Dr. Sara Gottfried: How to Optimize Female Hormone Health for Vitality & Longevity | Huberman Lab
发布时间 2023-01-30 13:00:10 来源
Welcome to the Huberman Lab Podcast where we discuss science and science-based tools for everyday life. I'm Andrew Huberman and I'm a professor of neurobiology and ophthalmology at Stanford School of Medicine. Today my guest is Dr. Sarah Gottfried. Dr. Sarah Gottfried is an obstetrician gynecologist who did her undergraduate training in bioengineering at the University of Washington in Seattle.
欢迎来到胡伯曼实验室播客，我们在这里讨论科学和基于科学的日常生活工具。我是安德鲁·胡伯曼，是斯坦福医学院的神经生物学和眼科学教授。今天我的嘉宾是莎拉·戈特弗里德博士。莎拉·戈特弗里德博士是一位妇产科医生，她在华盛顿大学西雅图分校主修生物工程。
She then completed her medical training at Harvard Medical School and she currently is a clinical professor of Integrative Medicine and Nutritional Sciences at Thomas Jefferson University. She has also been a clinician treating men and women in various aspects of hormone health and longevity for more than 20 years. She is an expert in not just traditional medicine as it relates to hormones and fertility, but also nutritional practices, supplementation and behavioral practices and combining all of that expertise in order to help women navigate every aspect and dimension of their hormones, longevity and vitality ranging from puberty to young adulthood, adulthood, perimenopause and menopause. And nowadays she's also treating men across the lifespan in terms of longevity, vitality and hormone health.
她随后在哈佛医学院完成了医学培训，目前是托马斯杰斐逊大学整合医学和营养科学的临床教授。她也是一名临床医生，在荷尔蒙健康和长寿的各个方面治疗男性和女性已经超过20年。她不仅是传统医学在荷尔蒙和生育方面的专家，还擅长营养实践、补充和行为实践，并结合所有这些专业知识，以帮助女性应对从青春期到青年期、成年期、更年期和绝经期的每个荷尔蒙、长寿和活力方面的挑战。如今，她还治疗男性各个阶段的长寿、活力和荷尔蒙健康。
During today's discussion Dr. Gottfried shares an enormous amount of information and tools that women can apply toward their hormone health, fertility, vitality and longevity. We discussed the gut microbiome which many people have heard about, but Dr. Gottfried points out the specific needs that women have in terms of managing their gut microbiome and the ways that that influences things like estrogen levels and metabolism, testosterone thyroid and growth hormone and much more. We also discussed nutrition and exercise. We touch on how the omega-3 fatty acids play a particularly important role in managing female hormone health. Dr. Gottfried points out why women have particular needs when it comes to essential fatty acids and how best to obtain those essential fatty acids for hormone health.
在今天的讨论中，戈特弗里德博士分享了大量信息和工具，供女性在激素健康、生育能力、活力和长寿方面使用。我们讨论了许多人已经听说过的肠道微生物群，但戈特弗里德博士指出了女性在管理肠道微生物群方面的特殊需求，以及这如何影响雌激素水平、新陈代谢、睾酮、甲状腺和生长激素等方面。我们还讨论了营养和运动。我们提到了欧米茄-3脂肪酸在管理女性激素健康中扮演着特别重要的角色。戈特弗里德博士指出了为什么女性在必需脂肪酸方面有特殊需求，以及如何最好地获取这些必需脂肪酸来保持激素健康。
We also discussed exercise and she offers some surprising information about the types and ratios of resistance training to cardiovascular training that women ought to use in order to maximize their hormone health. We also talk a lot about the digestive system. This was a surprising aspect of the conversation I did not anticipate. Dr. Gottfried shared with us for instance that women suffer from digestive issues at more than 10 times the frequency that do men and fortunately that there are tools specific to women that they can use in order to overcome those digestive issues and that in overcoming those digestive issues they can overcome many of the related hormone issues that so many women face. Dr.
我们还讨论了运动以及关于抵抗训练和有氧训练比例的一些令人惊讶的信息，这些比例可以帮助女性最大限度地改善其激素健康状况。我们还谈了很多关于消化系统的内容，这是我没有预料到的对话中的一个令人惊讶的方面。例如，Gottfried博士告诉我们，女性患消化问题的频率超过男性的10倍，幸运的是，有一些专门针对女性的工具可以帮助她们克服这些消化问题，在克服这些消化问题的过程中，她们也可以克服许多女性面临的相关激素问题。
Gottfried also shares with you tremendous knowledge about the specific types of tests, not just blood tests, but also urine and microbiome tests that women can use in order to really get a clear understanding of their hormone status, not just of present, but also where the trajectory of their hormones is taking them.
戈特弗里德还与您分享了关于特定类型的测试的巨大知识，不仅仅是血液测试，还有尿液和微生物组测试，这些测试可以帮助女性真正了解自己激素状况的清晰程度，不仅仅是目前的情况，也包括激素轨迹将会带领她们走向何方。
So we have an avid discussion about puberty, about young adulthood, adulthood, perimenopause and how best to manage and navigate perimenopause and menopause, including a discussion about hormone replacement therapy. In addition to her academic and clinical expertise Dr. Gottfried has authored many important books on nutrition, hormones and supplementation as it relates to women and to people who are not able to use them. The two books that I'd like to highlight and that we provided links to in the show note captions are Women, Food and Hormones and the Hormone Cure.
因此，我们就青春期、青年时期、成年期、更年期以及如何最好地管理和应对更年期和绝经期进行了热烈的讨论，包括激素替代疗法的讨论。戈特弗里德博士不仅在学术和临床方面有着丰富的专业知识，还撰写了许多关于营养、激素和补充剂与女性相关以及不能使用这些产品的人群的重要书籍。我想强调的两本书是《女性、食物与激素》和《激素疗法》，我们在节目注释中提供了链接。
I read the Hormone Cure and found it to be tremendously interesting and informative, not just in terms of teaching me about female hormone health and various treatments for female hormone health, but also as a man trying to understand how the endocrine system interacts with mindset, nutrition and supplementation more generally. So I highly recommend the Hormone Cure for anybody interested in hormones and hormone health and women food and hormones in particular for women, although again both books are going to be strongly informative for women wishing to optimize their hormone health, vitality and longevity. Before we begin, I'd like to emphasize that this podcast is separate from my teaching and research roles at Stanford. It is however part of my desire and effort to bring zero cost to consumer information about science and science related tools to the general public. In keeping with that theme, I'd like to thank the sponsors of today's podcast.
我读了《荷尔蒙疗法》，发现这本书非常有趣和信息丰富，不仅教会我关于女性荷尔蒙健康和各种治疗方法，也让作为一个男性想要了解内分泌系统如何与心态、营养和补充更普遍地互动的我受益匪浅。因此，我强烈推荐《荷尔蒙疗法》给任何对荷尔蒙和女性荷尔蒙健康感兴趣的人，特别是对女性、食物和荷尔蒙感兴趣的女性，尽管这两本书对希望优化荷尔蒙健康、活力和长寿的女性来说也会提供丰富的信息。在我们开始之前，我想强调一点，这个播客与我在斯坦福大学的教学和研究角色是分开的。然而，这是我希望努力为公众提供关于科学和科学相关工具的零成本信息的一部分。为此，我想感谢今天播客的赞助商。
Our first sponsor is ROCA. ROCA makes eyeglasses and sunglasses that are of the absolute highest quality. I spent a lifetime working on the biology of the visual system and I can tell you that your visual system has to contend with an enormous number of challenges in order for you to be able to see clearly. So for instance, when you go from a very brightly lit area to a dim lit area, your visual system has to make all sorts of adjustments that allow you to still see your environment. ROCA eyeglasses and sunglasses were built with the biology of the visual system in mind. So no matter what environment you're in, you'll be able to see with perfect clarity. And they have terrific aesthetics and enormous number of choices in terms of aesthetics. So unlike a lot of so-called performance eyeglasses out there that only give you the option to wear the ones that make you look like a cyborg, they have those options, but they also have a lot of options with aesthetics that you would be perfectly comfortable wearing to work or to dinner or anywhere else. If you'd like to try ROCA glasses, you can go to roca.com. That's R-O-K-A.com and enter the code Huberman to save 20% off your first order. Again, that's R-O-K-A.com and enter the code Huberman at checkout.
我们的第一个赞助商是ROCA。ROCA制造的眼镜和太阳镜质量绝对是最高的。我花了一生的时间研究视觉系统的生物学，我可以告诉你，为了让你能够清晰地看到，你的视觉系统必须应付大量的挑战。比如，当你从一个明亮的地方转移到一个昏暗的地方时，你的视觉系统必须做出各种调整，让你仍然能够看清周围的环境。ROCA的眼镜和太阳镜是专为视觉系统的生物学考虑而设计的。无论你身处何种环境，你都可以清晰地看到。它们不仅外观优美，而且在审美方面有着巨大的选择。所以，与那些只让你看起来像机器人的所谓性能眼镜不同，它们有那些选择，但也有许多外观让你完全可以穿着去工作、晚餐或任何其他地方。如果你想尝试ROCA眼镜，你可以访问roca.com。输入代码Huberman即可在首次下单时享受20%的折扣。再次强调，网址是R-O-K-A.com，结账时输入代码Huberman。
Today's episode is also brought to us by Thesis. Thesis makes custom neutropics. And as many of you know, I'm not a fan of the word neutropics because neutropics means smart drugs. And as a neuroscientist, I can tell you, there is no neural circuit in the brain for being smart. Thesis understands this and has designed different neutropics in order to bring your brain into specific states for specific types of work. So for instance, for creative work or to engage with more focus or to give you more energy for cognitive or physical work. So with Thesis, they'll design custom neutropics for you that will allow you more focus, better task switching, more creativity and so on. And they'll be sure to include only the ingredients that you want and not the ingredients that you don't. I've been using Thesis for more than a year now and I can confidently say that their neutropics have been a total game changer for me. I like the clarity formula prior to long bouts of cognitive work or the energy formula prior to physical workouts. If you'd like to try your own personalized neutropic starter kit, go online to takethesis.com slash Huberman. You'll take a brief three minute quiz and Thesis will send you four different formulas to try in your first month. Again, that's takethesis.com slash Huberman and use the code Huberman at checkout for 10% off your first box.
今天的节目也由 Thesis 支持。Thesis 制造定制的神经兴奋剂。正如许多人所知，我不喜欢神经兴奋剂这个词，因为神经兴奋剂意味着智能药物。作为一个神经科学家，我可以告诉你，大脑中没有任何与智力有关的神经回路。Thesis 理解这一点，并设计了不同的神经兴奋剂，以使您的大脑进入特定状态以进行特定类型的工作。例如，创作性工作或更专注地参与工作，或者为认知或体力劳动提供更多能量。因此，通过 Thesis，他们会为您设计定制的神经兴奋剂，让您拥有更好的专注力、更好的任务切换、更多的创造力等等。他们肯定会包含您想要的成分，而不会包含您不想要的成分。我现在已经使用 Thesis 一年多了，我可以自信地说，他们的神经兴奋剂对我来说是完全改变游戏规则的。我喜欢在进行长时间的认知工作之前使用清晰公式，或者在进行体力锻炼之前使用能量公式。如果您想尝试自己定制的神经兴奋剂入门套装，请登录 takethesis.com/huberman。你将花三分钟做一个简短的测验，Thesis 将会在你的第一个月寄送给你四种不同的配方供你尝试。再次强调，这是 takethesis.com/huberman，结账时使用代码 Huberman 可享受首个盒子 10% 的折扣。
Today's episode is also brought to us by Element. Element is an electrolyte drink that has everything you need and nothing you don't. That means the exact ratios of electrolytes are an element and those are sodium, magnesium and potassium, but it has no sugar. I've talked many times before on this podcast about the key role of hydration and electrolytes for nerve cell function, and neuron function, as well as the function of all the cells and all the tissues and organ systems of the body. If we have sodium, magnesium and potassium present in the proper ratios, all of those cells function properly and all our bodily systems can be optimized. If the electrolytes are not present and if hydration is low, we simply can't think as well as we would otherwise. Our mood is off, hormone systems go off, our ability to get into physical action, to engage in endurance and strength, and all sorts of other things is diminished. So with Element, you can make sure that you're staying on top of your hydration and that you're getting the proper ratios of electrolytes. If you'd like to try Element, you can go to drinkelement. That's LMT.com slash Huberman and you'll get a free Element sample pack with your purchase. They're all delicious. So again, if you want to try Element, you can go to element LMT.com slash Huberman.
今天的节目也由Element赞助。 Element是一种含有所需的一切但没有多余成分的电解质饮料。这意味着电解质的准确比例包括钠、镁和钾，但没有糖。我之前在这个播客中多次谈到了水合和电解质对神经细胞功能、神经元功能，以及身体所有细胞、组织和器官系统的功能起着关键作用。如果我们的体内有适量的钠、镁和钾，所有细胞都能正常运作，身体系统也能得到优化。如果电解质不足，水合不足，我们就无法像平常那样思考清楚。我们的情绪会不稳定，激素系统会紊乱，我们的身体活动能力、耐力和力量会受到影响。使用Element，您可以确保您的水合情况良好，并且摄入适量的电解质。如果您想尝试Element，您可以去drinkelement.com/huberman，购买时将获得免费的Element样品包。它们都非常美味。所以，如果您想尝试Element，可以前往element.com/huberman。
The Huberman Lab podcast is now partnered with Momentus Supplements. To find the supplements we discuss on the Huberman Lab podcast, you can go to Live Momentus spelled O U S, LiveMomentus.com slash Huberman. I should just mention that the library of those supplements is constantly expanding. Again, that's LiveMomentus.com slash Huberman.
Huberman实验室的播客现在与Momentus保健品合作。要找到我们在Huberman实验室播客中讨论的保健品，您可以访问Live Momentus，拼写为OUS，LiveMomentus.com/Huberman。我还要提一句，这些保健品的库存一直在扩大。再次强调，网址是LiveMomentus.com/Huberman。
And now for my discussion with Dr. Sarah Gottfried. Dr. Gottfried. Sarah, welcome. Thank you. So happy to be here. Yeah, I'm delighted and very excited to ask you about an enormous number of topics. You are expert in so many things. So the challenge for me is going to be to constrain this walk as it were. But I'm hoping that we can touch on a great number of things today.
现在是我和Sarah Gottfried博士的讨论时刻。戈特弗里德博士，欢迎。谢谢。很高兴能来这里。是的，我很高兴，也很兴奋能向您询问许多话题。您在很多领域都是专家。所以对我来说挑战就在于要将这一切限制在某些范围内。但我希望今天我们可以涉及许多话题。
The first of which is really about hormones and female hormones in particular. And I have a question which is, is it ever informative for a woman regardless of age to know something about her mother's, perhaps even her grandmother's experience vis-a-vis, hormones, not just pregnancy challenges with or ease with pregnancy and child, rearing childbirth, this sort of thing. But what sorts of conversations should women be having with themselves and with family members to get a window into what their specific needs might be? Love this question. So my work is really at the interface between genetics and environment. So your question gets to both. And I think it's essential that you understand what your grandmother went through. I'd even say your great-grandmother, depending on longevity in your family. So I grew up with my great-grandmother. I get that. And especially your mother. So I would probably start first with trauma and intergenerational trauma because I think that affects the endocrine system so hugely. Especially cortisol signaling, but the broader pine system, psychoimmuno-neuro endocrine system. And then there's, you know, if I think about the stages of the life cycle that a woman goes through, if you think about puberty, I think I don't know how genetically determined the age of puberty is. Certainly there's a lot of environmental influences like toxins can affect it. But pregnancy, the age at which you start to go through perimenopause, menopause, many of those have a genetic component.
首先，这与荷尔蒙有关，特别是女性荷尔蒙。我有一个问题，那就是，对于一个女性来说，无论年龄大小，了解一些关于她的母亲，甚至她奶奶的经验，尤其是在荷尔蒙方面是否有启发性呢？不仅仅是怀孕的挑战或者怀孕和育儿容易性，还有生孩子、抚养孩子等方面。但女性应该与自己和家庭成员进行哪些谈话来了解自己可能有哪些特殊需求呢？我很喜欢这个问题。所以我的工作实际上是在基因和环境之间的接口。你的问题涉及到两者。我认为了解你的祖母经历很重要。我会甚至说是你的曾祖母，根据家族的长寿情况而定。所以我和我的曾祖母一起长大，我理解这一点。尤其是你的母亲。所以我可能会首先从创伤和代际创伤开始，因为我觉得这会极大地影响内分泌系统。尤其是皮质醇信号，但更广泛的松果体系统、心理免疫神经内分泌系统。然后，当我考虑女性经历的生命周期阶段时，如果考虑到青春期，我不知道青春期的年龄在多大程度上是基因决定的。当然，环境因素也会对其产生影响，比如毒素可能会影响它。而怀孕、开始进入围绝经期的年龄、更年期等阶段，这些都有遗传成分。
So with pregnancy, I mean, you can certainly think the shape of the pelvis, your ability to have a vaginal birth. Some of that is genetically determined. I mean, you do have, you know, the sperm donor affecting some of that. But, you know, in my family, for instance, we have no cesarean sections. So everyone goes through this process of a relatively easy vaginal birth. I was a force-ups baby, but, you know, for the most part, you can find out about that. And then there's certain female conditions that have a very strong component genetically, most of which run in my family.
因此，在怀孕时，你当然可以考虑盆骨的形状，你进行阴道分娩的能力。其中一些是由基因决定的。我是说，你知道，精子捐赠者影响其中一部分。但是，在我家，比如说，我们都没有剖宫产。所以每个人都经历了一个相对容易的阴道分娩过程。我是一个 force-ups 婴儿，但总的来说，你可以了解到这一点。然后有一些女性疾病有一个很强的基因成分，其中大部分在我的家族中遗传。
So that includes enemy triosis, fibroids. I just had an astronomy. I had 50-plus fibroids and polycystic ovarian syndrome. And of those three, how frequent are those? And maybe I can constrain the question a little bit by saying, today's discussion, I imagine, is going to be heard by men and women of all sorts of ages. So maybe I'll direct the question a little bit toward, you know, at what age should these discussions start? You know, we always imagine that women in their 30s and 40s and 50s and onward should be getting certain tests and addressing things like ovarian reserve and other sorts of things.
这包括了敌人的三胞体和子宫肌瘤。我刚刚经历了一场宇宙术。我患有50多个子宫肌瘤和多囊卵巢综合征。这三种病症有多常见？也许我可以缩小问题范围，说一下，今天的讨论，我想会被各种年龄的男性和女性听到。也许我稍微引导问题，问一下，这些讨论应该在什么年龄开始呢？我们总是想象，30多岁、40多岁、50多岁及以上的女性应该接受一些特定的测试，并解决卵巢储备等问题。
But, you know, maybe we could march through and just say, for a woman in her teens who's already hit puberty, what sorts of biomarkers, whether or not they're blood-based or phenotyping, you know, the outward appearance of, should those young women be paying attention to likewise for women in their 20s, 30s, maybe we could take it more or less by decade, starting at puberty, assuming that woman hits puberty sometime between what is it now? The average in the US is somewhere between 12 and 16 years old. Do I have that right? No, you do not. Oh, great. I love to be wrong. So it used to be 12 to 16, I would say 50 years ago. It's been moving younger.
但是，你知道，也许我们可以逐步探讨，对于已经进入青春期的十几岁女性来说，无论是基于血液的生物标志还是表型特征，她们应该关注哪些生物标志，外表上的特征。类似的，对于二三十岁的女性，也许我们可以按照十年为单位进行讨论，从青春期开始，假设女性一般在什么时候进入青春期呢？美国的平均年龄大约在12到16岁之间。我记得对吗？不，你记错了。哦，太好了，我很喜欢被纠正。过去是12到16岁，我认为在50年前。现在越来越年轻了。
And we think some of that is related to toxin exposure, as I mentioned, but I was 10 when I went through puberty. So, well, I should say men are key and I started growing breasts much before that. So, I think now I'm going to step away from the science for a moment. I'm going to do that pretty fluidly and I'll try to call it out. I think there's also a huge influence from stress and like the development of the adrenal glands. So, going back to the science, the issue in teenage years is that the hypothalamic pituitary adrenal axis, and I like to think of it broader. So, stay with me. Hypothalamic pituitary adrenal, gonadal of recent women, testes of men, thyroid, gut access.
我们认为这与毒素暴露有关，正如我之前提到的，但我十岁就开始发育了。所以，嗯，我应该说男人是关键，我在那之前乳房就开始发育了。所以，我现在打算暂时远离科学。我会相当自如地做到，并尽量指出来。我认为压力也对此有很大影响，比如肾上腺皮质发育。因此，回到科学上来说，青少年时期的问题在于下丘脑垂体肾上腺轴，我倾向于更广泛地思考。因此，请继续跟着我。下丘脑垂体肾上腺，最近女性的生殖腺，男性的睾丸，甲状腺，肠道途径。
So, that means the control system. So, I'm kind of expressing my bioengineering side here. Well, I think it's great to include the other organs and tissue systems of the body because, as we both know, the narrow definition of just hypothalamic pituitary adrenal, it can't be just that. No, it can't. It doesn't tell the whole story. So, if you look at the main sex hormones in a young woman who's in her teenage years, the hypothalamic pituitary adrenal gonadal part of that is not fully mature.
So, they're more likely to skip periods, especially under stress. They have a lot of influences that really doesn't get well established until you're done with adolescence. And I'm told that adolescence now is until age 25 to 26. I heard that and I was like, I've got two daughters. I was like, that's a really long time. And not just psychologically defined or biopsychosocial. Mostly psychologically defined. I heard that from a psychologist. So, biomarkers, yes, about. In your teenage years, what I think is really interesting is to look at cortisol.
所以，这意味着控制系统。我在这里表达了我的生物工程一面。我认为将其他器官和组织系统包括进来是很好的，因为正如我们都知道的那样，仅仅将下丘脑垂体肾上腺定义为狭窄，这不够。不，不会。它不能讲清全部故事。因此，如果你看一个处于十几岁的年轻女性的主要性激素，下丘脑垂体肾上腺腺性部分还未完全发育。因此，她们更有可能在压力下跳过月经。他们有很多影响，直到青春期结束才真正确立。我听说现在青春期一直持续到25-26岁。我听到后觉得，我有两个女儿。我想着，那真的很长时间。并不仅在心理学上定义或生物心理社会学。大部分是心理学上定义的。我是从一位心理学家那里听到的。所以，生物标志物，是的，关于。在你的十几岁时，我认为真的很有趣的是观察皮质醇。
To look at the dance between estrogen and progesterone in those years is less helpful, because I think there's a lot of variability due to the immaturity of the system. If you've got someone who's got really regular periods, it's probably better to do some benchmarking at that age. But generally, I find that benchmarking is best performed in your 20s or 30s. Are periods not that regular in terms of duration of the menstrual cycle when the menstrual cycle first sets in? It depends. So, I was like clockwork every 28 days until I had my hysterectomy in August. Same thing with my daughters.
在那些年龄段看雌激素和孕激素之间的舞蹈并没有太大帮助，因为我认为由于系统的不成熟性而存在很大变化。如果你是一个月经非常规律的人，最好在那个年龄做一些基准测试。但一般来说，我发现在20岁或30岁进行基准测试效果最好。在月经周期第一次出现时，月经周期的间隔是否不那么规律？这取决于情况。所以，直到我在八月接受子宫切除手术之前，我的月经每28天就像钟表一样准时。我的女儿们也是一样的。
I've got two daughters, one 17, the other's 23. For a lot of women, they're not regular. And then there's the whole piece of oral contraceptives and other forms of contraception, where you have no idea what the normal cycle is. And I hope we'll have some time to talk a little bit about oral contraceptives, because I think it is, this is now opinion again, and not science. I think it is the number one endocrineopathy that is isiatrogenic for women. We will definitely talk about it. I get a lot of questions about oral contraceptives in the social media space, and also questions about IUDs quite a lot. Totally. In particular, copper IUDs, non-hormonal IUDs. So, we will definitely touch on that.
我有两个女儿，一个17岁，另一个23岁。对于很多女性来说，她们的月经周期并不规律。还有口服避孕药和其他避孕方法，你根本不知道什么是正常的周期。我希望我们能有一些时间来谈一谈口服避孕药，因为我认为这是一个观点，而不是科学。我认为口服避孕药是对女性造成的最常见的内分泌疾病。我们肯定会谈论这个话题。我在社交媒体上收到很多关于口服避孕药的问题，还有很多关于宫内节育器的问题。尤其是铜质宫内节育器，非激素宫内节育器。所以，我们肯定会谈及这些内容。
I'm an IUD crusader, so I just want to give you that warning. You're a fan. Do I have that right? Or you're an anti-IUD fan? I am a huge fan. Uh-huh. Which IUDs in particular? So, I like copper because it's non-hormonal. It's as effective as getting your tubes tied. Who would have thought? Right. It's that toxic to the sperm mobility, is that how it works? That's my understanding of it, is that it basically, it's like a, and it's more or less an electric fence to the sperm cap, and just that's it. Electric fence is a bit of a harsh analogy, but I'll work with that.
我是一个宫内节育器的支持者，所以我只是想提醒你。你是一个粉丝。我理解对吗？还是你是一个反宫内节育器的粉丝？我是一个大粉丝。哦。特别喜欢哪种宫内节育器？所以，我喜欢铜质的，因为它不含激素。它的效果和结扎输卵管一样。谁能想到呢？没错。它对精子的移动能力有毒吗，是这样起作用的吗？据我所知，它基本上就像是，或多或少是对精子帽的一种电子围栏，仅此而已。电子围栏有点太严厉的比喻，但我会接受。
But it's, you know, to have something that can last for 10 years so that you really have complete autonomy and sovereignty over your sexual life, that's profound. And to not get all those downstream risks that are associated with birth control pill, the other thing that's important to know about it, I know this is a cypore. Women who use the copper IUD have the highest satisfaction rate of anyone on contraceptives. The highest satisfaction rate. And yet, it is the least used of all forms of contraception. Now, my favorite is vasectomy. But short of vasectomy, I think I IUD is a really great choice. There are some risks associated with it. I'm not saying it's risk-free, but I love IUD. And I love it for younger women too, because it used to be that when I went through my training, which was 30 years ago, we were told, you know, don't put it in someone who asked an out of baby. And that is patriarchal messaging.
但要有一种可以持续十年的东西，这样你就可以完全掌控和主权自己的性生活，这是非常深刻的。而且不会承担与避孕药相关的所有下游风险，对此重要的另一点是，我知道这是一种铜环避孕器。使用铜环避孕器的女性对任何避孕措施的满意度最高。最高的满意度。然而，它是所有避孕方法中使用最少的。现在，我的最爱是结扎术。但除了结扎术之外，我认为IUD是一个非常好的选择。与之相关的风险。我不是说它是零风险的，但我喜欢IUD。我也喜欢年轻女性使用它，因为在我培训时，也就是30年前，我们被告知，不要给那些还没有孩子的人使用。这是父权主义的信息传递。
But getting back to your original question, which is about biomarkers per decade. In your 20s, that's when you want to do some base casing with estrogen progesterone and testosterone. So I think it's really helpful to know about this tango. You're from Argentina or your father. I have Argentine lineage. Yes. My grandparents did tango into their late 80s. I am in my late 40s, and I still haven't started, so I suppose there's time. It might be time for you to do that. Okay. And it might be a factor in their longevity. Do they have good health span? Not just what it's been. And my grandfather smoked cigarettes daily, remained mentally sharp until he died in his late 90s, but almost burned down their apartment several times falling asleep with a cigarette in his mouth. So I don't recommend anyone spoke, by the way. But it was coffee, matte, red meat, and cigarettes, and they lived into their 90s.
