Dr. Peter Attia's new book lays out a how-to guide for longevity, focusing on preventative approaches rather than treatment.

彼得-阿蒂亞博士的新書提供了長壽指南，重點在於預防而非治療。

And he is joining Hari Sreenivasan to discuss the best habits for a healthier life.

他將與哈里-斯里尼瓦桑一起討論如何養成更健康的生活習慣。

Biana, thanks, Dr. Peter Attia.

比亞娜，謝謝你，彼得-阿蒂亞博士。

Thanks so much for joining us.

非常感謝你加入我們。

Now, in your new book, Outlive, the Science and Art of Longevity, you're not just trying to help us live longer, but you're trying to get us to be healthy as well.

現在，在您的新書《長壽的科學與藝術》（Outlive, the Science and Art of Longevity）中，您不僅想讓我們活得更長，還想讓我們活得更健康。

I mean, you kind of make a distinction between lifespan and healthspan.

我的意思是，你把壽命和健康壽命區分開來了。

Spell that out.

拼出來。

Yeah.

是啊

Lifespan is probably the easier of those two things to explain, which is obviously how long you live.

壽命可能是這兩件事中比較容易解釋的，顯然就是你能活多久。

And that, in that sense, is kind of binary.

從這個意義上說，這是一種二元論。

It's all or none.

要麼全有，要麼全無。

You're alive or you're not alive.

你要麼活著，要麼死了。

And unfortunately, I think our medical system mostly fixates on that metric.

不幸的是，我認為我們的醫療系統大多隻關注這一指標。

And obviously, what gets measured gets managed, as the old saying goes.

顯然，俗話說得好，"量力而行，管理有方"。

What I think we're not paying nearly enough attention to is the quality of life.

我認為我們對生活品質的關注還遠遠不夠。

And that's what's captured in healthspan, right?

這就是健康手冊中記錄的內容，對嗎？

So there's a cognitive component to that.

是以，這裡面有認知的成分。

There's obviously a very physical component to that.

很明顯，這裡面有非常多的身體因素。

And there's an emotional component to that.

這其中有情感因素。

And if you don't really define metrics around those things, it's probably not surprising that we're not managing those things.

如果你沒有真正圍繞這些事情確定衡量標準，那麼我們沒有管理好這些事情也就不足為奇了。

And therefore, most of the resources and attention go to simply prolonging life, even at the expense of quality.

是以，大部分資源和注意力都用於延長生命，甚至犧牲品質。

So when a patient approaches you in your practice, I mean, kind of what are the questions that you're asking them so that you're kind of on the same path together?

所以，當病人在你的診所找到你時，我的意思是，你會問他們哪些問題，這樣你們就能在同一條道路上走下去？

Well, obviously, we want to talk about all of the medical things and all of the things that deal with prolonging life as well.

顯然，我們也想談談所有的醫療問題和延長生命的問題。

So we certainly want to understand all the risks coming in with respect to what we talk about as the four horsemen of death, you know, cardiovascular disease, neurodegenerative disease, cancer, etc.

是以，我們當然希望瞭解與我們所說的死亡四騎士（心血管疾病、神經退行性疾病、癌症等）有關的所有風險。

But on the healthspan side, we spend just as much time and energy thinking about, for example, what do you want to be able to do in the last decade of your life?

但在健康壽命方面，我們花了同樣多的時間和精力去思考，比如，你希望自己在生命的最後十年能做些什麼？

This becomes a very important framing question.

這成為一個非常重要的框架問題。

And the more detail that a person can provide, sometimes with our prodding as to what they actually want to be able to do, right?

有時，在我們的催促下，他們能提供的細節越多，他們就越想知道自己到底想做什麼，對嗎？

Do you want to be able to pick up a grandchild?

您想接孫子嗎？

Do you want to be able to travel?

您希望能夠旅行嗎？

These things require very deliberate planning.

這些都需要深思熟慮的規劃。

And most people can't do these things in the last decade of their life unless they train for it.

