#265 – How do you know if you are healthy and what your labs tell you? | Dr. Robert Lustig & Mike Haney
#265 – 如何知道你是否健康以及实验室报告告诉你什么？| 罗伯特·卢斯蒂格博士 & 迈克·海尼

Although not one single test can tell you whether you are healthy, some biomarkers and lab results can provide you a picture of your metabolic health, which can then inform you about your overall health.
虽然没有任何单一的测试能告诉你你是否健康，但一些生物标志物和实验室结果可以为你提供代谢健康状况的图景，这进而能告诉你你的整体健康状况。
Dr. Robert Lustig and Mike Haney discuss why fasting insulin is one of the best metabolic health biomarkers, how you can use continuous glucose monitoring as a proxy for insulin sensitivity, how fast your metabolic health can change, and why your uric acid level and the cholesterol marker ApoB are also important labs to receive.
罗伯特·卢斯蒂格博士和迈克·海尼讨论了空腹胰岛素为何是最佳代谢健康生物标志之一，如何使用连续血糖监测作为胰岛素敏感性的代理指标，你的代谢健康可以多快改变，以及为什么你的尿酸水平和胆固醇标记 ApoB 也是需要接收的重要实验室检查。

3:51 — Multiple factors help determine if you’re getting sicker or healthier
3:51 — 多个因素有助于判断你是否在恶化或好转

Several biomarkers, not just one, can provide an overall picture of your metabolic health.
多个生物标志物，而不仅仅是单一的，可以提供您代谢健康的整体图景。

You didn’t get sick in a day. You’re not going to get better in a day. And the markers that we look at to determine metabolic health didn’t go south in a day, so they’re not going to get changed in a day either.
你不是一天就生病的，所以你也不会在一天内好转。我们用来判断代谢健康的标准也不是一天就变坏的，因此它们也不会在一天内改变。
So this is why this is a mess in terms of people hawking one idea versus another, people hawking one supplement versus another, people hawking one lab test versus another. This is a very murky.
所以这就是为什么人们推销一种想法而不是另一种，推销一种补充剂而不是另一种，推销一种实验室测试而不是另一种，这是一团糟的原因。这非常模糊。
And if there was one test that could tell you whether or not you were getting healthy or not, everybody would be doing it. And they’re not, because it’s not that simple. Different people have different problems. Different people need different solutions.
如果有一个测试可以告诉你你是否正在变得健康，那么每个人都会去做。但他们不做，因为这并不那么简单。不同的人有不同的问题。不同的人需要不同的解决方案。
And different people respond differently to the different paradigms.
不同的个体对不同的范式有不同的反应。

7:52 — Fasting glucose is not a good gauge of your metabolic health
7:52 — 空腹血糖不是衡量你代谢健康的好指标

Doctors commonly use a fasting glucose or oral glucose tolerance test to diagnose someone with prediabetes or type 2 diabetes. However, these tests don’t account for insulin levels.
医生通常使用空腹血糖或口服葡萄糖耐量试验来诊断糖尿病前期或 2 型糖尿病。然而，这些测试不考虑胰岛素水平。
Even if someone’s glucose level is in the normal range, they may already be experiencing insulin resistance, placing them on a trajectory toward these conditions.
即使某人的血糖水平在正常范围内，他们可能已经经历了胰岛素抵抗，使他们朝着这些状况发展。

If you’re waiting for you to develop diabetes, you are so far behind the eight ball. You have missed the train. The train’s pulled out of the station. You are already sick. So the goal is to catch that way before.
如果你还在等待发展成糖尿病，你已经远远落后了。你错过了火车。火车已经离开车站。你已经生病了。所以目标是在那之前就抓住它。
So you go to your physician, and the physician does your fasting blood glucose, and it comes back 102, and he says, “Well, that’s fine. You’re far away from 125.” No, that’s not fine at all. In fact, let’s say you went and got your fasting blood glucose and it was 91.
所以你去找你的医生，医生做了你的空腹血糖测试，结果是 102，他说，“嗯，这很好。你离 125 还远着呢。”不，这根本不好。事实上，假设你去做了空腹血糖测试，结果是 91。
And you say, “Oh, you’re doing great.” No, you’re not. That’s already a problem. Okay. It’s on the way to glucose intolerance. It’s on the way to diabetes. It’s not there yet, but that’s an early indication.
你說，「哦，你做得很好。」不，你並沒有。這已經是一個問題。好的。它正在通往糖耐量異常的路上。它正在通往糖尿病的路上。還沒有到那裡，但這是一個早期的指標。
So how you read it—understanding what it means is extraordinarily valuable in and of itself. And it’s the last thing to change.
所以你怎么读它——理解它的含义本身就非常有价值，而且它是最后要改变的事情。
Now, if you take a look at fasting glucose tolerance tests over the last 50 years, the excursion of the glucose is pretty much the same for the last 50 years. But the amount of insulin needed to keep you at a normal excursion has gone up two- to four-fold.
现在，如果你回顾过去 50 年的空腹血糖耐受测试，过去 50 年的血糖波动基本相同。但维持正常波动所需的胰岛素量增加了两到四倍。
And that’s a sign of chronic metabolic disease. That is not measured in the fasting blood glucose. That isn’t even measured in the glucose tolerance test. You’re already sick and you don’ t even know it.
这是一种慢性代谢性疾病的表现。这并不体现在空腹血糖的测量中。甚至在糖耐量测试中也不进行测量。你已经生病了，甚至都不知道。
So fasting glucose is by far and away the worst metabolic parameter test than you can imagine if you’re waiting for that to change.
空腹血糖是你可以想象的最糟糕的代谢参数测试，如果你在等待它改变的话。

10:13 — The concern with a rising insulin level
10:13 — 对血糖水平上升的担忧

Insulin is an essential hormone that we cannot live without. But insulin levels are best kept lower.
胰岛素是一种必不可少的激素，我们无法没有它生存。但胰岛素水平最好保持较低。