关于生物标记物每年代之间的问题，我认为在你的20岁时应该开始使用雌激素、孕激素和睾丸素做一些基础检测。所以我认为了解这方面知识会很有帮助。你来自阿根廷或你的祖父。我有阿根廷的血统。是的。我的祖父母在他们80多岁时还在跳探戈。我现在已经40多岁了，但我还没开始跳探戈，所以我想还有时间。也许现在是你开始跳的时候了。好的。这可能是他们长寿的一个因素。他们的健康状况怎么样？不仅是过去的事情。我祖父每天抽烟，直到晚年仍然保持思维敏捷，但常常在嘴里抽烟睡着了，几乎把公寓烧毁。顺便说一句，我不建议任何人抽烟。但他们长寿的秘诀是咖啡、玛黛茶、红肉和烟草，他们活到90多岁。
So that side of my family has the genetic advantage, the other side, less so. But in any event, tango is a 2023 goal. It has been every year. The. I'm going to hold you accountable to that. Okay. We'll do. And there will be no YouTube video of me doing that. At least not initially. Tim Ferriss, actually, phenomenal podcaster, as we know, is. He's a badass tango dancer. He's a badass tango dancer. I know this through various sources. Yes. I've seen. Yeah. So this tango between estrogen and progesterone is incredibly important. You want to have the right lead, you want to have the right follow between the two hormones? Again, I'm stepping away from my science hat. But what happens a lot of the time is that estrogen dominates in that tango. And when that happens, it sets you up for greater risk of fibroids, enemetriosis, rest pain, probably in association with the microbiome and the astroblom.
所以我家族的那一边有遗传优势，另一边则没有那么好。但无论如何，探戈是2023年的目标。每年都是如此。我会记住这件事的。没问题。我们会做到的。至少起初不会有我跳探戈的YouTube视频。蒂姆·费里斯实际上是一个了不起的播客人，我们知道他是一个了不起的探戈舞者。我通过各种渠道得知这一点。是的，我看过。所以雌激素和孕激素之间的这种探戈非常重要。你想要正确的主导，你想要两种激素之间正确的跟随？再次，我摘下我的科学帽。但很多时候会发生的情况是雌激素在那场探戈中占主导地位。当这种情况发生时，会使你更容易患子宫肌瘤、子宫内膜异位症、休息疼痛，可能会与微生物群和天然气组成有关。
Oh, can you familiarize me with the astroblom? Yeah. I'm delighted to know that I don't recognize the term. Yeah. So the astroblom is the set of microbes in. And their DNA, their DNA mostly. In the gut microbiome, that set of microbes in their DNA. So it's. If you look at the totality, the subset of particular bacteria modulate estrogen levels. So a lot of this work was spearheaded by Martin Plaser. And what we know is that there are some women who have an astroblom that makes them have a greater risk of certain estrogen-mediated conditions, like breast cancer and amitral cancer, and in men prostate cancer. So the astroblom is incredibly important. There's not a lot of attention paid to it. But I always think in terms of my patients, could this be someone who's got a faulty astroblom? And we need to adjust it with some of the microbiome modulating nutrients, nutraceuticals that we have, so that they're less likely to have that tango that's not working with estrogen and progesterone.
哦，你能向我介绍一下微生物组吗？是的，我很高兴知道我不认识这个术语。是的，所谓的微生物组就是一组微生物及其DNA。在肠道微生物组中，这组微生物及其DNA。所以，如果你看总体来说，特定细菌的一个子集会调节雌激素水平。许多这方面的工作是由马丁·普拉瑟领导的。我们所知道的是，有些女性具有使她们更容易患上一些雌激素介导的疾病（如乳腺癌和子宫内膜癌）的微生物组，而男性则更容易患前列腺癌。微生物组非常重要，但却没有得到很多关注。但我总是考虑到我的病人，这可能是某人拥有有问题的微生物组，我们需要用一些微生物组调节营养素和营养补充剂来调整它，这样他们就不太可能出现雌激素和孕激素之间不协调的情况。
So getting back to the biomarkers. If you gave me an unlimited budget, which I kind of have with some of my clients that I work with now, what I would want to know is estrogen, progesterone, testosterone, and I'd want the timing rate for that. I'd want to know about DHEA and sort of the whole Anderson pathway. I'd want to know about the metabolites of estrogen, because some of them are protective and very helpful. Others are a bit like Homer Simpson. I mean, they are just like causing all kinds of problems in your body, increasing the risk of quinones, like DNA damage, and potentially an increased risk of breast cancer, although that data I think is mixed.
所以回到生物标志物上。如果你给了我一个无限的预算，我现在有一些客户有些像这样的预算，我想要知道的是雌激素、孕激素、睾丸素，我还想要知道这些激素的时机。我想要了解DHEA和整个安德森途径。我想要了解雌激素的代谢产物，因为其中一些对身体有保护作用，非常有帮助。另一些则有点像荷马·辛普森。我的意思是，它们就像在你的身体里引起各种问题，增加了对醌类物质的风险，比如DNA损伤，并可能增加患乳腺癌的风险，尽管我认为这些数据是混合的。
I'd also like to know about their stool, so I want to know about the microbiome. So the best that we have right now is to look when we do stool testing, and I do a lot of stool testing. We can look at things like beta-glucuronidase. Are you familiar with BG? I'm familiar with it as a term, and so for those listening, very often not always when you hear an ACE-A-C, you're dealing with an enzyme, so we can take a stab there, and it sounds like it's somehow involved in glucose metabolism of some sort. Glucuronidase.
我也想了解他们的排便情况，所以我想了解微生物组。目前最好的方法是进行排便检测，我做了很多这样的检测。我们可以查看一些东西，比如β-葡聚糖酶。你对β-葡聚糖酶熟悉吗？我知道这个词，对于那些在听的人来说，当你听到ACE-A-C时，通常不总是在处理一个酶，所以我们可以试着猜一下，听起来好像是在某种程度上与葡萄糖代谢有关的。葡聚糖酶。
So it's involved in when you produce estrogen in the body, this is like the simplified version, but when you produce estrogen, you are meant to use it, like send it to the receptors where it's meant to go, and then lose it. Like, you don't want to keep recirculating estrogen like bad karma, and that's what happens with people who have high beta-glucuronidase. So it's this enzyme that's produced by three bacteria in particular in the gut, and I see a lot of men and women who have elevated beta-glucuronidase, and then they have a semester since dominance related to that. Is that the total reason? We don't really know, but it's one of the drivers, it's one of the levers. And it can be detected from a microbiome AK stool sample. That's right.
因此，涉及你身体产生雌激素时，这就像是简化版本，但当你产生雌激素时，你打算使用它，就像把它发送到其应去的受体，然后消失。就像，你不想像坏业力那样不断地循环雌激素，而这正是那些拥有高β-葡萄糖醛酸酸酶的人所发生的。所以这是由肠道中三种特定细菌产生的酶，我看到很多男性和女性有增高的β-葡萄糖醛酸酸酶，然后因此产生激素失衡。这就是全部原因吗？我们还不太清楚，但这是其中一个推动因素，是其中一个杠杆。它可以通过肠道菌群AK大便样本检测。就是这样。
And in terms of blood testing, or various tests for these other biomarkers, getting estrogen, testosterone, and other ratios, I realize there are people who have different means, but in general, people wanting to do a blood test, it sounds like they're going to need to do it. What women will need to do it at different stages of their menstrual cycle. If they had to pick one, either in the follicular phase or in the luteal stage of their ovarian menstrual cycle, excuse me, ovulatory menstrual cycle, when would you suggest they do that if they had to pick one?
在进行血液检测或检测其他生物标志物时，获得雌激素、睾酮和其他比例的数值，我意识到有些人有不同的方法。但总的来说，想要进行血液检测的人似乎需要这么做。女性需要在不同的月经周期阶段进行检测。如果她们必须选择一个时间，无论是在卵泡期还是黄体期，或是排卵周期的哪个阶段，你会建议她们选择哪个时间？
So if you forced me to pick one, I would say probably day 21 to 22 for someone in her 20s. So we're focused right now on that decade. So for most women, they've got a menstrual cycle all day, that averages out at 28 days. So this is about a week before they start their period. For women or more irregular, it's harder to do that. As women get older, and we'll talk about this in a moment, usually the cycle gets a little shorter. So as they start to decline in their progesterone production, their period gets a little closer together. Like mine before August was about every 26 days. So at that point, you want a test sooner, like day 19, 20.
如果你非要让我选一个的话，我会说对于二十多岁的女性来说，可能是第21到22天。我们现在专注于这个十年。对于大多数女性来说，她们的月经周期大约是28天。所以这是她们来大姨妈前大约一周的时候。对于那些月经不规则的女性来说，这要难一些。随着女性年龄的增长，通常月经周期会变短一些。当她们的孕酮产生量开始下降时，月经周期会变得更加紧凑。比如我，之前每26天会来一次大姨妈。那个时候，你就需要更早一点测试，比如在第19或20天。
And I'm not talking about a blood test. A blood test is the cheapest thing. It's usually what's covered by insurance. But my preference would be to do dried urine. I like to use saliva for cortisol. I like to use dried urine so that I get metabolomics in addition to the levels of these hormones. And if I'm forced to, I'll use blood testing. And that's certainly the gold standard for all of these hormones that we're talking about. But it's not as comprehensive. And as you know, it's a quick little snapshot while the needle's in your vein for, you know, 30 seconds.
我说的并不是血液检测。血液检测是最便宜的方法。通常医保会覆盖这个项目。但我更喜欢使用干燥尿液进行检测。我喜欢用唾液来检测皮质醇。我喜欢使用干燥尿液，以便获得代谢组学信息，除了这些激素的水平。如果被迫的话，我会使用血液检测。当然，对于我们讨论的所有这些激素，血液检测是金标准。但它并不全面。你知道，那只是一瞬间的快照，当针头插在你的静脉里时，大概只有30秒。
The salivary cortisol makes sense to me because my understanding is that you get free cortisol, which is the active cortisol. You said with urine, you're also getting the metabolites. That's right. And then for blood testing, you're getting sort of a crude window into the averages. A static total level. So let me go back and say one other thing about biomarkers. A big part of the testing that I do in phenotyping my patients, I practice precision medicine. I like to almost start with nutritional testing. I don't think I've ever had a teenager. I've got some NBA players that are 19, 20, 21, so maybe those count. But those are men, obviously.
口腔唾液皮质醇对我来说是有道理的，因为我的理解是你得到的是自由皮质醇，这是活跃的皮质醇。你说用尿液测试，也会得到代谢产物。没错。然后用血液测试，你得到的是对平均水平的一种粗略窗口。一个静态的总水平。让我回过头来说一下有关生物标志物的另一件事情。在面型划分我的患者时的测试中，有很大一部分是我做的。我习惯于从营养测试开始。我想我从没见过一个十几岁的青少年。我有一些NBA球员，他们是19、20、21岁，也许这些算。但这些显然是男性。
But for nutritional testing, that would be potentially a helpful thing to do in your 20s. Becomes less important as you get older and you develop more micronutrient deficiencies. But micronutrients play a huge role in terms of hormone production. Magnesium, you know, the magnesium is hugely involved in the way that you get rid of estrogen. That's an example. So micronutrient testing, what I usually do is a combination of blood and urine. And so I'm looking at all of the micronutrients that we can measure that have some clinical scientific basis behind them. If I could do that for a teenager, I think it might be helpful because I recently gave a lecture on breast cancer risk reduction.
但是对于营养测试来说，在20多岁时可能是一件有帮助的事情。随着年龄增长以及微量营养素缺乏的发展，这会变得不那么重要。但微量营养素在激素产生方面起着巨大作用。镁，你知道，镁在排除雌激素的过程中起着非常重要的作用。这就是一个例子。所以微量营养素测试，我通常会结合血液和尿液进行测试。我会检查所有我们可以测量且有一定临床科学依据的微量营养素。如果我能为青少年进行这样的测试，我认为可能会有所帮助，因为我最近做了一个关于乳腺癌风险降低的讲座。
Another quick sidebar. And I was sad to find that intake of vegetables, polyphenols, is such an important predictor of future risk of breast cancer, like when you're 50, 60, plus. And the most important time is when you're a teenager. Now I have one daughter that eats vegetables, she loves them. And I have another daughter who eats food that's beige. And it's very hard to get her to eat the volume of vegetables, you know, five colors a day, which is what I do. And if you have evidence that you could show a 17 year old that they've got micronutrient gaps, I think that would be a motivator for them to eat differently at a time when it's so critical. Even though it's, you know, 25 years in the future, that it's going to potentially change this arc that they're on.
另一个快速的旁白。我很难过地发现，摄入蔬菜中的多酚类物质对未来患乳腺癌的风险有如此重要的预测作用，特别是在50、60岁以后。而最重要的时期是在青少年时期。我有一个女儿喜欢吃蔬菜。另一个女儿却只爱吃米色食物。让她吃足够多的蔬菜，比如每天五种颜色，真的很困难，而这是我的做法。如果你有证据能够向一个17岁的孩子展示他们有微量营养素缺口，我认为这会是激励他们在如此关键的时期改变饮食习惯的动力。尽管这影响可能要等25年后才能显现出来，但这有可能改变他们目前的生活轨迹。
What do you do for a young woman who doesn't like vegetables? Is it or is not somehow able or willing to get those five colors a day of vegetable to help support the microbiome? Are supplements a useful tool in that case? What other sorts of tools behavioral or otherwise are useful? Such a good question. So here I'm going to invoke Rob Knight at UCSD. So I think his gut project has really been helpful in terms of understanding what kind of modulators are going to be important.
对于一个不喜欢吃蔬菜的年轻女性，你会怎么做？她是否有能力或愿意每天摄入五种颜色的蔬菜来帮助支持肠道菌群？补充剂在这种情况下是否是一个有用的工具？还有哪些其他行为或其他方面的工具是有用的？这是一个很好的问题。在这里我要提到UCSD的Rob Knight。我认为他的肠道项目在理解什么样的调节剂是重要的方面上真的很有帮助。
So what I try to get that person to do, and I don't see many teens anymore other than MBA players, what I try to get them to do is to have a smoothie. Very hard to get them down to smoothie every day, but if I could get them down to smoothie three times a week and to throw some of these vegetables in, that makes a huge difference. I mean, we know that makes a difference in terms of microbiome change. You should be blending up broccoli or kale. Cauliflowers. So cauliflowers are great. They're putting things into the smoothie.
所以我试图让那个人做的事情，我不再见到很多青少年了，除了MBA球员，我尝试让他们喝一杯奶昔。每天让他们喝奶昔很难，但如果我能让他们每周喝奶昔三次，并添加一些蔬菜，那就会有很大的改变。我是说，我们知道这对肠道菌群的改变有影响。你应该把西兰花或羽衣甘蓝搅拌在一起。还有花椰菜。花椰菜很棒。把这些放进奶昔里。
Yeah, I don't know if you can get a teenager to do that, but they often will use, like I have them do steam broccoli that's in the freezer because it's got very little taste. So that they could do that in a chocolate smoothie. They could add some greens. I like greens powders are super convenient. So that with, you know, kind of a taste that they like, whether that's chocolate, which is what most of my clients want, or, you know, vanilla with berries and that sort of thing. So that can go a long way if you don't like vegetables. And short of that, I would say some supplements, but I would say that's a distant second to making a smoothie.
是的，我不知道你是否能让一个青少年这样做，但他们经常会使用，比如我让他们蒸冷冻冰箱里的西兰花，因为它几乎没有味道。这样他们可以在巧克力奶昔中添加。他们可以加一些绿叶蔬菜。我喜欢绿色粉末，非常方便。所以配合他们喜欢的口味，无论是巧克力（大部分客户喜欢的口味），还是香草配搭浆果等。如果你不喜欢蔬菜，这样做可以有所帮助。另外我会说一些补充剂，但我会说这是在制作奶昔之后的次要选择。
I've got one patient that I have to mention because he took this to the extreme. So he is a retired physicist professor at UCSD. He found out that his microbiome was a hot mess and developed autoimmune disease. And so he became hell bent, like only a physicist could on changing his microbiome. And he dramatically shifted it by having a smoothie every day with 57 vegetables and fruits in it. 57 independent. 57 independent. So, I mean, this just warms my heart the way that he did this, but he would go to the farmer's market. He would just get a bunch of this, a bunch of that. And he would go home, make the smoothie and then stick it in the freezer. So he'd have a serving every day. And he became a completely different person based on this microbiome change. His autoimmune disease is in remission. He dropped a huge amount of weight. He went from being, you know, kind of this phenotype that I know you know well of a professor high performing, traveling around the world on so many boards, so much innovation, so many great ideas, supercomputer guy, to being someone who gets up in the morning, gets in his hot tub, exercises for like one to two hours a day, and then does a little work. Like he completely shifted the way that he lives. And his microbiome shift, you know, who knows what's the chicken and what's the egg there. But he had a huge change in his physiology. And his glucose went from being quite high. And he tracks all of this, of course. It's like on a Jupiter. Right. And retired, I suppose, might have had a similar. And he's retired, but he's got the longest time series of anyone I know. And he's tracked his glucose and insulin going back 20 years. So he can show you, okay, here's where I started having my smoothie. And here's how my glucose and insulin change just result of that.
我有一个病人，必须提到，因为他把这个做到了极致。他是UCSD的一名退休物理学教授。他发现自己的微生物群落一团糟，导致自身免疫性疾病。因此，他下定决心，就像只有物理学家才能做到的那样，改变自己的微生物群落。他通过每天喝一个果蔬冰沙，其中包含57种蔬菜和水果，彻底改变了微生物群落。57种独立的成分。这种方式让我感到非常感动，他会去菜市场，买一堆这个、一堆那个，然后回家制作果蔬冰沙，放在冰箱里冷冻。每天喝一份。由于这种微生物群落的改变，他完全变了一个人。他的自身免疫疾病得到缓解，体重大幅减轻。他从一个高产、环球旅行、参与众多董事会、创新无数、有许多杰出想法的教授类型转变为每天早上起床后泡个热水澡，每天运动1到2小时，然后工作一会儿的人。他完全改变了生活方式。微生物群落的变化，谁知道是先有鸡还是先有蛋。但他的生理学发生了巨大变化。他的血糖从高位下降。当然，他追踪了所有这些数据，就像在朱庇特上一样。他退休了，我想可能会有类似的情况。他已经退休，但他拥有我所知道的最长的时间序列。他追踪了自己20年来的血糖和胰岛素水平。因此，他可以告诉你，我的果蔬冰沙开始饮用后，我的血糖和胰岛素是如何因此改变的。
So I'd like to take a quick break and acknowledge one of our sponsors, Athletic Greens. Athletic Greens, now called AG1, is a vitamin mineral probiotic drink that covers all of your foundational nutritional needs. I've been taking Athletic Greens since 2012, so I'm delighted that they're sponsoring the podcast. The reason I started taking Athletic Greens and the reason I still take Athletic Greens once or usually twice a day is that it gets to be the probiotics that I need for gut health. Our gut is very important. It's populated by gut microbiota that communicate with the brain, the immune system, and basically all the biological systems of our body to strongly impact our immediate and long-term health. And those probiotics in Athletic Greens are optimal and vital for Microbiotic Health. In addition, Athletic Greens contains a number of adaptogens, vitamins and minerals that make sure that all of my foundational nutritional needs are met. And it tastes great.
所以我想先稍作休息并感谢我们的一位赞助商，Athletic Greens。Athletic Greens现在被称为AG1，是一种维生素矿物质益生菌饮料，涵盖了所有基础营养需求。我自2012年开始就一直在服用Athletic Greens，所以很高兴他们能赞助这个播客节目。我开始服用Athletic Greens的原因，也是我至今仍然每天服用一次或通常是两次的原因，是因为它含有我需要促进肠道健康的益生菌。我们的肠道非常重要。它由肠道微生物群组成，它们与大脑、免疫系统以及我们身体的所有生物系统进行交流，从而会在直接和长期健康状况上产生强烈影响。而Athletic Greens中的益生菌对于微生物健康来说是最佳且至关重要的。此外，Athletic Greens还含有多种适应原、维生素和矿物质，确保我所有的基础营养需求都得到满足。而且口味很棒。
If you'd like to try Athletic Greens, you can go to athleticgreens.com slash Huberman, and they'll give you five free travel packs that make it really easy to mix up Athletic Greens while you're on the road and the car on the plane, etc. And they'll give you a year's supply of vitamin D3K2. Again, that's athleticgreens.com slash Huberman to get the five free travel packs and the year's supply of vitamin D3K2. Is there a case for, I'll say young women, but young women and men using over-the-counter probiotics as a way to enhance the microbiome? This is something I hear about a lot.
如果您想尝试Athletic Greens，您可以前往athleticgreens.com slash Huberman，他们会提供给您五个免费的旅行装，让您在旅途中轻松搅拌Athletic Greens，无论是在车上还是飞机上。他们还会为您提供一年的维生素D3K2供应。再次强调，这是athleticgreens.com slash Huberman，以获取五个免费的旅行装和一年的维生素D3K2供应。对于年轻妇女或年轻男子来说，使用非处方益生菌作为增强微生物组的方法有道理吗？这是我经常听到的一个问题。
I've heard that excessive doses of capsule probiotics can give a brain fog-like condition. I personally don't use capsule probiotics unless I feel like my system is under a significant amount of stress, in which case I might add that in for brief periods of time, or if I've just taken antibiotics for a period of time. Do you ever recommend that the college student or the high school student that she or he take capsule probiotics? Assuming that they're getting, let's say, three to five servings of vegetables per day, either in smoothie form or some other form, what are your thoughts on supplementing probiotics?
我听说过过量服用胶囊益生菌可能会导致大脑出现类似脑雾的状况。我个人不会使用胶囊益生菌，除非感觉自己的身体承受了大量压力，这种情况下我可能会在短时间内添加一些，或者在刚刚使用抗生素一段时间后。您是否会建议大学生或高中生服用胶囊益生菌？假设他们每天摄入三到五份蔬菜，无论是在冰沙形式还是其他形式，您对补充益生菌有什么看法？
It sounds like such a simple question. It is such a complex answer, and I don't think we really have the answer. I'll tell you the way that I approach it. I look for randomized trials to support my use of probiotics, and frankly, I'm underwhelmed. I've seen some data if I had spoke of my MBA players for a moment. Almost every player I've tested has increased intestinal permeability. They just have such a high training load, probably mediated by cortisol, very high glucose when they drain, that they have increased intestinal permeability.
这听起来像是一个很简单的问题。但实际上，这是一个非常复杂的答案，我不认为我们真的有答案。我会告诉你我的处理方法。我会寻找支持我使用益生菌的随机试验，但实话说，我并不是很满意。我曾看到一些数据，比如我曾研究过的MBA运动员。几乎每个我测试过的球员都有肠道通透性增加。他们的训练负荷非常大，可能是由皮质醇介导，排空时血糖非常高，所以肠道通透性增加。
So those tight junctions in their intestine become loose. They develop a lot of inflammation as a result of that. When you're a professional MBA player and you're making 20 million a year, you don't want a lot of inflammation. You want a little bit to help your muscles recover, but you don't want it to be adding to problems when you develop an injury. So this is leaky gut. I don't love that term, but yeah, we'll use it here. So there's a particular probiotic that is helpful in athletes with leaky gut. So that's the kind of specificity and randomized trial that I'm looking for. The rest of it. I think there's support if you find help from it.
因此，他们肠道中的紧密连接变得松弛。由此产生了大量的炎症。当你是一名年薪2000万的职业MBA球员时，你是不希望有太多的炎症的。你希望有一点点来帮助肌肉恢复，但当你受伤时，你不希望它加剧问题。所以这就是所谓的“漏肠”。我不太喜欢这个术语，但是是的，我们会在这里使用它。因此，有一种特定的益生菌对患有漏肠的运动员有益。这就是我正在寻找的具体性和随机试验。其余部分我认为，如果你找到了帮助的话，支持是会有的。
As you described, if you take a course of antibiotics, I mean, first of all, I would question whether you need them, but there's a kind of way. There have been instances where they've been prescribed and I took them mostly in the past. I was in college. They seem like they kind of gave them out. You had a science infection that gave you antibiotics using kind of like. Yeah, the worst treatment ever. Yeah. So if you're coming off of antibiotics, I think that's a good time to do what we call replacement dose probiotics. I think what's far more interesting is prebiotics. I think the data is much better for prebiotics and the selective use of polyphenols.
正如你所描述的，如果你服用抗生素，我是说，首先我会质疑你是否需要它们，但有一种方式。过去曾经有过处方，我大多数是在上大学的时候服用的。好像他们随便就给了。你得到了抗生素治疗像感染科学会给你。是的，最糟糕的治疗方式。所以如果你停止使用抗生素，我认为这是一个很好的时机来进行我们所称的替代剂益生菌的摄取。我认为更有趣的是益生元。我认为益生元和多酚的选择性使用的数据要好得多。
How would a person in their teens and twenties or any age for that matter know whether or not they have nutritional deficiencies? What is the best way to analyze if one is getting enough magnesium? And for that matter, what is going to be the best way to test the microbiome? You said stool sample and I'll come right back with the same question I asked about a blood test. What time of day, when during the month, to establish this baseline? This would be prior to embarking on a 97 vegetables or how much of per day. I was only 57. Well, I love the idea that we were telling us, if I'm gathering correctly, is that yes, there's a case for probiotics, but for the typical person, regardless of age, eating more vegetables or drinking more vegetables, as the case may be, is going to be beneficial for the gut microbiome.
十几岁到二十岁的年轻人，或者任何年龄段的人，怎样才能知道自己是否存在营养缺乏呢？如何最好的分析自己是否摄取足够的镁？对于检测微生物组，最佳方法是什么？你说是粪便样本，我会立刻问同样的问题，即血液检测。在一天中的什么时候，在月份的什么时候，建立这样的基准？这将是在开始摄入97种蔬菜之前。我只有57岁。我喜欢你说的这个想法，如果我理解正确的话，那就是是的，益生菌是有用的，但对于典型的人来说，无论年龄如何，多吃蔬菜或者多喝蔬菜汁是对肠道微生物有益的。
Perhaps without the need to go test whether or not one is making a certain number of estrogen-related metabolites or not. That's a great starting place. Eat or consume more vegetables. Totally. But if one wants to analyze their gut microbiome, are there good tests available to the general public? This has been, I'm not going to name companies, but I've been tracking this over the years, and it's never been clear to me that we know what constituents of the gut microbiome are best. We know that dysbiosis is bad, and we know that diversity of the microbiome is good. We hear this, but no one's ever told me that you want a particular ratio of one microbiota to another in a way that has made any sense to me at least.
也许不需要测试是否产生了某种雌激素相关代谢产物，这就是一个很好的起点。多吃蔬菜。完全没问题。但是，如果有人想分析他们的肠道菌群，是否有好的检测方法适用于普通大众？这个问题我一直在关注多年了，但我从来没有清楚地知道我们最好如何了解肠道菌群的成分。我们知道菌群失调是不好的，而菌群的多样性是好的。我们听说过这些，但至少没有人告诉过我，你需要一定比例的某种微生物群落来保持健康。
Totally. I'm not a microbiologist, but whereas with testosterone and men, we hear, okay, you want your free testosterone to be about 2% of your total, perhaps, with women are going to have more testosterone than estrogen on average, but still less than men when you look at testosterone, et cetera, et cetera. But you can get some crude measures, but for the microbiome, it just seems like long lists of microbiota for which I just get dizzy. If you just wrote out a bunch of I's and L's and S's, you can kind of halfway. Totally. You're getting a bit the same information. I'm not trying to poke at that field. It's a beautiful field, but they haven't told me what my microbiota ought to look like. What's a healthy microbiome chart? Well, that's because we don't know. I mean, the best we have is Rob Knight's work, but even that is limited in terms of, you know, can I tell you that a woman in her 20s should have this particular pattern with her microbiome? No, I can't. So let me go to your first question because I think you just asked about six. Your first question is about nutritional testing. What I like to do with nutritional testing is run a panel that's looking at antioxidants, select vitamin A, vitamin C, alpha lipoic acid, plant-based antioxidants, because you can measure that in the blood. I like to look at some of the key vitamins, especially the B vitamin range, because as you probably know, if you've got particular genetic polymorphism, see my blood.
