#845：如何利用酮症提升情绪、认知与长期脑部保护——Dominic D'Agostino博士的实用战术指南（附：解密Tim最新生酮实验）

你可以吃蔬菜。

You can have vegetables.

有一些东西你需要留意，以免打破生酮状态。

There are certain things you have to watch out for so you're not whacking yourself out of ketosis.

但就我而言，我不介意。

But in my particular case, I don't mind.

事实上，当我写《四小时身体》时，人们都说：天哪，你要我们一遍又一遍地吃同样的饭菜？

And the fact of the matter is when I wrote The four Hour Body, people were like, oh my god, you want us to repeat the same meals over and over again?

我问他们：过去五天你早餐吃了什么？

I'm like, what did you have for breakfast the last five days?

他们吃的也是同样的东西。

And they ate the same damn thing.

你只是在替换默认的餐食。

You're just swapping out default meals.

所以我的第一餐通常比较少，比如我之前说的鲭鱼，然后我会吃一顿大餐。

So my first meal is something typically pretty small, like the mackerel I explained, and then I have a big meal.

我可能会在中间再吃一些蛋白质，但昨天我吃了美味的羊排，搭配用空气炸锅做的蔬菜，完全没问题。

I might have some more protein in between, but it's like yesterday I had lamb chops that were delicious with some vegetables made in an air fryer, no problem.

稍后我可能会吃一块牛排，配上一大份沙拉，再加点别的东西，但也就这样了。

And later on, I might have like a rib eye on a big gigantic salad with some other stuff added to it, but that's about it.

你得小心澳洲坚果，这些东西会悄悄让你超标。

You have to be careful with the macadamia nuts, those things will creep up on you.

但这就是实际上的饮食方式。

But that is in effect the diet.

对吧？

Right?

我在进行训练。

And I'm doing my training.

我在进行康复。

I'm doing my rehab.

我在进行二区训练。

I'm doing my zone two.

我确实发现自己在生酮状态下，可以说，表现会稍微差一些。

I do find I'm a little, let's say, lower performance when I'm in ketosis.

但我想讨论的也许是我经历的一个假阴性情况。

But what I wanted to talk about is maybe a false negative that I've experienced.

我会解释一下这是什么意思。

And I'll explain what that is.

所以这就是如何判断你是否——我一直用引号强调——‘处于生酮状态’。

And this is so how do you know if you're and I keep putting this in quotation marks, quote unquote, in ketosis.

对吧？

Right?

因为大多数人，或者可能所有人，都在产生一定水平的酮体。

Because people are most people are or maybe all people are producing some level of ketones.

所以有不同的浓度，你可以通过指尖采血来测量，就像测血糖一样。

So there are different concentrations, right, that you can measure with a finger prick just like you would look at glucose.

至少通过指尖采血，我认为它测量的是你之前提到的在许多研究中非常有益的物质——β-羟基丁酸，也就是BHB。

And at least with the finger prick, I think that's measuring what you mentioned earlier as being so beneficial in a lot of studies, the beta hydroxybutyrate, BHB.

为了进行这项追踪，我还戴了一个G7 Dexcom连续血糖监测仪在一只手臂上，另一只手臂上则戴着CyBio（如果发音不对请见谅）连续酮体监测仪。

I also have, because I wanted to run this tracking, a g seven Dexcom continuous glucose monitor on one arm and then a CyBio, apologies if I'm not pronouncing that correctly, continuous ketone monitor on the other arm.

睡觉时我会佩戴Oura戒指，以观察这一切如何影响我的睡眠结构和其他方面。

And I'm wearing an Oura Ring when I sleep to see how all of this affects my sleep architecture and everything else.

因此，我收集了所有这些数据，但后来我发现了一些非常奇怪的现象，我已经发消息告诉过你了，因为我总觉得自己在生酮饮食上失败了。

So I'm gathering all of this, but then I noticed something really weird, which I've texted you about because I I keep feeling like I'm failing at keto.

但我感觉很棒。

I feel great.

我感觉思维敏锐。

I feel sharp.

然而，当我查看的不仅是连续血糖监测仪的数据，甚至包括指尖采血的数据时，因为这些设备通常需要校准。

And yet when I look at not just the continuous glucose monitor, but even with the finger prick, because you do have to often calibrate these things.

对吧？

Right?

别以为你的连续监测设备一定是准确的。

Don't assume that your continuous monitors are accurate.

你需要校准它们。

You wanna calibrate them.

但我正在看这些数据。

But I'm looking at the numbers.

比如，前几天晚上我女朋友吓坏了，因为我的手机突然大叫起来。

And for instance, my girlfriend freaked out the other night because my phone started screaming.

我当时戴了耳塞，所以没听到。

I had earplugs in because I didn't hear it.

它发出的是严重医疗警报，或者说是红色警报，因为我的血糖降到了69，我想。

And it was like critical medical alert or whatever the code red was because my glucose was 69, I suppose.

在生酮状态下，血糖会降得更低，但通常维持在65到80之间。

It's gotten quite a bit lower on ketosis, but usually hovers somewhere between like sixty five and eighty.

而我的酮体水平是0.2毫摩尔。

And my ketones were 0.2 millimolars.

之前我们讨论过你应该瞄准的目标，似乎1.2到2毫摩尔的酮体水平具有抗焦虑作用，对吧，能降低焦虑。

Now, when we've talked in prior conversations about what kind of target you might aim for, it seems like between one point two and two millimolars is anxiolytic, right, lowers anxiety.

然后你关注的是这个比例，你可以谈谈GKI，也就是葡萄糖与酮体的比例。

And then you're looking for this ratio, you could talk about this, but the GKI, there's a ratio, glucose to ketones.

我看着这些数字，觉得这对我来说毫无意义，因为我的葡萄糖水平不足以让我良好地运作。

And I look at those numbers and I'm like, this makes no sense to me because I'm not getting enough glucose to function well.

如果我依据Keto Mojo的指尖采血检测，或者Abbott的Precision Xtra，甚至我的连续酮体监测仪，按字面意思来看，我也根本测不到任何酮体。

And if I'm basing it off of the Keto Mojo finger prick, even the Precision Xtra from Abbott, or my continuous ketone monitor, I'm not getting any ketones either if you're taking it at face value.

那我是怎么正常运作的呢？

So how am I functioning?

你会怎么回答这个问题？

How would you answer that?

因为我觉得，如果有人遇到这种情况，不会只有我一个人觉得自己做错了什么。

Because I don't think I'd be the only person who feels like they're doing something wrong if they run into this.

那你该如何解读这种情况？

But how would you interpret this?

我肯定会说，你正处于一种非常精瘦的状态。

I would definitely say you're running lean.

我认为你在OGT测试中的表现非常好。

And I think what you've done in your OGT test is really good.

我想你之前发过消息。

I think you had messaged.

是的。

Yeah.

对于普通人来说，OGT就是口服葡萄糖耐量测试，你需要喝下大量葡萄糖水，然后在两小时内每半小时抽一次血，观察你对葡萄糖的反应。

And the OGT for folks is just that oral glucose tolerance test where you drink a bunch of dextrose water, and then they take your blood every thirty minutes for two hours to see how you're responding to it.

最大的代谢影响因素是你具有增强的胰岛素敏感性，我认为这一直是关注的重点。

The biggest metabolic lever would be you have enhanced insulin sensitivity, and I think that has been the focus.

例如，本·比克曼写了一本关于这个主题的书，并做了数百期播客，探讨如何逆转胰岛素抵抗，以及低碳生酮饮食对此的有效性。

For example, Ben Bickman wrote a book on this and doing hundreds of podcasts on reversing insulin resistance and low carb ketogenic being effective for that.

首先，你的胰岛素敏感性非常高，脂肪氧化能力也很强，葡萄糖清除率也很高。

That, first and foremost, your insulin sensitivity is very high, your fat oxidation is really high, and your glucose disposal is high.

如果你处于热量赤字状态，你的酮体摄取能力会非常高。

And if you're in a caloric deficit, your ketone uptake is very high.

我们在老年大鼠身上清楚地观察到这一点：当通过胃管喂食时，它们的酮体水平会达到有毒程度，而代谢状况良好的年轻啮齿动物则能迅速清除酮体。

We see this quite convincingly in older rats where we gavage, where we tube feed the rats and they're older, the ketones get to toxic levels, whereas a younger metabolically fit rodent will dispose of it very quickly.