Everyone thinks insulin is good because it lowers blood glucose. Well, insulin has its own negative side effects. It is a growth factor, so it causes vascular smooth muscle growth, like coronary artery smooth muscle growth.
每个人都认为胰岛素好，因为它能降低血糖。嗯，胰岛素有自己的副作用。它是生长因子，因此会导致血管平滑肌生长，比如冠状动脉平滑肌生长。
It causes glandular growth—like, for instance, breast growth and prostate growth—so it is a risk factor for both breast cancer and prostate cancer. So things that we associate with aging are made worse by insulin going up.
它会导致腺体生长，例如乳腺和前列腺的生长，因此它是乳腺癌和前列腺癌的风险因素。所以我们认为与衰老相关的事物，胰岛素上升会使它们变得更糟。
So if you need more insulin to do the same job and keep your blood glucose constant, you’re not in danger because your glucose is rising; you’re in danger because your insulin’s rising.
所以，如果你需要更多的胰岛素来做同样的工作并保持血糖恒定，你不是因为血糖在上升而处于危险中，你是因为胰岛素在上升而处于危险中。

19:22 — A good goal is to keep glucose levels more stable, but you’re going to have rises
19:22 — 一个良好的目标是使血糖水平更加稳定，但你可能会有上升

Unless you’re fasting or only eating fat, you will have blood sugar rises. The goal is to avoid extreme spikes and minimize how many spikes you have.
除非你在禁食或只摄入脂肪，否则你的血糖水平会上升。目标是避免极端波动，并尽量减少血糖波动的次数。

I’m going to start with a controversial saying: We’re all going to die. Okay. You’re going to die sometime. Everyone dies. And no matter how metabolically healthy you are, you’re still going to die. Now, the question is when.
我将从一个有争议的言论开始：我们都会死亡。好吧。你总有一天会死。每个人都会死。不管你新陈代谢有多健康，你仍然会死亡。现在的问题是何时。
Obviously, we all want to put it off for as long as possible. And as George W. Bush famously said, “We all want to die as late as possible.” Right? And that’s why Levels does what it does. And I’m totally for it. I’m totally in support of it. You’re going to have glucose spikes.
显然，我们都希望尽可能推迟。正如乔治·W·布什曾经著名地说过，“我们都希望尽可能晚地死去。”对吧？这就是为什么 Levels 会做它所做的事情。我完全支持它。你将会经历血糖峰值。
You can’t not have glucose spikes. You can’t freak out about it either. If you do, now you’ve got something called orthorexia: when you start worrying about actually what you’re eating all the time. Now, we do not want to be contributing to orthorexia.
你不能没有血糖波动。你也不能对此感到恐慌。如果你这样做，你就有了所谓的正食症：开始担心你一直在吃什么。现在，我们不想助长正食症。
And some people will take this information and use it, shall we say, not for good. And we need to protect against that as much as possible. So I’m here to tell you, you’re going to have spikes. The question: How many spikes?
有些人会利用这些信息，我们可以说，不是为了好的目的。我们需要尽可能地保护自己不受其影响。所以我要告诉你，你会经历波动。问题是：会有多少波动？

30:12 — What a glucose excursion can tell you
30:12 — 一血糖波动能告诉你什么

When your glucose spikes on a CGM, how high its spikes and how long it stays elevated can tell you whether your cells are using glucose efficiently or if you’re storing excess glucose as fat.
当您的连续血糖监测（CGM）显示血糖升高时，其升高的程度和持续升高的时间可以告诉您您的细胞是否高效地使用葡萄糖，或者您是否将过多的葡萄糖储存为脂肪。

I think this is really helpful in understanding this glucose journey and what this glucose journey on a glucose graph is telling me. So if I am healthy, I take in a load of glucose.
我认为这真的有助于理解这个血糖旅程，以及血糖图上的旅程在告诉我什么。所以如果我健康，我会摄入大量的血糖。
I see it rise, but I’m seeing it clear quickly, which is a sign that my cells are taking it up as efficiently as they possibly can. It’s not then going to be deposited in my muscle and fat tissue as fat.
我看到了它，但我看到它消失得很快，这是一个信号，表明我的细胞正在尽可能高效地吸收它。它不会被沉积在我的肌肉和脂肪组织中作为脂肪。
So if it takes a long time for it to clear, that’s essentially a sign that, in other words—let me see how to phrase this—if it’s being cleared quickly, it means it’s going into the cells.
所以，如果它需要很长时间才能清除，这基本上是一个信号，换句话说——让我看看如何表达这个如果它被快速清除，这意味着它正在进入细胞。
If it’s not being cleared quickly, that means it’s not going into the cells where I wanted it to go and it’s going to go into this other tissue.
如果它没有快速清除，这意味着它没有进入我所希望的细胞，而是进入其他组织。

31:24 — Why doctors don’t check fasting insulin, even though it’s a better marker than glucose?
31:24 — 为什么医生不检查空腹胰岛素，尽管它比血糖更好的指标？

Fasting insulin is a better marker for how well your mitochondria are working or whether you have mitochondrial dysfunction, but doctors typically don’t check fasting insulin for several reasons.
空腹胰岛素是衡量您的线粒体工作状况或是否存在线粒体功能障碍的更好指标，但医生通常出于多种原因不会检查空腹胰岛素。

If your mitochondria are not working, your fasting insulin’s high. It’s our best proxy for mitochondrial function. And so I think that the fasting insulin is the single best marker for metabolic health that we could order. And I routinely suggest it and order it on my patients.
如果您的线粒体没有正常工作，您的空腹胰岛素水平会很高。这是我们衡量线粒体功能的最佳指标。因此，我认为空腹胰岛素是衡量代谢健康的最佳单一指标，我们可以订购。我通常会建议并为我的患者订购它。
And I’m trying to get the medical profession to, you know, glom onto this idea, but I will tell you there are a super number of obstacles. One is the insurance industry, because they don’t want to pay for it, even though it’s not expensive . . . And of course the food industry.
我正在努力让医疗界接受这个想法，你知道，让他们抓住这个理念，但我要告诉你，有很多障碍。其中一个障碍是保险行业，因为他们不想为此付费，尽管它并不昂贵……当然还有食品行业。
The food industry is not happy about that at all, because it’s one of the ways they get away with putting junk in our food. Because if you’re fasting insulin is going up and the only way to fix it is your food, they don’t want you to know.
食品行业对此非常不满，因为这是他们将垃圾食品混入我们食物的一种方式。因为如果你的空腹胰岛素水平上升，唯一的方法是通过食物来解决，他们不想让你知道这一点。
And then third, the American Diabetes Association. Now, you would think that the American Diabetes Association would be very happy for people to not be insulin resistant. You would think that that would prevent them from getting diabetes.
然后第三，美国糖尿病协会。现在，你可能会认为美国糖尿病协会会非常高兴人们不会对胰岛素产生抵抗。你可能会认为这能防止他们患上糖尿病。
Well, the American Diabetes Association is really not into prevention; they’re into treatment. They’re into pharmacology. They’re into pharmaceuticals. Because their entire budget is basically underwritten by Big Pharma.
美国糖尿病协会实际上并不注重预防；他们专注于治疗。他们专注于药理学和制药。因为他们的整个预算基本上是由大型制药公司资助的。

