleep every night, and improve the quality of your relationships. And what

为了改善心脏健康，应该去除的三件事是什么呢？好的，第一点，要留意你吃进嘴里的东西。去除加工食品和高度加工食品以及添加糖分，因为控制葡萄糖和糖分管理是非常重要的风险因素。正如我们之前讨论的，这与2型糖尿病、代谢综合征等导致冠心病的因素密切相关。显然，高度加工食品再次推动了这种炎症反应。

would be three things to remove to improve your heart health? Okay. So the first would be be conscious of what you're putting in your mouth. Remove the processed and ultra processed foods and added sugars because glucose management, sugar management is such an important risk factor when we look at things like type two diabetes, metabolic syndrome, all of these things that drive coronary disease, as we discussed earlier. Obviously, ultra processed foods, again, driving this inflammatory engine.

去掉那些专注于全食物饮食的人，真的只是对你吃进去的东西多加思考。

Removing those focusing on a whole foods diet, and really just being thoughtful about what you're putting in your mouth.

好的。

Okay.

下一个显然是吸烟。我们必须把它从名单上去掉。

The next one is obviously smoking. We got to remove that from the list.

还有电子烟，对吧？

And vaping, right?

我很想把这两项都包括进去。如果我能用数据支持这一点，我一定会把它们都加上去。不过我想最终来说，是的。

I would love to include both. If I could support it with the data, I would definitely put it on there. But I think that ultimately, yes.

嗯，你看到过年轻人因为吸电子烟来到你的手术室。绝对有这种情况。这已经影响到了他们的心脏。

Well, data of you've seen young people come in your operating room. Absolutely. From vaping. Absolutely. That has impacted their heart.

嗯，那是你的个人经验。我想你还没有在文献资料中看到相关数据。

Mean, that's your personal data. You haven't seen the data in the literature, I guess.

没错，正是如此。

Right. Exactly.

那第三个要戒除的是什么？

And the third thing to remove?

是的，我会把酒精列在名单上。是的。这既来自我的个人经历，也来自我的临床经验。那些我不饮酒的病人，他们是一群不同的人。挺有意思的。

Yeah, I would have to put alcohol on that list. Yeah. Both from my personal experience and from my clinical experience. That the patients that I, you know, the patients that I care for that don't drink are a different group of patients. Interesting.

比起那些实际去做的，挺有意思的。只是因为通常那种生活方式的其他方面也与那种心态一致。

Than the ones that do. Interesting. Just because typically the rest of the pieces of that lifestyle also go in line with that mindset.

是的，对一个人来说保持健康的睡眠并把睡眠放在优先位置很难。是的，活动身体、饮食干净。对，拥有良好的人际关系，同时又酗酒，这很难。

Yeah, it's hard for someone to be healthy with their sleep and prioritize sleep. Yeah. Move their body, eat really clean. Right. Have good relationships and then also be an alcoholic.

就像很难拥有，你知道的，如果你把所有这些事情都做得很好，你就会看到酒精带来的负面影响。它影响我的睡眠，影响我的人际关系，影响我的健康水平，我无法高强度训练。

Like it's hard to have, you know, it's like, if you're doing all these things well, you see the effects of alcohol. It's hurting my sleep. It's hurting my relationships. It's hurting my fitness levels. I can't train as hard.

所以你可能会更加留意。也许你偶尔会喝一杯，但不会每晚都喝酒，对吧？你会更加在意。如果你对其他所有事情都有意识，唯独在这方面不上心，那肯定哪里不对。

So you're probably more mindful. Maybe you drink every now and then, but you're not drinking every night, you know? You're more mindful. If you're conscious of all these other things, but not here, something's off.

你知道，我认为这引出了一个观点。我们每个人都有自己的使用说明书。

You know, and I think that brings up a point. You know, we all have our own instruction manuals.

是的。

Yeah.

对吧？比如你的说明书和我的不一样。你的饮食会和我的略有不同。关键是找到适合你自己的。我认为整个旅程中很重要的一部分就是去弄清楚自己的使用说明书是什么。

Right? Like yours is different than mine. Your diet is going to be a little bit different than mine. It's about what works for you. And I think a big part of this whole journey is figuring out what that instruction manual is.

这些大体上是一些关键因素，然后你需要弄清楚如何、在何处以及何时去落实它们。

These are kind of the major levers and then you need to figure out how and where and when you're gonna

是的，没错。

Yeah, exactly.

在那之后去落实。

Work after those.

我的意思是，我说这些时充满信念，但我希望观看或聆听我们对话的人明白，如果你真的想喝酒，那就喝吧。我知道我的生活方式并不完美健康。我摄入的糖分太多，加工食品可能也太多了。

I mean, and I speak with a lot of conviction, but I hope that people watching or listening to both of us, you know, if people want to drink, drink. You know, my Yeah. I know I don't live a perfect healthy lifestyle. I have too much sugar. I probably have too many processed foods.

我清楚这一点，但我也对此有意识。大多数时候，我吃的新鲜天然食品要比加工食品多。是的。但当我吃这些不健康食品的时候，我心里也清楚，我会想，我应该做得更好。没错。

And I know that, but I'm conscious of it. And I have more whole foods than I do processed most of the time. Yeah. But I also know when I'm doing it, I'm like, you know, I need to be doing better. That's right.

让我暂停一下这个话题。

Let me pause this.

我之前说了什么？我们其实知道什么更好，但并没有去做到更好。

What did I say earlier? We know better, but we don't do better.

所以关键在于要有意识。如果你要喝酒，你要想清楚，好吧，也许我每周只喝一次，或者偶尔喝一次，类似这样的安排。如果可以的话，尽量控制饮酒量。没有人需要做到完美，你也不必太担心。

So it's about being, you know, being conscious of it. If you are drinking, it's about like, okay, only I'm gonna do this once a week maybe, or once every now and then, or something like that. And really try to limit it if you can. No one needs to be perfect. You don't have to worry about that.

我并不是在这里评判他人，但我确实希望提升自己，也帮助他人过上更好的生活。如果这意味着需要提醒大家，那这就是我希望大家去做的。

And I'm, I'm not here to judge people, but I am here to elevate myself and others to living a better life. And if that means calling people up, then that's what I want us to do.

完全同意。这正是关于进步，而不是完美。没错，就像我自己的情况，如果我能有80%的时间吃天然健康的食物，效果就已经非常显著了。

Absolutely. And it's about, it's about progression, not Exactly. And you're right. Like even for me personally, if I'm eating whole foods 80% of the time. It's amazing.

剩下20%的时间我可能会偏离轨道，但对我来说，这已经是一次巨大的胜利了。

And 20% of the time I fall off, that's a W for me. That's a win.

这确实是一次很大的胜利。

It's a big win.

对我来说，我已经很满足了。是的。当你谈到如何评估自己健康的起点，或者你认为最重要的建议是什么的时候，其实很难为每个人给出一个统一的答案。因为如果我来对你说，你需要每天运动。

And I'm comfortable with that for me. Yes. And when you talk about, you know, like how do you evaluate where I start with my health or, you know, what's the one thing I would say do? It's very difficult when we talk about all of us as individuals to give that one thing. Because if I came to you and said, well you need to move every day.