对于久坐不动的人类和顶级运动员也是如此。

Same with a couch potato human, same with an elite level athlete.

因此，当你测量血液中的酮体时，这反映了酮体的生成与利用之间的平衡；代谢状况良好的人，酮体利用率可能高出两到五倍，这部分归因于催化酶的作用。

So when you measure ketones in the blood, that's function of ketone production and ketone utilization, and you could have two to five times higher ketone utilization with high metabolic fitness, and that's due in part to catalytic enzymes.

你会上调MCT转运蛋白，在啮齿动物中，其表达量可高出两到三倍。

You upregulate the MCT transporters that could be two or in rodents, two or three times higher.

我本人尚未做过这项实验，但我们有一些关于人类的数据尚未发表，但这确实是真实存在的现象，我认为你正在体验它。

I haven't done that personally, and we have some data in humans we haven't published yet, but that is a real thing and I think that you're experiencing.

此外，如果你处于热量赤字状态，酮体的溢出就会减少。

Also, if you're in a caloric deficit, there's less spillover.

我刚买了一辆古董摩托车，它装有化油器，浮子有点卡住，每次运行时都会从化油器滴漏，停下来时更是大量外溢，这就是燃料的溢出。

I just bought an antique motorcycle and it's got a carburetor and the float sticks a little bit and it always drips out the carburetor when I'm running it and when I stop it's pouring out the carburetor, so there's spillover of fuel.

但当我骑行时，发动机处于贫油状态，因为所有进入化油器的燃料都被有效利用了。

But when I'm running it, it's running lean because I'm using the fuel that's going to the carburetor.

这里的类似情况是，例如，也许最好只是静坐一处，放松一下，稍微多吃一点热量，甚至吃一点碳水化合物，你常常会发现自己的酮体水平会飙升。

The same analogy here is that if, for example, it might be good to just sit in one spot and relax and maybe eat a little bit of surplus calories or even eat a little bit of carbs, and what you'll see often is like your ketones spike up.

我记得我曾经最高的酮体水平，就是在禁食或处于生酮状态后摄入碳水化合物的时候。

So I remember some of my highest levels ever is when I consumed carbohydrates after I was fasting or in a state of ketone.

酮体水平一下子升到了五、六、七，我当时就想：这到底是怎么回事？

It jumped up to five, six, seven, and I was like, What is going on here?

但在这种情况下，葡萄糖起到了节约酮体的作用，但同时葡萄糖也会抑制酮体生成，所以之后酮体水平会急剧下降。

But the glucose in that context is ketone sparing, but the glucose will also shut off ketogenesis, so it'll tank, you know, after.

是的。

Yeah.

之后。

Afterwards.

是的。

Yeah.

好的。

Okay.

所以听起来，由于很大程度上的间歇性禁食，我认为如果我的胰岛素敏感性足够高，就可以与更高的酮体利用率相结合。

So it sounds like then because of probably the intermittent fasting in large part, would think, if my insulin sensitivity is high enough, that can be paired with higher ketone utilization.

所以，如果从我身体的生产线来看，它们产生了10个单位的酮体，而如果我的酮体利用率不高，这是我第一次进入酮症或生酮饮食，那么指尖采血可能会检测到全部10个单位。

So if on the assembly line of my body, right, they're producing 10 units of ketones, if I didn't have good ketone utilization and it was my first rodeo with ketosis, let's just say, or ketogenic diet, the finger prick might pick up all 10 of those units.

我这里做了简化。

I'm simplifying here.

对吧？

Right?

但如果我的酮体利用率很高，身体迅速消耗了其中8个单位，尤其是在热量不足的情况下，那么检测到的就只有2个单位，这会导致我误以为自己根本没有产生酮体，从而出现假阴性结果。

But if I have high ketone utilization and my body's quickly using eight of those, especially in a caloric deficit, then it's only measuring two and I'm getting the false negative that I'm not actually producing ketones in the first place.

这是一个公平且非常简化的描述吗？

Is that a fair, very, very simplified description?

而且你测量的并不是组织中的酮体水平，我们其实也测量过，甚至包括大脑，那里的酮体水平会飙升得非常高。

And you're not measuring tissue levels of ketones, which we have done too, even in the brain, and that can shoot up really high.

而且我和彼得·阿蒂亚也做过类似实验，我们同时测量了血液和呼出气体中的酮体。

That's Also, and I've done this with Peter Attia too, we were measuring blood and then breath.

当我们处于热量限制禁食状态时，血液中的酮体水平非常低。

And it seems like when we were in a caloric deficit fasting, our ketones were really low in the blood.

低值是一到二，但我们实际上已经深度禁食，而我们的呼气酮体却达到了仪器的最大值。

Low is one to two, but we're really deep into fasting, whereas our breath ketones were maxing out the meters.

经过大量测试后，我们得出结论：在热量限制状态下，呼气酮体几乎是更好的酮症指标，可以说更准确。

We concluded that after a lot of testing that the breath ketones were almost a better indicator of ketosis, a more accurate, I guess you could say, in a caloric deficit.

因为当你处于热量限制状态时，身体对酮体的摄取和利用速度非常快。

Because when you're in a caloric deficit, you just have very high ketone disposal uptake into the tissues.

这看起来像一个酒精呼气检测仪。

It looks like a breathalyzer.

对吧？

Right?

那么它测量的是什么呢？

So is that measuring what is it?

乙酰乙酸？

Acetoacetate?

不。

No.

我只是在重复我听过一两次的词。

I'm just trying to repeat words that I've heard once or twice.

但这不是BHB。

But it's not BHB.

丙酮。

Acetone.

丙酮。

Acetone.

该死。

Goddamn it.

好吧。

Alright.

我知道我差不多猜对了。

I know I was close.

那是五五开的机会。

That was it was a fifty fifty.

它来自于乙酰乙酸盐的自发脱羧。

Comes from spontaneous decarboxylation of acetoacetate.

就像，我们大约会排出20%的乙酰乙酸盐转化为丙酮，然后你可以——我明白了？

Like, we'll spit out about 20% of the acetoacetate will kick off to acetone, and then you can I got it?

我们测量过每种物质的血液浓度，虽然这非常棘手，但我们在实验室里已经做到了。

We've measured blood levels of each, and it's very tricky to do that, but we've done it in the lab.

这里还有一个实用的战术问题要问你，因为我一直在反复思考这个问题，而Chad GPT叔叔把我搞得一头雾水。

Here's another practical tactical question for you because I've gone back and forth on this, and uncle Chad GPT has confused the shit out of me.

所以也许你能帮忙解决一下。

So maybe you can help resolve it.

糖异生作用和蛋白质摄入。

Gluconeogenesis and protein intake.

所以你每天摄入大约两百到两百四十克左右的蛋白质，是这样吗？

So you consume, what is it, between, like, two hundred and two hundred and forty grams of protein a day, something like that?

在活跃的日子里，如果只是整天坐在电脑前，可能接近180到200克。

On active days, on, like, less active days, if I'm just behind my computer all day, maybe closer to one eighty, 200.

但没错。

But yeah.

是的。

Yeah.

人们可能注意到了，当多姆随意提到，比如你蹲过400磅，休息一段时间后重新开始，就只能蹲300磅了。

And people might have picked up when Dom casually throwing around like, you know, when you've been squatting 400 and you take a break and then you go back and you know, like, it's squat 300 pounds.

多姆是个体型很大的人，曾经在禁食一周后，还能用500磅做10次硬拉。

Dom's a pretty big guy who's also deadlifted 500 pounds for like 10 reps before after fasting for a week.

所以我和他的体型并不一样。

So he and I are not the same size.

但无论如何，我想弄清楚，一方面，我到底能吃多少蛋白质，才不会让肝脏把多余的蛋白质和氨基酸转化成葡萄糖。

But nonetheless, I'm trying to figure out on one hand how much protein I can eat without my liver taking excess protein, amino acids, and turning it into glucose.

根据我查阅的资料——我看过一些非ChatGPT的来源——一方面有人认为不必担心这个问题。

And depending on what I look at, and I have looked at sources outside of chat GPT, on one hand, there are folks who say, don't worry about it.

如果你摄入了足够的脂肪，就真的不必担心这个问题。

If you're consuming enough fat, you really don't have to worry about it.

还有其他人则提醒要注意。

And then there are other folks who are like, watch out.

要注意。

Watch out.