46:12 — How often should you get your fasting insulin checked?
46:12 — 您应该多久检查一次空腹胰岛素？

Dr. Robert Lustig recommends getting your fasting insulin checked once a year. But you may also wish to get it checked four weeks after making a lifestyle change to see if your level is trending in the right direction.
罗伯特·卢斯蒂格博士建议每年检查一次空腹胰岛素。但你也可以在生活方式改变后四周检查一次，看看你的水平是否朝着正确的方向发展。
This can help provide continued motivation for healthier habits.
这可以帮助提供持续的动力来保持更健康的习惯。

I think that everyone should get their fasting insulin done once a year, along with their standard lab draw, but they need them to be fasting, because if you’re not fasting, you don’t know where you are on the insulin curve, and then it’s useless.
我认为每个人都应该每年在进行常规实验室检查时，进行一次空腹胰岛素检测，但需要空腹进行，因为如果不空腹，你就无法知道你在胰岛素曲线上的位置，然后这将毫无用处。
But if you’re fasting, then you should get it done once a year.
但如果你在禁食，那么你应该每年做一次。
And if you’re changing diet or exercise or, you know, some lifestyle or environmental intervention that you think is going to improve metabolic health, I would strongly suggest getting a second fasting insulin four weeks after the change so that you can monitor it, know that you’re doing the right thing, note that the fasting insulin is coming down so that you will, number one, be positively reinforced and continue on your weight loss or metabolic health journey and be rewarded for your efforts.
如果你正在改变饮食、运动或你认为能改善代谢健康的某些生活方式或环境干预措施，我强烈建议在改变后的四周后进行第二次空腹胰岛素检测，以便监测情况，确保你正在做正确的事情，注意到空腹胰岛素水平下降，这样你不仅可以得到积极的强化，继续你的减重或代谢健康之旅，而且会因为你的努力而得到回报。
And it’ll give your physician a new baseline to work off of. So I think that once a year and four weeks after changing your lifestyle.
这将为您的医生提供一个新的基准线来进行工作。所以我认为，每年一次，在改变生活方式后四周。

50:08 — A continuous glucose monitor can show you your glucose excursions
50:08 — 持续葡萄糖监测器可以显示您的血糖波动

A continuous glucose monitor (CGM) tracks your glucose in real time so you can see how high and how long your glucose stays elevated after eating a specific food. These rises can serve as a proxy for how well your insulin is working.
连续血糖监测器（CGM）实时跟踪您的血糖水平，让您可以看到在食用特定食物后，血糖水平升高并持续升高的情况。这些升高可以作为胰岛素工作效果的代理指标。

The longer it stays up, the more of a problem it is. That’s really what I can say. You should be able to clear your glucose within an hour. That’s what I can say.
停留的时间越长，问题就越严重。我可以说的就是这些。你应该能够在一小时内清除血糖。我可以说的就是这些。
Now, different foods will give you different rises, and different foods will probably have different effects on how fast that glucose gets cleared as well. Those are called Kraft curves. Okay, K-R-A-F-T, for Dr. Kraft who first utilized them.
现在，不同的食物会给你带来不同的血糖上升，而且不同的食物可能对血糖清除的速度产生不同的影响。这些被称为 Kraft 曲线。好的，K-R-A-F-T，指的是首次使用这些曲线的 Kraft 博士。
So different foods will provide you with different information. And that’s one of the reasons why CGMs are so great because then you can determine what gives you the lowest glucose excursion, what gives you the best Kraft curve for your personal biochemistry.
所以不同的食物会为你提供不同的信息。这就是为什么连续葡萄糖监测仪如此出色的原因之一，因为这样你就可以确定什么能给你最低的血糖波动，什么能给你个人生物化学最佳的 Kraft 曲线。
You can get that out of the CGM. Now, the Kraft curve of course measures insulin. It doesn’t measure glucose. So you’re not getting that, but you’re getting a proxy. Because if you’re clearing your glucose fast, that means your insulin’s in good shape.
你可以从 CGM 中获取那个信息。当然，卡夫曲线测量的是胰岛素，而不是葡萄糖。所以你得不到葡萄糖的信息，但你得到了一个代理指标。因为如果你快速清除葡萄糖，这意味着你的胰岛素状态良好。
So you have to understand what we’re measuring: glucose. But really what you want to know about is the insulin.
所以你必须理解我们在测量什么：葡萄糖。但实际上你想要了解的是胰岛素。

58:42 — Why uric acid is an important biomarker
58:42 — 为什么尿酸是一个重要的生物标志

Fructose, purines, and alcohol drive higher uric acid levels, which can contribute to high blood pressure and more.
果糖、嘌呤和酒精导致尿酸水平升高，这可能与高血压有关。

The problem is that uric acid does two things that you wish it didn’t do. One is it is the inhibitor of an enzyme in your arteries called endothelial nitric oxide synthase, or ENOS.
问题在于，尿酸做了两件事，你希望它不做。一是它抑制了你动脉中称为内皮一氧化氮合酶或 ENOS 的酶。
And that’s the enzyme that makes nitric oxide, and nitric oxide is your endogenous blood pressure lowerer. It’s the thing that causes your blood vessels to relax. Therefore, it’s the thing that keeps your blood pressure down.
这就是制造一氧化氮的酶，一氧化氮是你的内源性血压降低剂。它是使你的血管放松的东西。因此，它是保持血压正常的东西。
And so, if you’re inhibiting it, it means your blood pressure is going to go up. So it is a primary contributor to hypertension.
所以，如果你抑制它，这意味着你的血压会上升。所以它是高血压的主要贡献者。