而大多數人在生命的最後十年都無法做到這些事情，除非他們為此進行訓練。

So you took a look and studied people who are 100 years old.

所以，你看了看，研究了一下 100 歲的人。

And was there something that they had in common that we can apply in our lives?

他們是否有什麼共同點可以應用到我們的生活中？

So the one thing that is common to all centenarians is that from the standpoint of chronic disease, they're about 20 to 25 years younger than their birth certificate age says.

是以，所有百歲老人的一個共同點是，從慢性病的角度來看，他們比出生證明上的年齡年輕 20 到 25 歲。

In other words, their first brush with cancer, their first brush with heart disease, their first brush with any sort of chronic ailment is about 20 to 30 years after you would expect based on their birth certificate age.

換句話說，根據出生證明上的年齡，他們第一次罹患癌症、第一次罹患心臟病、第一次罹患任何慢性疾病的時間，都要比你預計的晚 20 到 30 年。

So they have a superpower.

所以他們有一種超能力。

And the superpower is they delay the onset of chronic disease.

它們的超強功效就是能延緩慢性疾病的發生。

Now, the question, of course, the million-dollar question is, are they doing something in order to get that superpower, right?

現在，問題是，當然，這個百萬美元的問題是，他們是否為了獲得這種超能力而做了什麼，對嗎？

Is there some magic diet or something like that?

有沒有什麼神奇的減肥方法之類的？

And unfortunately, I say unfortunately for the rest of us who don't have those genes, the answer is no.

不幸的是，對於我們這些沒有這些基因的人來說，答案是否定的。

And it's actually more likely your observation, which is on average, believe it or not, centenarians are more likely to smoke, more likely to drink, less likely to exercise, and less likely to eat well.

實際上，根據你的觀察，百歲老人更有可能吸菸，更有可能喝酒，更不可能鍛鍊，也更不可能吃得好。

And yet, despite those things, they have this supernatural lifespan.

然而，儘管如此，他們卻擁有超自然的壽命。

But that doesn't mean we can't learn from them.

但這並不意味著我們不能向他們學習。

What we learn is we have to apply to ourselves other tools to get their benefits.

我們所學到的是，我們必須將其他工具應用到自己身上，才能獲得它們的益處。

In other words, we have to use nutrition, exercise, sleep, stress, all those other as tools to get what they get for free genetically.

換句話說，我們必須利用營養、運動、睡眠、壓力等所有這些工具，來獲得他們在基因上免費獲得的東西。

We have to create a phase shift of time in the onset of chronic disease.

我們必須對慢性病的發病時間進行階段性調整。

Let's first talk about just exercise.

我們先來談談運動。

I mean, you write a tremendous amount that that is one of the most beneficial things that we could be doing earlier in our lives to prevent a lot of ailments.

我的意思是，你寫了大量的文章，這是我們在生命早期可以做的最有益的事情之一，可以預防很多疾病。

Yep, exercise is hands down the most potent tool slash intervention that we have to affect both of the metrics we care about, lifespan and healthspan.

沒錯，運動是影響我們所關心的壽命和健康期限這兩項指標的最有效工具。

So on the lifespan side of the equation, having a very high degree of cardiorespiratory fitness, having high muscle mass and high strength relative to your sex and age is a better predictor of longer life, meaning a greater reduction of all cause mortality, death from any causes than anything else we have, positive or negative.

是以，從壽命的角度來看，相對於性別和年齡而言，擁有非常高的心肺功能、高肌肉品質和高力量，是預測長壽的更好指標，也就是說，與其他任何積極或消極的因素相比，能更大程度地降低各種原因導致的死亡率。

The benefit bestowed on an individual from being very high in those categories is greater than the harm that comes from smoking, having high blood pressure, having type two diabetes, even having kidney disease, which would be the step right before needing a transplant.

如果一個人在這些類別中排名非常靠前，那麼他所獲得的益處要大於吸菸、高血壓、二型糖尿病甚至腎臟疾病所帶來的危害，而腎臟疾病正是需要移植手術的前一步。

So as much as we understand how harmful those things are, it's even more beneficial to be incredibly fit and incredibly strong.