如果你在一餐中摄入超过x克的蛋白质，就很容易让自己脱离生酮状态，如果这是真的，那这或许能解释为什么我在三点吃了一顿小餐，之后又吃了一顿大餐后，血糖读数会这么低。

If you consume more than x number of grams at a given meal, you can very easily knock yourself out of ketosis, which would, if that's true, be maybe an alternate explanation for why I'm getting these low readings if I'm having a small meal around three and then a gigantic meal later on.

我该如何思考这个问题？听众又该如何看待这个问题？

How should I and how should listeners think about this?

如果你以液体形式摄入蛋白质，比如乳清蛋白之类的，那么氨基酸会迅速从你的小肠进入血液，从而抑制生酮状态。

If you were to consume protein in the form of liquid, for example, like whey or something like that, then the rapid entry of amino acids into your bloodstream from your small intestine will shut off ketosis.

脂肪、纤维和盐分会让你的幽门括约肌保持紧闭，直到你开始进食。

So fat and fiber and salt because your pyloric sphincter will basically be pretty tight until you're Talking

肮脏，愚蠢。

dirty, dumb.

那就是你的胃和小肠连接的地方吗？

Is that where your stomach connects to your small intestine?

如果你吃了一顿非常油腻、高盐、高纤维的餐食，这个入口——我们称之为括约肌，即幽门括约肌——会保持关闭状态，直到胃内容物变得等渗，这意味着你的身体必须释放一些水分，并不断搅拌和分解食物。

If you have a very fatty, salty, high fiber meal, that entryway, we call that the sphincter, it's the pyloric sphincter, will remain shut until the contents of your stomach become isotonic, which means that your body has to kind of give up water and it's got to churn it and break it down.

因此，仅靠脂肪、纤维和盐就能有效延缓胃部吸收。

So you could delay gastric absorption simply with fat, fiber, and salt is pretty good too.

你可以使用酮盐或仅用盐和电解质。

You could do ketone salts or just salt electrolytes.

这样可以延缓氨基酸或蛋白质进入小肠，进而延缓氨基酸进入血液。

So that will delay the entry of amino acids or protein into the small intestine and thus amino acids into the bloodstream.

这是影响酮症的主要调节因素，它会影响胰岛素水平以及糖异生的速度。

And that's the major regulator of ketosis having an impact on insulin and also having an impact on gluconeogenesis to that rate of entry.

如果你能减缓这一过程，连续血糖监测仪上就不会有明显波动，你的酮体水平也能基本保持稳定。

And if you can slow that down, you see nothing on the CGM and your ketosis levels can basically stay.

你还可以通过在蛋白质和纤维中添加MCT油来进一步增强这种效果。

You could further augment that by using MCT oil with the protein and the fiber.

所以，如果你摄入来自牛排的长链脂肪和MCT油，再加上纤维——无论是不溶性纤维还是可溶性纤维，效果都很好。

So if you have long chain fats from a fatty steak and MCT oil, then fiber, and that could be insoluble fiber is pretty good to soluble and insoluble.

这可以减缓氨基酸的进入，从而缓冲糖异生反应。

That can slow the entry of amino acids and essentially buffer the gluconeogenic response.

简单感谢一下我们的赞助商，马上回来继续节目。

Just a quick thanks to our sponsors, we'll be right back to the show.

我一直在寻找既不影响口味也不影响营养的蛋白质来源。

I am always on the hunt for protein sources that don't require sacrifices in taste or nutrition.

这就是我喜欢今天赞助商David的蛋白棒的原因。

And that's why I love the protein bars from today's sponsor, David.

它们是我外出时的首选蛋白质来源。

They are my go to protein source on the run.

只要担心自己可能无法获得优质蛋白质，我就会把它们放进包里。

I throw them in my bag whenever I am in doubt that I might be able to get a good source of protein.

David蛋白棒含有28克蛋白质、150卡路里，且糖分含量为零。

David has 28 grams of protein, 150 calories, and zero grams of sugar.

而且，David的味道非常好。

And on top of that, David tastes great.

他们的能量棒有六种美味口味。

Their bars come in six delicious flavors.

都值得一试。

They are all worth trying.

蛋白质也是最能产生饱腹感的宏量营养素。

Protein is also the most satiating macronutrient.

这是什么意思？

What does that mean?

这意味着，在碳水化合物、脂肪和蛋白质中，蛋白质能抑制你的食欲，同时滋养你想要滋养的身体部位，帮助你全天减少热量摄入。

It means that protein out of carbohydrates, fat and protein inhibits your appetite while also feeding all the things you wanna feed, which helps you consume fewer calories throughout the day.

你不太可能去吃垃圾食品。

You're less inclined to eat garbage.

所有这些都有助于减脂并降低多种疾病的风险。

All of that contributes to fat loss and reducing the risk of various diseases.

现在，蒂姆·费里斯节目的听众们，购买四盒即可免费获得第五盒。

And now you guys, listeners of the Tim Ferriss show, who buy four boxes get a fifth box for free.

你可以去看看。

You can check it out.

你也可以一次只买一盒。

You could also buy one box at a time.

前往 davidprotein.com/tim 亲自试一试。

Try them for yourself at davidprotein.com/tim.

了解更多相关信息。

Learn all about it.

访问 davidprotein.com/tim，购买四盒即送一盒，或仅了解更多信息。

That's davidprotein.com/tim to get a free box with a four box purchase or simply learn more.

去看看吧。

Check it out.

davidprotein.com/tim。

Davidprotein.com/tim.

嘿，各位。

Hey, folks.

我是蒂姆。

Tim here.

我最畅销的卡牌游戏《郊狼》，是我与Exploding Kittens的优秀团队共同打造的，刚刚荣获2025年Pop Insider最佳极客游戏奖，以及2025年Made for Mums玩具奖的最佳圣诞袜填充玩具奖。

My best selling card game Coyote, which I made with the amazing team at Exploding Kittens, just won the Pop Insider best geeky game of 2025 and also best stocking filler in the Made for Mums Toy Awards twenty twenty five.

它在所有地方都在打折。

It is on sale everywhere.

价格便宜。

It's cheap.

容易上手。

It's fast to learn.

评分高达五分之四点八。

It has 4.8 stars out of five.

人们都非常喜欢它。

People are loving it.

Coyotegame.com 会引导你到所有零售商，但你 everywhere 都能找到它。

Coyotegame.com will take you to all the retailers, but you can find it everywhere.

这是一款需要快速思考、更快大笑的游戏。

It is a game of thinking fast and laughing faster.

想象一下哑剧、热土豆和一堆脑力乐趣的结合。

Think charades meets hot potato meets a bunch of brain fun.

这对你的大脑很有好处。

It's good for your head.

它非常适合有10岁孩子的家庭，或者内心仍保有童真的成年人，又或者不把自己太当回事的人。

It's perfect for families with kids aged 10 or adults who are kids at heart or don't take themselves too seriously.

很多成年人都喜欢这款游戏。

A lot of adults love this game.

正如我所说，它在各个地方都有售。

And as I said, it's available everywhere.

亚马逊、沃尔玛、塔吉特、八千多家零售店，你想得到的地方都有。

Amazon, Walmart, Target, 8,000 plus retail locations, you name it.

所以请去试试吧。

So please check it out.

我非常喜欢制作这个游戏。

I loved making it.

人们真的非常喜欢它。

People are really enjoying it.

它在网上有三亿到四亿次以上的游戏视频播放量。

It has 300 or 400,000,000 plus social views of gameplay online.

去玩一玩吧。

And try it.

这个假期享受它吧。

Enjoy it this holiday season.

去了解一下吧。

Check it out.

Coyotegame.com 再说一遍。

Coyotegame.com one more time.

那就是coyotegame.com，或者你购买游戏的任何地方。

That's coyotegame.com or anywhere you buy your games.

现在回到这一集。

Now back to the episode.

假设我那天在旧金山待得很晚。

So let's say I was stuck in San Francisco late.

我只是难得来这里一趟，而如今正值人工智能热潮，能在这里真是令人兴奋。

I'm just taking a rare trip over here, which is pretty exciting time to be here with all of the mania with AI going on.

我的意思是，大家都像喝多了兴奋剂一样，但那是另一个话题了。

I mean, there's everyone's kinda drunk on the Kool Aid, but that's a separate story.

我不想应付交通拥堵之类的麻烦，结果被困在了市中心。

I got trapped downtown because didn't wanna deal with traffic and blah blah blah blah blah.

于是我吃了一个巨大的无面包双层芝士汉堡，大得惊人。

So I ended up having a huge bunless double cheeseburger, like gigantic.