1:08:37 — Why you should get ApoB checked
1:08:37 — 为什么你应该检查 ApoB

Apolipoprotein B (ApoB) is a better biomarker than traditional cholesterol tests because it provides a more accurate picture of harmful cholesterol particles.
载脂蛋白 B（ApoB）是一种比传统胆固醇测试更好的生物标志物，因为它能提供更准确的有害胆固醇颗粒的图像。

What you care about is your LDL, but you care about it in the face of your serum triglyceride. So, high LDL, low triglyceride, not a big deal. High LDL, high triglyceride, very big deal. At Levels, we understood this, and so we are not measuring LDL or triglyceride.
您关心的是您的 LDL，但您是在面对血清甘油三酯的情况下关心它。所以，高 LDL，低甘油三酯，没什么大不了。高 LDL，高甘油三酯，非常严重。在我们 Levels，我们理解这一点，所以我们不测量 LDL 或甘油三酯。
We’re measuring something called ApoB, Apolipoprotein B. And the reason is because LDL and triglyceride both have ApoB. Because one’s an evolution of the other. And so that’s a way of figuring it out. So that’s another reason why Labs 2.
我们在测量一种叫做 apoB，载脂蛋白 B 的东西。原因是 LDL 和甘油三酯都含有 apoB。因为一个是另一个的进化。这就是我们计算出来的方式。这就是为什么实验室 2 的另一个原因。
0 for Levels includes ApoB as one of the markers. Okay, so that’s basically what we’ve learned. Levels is doing this right now with tests that are normally and routinely available and coverable by insurance.
0 级包括 ApoB 作为指标之一。好吧，基本上就是我们学到的。Levels 正在使用当前常规可用且可通过保险覆盖的测试来进行这一操作。

Rob Lustig (00:00:00): 罗布·卢斯蒂格（00:00:00）:

45% of Americans have fatty liver, 25% of children. Notice I didn’t say obese adults or obese children, all adults, all children. This is something that didn’t even exist before 1980.
45%的美国人有脂肪肝，25%的儿童。请注意，我没有说肥胖成年人或肥胖儿童，所有成年人，所有儿童。这是在 1980 年之前甚至不存在的事情。
And here we are now 45 years later, and 45% of the population has a disease that we never heard of before.
而现在，我们在这里，45 年后，45%的人口患有我们以前从未听说过的疾病。
So we know something’s going on, and this is a clear indicator of metabolic dysfunction, a clear indicator of inability to utilize fat because of defective mitochondria, because of insulin resistance. So these things all go together.
所以我们知道有些事情正在发生，这是一个明显的代谢功能障碍指标，也是由于线粒体缺陷或胰岛素抵抗导致无法利用脂肪的明确指示。所以这些事情都是一起发生的。
So your fasting insulin and your uric acid and your ALT should all line up together because they’re all part and parcel of the same pathophysiologic pathway.
所以你的空腹胰岛素、尿酸和 ALT 都应该一起排列，因为它们都是同一条病理生理途径的一部分。

Ben Grynol (00:00:53): 本格里诺（00:00:53）：

Am I getting healthier? It’s a question that we often ask ourselves. And earlier this year, Mike Haney, our editorial director, found himself asking that same question.
我在变健康吗？这是我们经常问自己的问题。今年早些时候，我们的编辑总监迈克·汉尼也问了自己同样的问题。
He’s been tracking his glucose and paying attention to his metabolic health over time, but he was wondering, am I getting healthier with making some of the lifestyle changes that I have been doing?
他一直在追踪自己的血糖水平，并关注他的新陈代谢健康，但他想知道，我通过做出一些生活方式的改变，是否真的变得更健康了？
And so Haney having access to a number of our thought leaders and advisors tapped our good friend Dr. Robert Lustig on the shoulder, and said, “Hey, Rob, would you be interested in having a conversation around biomarkers so that we can understand more about some of these things?
汉尼利用我们众多思想领袖和顾问的资源，邀请了我们的好友罗伯特·卢斯汀博士进行了一次关于生物标志物的对话，以便我们能更深入地了解一些事情。
Am I getting healthier? What should I be paying attention to?” And so the two of them sat down in Los Angeles and they discuss this idea of the limitations around standard tests, things like fasting glucose and A1C for detecting early metabolic issues.
我在变健康吗？我应该关注什么？”于是，他们两人在洛杉矶坐下来，讨论关于标准测试限制的想法，比如空腹血糖和 A1C 检测早期代谢问题。

(00:01:43):

There are a number of limitations when you look at those markers in isolation. When you start to look at things like fasting insulin, you understand why it’s a critical marker for metabolic health and insulin sensitivity.
当你单独查看这些指标时，存在一些限制。当你开始查看如空腹胰岛素这样的指标时，你就能理解为什么它是衡量代谢健康和胰岛素敏感性的重要指标。
It’s a much better indicator for metabolic health over time because insulin resistance is directly related to mitochondrial function. They also discussed uric acid and why it’s an important marker for cellular health.
这在长期代谢健康方面是一个更好的指标，因为胰岛素抵抗直接与线粒体功能有关。他们还讨论了尿酸及其对细胞健康的重要标志。
Uric acid is directly connected to your diet, what you consume, whether it’s increases in things like fructose or increases in purine-rich foods. That being things like game meats as one example.
尿酸直接与您的饮食有关，您所摄入的食物，比如果糖或富含嘌呤的食物的增加。例如，像狩猎肉类就是其中之一的例子。

(00:02:21):

So increases in uric acid can increase blood pressure over time, and we all know that increases in blood pressure are not great for your cardiovascular health. There are also a number of problems with other tests like cholesterol testing when it’s done in its standard way.
因此，尿酸水平的增加会随着时间推移导致血压升高，我们都知道血压升高对心血管健康不利。而且，当以标准方式执行时，胆固醇测试等其他测试也存在一些问题。
If you look at cholesterol markers like HDL and LDL in isolation, or if you just look at them in absolute terms, there may be not as great an indicator of metabolic health as other markers like ApoB. There are also other potential future markers that we can start to consider.
如果你单独查看胆固醇指标如 HDL 和 LDL，或者只是以绝对值来看，它们可能不像 ApoB 等其他指标那样能很好地反映代谢健康。还有一些其他潜在的未来指标，我们可以开始考虑。
Things like homocysteine isn’t as widely discussed, but increases in homocysteine have been linked to things like increases in cardiovascular disease, insulin resistance, oxidative stress, and even Alzheimer’s disease. Anyway, Haney and Rob, they had a great conversation.
同半胱氨酸并不是那么广为人知，但同半胱氨酸的增加与心血管疾病、胰岛素抵抗、氧化应激，甚至阿尔茨海默病的增加有关。无论如何，汉尼和罗布进行了一次很棒的对话。
They dug deep. No need to wait. Here is Haney and Rob.
他们挖得很深。无需等待。这是汉尼和罗布。