完全正确。我不是微生物学家，但是对于男性来说，我们听到，好吧，你希望你的游离睾酮占总睾酮的大约2％，也许对于女性来说，平均来看，她们的睾酮会比雌激素多一些，但当你看睾酮等等时，仍然比男性少。但你可以得到一些粗略的测量数据，但对于微生物群落来说，它似乎只是一长串微生物的清单，让我眼花缭乱。如果你只是写一堆I、L和S，你可能会有些了解。完全正确。你会得到一些相同的信息。我不是想挑战那个领域。那是一个美丽的领域，但他们没有告诉我我的微生物群落应该是什么样子。健康的微生物群落图是什么？那是因为我们不知道。我是说，目前最好的是罗布·奈特的工作，但即使如此，在微生物群落的模式方面也有限制，你说一个20多岁的女性的微生物群落应该是什么样的？不，我不能告诉你。所以让我回答你第一个问题，因为我觉得你刚刚问了六个问题。你的第一个问题是关于营养测试。我喜欢做的是运行一个看抗氧化剂、选择性维生素A、维生素C、α-硫辛酸、植物来源的抗氧化剂的面板，因为这些可以在血液中测量。我喜欢看一些关键维生素，特别是B族维生素的范围，因为你可能知道，如果你有特定的基因多态性，可以在我的血液中看到。
So, I think that's actually morphism. See, it might be less likely to be absorbing the right level of vitamin B9, folate, vitamin B12, etc. I'm also looking and going back to the antioxidants at glutathione, because I think that's such an important lever when it comes to detoxification, which we haven't talked about yet. And then I'm looking at some of the minerals. Magnesium is really the most important, and we know that somewhere around 78% of Americans are deficient in magnesium. That's like the lowest hanging fruit. I would be curious, for instance, with magnesium, if that number of people are deficient, does that mean that that number of people should be targeting their nutrition towards foods that contain magnesium and or supplementing with magnesium? And if so, what forms of magnesium? We've talked about Mag 3 and 8 for sleep. There's so many forms. It can be a little bit of overwhelming to people. So any detail and sourcing would appreciate it. Great. So first, in terms of testing, what I prefer to do is to mention more than one lab and more than one brand. And I can just, I'm speaking mostly from experience. So, for testing, I do a lot of genova neutrophils. During the pandemic, they developed an at-home test. Normally with a neutrophil, you have to get your blood drawn, and you have to do a urine sample. So a lot of people can't do that. The great thing about this test is your insurance usually pays for most of it, and so the copay is about $150. So during the pandemic, they developed another test called metabolomics, which does much of the same testing, but it's a fingerprint. So most of my patients prefer that. In fact, they haven't gone back to the neutrophil. Second lab is spectracell. I use spectracell occasionally. I find it not quite as easy in terms of fitting into my practice, but I've got friends and mentors like Mark Houston, who does a lot of kind of precision cardiometabolic health. He thinks spectracell is the best test out there. So you asked about magnesium. You have to measure red blood cell magnesium, like whole blood. And with deficiency, it's interesting with supplementation. For my patients who tend toward constipation, and that's frankly about 80% of the women that I take care of. Really? Yes. Wow. I'd be curious as to why that is. I can guess diet, stress, patriarchy, rage. It's a psychosychoma so the pine system. Right. Psychology, immunology, neural and endocrine factors combined. Yes. And then I would say there's another factor, which is being female is a health hazard. So we've twice the rate of depression and somnia. We've got 3 to 4x increased risk of multiple sclerosis. We've got 5 to 8 times the risk of thyroid dysfunction. So if you just look at that and you look at subtle preclinical thyroid dysfunction, a huge number of the women that I take care of, well let me back off, a large number of the women that I take care of have thyroid dysfunction that's contributing to constipation. And if we go back to that control system, I have a lot of laminic pituitary adrenal thyroid canal, gut access, and they have a lot of perceived stress together with this borderline thyroid function that no mainstream medicine doctor has told her is a problem.
我认为这实际上是形态学。看，可能不太可能吸收足够的维生素B9、叶酸、维生素B12等。我也在回顾抗氧化剂谷胱甘肽，因为我认为这在解毒方面起着重要作用，我们还没讨论过。然后我在看一些矿物质。镁真的是最重要的，我们知道大约78%的美国人体内缺乏镁。这就好像是最容易解决的问题。比如，我会好奇，对于镁，如果这么多人体内缺乏，是否意味着这些人应该将他们的营养目标定向于含有镁的食物或者补充镁？如果是的话，应该选择哪种形式的镁？我们已经谈到了Mag 3和8对于睡眠的作用。有很多种形式。这可能会让人有点困惑。任何详细信息和信息来源都会得到赞赏。在测试方面，我更倾向于提到多过一个实验室和多过一个品牌。对于测试，我大量使用genova neutrophils。在疫情期间，他们开发了一种在家测试。通常情况下，进行neutrophil测试，你需要抽血，还要进行尿样检测。因此很多人无法做到。这个测试的好处是你的保险通常会支付大部分费用，所以自付只有大约150美元。在疫情期间，他们开发了另一种名为代谢组学的测试，它进行了许多相同的测试，但是是通过指纹进行的。因此，大部分我的患者更喜欢这种测试方法。事实上，他们已经不再使用neutrophil测试。第二个实验室是spectracell。我偶尔使用spectracell。我觉得它在融入我的实践上不太方便，但我有像马克·休斯顿这样的朋友和导师，他在精准心脏代谢健康方面做了很多工作。他认为spectracell是目前最好的测试。关于镁，你必须测量红细胞镁，如全血。至于缺乏，有意思的是补充。对于那些倾向于便秘的患者，实际上大约是我照顾的女性的80%。真的吗？是的，太惊人了。我很好奇为什么会这样。我猜测是饮食、压力、父权制度、愤怒。这是一种心理身体疾病所以系统。对，心理学、免疫学、神经和内分泌因素结合在一起。是的。我还想说还有另一个因素，女性本身就是一种健康危害。我们患抑郁症和失眠的比率是两倍。我们患多发性硬化症的风险是3至4倍增加。我们患甲状腺功能障碍的风险是5至8倍增加。因此，如果你仅仅看这一点，看看微小的临床前甲状腺功能障碍，我照顾的很多女性中，让我回头看看，我照顾的许多女性有参与便秘的甲状腺功能障碍。回顾控制系统，我有很多脑下垂体肾上腺甲状腺肠通路，她们有很多感知压力，再加上这种边缘甲状腺功能，没有一个主流医学医生告诉她这是个问题。
And then she's got a problem with the tango between estrogen and progesterone. She's going to tend toward constipation. Women have a lot more constipation than men. The gut is about 10 feet longer in women compared to men. We should talk about some sex and gender differences and define those. And they are much more likely to have a torturous colon. And the way you know that is you get a colonoscopy and they tell you, yeah, it's really hard to get in there and do what we need to do.
然后她的问题与雌激素和孕酮之间的相互作用有关。她可能会倾向于便秘。女性比男性更容易便秘。女性的肠道比男性长出约10英尺。我们应该谈一谈一些性别差异并加以定义。女性更有可能患有扭曲结肠。你可以通过进行结肠镜检查来了解这一点，医生会告诉你，是的，很难进入那里并做我们需要做的事情。
As a brief tangent, but I think this is the time to ask, what age now do physicians insist their female patients get colonoscopies? For men, I think the age used to be 50. Now it's getting ratcheted back to 45 or 40. Again, these are recommendations, not requirements, but they're pretty strong recommendations from depending on where you live, etc. For women, how early do you think they should get a colonoscopy to explore for possible polyps and or colon cancer? Yeah, it's a really good question. I don't know the answer. So what I've always operated with is 50. The way that I answer that is to go to the US preventive task force rating to determine based on their synthesis of the data, what age is the most appropriate? Has it changed? Is it just described from men from 50 to younger? I don't know. So we should backtrack that.
作为一个简短的话题，但我认为现在是问一问的时候了，医生现在坚持让女性患者做结肠镜检查的年龄是多大？对于男性，我记得这个年龄曾经是50岁。现在正逐渐提前到45或者40岁。再次提醒，这些只是建议，不是要求，但根据你所在的地方，这些建议还是相当强烈的。对于女性，你认为她们多大年龄应该做结肠镜检查以探测可能存在的息肉或结肠癌？是的，这是一个非常好的问题。我不知道答案。所以我一直按照50岁操作。我查看美国预防任务队力的评级来确定根据他们对数据的综合评估，哪个年龄是最合适的？有没有改变？只是从50岁的男性变为更年轻的年龄？我不知道。因此我们应该追溯这一点。
All these additional health hazards for women, you broadly mention psychological impact. And of course, these things are all related to psychology, immunology. And they're one of the, I think, wonderful things about neuroscience and science in general and medicine is that there's now an understanding that all the organs are connected to one another. It's a network. It's a network. And that the microbiome sits at a key node within that network. And I think most people accept that now. Yes. Yeah. That seems to be a theme that at least in the last 10 years is really wonderful because certainly for neuroscience, it was thought that unless it's in the cranial vault, it's not neural, which is ridiculous because there's lots of nervous system outside the skull.
所有这些额外的健康风险对于妇女来说，您广泛提到了心理影响。当然，所有这些事情都与心理学、免疫学相关。我认为神经科学和科学以及医学的一件了不起的事情是，现在人们已经意识到所有器官是相互连接的。它是一个网络。而微生物群坐落在这个网络中的一个关键节点。我认为现在大多数人都接受这一点。是的。是的。在过去的10年中，这似乎是一个主题，这真的很棒，因为肯定对于神经科学来说，人们认为除非存在于颅骨内，否则不是神经，这是荒谬的，因为颅骨外有很多神经系统。
But in any case, for a second, yes, please. So I think you're right that there's an understanding about the network effect. But I think that as much as I love mainstream medicine and I trained in it and I'm so grateful for my education, I still think it is a silo-based way of taking care of patients. So even if there's an understanding of the network effect more at the science level or as you described in neuroscience, there's still, you know, if you are a woman who has constipation, fatigue, maybe an autoimmune condition, feel stressed out all the time, feel like your hormones are out of whack, you get sent to the gastroenterologist for the constipation, you get sent to the rheumatologist for your autoimmune issues, you maybe get sent to an endocrinologist if you've got thyroid problems. And there's very little collaboration between these groups. So even though there's an understanding of the network effect in real life, it's not happening.
但无论如何，再说一遍，是的，请。我认为你说得对，人们对网络效应有所了解。但我觉得，尽管我热爱主流医学，接受过相关训练并感激获得的教育，我仍认为这种方式是一种以孤立的方式照顾患者。所以即使在科学层面或者你所描述的神经科学中更了解了网络效应，但如果你是一个有便秘、疲劳、可能有自身免疫疾病的女性，总是感到压力巨大，感觉激素失调，你会被送去看消化科医生解决便秘问题，被送到风湿科医生那里处理自身免疫问题，如果有甲状腺问题可能会被送到内分泌科。这些医生之间几乎没有什么协作。所以即使在现实生活中有对网络效应的认识，但真正协作的情况并不多见。
Let's go deeper down that path because you point out something really important and you've mentioned constipation a few times. Can we view constipation as a serious enough symptom that it warrants an immediate intervention? That is, does it flag or signal problems that are severe enough that that should be the issue that's dealt with for anybody that's experiencing it? And I mean, sort of an odd topic for many people because they think, oh, you know, bowel movements and sort of, you know, there's that kind of pre-adolescent humor around this. But I think it's so important. What I'm hearing you say is that constipation is far more common in women and it signals a general set of many problems occurring. Does that mean that women should address constipation? And if so, what's the best way to address constipation? Yeah, I love this question because you're doing, can we have a quick little meta conversation? So you're doing something that I knew you would do, which is you're teaching me something and you're changing like there's a social genomics thing happening where you're changing my thought about this. So I just wanted to acknowledge that. Thank you.
让我们深入探讨这个问题，因为你指出了一些非常重要的东西，而且你几次提到了便秘。我们能把便秘视为一个严重到需要立即干预的症状吗？也就是说，它是否暗示着严重到任何人都应该处理的问题？我是说，这对很多人来说可能是个奇怪的话题，因为他们认为，便秘和排便之类的事情有点像是幼稚的幽默。但我认为这非常重要。我听到你说的是，便秘在女性中更为常见，而且它暗示着许多问题的普遍发生。这是否意味着女性应该解决便秘问题？如果是，那么解决便秘的最佳方法是什么？是的，我喜欢这个问题，因为你在做一些事情，我们能稍微有一个元对话吗？所以你正在做一些我知道你会做的事情，你正在教我一些东西，并且你正在改变我的想法。在这里发生了一些社会基因组学的事情。所以我想要承认一下。谢谢。
Well, I think for me, you know, when I hear that there's a kind of, you know, you're talking about a phenotype, constipation is a phenotype. It's one that people generally don't wear a t-shirt explaining it to people, but that I'm guessing anything to do with sexual health, bowel health, urology, people just don't talk about. Right. For all sorts of reasons. And those reasons are probably so obvious that they're not even worth discussing. But also because we won't change them except by talking about them. Yeah. So if you say, um, women are far more constipated and that's signaling a larger set of problems, yes, then my immediate thought is, well, we're leaving constipation pun, uh, intended retroactively. Um, will that assist in a great number of issues and or will it get them down the road of thinking about those other issues more specifically? Like, do I need more magnesium or should I be putting vegetables in my smoothie?
我认为，当我听到这种说法时，你知道，你在谈论一种现象，便秘就是一种现象。这是一种人们通常不会穿着T恤向他人解释的现象，但我猜与性健康、肠道健康、泌尿学有关的任何事情，人们都不会谈论。对各种原因。这些原因可能是如此明显，以至于不值得讨论。但也因为我们只有通过讨论才能改变它们。所以如果你说，嗯，女性更容易便秘，这暗示着一系列更大的问题，是的，那么我的第一个想法是，我们正让便秘成为过时的笑话。那会帮助解决很多问题吗？还是会使他们更具体地考虑其他问题？比如，我需要多补充镁元素，还是应该在我的冰沙中添加更多蔬菜？
You know, so I'm curious about constipation as a target. Yeah. For intervention that then opens up a bunch of other discussions because there are these certain nodes in the, in the mental health, physical health space that when someone, you know, like we talk a lot of deliberate cold exposure, do I think it's magic? No, but I think that if someone's getting themselves into a cold shower once a day, it opens up a number of questions about themselves and reveals a number of things to themselves. I'm like, how do I buffer stress? Yeah. What sorts of levels of control do I actually have and on and on? So perhaps not the best example, but, um, some of us hate cold exposure.
你知道，我对便秘作为一个目标很感兴趣。是的。通过干预这一点，就会引发许多其他讨论，因为在心理健康、身体健康领域中有一些特定的节点，当有人参与其中时，我们会谈论到故意接受冷暴露，我认为这是一种魔法吗？不，但我认为如果有人每天冷水淋浴一次，就会对自己提出很多问题，并揭示出很多事情。比如，我如何缓解压力？我实际上有哪些控制级别等等？也许这不是最好的例子，但有些人讨厌冷暴露。
Right. Which is we have, we have like a gene that makes us stress out, like you wouldn't believe which which I would argue makes it very likely that even 10 seconds of cold exposure gets you the effect that you want as opposed to someone who adores cold exposure like a penguin needs a lot more cold exposure for it to have the adaptive response. Anyway, that's my way of gum being through that. Quite you're, you're quite correct. So, so let's answer this question. So the constipation issue. Yeah. So this is how you're changing the way I think about this. So you're asking, okay, instead of looking at constipation as a constellation of symptoms, what about if you just used it on its own as sort of a, um, a key indicator or signal of dysfunction with my network or maybe something broader? And I think that's right. So it makes me think of a few things. It makes me, you're also changing this book that I'm writing on autoimmunity and trauma. So thank you for that. So, women experience more trauma than men. This is well established. If you look at the ACE studies that were done by the CDC and Kaiser in 1998, we know that men for the most part, middle-aged men, have about, um, about 50% of them experience significant trauma as defined by the ACE questionnaire.
没错。我们有一种基因让我们感到压力，简直让你无法想象，我认为这样很可能使得即使只有10秒的寒冷暴露也会产生你想要的效果，而与之相反，喜欢寒冷暴露像企鹅那样的人需要更多的寒冷暴露才能产生适应性反应。总之，这是我的一种认识方式。你说得对。所以，让我们来回答这个问题。关于便秘问题。是的。这就是你改变了我对这个问题的看法。你问，好吧，不要把便秘看作症状的综合，如果你把它单独使用作为我的网络功能失调或更广泛的信号指标，会怎么样？我认为这是正确的。这让我想到了几件事情。这也让我改变了我正在写的有关自身免疫和创伤的书。感谢你。女性比男性更容易经历创伤，这已经被证实。如果你看看CDC和凯撒公司在1998年进行的ACE研究，我们知道，大多数中年男性，大约有50%的人根据ACE问卷的定义经历过重大创伤。
Women are at 60%. And that's pretty durable since 1998. So women have more. They have different forms of abuse, much more likely to have sexual abuse. They have a different HPA response than men. Their perceived stress tends to be higher. And I'm generalizing for a population. Side note, you know, in precision medicine, we don't do that. We do medicine for the individual, not the population, not medicine for the average. And so if you look at the physiology of a female, I think that, um, constipation and that need to like control and restrain and hold things in, you know, tighten the anal sphincter. I think that's part of the physiology. So I'm veering away from the science, but I do think that it is a really important signal to pay a lot of attention to. Now you also asked about microbiome testing. Should we do that or do you?
女性占比60％。自1998年以来这种比例相当持久。所以女性拥有更多。她们受到不同形式的虐待，更有可能受到性虐待。她们的HPA反应与男性不同。她们的感知压力往往更高。我这里是对整个人群进行概括。顺便提一下，在精准医学中，我们不这样做。我们为个体进行医疗，而不是为整体人群或者平均水平进行医疗。所以如果看看女性的生理学，我认为，便秘和控制、克制、保持事物的需求，你知道，收紧肛门括约肌。我认为这是生理学的一部分。虽然我偏离了科学，但我确实认为这是一个非常重要的信号，需要引起大家的高度关注。现在你也问到了微生物组测试。我们应该做吗，或者你做呢？
Yeah. Well, I have one, I have a couple more questions about constipation. I never thought I'd ask this many questions about constipation, but now I'm fascinated. By the way, also this morning, I taught medical students at Stanford about the fact that we are basically a series of tubes. So that you talked about the anal sphincter. We are a set of sphincters from one end to the other. I mean, we are a set of tubes, a nervous system being one of those tubes. And, and I think in Eastern medicine, they talk about the various locks between those tubes and chambers.
是的。嗯，我有一个问题，还有几个关于便秘的问题。我从没想过我会问这么多关于便秘的问题，但现在我很着迷。顺便说一句，今天早上，我在斯坦福教授医学生们关于我们基本上是一系列管道的事实。所以你提到了肛门括约肌。我们是从一端到另一端的一组括约肌。我的意思是，我们是一组管道，神经系统是这些管道之一。而且，我认为在东方医学中，他们谈论穿过这些管道和腔室之间的各种锁。
And it's not without coincidence. There's some real wisdom there, of course. Wait, did you just talk about energetic anatomy? More or less. I didn't say the word chakra, but I might in passing the bond us right are the are the are the the the the sphincters. Yes, that's right. Thank you for that. The, so what defines constipation? I mean, in other words, let's let's think about the healthy rather than think about the unhealthy, let's how many bowel movements should a woman or a man have per day, assuming this is where it gets tricky, because some people are doing time restricted feeding, some people are eating more, some people are eating more fiber, more bulk, larger meal at the end of the day, a large meal at the beginning of the day, we will never be able to sort out all those variables.
这并非巧合。当然那里有一些真正的智慧。等等，你刚刚在谈论能量解剖学吗？多多少少是的。我没说到脉轮这个词，但可以顺便提一下，将我们联系在一起的是括约肌。是的，没错。谢谢你提到。那么，什么定义了便秘呢？我是说，换句话说，让我们考虑健康而不是疾病，一个女人或一个男人每天应该有多少次排便？假设这就是问题所在，因为有些人正在进行时间限制饮食，有些人在吃更多食物，有些人在摄入更多纤维，更多体积，一些人在一天的最后吃大餐，另一些人在一天的开始吃大餐，我们永远无法弄清所有这些变量。
But on average, how many bowel movements and is timing during the day for bowel movements at all informative? What works for you? Well, when I'm asleep, generally, I don't want a bowel movement. So I'm going to be like, most people, right? Well, sleep is primary for you. Right, exactly. I'm I always assumed that morning time was a was a healthy time for bowel movements. And I think almost everybody babies included recognize the feeling of being lighter and more energetic when they've evacuated to colon. Totally, totally. In fact, so much so that I'm obsessed with Jungian and Freudian psychology that the first thing we learn when we come into this world, right, is that we want something we we feel some sort of autonomic arousal stress, whether not it's food or warmth, or the need to have a bowel movement.
但是平均而言，一天有多少次大便和排便时间是否有信息意义呢？对你来说什么有效呢？嗯，当我睡觉时，一般来说，我不想排便。那么我应该和大多数人一样，对吧？嗯，睡眠对你来说很重要。对，确实是这样。我一直以为早上是排便的健康时间，我想几乎所有人，包括婴儿，在排便后都会感觉更轻盈和更有活力。完全对，事实上，我对荣格和弗洛伊德的心理学深感着迷，我们来到这个世界时学会的第一件事就是我们想要某种自主性激发压力，无论是食物、温暖还是排便的需求。
And one of the first things that parents learn is how to recognize that not by the odor coming from the diaper, but by the look on the baby's face or their agitation, agitation signals the need for some sort of relief, right, temperature relief, food relief, evacuating the bowel relief. So my understanding is that as autonomic arousal increases in the early part of the day, ideally after a good night's sleep, that bowel movements become more likely unless that arousal becomes so great that then people feel so quote unquote locked up, right, because of the balance of the autonomic features.
父母第一次学会的事情之一就是如何辨认宝宝的需要，不是通过尿布散发的气味，而是通过宝宝的表情或不安来判断。不安信号表明需要某种缓解，可能是温度、食物或排便。我的理解是，随着一天早期交感兴奋增加，尤其是经过一晚睡眠后，排便变得更有可能，除非这种兴奋变得如此强烈，导致人们感到如同被“禁锢”一样，这是因为交感神经特征的平衡问题。
So early day, I'm guessing, and again, in the second half of the day, and here I'm totally guessing, and certainly not having to wake in the middle of the night. Yeah, those are my best guesses. That's great. So I would agree with that. When I was at Harvard Medical School in UCSF for residency, I was taught that constipation is having a bowel movement less frequently than one every once every three days. So I don't think I've ever laughed out loud on this podcast as a consequence of textbook medical knowledge. Are you kidding me? Is that ridiculous?
在一天的早些时候，我猜测，再次在一天的后半段，我完全是在猜测，肯定不会在半夜醒来。是的，这些是我最好的猜测。太棒了。所以我同意这一点。当我在哈佛医学院和UCSF进行住院医生培训时，我被告知便秘是指排便的频率少于每三天一次。所以我想我从来没有因为传统医学知识在播客中大笑过。你开玩笑吧？这太荒谬了。
Well, that sounds like, and here pun intended, that sounds like the the conclusion of some very emotionally and in other ways constipated individuals. And again, this might seem like an odd conversation, but the discussion around constipation is present in psychological literature. Yes. Because of this relationship to the autonomic system. Well, it's a metaphor in literature. It's crucial. So you you spoke to a number of different threads that I think are important here. So that's the definition that I learned. And I was I heard that and I was like, hell no, that doesn't work for me. It doesn't work for anyone I know.
嗯，听起来，打趣地说，这听起来像是一些非常情感上以及其他方面受阻的个体们的结论。而且，这可能看起来像是一次奇怪的对话，但是关于便秘的讨论在心理学文献中是存在的。是的，因为它与自主神经系统有关。在文学中，这是一个隐喻。这是至关重要的。所以你提到了我认为这里很重要的几个方面。这就是我学到的定义。当我听到这个定义时，我感到不对劲，这对我来说行不通，对我认识的任何人都行不通。
And I spent a lot of time, especially in medical school and in my internship where you rotate on medicine, disempacting women, like older women who come in who have an ad about movement in a month. Whoa. And that let me tell you that is not nice for anybody. Believe me, I became a scientist and a physician for a number of reasons. Both positive and negative. That's one of them. Yeah. So my definition of constipation as a Western, mostly white girl, is that if you're not having a bowel movement every single morning and you have a feeling of complete evacuation, anything less than that is constipation.
我花了很多时间，尤其是在医学院和实习期间，轮转在医务科上，接触到许多妇女，比如那些年长的妇女来看病，一个月中几乎没有排便。哇。相信我，这对任何人来说都不好。我选择成为科学家和医生有很多原因，其中之一是这个经历。是的。作为一个西方人，大多是白人女孩，我对便秘的定义是，如果你每天早晨没有排便，且感到完全排空的感觉，任何低于这个标准的情况都是便秘。
So that's how I define it. If you're in India and you're eating food that's got a fair amount of microbes in it, it's less, you know, sanitary, I'm using that word as carefully as I can. Generally, they have a bowel movement after every meal. But they've got a different microbiome. They're exposed to different microbes. Here in the US, I would say once a day. You also spoke to something very important, which is the balance between the parasympathetic nervous system, rest and digest and poop versus the sympathetic nervous system, kind of the on button, you know, fight, fight, freeze, on. So I think for those of us who've got issues with autonomic balance, it can lead to constipation. And I like that constipation could be pulled out and kind of writ larger as an important signal. What sorts of tools do you recommend people use to relieve constipation in eating more fiber? Sounds like reducing stress is going to be a huge one. Yes. What are your favorite stress reduction tools? I like to divide these into real-time tools. So big proponent of like physiological sign, real-time, you know, these sorts of things. But things that can really lower the baseline on stress overall to facilitate constipation and other broad indicators of health.
这就是我的定义。如果你在印度，吃的食物里含有相当多的微生物，它就不那么，你知道，卫生，我用这个词很谨慎。一般来说，他们每顿饭后都会有一次大便。但他们有不同的微生物群。他们接触到不同的微生物。在美国，我会说是每天一次。你还谈到了一件非常重要的事情，那就是副交感神经系统与交感神经系统之间的平衡，休息和消化以及排便与战斗，或者说激活的开关。所以我觉得对于那些自主神经平衡有问题的人来说，可能会导致便秘。而且我喜欢便秘可以被看作是一个重要的信号。你推荐人们采取什么样的方法来缓解便秘？是更多地摄入纤维吗？听起来减轻压力会起到很大的作用。对，你最喜欢的减压工具是什么？我喜欢把它们分为实时工具。我非常赞成像生理标志、实时的这些东西。但是低于整体压力基线的那些东西，可以促进便秘以及其他广泛的健康指标。
So I'm not a fan of lowering stress. I'm a fan of lowering perceived stress. And I think the distinction is really important. I learned when I was in my 30s that I was a massive stress case and I didn't know it. It was just sort of, I think I threw residency through working under 20 hours a week. I just was so accustomed and sort of. That was 120. Not under 20 folks. Yeah. Not unusual in medicine. Well, they've changed training so that you work no more than 80 hours a week now, but that was before my time. So I became accustomed to a massive amount of cortisol, massive. And I would say I've spent the past 20 years really working on perceived stress to find, I think all of us need an all-acart menu of what is most effective. So what works for me now at my age is different than, you know, the, the TM I did as a college student, transcendental meditation. It's different than the, I became a certified yoga teacher when I was in my 30s. That is very effective for a lot of people. It wasn't enough for my matrix.