这东西，我完全没想到会这么大。

This thing, I did not expect it to be as big as it was.

于是我上网查了查这东西的蛋白质含量，发现有80克蛋白质。

And so I go online to try to figure out what the protein content of this thing might be, and it's like 80 grams of protein.

但脂肪肯定很多，脂肪多到爆，咸得要命，盐分也很高，纤维含量不多，这个我们就忽略吧。

But plenty of fat, certainly, tons of fat, salty AF, plenty of salt, not a lot of fiber, we'll give that one a pass.

我应该担心这种食物会让我退出生酮状态吗？

Should I be worried about something like that knocking me out of ketosis?

我觉得你需要测量一下。

I think you need to measure.

我通常会回到一个观点：每个人都是独特的代谢个体，但如果你吃了这个，同时你的活动量很高，处于轻微的热量赤字状态，并且没有过量摄入总热量——我知道我的身体，我知道我的身体，我完全可以保持在生酮状态。

So I'm kind of default back to, like, everybody's a unique metabolic entity, but if you eat that and kind of your activity level is high and you're in a bit of a caloric deficit and you were to have that and sort of not overdo it on the total calories, I know my body, I know my body, I could stay in ketosis.

但如果你吃了之后有饱胀感，我们体内有神经通路连接肝脏和肠道，反之亦然。

But if you have that over satiated feeling, so we have neurons, we have neuronal pathways to and from the liver and to and from the gut.

我们把这称为肠神经系统中的传入和传出信号。

We call that afferent and efferent signaling in the enteric nervous system.

一顿大餐会向你的大脑传递你吃了很多的信息。

And a big meal will basically tell your brain that you had a big meal.

我之前提到过，氨基酸进入血液会把你踢出酮症状态。

I talked about the amino acids going into the bloodstream kicking you out of ketosis.

但当你有牵张感受器，胃里装满一大餐时，这实际上会向大脑发出信号，激活交感神经系统。

But there's also when you have stretch receptors and you have a big full meal in your gut, then that could actually tell your brain to activate the sympathetic nervous system.

而通过释放儿茶酚胺，比如我们所说的肾上腺素、去甲肾上腺素等物质，可以进一步促进和增强糖异生作用。

And then that, by virtue of spilling out catecholamines, can basically like we're talking adrenaline, epinephrine, things like that that can further augment and enhance gluconeogenesis.

好的。

Okay.

让我稍微翻译一下这句话。

Let me just translate that for a second.

所以人们早上醒来时，皮质醇在许多网络意见领袖中名声不佳，但你其实确实需要皮质醇。

So people wake up, the cortisol has developed this like, bad reputation among a lot of, like, online influencers, but it's like, you really need cortisol.

所以当你早上醒来，看到血糖略有升高时，这实际上很重要，它在催你赶紧起床活动。

So when you wake up in the morning and you see a bit of a glucose spike, like, it's actually important to get your ass up and moving.

如果你处于酮症状态，情况就不同了。

If you're in ketosis, it's a different thing.

对吧？

Right?

所以如果我理解得没错的话，除了人们通常对消化、血糖、胰岛素等的看法之外，仅仅通过胃部被拉伸，这些机械感受器接收信号，就能向大脑发出“该行动了”的指令。

So if I'm hearing you correctly, right, outside of how people think about digestion, blood sugar, insulin, etcetera, that just based on stretching your stomach, etcetera, right, with these mechanoreceptors taking the inputs, that that signals to the brain, it's go time.

所以，这些激素会促使身体开始运作，而这本身就能触发肝脏产生更多葡萄糖或释放更多糖原，对吧？

So let's basically get things moving with these hormones, and that could in and of itself then trigger the liver to produce more glucose or liberate more glycogen, I guess?

可以。

It can.

这超出了你通常进食的量，比如如果你的身体已经适应了这种分量的餐食，但它还会激活其他肠道激素，比如胆囊收缩素（CCK），以及其他一些稍后会激活副交感神经系统的物质。

It's above and beyond what you normally eat, like if you train your body to that size meal, but it also activates other, like, gut hormones like cholecystokinin, that's called CCK, and other things that can then activate the parasympathetic nervous system that comes in a little bit after.

与此同时，它会分叉开来。

At the same time, it sort of bifurcates.

但副交感神经系统的作用是放松、消化、休息，也就是之后才出现的放松与消化。

But then the parasympathetic nervous system is sort of relax, digest, rest and relax, digest, So that kind of comes in after.

所以你可能会看到一个短暂的波动，甚至感觉有点被刺激了。

So you might see a blip and sort of might feel kind of stimulated.

此外，这是一顿咸餐，它会扩张你的血浆容量。

Also, it's a salty meal, it's going to expand your plasma volume.

你的血容量会增加，这可能会使你的血压略有上升，并激活你的交感神经系统。

Your blood volume will increase, and that can increase your blood pressure a little bit, and that can activate your sympathetic nervous system.

所以大餐后去散散步总是好的。

So it's always good to go take a walk after a big meal.

是的。

Yeah.

是的。

Yeah.

我会那样做。

I do that.

不是像去做深蹲和硬拉那样，但就是的。

Not like go squat and deadlift, but just yeah.

即使只是十分钟、十五分钟，理想的话二十分钟的快步走，在大餐后也非常有益。

Even a ten, fifteen, ideally, like a twenty minute brisk walk is really good after a big meal.

我想问你关于散步时间的问题。

Let me ask you this on the walk timing.

当我吃大餐时，我会说我觉得我已经让身体适应了大餐，具体反应我只能主观地告诉你我的感受，以及监测仪显示的数据。

So when I have a big meal, and I will say I think I have trained my body to have big meals, what the exact response is, I can only give you subjectively what I feel, and I can give you what the monitors show.

但我通常感觉还不错。

But I typically feel pretty good.

然而，无论我是否处于生酮状态，当我吃大餐后，血糖峰值并不会立刻出现，而是取决于餐食内容，对吧？

However, if I have a big meal, whether this is in ketosis or otherwise, I don't see the biggest spike until something like depends on the meal, right?

但通常在六十到九十分钟后，我才会看到血糖峰值。

But sixty to ninety minutes later, that's when I see the spike.

那么我应该在六十到九十分钟后散步，还是饭后立即散步？

So should I do the walk at sixty to ninety minutes, or should I do the walk right after the meal?

我到底该什么时候安排散步？

When should I actually time the walk?

你吃完饭后去散步，然后六十到九十分钟后才看到血糖上升，还是说这个上升和散步无关？

So you eat a meal, you go walk, and then you see the rise sixty to ninety minutes after, or is that independent of the walk?

与散步无关。

Independent of the walk.

好的。

Okay.

所以你没有散步，但仍然在六十到九十分钟后看到血糖上升。

So you're not walking, but you see the rise sixty to ninety minutes later.

所以我说，你可能不会在六十或九十分钟后看到这种上升。

So I'm saying that you might not see that rise sixty or ninety minutes later.

如果你在饭后立即散步呢？

If you did it right after the meal?

是的，因为一点点就能产生很大效果。

Yeah, just because a little bit goes a long way.

所以就像散步一样，做一些拉伸和散步，可以激活葡萄糖转运蛋白GLUT4。

So just like walking, actually doing some stretching and walking too, it activates the glucose four, the GLUT four transporters.

因此，这是胰岛素非依赖性的，释放的胰岛素更少，葡萄糖摄取更多。

So that's insulin independent, so less insulin is dumped, greater glucose uptake.

在散步期间，你还通过糖异生激活了交感神经系统的葡萄糖动员，这会减弱酮体生成的缓冲作用。

And you're also using the sympathetic nervous system mobilization of glucose through gluconeogenesis during that walk, it then attenuates the buffering of ketogenesis.

比如，短短几分钟的散步就能产生很大效果。

Like, a very short walk can go a long way.

是的。

Yeah.

好的。

Okay.

很棒。

Cool.

是的。

Yeah.

这个GLUT是干什么的？

The is it glut for?

GLUT是干什么的？

Glut for?

这个怎么读？

How do you pronounce that?

我不知道。

I don't know.

人们是怎么说的？

How do people say that?

我总是读作 glute。

I always say glute.

我读作 glute for。

I say glute for.

嗯。

Yeah.

好的。

Alright.

glute for。

Glute for.

说glute。

Say glute.

嗯。

Yeah.

对于观众中的元老们，回去找找《四小时身体》里的GLUT四。

For the OGs in the audience, go back and look for GLUT four in, the four hour body.