Mike Haney (00:03:12): 迈克·汉尼 (00:03:12):

The genesis of today, I’ll set this up a little bit before we get into it, the genesis of this conversation is Levels at its core is an app designed to help people get healthier. That’s the mission, cut out everything else. We just want folks to get healthier.
今天的起源，我们在深入讨论之前，这个对话的起源在于“Levels”。它的核心是一款旨在帮助人们变得更健康的应用。这就是我们的使命，去除其他一切。我们只是希望人们能够变得更健康。

Rob Lustig (00:03:26): 罗布·卢斯蒂格（00:03:26）:

My mission too. 我的任务也是如此。

Mike Haney (00:03:27): 迈克·汉尼 (00:03:27):

But that begs a really key question. How do you know when you’re getting healthier? How do you know the things you’re doing are working?
但这就引出了一个真正关键的问题。你怎么知道你正在变得更健康？你怎么知道你所做的事情正在起作用？

Rob Lustig (00:03:35): 罗布·卢斯蒂格（00:03:35）:

And it’s really hard to know. You didn’t get sick in a day, you’re not going to get better in a day. And the markers that we look at to determine metabolic health didn’t go south in a day, so they’re not going to get changed in a day either.
真的很难知道。你不是一天生病的，所以你也不会在一天内好转。我们用来判断代谢健康的标准没有在一天内变差，所以它们也不会在一天内改变。
So this is why this is a mess in terms of people hawking one idea versus another, people hawking one supplement versus another, people hawking one lab test versus another. This is a very murky area.
所以这就是为什么人们推销一种想法而不是另一种，推销一种补充剂而不是另一种，推销一种实验室测试而不是另一种，这是一片非常混沌的领域。
And if there was one test that could tell you whether or not you were getting healthy or not, everybody would be doing it, and they’re not because it’s not that simple.
如果有一个测试可以告诉你你是否正在变得健康，那么每个人都会去做，但他们不做，因为事情没有那么简单。
Different people have different problem, different people need different solutions, and different people respond differently to the different paradigms. So this is, shall we say, a mélange of different ideas.
不同的人有不同的问题，不同的人需要不同的解决方案，对不同的范式有不同的反应。所以，这可以说是不同想法的混合。
And I’m happy to discuss each of them with you for the purpose of the audience, understanding the value of these different things. But if you think you can just go to your doctor and get a test, think again.
我很高兴与您讨论它们，目的是让观众理解这些不同事物的价值。但如果您认为只需去看医生并进行一次测试就可以，那就再考虑一下吧。

Mike Haney (00:04:51): 迈克·汉尼（00:04:51）:

Well, I think that’s really helpful context, and I think we’ll split this into sort of two parts.
嗯，我认为这真的很有助于理解背景，我认为我们会将其分为两部分。
One, we’ll talk about broad set of markers, and then we’re going to narrow in a little bit I think on glucose and insulin because that is where a lot of Levels bread and butter is and where a lot of our members are measuring or paying attention to or maybe visualizing their health or at least their metabolic health.
我们将讨论一系列广泛的指标，然后我认为我们将更具体地关注血糖和胰岛素，因为这正是我们产品的主要功能所在，也是我们大多数成员在测量、关注或可视化他们的健康，特别是代谢健康时的重点。
So I think that setup is helpful for getting into it, that realizing we’re not going to determine in this conversation, here are the five key markers.
所以我认为这种设置有助于我们开始，意识到在这次对话中，我们不会确定这五个关键指标。

(00:05:21):

Well, I would love that headline as an old magazine editor. We’re not going to come out of this conversation with that. What I think might be helpful is to maybe narrow in on some markers that to my mind, need to have two criteria.
好吧，作为一位老杂志编辑，我也会喜欢那个头条。我们不会从这次对话中得出那样的结论。我认为可能有帮助的是，也许可以专注于一些需要两个标准的指标。
One is that they tell us something about our underlying physiology, which is to say there’s some clarity in the signal that relates to something happening in our body, a process that we want to maybe be working functionally. And the second is that they’re movable.
一种是它们能告诉我们一些关于我们基础生理学的信息，也就是说，信号中有一些清晰的部分与我们体内发生的事情有关，一个我们可能希望正常运作的过程。第二种是它们是可移动的。
There are things we can actually do something about.
我们可以做一些事情。

Rob Lustig (00:05:51): 罗布·卢斯蒂格（00:05:51）:

Well, and that they’re titratable.
嗯，而且它们是可以调节的。

Mike Haney (00:05:53): 迈克·汉尼 (00:05:53):

Sure. 当然。

Rob Lustig (00:05:54): 罗布·卢斯蒂格（00:05:54）:

That is they’re on a scale and they tell you something about severity. It’s not just an on-off type of deal. That there’s a dynamic range of whatever the marker is to tell you, oh, you’re at this level, you’re at that level, you’re at the worst level.
那是它们在量表上，告诉你关于严重程度的信息。这不仅仅是一个开或关的问题。无论标记的是什么，它会告诉你，你处于这个水平，你处于那个水平，你处于最严重的水平。
That’s very important as well. And it has to then change with either the worsening or with the improvement. Those are hard to come by.
那也很重要，而且它必须随着病情的恶化或改善而改变。这很难做到。

Mike Haney (00:06:21): 迈克·汉尼 (00:06:21):

So I think most people’s interaction with markers, with biomarkers is if they go to an annual physical, which so many folks don’t, but if you go to an annual physical, you get your labs and essentially in there you’re getting glucose and cholesterol.
所以我认为大多数人与标记物、生物标记物的互动，如果他们去做年度体检，尽管很多人不做，但如果你去做年度体检，你会得到你的实验室检查结果，基本上在里面你会得到血糖和胆固醇。
That’s primarily what’s being measured.
那主要是正在测量的内容。