是以，儘管我們知道這些東西有多大的危害，但擁有令人難以置信的健康和強壯的體魄更有益處。

So if you're just thinking about how do I live longer, that's the ticket.

所以，如果你只是在考慮如何才能活得更久，這就是你的選擇。

On the other side of the ledger, when we think about the quality of life, there simply is no greater tool to foster neuroprotection and ward off neurodegeneration than exercise.

另一方面，當我們考慮生活品質時，沒有比運動更能促進神經保護和防止神經退化的工具了。

And of course, exercise is the most important piece in maintaining your physical body as you age.

當然，隨著年齡的增長，運動是保持身體健康最重要的一環。

So you can do all those things you would want to do in that last decade of your life.

這樣，你就可以在生命的最後十年做你想做的所有事情。

Is there a combination of things that will help your body prepare for aging better than anything else?

是否有一種組合能比其他任何東西都更有效地幫助你的身體為衰老做好準備？

You know, if there's one drawback to exercise, it's that it takes more time than all of the other things that we might think of as being beneficial.

要知道，如果說運動有什麼缺點的話，那就是它比其他所有我們認為有益的事情都要花費更多的時間。

Few things take as much time to reap the full benefit from as exercise.

很少有什麼事情能像運動一樣，需要花費大量時間才能充分獲益。

You need to be doing strength training.

你需要進行力量訓練。

You need to be doing cardiorespiratory training, and that cardio training needs to be at different levels of intensity.

你需要進行心肺訓練，而心肺訓練需要有不同的強度。

About 80% of it needs to be at relatively low intensity, the level of intensity at which you could still carry out a conversation, albeit a strained one.

大約 80% 的時間需要在相對較低的強度下進行，在這種強度下，你仍然可以進行對話，儘管是緊張的對話。

And about 20% of it needs to be at a higher level of intensity where you couldn't carry out a conversation.

大約 20% 的時間需要達到較高的強度，以至於你無法進行對話。

And I think for the individual who says, look, Peter, I am not willing to spend more than 90 minutes a week exercising.

我認為，對於那些說，彼得，我不願意每週花超過 90 分鐘鍛鍊的人來說。

Yes, I would rather have them, you know, focus on what's not necessarily what I think the best approach to exercise is, but doing whatever they can to get some benefits.

是的，我寧願讓他們，你知道，專注於我認為最好的鍛鍊方法不一定是什麼，但盡他們所能去獲得一些好處。

But the way I ask my patients is very different.

但我詢問病人的方式卻截然不同。

I start in reverse.

我開始倒車。

I say, tell me how many hours a week you're willing to put into this.

我說，告訴我你每週願意為此投入多少時間。

And I've already explained to them and shown them all the data that explain why this is going to have a greater impact on the length and quality of their life than anything they will ever do.

我已經向他們解釋並向他們展示了所有的數據，這些數據解釋了為什麼這對他們生命的長度和品質的影響比他們所做的任何事情都要大。

Let's talk a little bit about nutrition.

讓我們來談談營養學。

You, for a time being, were a big fan of keto diets.

你曾一度是酮類飲食的忠實粉絲。

And in the book, you kind of walk through why and how you changed your mind about that.

在書中，你講述了你改變想法的原因和過程。

Explain to our audience, how should we be thinking about nutrition in the context of aging?

向聽眾解釋一下，我們應該如何看待老齡化背景下的營養問題？

I go to great lengths in the book to detach from diets and really just talk about nutrition as a biochemistry phenomenon.

我在書中不遺餘力地脫離飲食，真正將營養作為一種生化現象來討論。

Let's just talk about it through the lens of biochemistry and molecules.

讓我們從生物化學和分子的角度來談談這個問題。

The most important component of your nutrition is basically the energy balance it creates in your body.

營養最重要的組成部分基本上是它在體內形成的能量平衡。

In other words, is a person overnourished or undernourished?