里面有的。

It's in there.

我想问你的另一个测量问题是，这些连续葡萄糖和酮体监测仪并不是为我这样的人设计的。

So the other measurement question I wanna ask you about, which is, you know, these continuous glucose and ketone monitors are not designed for someone like me.

它们的开发目的，我不知道酮体监测仪是这样，但就葡萄糖而言，是为了帮助有严重疾病的人避免陷入极其危险的状况。

They're developed presumably I don't know about the ketone monitor, but in the case of glucose, to help people with serious conditions not end up in very serious situations.

对吧？

Right?

所以当我查看我的酮体水平时，比如现在，我感觉非常清醒。

So when I am looking at my ketone levels, right, like right now, I feel very sharp.

我不久前刚吃过一种生酮启动产品，你知道的，那种外源性酮盐类产品，就用热水冲了一下，加了一点MCT油。

I had some keto start, you know this well, exogenous ketone salt based product not too long ago, just in hot water with a little bit of MCT oil.

这大概是大约一个半小时前的事，但现在我的酮体水平是0.4毫摩尔。

This was, I guess, an hour, hour and a half ago, but I'm at 0.4 millimolars.

我想说的是，无论我吃了一大餐，还是像现在这样禁食，我的酮体水平绝大多数时间都维持在0.1到0.4之间。

And I guess what I'm saying is whether I have a huge meal or I'm fasting as I am right now, my range is basically zero point one to zero point four ninety five percent of the time.

只有少数例外情况。

There are a few outlier cases.

如果我纯粹是玩一把大的，你知道的，一次性摄入尽可能多的外源性酮体，那确实可能把数值推高，不过我们可以聊聊这个。

If I'm just doing like a YOLO, you know, as many grams as possible exogenous ketone party, then, yeah, you know, maybe I could goose it, but we can talk about this.

一旦酮体水平超过某个点，我可能会刺激胰岛素分泌，然后接着出现血糖骤降。

Like, once it gets past a certain point, then I might spike insulin and, like, have a have a subsequent crash.

但简而言之，我想说的是，不管我是禁食还是吃了一个巨大的双层芝士汉堡，我的酮体水平主要都在0.1到0.4之间。

But I guess what I'm what I'm trying to say in brief is my range for the most part is 0.1 to 0.4, regardless of whether I'm fasting or eating a gigantic double cheeseburger.

所以，我其实不太清楚它到底产生了什么效果。

So I'm not really sure how to determine what effect it's having.

我可以监测血糖，但目前我的CyBio检测结果显示酮体浓度为0.4毫摩尔。

I can watch the glucose, but, you know, right now I'm 0.4 millimolars of concentration on the CyBio.

正如我们之前讨论的，Precision Xtra可能会给我多出零点一到零点二的数值，但到目前为止两者结果非常接近。

And as we've talked about, maybe the Precision Xtra would give me an extra point one or two, but they've been pretty close so far.

自从我吃了一顿放纵餐后，我们做了这个实验，对吧？我想看看上周六在锻炼后吃一两顿放纵餐会怎样，现在是周四，而我现在的血糖是103，比上周同期要高。

And then ever since my cheat meal, we had this experiment, right, I wanted to see if I did a workout and then had one or two cheat meals last Saturday, it is now Thursday, but my glucose right now is one zero three, which is higher than the week prior.

但血糖会波动。

But it goes around.

它会上下变动。

It moves around.

对吧？

Right?

比如昨晚，血糖大概是七十多。

Like last night, it was probably 70 something.

你有什么建议能帮我看懂这些信号吗？还是主要靠主观感受？

Do you have any suggestions for how to read the tea leaves, or is it mostly just subjective feel?

还在想着这顿饭的分量。

Still thinking about the size of the meal.

但我想说的是，如果我的设备现在告诉我，0.4，说明脂肪没有在燃烧。

But I I guess what I'm saying is if my device is telling me as it is right now, right, 0.4, fat not burning.

你此刻几乎没在燃烧脂肪。

You're almost not burning fat at the moment.

没有进入生酮状态。

Not in ketone.

这简直是在责备我。

Like, it's very chastising.

所以，如果我严格按照屏幕上的数据来判断，那我就是在生酮上失败了。

So if I'm to believe this by the letter of the law on the screen, I'm failing at ketosis.

你有什么建议，能帮我看懂这些信号吗？

Any thoughts on how to kind of read the tea leaves here?

我会基本忽略这个数据。

I would kind of ignore that.

我认为这个应用正处于一种针对脂肪刺激的开发过程中。

I think that's sort of an app in the process of being sort of developed with fat stimuli.

所以要真正回答你是否在燃烧脂肪这个问题，你需要进行全身体代谢组学分析，或者使用代谢车检测呼吸商之类的指标。

So you would need whole body metabolomics to really answer that question if you're in fat burning or do a metabolic cart and look at respiratory quotient or whatever.

但主观上，如果你感觉良好，我们已经看到，在运动员中，尤其是更高级的运动员，即使我们严格执行生酮宏量营养素比例，我们测得的数值最高也就到0.8左右，这已经是平均水平了。

But subjectively, if you feel good, we have seen like in athletes, especially more advanced athletes that and we do a very strict, you know, strict keto macros and everything that basically with a bunch of athletes with, like, point eight is about as high as we get, and that's the average.

有时候，有些人每天的数值会达到2.5、2.6，而同一个体，具有相同的代谢特征，却可能在0.4或0.3之间波动。

Sometimes you get guys like 2.5, 2.6 every day, and the same guy with the same, you know, essentially metabolic phenotype will be running 0.4 or 0.3.

他可能只是对酮体的利用能力更强。

He could potentially just have greater ketone utilization.

所以我认为测量血液中的酮体水平很重要。

So I think it would be important to measure your blood.

连续酮体监测仪测量的是组织间液中的酮体浓度。

So a continuous ketone monitor measures interstitial.

这可能会有所不同。

That can be different.

CyBio，我认为它是一个很棒的设备。

The CyBio, I think it's a great device.

它非常多功能。

It's very versatile.

我可以随意进出盐水环境。

I can kind of jump in and out of saltwater.

这个设备一直戴在我身上。

The thing stays on me.

它几乎比连续血糖监测仪更可靠。

It's almost more reliable than a CGM.

但我确实注意到，我大概用过大约50个这类设备，第一周相当准确，然后灵敏度就会逐渐下降。

But I did notice, and I probably used about 50 of these devices, that the first week is pretty accurate and then it tapers off, the sensitivity.

这是该技术的一个已知局限性，本质上基于酶的传感器系统往往会退化，理论上你可以通过在应用程序中增加校准功能来规避这个问题。

And this is a known limitation of the technology, that essentially the enzyme based sensor system tends to just de, and you could get around that conceivably just by having the ability in the app to calibrate it.

所以如果你测量时，连续酮体监测仪显示为1.0，但你的血酮是2.0，你应该能够像使用德康血糖仪那样进行校准。

So if you were to measure it and the continuous ketone monitor is measuring one point zero but your blood ketones is two point zero, that you should be able to calibrate it like you can with a Dexcom.

所以公司方面承认了这一点，并表示同意。

So they acknowledged that at the company, and they said, yes.

我们意识到这能解决问题，但目前应用中还没有这个功能。

We realized that that would fix the problem, but that's not a feature of the app yet.

他们确实有事件记录功能。

They do have in events.

他们在右下角有血酮测量功能。

They have blood ketone on the bottom right.

我不确定这是否真的能校准设备。

I don't know if it actually calibrates it.

目前它可能只是记录血酮值。

It may just record the blood ketone at this point.

据我所知，它不具备校准功能。

It does not have the ability to calibrate it to my knowledge.

我在Keto Mojo上输入了一次测量值，但似乎没有改变任何设置。

I inputted one measurement on the Keto Mojo, and it didn't seem to change it.

对吧？

Right?

数字没变。

The number stayed the same.

所以我认为它只是在记录数据，因为血糖仪也可以这么做。

So I think it's just logging it because you can do that with a glucometer.

你可以用Dexcom做，但Abbott不行。

Well, you can do it with Dexcom, but not Abbott.

所以Abbott Freestyle也有这个问题，这是我给他们的反馈，因为我用了这些设备。

So that's a problem with the Abbott Freestyle too, that's the feedback I gave them because I put these devices on.