Rob Lustig (00:06:37): 罗布·卢斯蒂格（00:06:37）:

Yeah. And that’s about the worst thing you can get.
是的。那大概是你可以得到的最糟糕的事情。

Mike Haney (00:06:40): 迈克·汉尼 (00:06:40):

Yeah. So let’s start there. Tell me what’s wrong with that as a core set of things, maybe what’s right with it, but also what’s wrong with it in terms of a core set that we’re at least checking in on annually?
是的。那么，让我们从这里开始。告诉我，作为核心设置的这些事情有什么问题，也许其中有什么是对的，但也要告诉我们，从至少每年检查的角度来看，它在核心设置方面有什么问题？

Rob Lustig (00:06:51): 罗布·卢斯蒂格（00:06:51）:

Okay. Let’s start with glucose. Fasting glucose. Fasting glucose is the single worst thing to measure, but it’s the thing that everyone measures. And the reason everyone measures is because it’ll tell you if you have diabetes or not. And in that way, well, that’s an on-off.
好的。我们从葡萄糖开始。空腹血糖。空腹血糖是测量最差的事情，但却是每个人都测量的。每个人都测量的原因是，它可以告诉你是否患有糖尿病。以这种方式，是开或关。
If you’re fasting blood glucose is above 125 you have diabetes. If you’re fasting blood glucose is below 125, you don’t have diabetes.
如果您的空腹血糖高于 125，您可能患有糖尿病。如果您的空腹血糖低于 125，您可能没有糖尿病。
And that’s basically what the physician is drawing it for and that’s what they’re referring to and that’s what the guidelines say, and there is so much more information to be gained, and that is just the tip of the iceberg.
这就是医生绘制它的原因，也是他们引用的，也是指南所说明的，还有更多信息可以获取，这只是冰山一角。
And most importantly, if you are waiting for you to develop diabetes, you are so far behind the eight-ball, you have missed the train. Okay. Train’s pulled out of the station, okay, you are already sick. So the goal is to catch that way before.
最重要的是，如果你正在等待发展成糖尿病，你已经远远落后了，错过了机会。好吧。火车已经离开车站，你已经生病了。所以目标是在这种情况发生之前就抓住它。

(00:07:55):

So you go to your physician and the physician does your fasting blood glucose and it comes out back 102 and he says, well, that’s fine. You’re far away from 125. No, that’s not fine at all. In fact, let’s say you went and got your fasting blood glucose and it was 91.
所以你去找你的医生，医生做了你的空腹血糖，结果是 102，他说，这很好。你离 125 还远着呢。不，这根本不好。事实上，假设你去做了空腹血糖，结果是 91。
And you say, “Oh, you’re doing great.” No you’re not. That’s already a problem. It’s on the way to glucose intolerance, it’s on the way to diabetes. It’s not there yet, but that’s an early indication.
你说，“哦，你做得很好。”不，你没有。这已经是一个问题。它正走向糖耐量异常，正走向糖尿病。它还没有到达那里，但这是一种早期迹象。
So how you read it and understanding what it means is extraordinarily valuable in and of itself, and it’s the last thing to change.
所以，如何阅读它以及理解它的含义本身就极其宝贵，而且它是最后要改变的事情。

(00:08:43):

Now, if you take a look at glucose tolerance tests, fasting glucose, glucose tolerance tests over the last 50 years, the excursion of the glucose is pretty much the same for the last 50 years, but the amount of insulin needed to keep you at a normal excursion has gone up two to four fold, and that’s a sign of chronic metabolic disease.
现在，如果你查看过去 50 年的葡萄糖耐量测试、空腹血糖和葡萄糖耐量测试，葡萄糖的波动在过去 50 年中基本保持不变，但维持正常波动所需的胰岛素量增加了两到四倍，这是慢性代谢性疾病的一个迹象。
That is not measured in the fasting blood glucose, that isn’t even measured in the glucose tolerance test. You are already sick and you don’t even know it. So a fasting glucose is by far and away the worst metabolic parameter test than you can imagine.
那不是在空腹血糖中测量的，甚至在糖耐量测试中也不会测量。你已经生病了，却不知道。所以空腹血糖测试是你可以想象的最糟糕的代谢参数测试。
If you’re waiting for that to change, you’re waiting for [inaudible 00:09:34].
如果你在等待这种情况改变，你就是在等待[00:09:34 听不清的内容]。

Mike Haney (00:09:33): 迈克·汉尼 (00:09:33):

A couple of things that I want to follow up on, but one, tell me why the OGTT, the oral glucose tolerance test, doesn’t do a good job of capturing that insulin response. Isn’t that what it’s sort of meant to do is to say, here’s how your body responds to a glucose load?
我想跟进的几点，但首先，请告诉我为什么口服葡萄糖耐量试验（OGTT）不能很好地捕捉到胰岛素反应。这难道不是它的本意吗？也就是说，这是如何在面对葡萄糖负荷时，你的身体做出的反应？

Rob Lustig (00:09:47): 罗布·卢斯蒂格（00:09:47）:

Well, and that’s true how your body responds to a glucose load by having to put out more insulin to handle it. Insulin in and of itself is part of the problem. Everyone thinks insulin is good because it lowers blood glucose. Well, insulin has its own negative side effects.
好吧，确实，当你的身体对葡萄糖负荷做出反应，需要分泌更多的胰岛素来处理它。胰岛素本身是问题的一部分。大家都认为胰岛素是好的，因为它能降低血糖。然而，胰岛素也有它自己的副作用。
It is a growth factor, so it causes vascular smooth muscle growth like coronary artery smooth muscle growth. It causes glandular growth like for instance, breast growth and prostate growth. So it is a risk factor for both breast cancer and prostate cancer.
它是一种生长因子，因此会导致血管平滑肌生长，类似于冠状动脉平滑肌生长。它会导致腺体生长，例如乳腺和前列腺生长。因此，它既是乳腺癌也是前列腺癌的风险因素。
So things that we associate with aging are made worse by insulin going up. So if you need more insulin to do the same job and keep your blood glucose constant, you’re not in danger because your glucose is rising, you’re in danger because your insulin is rising.
所以我们与衰老相关的那些事情，由于胰岛素水平上升而变得更糟。所以如果你需要更多的胰岛素来做同样的工作并保持血糖稳定，你不是因为血糖上升而处于危险之中，你是因为胰岛素上升而处于危险之中。
And that’s not measured in the glucose tolerance test. We infer it, but you don’t know it.
这不是在葡萄糖耐量测试中衡量的。我们只是推断，但你并不知道。