所以我不是降低压力的粉丝。我是降低感知压力的粉丝。我认为这个区别非常重要。我在30多岁的时候意识到自己是一个非常压力大的人，而我之前并不知道。那时我工作超过20小时一周，我已经习惯了。在医学方面这并不罕见。虽然如今培训已经改变，每周工作时间不超过80小时，但那是在我之前。我适应了大量的皮质醇，非常大量。我会说，过去20年我一直在努力降低感知压力，我认为所有人都需要一种最有效的方法。现在对我的年龄来说，适合我的方法与我上大学时做的那个传统冥想、我30多岁时成为的瑜伽教练是不同的。那对很多人来说非常有效，但对我来说还不够。
I do holotropic breath work. I didn't read it, but I saw that she just had a paper and sell on your sign. And it kind of, it made me think like, teach me how to sigh, teach, teach me how to sigh. Like, can you say a little bit about that? Like, how do you do it? Yeah, very briefly that study was we wanted to find a minimal effective dose intervention. Yeah, five minutes. So I just wanted, yeah, five minutes a day, we need to figure out what people do every day. Yeah. And we were monitoring subjective mood, etc, but also biometrics remotely. So it's kind of a nice, biometrics, HRV, HRV, nighttime sleep, cortisol, I wish. So this was done during the pandemic. More than 100 subjects. The advantage was that we got data 24 hours a day because they're pinging us in their data, wearing a 24. Yeah. Nice. So that was nice, resting heart rate, subjective mood, we would get in touch with them daily. So when people were swapped between groups like any good study, but five minutes a day of sort of standard, if you will, forgive me, meditations are just sitting, no instructions about how to breathe, just focusing on closing their eyes and focusing on focusing.
我做全息呼吸工作。我没有读过它，但我看到她只是拿着一张纸，在你的牌子上卖。这让我想，教我如何叹息，教，教我如何叹息。你能稍微说说吗？你是怎么做的？是的，很简单，那项研究是我们想找到最小有效剂量的干预措施。是的，五分钟。所以我只想，是的，每天五分钟，我们需要弄清楚人们每天做什么。是的。我们一直在远程监测主观心情等，但也监测生物测量指标。这种生物测量指标，HRV，夜间睡眠，皮质醇，我希望。这是在疫情期间进行的。超过100名受试者。优势是我们每天得到数据，因为他们在他们的数据中给我们发出信号，佩戴着24小时。是的。很好。所以那很好，休息心率，主观心情，我们会每天跟他们联系。所以当人们在不同组之间交换时，像任何好的研究一样，但是每天五分钟的标准，如果可以的话，请原谅我，冥想或者只是坐着，没有关于如何呼吸的指导，只是专注于闭上眼睛，专注于专注。
Yeah. Another group did box breathing. Yeah, inhale, hold, exhale, hold for equal durations. The duration of each of those inhales and holds was set by their carbon dioxide tolerance. So somewhere between three and eight seconds, depending on how well they regulate carbon dioxide. Another group did cyclic signs. So this would be double inhale through the nose. So big inhale through the nose, followed by it to lungs empty exhale. That second inhale after the first big lung inhale through the nose is really important because it makes sure that all the collapsed, abioli lungs, snap open, and then the exhale, you offload a lot of carbon dioxide. That's very similar to holotropic breath work. Not yes, not unlike holotropic breath work, a little bit pranayama-ish, but the exhale is rather passive as opposed to active. And then the fourth category was cyclic hyperventilation, which is a lot like Tummo, AK Wim Hof-ish breathing, different than Wim Hof breathing.
是的。另一组进行了盒式呼吸。是的，吸气、屏气、呼气、屏气，持续时间相等。每次吸气和屏气的持续时间取决于他们的二氧化碳耐受能力。所以大约在三到八秒之间，取决于他们对二氧化碳的调节能力。另一组进行了循环呼吸。所以这是通过鼻子进行双倍吸气。通过鼻子进行大吸气，然后呼出空气至肺部清空。在第一个大吸气后的第二次吸气非常重要，因为它确保所有崩溃的肺泡被打开，然后呼气，排出大量的二氧化碳。这与整体呼吸工作非常相似。不完全像整体呼吸工作，有点像调息术，但呼气相对 passsive 而不是主动。第四类是循环过度呼吸，这很像托摩，即 Wim Hof 的呼吸，与 Wim Hof 的呼吸有所不同。
So this would be so very active inhales and exhales. Every 25 cycles of inhale exhale, that would be one cycle. Long exhale, hold lungs empty 15 to 30 seconds, then repeat for about five minutes. And everyone did that for five minutes. And what we found was that the cyclic sign led to the greatest improvements in mood around the clock, not just around the practice or during the practice, as well as lowered resting heart rate, improvements in sleep, etc. And you got to publish themselves. So amazing. Yeah, we were very fortunate. I think that thankfully the reviewers and editors understood that these minimal intervention things hopefully are going to be of use to people. So useful to people. I mean, how often do you read a paper like that that could offer a behavior change that is so easy to implement? I mean, I love that question. Thank you.
所以这将是非常活跃的吸气和呼气。每次吸气呼气25次，那就是一个循环。长呼气，让肺部保持空气空15到30秒，然后重复约五分钟。每个人都这样做了五分钟。我们发现循环呼吸法在整天的情绪改善方面效果最好，不仅仅在练习期间或者练习期间，还有降低静息心率、改善睡眠等方面。你们发表了这项研究结果。太不可思议了。是啊，我们非常幸运。我想幸好审阅者和编辑们理解这些微小干预的重要性，希望它们对人们有所帮助。对人们来说是如此有用。我的意思是，你有多久没读到一篇像这样的论文，可以提供如此易于实施的行为改变呢？我喜欢这个问题。谢谢。
So what about did you tell them not to drink because alcohol has such a huge effect on HIV? Yeah. So in this case, we didn't tell them to alter anything else about their behavior. Just hoping it was background kind of across the same all of our groups. Yes. And some were Stanford students, others were from the general population. Any frat boys that were drinking heavily? Probably not. Well, during the pandemic, I think alcohol intake went way up across the board. I mean, it's enough. I had a magic wand. I would ask that people either not drink or drink two drinks per week maximum. At least that's my understanding of the literature. Are you familiar with the Woop data with alcohol? No, but we have a collaboration with Woop through that paper. And it certainly disrupts patterns of nighttime sleep. In particular, from my understanding, that first phase of sleep that's related to the massive growth hormone release that you all really need and want in their first time. And you didn't measure growth hormone? We did not. No, the second iteration of the study will certainly include free cortisol by saliva, hormone panels.
所以你有告诉他们不要喝酒，因为酒精对HIV有很大影响吗？是的。在这种情况下，我们并没有告诉他们改变其他任何行为。只是希望这是我们所有小组都带有的背景。是的。有些是斯坦福大学的学生，其他的来自一般人群。有没有酒量很大的兄弟会男孩？可能没有。嗯，在疫情期间，我认为整体来说饮酒量都大幅上升了。我是说，如果我有魔法棒的话，我会希望人们要么不喝酒，要么一周最多两杯。至少这是我对文献的理解。你了解关于酒精的Woop数据吗？不，但我们通过那篇论文与Woop有合作。它肯定会打乱夜间睡眠模式。特别是在我了解到的情况下，那种与大量生长激素释放相关的第一阶段的睡眠。你们没有测量生长激素吗？我们没有。不，第二次研究肯定会包括通过唾液检测的游离皮质醇，激素面板。
Well, I'm beginning to think that we should also be asking people how often they're going to the bathroom and what time of day? Yes. I mean, this thing around constipation is super interesting. And I think that plus blood markers, and then I'm very excited to learn that urine contains additional markers that could be informative. So yeah, it was a fun study, not easy study to do with that number of subjects. Tastes a lot of training for your research assistants. Yeah, it was a big group. It was nine people in our group and three clinicians and a lot of phone calls and a lot of back and forth. And thank you to the subjects who served as the real-life guinea pigs. So yeah, I think that stress, you know, people's, I think people are starting to appreciate that there are ways that they can relieve their stress that don't all only fall under the categories of vacation and meditation.
嗯，我开始觉得我们也应该问问人们他们多久上一次厕所，什么时间呢？是的。我是说，便秘这个问题非常有趣。我觉得加上血液标志物，还有我很兴奋的发现尿液中含有其他可以提供信息的标志物。所以，这是一个有趣的研究，但对于那么多被试而言并不容易。需要为你的研究助手做大量的培训。是的，这是一个庞大的团队。我们组里有九个人，还有三位临床医生，还有大量的电话和往返溝通。感谢那些当真实的“试验品”的受试者。所以，我认为压力，你知道的，人们开始意识到除了度假和冥想之外，还有其他方法可以缓解他们的压力。
But I want to say that meditation is obviously a wonderful tool. It's just it's a tool, not unlike any other tool that is great for some people and less great for others. Well, certainly it's a great tool and it's got such a scientific basis behind it. But there's so many things on this all-acart menu, sex, orgasm, connection, feeling heard and seen and loved. Yeah, let's talk about that. You mentioned earlier that all these stress factors, you said patriarchy, right? But I think what if I may, at risk of just strengthening that statement, I mean, that to me is signaling a bunch of other factors around as you said, like keeping things in. What do you think explains? Let's talk about that because I think that's likely to have raised a certain flag in people's minds.
但是我想说，冥想显然是一个很棒的工具。它只是一个工具，与其他一些适合一些人而不适合其他人的工具并无二致。当然，它是一个很棒的工具，有着科学依据支持。但在这个全能菜单中，还有很多其他东西，比如性、高潮、连接、感觉被倾听、被看到和被爱。是的，让我们谈谈这个。你之前提到了所有这些压力因素，你说的是父权社会，对吧？但我认为，冒一下风险，加强这个说法，我觉得这向我暗示了其他一些因素，就像你说的，不敢发表意见。你认为是什么原因解释了这种现象？让我们谈谈这个，因为我认为这可能引起了人们的某种担忧。
Like, what exactly is she talking about? Are you talking about less opportunity? Are you talking about less opportunity to vocalize? Are you talking about less opportunity to vocalize and be heard? I mean, I realize that there are an infinite number of variables, but given that, it sounds like a really strong input to the system. What I mean by that is that psychology is influencing biology and you're saying that these power dynamics, structures and dynamics are impacting it. I love, let's hear your thoughts on that because I hate to let a flag like that go by without flushing it out. Never waste a good flag. Well, and let's preface it by just saying that people will have different opinions on this and I think that's healthy and like with the discussion about constipation, let's talk about what people aren't willing to talk about when it comes to health. Love it.
她到底在说什么呢？你是在谈论更少的机会吗？你是在谈论更少的机会来表达自己吗？你是在说更少的机会来表达自己并被倾听吗？我的意思是，我意识到有无尽的因素，但鉴于这一点，这听起来像是对系统的一个非常强有力的输入。我的意思是心理学正在影响生物学，你在说这些权力动态、结构和力量正在影响它。我很喜欢，让我们听听你对此的想法，因为我不希望错过这样的一个提示而不加以探讨。永远不要浪费一个好的提示。嗯，让我们先说，人们对此会有不同的意见，我认为这是健康的，就像关于便秘的讨论一样，让我们谈谈当涉及健康时人们不愿意谈论的事情。太棒了。
So we might need to talk about patriarchy on part two, but I'll give you some material that I've been working with. I started, I did not even understand the existence of patriarchy until I was a bioengineering undergraduate at MIT, I should mention, which has always had a bit of a of a male, askewed male in terms of faculty numbers. Well, my, my, that's true at most universities. True. Well, my postdoc advisor was the late Ben Barris who was a female to male transition transgender, first transgender member of the National Academy of Sciences where my closest friends, unfortunately, he died of pancreatic cancer. We were very, very close. They're actually making a documentary about Ben, but Ben, this is interesting, Ben went to MIT because he wanted to be around a lot of men.
所以我们可能需要在第二部分谈论父权制，但我会给你一些我一直在研究的材料。我刚开始的时候甚至不了解父权制的存在，直到我在麻省理工学院读生物工程专业时。我必须提一下，这个学校在教职人员方面一直有点男性偏多。好吧，大多数大学都是如此。我博士后的导师是已故的本·巴里斯，他是一个女性向男性过渡的跨性别者，他是国家科学院首位跨性别成员。他是我最亲密的朋友，不幸的是，他去世了，因为胰腺癌。我们非常亲密。他们实际上正在制作一部关于本的纪录片，但有趣的是，本之所以去了麻省理工学院，是因为他想身边有很多男人。
Yeah. That's a lesser known fact. But then he was a very strong advocate for women. He went as Barbara when he was Barbara. And by the way, he's given me permission to share all this prior to his death. I recorded a lot of conversations. Yeah. I only ever knew him as Ben, by the way, but when he was at MIT, he was identified female and he later talked about the intense um, suppression, oppression, literally is how he described it, especially given that he was performing so well. Yes. So you just defined patriarchy. You did it yourself. A couple things. When I was in bioengineering, I took a women's studies class and it was all about teaching undergraduates about the existence of patriarchy, which I would define maybe at its simplest as power over. I'm not saying men are patriarchy. I'm saying something very different, which is power over.
是的。这是一个较少人知道的事实。但他是女权主义者的坚定支持者。当他是芭芭拉时，他就是一个很坚定的支持者。顺便说一句，他已经允许我在他去世之前分享所有这些。我记录了很多谈话。是的。顺便说一下，我只知道他是本（Ben），但当他在麻省理工学院时，他被认定为女性，后来谈到了他所描述的强烈的压抑、压迫，尤其是考虑到他表现得如此出色。是的。你刚刚定义了父权制。你自己做到了。有几点。当我在生物工程专业时，我上了一门妇女研究课程，这门课程是为了教育本科生关于父权制的存在，我可能会简单地将其定义为权力支配。我并不是说男性是父权制。我想表达的是非常不同的意思，就是权力支配。
Let me correct one thing that she said. I didn't go to MIT as an undergraduate. So I'm from, I was in Alaska and I went to the University of Washington for bioengineering. In Seattle. In Seattle. Okay. I dropped out of a graduate program in bioengineering to go to the Harvard MIT program for health sciences and technology in Boston. Thanks for that clarification. University of Washington also wonderful place. I have many, many, many, many wonderful close colleagues there. It's an incredible place, especially for vision science. It's especially good for engineering, bioengineering, but um, yeah.
让我纠正她说的一件事。我并非本科毕业于麻省理工学院。我来自阿拉斯加，曾在西雅图的华盛顿大学攻读生物工程。在西雅图。在西雅图。好的。我放弃了生物工程的研究生课程，去了波士顿的哈佛麻省理工医学与技术项目。谢谢澄清。华盛顿大学也是一个很不错的地方。我在那里有许多非常好的同事。那是一个令人难以置信的地方，尤其在视觉科学方面。它对工程学、生物工程尤其是很好，但是，是的。
So my, my MD is jointly between MIT and Harvard and it's the oldest, maybe largest, although Harvard says this a lot, program for biomedical engineers and MD PhDs physician scientist training program. Great. Thanks for that clarification. I'm going to blame the internet for this one. I am. I think we need to send our Wikipedia editors out. I think LinkedIn is correct. Okay. Great. Well, Wikipedia editors note, get out there and make the correction. Now you heard it. So stress that is what you're really talking about is systemic stress in the body as a conscious, as a consequence, excuse me, a systemic stress of environment. That's right. But there's, you know, there's particular forms of it. I would say this also relates to white privilege. It relates to racism.
我的博士学位是麻省理工学院和哈佛大学联合举办的，这是最古老、可能也是规模最大的生物医学工程师和博士医学科学家培训项目，虽然哈佛经常这样说。感谢你的澄清。我要怪罪互联网。我认为我们需要派出维基百科编辑去查证。我认为LinkedIn是正确的。好的。维基百科编辑们，请注意，去修改一下。现在你听到了。所以压力，你真正谈论的是身体内的系统性压力，作为环境的后果。是的。但有特定形式的压力。我要说，这也涉及到白人特权。它涉及到种族主义。
And when you look at, you know, kind of the way that systems, including my beloved MIT, the way that they're set up is that might make, makes right. And generally the people that are the strongest, you know, big men, strong men, they're the ones who tend to be the most successful. So for people who are BIPOC, for people who don't have white privilege, for women, it's a different experience. And so I'm using patriarchy as kind of a umbrella here, but it connects to many other things. I'd like to take a brief break and thank our sponsor Inside Tracker. Inside Tracker is a personalized nutrition platform that analyzes data from your blood and DNA to help you better understand your body and help you reach your health goals. I've long been a believer in getting regular blood work done for the simple reason that many of the factors that impact your immediate and long term health can only be analyzed from a quality blood test.
当你看到系统的运作方式，包括我心爱的麻省理工学院在内，它们通常是强者为尊。一般来说，最强壮的人，像大男人、强壮的男人，往往是最成功的人。因此，对于有色人种、没有白人特权、女性来说，体验是不同的。所以我在这里使用父权制作为一个总称，但它与许多其他事物有关。我想暂时休息一下，感谢我们的赞助商Inside Tracker。Inside Tracker是一个个性化营养平台，通过分析你的血液和DNA数据，帮助你更好地了解你的身体，实现健康目标。我一直支持定期检查血液的原因很简单，许多影响你即时和长期健康的因素只能通过质量血液检测来分析。
The problem with a lot of blood and DNA tests out there, however, is that you get data back about metabolic factors, lipids and hormones and so forth. But you don't know what to do with those data. Inside Tracker solves that problem and makes it very easy for you to understand what sorts of nutritional, behavioral, maybe even supplementation-based interventions you might want to take on in order to adjust the numbers of those metabolic factors, hormones, lipids and other things that impact your immediate and long term health to bring those numbers into the ranges that are appropriate and indeed optimal for you. If you'd like to try Inside Tracker, you can visit inside tracker.com slash Huberman and get 20% off any of Inside Tracker's plans. That's inside tracker.com Huberman to get 20% off.
然而，目前许多血液和DNA测试的问题在于，你会收到有关代谢因子、脂质和激素等数据。但你不知道如何处理这些数据。Inside Tracker解决了这个问题，让你很容易理解你可能需要采取的营养、行为甚至补充干预措施，以调整那些影响你即时和长期健康的代谢因子、激素、脂质和其他因素的数据，使这些数字达到适当甚至最佳的范围。如果你想尝试Inside Tracker，你可以访问inside tracker.com/Huberman，并享受Inside Tracker任何计划的8折优惠。就是inside tracker.com Huberman，可以享受8折优惠。
I want to use this as an opportunity to A. Keep this in mind as we turn to a question that I didn't close the hatch on earlier and it's my fault, which is I'm now clear on the fact that a woman in her late teens, early 20s ought to know something about her testosterone estrogen thyroid cortisol levels should start at least thinking about her microbiome should be thinking about how many bowel movements and the timing of those bowel movements per day, really. I'm assuming that what I just described is also true for women in their 20s, 30s, 40s, 50s on up to hundreds. Is that correct? That's correct, but I would say that there are differential opportunities by decade. So I'm glad she circled it back to teenagers and testosterone, because I think if you know, for instance, in your teenage years that you have high androgens and that you've got this potential phenotype way into the future that you may not even notice. I mean, maybe you noticed you've got a few extra hairs on your chin or something. If you know that your testosterone is elevated or some other antigen, it might change the arc of how you take care of yourself.
我想利用这个机会，首先，我们需要记住，我之前没有及时谈及的一个问题，这是我的错，我现在清楚地知道，一个处于晚青少年或早20岁的女性应该了解一些关于她的睾酮、雌激素、甲状腺素和皮质醇水平的知识，并开始至少考虑一下自己的微生物组。需要考虑的是每天排便次数和排便的时间，真的。我推测我刚刚描述的情况对20岁、30岁、40岁、50岁及以上的女性也是适用的。对吗？这是正确的，但我要说每个年代有不同的机会。所以我很高兴她把话题带回到了青少年和睾酮方面，因为我认为，比如，在青少年时期，如果你知道自己的雄激素水平很高，以及将来可能会产生的潜在表型，那么你甚至可能都没有注意到。也许你注意到你下巴上多长了几根额外的毛发之类的细节。如果你知道你的睾酮或其他抗原水平升高了，这可能会改变你自我保健的方式。
So I think that could be very helpful in your teenage years, in your 20s, for people who are a stress case like me, so age 27 on the words at UCSF, if I had known that I was such a high cortisol person, I think I would have done things differently. I would have changed my behavior. And I don't know because I didn't base case these, but your testosterone can decline, starting in your 20s, kind of depending on how much stress your matrix is under. So for women that can start as early as 28, usually your testosterone declines by about 1% per year. What level of testosterone do you like to see in a woman once she's sort of post, let's say after age 25, what kind of range is healthy? I know what the reference range is only because I know one could look it up. I don't know at the top of my head immediately. But what's a kind of a nice reference point there? So the way I tend to describe this on podcasts is the top half of the normal range. Great. So that I think is a good benchmark.
我认为这对你的青少年时期和20岁时非常有帮助，特别是对像我这样压力巨大的人来说。如果在UCSF的时候，27岁以后，我知道自己的皮质醇水平如此之高，我想我会做出不同的选择。我会改变我的行为。尽管我没有进行基线检查，但你的睾酮水平可能会下降，从20多岁开始，取决于你的压力水平。对于女性来说，这可能会在28岁开始，通常每年大约下降1%。关于女性在25岁之后的睾酮水平，你认为哪个范围是健康的？我知道参考范围，因为可以查阅资料。但我并不立刻记得。但有什么好的参考标准吗？我倾向于在播客上以正常范围的前一半描述这个范围。这样我认为是一个很好的基准。
For PCOS, generally, it's much higher than that. I've seen patients with PCOS where there are total testosterone, it's 100 to 200. Do they always have peripheral manifestations of that? A little bit of hair, the skin plaques, I've heard about so dark and skin plaques. Regular periods. Regular periods. I get a lot of questions about PCOS. Yeah. And you're the first person we've had on this podcast that's really qualified to talk about PCOS in a real way. So here we're talking about too many androgens, cisome ovary, irregular ovarian, excuse me, I keep saying that ovulatory slash menstrual cycle.
对于多囊卵巢综合征（PCOS），一般来说，患者的雄激素水平要高得多。我见过一些PCOS患者的总睾酮水平达到100到200。他们总是有外周表现吗？稍微多一些的体毛、皮肤病变，我听说还有那么深色的皮肤斑块。定期月经。定期月经。我经常收到关于PCOS的问题。是的。你是我们播客中第一个真正有资格谈论PCOS的人。因此，这里我们在谈论雄激素过多、卵巢囊肿、不规则的排卵/月经周期。
What are some other indicators? And do you recommend that women start taking androgen blockers? Or I mean, how do it seems to be a lot of PCOS out there? I'm hearing about it a lot. So glad you asked about this. So PCOS is one of those really poorly understood conditions that gets, it kind of flies below the radar until a woman wants to get pregnant or she's got some other issue that drives her to a physician. The problem is that it is a syndrome, right? So polycystic ovary syndrome, sometimes polycystic ovarian syndrome. And syndromes don't necessarily fit together into a really clear diagnostic criteria. So in this instance, there are three different criteria that we look for. So this is some of the ovaries having clinical manifestations of hyperandrogenism. So that could be herstitism, acne, other things, and then usually irregular periods. And the way that that's defined, at least by the latest criteria is having a period every 35 days or less. So typical cycle length 28 days, 35 days, you're skipping a period here and there. So those are the criteria that we use to diagnose PCOS.
有其他一些指标是什么？您是否建议女性开始服用雄激素拮抗剂？或者我是说，似乎有很多多囊卵巢综合征存在？我经常听到这个问题。很高兴你问到这个。多囊卵巢综合征是一种很难理解的疾病，直到女性想怀孕或者有其他问题导致她去看医生时，这种疾病才开始受到关注。问题在于，这是一种综合症，对吗？多囊卵巢综合征，有时也被称为多囊卵巢综合症。综合症不一定能够清晰地符合一些诊断标准。在这种情况下，我们寻找的是三个不同的标准。首先是卵巢有多囊以及临床表现出的雄激素过多，如多毛症、痤疮等症状，通常还会有月经不规律。至少根据最新标准，月经周期应该在35天以内。典型的周期长度为28天，如果超过35天，就会有漏经现象。这些是我们用来诊断PCOS的标准。
There are about four different systems out there in the literature for diagnosing PCOS, which is where it starts to get confusing. So there's some women who have gnosis on their ovaries, but they've got herstitism and they've got irregular periods. Could you define herstitism? Herstitism is increased hair growth. Usually in places that you don't want it. So for women, it can be kind of male pattern. They might notice it on their breasts, on their chest. And then there's, of course, familial quality to that. Like I was just looking at a paper last night looking at Israelis and how much hearstitism they have and whether this is related to CAG repeats on the Anderson receptor. Do they get not Israelis, but do women who might have PCOS experience androgenic alopecia, so hair loss that sort of the quote unquote male pattern baldness? Of course, it's androgen pattern baldness as opposed to male that we're taking a testosterone DHT related. Sometimes, this is where I'm going to invoke clinical experience rather than what I've seen in the literature. Women definitely can have some androgenic alopecia. I tend to see it later in life, but this is an important point because we think of PCOS as, I was just talking about it in teenage years. Wouldn't it be nice to know that you have this phenotype in your risk for all the things that people are at risk for? And we haven't talked about glucose and insulin yet, we should.
在文献中有大约四种不同的系统用于诊断PCOS，这就是导致困惑的起点。所以有一些女性在卵巢上有囊肿，但她们有多毛和月经不规律。你能定义多毛吗？多毛是指增加的毛发生长。通常出现在你不希望出现的地方。对于女性来说，可能呈现出男性特征。她们可能会注意到毛发在胸部、胸前等部位的生长。当然，这也有遗传因素。比如我昨晚看了一篇论文，研究了以色列人多毛的情况以及这是否与雄激素受体上的CAG重复有关。非以色列人，但那些可能患有PCOS的女性是否会出现雄激素性脱发，即所谓的男性型脱发？当然，这是雄激素型脱发，与男性无关，我们谈论的是与睾酮DHT相关的。有时，这就是我要提及临床经验而不是文献中看到的地方。女性确实可能出现一些雄激素性脱发。我倾向于在晚年看到这种情况，但这是一个重要的观点，因为我们通常认为PCOS是青少年时期的问题。知道你具有这种表型风险，以及患病的可能性会很好，我们还没有讨论葡萄糖和胰岛素，我们应该讨论一下。
What we know is that PCOS is not just a problem in terms of irregular periods and then difficulty getting pregnant. So those are mostly problems in your 20s, 30s, early 40s, but it is a massive risk factor for cardi-metabolic disease as you get older. So many people tend to pitch and hole. PCOS is a problem of reproductive age. We have to be thinking of it over the entire female life cycle. And I would say it's even more important to consider it over the age of 50, you know, average age of menopause is 51 to 52 because we know that that elevated testosterone, the high androgens, are probably the greatest cardi-metabolic driver of disease for women with PCOS.
我们知道的是，多囊卵巢综合征不仅仅是一个关于月经不规律和难以怀孕的问题。这些问题大多出现在20、30和40岁前期，但随着年龄的增长，它是一种巨大的心脏代谢疾病的风险因素。许多人往往会忽视这个问题。多囊卵巢综合征是一种生育年龄的问题。我们必须在整个女性生命周期内考虑它。我要说的是，在50岁以后考虑这个问题甚至更加重要，因为我们知道，高雄激素和雄激素水平升高可能是多囊卵巢综合征女性患病最重要的心脏代谢驱动因素。
Now, one other thing I want to mention, and I still have my notes that we're going to talk about microbiome testing because that's such a fun subject. What I was taught to do, again, saying this with so much love for the people who have taught me how to do medicine, what I was taught to do is that if you have a woman with PCOS, you make the diagnosis, you measure her testosterone, you see if she has acne, blah, blah, blah. You ask that woman one question. Do you want to get pregnant or not? So then you have these women with PCOS who get started on a birth control bill if they don't want to get pregnant. If they want to get pregnant, then you help them get pregnant by addressing some of these PCOS issues, like maybe you give them clomid or you do something to make them ovulate more frequently. That is the way that most conventional medicine approaches this, and it does women at gigantic disservice.