它显示我血糖是130，但我自己测的时候只有80，甚至低到50，因为如果你体型偏瘦，葡萄糖会卡在肌肉里而不是脂肪组织里，血糖水平就会偏高，尤其是在运动后，我注意到了这一点。

It's reading me like one thirty, but I measure my, I'm like 80, literally like 50 because if you are lean and it's stuck in your muscle instead of your adipose tissue, the glucose levels are gonna be higher, especially like when you're So working off and I've noticed this.

所以Dexcom很好，因为我也可以校准它。

So that's why the Dexcom is very nice because I can calibrate it too.

是的。

Yeah.

我始终表现出这一点，这曾是我遇到的一个主要问题。

And I consistently show that, and that was a major issue I had.

是的。

Yeah.

我也想插一句，这可能很难量化，但就我个人而言，我之前之所以长期避免间歇性禁食，是因为我以为自己无法摄入足够的蛋白质或热量，会导致大量肌肉流失。

Let me hop in also and just tell folks this is not gonna be very quantifiable, but for what it's worth, part of my reason I avoided intermittent fasting for so long is that I thought I would not be able to get sufficient protein or caloric intake and that I would lose a bunch of muscle mass.

我在这方面完全错了。

I was dead wrong about that.

我错得非常离谱。

I was very, very wrong.

相反，禁食似乎提升了我每摄入一卡路里或每克蛋白质时增肌的能力。

If anything, it seems to have enhanced my ability to put on muscle kind of per calorie or per gram of protein ingested.

所以我承认，我对这一点完全误解了。

So I admit I was totally wrong about that.

此外，在这种生酮饮食中，我过去一直觉得很难增肌，或者我不该说保持肌肉，因为我只坚持了几周。

Furthermore, on this ketogenic diet where I've historically found it pretty hard to put on muscle or, maybe I shouldn't say keep muscle because I'm only doing it for a few weeks.

但我对只吃一顿小饭感到非常惊讶。

But I have been astonished by having one small meal.

比如，我会在之后吃一些牛尾汤，配上一些蔬菜，当然还有牛尾。

Like, I'll have some oxtail soup after this with some veggies and and obviously, oxtail.

这是另一个完全独立的故事了。

It's a whole separate story.

然后我大概三四个小时后会再吃一顿饭，那会是一顿大得多的饭。

And then I'll go out and have another meal probably in, like, three or four hours, which will be a much bigger meal.

仅仅通过这样，再加上我留意蛋白质摄入量等，但当我照镜子或看我在健身房举的重量时，我感觉并没有失去任何肌肉，反而觉得身体更紧致了。

And just with that and I am watching some of the grams of protein intake and so on, but I have not looking in the mirror and looking at the weights that I'm putting up in the gym, I don't feel like I have lost any muscle, and I feel like I have leaned out.

其中一部分是水分流失，但让我印象深刻的是，相比大学时我靠吃增重粉和各种垃圾食品来维持肌肉，现在维持肌肉实际上需要的量少得惊人。

Some of that's losing fluid, but I've been really impressed with how little relative to what I used to do in college, like taking weight gainers and just all this garbage, like how little it actually takes to at least maintain muscle mass.

但我有个问题想问你，这个问题我一直没能得到满意的答案，它和‘兔子饥饿症’有点关系。

But I do have a question for you, which I've never really been able to answer to my satisfaction, and it kind of relates to rabbit starvation.

对于不了解什么是兔子饥饿症的人，你可能能解释得更好。

So for people who don't know what that is, you could probably give a better description.

但如果你看过《荒野求生》这个节目，那它可能是我唯一喜欢看的真人秀。

But if you've ever watched the show Alone, Alone is probably the only reality TV show that I love to watch.

尤其是第六季和第七季，对观众来说非常出色。

Seasons six and seven in particular are outstanding for folks.

但你会发现，如果人们试图在野外生存并坚持到最后，这就是节目的核心。

But what you will notice is that if people are trying to survive in the wilderness to outlast everyone else, that's what the show is.

你可以选择少量物品，然后被空投到某个地点，你无法选择降落位置，之后只能尽可能长时间地生存下去。

You get to pick a handful of items, you get dropped off, you don't get to choose where you're dropped, and then you just need to survive for as long as possible.

有时是一百天，有时是看谁最后能坚持下来。

Sometimes it's a hundred days, sometimes it's last man or woman standing.

如果一个人只吃瘦肉蛋白，比如兔子肉，他会逐渐衰弱。

If somebody is only eating lean protein like rabbits, they will waste away.

他无法坚持太久。

They will not last.

最终会因为健康原因被强制撤出。

They will have to get yanked out for medical reasons.

这可能对有些人来说很奇怪。

And that might seem strange to people.

但我的问题是，具体到生酮饮食，你能否只摄入瘦蛋白，然后依靠身体脂肪来提供脂肪？

My question though is on a ketogenic diet specifically, can you just consume leaner protein and then rely on body fat for the fat?

有些人会说，是的，大家都明白这行不通。

And some people are like, yeah, everybody knows that doesn't work.

但我真的想弄清楚为什么会这样。

But I'm I really wanna understand why that's the case.

对吧？

Right?

因为我知道膳食脂肪会抑制胰岛素反应，或者至少我是这么理解的。

Because I understand dietary fat sort of dampens insulin response, or at least that's my understanding.

也许身体脂肪分解和利用的速度存在一个限制步骤。

Maybe there's a rate limiting step in how much body fat you can break down and use.

对吧？

Right?

谁知道这是不是由肾脏或肝脏介导的，我也不清楚。

And who knows if that's mediated by the kidneys or who the hell liver, I don't know.

对吧？

Right?

我想这大概应该是肝脏。

I guess it would probably be liver.

但我非常想听听你的看法，因为过去我和许多阅读《For Our Body》的人都发现，自己减掉的体脂比通过DEXA扫描和其他方法所告知的极限还要多。

But I'd love to hear your take on it because certainly in the past, I and lots of people reading the For Our Body have been able to lose more body fat than they are told they are capable of losing as measured through DEXA scans and other things.

如果你的目标部分是减脂，能否采用中等脂肪或低脂肪的蛋白质型生酮饮食？还是说这样会适得其反？

Can you do a moderate fat or low fat protein based keto diet if your goal in part is to lose body fat, or does that backfire?

但无法长期坚持。

Just not indefinitely.

当我进行一年生酮饮食时，每天摄入大约300到320克脂肪，有时甚至达到350克。

So when I was did the ketogenic diet for a year, I was cruising about 300 to 320 grams of fat, sometimes 350 grams of fat per day.

后来我尝试每周安排两天只吃蛋白质和蔬菜，脂肪摄入量控制在50到100克左右。

And then just experimenting, I would throw in two days per week of protein veggies with about 50 to 100 grams of fat.

在那些日子里，我从每天摄入300多克脂肪降到每天50到100克脂肪，两天后，我发誓自己减掉了大约2%的体脂，然后我就再恢复回去。

And in those days of dropping to 300 plus grams of fat to 50 to 100 grams of fat, after two days, like, I swore, like, I lost, like, 2% body fat, like, that and I would just transition back.

所以我只是定期加入蛋白质蔬菜日。

So I would just periodically throw in protein veggie days.

我会持续进行生酮饮食，然后周期性地加入蛋白质蔬菜日，以帮助改善体成分。

I would cruise on keto and then periodically titrate in the protein veggie days to assist body composition alteration.

如果我一直这样坚持下去，就能变得非常瘦，甚至瘦得有点吓人，而且速度非常快。

And if I kept that going, I could get pretty dramatic, almost scary lean to where it happened very fast.

这几乎像是生酮饮食训练了你的脂肪代谢能力。

It's almost keto trains your fat metabolism.

然后当你开始逐步加入蛋白质蔬菜日时，身体就会直接调动脂肪。

Then if you just start titrating in, it's just pulling fat out.

我觉得我的身体真的很喜欢加入富含纤维的蔬菜。

I think my body really liked throwing in the veggies with the fiber.

这似乎对肠道健康很有帮助。

It seemed to help with gut health.

我每周会这样做两次，效果非常明显。

And I would do that twice a week, and and it's it's pretty dramatic.

为什么不每天都做呢？

Why not do it seven days a week?

如果你尝试更长时间会怎么样？

What happens when you try to do it for more?

如果目标是保持生酮状态，当我吃蛋白质和蔬菜时，我很难保持在生酮状态。

If the idea is to stay in ketosis, it was, like, really hard for me to stay in ketosis if I do, like, protein veggies.