換句話說，一個人是營養過剩還是營養不良？

Now, for most of our existence, we have been undernourished, right?

現在，在我們存在的大部分時間裡，我們都營養不良，對嗎？

For if you think about a thousand years ago, 500 years ago, 200 years ago, most of us were barely getting enough energy, right?

因為如果你想想一千年前、五百年前、兩百年前，我們中的大多數人都只能勉強獲得足夠的能量，對嗎？

And our bodies, of course, evolved remarkable ways to store and hold on to energy.

當然，我們的身體也進化出了儲存和保持能量的非凡方法。

This is what basically allowed us to leapfrog ahead of all other species in terms of our remarkable brains, because our brains are so energy hungry.

正因為如此，我們的大腦才會如此渴求能量，從而使我們的大腦比其他所有物種都更加出色。

Well, that worked really well until our modern environment, which basically created such an abundance of food that now most of us are on the other side of that.

在我們的現代環境之前，這種方法一直很有效，因為現代環境基本上創造瞭如此豐富的食物，以至於現在我們中的大多數人都處於這種環境的另一面。

We are overnourished.

我們營養過剩。

Strategy number one is you have to reduce energy intake.

戰略一是你必須減少能量攝入。

And there are basically three approaches to that, each of which can work, each of which has advantages, and each of which has disadvantages.

基本上有三種方法，每種方法都能奏效，各有利弊。

So broadly speaking, they are direct caloric restriction, dietary restriction, and time restriction.

是以，從廣義上講，它們是直接的熱量限制、飲食限制和時間限制。

To say a bit more about them, direct caloric restriction, as the name suggests, means you just deliberately go about eating less while paying attention to how much you are eating.

說得更詳細一點，直接限制熱量，顧名思義，就是你故意少吃，同時注意自己吃了多少。

Not necessarily paying attention to when you're eating or what you're eating, but just reducing the total caloric burden.

不一定要注意什麼時候吃，也不一定要注意吃什麼，只要減少總熱量負擔就可以了。

Dietary restriction, of which you mentioned an example, a ketogenic diet is a form of dietary restriction, but so are most quote unquote diets.

飲食限制，你提到過一個例子，生酮飲食就是飲食限制的一種形式，但大多數無引號的飲食也是如此。

This is when you just restrict certain elements within the diet, and what that results in is less overall consumption.

這是指限制飲食中的某些元素，其結果是減少總體消耗量。

So it's an indirect way to go about calorie restriction.

是以，這是一種間接限制卡路里的方法。

Finally, time restriction is also an indirect way to go about calorie restricting by creating a narrower and narrower window in which you eat.

最後，限制時間也是一種間接限制卡路里的方法，它可以讓你進食的時間越來越少。

And if you create a narrow enough window, you will end up reducing intake.

如果窗口足夠小，最終就會減少攝入量。

Now, we don't have to go into the details of how each of these has a benefit and each of these has a risk, but none of these are things that you should do mindlessly.

現在，我們不必細說這其中的每一個好處和每一個風險，但這些都不是你應該漫不經心地做的事情。

Each of these are things you have to be mindful of the blind spots and pitfalls and work around them.

這些都是你必須注意的盲點和陷阱，並加以解決。

You spent a fair amount of time talking about sleep.

你花了不少時間談論睡眠。

Why is it as important?

為什麼它如此重要？

I mean, I'm somebody who doesn't get enough sleep and I feel like it's underrated, but younger points in my life, I didn't really think about how much I was getting, maybe because I was obviously younger and I was fitter and I was able to rebound faster.

我的意思是，我是一個睡眠不足的人，我覺得它被低估了，但在我年輕的時候，我真的沒有想過我的睡眠有多少，也許是因為我顯然更年輕，我更健康，我能夠更快地反彈。

But now if I don't get a good night's rest, it's really difficult to perform at the same level every day.

但現在，如果我晚上休息不好，就很難每天都有同樣的表現。

In the book, I talk about a thought experiment, which is effectively like, you know, evolution didn't muck around, right?