现在，还有一件事我想要提到的，我还有笔记要讨论微生物组检测，因为这是一个很有趣的主题。我学到的做法，再次强调，我对教我如何进行医学的人充满爱意，我学到的做法是，如果你遇到一个有多囊卵巢综合征的女性，你会给她做出诊断，测量她的睾酮水平，看看她是否有痤疮，等等。然后你问这个女性一个问题。你想要怀孕吗？所以，你会看到这些患有多囊卵巢综合征的女性，如果她们不想怀孕，则会开始服用避孕药。如果她们想要怀孕，那么你会通过解决一些多囊卵巢综合征问题来帮助她们怀孕，比如给她们服用克罗米芬或者其他能让她们更频繁排卵的方法。这是大多数传统医学处理此问题的方式，它对女性造成了巨大的伤害。
So one of the things I'm speaking into is the gender gap that exists. So my feeling is that the research money that goes into women's health is abysmal compared to what goes into men's health. And I think that's changing, but there's also a huge lack of awareness of sex and gender differences when it comes to the way that we construct clinical trials and other experiments. Well, that's absolutely true. I mean, I've sat on an NIH review panels for more than a decade now, I'm a regular standing member, which is only to say that I see the research as it's being proposed. And now it's required, no grant will get funded without sex as a biological variable. And here I'm, by the way, folks, this is sex, biological sex, the noun, not sex, the verb, both are super interesting, obviously. But when we say sex as a biological variable, meaning even if it's a study on mice, we have to start though, that didn't start that long ago, it must have been, I think we can think, I don't want to misattribute here, I think we can thank Francis Collins for insisting on this.
因此，我正在讨论的一个问题是存在的性别差距。我觉得投入妇女健康研究的资金与投入男性健康研究的资金相比差距巨大。我认为情况正在改变，但在构建临床试验和其他实验时，我们对性别差异缺乏意识。这绝对是真的。我在NIH审查小组上已经坐了十多年了，我是常任委员，这意味着我看到了正在被提议的研究。现在，性别作为生物学变量是必须的，没有性别作为生物学变量的资助将获得资助。当我们说性别作为生物学变量时，我们指的是生物性别，而不是性行为，两者都非常有趣，但必须注意这并不是很久以前才开始的，我认为我们应该感谢弗朗西斯·柯林斯坚持这一点。
Amen, Francis. And Bernadine Healy has done so much to help us. But you know, she made the women's health initiative, which I hope will get to, which is a hot mess, like so confusing, the data that came out of that. So these trials are long. And so the data are only now starting to emerge. So just to be clear, I mean, I have a question that I don't think is going to take us off track, but this is, I'm going to pose this question as a hypothesis, because I think it's likely to be a little bit of a, of a, not a barbed wire question, but maybe like a prickly question when people first hear it, but it's poses a hypothesis.
阿门，弗朗西斯。伯纳丁·希利也为我们做了很多事情。但是你知道，她制定了妇女健康倡议计划，我希望能够谈到这个计划，这个混乱不堪，数据非常令人困惑。所以这些试验持续时间很长。现在数据才开始涌现。所以我只是想明确一点，我的问题不会让我们偏离主题，但这是一个假设性问题，因为我认为当人们第一次听到时可能会有一些不舒服，但这只是一个提出假设性问题。
You mentioned some of the psychosocial stress issues based on at the organizational level, institutional level, societal level, maybe right down to the family, and just life that are biasing health outcomes for the worse in female populations. Okay, you refer to as the patriarchy, I'm just trying to put, make sure that we're both talking about the same thing. And that's non exhaustive, I realize, that's just a subset of the issues.
你提到了一些心理社会压力问题，这些问题存在于组织层、制度层、社会层，甚至直至家庭和个人生活中，这些问题导致了女性群体的健康结果不佳。好的，你提到了父权制，我只是想确保我们在讨论同一个问题。这只是一部分问题，我意识到这并不全面。
I'm also hearing there's a lot more PCOS, which is hyperandrogenization of the ovary in there. We're talking about, you mentioned, you know, excess testosterone, which females naturally have more testosterone than they do estrogen anyway, but we're talking about elevated levels. Here's a hypothesis. One hypothesis would be that the increased androgens and the PCOS are a consequence of the psychosocial conditions that are, I don't want to say forcing, but are biasing the need for females to think, behave, react, act in certain ways to survive, let alone thrive.
我也听说有很多多囊卵巢综合症（PCOS），这是卵巢过度雄激素化。我们在谈论，你提到过，你知道，女性天生就比雌激素多一些睾酮，但我们谈论的是升高的水平。这里有一个假设。一个假设是增加的雄激素和多囊卵巢综合症是心理社会条件的结果，这些条件并不一定强迫，但却在使女性需要以某种方式来思考、行为、反应、行动来生存，更不用说茁壮成长。
Is that a, I don't say this for any kind of political correctness hypothesis, this is a, it might, this would be a fun, interesting, and I think important study to run, right? Depending on stress and the conditions, the specific type of stress, do females under produce or over produce androgens, or is it a neutral effect? Does that make sense? I love this question. So let me just paraphrase the last part of it to make sure I got it.
这个问题不是基于任何政治正确假设而提出的，而是一个有趣、有趣，我认为也很重要的研究。 根据压力和条件的不同，特定类型的压力，女性是产生睾酮的过少还是过多，还是中性效应？这样说你能明白吗？我喜欢这个问题。让我换一种方式表达一下最后的部分，确认一下是否理解正确。
It sounds like what you're asking is, could PCOS or at least some phenotypes of PCOS be a response to what I'm calling patriarchy? And then you add a second part to it, which is do healthy women, like what is their production of testosterone like? Is that right? Yes. And with the acknowledgement, I mean, you're the expert here. You're the physician, clinician, and expert in hormones, and I'm not, but with the understanding that absolute levels of hormones are interesting, but perhaps not as interesting as the ratios of testosterone to estrogen.
听起来你在问的是，PCOS或至少某些PCOS表型是否可能是对我所说的父权制的一种反应？然后你再添加一个问题，就是健康女性，她们的睾酮产量是怎样的？是这样吗？是的。我承认，我是个专家。你是医生、临床医师和激素专家，而我不是，但要理解绝对激素水平很有趣，但也许与雌激素比例不那么有趣。
So when we're talking about excess testosterone, we're really not talking about, oh, women making a lot of testosterone because frankly, they already make a lot, like, then most people that weren't aware of that, I wasn't aware that women make more testosterone than estrogen. And we need it. Right. And so it's not saying that testosterone in women is bad or is always a reaction to the environment. Yes. But when it becomes, um, super physiological or hyper elevated, is, I could imagine all sorts of social conditions that would create that.
所以当我们谈论过多的睾丸激素时，我们真的不是在谈论，哦，女性产生大量的睾丸激素，因为坦率地说，她们已经产生了很多，就像大多数人不知道的那样，我不知道女性产生的睾丸激素比雌激素还多。而我们需要它。是的。所以并不是说女性体内的睾丸激素是不好的或者总是对环境做出的反应。是的。但当它超出生理水平或者过度升高时，我可以想象会有各种社会条件导致这种情况。
So in males and females, but here we're talking about PCOS and females in particular. So I'd love for you to speculate. Should we run the study? We should totally run the study because I don't know the answer. I suspect that you're onto something. It may not explain all of the women with PCOS because as I mentioned, there's a lot of different phenotypes, but I think it could explain a significant portion. And you know, you're almost, you're saying if we look at the gene environment interface, this environmental influence of having being someone who's got power over you, if, if PCOS was a response to that, the way that we treat it would be completely different.
所以在男性和女性中，但这里我们谈论的是多囊卵巢综合征和女性特别是。所以我希望你们可以猜测一下。我们应该进行这项研究吗？我们完全应该进行这项研究，因为我不知道答案。我怀疑你的想法可能有道理。可能不能解释所有患有多囊卵巢综合征的女性，因为正如我所提到的，有很多不同的表型，但我认为这可能解释了相当大比例。而且，你说的几乎是，如果我们看看基因环境界面，这种被控制影响的环境因素，如果多囊卵巢综合征是对此的一种反应，那我们对待它的方式将会完全不同。
So on the one hand, I want to be careful not to dismiss the suffering and experience of women with PCOS. I've got a lot of women with PCOS in my family. And it is, there's so much pain and suffering, you know, especially if you want to have a baby and you try for years and you just can't ovulate. On the other hand, I read a paper recently and maybe we could cite this that compares the phenotype of a woman with PCOS to a man who is hypo-entrogenic. And I think that's a really interesting way to look at this because the thread we haven't talked about with PCOS is the role of insulin and glucose.
一方面，我想要谨慎对待患有多囊卵巢综合征的女性的痛苦和经历。我家里有很多患有多囊卵巢综合征的女性。尤其是如果你想要孩子，尝试了多年却无法排卵，会有很多痛苦和苦难。另一方面，我最近读了一篇论文，也许我们可以引用一下，比较了患有多囊卵巢综合征的女性与雌激素不足的男性的表型。我觉得这是一个非常有趣的角度来看待这个问题，因为我们还没有谈论的一个方面是多囊卵巢综合征与胰岛素和葡萄糖的关系。
So for some of the phenotypes of PCOS, the problem is hyperinsulin emia, high insulin in the blood is driving those theca cells and ovaries to over produce testosterone. These women are insulin insensitive. So more insulin is being cranked out and these cells in the ovary are therefore making more androgen. You don't like to say insulin resistant? Oh, I can, I don't have a problem saying insulin resistance. I just, I like the way I'm just, I'm just a little bit outside the lane lines of my expertise. So I was trying to use it.
因此，对于一些PCOS的表现型，问题在于高胰岛素血症，血液中的高胰岛素促使那些黄体和卵巢过度产生睾酮。这些女性对胰岛素不敏感。因此更多的胰岛素被产生出来，卵巢中的这些细胞因此产生更多雄激素。你不想说胰岛素抵抗吗？哦，我可以说，我没有问题说胰岛素抵抗。我只是，我喜欢我这样，我只是超出了我的专业知识范围。所以我试图使用它。
What, what is the correct nomenclature so that we can make sure? Well, what I like about insulin insensitive, the way that you just said it is that I think that offers people a way in and I love to do that in terms of messaging. Insulin resistance starts to lose people because they don't really get what that means at a receptor level. I think I say insulin insensitive because when people hear insulin sensitive, it almost sounds like a bad thing, but that's actually what you want. So I think that's how I defaulted to insulin insensibility. What's your insulin? I don't know. What? I'm due for a blood test. Yes, you are. I'm due for a blood test. I had blood work done about eight months. Sure. That'd be great. I, I, I'm always experimenting with different supplements and different behavioral regimens and I've kept charts since I was 19. Oh, you're like my patient.
什么是正确的名词？这样我们才能确保？嗯，我喜欢胰岛素不敏感，就像你刚刚说的那样，我觉得这为人们提供了一种理解的方式，我喜欢在传达信息方面这样做。胰岛素抵抗开始让人困惑，因为他们不真正明白在受体水平上意味着什么。我想说胰岛素不敏感，因为当人们听到胰岛素敏感时，几乎听起来像是一件坏事，但实际上这正是你想要的。所以我觉得我就默认了胰岛素不敏感。你的胰岛素怎么样？我不知道。什么？我该做一个血液检测。是的，该你了。我该做一个血液检测。我大约8个月前做过血液检查。好的。太好了。我总是尝试不同的补充剂和不同的行为方案，自从19岁起我就一直记录着。哦，你就像我的病人。
I've been sort of obsessed by this and I would say everybody, if you can afford it and at the time actually I had to save up insurance wouldn't cover it. Get some basic blood work done so that you have a reference point. Do it as soon as possible because even, you know, the, we've been talking about these women over the life cycle. I wish I knew what my insulin was when I was a teenager. I wish, I knew what my fasting insulin was. I really wish I knew my post-prandial insulin like in my teenage years, in my 20s, in my 30s. Well, I knew it in my 30s starting at 35. Are you a fan of continuous glucose monitors? The hugest, most gigantic fan of CGM's. I've never seen any tool that I've ever used in medicine change behavior the way that CGM's do. Wow.
我对这个有点着迷，我会说每个人，如果你有能力负担得起，当时实际上我不得不省钱，因为保险不会覆盖。做一些基本的血液检查，这样你就有一个参考点。尽快去做，因为即使，你知道，我们一直在谈论这些女性在整个生命周期中。我希望我知道我十几岁时胰岛素是多少。我希望我知道我的空腹胰岛素是多少。我真的希望我知道我的餐后胰岛素，在我的十几岁，我的二十岁，我的三十岁。好吧，我知道从35岁开始的30岁的时候。你是连续血糖监测仪的粉丝吗？我是连续血糖监测仪的最大，最巨大的粉丝。我从未见过任何我在医学上使用的工具像连续血糖监测仪那样改变行为。哇。
Why do you think they are so effective at changing behavior? I've tried one and I really liked it. I learned that in the sauna, my insulin, my blood glucose goes up probably by a bit of dehydration. I learned what kind of foods work for me, which don't. I thought it was fascinating. I learned how every behavior you could possibly imagine your imagination impacts blood glucose. Totally fascinating to me, including how a two wakeups during the middle of the night versus one versus none impacted blood glucose the next morning. Fascinating for a data junkie like me. It was like, I was in heaven. Why do you think they are so effective in changing behavior? Is it because of that that people can see that real time control like scan in and like, oh, that's the, that's the sandwich.
你认为为什么它们能够如此有效地改变行为？我试过一个，我真的非常喜欢。我学到在桑拿里，我的胰岛素，我的血糖会上升，可能是因为有点脱水。我学到了什么样的食物适合我，什么不适合。我觉得这很有趣。我学到了每一种可能影响血糖的行为都是如何的。对我来说完全迷人，包括晚上中间醒来两次和一次与没有会如何影响第二天早上的血糖。对于像我这样的数据爱好者来说，这简直就像是置身天堂。你认为它们为何在改变行为方面如此有效？是因为人们可以实时看到像扫描这样的真实控制，比如，“哦，那就是三明治”吗？
I think it's many things. I think it's generally the enchantment of learning about your own chemistry and biology. I love that. And I think for me, what I've seen, I feel like doctors are basically marketers, like a sacred marketing. Our job as a physician is to convince people to do something that we think is good for them based on the best science. But we can't just say, here, why don't you fill this prescription for a CGM? You have to market it. You have to say, I think this completely changes the way that you approach your prediabetes. I think this could dramatically affect your risk of Alzheimer's disease, which you're so worried about that your mother has. Our job as physicians is to be that sacred marketer. So CGM's are one of my tools that I think are so crucial. So enchantment number two, yeah, it's the real time effect.
我认为这是许多事情。我认为这通常是了解自己的化学和生物发生魅力的过程。我喜欢。对我来说，我看到的是，我觉得医生基本上是营销人员，像是神圣的营销人员。我们作为医生的工作是说服人们做一些我们认为对他们有好处的事情，基于最佳科学。但我们不能只是说，这里，为什么不试试这个连续葡萄糖监测仪的处方？你必须市场推广它。你必须说，我认为这会彻底改变你对潜在糖尿病的看法。我认为这可能会极大地影响你对阿尔茨海默病的风险，你对此非常担忧，因为你的母亲患有这种疾病。我们作为医生的工作就是充当那个神圣的营销员。所以CGM是我认为非常关键的工具之一。所以，魅力之二，是实时效果。
So if you go get your glucose and insulin measured, or maybe you do like a two hour glucose challenge test where you look at glucose and insulin at the fasting point one hour later, two hours later, or more frequently, that does not have the same kind of behavior effect as having continuous data where you can say, okay, I drove to see you Andrew from my place in Berkeley and it was stressful. It was trentially raining. And I know my glucose was elevated. Like, I think really understanding what the mediators are of your glucose control is essential. Now that said, it's also kind of a later effect. I mean, I'd rather know your insulin. And we know from the White Hall study that insulin, especially postprandial insulin, fasting insulin too, can change years and years before you get a change in glucose. So that's more for prediabetes and diabetes. So I think those are the main reasons why I think it's such an important tool. Third thing is it democratizes data, which you do too. I mean, incredible how you do that with your podcast.
所以如果你去检查你的葡萄糖和胰岛素水平，或者也许你做了一个两小时葡萄糖耐量试验，在空腹时检查葡萄糖和胰岛素，之后一小时、两小时或更频繁地检查，这并没有持续数据那种行为影响的效果，你可以说，好吧，我从伯克利的家开车去看你安德鲁，这是很有压力的。外面还在下着大雨。我知道我的葡萄糖水平升高了。我认为真正理解你的葡萄糖控制中介者是至关重要的。尽管如此，这也是一种较晚的效应。我更想知道你的胰岛素水平。我们知道从怀特霍尔研究中，胰岛素，尤其是饭后胰岛素、空腹胰岛素，可能在你的葡萄糖发生变化前几年就会改变。所以这更多适用于糖尿病前期和糖尿病。所以我认为这些是我认为这是如此重要的工具的主要原因。 第三个原因是它使数据民主化，这也是你所做的。我觉得你通过播客做这件事真是了不起。
But I think one of the most hopeful and exciting things that I'm seeing right now in the health space is that we're going from this patriarchal relationship where doctors hold the power and are the gatekeepers of data to patients and clients having much more access to that enchantment about their own chemistry and their own biology. So to me, that is so exciting. Like for me to be able to, I've got, you know, probably 100 patients that are in a data stream with me where we're looking at their glucose. And I can, I mean, I'm on spaticals. So I'm not doing this so much anymore. But I can call a patient be like, why is your glucose so high? Like, what did you do? Oh, is my birthday? I had a piece of birthday cake. Like that kind of collaboration that also is teaching the patient to be their own clinician. To me, that is a loop of benevolence and integrity that I think is essential to creating health. We've got a disease care system. We need the democratization of data to become a health-based system. Amen to that a million times over. We share that sentiment at the, can tell it at a deep level. I think the pandemic actually assisted in, well, it harmed many things, but it assisted in people's understanding that no magic fairy nor the government nor any, anyone was going to arrive at their door with a kit of things to make them healthy, right, that provides sunlight movement, sleep, and all the various aspects of nutrition. No, nothing, nothing that everyone has to have access to first and foremost, and then implement those things as best they can.
目前我认为，在健康领域最令人充满希望和激动的事情之一是，我们正在从医生拥有权力、是数据的守门人的父权关系转变为患者和客户对他们自己的化学和生物学有更多的了解。对我来说，这是如此令人兴奋。比如说，我有大约100位正在与我共同查看他们血糖数据的患者。我可以打电话给一个患者，问他们的血糖为什么这么高，他们做了什么？哦，是我生日，我吃了一块生日蛋糕。这种合作也教导了患者如何成为自己的临床医师。对我来说，这种仁慈和诚实的循环是建立健康的关键。我们有一个治疗疾病的系统。我们需要数据民主化才能构建一个以健康为基础的系统。我们对此表示强烈赞同，深表认同。我认为这次流行病实际上有助于人们明白，没有魔法仙子，政府或任何人会带着一套东西来帮助他们变得健康，而是需要阳光、运动、睡眠以及各种营养。这些东西每个人首先都必须能够获得，并尽可能地实施。
Speaking of which, and kind of circling back to this idea of people in their late teens, 20s, 30s, and onward, if you had a magic wand and you could give two or three don'ts or to make it personal, if you could go back in time and erase certain behaviors, what would the don'ts category be? You couldn't tell us more than two or three, but if the goal is to maximize vitality and longevity, and those are not always parallel to one another, it's certainly not the same thing, sometimes orthogonal, but let's just say fertility being a proxy for vitality and longevity. I think people will sometimes forget this, that fertility isn't just about people who want to conceive children, it's also, it can serve as a proxy for vitality and longevity. So what would you like to see patients, let's focus first on female patients, but if it extends to male patients as well, what would you like to see them not do or do far less of? I really like that. So I would say a few things, I'll just headline them and then we can go into detail. Number one sleep, I do want to diverge from you a little bit on some things, but sleep is probably not one of them. No, well, feel free. I mean, you're the one that worked a hundred, you know, that worked 120 hours a week. I can't imagine unless you lived in a different reality than I do. And there are times in my career where I was pulling all nighters and sleep to probably there's just, I don't recommend it, but I did it. I hope you don't do that anymore. No longer if I can avoid it, but there were years, many years where it was like, all right, here we go. And I'm quite adept at it for one cycle. But two nights, I kind of start to fall apart. Totally. So I would say sleep, alcohol, high perceived stress.
说到这一点，回到年轻人晚近的人的想法，如果你有魔法棒，你可以给出两三个不要的建议，或者更加个人化，如果你可以回到过去抹掉某些行为，那么不要做什么会是什么类别？你只能告诉我们两到三个，但如果目标是最大化活力和长寿，它们并不总是平行的，它们绝对不是同一回事，有时是正交的，但我们只说，生育力作为代表活力和长寿。我想人们有时会忘记这一点，生育力不仅仅是想要怀孩子的人，它也可以作为活力和长寿的代表。那么对于患者，首先集中在女性患者身上，但如果扩展到男性患者，你希望看到他们很少或不再做什么？我真的很喜欢这一点。所以我想说几点，我先把它们概括一下，然后我们可以详细讨论。第一，睡眠，我确实有点不同意你在一些事情上，但睡眠可能不是其中之一。不是的，随意发挥。我的意思是你工作了一百多小时一周。我无法想象，除非你生活在一个不同的现实中。在我的职业生涯中，有时候我整夜不睡觉，也许不推荐，但我做到了。我希望你现在不再这样做了。如果可以避免，我不会再这样做了，但有许多多年，这就像，好吧，我们开始吧。为了一个周期，我相当擅长这个。但两个晚上，我就开始崩溃了。完全是。所以我会说睡眠，酒精，高感知压力。
And I'd love to talk about maybe the date on telomeres and where we know. So you'd like to see people get enough sleep. So don't, don't. Yeah, not all of these are concordant. So not enough sleep, too much alcohol, too much perceived stress, eating the wrong foods, toxic relationships, and isolation. And then number six, not moving enough or not moving and exercising in a way that really fits with your body. So we start with that one, actually, just because it's such a, and then work backwards. That's interesting. I think nowadays people appreciate the need for quote unquote cardio. I know that the exercise physiologists cringe and dissolve into a puddle of tears when I say that, but getting the heart rate up over some period of time, longer than 10 minutes in order to generate cardiovascular health circulation.
我很乐意谈谈关于端粒的日期和我们所知道的内容。所以你想看到人们有足够的睡眠。所以不要，不要。是的，并不是所有这些都是一致的。所以睡眠不足，饮酒过量，过度的压力感，吃错食物，有毒的关系，和孤立。然后第六点，运动不足或者运动和锻炼的方式并不真正适合你的身体。所以我们首先从这一点开始，实际上，因为这是一个，然后向后工作。这很有趣。我认为现在人们欣赏所谓的有氧需要。我知道运动生理学家听到这句话时会感到不快，并流眼泪，但是要让心率在一定时间内超过10分钟，以促进心血管健康循环。
So and resistance training of some kind, maybe flexibility. What do you mean by body phenotype or an exercise? I'll speak from personal experience. So what I did through, I mean, I gave up my 20s to medicine. And during that time, I occasionally got to the gym. You know what UCSF, I'm pronouncing, you could go to the gym. And then as soon as your beeper went off, you're back into the hospital. But I didn't exercise much. I had, do you remember Nordic tracks? I had a Nordic track in my house, and that was, that was like it. What I believe, because for me, the primary outcome that I'm interested in is cardiometabolic health. So when it comes to exercise, what I really feel, if we're going to be at a population level, I feel that about a third cardio, two-thirds resistance training is based on my synthesis of the literature, the best combination. And I think there's, you know, as you described with your sign study, I think there's a minimal effective dose, which for a population is about 150 minutes. I think most of us need a lot more than that. Per week. But I think, you know, for me, because I have a phenotype that produces a lot of insulin, kind of depending on how I'm on my game, I have a lot of glucose. So I have to exercise a lot more to dispose that glucose. So I think you then have to move from medicine for the population, or prescriptions for the population to what works for the individual. I think that recommendation is fantastic.
因此和某种形式的抗阻力训练，也许是柔韧性训练。你说的“身体类型”或者是一种锻炼是什么意思？我将从个人经验来谈。在那段时间里，我放弃了我的20岁去学习医学。在那段时间里，我偶尔去健身房。你知道UCSF吧，我在那里去健身房。一旦你的寻呼机响了，你就得回到医院。但是我没有做很多锻炼。我有一个北欧滑雪机在家里，那就是我的全部了。在我看来，我主要关心的结果是心脏代谢健康。因此，对于锻炼，我真的认为，如果我们要在整个人群中考虑，我觉得有氧运动占三分之一，阻力训练占三分之二，这是我从文献综合得出的最佳组合。我认为，就像你在你的研究中所描述的那样，有一个最低有效量，对于整个人群来说大约是150分钟。我认为大多数人需要比这个更多的时间。但是对于我来说，由于我的体质会产生大量胰岛素，所以我必须进行更多的锻炼来清除这些糖分。因此，我认为你需要从针对整个人群的医学处方转移到适合个体的方法。我觉得这个建议非常棒。
I think resistance training, well, let me put it this way. I'm neither a trainer nor a physician, but I've seen in family members that we're doing it. I wouldn't say a lot of cardio, but just cardio, that when they add resistance training, everything in terms, including their biomarkers, have improved dramatically. Yes. In particular, for female members of my family. Well, one of the one of the mediators that I think is important, especially for people who do what I call chronic cardio, which is what I did, is cortisol. So we know that runners, especially marathon runners, people who do a lot of cardio and don't do much resistance training, they tend to have much higher cortisol levels. And you can buffer that with vitamin C vitamin C can decrease the effect. But chronic cardio doesn't always serve people.
我认为，抗阻训练，嗯，让我这样说吧。我既不是教练也不是医生，但我在家人身上见过他们这么做。我不会说多做有氧运动，但有一些有氧运动，当他们增加抗阻训练时，一切都会明显改善，包括生物标记。是的。尤其是对于我的家人中的女性成员。我认为重要的一个介质是皮质醇，尤其对于那些我称之为慢性有氧运动的人，就像我以前的做法一样，皮质醇是一个重要问题。我们知道，跑步者，特别是马拉松跑者，以及那些做大量有氧运动但没有做足够抗阻训练的人，他们的皮质醇水平通常会更高。你可以用维生素C来缓解这种效应。但慢性有氧运动并不总是对所有人有效。
So quick personal example, when I first started measuring hormone panels in myself, I went to my physician and I said, I'm 35. I've had one kid, I want to have another kid. I've never been so exhausted in my life. I just feel like I'm pushing a rock up the hill. I've got this belly fat that I don't like. And I don't want to have sex with my husband. So what do you think? What could we do about this? And he offered a birth control pill and an antidepressant. So I left him and I went to the lab and I ran a hormone panel. And my cortisol was three times what it should have been. My insulin was in the 20s. I was fasting. My glucose was 105. My thyroid was mildly abnormal. My progesterone was low. And that set me on this course of realizing that what I was doing as a physician taking care, especially of women, was not getting to some of these root causes that are so essential. And I would say I had to start first with cortisol. At that time, I was running four miles, three times a week, four times a week. That was just raising my cortisol further. So that was not the right exercise for me. I needed more adaptive exercise. I started doing Pilates, more yoga. That helped to lower my cortisol. I mean, it started me on changing the way I was managing perceived stress. And it also changed my supplement, Richmond. Can we talk about that?