比如两天后，我就差不多出酮了，但我的新陈代谢却在高速运转。

Like, after two days, I would kind of be out, but my metabolism would be cranking.

从机制上讲，为什么会这样？

Mechanistically, why is that the case?

为什么你的身体不分解更多的体脂呢？

Why doesn't your body just break down more body fat?

是的。

Yeah.

因为这既从外部又从内部摄取脂肪，我认为进入肝脏的脂肪越多，血液循环中的脂肪越多，就会被更多地转运到肝脏，从而刺激肝脏的β氧化。

Because, well, it's taking body fat exogenously and endogenously, and I think the more fat going to the liver, you know, and the more fat that's in circulation gets sort of shuttled to the liver, and then that's sort of stimulating beta oxidation in the liver.

你只是拥有更大的脂肪储备。

You just have a greater fat pool.

但实际上，我觉得在我进行蛋白质蔬菜日的那天，以及我重新回到生酮状态的那天，酮体水平会像那天一样大幅上升。

But actually, I think the day that I would do protein veggie days and then the day I would jump back into ketosis, I would see this big ramp up in ketones like that day.

而如果我搞一个欺骗日，大量摄入碳水化合物，那就需要两到三天才能重新进入生酮状态。

Whereas if I did like a cheat day and just ate a lot of carbohydrates, it took me like two or three days to get back into ketosis.

但如果我只是吃蛋白质和蔬菜，慢慢回到生酮状态，我就能迅速重新进入生酮状态，同时让身体从脂肪中得到短暂休息。

But if I just did like protein and veggies and cruised back into ketosis, then I would rapidly get back into ketosis and just give my body a break from the fat.

但我认为，这种短暂的时间确实能刺激身体动员脂肪，因为你的身体习惯了从外部获取脂肪，而这时你只是更多地从体内提取脂肪。

But I think just that short amount of time really stimulates mobilization of fat from your body because your body is used to getting it exogenously and then you're just pulling more fat off.

但没错，我觉得在蛋白质蔬菜日，我从蛋白质中摄入了更多的热量，这会产生一定的抗生酮效果。

But yeah, I think on the protein veggie days, I'm getting higher amounts of calories from protein, so that has a bit of an anti ketogenic effect.

然后在第三天重新回到生酮状态时，我每周的酮体数值通常都是最好的。

And then shifting back into ketosis on that third day, I always had probably the best, you know, keto numbers for the week.

我不想再纠缠这个老生常谈的问题了，但我真的很想听听你再多聊聊这个，因为在我看来，你在只吃蛋白质和蔬菜的日子里，如果摄入的蛋白质足够多，但又不足以满足你所有的静息代谢率，那你就是热量不足，但又摄入了足够的蛋白质来防止肌肉流失，那为什么身体不能直接分解所需的脂肪来持续产生酮体呢？

I don't wanna beat this dead horse too long, but I'd love to just hear you riff on this a little bit more because I guess in my mind, I'm thinking, well, on your protein veggie only days, if you're getting enough protein, not enough protein to satisfy all of your resting metabolic rate, you're hypocaloric, but you're getting enough protein to not lose muscle, why wouldn't the body just break down the fat that it needs to continue producing ketones?

所以我正在努力避免那种葡萄糖异生的问题——比如一顿饭吃200克碳水化合物，却没有脂肪来中和它。

So I'm trying to avoid the gluconeogenesis problem where you're having, like, 200 grams at a meal with no fat to offset it.

但如果你摄入的是少量、缓慢消化的蛋白质，刚好足够防止肌肉流失，也许你还配合了一些力量训练之类的，那么我想弄清楚的是，为什么膳食脂肪如此重要。

But if you're having smaller amounts that are slowly digested, but it's just enough to keep you from losing muscle mass, maybe you're doing some weight training to help with that or whatever, then I guess what I'm trying to figure out is why the dietary fat is so important.

因为我在想身体的运作方式。

Because I think of the body.

对吧？

Right?

每磅储存的体脂相当于多少？

It's like each pound of stored body fat is what?

3600。

3,600.

没错。

Yeah.

好吧。

Alright.

所以3600大卡，这可是相当多的热量。

So 3,600 calories, that's a decent amount of calories.

对吧？

Right?

假设你体重150磅，体脂率10%，那么你有15乘以3600。

And for somebody who's let's just say you're a hundred and fifty pounds, 10% body fat, okay, you got 15 times 3,600.

你的体脂绰绰有余。

You got plenty of body fat to go around.

所以看起来，即使低碳脂肪、高蛋白，只要蛋白质分次缓慢摄入，不至于大量刺激肝脏进行糖异生，也足以支撑几周的生酮状态。

So it would seem to be enough to do a few weeks of ketosis that is low fat, higher protein, but not enough protein to necessarily be hammering your liver with gluconeogenesis if you're dividing it up, slowly digested protein.

有些人可能会对我拖这么长时间感到很烦。

Some people are gonna be really annoyed with me dragging this out so long.

但为什么膳食脂肪这么重要？

But why is dietary fat so important?

因为，那正是你所使用的燃料。

Because, I mean, that's the fuel that that you are using.

你让身体转向使用脂肪，我应该为我的蛋白质蔬菜日补充一点背景信息。

You coax your body into using, and I should probably add a little bit of context to my protein veggie days.

我会从大约125克蛋白质增加到300克蛋白质。

So I would go from, like, a 125 grams of protein to like 300 grams of protein.

对。

Right.

对。

Right.

这是一大笔蛋白质摄入量。

That's a pretty big bolus of protein.

太多了。

That's a lot.

是的。

Yeah.

如果一个人从100克蛋白质增加到170克、200克左右，可能不会脱离生酮状态。

If one was to go a 100 grams of protein or whatever and then bump it up to like one seventy or 200 or something, they may not kick out of ketosis.

但我记得当时酮体水平降低了，我仍然处于生酮状态。

But I remember just lower ketones, not adding I was still in ketosis.

通常，我觉得我的蛋白质蔬菜日都是安排在深蹲或硬拉等高强度训练之后。

Typically, I think I did it like my protein veggie days were following a heavy deadlift or squat workout.

这样做的想法是，我在那两天进行恢复，氨基酸、蛋白质和mTOR激活有助于肌肉恢复和骨骼肌蛋白合成。

The thinking was that I'm recovering for those two days and the amino acids and proteins and mTOR activation is sort of assisting in recovery and regeneration skeletal muscle protein synthesis.

然后我会以这种方式进行计算。

And then I would kind of go back to I kind of calculated it in that way.

所以，是的，我在蛋白质蔬菜日把蛋白质摄入量翻倍了，但我的总热量基本保持不变，或者稍微低一点。

So, yeah, I, like, doubled the protein on the protein veggie days, but my calories were about the same or maybe a little bit lower.

嗯。

Yeah.

如果SciBio在听，请允许我用指尖采血校准一下，因为我需要更广的测量范围。

I need SciBio, if you're listening, please allow me to calibrate this with a finger prick because I need a little more range.

我需要比0.01到0.04更宽的范围，才能有效读取这类数据。

I need a little more range than point zero one to point zero four for me to be able to read this type of thing effectively.

对吧？

Right?

因为从目前的读数来看，我似乎根本不在生酮状态。

Because technically, if I'm believe I'd like if I'm reading this as it is, like, I'm never in ketosis.

我不该说‘根本不在’。

I shouldn't say never.

这不对。

That's not true.

无论如何，能够校准一下会更好。

In any case, it would be nice to be able to calibrate.

我们回到我之前答应要问的问题吧，关于神经退行性疾病，比如阿尔茨海默病等等。

Let's come back to something I promised that I would ask about, is neurodegenerative disease, Alzheimer's, etcetera.

生酮饮食对这些疾病患者有帮助吗？

Could the ketogenic diet benefit people with these conditions?

同样重要的是，就我个人而言，生酮饮食如果长期坚持，是否有可能通过某种机制延缓这些疾病的发生？

And just as important, certainly for me personally, is it plausible there's a mechanism by which the ketogenic diet, regularly done could help delay the onset of any of these diseases?

还是我只是在盲目乐观，期待不切实际的幻想？

Or am I just Pollyanna hoping for a pie in the sky?