在書中，我談到了一個思想實驗，它實際上就像，你知道，進化論沒有亂搞，對嗎？

Evolution, everything about evolution is really laser focused.

進化論，關於進化論的一切都非常有針對性。

And if you think about it, no one disputes that we are optimized to forage for food, to reproduce, to fend for ourselves.

如果你仔細想想，沒有人質疑我們是為了覓食、繁衍後代、自食其力而優化的。

I mean, these are the characteristics that evolution honed.

我是說，這些都是進化磨練出來的特徵。

Why would evolution have kept around this behavior that rendered us unconscious for eight hours a day?

為什麼進化過程中會保留這種讓我們每天昏迷八小時的行為呢？

It just doesn't make any sense.

這根本說不通。

And the only way you could really justify this is if that eight hours, i.e. one third of our life that is spent in unconsciousness must be doing something so important, we have never figured out a way to out-evolve it.

唯一能證明這一點的理由是，這 8 個小時，也就是我們生命中三分之一的時間都是在無意識狀態下度過的，一定是在做一件非常重要的事情，而我們還沒有找到超越它的方法。

We've never even figured out a way to reduce it by half.

我們甚至還沒想出能減少一半的辦法。

It's basically just stuck there at about seven to eight hours.

基本上就停留在七八個小時左右。

And that's kind of what I think I talk a little bit about in the book, right?

這也是我在書中提到的一點，對嗎？

It's like, what are those features of sleep?

睡眠有哪些特徵？

Why is that important to brain health?

為什麼這對大腦健康很重要？

Why is that important to memory consolidation?

為什麼這對記憶鞏固很重要？

Why does that play a profound role in metabolism, right?

為什麼會對新陳代謝產生深遠影響呢？

So many of the problems that I think we have with obesity, metabolic health, insulin resistance, type two diabetes can actually be attributed to poor sleep just as much as they can be attributed to poor diet.

我認為，我們在肥胖、代謝健康、胰島素抵抗、二型糖尿病等方面遇到的許多問題，實際上都可以歸咎於睡眠不好，就像它們可以歸咎於飲食不當一樣。

Now, a lot of the book also takes a critical look at our existing healthcare system.

現在，這本書的很多內容也對我們現有的醫療保健系統進行了批判性的審視。

You write that, quote, health insurance companies won't pay a doctor very much to tell a patient to change the way he eats or to monitor his blood glucose levels in order to help prevent him from developing type two diabetes.

你寫道，引述一下，如果醫生告訴病人改變飲食方式或監測血糖水準，以幫助他預防患上二型糖尿病，醫療保險公司是不會付給他多少錢的。

Yet insurance will pay for this same patient's very expensive insulin after he's been diagnosed.

然而，在確診後，保險公司會為這位病人支付非常昂貴的胰島素費用。

So is there a way to turn what seems like the largest industry in the country around to think kind of proactively instead of reactively?

那麼，是否有辦法將這個看似全國最大的行業轉變為主動思考而非被動反應的行業呢？

I mean, there clearly is from a conceptual standpoint.

我的意思是，從概念的角度來看，顯然是有的。

From a structural standpoint, I don't want to be naive and suggest that it's going to be easy.

從結構的角度來看，我不想天真地認為這會很容易。

But that example that you read the quote from, I think illustrates kind of the point, right?

但我認為，你引用的那個例子說明了問題的關鍵所在，對嗎？

Which is everything follows the dollar.

也就是一切都跟著美元走。

And I don't say that as a skeptical guy.

我這麼說不是因為我持懷疑態度。

Like dollars are important.

比如美元很重要。

I'm a capitalist.

我是一個資本家。

It's all about, you have to set the right economic incentives.

關鍵在於，你必須制定正確的經濟激勵措施。

But right now, the economic incentives in medicine are around diagnosis and pharmacologic treatment.

但目前，醫學界的經濟激勵機制主要圍繞診斷和藥物治療。

And I'm not here to say pharmacologic treatments don't matter.