这里举了一个快速的个人例子。当我第一次开始在自己身上测量激素水平时，我去见了我的医生，我说，我35岁了，已经有一个孩子，想再生一个孩子。我从来没有感到过这么疲惫。我感觉就像是在推着一块石头上山。我有着我不喜欢的腹部脂肪，我也不想和丈夫发生性关系。那你认为我们可以怎么做呢？他提供了避孕药和抗抑郁药。所以我离开了他，去实验室跑了一个激素检测。我的皮质醇水平是正常值的三倍，胰岛素达到了20多，而且我还处于空腹状态下。我的血糖是105，我的甲状腺微弱异常，孕酮水平低。这让我意识到，作为一名医生，尤其是在照顾女性时，我并没有解决一些根本原因，这些原因是至关重要的。我认为首先我必须从皮质醇入手。那时，我每周跑三次、四次四英里。这只会进一步提高我的皮质醇水平。那不是适合我的运动方式。我需要更具适应性的运动方式。我开始做普拉提，更多的瑜伽。这有助于降低我的皮质醇水平，这让我开始改变我的压力管理方式。同时，我也改变了我的补充剂。我们可以谈谈这个吗？
With the moment you said lowering cortisol, thought of the two supplements that come to mind are ashwagandha, which I think can potently reduce cortisol. But I've heard some recommendations about cycling it. And I've always wondered about time of day for ashwagandha intake because sort of quote unquote want cortisol elevated in the early part of the day. We know this. We know you do not want cortisol peaking later in the day. No, you do not. Interferes with sleep. Interferes with sleep. And then the other supplement is rotiolarization. Do I have my pronounce in that correctly? Yeah, so rutiola is very effective. It's been shown in multiple randomized trials to lower cortisol. So that could be very effective. What's word dose? I've started taking it recently, by the way, and I made a huge mistake.
在你说降低皮质醇的瞬间，我想到了两种补充剂，一种是灵芝，我觉得它可以有效降低皮质醇。但我听说有人建议进行循环服用。我一直在疑惑什么时候服用灵芝更合适，因为我希望在一天的早些时候皮质醇升高。我们知道这一点。我们知道你不希望皮质醇在一天后期达到顶峰。不，你不想要。这会影响睡眠。这会影响睡眠。另一种补充剂是金丝桃化合物。我发音对吗？是的，金丝桃非常有效。多项随机试验表明金丝莲能够降低皮质醇。这可能非常有效。用量是多少？顺便说一句，我最近开始服用它，犯了一个大错误。
I like to make the mistakes first. So then my audiences don't make them as I was taking it. I heard it was an adaptogen. So I thought, Oh, I'll take it before resistance training. But of course, you want the cortisol peak during resistance training because that's going to set in motion the adaptive response. So I started taking it later in the day. And it's really improved. I would say my late day, second half of the day cognition, this is subjective, to be fair, I just feel like I'm in a more even plane of attention in the second half of the day. So you're describing an enough one experiment, which is it well, it is not anecdotal. So I was taught at Harvard Medical School that the hierarchy of evidence starts at the lowest with expert opinion, you know, case studies, then you've got cohort studies, then you've got observational data that's prospective, then you have randomized trial. But the highest quality evidence of all is the end of one experiment, where you serve as your own control. So what you're describing with rodeola, I would frame that as an end of one experiment, where you have a washout period and you compare before and after. And I'd like to measure some other metrics to see if there's an effect, including your cortisol. So rodeola has been shown in multiple randomized trials to reduce cortisol. The other thing that I think is super effective is phosphatidyl serine, ps for short. Fish oil also more modestly reduces cortisol.
我喜欢先犯错误。这样我的观众看到我犯错时就不会重蹈覆辙。我听说这是一种适应原。所以我想，哦，我应该在进行抗阻力训练之前服用。但当然，你希望皮质醇在抗阻力训练时达到峰值，因为这将引发适应性反应。所以我开始在一天的后半段服用。这真的有所改善。我想说我的认知能力在一天的后半段，这是主观的，公平地说，我觉得自己在一天的后半段更加专注。所以你描述的是一个足够的实验，并不只是陈述。所以我在哈佛医学院学到的是证据的等级从最低开始是专家意见，比如案例研究，然后是队列研究，然后有前瞻性的观察数据，最后是随机试验。但所有证据中最高质量的是自身的实验，也就是让自己做对照。所以你描述的关于特有的实验，我会把它框架为一个以自己为对照的实验，你可以有一个清洗期，比较前后的差异。我想测量一些其他指标，看看是否有影响，包括皮质醇。罗乐酸在多个随机试验中已被证明可降低皮质醇。另一件我认为非常有效的事情是磷脂酰丝氨酸，简称PS。鱼油也会适度降低皮质醇。
Ashwagandha is interesting. So in my first book, The Hormone Cure, which I read, by the way, you did. I was hoping that was the one you read. I did. I read it and it's spectacular. And I thought going into it, I had this like, you know, let's just call it what it was, it's kind of male bias. Like, is there going to be anything in here for me? Because I don't have ovaries and you know, it's going to be and it was immensely informative. So thank you. Yeah, I have very fond recollections of the walks I took listening to it. And then I own the print version too. So I like to switch back and forth. So thank you for that. It's a, it's just a per book for anyone to read. Thank you. I so appreciate that.
灵草是很有趣的。所以在我第一本书《荷尔蒙疗法》中，我读了，顺便说一句，你也读过。我希望你就是读的那本。是的，我读过了，太棒了。当我开始阅读的时候，我有点带着男性偏见，就是说，这本书里会有什么对我有用的东西吗？因为我没有卵巢，你懂的，但这本书给了我很多信息。所以谢谢你。是的，我对听的时候散步有着美好的回忆。而且我还有印刷版的书，所以我喜欢互相切换。所以谢谢你，这是一本任何人都应该阅读的好书。谢谢你，我非常感激。
So in chapter four, you may or may not remember that Ashwagandha, at least the time that I wrote that book, Ashwagandha's data is not great, but lack of proof is not proof against. So with Ashwagandha, most of the data comes from thousands of years of using it in iVetic medicine. And it's considered, again, not my science hat, it's considered a double adaptogen so that it's potentially helpful when you are a high cortisol phenotype. Like I was, like I sometimes still am, or low cortisol. I haven't found that in my patients, although I'll give you one exception. So Ashwagandha is mostly based on animal studies. There is not as much human data, but it is used a ton in integrative medicine.
因此，在第四章中，你可能还记得瓦尔努曼根，至少在我写这本书的时候，瓦尔努曼根的数据并不是很好，但没有证据并不意味着不存在证据。所以关于瓦尔努曼根，大部分数据来自于几千年来在阿育吠陀医学中的使用。而且，它被认为拥有双重适应原的功效，可能在你是高皮质酮表型的时候有帮助，就像我曾经是的，有时候我还是，或者是低皮质酮的情况。我在我的患者身上还没找到这种情况，尽管我可以给你一个例外。瓦尔努曼根大部分是基于动物研究的。人类数据并不多，但它在整合医学中被广泛使用。
There's one supplement that I've found to be incredibly helpful for people who tend to have high cortisol at night. And that's called a cortisol manager. It's by integrative therapeutics. I don't have a second supplement manufacturer that makes something similar. It's their number one selling supplement because it's so effective. Is it a cocktail of several things? It's a combination of phosphatidylserine and Ashwagandha. Tell me more about phosphatidylserine. I am familiar with it for, it's been mentioned by some guests that were on the Tim Ferriss podcast long ago for other reasons, I think, related to sleep. And maybe that's another reason why you like it. But before we move on from Rodeola, is there a dosage of Rodeola rosacea that you found?
有一种补品我发现对那些晚上肾上腺皮质醇水平较高的人非常有帮助。那就是一种叫做肾上腺皮质醇管理剂的补品。这是由整合疗法公司生产的。我没有找到其他生产商生产类似产品的。这是他们最畅销的补品，因为非常有效。它是由几种成分混合而成的吗？它是磷脂酰丝氨酸和艾胡草的组合。告诉我更多关于磷脂酰丝氨酸的信息。我对它比较熟悉，因为一些嘉宾在很久以前参加了蒂姆·费里斯的播客，提到了它，我想是与睡眠有关的其他原因。也许这也是你喜欢它的另一个原因。但在我们离开Rodeola之前，你找到了一种Rodeola rosacea的剂量吗？
So I would refer people to my book because the randomized trials and the doses that were used are in there. So I can't remember with Rodeola, although I took it this morning to prepare it to be with you. We can look it up and put a show note caption to people. I can remember the dose with phosphatidylserine because I take that regularly. So 400 to 800 milligrams is the typical dose for PS. And what's interesting is that in the randomized trials that were done, 400 milligrams was more effective than 800 milligrams. Interesting. I've found that for several supplements that the lower dose was more effective. Yeah, it doesn't matter what those were.
因此，我会推荐人们阅读我的书，因为里面包含了随机试验和使用的剂量。所以我记不得罗迪奥拉是多少剂量，尽管我今天早上已经服用了，以便能跟你在一起。我们可以查一下，并为观众提供节目注释。我记得磷脂酰丝氨酸的剂量，因为我经常服用。所以每天400到800毫克是PS的典型剂量。有趣的是，在进行的随机试验中，400毫克比800毫克更有效。有趣的是，我发现对于几种补充剂来说，较低的剂量更有效。是的，不管那些剂量是多少。
And so when you say PS you were referring to, by the way, folks, not PCOS, just because scientists and clinicians are familiar with and military, very familiar with acronyms, phosphatidylserine PSO, 400 to 800 milligrams, 400 being more effective, taken later in the day or early day, does it matter? It depends on when your cortisol is high. So for me, I tend to, you know, what's the pattern for cortisol? Typically it rises to its peak 30 to 60 minutes after you get up. Then it has this gradual kind of asymptotic decline until you go to bed. So if you're someone like me who peaks like way crazy high, I don't do that anymore, but that's what I used to do. I need a phosphatidylserine in the morning for people who are high at night, who have what's known as a flat cortisol pattern or a inverted pattern. You want to take it at night. And the flat pattern, just a quick sidebar, is that that's associated with a number of conditions that most mainstream physicians don't know about. So a flat pattern where it's low in the morning and it's high at night, is associated with anxiety, depression, decreased survival from breast cancer that was studied at Stanford by David Spiegel. He was my close even collaborator, even on the breathwork study that we just.
所以当你说PS时，顺便提一句，朋友们，你不是在指PCOS，只是因为科学家和临床医生熟悉军队非常熟悉缩写词，磷脂酰丝氨酸PSO，400到800毫克，400更有效，晚些时候或一早服用，会有影响吗？这取决于您的皮质醇高峰出现在什么时候。对于我来说，我倾向于，你知道，皮质醇的模式是什么？通常情况下，在起床后的30到60分钟达到峰值，然后在睡觉前有一个逐渐的指数下降。所以如果你像我这样高峰很高的人，我不再这样做了，但那是我以前做的。我早上需要磷脂酰丝氨酸，对于晚上高峰的人，这种模式被称为平缓皮质醇模式或反转模式。你想晚上服用。平缓模式，简单的旁注，与许多主流医生不了解的一些疾病有关。低晨高夜的平缓模式与焦虑、抑郁、斯坦福大学的大卫·斯皮格尔进行的乳腺癌生存率降低研究有关。他是我的密切合作者，甚至参与了我们最近进行的呼吸法研究。
Oh interesting. Yeah. He's our associate chair of psychiatry now. So a wonderful human being has. Amazing. .has been a guest on this podcast and I'm now fantasizing about a conversation that includes a panel of incredible minds like you and David from the clinical side. So in any case, yeah, the late shifted cortisol, not good. Not good. And it seems to have the worst immune downstream issues of any of the cortisol patterns. So that's really important to know about because it then maps to things like it's related to PTSD.
哦，很有意思。是的，他现在是我们精神病学的副主席。他是个了不起的人。太棒了。他曾经在这个播客节目上做过嘉宾，我现在在想象一个包括像你和临床方面的大卫这样的不可思议头脑的对话。无论如何，是的，晚期的皮质醇不好。不好。似乎它具有任何皮质醇模式中最糟糕的免疫下游问题。因此，了解这一点非常重要，因为它与创伤后应激障碍等问题相关。
So that's the pattern we see like in vets who've got PTSD as well as others. It maps to autoimmunity. It maps to fibromyalgia. I was told that one in 12 people have our heterozygous, so one mutant copy or hypermorphic for some mutation in adrenal related genes. So congenital adrenal hyperplasia. Is that true? And if so, that means that one in 12 people walking around are cranking out far too much cortisol or not enough cortisol or the cortisol system is already skewed in a direction that makes life more challenging at the levels we're talking about. Did I hear that correctly? Because that one in 12 is not a small number. It's not a small number. It fits with what I see clinically. I mean, I want to see that data just to see what does that mean? And could you modulate it with environmental influences? But it certainly fits with what I see.
这就是我们在受过创伤的兽医以及其他人身上看到的模式。这与自身免疫性疾病、纤维肌痛相关。我听说大约每12个人中就有一个人是杂合子，即在肾上腺相关基因中拥有一份突变拷贝或高表达的基因。那么先天性肾上腺增生是真的吗？如果是的话，那意味着每12个人中就有一个成天产生过多的皮质醇或者皮质醇不足，或者皮质醇系统已经倾向于某种方向，使我们所谈论的水平更具挑战性。我听对了吗？因为这12中的一个并不是一个小数目。这不是一个小数目。这符合我的临床观察。我想要看到数据以了解这意味着什么？能不能通过环境影响来调节它？但它确实符合我所见到的情况。
I was taught once again in mainstream medicine that in terms of adrenal function, it's very binary how most clinicians think about it. You either have Addison's disease and you don't make enough cortisol or you've got cushings or crocheting-wood pattern and you make too much cortisol. And anything in the middle is normal. And my experience is that, hell no. Like those of us like me who make a lot of cortisol, I don't have cushings. Maybe I've got one of these, I wouldn't call it a mutant gene, I would call it more of a vulnerable gene. So maybe I have one of those. Maybe that's part of the reason why I make, you know, two to three times what I should be. I'm aware of certain groups of individuals from within the military sector that have, there's a more frequent occurrence of some mutation in CH, congenital adrenal hyperpension, not necessarily two copies, which if people look that out, they're going to go, oh wow, there's all these phenotypes. But sort of hypomorphic type things, so you don't lessen or too much cortisol.
在主流医学中，我曾再次学到，就肾上腺功能而言，大多数临床医生都非常二元地思考。你要么患有艾迪生氏病，肾上腺皮质功能不足而无法产生足够的皮质醇，要么患有库欣病或克林顿-伍德综合征，产生过多皮质醇。而处于中间的任何情况都被认为是正常的。但我的经验是，绝对不是这样。像我这样产生大量皮质醇的人，并不一定患有库欣病。也许我拥有某种 基因异常，我不会称之为变异基因，更愿意称之为易感基因。也许我就是其中之一。也许这就是我产生两到三倍皮质醇的原因之一。我知道军事部门的某些群体中，患有CH（先天性肾上腺高血压）突变的频率更高，不一定是双倍子，如果人们了解了这种突变，他们会说，哇，这些表型真多。但有些是缺损性变异型，所以无法产生或产生过多的皮质醇。
And they are very good at staying up multiple days per night, multiple nights in the series. So they can pull all nighters very easily, they can push harder when most people would quit. And everyone thinks, well, that's a great phenotype to have. But guess what? It's because they hyper produce cortisol. And so that's interesting. And I think if we were to panel medical students and graduate students, and you were looking at, you know, who's pulling excessively long hours, who stressed out a lot, even outside of academia and medicine, and pushing, pushing, pushing really hard, I think the ability to push and not crash, we think of it as adaptive, but in some sense, it's maladaptive over a series of years, which is sort of what you described earlier.
他们非常擅长连续多天熬夜，连续几晚不睡觉。所以他们可以轻松地熬夜，他们可以在大多数人会放弃的时候继续努力。每个人都认为，这是一种很棒的表型。但猜猜呢？这是因为他们超产皮质醇。这是很有趣的。我认为如果我们调查医学生和研究生，看看谁工作时间过长，谁压力过大，甚至在学术和医学之外，不断努力，不断推动，我认为能够持续努力而不崩溃的能力，我们认为这是适应性的，但在某种程度上，这在一系列年份里是不适应性的，这是您之前描述的情况。
Yeah, it's such a good point because, you know, in some ways you want to select for that in certain professions, like in the military, like in medicine. But I would wonder for those folks about the downstream consequences of producing so much cortisol, it's got to be detrimental for their health in the long run. And you see that. But even the data shows that if you're someone like me who makes a lot of cortisol, higher rates of depression, like 50% of people with major depression have high cortisol levels, higher rates of suicide, much more metabolic dysfunction.
是的，这是一个很好的观点，因为你知道，在某种程度上，你希望在某些职业中选择这种特质，比如军队、医学。但我会对那些产生大量皮质醇的人担心，这必定对他们未来的健康有害。你会看到这点。但即使数据显示，像我这种产生大量皮质醇的人，抑郁症的发病率更高，像50%的重度抑郁症患者体内有高水平的皮质醇，自杀率更高，代谢功能更差。
We know that trauma as an example, maps to an increased risk of glucose, metabolism issues, and certainly high cortisol does that because it's one of the jobs of cortisol is to manage glucose. And it kind of sets you up for this one number five, which is toxic relationships. You know, someone who hyper produces cortisol, it's hard to live with someone like that. It's also, I would say, people that have this, let's just call it biological resilience. It's not always adaptive because you can stay in bad circumstances longer.
我们知道，创伤比如，会增加葡萄糖代谢问题的风险，当然高皮质醇也会引起这种情况，因为皮质醇的工作之一就是管理葡萄糖。这种情况会导致你面临毒性关系这一问题。你知道，与那些过度产生皮质醇的人一起生活是很困难的。而且，我想说，那些具有生物韧性的人，这并不总是适应性的，因为你可能会在糟糕的环境中待更长时间。
The ability to crash provided it's not suicide or life, life destroying or, you know, long arc of pause and the requirement to take two years off from work or school or something. The ability to keep pressing on is a double edged sword. I want to make sure in staying within this conversation, because you mentioned phosphoryl serine, we talked about rhodiola, razaysia, we talked a bit about ashwagandha. You've also talked about omega threes and fish oil in particular. I'd love to know your favorite sources of these.
可以崩溃的能力，只要不是自杀或毁灭性的，你知道的，或者需要从工作或学校或其他地方休息两年。坚持下去的能力是一把双刃剑。我想确保在这个对话中保持一致，因为你提到了磷酸丝氨酸，我们谈到了鹿茸、拉津西亚，我们也聊了一点儿印度女人参。你还谈到了欧米茄三和鱼油。我想知道你最喜欢这些的来源是什么。
I think nowadays there's more general acceptance that getting these essential fatty acids is important. Do you have a threshold level of sort of grams? I've encouraged podcast listeners to consider, depending on what they're eating, to try and get a gram of EPA or more per day. Does that seem excessive? And what are the real data on EPA's? Because then the cardiovascular experts always hit back and say, oh no, it's not good for cardiovascular health. And then you go, oh, it's better than antidepressants and other studies. And they go, no. So I feel like if you really want to make your life difficult, you want to raise your cortisol, you go on Twitter and you say something positive about omega threes and fish oil. And you learn a lot. What are your thoughts on omega threes? I take a lot of them. I've always been a big fan. Yeah. So this is where I personalize. I think some people need more than others.
我认为现在更普遍接受的观念是摄入这些必需脂肪酸很重要。你有一定克数的阈值吗？我鼓励播客听众考虑，根据他们的饮食，尝试每天摄入一克以上的EPA。这看起来是否过量？关于EPA的真实数据是什么？因为心血管专家们总是反驳说，哦不，对心血管健康不好。然后你会说，哦，比抗抑郁药更好，还有其他研究支持。他们又会说，不是。所以我觉得如果你真的想让生活变得困难，你可以在Twitter上说些关于欧米茄-3和鱼油的积极的话。你会学到很多。你对欧米茄-3有什么看法？我摄入很多。我一直是一个忠实的粉丝。是的。这就是我个人化的看法。我认为有些人可能需要比其他人更多。
And what I do is I measure your level. So this gets back to nutritional testing. So for you, I would suggest an omega quant or one of my favorite cardi metabolic panels is to do a Cleveland heart lab. So I think they give me the most reliable information, not just for lipids and subclasses and, you know, NMR fractionation, but it also gives me an insulin resistance score. It gives me levels of omega threes. Right. We'll provide links to these different sites so that people, but one quick thing about that, the whole story is not omega threes in taking fish oil. So the work of Charlie Serhan at the Brigham is showing that the way that we resolve inflammation, our understanding of it is really, I think, in the learning to crawl stage. And so if you look at the omega threes six pathway in the body, fish oils can help, you know, kind of push the reactions in a particular direction. But typically, they're not enough for the resolution of inflammation.
我所做的是测量您的水平。这与营养测试有关。针对您，我建议进行Ω三脂肪酸检测，或者我的最喜欢的心脏代谢面板之一是克利夫兰心脏实验室。我认为它们提供的信息最可靠，不仅包括脂质和亚类以及核磁共振分级，还包括胰岛素抗性得分，Ω三脂肪酸水平。我们将提供这些不同网站的链接供大家参考，但关于这一整体故事，不仅仅是摄取鱼油中的Ω三脂肪酸。Brigham的查理·塞罕的研究表明，我们解决炎症的方式，我们对其的理解真的处于学步阶段。因此，如果看看人体中的Ω三, Ω六途径，鱼油可以帮助将反应推向特定方向。但通常，这些并不足以解决炎症。
Now, what most people do, including my NBA players, is they pop an ibuprofen or something like that when they've got inflammation, that's got lots of other side effects that are not so good for you. And we know in terms of the resolution of inflammation that taking something like ibuprofen reduces the amplitude of inflammation by about 50%, but then it potentially blocks the complete resolution of inflammation. So there's these new supplements that you may have heard of called specialized pro-resolving mediators. There's a lot of different supplement companies that make them. And that combined with fish oil seems to be the best combination.
现在，大多数人，包括我的NBA球员，遇到炎症时会吃布洛芬或类似药物，但这些药物会有许多其他对健康不利的副作用。我们知道，使用布洛芬等药物可以减轻炎症的程度约50％，但它也有可能阻碍完全解决炎症的过程。因此，现在有一种新的补充剂，称为专门的解炎介质。有许多不同的补充剂公司生产这种产品。结合鱼油一起使用似乎是最佳组合。
And what I do for athletes who've got, you know, kind of the normal aches and pains of the training load they have is all combine a little aspirin, small dose, just like 81 milligrams or two of those baby aspirin together with fish oil plus specialized pro-resolving mediators. And there's some that are NSF, they're certified for sports. But the dose, I would say with my patients, some of them only need a thousand milligrams, your gram that you mentioned for the population. Some of them need six grams together with spams. So I think it has to be personalized. How young is it okay for people to start taking omega-3s? For instance, young women in their teens, when they're 20s and their 30s, young guys in their 20s and 30s, should they take fish oil? If just as a, assuming they're not going to get anything tested.
对于那些受训练负荷带来一般的疼痛和不适的运动员，我会给他们组合一点阿司匹林，剂量很小，比如81毫克或两片婴儿阿司匹林，再加上鱼油和特定的解析介质。有一些是NSF认证的，适用于运动员。但我会告诉我的病人，一些人可能只需要1000毫克，也就是你提到的1克，有些人可能需要6克，还要加上痙攣。所以我觉得用量必须个性化。多大年纪的人开始服用欧米茄-3是安全的呢？比如十几岁和二十多岁的女性、二十多岁和三十多岁的男性，他们应该服用鱼油吗？假设他们不会进行任何检测。
I'm thinking about the college student who is really into biomarkers and that sort of thing will go due to some of this. But many people won't, but they want to do the right thing. So they'll try and drink a little less, hopefully, hopefully they won't smoke or vape. Please don't smoke or vape. The idea that vaping is okay, it's like we had it all up so it's so bad, so bad for everything we're talking about. Let's end that chapter. Exactly. So just, you know, they hopefully they'll try and avoid those things. Hopefully they'll avoid hard drugs. Hopefully they'll avoid getting any STIs if they do that will resolve them quickly, hopefully. Yes.
我在想那些热衷于生物标志物等方面的大学生将会因为这些原因而前进。但很多人不会这样做，但他们想做正确的事情。所以他们会尽量少喝一点，希望他们不会吸烟或者吸电子烟。请不要吸烟或者吸电子烟。认为吸电子烟没事，就像我们把所有的问题都藏起来一样，这对我们谈论的一切都很糟糕。让我们结束这一章吧。没错。所以他们希望尽量避免那些事情。希望他们能避免吸毒。希望他们能避免感染性病，如果感染了希望他们能尽快解决。是的。
So, but they might say, oh, well, okay, I'm willing to, you know, take some magnesium or take some phosphodilic earring, buffer my cortisol, eat some vegetables. Should they consider taking fish oil as a kind of a cross the board and oculatory thing? So I'd like to rank order these. I would say fish oil, yes. I think a thousand milligrams is a general recommendation is good, but I also have a food first philosophy. So my preference would be that they're having salmon or some kind of smashed fish and they're getting that as the primary source of their omega threes. And then the days that they don't have fish, I recommend it probably twice a week that they take fish oil. Then I would put magnesium next since so many people are deficient. Then I'd probably put vitamin D. What, how many are you vitamin D per day? Well, you keep asking me this, like for the population.
因此，他们可能会说，哦，好的，我愿意，你知道，服用一些镁或者磷脂耳环，稳定我的皮质醇，多吃一些蔬菜。他们是否应该考虑服用鱼油作为一种全面的营养补充品呢？所以我想对这些进行排名。我会说鱼油，是的。我认为一千毫克是一个良好的一般建议，但我也有“食物优先”的理念。所以我更倾向于他们吃鲑鱼或者一些其他种类的鱼，以此作为他们的欧米伽三脂酸的主要来源。然后在没有吃到鱼的那些天，我建议他们每周大概服用两次鱼油。接着我会把镁列在其次，因为很多人缺乏镁。然后我可能会推荐维生素D。嗯，每天需要摄取多少维生素D呢？嗯，你一直在问我这个问题，对于人群而言。
Yeah. Well, for the, let me put it this way. For the lazy person or, and this is an or, not an or the person who just doesn't have the finances to go get measures and levels measured because in our audience, there's a huge range. We've got people who can have tons of disposable income that listen to this, but we have people have no disposable income. So a thousand to two thousand international units, but my, you know, what I do is I dose to a serum level that's between about 50 and 90. Great. And so I have a vitamin D receptor uh, SNP. And so I need to take about five thousand a day to get to what I need. A lot of people don't need that. And you know, there's some supplements that I don't know if they need.
是的。嗯，对于那些懒惰的人，或者，这是一个或者，并不是一个必须出于财务原因去做测试和测量的人，因为在我们的听众中，有一个很大的范围。我们有很多有很多闲钱的人在听，但也有一些没有多余收入的人。所以国际单位是一千到两千，但我，你知道，我按照血清水平来用药，大约在50到90之间。很好。所以我有一个维生素D受体的SNP。所以我需要每天服用五千。很多人不需要那么多。你知道，有些补充剂我不确定他们是否需要。
So you mentioned phosphatidylserine for someone who's a college student and their cortisol is completely normal. They're wasting their money on PS. They don't need it. They might need it later, but they don't need it now. I'd like to make sure that we circle back to birth control in particular oral contraceptive birth control. And we should touch on IUDs, perhaps a little bit more. But what are your thoughts on sort of pure estrogen birth control is what I learned when I was in college is that birth control is basically tonic estrogen. So constantly taking estrogen and estrogen women are taking estrogen so that they don't get the estrogen priming of progesterone. You're not getting any ovulation. And I've known women that have been taking oral cont- or that took oral contraception as like estrogen pills basically for five, 10, 15 years.
所以你提到过磷脂酰丝氨酸对于一个大学生来说，他们的皮质醇完全正常。他们在PS上浪费了金钱。他们不需要它。也许以后会需要，但现在不需要。我想确保我们回到避孕，特别是口服避孕药方面。我们也应该更多地谈谈IUD。但你对纯雌激素避孕药有什么想法？我在大学时学到的是避孕药基本上是雌激素。所以不断地摄取雌激素，女性摄取雌激素是为了避免雌激素激活黄体素。你不会有排卵。我认识有些女性已经服用口服避孕药，基本上是雌激素片剂，已经有五年、十年、十五年。
Are there long term consequences of this as it relates to pregnancy, PCOS, menopause, what if so, what are some of those consequences? What are your concerns? What do you like about oral contraceptives? What do you dislike about them? I like how balanced you asked that question. So women who take oral contraceptives as long as you're describing like 10 years or longer, we call those Olympic oral contraceptive users. In terms of benefit, I think that especially when they first came out and even now, it gives women reproductive choice. And that's essential. As you may know, a reproductive choice has been declining recently.