我认为这个问题我们还没有明确的答案，但所有的科学证据都指向一个方向：如果你能改善并优化你的心血管免疫代谢指标——我更倾向于说‘心血管免疫代谢指标’而非‘心血管代谢指标’，因为如果你能把胰岛素水平控制在2到6之间，并将高敏C反应蛋白降至0.6以下，同时优化血红蛋白A1c或血糖水平，

I think that's a question we don't have an unambiguous answer to, but I think all the science points into the direction that if you improve upon and optimize your cardiometabolic I like to say cardio immunometabolic biomarkers instead of cardiometabolic biomarkers because if you can lower, for example, your insulin and keep that between two to six, and if you lower your hSCRP below 0.6 and then optimize your hemoglobin A1c or glucose.

我和隆达·帕特里克以及其他人都讨论过这一点：如果你检测你的Omega-3脂肪酸，并关注Omega-3与Omega-6的比例，我认为这个指标最终会成为常规血液检查的一部分，因为相关数据非常令人信服。

And talked about this with Rhonda Patrick and other people too, that if you measure your omega-three fatty acids and look at your omega-three to six ratio, I think that's going to be a biomarker that's probably going to end up in standard blood work because it's so compelling, the data behind it.

你也要检测维生素B12。

And you also measure your B12, too.

我认为这很重要。

I think that's important.

一些来到阿尔茨海默病中心就诊的患者，表面上看起来是典型的阿尔茨海默病，但当你纠正他们的维生素B12缺乏后，B12缺乏会导致脑萎缩，而这种状况可以通过补充B12得到逆转。

People coming into the Alzheimer's Center that can present as flat out Alzheimer's disease and then you correct their B12, a B12 deficiency will cause brain atrophy, and that could be reversed with B12.

因此，如果你正在遵循生酮代谢疗法，它正在影响那些我们已知驱动衰老相关慢性疾病的因素。

So the things that, if you're following ketone metabolic therapy, it's impacting the things that we know are driving age related chronic diseases.

而显然，其中之一就是阿尔茨海默病。

And then, obviously, one of them is Alzheimer's.

如今，炎症水平，即高敏C反应蛋白，可能比低密度脂蛋白更具致动脉粥样硬化性。

The level of inflammation, hSCRP now is probably more atherogenic than LDL.

可能有些销售他汀类药物的人不想听这个，但我们知道，相关数据现在正在涌现。

There's probably people selling statins that don't want hear that, but we know that the data is emerging on that now.

因此，降低胰岛素，降低炎症。

So lower insulin, lower inflammation.

那是一个炎症标志物，对吧？

And that's an inflammatory marker, right?

C反应蛋白中的HS代表什么？

The C reactive What does the HS stand for?

高敏感性，C反应蛋白。

High sensitivity, C reactive protein.

高敏感性。

High sensitivity.

是的。

Yeah.

所以它在较低范围内进行测量。

So it measures in that lower range.

我以前在高碳水饮食时，CRP和hsCRP的数值通常在2到3之间。

And I used to trend to, like, two to two to three, like, my early CRP, HSCRP when I was, like, on a high carb.

我只在高碳水饮食期间测过两次。

I only had it measured twice when I was, like, on a, like, a high carb diet.

但自从我开始生酮饮食后，数值要么检测不到，要么就是0.2左右。

But, you know, since I've been keto, it's, like, either nondetectable or, like, 0.2.

或者当我对自己进行极端环境研究时，数值会稍微升高一点。

Or when I did extreme environment research on myself, you know, then I could bump it up a little bit.

当我患上细菌性或病毒性胃肠炎时，数值会飙升，因为它激活了免疫系统。

And when I had a bacterial or viral gastroenteritis, it shot through the roof because it activated your immune system.

但通常来说，hsCRP是一个主要的影响因素。

But generally, that hSCRP is a big driver.

我以前还笑话它，觉得这东西不敏感。

I used to laugh at it and be like, it's this non sensitive thing.

但现在所有数据都指向我们需要在这方面加以重视。

But now all the data is pointing in the direction that we need to add to that.

你的Omega-3水平、B12水平，确保没有缺乏，因为这些缺乏可能导致阿尔茨海默病迅速进展，还有你的镁水平。

Your omega-three status, your B12, make sure you don't have any deficiencies because that could lead to rapid progression to Alzheimer's disease, your magnesium levels.

但总的来说，运动是你身体最大的代谢杠杆，还有你的体重和体成分。

But also just in general, exercise, the biggest metabolic lever and your body weight, body composition.

去做一下DEXA扫描。

Get DEXA scans.

我知道在你进行生酮实验时，做DEXA扫描可能对你也有帮助。

I know it might be good for you to do a DEXA scan with your keto experiments, too.

我以前每年做一次，但现在我一年要做三到四次，因为我经常做些小实验，看看某些因素如何直接影响我的体成分。

I was doing it once a year, but now I end up doing three or four times a year because I do these mini experiments to see how acutely some of the things are impacting my body composition.

我只是对这个问题的答案感到坐立不安。

I just get antsy for an answer to that.

但这番冗长的解释基本上就是说，你的代谢健康与大脑健康紧密相连，并能显著延缓阿尔茨海默病的发作。

But it's a long winded explanation to just basically say that your metabolic health is tightly linked to your brain health and can dramatically delay the onset of Alzheimer's disease.

并不是说你会得这个病，或者在最终被其他疾病夺走生命前能完全逆转它。

Not that you're gonna get it or reverse it altogether before something else gets you in the end.

我的意思是，代谢健康这部分，我想强调一下，我那位有问题的亲戚是APOE三三基因型，我知道这不是唯一的风险因素，但似乎总缺了点什么，对吧，因为病情恶化得太突然了。

I mean, the metabolic health piece, just to underscore that, I mean, one of my relatives in question, APOE three three, I understand that's not the only risk factor, but something just seemed to be missing, right, because the decline was so precipitous.

这与和我合作的一些同时也是研究人员的医生们见过的任何患者数据或临床数据都对不上。

It didn't map to any patient data or clinical data that a number of doctors who are also researchers I was working with had seen.

还因为这位亲戚在四、五年前接受过评估，当时并未显示出任何快速衰退的遗传倾向。

Also because this person, this relative had been assessed four or five years prior and did not show any indication of predisposition to a rapid decline.

我是APOE三/四型，再次认识到还有其他因素在起作用。

I'm APOE three four, again, recognizing there are other factors at play.

但当她几乎崩溃时，有几件事情浮出水面。

But when she just kinda disintegrated, there are few things that came to light.

第一点是她的本地全科医生多年来基本上忽略了严重的代谢功能障碍。

Number one is her local GP had basically missed severe metabolic dysfunction for years.

我记不清参考范围了，但胰岛素，比如说上限是12。

And I can't remember the reference range, but, like, insulin, let's call it upper bound of 12.

我这是随便说的，但你能明白我的意思。

I'm making this up, but you'll get the idea.

她的数值高达43。

And she was, like, 43.

对吧？

Right?

这简直糟糕透顶。

It was just absolutely atrocious.

体重和整体的身体成分呢？

Body weight and just general, like, composition?

体脂率很差。

I mean, poor body composition.

是的。

Yeah.

身体成分差，尽管我尽了最大努力，但运动量极少，饮食上表现极差，虽然不算病态肥胖，但确实如此

Poor body composition, very little exercise despite my best efforts, misbehaves horribly, dietarily, not morbidly obese, but certainly

不吸烟、不喝酒、不用其他毒品吗？

No smoking alcohol, other drugs?

不吸烟，也不喝酒。

No smoking or alcohol.

但还有另一点，她被诊断出患有早期乳腺癌，接受了肿块切除术，肿瘤被移除，当时七十多岁，被开了他莫昔芬类药物，我想是一种叫来曲唑的雌激素阻断剂。

But here's the other piece that, so she had been diagnosed with stage one breast cancer, had a lumpectomy, was removed, Late seventies, was put on an estrogen, I think it's an estrogen blocker called Letrozole.

我看到这个情况后，咨询了一位做放射肿瘤学的朋友，她说，从认知角度来看，这种药大多数女性都很难耐受。

And I looked at this and I spoke to a friend of mine who was a radio oncologist and she said, it is very poorly tolerated by most women from a cognitive perspective.

总的来说，她们会受到严重打击。

Like, they get smashed by and large.

男性也是，顺便说一下。

Guys too, by the way.

男性。

Guys.

服用芳香化酶抑制剂的男性，比如用于睾酮替代治疗之类的。

Guys that take aromatase inhibitors, you know, for like TRT and things like that.

好的。

Okay.

是的。

Yeah.

男性不

Guys not

没必要大惊小怪。

a big to do.

没错。

Yep.

没错。

Yep.

是的。

Yeah.