我不是說藥物治療不重要。

They're very important and we do rely on them.

它們非常重要，我們確實依賴它們。

But the point here is we were really only educated along one parameter of intervention, which is procedural and pharmacologic.

但問題是，我們實際上只接受了一種干預參數的教育，那就是程序性和藥物性干預。

And if the entire system of reimbursement is based on creating a diagnosis and developing a treatment plan along those metrics, and by the way, go back to what I said at the outset, and the only metric of interest is length of life, you will create the machine we have called medicine 2.0.

如果整個報帳系統都建立在做出診斷和根據這些指標制定治療方案的基礎上，順便回到我一開始說過的話，唯一感興趣的指標就是生命的長度，那麼你就會創造出我們稱之為醫學 2.0 的機器。

And by the way, medicine 2.0 was very successful at treating some things, namely infectious diseases and acute problems such as trauma.

順便說一句，醫學 2.0 在治療某些疾病（即傳染病和創傷等急性問題）方面非常成功。

This is what has effectively doubled the lifespan of humans in the last 150 years.

是以，在過去的 150 年裡，人類的壽命實際上延長了一倍。

It's the success of that model, medicine 2.0, applied in that way, which is wait till the problem happens, treat it with pharmacologic intervention or procedural intervention.

這就是醫學 2.0 模式的成功之處，它的應用方式是等到問題發生後，通過藥物干預或程序干預進行治療。

What we're seeing is that playbook is not working with chronic diseases, not even close.

我們看到的是，這套玩法對慢性病不起作用，甚至根本不起作用。

And the only way you're going to treat chronic diseases is moving on to an approach where you treat, where you really enact prevention.

而治療慢性病的唯一方法，就是轉而採取一種治療方法，真正做到預防為主。

And if you want to incentivize physicians to do that, they have to be educated in this way and you have to be able to reimburse for these tools.

如果要激勵醫生這樣做，就必須以這種方式對他們進行教育，而且必須能夠報帳這些工具的費用。

You have to be able to reimburse physicians and you have to be able to incentivize patients to take care of themselves 30 years before they have that heart attack.

你必須能夠償還醫生的費用，你必須能夠激勵病人在心臟病發作前 30 年照顧好自己。

If you were to advise a patient that's heading to their doctor, what are the kinds of things that you would tell him to kind of perk their ears up on or listen close to this number that are good guides for healthfulness?

如果你要給一位正在看病的病人提建議，你會告訴他哪些事情可以讓他豎起耳朵聽，或者仔細聽聽這個數字，這對健康有很好的指導作用？

I want patients to understand there are some things that labs are really good at.

我希望患者明白，有些事情實驗室真的很擅長。

There are a lot of things they're not good at.

他們不擅長的事情有很多。

Everybody should know their ApoB.

每個人都應該瞭解自己的載脂蛋白B。

ApoB is a number that measures the total concentration of the cholesterol-carrying particles in the blood that drive atherosclerosis, which is the dominant force driving heart disease.

載脂蛋白 B 是衡量血液中攜帶膽固醇的微粒總濃度的一個數字，這種微粒會導致動脈粥樣硬化，而動脈粥樣硬化是心臟病的主要誘因。

Again, can't say it enough, right?

還是那句話，怎麼說都不為過，對吧？

Atherosclerotic heart disease is the leading killer globally.

動脈粥樣硬化性心臟病是全球頭號殺手。

About 19 million people per year die of atherosclerotic cardiovascular disease, which dwarfs the number two killer, by the way, which is cancer at about 12 to 13 million.

每年約有 1900 萬人死於動脈粥樣硬化性心血管疾病，這讓癌症這一第二號殺手相形見絀，後者的死亡人數約為 1200 萬至 1300 萬。

You've got to know this ApoB concentration.

你必須瞭解載脂蛋白B的濃度。

Everybody, at least once in their life, needs to have their LP, little a, measured.

每個人一生中至少都需要測量一次自己的 LP（小 A）。

That's genetically determined.

這是基因決定的。