这与怀孕、多囊卵巢综合征、更年期有长期后果吗？如果有，有哪些后果？你关心什么？你喜欢口服避孕药的哪些方面？你不喜欢它们的哪些方面？我很喜欢你问这个问题的方式。所以，长期服用口服避孕药的女性，比如描述中的10年或更长时间，我们称之为奥运口服避孕药用户。在好处方面，我认为特别是在口服避孕药刚问世时，甚至现在，它给予了女性生育选择权。那是必不可少的。正如你可能知道的，生育选择权最近一直在下降。
So I'm a big fan in that regard and we've got a lot of data to show both the risks and also the benefits of it. So I'll speak first into the benefits because I'm going to get on a sub box a little bit about the risks. So we know that it reduces the risk of ovarian cancer. So there's something about this idea of incessant ovulation that is not good for the female body. So if you look at, for instance, women who are nuns, who don't take oral contraceptives and they have a period every single month of their reproductive lives, they have a greater risk of ovarian cancer. So if you look then at women who have several babies and they've got a period of time when they're pregnant that they're not ovulating and then they breastfeed for some period of time, they have a lower risk of ovarian cancer.
因此，就这一方面我是一个忠实的支持者，我们有很多数据来展示它的风险和好处。所以我先来谈谈好处，因为接下来我会稍微提一下风险。我们知道避孕药可以降低患卵巢癌的风险。有关无休止的排卵对女性身体不利的观点。例如，看看那些终身未婚或未用口服避孕药的修女，她们每个月都会有一次生理期，卵巢癌的风险更高。相比之下，看看那些有多个孩子的女性，在怀孕期间由于不排卵，并且哺乳一段时间后，她们患卵巢癌的风险更低。
So oral contraceptives help with reducing ovulation and reducing risk. We know that if you take the oral contraceptive for about five years, it reduces your risk of ovarian cancer by 50%. And that's significant because we're so poor at diagnosing ovarian cancer early. There's really no method that's really effective. We use CA125 and ultrasound screening, especially in women who are at greater genetic risk. But even that, often we diagnose it in a later stage. Maybe just because that statement is going to highlight for a number of people, the question of what are some of the earliest symptoms that people can recognize without a blood test?
口服避孕药有助于减少排卵和减少风险。我们知道，如果您服用口服避孕药大约五年，那么您患卵巢癌的风险将减少50％。这很重要，因为我们对早期诊断卵巢癌的效果非常有限。目前没有方法真正有效。我们使用CA125和超声筛查，特别是对那些患有遗传风险的妇女。但即便如此，我们经常在晚期诊断出它。也许这个说法会引起一些人关于早期症状是什么以便在没有进行血液检查的情况下能够识别的问题。
So is ovarian cancer, is it going to be pain? So the problem is the symptoms are so big and they're so non-specific. One of the most common symptoms is bloating. And we've already talked about constipation. We've talked about how women have this longer track GI track. And so bloating is a really common experience for most women. You can have bulk symptoms. Feeling like your lower belly is kind of pressed out. So the way that we inform women in terms of watching for this is to get regular gynecologic exams for women who are at high risk, where they have, for instance, an ultrasound for some reason, it shows a mass that we're concerned about. There's a way to triage that in terms of what kind of evaluation that they need. And that's a situation where you might get a blood test called the CA129. CA125.
那卵巢癌是疼痛吗？问题是症状非常丰富且非特异性。其中最常见的症状之一是腹胀。我们已经谈过了便秘。我们已经讨论了女性拥有更长的消化道。所以对大多数女性来说，腹部胀气是一种常见体验。你可能会出现体积大的症状。感觉下腹部被按压出来。我们告诉女性要定期接受妇科检查，特别是高危人群，例如如果超声波显示出令我们担忧的肿块。我们可以根据情况对需要进行何种评估进行分级。这种情况下，可能会进行一种血液检测称为CA125。
Yeah, the problem is the symptoms are so vague. It depends on how big the tumor is, how much bulk you have, what it's pressing on. So if taking estrogen and thereby reducing the frequency of ovulation lowers the risk of ovarian cancer, should women that are even women who are not sexually active, so they're not actively trying to get pregnant or avoid getting pregnant. But if they're not sexually active, then the probability of conceiving unless they go through some IUI or some other route is very low, as far as I know. So I was taught in high school anyway. Would they be wise to suppress ovulation for periodically using hormone-based contraception just so that they can offset the risk of ovarian cancer? That's a very rational question, and I would say that's what mainstream medicine has had at its back to recommend oral contraceptives, not just for women who are seeking contraception, but for acne, for painful periods, for really kind of the drop of a hat, they're prescribing oral contraceptives. That's what I was taught to do. But there are so many consequences, and I think the issue here is more about consent, because in OBGYN, and I started out as a board certified OBGYN, and I now mostly see men, but I was taught as an OBGYN to convince women to go on the oral contraceptive, and I think a lot of that is pharmaceutical influence. So maybe we could talk about the risks and why the answer is no to your question. As we do that, could I just ask, is the so-called the ring, it used to be called the new for ring. Maybe that's a brand name, but when I was in college, there was always discussion about the ring, by both men and women for reasons that don't belong on the podcast. Use your imagination, folks. So the ring, obviously, it's not oral hormone contraception, but it's hormone based. The ring is releasing estrogen locally as opposed to taking it orally, but would you would you slot it under what you're about to tell us in terms of the concerns?
是的，问题在于症状很模糊。这取决于肿瘤有多大，你有多少体重，还有它压迫到了什么地方。因此，如果服用雌激素并因此减少排卵频率可以降低患卵巢癌的风险，那么即使不是性活跃的女性，她们也应该这样吗？因为她们并没有积极尝试怀孕或避免怀孕。但是如果她们不是性活跃的，那么我知道，除非她们进行某种人工授精或其他方法，怀孕的机率是非常低的。所以，我在高中时被教导的。为了抵消患卵巢癌的风险，她们是否明智地应定期抑制排卵，使用基于激素的避孕措施？这是一个非常理性的问题，我认为这就是主流医学一直在背后建议口服避孕药，不仅适用于寻求避孕的女性，还适用于治疗痤疮、减轻疼痛经期的女性，实际上只要一有机会，就会开处方给女性口服避孕药。我被教导就是这样做的。但是会有很多后果，我认为问题更多的是关于同意，因为在妇产科学，我一开始是一名获得认证的妇产科医生，现在我主要看男性，但是我被教导为了说服女性服用口服避孕药，我认为很多是受到制药公司的影响。所以也许我们可以讨论一下风险以及为什么对你的问题的答案是否定的。在我们这样做的同时，我可以问一下，所谓的环状避孕器，它曾被称为新环。也许这是一个品牌名字，但我在大学时，经常听到男性和女性讨论环状避孕器，原因不适合在播客上谈论。大家来想象一下。所以环状避孕器显然不是口服激素避孕药，但是以激素为基础。环状避孕器在局部释放雌激素，而不是口服摄入，但您是否会在即将告诉我们的问题中加以考虑它的疑虑？
So we have less data about the ring. So the oral contraceptive is two hormones. It's eponal estrogen, and it's a progestin. So it's not the normal progesterone that your body makes, that your ovaries make, and your adrenals make. It is a synthetic form of progesterone, and it is the same progestin, similar, same class that was shown to be dangerous and provocative in the Women's Health Initiative. So I'm not a fan of progestins. I do not recommend them for any woman, unless the consequence of not taking them is surgery or some other, unless it gives them some freedom in some way. So I don't like progestins. The new for ring is estrogen plus progestin, but it's released transdermally through the vagina. So given the way that it's delivered to the vagina, the doses are lower than what's taken orally. But in terms of some of the risks that I'm about to talk about, we don't know about much of the data. We think that it's similar. There's probably a spectrum of risk, and the new for ring is a little more towards the middle than what I'm talking about with oral contraceptives
因此，关于环内避孕环的数据较少。口服避孕药是由两种激素组成的。它含有雌激素和孕激素。它不是你的身体、卵巢和肾上腺产生的正常黄体激素。它是一种合成孕激素，与在妇女健康倡议研究中被证明危险和具有刺激性的同类孕激素不同。因此，我不喜欢孕激素。我不建议任何女性使用它们，除非不服用会导致手术或其他后果，除非它在某种程度上为她们带来了一些自由。我不喜欢孕激素。环内新型避孕环是含有雌激素和孕激素的，但是通过阴道皮肤透过释放。考虑到给予阴道的方式，其剂量比口服的要低。但就我将要讨论的一些风险而言，我们了解的数据并不多。我们认为它类似。可能存在一定风险的范围，而新型环内避孕环在这个范围中略微靠近中间，而不像口服避孕药那样。
Are you ready for that? Yeah, I'm ready for the risks. Okay. So like with almost any pharmaceutical, the oral contraceptive depletes certain micronutrients. So magnesium, there's certain vitamin Bs that are depleted. It also affects the microbiome. That data is not as strong, but there seems to be some effect and there's also an increased risk of inflammatory bowel disease and autoimmune condition. It increases inflammatory tone. So the studies that I've seen increase one of the markers of inflammatory tone high sensitivity CRP by about two to three X. It seems to make the hypoflamic pituitary adrenal axis more rigid so that you can't kind of roll with the punches and wax and wane in terms of cortisol production the way that you can off the birth control pill. It can affect thyroid function.
你准备好了吗？是的，我已经准备好面对风险了。好的。就像几乎所有药物一样，口服避孕药会消耗某些微量营养素。例如镁，某些维生素B也会被消耗。它还会影响肠道微生物组。虽然这方面的数据不够强有力，但似乎有一些影响，同时还会增加患炎症性肠疾病和自身免疫疾病的风险。它会增加炎症状态。据我所看到的研究，会将炎症状态的一个标志物hs-CRP提高约两到三倍。它似乎使下丘脑垂体肾上腺轴更加僵化，以至于无法像在避孕药之外那样灵活地应对和调节皮质醇的产生。它还会影响甲状腺功能。
I'm thinking of the slide that I have that has like 10 problems assisted with oral contraceptive, but that's what I can remember right now. That's very helpful. And it makes me wonder whether or not if on the one hand oral contraceptives are protective in women, it's ovarian cancer, but then they have these other issues. Yeah, there's one other I want to mention. Please. Anytime you take oral estrogen, it raises sex hormone binding globulin. And you've talked to other podcasts guests about this, Kyle, I think sex hormone binding globulin, I think of it as a sponge that soaks up free estrogen and free testosterone. So when you go on the birth control pill, you raise your sex hormone binding globulin. It soaks up especially free testosterone. And for some women, it's not a big deal. They don't notice much of a difference. But then there's a phenotype maybe related to CAG repeats on the androgen receptor who are exquisitely sensitive to that decline in free testosterone.
我在想的是我有一个幻灯片，上面有10个问题涉及口服避孕药，但这是我现在记得的。这对我非常有帮助。这让我想到一方面口服避孕药对女性的卵巢癌有保护作用，但另一方面又有其他问题。是的，还有一点我想提一下。请讲。每次服用口服雌激素，都会提高性激素结合球蛋白。你和其他播客嘉宾讨论过这个问题，凯尔，我认为性激素结合球蛋白，我认为是一个吸收游离雌激素和游离睾酮的海绵。所以当你服用避孕药时，你会提高你的性激素结合球蛋白。它尤其吸收游离睾酮。对一些女性来说，这并不是什么大问题。她们并没有注意到有太大的不同。但是，可能与雄激素受体上的CAG重复相关的表型，对那些对游离睾酮下降异常敏感的人来说问题很大。
So this then opens the portal of talking a little bit about testosterone and women. So we've mentioned already that it's the most abundant, biologically the most abundant hormone in the female system, even though men make almost 10 times as much or even more than 10 times, it is so important for women. It is essential to so many things, not just sex drive and muscle mass and seeing a response to resistance training, but also confidence and agency. And so those women who are so sensitive to their testosterone level, they've got this high sex hormone by nicholobulin, their testosterone declines. What they describe is vaginal dryness, maybe a decline in sex drive.
这样一来，就可以稍微谈谈关于女性的睾丸激素。我们已经提到过，尽管男性产生的雄激素几乎是女性的10倍甚至更多，但它在女性体系中是生物学上数量最丰富的激素。它对女性非常重要。它对很多事情都是必不可少的，不仅仅是性欲、肌肉量和对抗性训练的反应，还包括自信和自主权。所以那些对自己的睾丸激素水平非常敏感的女性，当她们的睾丸激素下降时，会出现阴道干燥，可能会有性欲下降的情况。
But there's also this bigger issue related to confidence and agency, even risk taking from studies that we've done with MBA students that I think is a serious problem. Maybe the most important out of all of these things is that it can shrink the clitoris by up to 20%. 20%. And that includes the regression of the nerves that innervate the clitoris. That's a very good question as a neuroscientist. Yeah, I would think used to teach the neural side of reproductive health. We need to do a series on sexual health. Maybe you would co-host that with me. We could certainly use your expertise.
但还有一个与自信和行动能力有关的更大问题，甚至涉及到我们与MBA学生进行的研究中所做出的风险承担。我认为这是一个严重的问题。也许所有这些问题中最重要的一点是，它可以使阴蒂缩小高达20%。20%。这包括支配阴蒂的神经的退化。这是一个非常好的问题，作为一名神经科学家。是的，我曾经教授过生殖健康的神经方面的课程。我们需要进行一系列关于性健康的节目。也许你可以和我一起担任主持人。我们肯定可以用到你的专长。
I think, yeah, that's a dramatic number. Yeah, but then let's go back to this sacred marketing. If I've got a woman that I think should not be on the birth control bill, maybe she's taking it for acne or taking it because her periods were a little painful. What I'm going to do is say, let's leverage these other ways of making your period less painful. Let's take the message of your painful periods and figure out, okay, it's that you're inflammatory tone. And we give you some fish oil and SPMs, maybe a little aspirin when you've got your period. Like, let's find some other ways to deal with it. Then to take the oral contraceptive, which you have not received informed consent about because it can shrink your clitoris by up to 20%. Now that usually convinces most people to come off it. Is that reversible? The elevation in sex hormone binding globulin does not seem to go away when you come off the birth control bill. To me, that is the biggest problem with prescribing oral contraceptives. Now, the data that we have is limited. There's one woman who Claudia, something, something who looked at sex hormone binding globulin a year out from stopping the birth control pill.
我觉得，是的，那个数字是令人震惊的。但让我们回到这个神圣的营销上。如果我有一个女性，我认为她不应该服用避孕药，也许她是因为痘痘或者经期有点痛而服用的。我会说，让我们利用其他方法来减轻你的经痛。让我们找出你经期疼痛的原因，也许是因为你的炎症反应过高。我们给你一些鱼油和SPMs，或者在经期时服用一点阿司匹林。让我们找到其他处理方法。而不是服用口服避孕药，因为你没有得到知情同意，它可能会使你的阴蒂缩小多达20%。通常这会说服大多数人停止使用它。这个是否可逆？停止服用避孕药后，性激素结合球蛋白的升高似乎不会消失。对我来说，给予口服避孕药处方的最大问题就是这个。现在，我们所拥有的数据有限。有一个名叫克劳迪娅的女性，她研究了停止服用口服避孕药后一年内的性激素结合球蛋白的情况。
And it was still elevated. It wasn't as high as it was when they were on the pill, but it was still elevated. So your question about reversibility? I don't know if we know the answer to that. Wow. Okay. That's a significant statement and something for consideration. Related to this, although this might seem not related, it is. How early do you recommend that women go get their follicle number assessed? In other words, to get a sense of the size of the ovarian reserve and their AMH levels measured? I'm an amateur outsider, as I say this, but we have an episode on fertility, where I just described the ovulatory menstrual cycle. Yeah. I'm not the best person to answer that. Yeah. Well, we can- I'm too far out from it. Okay. Well, I suppose then from taking the perspective of somebody who thinks about fertility, in terms of at least congruent with vitality and longevity, given that it's fairly non-invasive, it's an ultrasound or a blood draw for AMH, or both, is there any reason why a woman would not want to get her follicle number assessed or her AMH levels assessed? Is there any reason why? Because I was shocked to learn that most women don't do this until they're hitting their late 30s or early 40s and they either haven't conceived or they suddenly decide that they want to conceive.
并且这个值仍然升高。虽然没有像服用避孕药那样高，但仍然升高。所以关于可逆性的问题？我不知道我们是否知道答案。哇。好的。这是一个重要的观点，值得考虑。与此相关的，尽管这看起来可能与此无关，但实际上是有关的。您建议女性多早去检查她们的卵泡数量？换句话说，了解卵巢储备情况和测量她们的AMH水平？我是个门外汉，但我们有一集关于生育的节目，我在那里描述了排卵月经周期。是的。我不太适合回答这个问题。是的。我们可以-我已经离这个太久了。好吧。我想至少从一个关注生育问题的人的角度来考虑，考虑到它相当无创，通过超声或者抽血检查AMH水平，或者同时进行两种检查，有没有任何理由女性不想要检查自己的卵泡数量或者AMH水平呢？有没有任何理由？因为我惊讶地发现大多数妇女在三十多岁甚至四十岁之前并没有做这种检查，要么是因为她们没有怀孕，要么突然决定要怀孕。
And I thought, why doesn't every doctor insist that their female patients have their AMH level addressed so that if they need to freeze eggs- It's caused. Yeah. So I think if you've got the disposable income to do it, go for it. It's not included in a standard blood panel. No. Wow. The only women in my practice who've had AMH has done and have looked at their follicle count are women who want to freeze their eggs or in that requires disposable income or they are having trouble getting pregnant. So they are in the reproductive endocrinology system and they're getting an evaluation. And then they're also the women who have symptoms of early menopause. So premature ovarian insufficiency, which is before age 40, those are the women that I see getting tested.
我想，为什么不是每个医生都坚持让女性患者检查她们的抗微精子蛋白（AMH）水平，这样如果她们需要冷冻卵子的话，就可以尽早处理。是的。所以我认为如果你有多余的收入，就去做吧。这不包含在标准血液检查中。哇。在我的诊所里接受抗微精子蛋白（AMH）检查和查看卵泡计数的唯一女性患者是那些想要冷冻卵子，或者具备多余收入的，或者遇到怀孕困难的女性。所以她们就在生殖内分泌系统中，接受评估。然后还有那些出现早期更年期症状的女性，即40岁之前发生卵巢功能不全的女性，这些是我见过接受检测的女性。
And I think you're right that it should be offered more broadly. It speaks to the democratization of data again. And I think most women don't know that. So you're doing a huge service, I think, to be speaking into this. One other point related to that is that what I see in conventional medicine is that when a woman asks for a hormone panel and she's not trying to get pregnant, she usually gets told that hormones vary too much. It's a waste of money. You don't need it. Or if you're feeling hormonal, when it should go on a birth control bill. Unless she's trying to get pregnant. If she's trying to get pregnant, suddenly those same tests are very reliable. And they get, you know, their test ossarone, their free test ossarone, their thyroid panel, they get their estrogen and progesterone, maybe they get their cortisol, they get their AMH. So there's a double standard between those who want to get pregnant and those who don't. And that needs to end.
我认为你说得对，这个应该更广泛地提供。这再次涉及到数据的民主化。我认为大多数女性并不知道这一点。所以我认为你在这方面所做的贡献是很大的。另外一个相关的观点是，我在传统医学中看到的情况是，当一个女性要求进行激素检查但不是想怀孕时，通常会被告知激素变化太大，是浪费钱的，不需要进行检查。或者如果她感到激素失调，就应该开始避孕药物。除非她想怀孕。如果她想怀孕，突然间这些相同的检查就变得非常可靠了。她们会做睾酮、游离睾酮、甲状腺、雌激素和孕激素、皮质醇、AMH等检查。所以在想要怀孕和不想要怀孕的人之间存在着双重标准。这种情况需要结束。
Yeah, I totally agree. As I've learned more about ovulatory cycle and AMH and the entral population of follicles, it's fascinating. It just seems to me, wow, relatively straightforward test, one definitely invasive ultrasound. But- I don't consider that. Yeah, not terribly invasive, but invasive, at least, but the other one just pure blood test. It just seems like why wouldn't I would this be offered or covered by insurance or that anyone that wanted it. But now I understand why. You mentioned menopause. Huge topic, enormous topic. We had a guest on the podcast who's not a clinician who said something in passing. So I want it, I'm likely to get this wrong. But what they said was that the results of the large scale trials on hormone replacement therapy for women for menopause said something to the effect of if the hormone therapy was started early enough, it was very beneficial for vitality and health outcomes. Whereas if women went through menopause and then initiated the hormone therapy, hormone replacement therapy, that it could be detrimental to their health. So first of all, do I recall that statement correctly? And then second of all, what sorts of hormones are being replaced? Is it just estrogen and how is that done? Is it done through birth control? So oral contraceptives, new variants, what are your thoughts on menopause?
是的，我完全同意。随着我了解更多有关排卵周期、AMH和卵泡的中心人口的知识，我觉得这些都很有趣。在我看来，这只是一个相对简单的测试，一个肯定有侵入性的超声波检查。但是-我并不认为那个过于侵入性，至少是有侵入性的，但另一个只是一个纯粹的血液测试。我想知道，为什么这种测试或者检查不被提供或者被保险覆盖，或者为什么任何需要它的人不会得到提供。但现在我明白了原因。你提到了绝经。这是一个巨大的话题，一个庞大的话题。我们的播客上有一个来宾，不是临床医生，他顺便说了一句话。所以我想，我可能记错了。但他们说的是大规模试验有关维持女性绝经期激素替代疗法的结果显示，如果激素疗法开始得早，对健康和活力都是非常有益的。然而如果女性度过绝经期然后开始激素替代疗法，可能对健康有害。首先，我记得那句话正确吗？其次，什么样的激素被替代了？只是雌激素吗？这是如何完成的？通过避孕药吗？口服避孕药，新变体，你对绝经有什么看法？
When should people start thinking about it? And what is the palette of things available so that we can do an entire episode with you on this topic in the future? But just to- I get a lot of questions about this. And I'm guessing based on everything you've told me today that there are women in their 30s that while they may be 20 years out from menopause, probably should be doing things now in anticipation of that. Yes. So we haven't talked about the 30s something, but I totally agree with you. The more you know about your phenotype, your hormonal phenotype when you're in your 30s, you're set up in terms of what to do in the future, especially things like your thyroid, your estrogen and progesterone levels, because you can replace to a state of youth thyroid, whatever that is for you. You can replace- I don't usually go exactly back to where the estrogen and progesterone levels were, but we can get pretty close. So in your 30s having a base case, I think is really essential.
人们应该何时开始考虑这个问题呢？未来我们可以在这个主题上做一整集节目，可供选择的事情有哪些？我收到很多关于这个问题的提问。根据你今天告诉我的一切，我猜测30多岁的女性可能需要现在就开始做一些准备工作，尽管她们距离绝经还有20年。是的，在30多岁时我们还没有讨论，但我完全同意你的观点。了解自己在30多岁时的内分泌特征更多，可以为未来做好准备，特别是像甲状腺、雌激素和孕激素水平等因素，你可以通过替换来恢复年轻状态的甲状腺，无论对你来说是什么。我们可以接近替代，虽然我通常不会完全回到雌激素和孕激素水平曾经的状态。所以在30多岁的时候，拥有一个基准案例是非常重要的。
So you spoke to the Women's Health Initiative, which was published in 2002. And we went from a huge number of women taking hormone therapy to a very small percentage, like in the range of 5%. And that means we've got millions, millions of women who are suffering needlessly with things like insomnia, difficulty with their mood, difficulty with sex drive, feeling like they are closing the store in terms of sex, because they're not on hormone therapy. I would agree with the statement that you made that hormone therapy, particular forms that are similar to what your body always made when it's given judiciously at the right time, typically within 5 to 10 years of menopause, which is 51 to 52, that is incredibly safe. So it's a complicated study, the Women's Health Initiative, but it was the wrong study and the wrong patients with the wrong medications and with some of the wrong outcomes. So it was powered to look at cardiovascular outcomes. It was not powered to look at breast cancer. It was stopped because of breast cancer risk.
因此，你谈到了2002年发表的妇女健康倡议。我们从大量女性接受激素疗法的情况转变为非常小的百分比，大约5%的范围。这意味着我们有数百万女性不必要地遭受失眠、情绪困扰、性欲困扰等问题，感觉就像在性生活上关店一样，因为她们没有接受激素疗法。我同意你所说的那种激素疗法，特别是类似于身体一直产生的那种，如果在正确的时间得到恰如其分的应用，通常是在更年期的5至10年内，也就是51至52岁之间，是非常安全的。妇女健康倡议是一项复杂的研究，但它选择了错误的研究对象、错误的药物以及一些错误的结果。它的研究重点是心血管结局，而不是乳腺癌。由于乳腺癌风险，研究被中止了。
But what happened in the control arm of the study was that they had an incredibly low rate of breast cancer. And so as a result, they ended up having this increased risk of breast cancer at five years and they stopped the study. Now the study was done with synthetics. It was done with conjugated equine estrogen, known as pyrimerin, and medroxyprogesterone acetate. Those were the so-called estrogen and progesterone. Those are synthetic hormones. We think especially the progestion is associated with the greater risk of breast cancer. Although the subsequent reevaluations of the data, now 18 years out, have shown that this problem with the control group and no increased risk of breast cancer. And for the women who got estrogen only, those who had an esterectomy, the pyrimerin, they actually had a decreased breast cancer risk and decreased breast cancer mortality. So there's a lot to be said about this. I'm trying to keep it really brief. But if you look at the women 50 to 60, so within 10 years of menopause, they're the ones who seem to have the greatest benefit.
但是在研究的对照组中发生了什么是，他们患乳腺癌的发病率非常低。因此，他们在五年内患乳腺癌的风险增加，因此停止了这项研究。这项研究使用了合成激素，包括已知为偏脱雌酮的共轭雌马尿素（pyrimerin）和醋酸甲羟孕酮（medroxyprogesterone acetate）。这些就是所谓的雌激素和孕激素。我们认为特别是孕激素与乳腺癌风险增加有关。尽管随后对数据的再评估，现在已经达到18年，显示出了对照组存在的问题，没有乳腺癌风险增加。对于那些接受单独雌激素的女性，即行了卵巢摘除术的女性，偏脱雌酮，她们实际上乳腺癌风险和乳腺癌死亡率都降低。关于这一点有很多要说。我试着保持简洁。但是如果你看看50到60岁的女性，也就是在绝经后10年内的女性，她们似乎受益最大。
So they had decreased subclinical atherosclerosis, so less cardiovascular disease. They had an improvement in terms of bone health, less progression to diabetes. And then over the age of 60, they started to have greater risk of certain outcomes, such as cardiovascular disease, myocardial infarction, and so on. You asked about what do I do? And to me, this problem is not just menopause. What's more interesting is to talk about perimenopause. So perimenopause is the period of time before your final menstrual cycle. And for most women, depending on how it's tuned to you are to the symptoms, it can last for 10 years. So I'm still in period of time. It's been like 20 years because I've been tracking it so carefully. It usually gets kicked off by having your cycle get closer together.
因此，他们患有潜在动脉粥样硬化的几率降低，心血管疾病发病率也降低。骨骼健康有所改善，糖尿病的发展也减缓。但是当他们超过60岁后，某些结果的风险就会增加，比如心血管疾病、心肌梗死等。你问我应该怎么办？对我来说，这个问题不仅仅是更年期的问题，更重要的是要讨论围绝经期。围绝经期是你最后一个月经周期之前的时间段。对大多数女性来说，这一阶段可能会持续10年，取决于你对症状的敏感程度。我现在还处于这个时期。因为我一直在仔细追踪它，所以已经持续了20年。一般来说，最初的迹象是月经周期变得更加接近。
So that can happen in your 30s or your 40s. You go from 28 days to 25 days, that sort of thing. You may notice that you start sleeping more poorly because progesterone is so important. You talked about that with Kyle. You may notice it as more anxiety, difficulty sleeping, and that probably is related to the estrogen receptor. So your alpha is estrogen receptor. Alpha is angio. It increases anxiety. Your beta is associated with an anxiolytic activity. And then there's a total of about six estrogen receptors.
这可能发生在你的30岁或40岁时。你的月经周期从28天缩短到25天，类似这样的情况。你可能会注意到你开始睡眠质量变差，因为孕酮非常重要。你已经和凯尔谈过这个问题。你可能会感到更加焦虑，难以入睡，这可能与雌激素受体有关。你的阿尔法是雌激素受体。阿尔法会增加焦虑。你的贝塔与抗焦虑活动相关。然后总共大约有六种雌激素受体。
Now there's the G protein coupled estrogen receptors and those are mixed anxiolytic, anxiogenic. So there's this whole period of perimenopause. And what's most fascinating to me, and we've got to talk about this either today or another time, is that there is this massive, massive change that happens in the female brain that people are not talking about enough. And so looking at the work of Lisa Moscone at Cornell from starting around age 40, there is this massive change in cerebral metabolism. So you can do FDC PET scans. You can look at glucose uptake. And there's about, on average, a 20% decline from premenopause, you know, up to like age 35, to perimenopause, to postmenopause. The women who are having the most symptoms in perimenopause, menopause, the hot flashes, the night sweats, the difficulties sleeping. Those are the ones who have the most significant cerebral hypometabolism.
现在有G蛋白偶联雌激素受体，这些受体在焦虑和抗焦虑之间起到了平衡作用。在更年期前后有一个整个过程。对我来说最有趣的是，我们必须要讨论的是，女性大脑发生了巨大的变化，但人们对此关注不够。从大约40岁开始，看看康奈尔大学的丽莎·莫斯科尼的研究，女性大脑代谢发生了巨大的变化。你可以做FDC PET扫描，观察葡萄糖摄取量。平均而言，从更年期前到更年期和绝经期，脑部新陈代谢会下降大约20%。在更年期、绝经期时出现最多症状的女性，比如潮热、盗汗、睡眠困难，他们的大脑新陈代谢降低最为明显。
So it's almost like a, I don't want to scare people with this language, but it's a low level, or let's call it pseudo dementia of sorts. Yes, it seems to be a phenotype that you can then map to Alzheimer's disease, because that's Lisa Moscone's work. She's looking at, okay, Alzheimer's disease is not a disease of old age. It is disease of middle age. What are some of the biomarkers that we can define that can tell you what your risk is? I've got a mother and a grandmother with Alzheimer's disease. You can believe I am all over this data. An insulin resistance. Huge part of it. And sensitivity, as we talked about before, seems to be somewhere in there, which I think when that idea first surfaced, a few people like really, but then of course, right? I mean, the brain is just incredibly metabolically demanding organ. You deprive neurons of fuel sources, they, or you make them less sensitive to fuel sources. They start dying. They certainly start firing less. It makes perfect sense.
这就像是一种低级的，或者我们称之为伪痴呆症。是的，这似乎是一种表型，你可以将其映射到阿尔茨海默病，因为这是Lisa Moscone的研究结果。她在研究，阿尔茨海默病不是老年病，而是中年病。有哪些生物标志可以告诉你风险有多大？我有一个患有阿尔茨海默病的母亲和祖母。你可以相信我对这些数据了如指掌。胰岛素抗性。这是其中一个重要因素。敏感性，正如我们之前谈到的，似乎也在其中。我觉得当这个想法第一次被提出时，一些人确实很惊讶，但是当然，对吧？我是说，大脑是一个极其对新陈代谢需求高的器官。如果你剥夺神经元的燃料来源，它们就会死亡，或者你使它们对燃料来源不那么敏感。它们肯定会开始死亡。它们肯定会开始发射更少。这完全说得通。
And I think now it's, thanks to Lisa's work, work that you've done and talked about quite a lot is in your books and elsewhere. I think it's really highlighted for people that metabolism and metabolomics is going to be as important as genes and genomics when it comes to dementia. Perhaps especially in women, is it safe to say that? I think so, because we believe that the system is regulated by estrogen. So the decline in estrogen, starting around age 43, is kind of the average, seems to be the driver behind cerebral hypometabolism. The way I describe it to my patients is it's like slow brain energy. So you walk into a room, you can't remember why, like you just noticed that you can't manage all the tasks the way that you once could. Like, things are just a little slower. And I say that to women and they're like, I have that, like, help me.
我认为现在，多亏了丽莎的工作，你所做的工作并且在你的书籍和其他地方谈论过的工作，真正突出了代谢和代谢组学在痴呆症中将会和基因和基因组学一样重要的事实。也许特别是在女性中，这样说安全吗？我认为是的，因为我们相信这个系统受雌激素的调节。所以，43岁左右开始下降的雌激素似乎是导致大脑代谢减慢的驱动因素。我向患者描述的方式是这就像大脑能量下降了。所以当你走进一个房间，忘记自己为什么来的时候，当你发现你不能像以前一样处理所有任务时，就会出现这种情况。就像，一切都变得慢了一点。我对女性说这些话，她们说，我有这个问题，帮助我。
So this is then circling back to WHI, where women are scared to death of taking hormone therapy. And we've got all of these women that are marching toward potentially a greater risk of Alzheimer's disease. And they have this opportunity in their 40s and their 50s to take hormone therapy. And they may not be offered it because the typical conventional approach, based on WHI, is to say, unless you're having hot flashes and night sweats that are severe, I'm not going to give you hormone therapy. And I just want to call that out. I would say no, that is not the way to approach it.
因此，这就回到了妇女做出对激素替代疗法感到恐惧的 WHI 研究。我们有许多妇女可能会面临更大的阿尔茨海默病风险。而她们在 40 和 50 岁时有机会接受激素替代疗法。但她们可能没有被提供这个选择，因为基于 WHI 研究，典型传统的方法是，除非你有严重的潮热和夜间出汗，否则我不会给你激素替代疗法。我想要指出这一点。我会说，不，这不是处理的方式。
Further, the concept right now in conventional medicine is that hot flashes and night sweats are these nuisance symptoms that we will take care of temporarily, maybe with a little bit of estrogen and progesterone or birth control bill, because it's given a lot. Or that they pass. Or this idea, you know, suck it up, suck it up. It doesn't matter that you're not sleeping anymore, you know, turn down the temperature in your room. And that's not right, because hot flashes and night sweats are a biomarker of cardiometabolic disease. They are a biomarker of increased bone loss. They are a biomarker of changes in the brain. Many of these symptoms that occur in perimenopause are not driven by the ovaries. They are driven by the brain.
此外，传统医学目前的概念是潮热和盗汗是这些讨厌的症状，我们可能会暂时处理，也许会用一点雌激素和孕激素或避孕药，因为它被广泛使用。或者他们会过去。或者这种想法，你知道，忍耐一下，忍一下。不要紧，你再也不能睡觉了，你知道，把房间的温度降低。这是不对的，因为潮热和盗汗是心脏代谢疾病的生物标志。它们是骨质流失增加的生物标志。它们是大脑变化的生物标志。在围绝经期发生的许多这些症状不是由卵巢驱动的，而是由大脑驱动的。
Yeah, it's the bi-directional cross talk between the body and the brain keeps, you know, I think is this resounding theme. We had Chris Palmer on here, a psychiatrist who's talking about ketogenic diet for mental health. I know we could have a whole other discussion of it. And we will, I hope, if you'll agree to it about nutrition and as it relates to hormones of specific diets and so forth. But the. And that's a question too, whether this problem of cerebral hypometabolism, could we solve it with estrogen and or increased metabolic flexibility? So I just wanted to footnote that, sorry to interrupt you. No, please interrupt. I know you're, as long as we're there, I know you are a fan in some instances of intermittent fasting, time restricted feeding, and or ketogenic diet to get cells sensitive to insulin, which is not to say, if I understand correctly, which is not to say that women need to stay on the ketogenic diet for long periods of time or intermittent fast for only time restricted feeding for eight hours or six hours a day. But that by increasing, you said metabolic flexibility, excuse me, but by increasing cells sensitivity to insulin, and then maybe returning to a more typical eating pattern, and periodically switching back and forth, that might actually be beneficial. Do I have that right?
是的，身体和大脑之间的双向交流保持着，我认为这是一个响亮的主题。我们曾经邀请过克里斯·帕尔默（Chris Palmer），一位讲述生酮饮食对心理健康的精神科医生。我知道我们可能会为此展开另一个讨论。我希望您同意关于营养和与特定饮食以及激素有关的内容等等所以。但是。这也是一个问题，我们是否可以通过雌激素或增加代谢灵活性来解决大脑代谢过低的问题？所以我只是想在这里加个脚注，抱歉打断您。不，别客气。我知道您有时候喜欢间歇性禁食、时间限制性进食，或者生酮饮食来使细胞对胰岛素敏感，这并不意味着，如果我理解正确的话，这并不意味着女性需要长时间坚持生酮饮食或只进行时间限制性进食八小时或每天六小时。相反，通过增加您说的代谢灵活性，但通过增加细胞对胰岛素的敏感性，然后可能返回更典型的饮食模式，并定期来回切换，这实际上可能是有益的。我理解对吗？
Yeah, I love the pulse. So I feel like it's much more physiologic than say going on a ketogenic diet and staying there for years. All of the data that we have on the ketogenic diet, it's pretty limited in terms of duration. You know, the longest players that we have in terms of the data are the focus with epilepsy. And that's just a different phenotype. So I think in terms of microbiome effects, diversity, dysbiosis, some of those issues, we really don't know in terms of long-term effects. So I prefer with a ketogenic diet that it's used as an end of one experiment and that you do it for four weeks. Maybe you measure biomarkers before and afterwards. Maybe you look at your stool before and afterwards, and we still haven't talked about stool tests yet. But you could measure your fasting insulin and your glucose. You could just start there, do four weeks of keto, clean keto, including vegetables. It doesn't have to be 57 a day.
是的，我喜欢脉搏。所以我觉得它比长期进行生酮饮食更符合生理学。我们对生酮饮食的所有数据在持续时间上都相当有限。我们知道，我们所拥有的数据中持续时间最长的是关于癫痫的病例。但那只是一个不同的表型。所以我认为在微生物组效应、多样性、菌群失调等方面，我们对长期效应真的一无所知。因此，我更喜欢将生酮饮食作为一个以自身为单位的实验，并在四周内进行。也许你可以在之前和之后测量生物标志物。也许你可以在之前和之后查看你的大便样品，而且我们还没有讨论过大便检测。但你可以测量你的空腹胰岛素和血糖。你可以从那里开始，进行四周的生酮饮食，健康饮食，包括蔬菜。不一定每天吃57种蔬菜。
And then measure it again afterwards. Since you mentioned mentioned stool testing. Yes. What is your recommendation about stool testing? So my recommendation, this is again in the field of if you have the disposable income. So I usually start with Genova because they've got a good copay system with insurance. That's what I typically use. So I usually do their one day stool test where you have to go digging through your stool and send it off to this lab that's in North Carolina. I usually do the one day unless I'm concerned about parasites. In that case, I tend to do three days.
然后之后再进行测量。因为你提到了大便检测。是的。你对大便检测有什么建议？所以我的建议，这是针对有闲钱可任意花费的人群。我通常选择Genova，因为他们与保险有很好的共付制度。那是我通常使用的。所以我通常会做他们的一天大便检测，你需要深入检查你的大便，并寄到北卡罗来纳州的这个实验室。我通常会选择一天的测试，除非我担心寄生虫。在这种情况下，我倾向于选择三天的测试。
I do that for people who travel a fair amount and go to places where there's greater risk or they just have gut symptoms. Another test that I do a lot is because I was like to mention two labs is a test by one, Gevity. And this is much more of a data wonk type of test because it's powered by AI. It was designed by a guy who's got inflammatory bowel disease. And he is a PhD, deep phenotyping bioinformatics guy who wanted to make this really easy. So the test is under the umbrella of thorn.
我为经常旅行或去风险较大地方，或者有肠胃症状的人进行检测。另一个我经常进行的测试是由Gevity实验室提供的，这是一种更注重数据的测试，因为它采用AI技术。这项测试是由一位患有炎症性肠病的博士设计的，他是一位深度表型生物信息学专家，希望能够让测试变得更简单。这项测试是由索恩（thorn）公司开展的。
And these call it gut bio. They might have another name for it. And they just improved it so that it's a wipe instead of digging through your stool. And so my athletes will do it now. They were not so into digging through their stool before. Is anybody? Really no one is. I don't want the answer to that. I know the answer I prefer to that. But that's a super interesting test because it's you get much more dense data. The issue is with apologies to my friends at Thorne. The issue is that their recommendations end up being thorn supplements.
这些被称为肠道菌群检测。可能有其他名字。他们只是改良了它，使之成为一种擦拭，而不是翻阅你的粪便。所以现在我的运动员会做这个检测。他们之前并不喜欢翻阅自己的粪便。有人会喜欢吗？真的没有人会喜欢。我不想知道答案。我知道我更喜欢哪种答案。但这是一个非常有趣的测试，因为你可以得到更密集的数据。抱歉对不起我的Thorne的朋友们。问题是他们的建议最终会成为植物补充剂。
So that can be very easy for people who want to connect the dots. That's not always the way that I like to do it. But first of all, three things. You shared with us an immense amount of knowledge. And in that first statement, I also want to apologize because I threw at you the entire lifespan of female lifespan, reproductive health, contraception, diet, microbiome, so many things. But I first, I just want to say, you taught me a tremendous amount, including I think something that most people include myself have not thought about enough, which is the psychosocial impact on things that we're all familiar with.
为了让想要串联起点滴的人更容易理解。这并不总是我喜欢的方式。但首先，我要说三件事。您向我们分享了大量知识。在那第一次发言中，我也要道歉，因为我向您扔出了女性寿命、生殖健康、避孕、饮食、微生物组等等的整个生命周期，如此繁杂的内容。但我首先要说的是，您教会了我很多东西，包括我认为大多数人，包括我自己，还没有足够思考的事情，那就是心理社会对我们所熟悉的事物产生的影响。
Constipation, bowel movements, what we eat, what we avoid. I have to say really a huge thank you for that because it's not something that's been discussed on this podcast before. Sort of know that brain communicates with body psychology and biology are linked. But I think this is the first time that anyone's ever directly linked circumstances and biology and psychology in such a concrete way. So that's the first thing. I speak for many people on that. Second of all, we barely scratched the surface of your knowledge, and which is both frustrating for me because I always want to learn more. And I know many other people do as well, but also very, very exciting because with hopefully without much persuasion, we can have you back on to talk about things.
便秘、排便、我们的饮食、我们要避免的事情。我必须真心地对此表示巨大的感谢，因为这不是之前在这个播客中讨论过的话题。大家都知道大脑与身体心理学和生物学之间有联系。但我认为这是第一次有人如此直接地将环境、生物学和心理学以如此具体的方式联系在一起。所以这是第一点。我代表很多人说这话。
其次，我们仅仅触及了你的知识的表面，这让我感到很沮丧，因为我总是想要学到更多。我知道还有很多其他人也是如此，但同时也让人感到兴奋，因为希望在没有太多劝说的情况下，我们可以请你再次来谈论这些事情。
I know you're working with men now, men's health, some particulars around. I think there's more for us to explore in terms of PCOS, menopause, contraception, and all of the above. But then something that you and I were talking about off camera before we started, which I think is a really important factor that ties back to this issue of trauma and stress and the bi-directional relationship between biology and psychology. Hopefully someday we won't even separate those two, which is the use of specific medicines, including plant medicines, and how that can influence overall health, which no doubt will include hormone health.
我知道你现在正在与男人合作，关注男性健康和一些具体内容。我认为在多囊卵巢综合征、更年期、避孕以及以上方面我们还有更多可以探讨的地方。但在我们开始前的镜头外谈过的一点，我认为这是一个非常重要的因素，与创伤和压力以及生物学和心理学之间双向关系的问题有关。希望有一天我们甚至不会再把这两者分开，例如利用特定药物，包括植物药物，以及它们如何影响整体健康，毋庸置疑包括激素健康在内。
So I say all of that for two reasons. First of all, to queue up the, we won't even call it a part two, but a sequel to this, which I'm gratified to hear that you'll join us for that. And then also to just really extend a huge thank you. The amount of knowledge that you shared is immense and is going to be very, very useful and actionable for men in terms of their thinking and their actions and for women in particular today's discussion in particular for women in terms of how to think about their health and biology, how to think about their psychology and the environment that all of that is embedded in. I just want to say an enormous thank you. Thank you, Andrew. I so appreciate that. And I so appreciate what you offer to the world in terms of a way and a way to understand physiology and how to craft a architect a better life. Can I just add one last thing? I shouldn't. I shouldn't. Talk about it since we didn't get to the 40s and the 50s and those listed biomarkers.
所以我说这一切有两个原因。首先，为了引出接下来的内容，我们甚至不会称之为第二部分，而是这个的续集，很高兴听到您将加入我们。其次，非常衷心地向您致以最诚挚的感谢。您分享的知识量巨大，将对男性的思维和行动以及特别是今天特别为女性而进行的讨论中女性的健康和生物学，心理学及嵌入其中的环境的思考方法非常有帮助和可操作性。我只想说一声无比的感谢。谢谢你，Andrew。我非常感激。也非常感激你为世界所提供的理解生理学以及如何塑造和打造更美好生活的方式。我可以再加一句吗？我不应该。我不应该。由于我们没有讨论到40年代和50年代以及列出的生物标志物，我不应该提及这一点。
So I feel like if people, if women went away with one thing today, it would be to do a coronary artery calcium score by age 45 and sooner if you've got premature heart disease. How is that taken? So it's a CT scan of the chest. You can self order it. Like I think it's Stanford Hospital. You can self order it. Last time a patient checked, it was $250. So again, disposable income. But it tells you it almost gives you this fork in the road in terms of how much you need to pay attention to cardiovascular health as a woman. And it's 45 for men too. So if you haven't had one, have you had one? No. You need one. In the sun, cortisol, CAC. Great.
所以我觉得如果人们，尤其是女性，今天能从中得到一个建议，那就是在45岁时做一次冠状动脉钙化评分，如果有早发心脏病的话，那更早一点。这个测试是怎么进行的？通过胸部的CT扫描。你可以自己预约。比如斯坦福医院，你可以自己预约。上一次病人检查时，花费是250美元。所以这又是与可支配收入相关的事情。但这个测试几乎可以告诉你在女性心血管健康方面需要多关注程度。对男性来说，也是在45岁时。所以如果你还没有做过这个测试，你做过吗？没有。你需要做一次。阳光下，皮质醇，冠状动脉钙化评分。很棒。
So I'll run all that by you. It's really essential. And it's so fascinating because there's some women who have a zero. So my score is zero. And that's great. So often you can just keep doing what you're doing. But if you're 45 and you're starting to be elevated or maybe you've got PCOS or you've got some other biomarkers tending you in this direction toward the number one killer, really 8 to 9 out of the top 10 killers in the US, that allows you to really start to make changes. And I think it's essential to know that data. It's not it's probably not going to be offered by your doctor. Certainly, Peter, Tia is going to offer it. But most conventional doctors are not going to do it.
所以我会向你详细介绍。这真的很重要。这很有趣，因为有些女性的得分是零。我的得分就是零。这非常棒。通常情况下，你可以继续你正在做的事情。但如果你45岁了，开始升高，或者可能患有多囊卵巢综合征，或者有其他生物标志指向你朝着第一号杀手的方向发展，实际上美国前十大杀手中的8到9名，这让你真正开始做出改变。我认为了解这些数据是至关重要的。这可能不会由你的医生提供。当然，Peter，Tia会提供。但大多数传统医生不会这样做。
And then the last thing I want to say before you mentioned it. So if I were to go to my doctor and I just say, I want a cardiac calcium score, that's what people are. Primary artery calcium score. CAC. Okay. So everyone hear that and know that if you're 40 or older and maybe if you're 45 or older, get get it. So the last thing is, and this is for men and women, is your A score. So adverse childhood experiences. Knowing your A score is so essential in terms of a baseline for how much trauma your system, your pine system endured when you were a kid. And we know that childhood trauma, whether it's abuse or neglect or having an alcoholic parent, that maps to disease and middle age. And it can give you so much insight. I'll give you an example. I've got a patient who had an elevated coronary artery calcium score who does everything right with her food. I think it was her trauma that elevated her CAC when she was 45.
然后在你提到之前，我想说的最后一件事。所以如果我去看医生，我只要说，我想要一个心脏钙化评分，这就是人们所说的主要动脉钙化评分。CAC。好的，所以每个人都要听到这个，并且知道，如果你已经40岁或者更年长一点，也许是45岁或更年长一点，请去做。最后一件事是，这对男性和女性都适用，那就是你的A得分。也就是不良童年经历。了解你的A得分对于衡量你在孩提时期经历了多少创伤对于你的身心系统至关重要。我们知道童年创伤，无论是虐待、忽视还是有酗酒家长，都会导致疾病和中年时期。它可以为你提供很多见解。举个例子，我有一个患者，她的冠状动脉钙化评分升高了，虽然她在饮食方面做得很好。我认为是她45岁时的创伤提高了她的CAC。
So I think an A score, knowing your A score, starting as a teenager, like knowing it and knowing how to work with that is really essential. There are certain people, they are exceedingly rare, but you are one such person that when they speak knowledge just comes out of them and it's incredibly useful and helpful knowledge. So thank you. I'm going to get both of those things. Good. And I highly recommend that everyone else pursue ways that they can get those or if they can't get them that they, you know, earmark those as things to get at the point where they can obtain sufficient disposable income. Sounds like that the health, the detriments to health that those can offset would be well worth the cost. Totally. Thank you. Thank you for joining me for today's discussion all about female hormone health, vitality and longevity with Dr. Sarah Gottfried.
因此，我认为拥有 A 分数，了解自己的 A 分数，从十几岁开始，就像了解它，并知道如何运用它是非常重要的。有些人，他们极为罕见，但你就是这样的一个人，当他们说话时，知识就会从他们口中流露出来，这是非常有用和有帮助的知识。所以谢谢你。我将会得到这两样东西。好的。我强烈建议每个人都追求他们能够得到这些东西，或者如果他们不能得到的话，他们可以将这些作为在能够获得足够的可支配收入时获得的东西。听起来，在健康方面，这些可以抵消的健康损害是绝对物有所值的成本。完全是这样。谢谢你。谢谢你加入今天与 Sarah Gottfried 博士讨论女性激素健康、活力和长寿的讨论。
If you'd like to learn more about Dr. Gottfried's work, please check out her social media channels. We've provided links to those in the show note captions. In addition, please check out one or all of Dr. Gottfried's excellent books that she's written about nutrition supplementation and various treatments for hormone health, longevity and vitality. We've linked to two of those, notably women, food and hormones and her book, The Hormone Cure in our show note captions. If you're learning from and or enjoying this podcast, please subscribe to our YouTube channel. That's a terrific zero-cost way to support us.
如果您想了解更多戈特弗里德博士的工作，请查看她的社交媒体频道。我们在节目注释中提供了这些链接。此外，请查看戈特弗里德博士撰写的关于营养补充和激素健康、长寿和活力多种治疗方法的优秀书籍中的一本或全部。我们在节目注释中提供了两本书的链接，特别是《女性、食物和激素》和她的书《激素治疗》。如果您正在从这个播客中学到或享受到乐趣，请订阅我们的YouTube频道。这是支持我们的一个非常好的零成本方式。
In addition, please subscribe to the podcast on Spotify and Apple. In addition, on both Spotify and Apple, you can give us up to a five-star review. If you have questions or comments or topics or guests that you'd like me to cover on the Huberman Lab podcast, please put those in the comment section on YouTube. I do read all the comments. In addition, please check out the sponsors mentioned at the beginning of and throughout today's episode. That's the best way to support this podcast. If you're not already following us on social media, we are Huberman Lab on Instagram, Twitter, Facebook and LinkedIn.
另外，请订阅在Spotify和Apple上的播客。另外，在Spotify和Apple，您可以给我们最多五星的评价。如果您有问题、评论、话题或您希望我在Huberman实验室播客中涉及的嘉宾，请在YouTube的评论部分留言。我会阅读所有评论。此外，请查看今天节目中提到的赞助商。这是支持这个播客的最佳方式。如果您还没有在社交媒体上关注我们，我们在Instagram、Twitter、Facebook和LinkedIn上是Huberman实验室。
I should mention that on both Instagram and Twitter, I cover science and science-related tools for mental health, physical health and performance, some of which overlap with the contents of the Huberman Lab podcast, but much of which is distinct from the contents of the Huberman Lab podcast. Again, it's Huberman Lab on all social media channels. If you haven't already subscribed to the Huberman Lab podcast, so-called neural network newsletter, that's a monthly newsletter. It's completely zero cost. We provide summaries of podcast episodes as well as summaries of tools for everything from optimizing sleep to hormone health, deliberate cold exposure, deliberate heat exposure, fitness and so on. It's very easy to sign up for you. Go to Huberman Lab dot com. Go to the menu and scroll to newsletter. You simply provide your email. We do not share your email with anybody. As I mentioned before, it is completely zero cost. Again, that's the neural network newsletter and you can find it at Huberman Lab dot com.
我应该提到，在Instagram和Twitter上，我涵盖了与心理健康、身体健康和表现相关的科学和科学工具，其中一些与Huberman实验室播客的内容重叠，但许多内容与Huberman实验室播客的内容不同。再次强调，所有社交媒体渠道上都是Huberman实验室。如果你还没有订阅Huberman实验室播客的所谓的神经网络通讯，那是一个每月的通讯。它完全免费。我们提供播客集数的摘要，以及从优化睡眠到激素健康、有意识的受冷暴露、有意识的受热暴露、健身等方面的工具摘要。注册非常简单。去Huberman实验室点com。去菜单，滚动到通讯。只需提供你的电子邮件。我们不会与任何人分享你的电子邮件。正如我之前提到的，这完全免费。再次强调，那是神经网络通讯，你可以在Huberman实验室点com找到它。
During today's episode and on many previous episodes of the Huberman Lab podcast, we discuss supplements. While supplements aren't necessary for everybody, many people derive tremendous benefit from them for everything from sleep to focus to hormone regulation. The Huberman Lab podcast is happy to announce that we partnered with Momentus Supplements because Momentus Supplements are of the absolute highest quality. Also, they include many single ingredient formulations, which is essential if you want to design a supplement regimen that is both cost effective and the most biologically effective supplement regimen. That's very hard to do with blends of supplements. It's very straightforward to do with single ingredient formulations. Also, Momentus Supplements ship internationally, which is important because we realize that many of you reside outside of the United States.
在今天的节目以及之前的许多Huberman Lab播客节目中，我们讨论了补充剂的话题。虽然并非每个人都需要补充剂，但许多人从中获得了巨大的好处，从改善睡眠到增强专注力再到调节激素。Huberman Lab播客很高兴地宣布我们与Momentus Supplements合作，因为Momentus Supplements质量最高。此外，它们包含许多单一成分的配方，这是设计既经济实惠又生物效果最佳的补充剂方案所必需的。这对于混合多种补充剂来说是非常难做到的。使用单一成分的配方非常直截了当。此外，Momentus Supplements可以国际发货，这一点非常重要，因为我们意识到许多人居住在美国境外。
If you'd like to see the supplements discussed on the Huberman Lab podcast, you can go to livemomentuspelledos.com slash Huberman. Thank you once again for joining me for today's discussion all about female hormone health, vitality and longevity with Dr. Sarah Gottfried and last but certainly not least, thank you for your interest in science.
如果你想看一下Huberman Lab播客中讨论的补充剂，可以访问livemomentuspelledos.com/Huberman。再次感谢今天和我一起讨论女性荷尔蒙健康、活力和长寿的Sarah Gottfried博士，最后但同样重要的是，感谢你对科学的关注。