Mike Haney (00:10:57): 迈克·汉尼 (00:10:57):

Right. So two people could essentially have the same OGTT score, but one is pumping out twice the amount of insulin, one is much further along in an insulin resistant state than the other one, and that’s not going to be revealed in that test.
正确。所以两个人实际上可以有相同的 OGTT 分数，但一个人的胰岛素分泌量是另一个人的两倍，一个人的胰岛素抵抗状态比另一个严重得多，这在测试中不会被揭示出来。

Rob Lustig (00:11:11): 罗布·卢斯蒂格（00:11:11）:

Exactly right. 完全正确。
So the glucose tolerance test is good, and certainly what we do at Levels can glean a lot of information from that glucose excursion that will tell you, but it’s not necessarily the amplitude, it’s not necessarily the fasting level, and it’s not even necessarily the peak.
所以，葡萄糖耐量试验很好，而且在 Levels 中，我们可以通过葡萄糖波动获得很多信息，这些信息可以告诉你很多情况，但这并不一定是指波动幅度，也不一定是空腹水平，甚至不一定是指峰值。
It’s actually more how it gets disposed of. The decline downward. That’s why the curve is valuable. That’s why we do this. That’s why Levels exist is because the change from the peak down to baseline has lots of information in it.
其实更重要的是它如何被处理。下降的趋势。这就是曲线有价值的原因。这就是我们这样做是因为从峰值下降到基线的变化包含了很多信息。这就是为什么存在不同级别的原因。
But in fact, what you really want to know is how much insulin did it take to do that and how quickly did the insulin clear to bring you back to baseline? And you’re not getting any of that from a standard fasting glucose or an OGTT.
但事实上，你真正想知道的是，达到这种效果需要多少单位的胰岛素，以及胰岛素清除速度有多快，才能使你恢复到基线水平？而这些信息你无法从标准的空腹血糖或口服葡萄糖耐量试验中获得。

Mike Haney (00:12:05): 迈克·汉尼 (00:12:05):

Is there anything, this is jumping ahead a little bit to where I want to go with some of the dynamics of a glucose curve, but I think it’s relevant here. What can I infer about my insulin sensitivity from simply looking at the shape of a glucose spike or a glucose curve?
是否有任何事情，这有点提前到我想讨论的葡萄糖曲线动态，但我认为这在这里相关。我如何从仅仅观察葡萄糖峰值或葡萄糖曲线的形状中推断出我的胰岛素敏感性？

Rob Lustig (00:12:21): 罗布·卢斯蒂格（00:12:21）:

Right. So the higher the glucose goes, the less insulin reserve you have and the slower the glucose return to normal, the less well insulin’s working. So the more insulin resistance. So there are two phenomena that you can capture, but neither of them are direct measures.
正确。因此，血糖越高，可用的胰岛素储备越少，血糖恢复正常的速度越慢，胰岛素的作用就越差。因此，胰岛素抵抗的程度就越高。你可以捕捉到两种现象，但它们都不是直接的测量指标。
So the height of the glucose response basically tells you, hey, what’s going on with my beta cell? I should be able to keep up with this. There must be defective reserve or delayed response. Either way, that’s a problem of the beta cell.
所以，血糖反应的高度基本上告诉你，嘿，我的β细胞状况如何？我应该能够跟上这个。这可能是储备功能缺陷或反应延迟的问题。无论哪种情况，都是β细胞的问题。
Then how quickly things go back to normal. If they go back to normal quickly, that means that insulin’s chugging out and it’s working and it’s clearing and everything’s fine. That means you have good beta cell function with good insulin sensitivity.
然后事情如何迅速恢复正常。如果事情迅速恢复正常，这意味着胰岛素在持续分泌，它在起作用，正在清除，一切都很好。这意味着你有良好的β细胞功能和良好的胰岛素敏感性。
But if you’ve got a plateau and it takes a while for it to come down, then that’s a marker for insulin resistance. And you couldn’t see that from a fasting specimen and you may not even see it from a two-hour specimen, which is all that your physician is concerned about.
但如果你遇到了平台期，而且需要一段时间才能下降，那么这就是胰岛素抵抗的标志。你无法从空腹样本中看到这一点，你的医生可能甚至无法从两小时样本中看到这一点，而这正是他们关心的。

Mike Haney (00:13:33): 迈克·汉尼 (00:13:33):

I’m glad you used the phrase there, keep up, because one of the things I found that I didn’t really understand in trying to explain even these basic dynamics is a question of timing.
我很高兴你使用了那个短语，继续下去，因为在试图解释即使是这些基本动态时，我发现的一个问题是时间的问题。
So a glucose spike, if I watch my glucose go up very sharply and come back down, that’s at its most core reflection of something that I have done, right?
所以，如果我观察到血糖急剧上升然后又下降，这最核心的反映是我所做的事情，对吧？
I’ve eaten a high carb load, there’s a bunch of glucose now in my blood that CGM is going to measure that as a peak and then it’s going to come back down.
我已经摄入了高碳水化合物，血液中现在有大量的葡萄糖，CGM 会将其测量为峰值，然后会下降。
So how much of that spike is the result of what I’ve eaten is directly related to just the amount of carbs I have poured into my body and how much is related to my insulin response, which is another way of saying how fast can I expect my insulin to actually work and bring it down?
所以，那波增长有多少是由于我所吃的食物直接与我体内摄入的碳水化合物数量有关，又有多少与我的胰岛素反应有关，换句话说，我预期胰岛素能多快地发挥作用并将其降低？
Is there a world in which I am so insulin sensitive that even if I eat a ho-ho, I’m not going to see a big spike, or?
是否存在这样一个世界，在这个世界里，我对胰岛素的敏感度如此之高，以至于即使我吃了一个霍霍（一种甜点），我也不会看到血糖有大的波动？

Rob Lustig (00:14:24): 罗布·卢斯蒂格（00:14:24）:

You’ll always see a spike.
你总能看到峰值。

Mike Haney (00:14:25): 迈克·汉尼 (00:14:25):

Okay. 好的。

Rob Lustig (00:14:26): 罗布·卢斯蒂格（00:14:26）:

You’ll always see a spike. The reason is when you consume the glucose, it will go first to the liver. It’ll be absorbed from the intestine, it’ll go via the portal vein to the liver.
你总能看到峰值。原因是当你摄入葡萄糖时，它首先会到达肝脏。从肠道吸收后，它会通过门静脉到达肝脏。
The liver will take 20% of that glucose and throw it straight into the liver for conversion to glycogen. That means 80% will make it past the liver and generate a glucose response. You will get a glycemic excursion.
肝脏将吸收那 20%的葡萄糖，并直接送入肝脏转化为糖原。这意味着 80%的葡萄糖将越过肝脏，产生葡萄糖反应。你将经历一次血糖波动。
Now, the beta cell will then see that because it’s got to go circulate in the blood, the beta cell will see the rise in the glucose and we’ll start pumping out insulin saying, “Hey, I’ve got to clear this. This is not the baseline.
现在，β细胞会看到因为需要在血液中循环，β细胞会看到血糖的上升，我们开始分泌胰岛素说，“嘿，我必须清除这个。这不是基线。
Let’s get the glucose back down.” So you’ll see a glucose spike no matter what. The only way to not have a glucose spike is to not consume glucose.
让我们把血糖降下来。”所以不管你怎么做，你都会看到血糖升高。没有血糖升高唯一的方法就是不摄入血糖。

(00:15:23):

So if you’re consuming straight fat, you won’t see much of a glucose spike if at all. If you are fasting, you won’t see a glucose spike. But otherwise, if you’re consuming food, you’re going to see a glucose spike. The question is how high and how long?
所以，如果你摄入的是纯脂肪，你可能不会看到血糖峰值，或者几乎看不到。如果你在禁食，你可能不会看到血糖峰值。但是，如果你摄入食物，你会看到血糖峰值。问题是多高以及持续多久。
Those are the two questions. How high tells you what was in that, but it also tells you whether or not your beta cell’s keeping up. And how long basically tells you if you’re insulin resistant.
这两个问题是。高度告诉你里面有什么，同时也告诉你你的β细胞是否跟得上。而时间基本上告诉你你是否对胰岛素有抵抗性。
So the how high gives you information about the beta cell, how long tells you more about the body.
所以，高度告诉你关于β细胞的信息，时间则告诉你更多关于身体的情况。

Mike Haney (00:16:02): 迈克·汉尼（00:16:02）:

And in terms of that, just to keep on this path of understanding the glucose curve, how much can I expect that to change as I get more insulin sensitive?
就理解血糖曲线而言，随着我胰岛素敏感性增加，我期望这个曲线会有多大变化？
And if I start eating lower carb, getting my insulin in a proper place, should I expect that if I’m eating the same diet, I’m going to see lower peaks and I’m going to see faster returns?
如果我开始摄入较低的碳水化合物，让我的胰岛素处于适当的位置，如果我吃同样的饮食，我是否可以期待看到较低的峰值和更快的恢复？

Rob Lustig (00:16:25): 罗布·卢斯蒂格（00:16:25）:

Right. We did that study in children and we saw that if we changed the diet, we could see changes in the glucose area under the curve, the peak glucose response and the insulin sensitivity in 10 days in children.
正确。我们在儿童身上进行了这项研究，我们发现如果改变饮食，可以在 10 天内看到血糖曲线下面积、血糖峰值响应和胰岛素敏感性在儿童身上的变化。
And my colleagues at San Francisco General did it in adults, and they saw those same changes in two weeks. So it doesn’t take long, but will you see it after one meal? Unlikely. Will you see it after one day? Probably not.
我的旧金山总医院的同事在成年人身上做到了，他们在两周内看到了同样的变化。所以时间不会太长，但你能在一顿饭后看到吗？不太可能。你能在一天后看到吗？可能不会。
But 10 days, most people can tough it out for 10 days to be able to see something that will help, shall we say, solidify their belief in making metabolic health changes for the better.
但 10 天，大多数人可以坚持 10 天，以看到一些能帮助他们坚定信念，为了改善新陈代谢健康做出改变的东西。

Mike Haney (00:17:16): 迈克·汉尼 (00:17:16):

And then if it can change that quickly to get healthier, how durable is that change then? Can I revert it back to being less insulin sensitive by giving up on my low-carb diet?
然后，如果它可以那么快地变得健康，那么这种变化的持久性如何？如果我放弃低碳饮食，能否恢复到胰岛素敏感性较低的状态？

Rob Lustig (00:17:25): 罗布·卢斯蒂格（00:17:25）:

Absolutely, within two weeks. But bottom line, it’s relatively responsive to changes in diet and also by the way, changes in exercise. So if you exercise, you’ll start seeing improvements in insulin sensitivity too.
当然，在两周内。但总的来说，它对饮食变化相对敏感，顺便说一下，对运动方式的变化也敏感。所以如果你锻炼，你也会开始看到胰岛素敏感性改善。
If you stop exercising within two weeks, you’ll be back to baseline. So I would say there’s a two-week transition from metabolically unhealthy to metabolically healthy, at least as far as glucose dynamics go.
如果你在两周内停止锻炼，你就会回到基线状态。所以可以说，从代谢不健康到代谢健康有一个两周的过渡期，至少在葡萄糖动力学方面是如此。

Mike Haney (00:17:59): 迈克·汉尼 (00:17:59):

And we’ll come back to insulin for a minute because I think we’re going to want to talk a lot about that as a marker. But again, just on the glucose curve side, how do you think about glucose spikes?
我们稍后再回来讨论胰岛素，因为我认为我们会大量谈论它作为指标。但再次回到血糖曲线方面，你如何考虑血糖峰值？
A lot of what we’ve talked about over the years, and I do all the content at Levels, is the simplified version is glucose spike, bad, glucose spike, unhealthy, don’t do that.
多年来我们讨论过的内容，以及我在 Levels 中所做的一切内容，简化版就是血糖升高，不好，血糖升高，不健康，不要这样做。

Rob Lustig (00:18:21): 罗布·卢斯蒂格（00:18:21）:

That’s true. 那是真的。

Mike Haney (00:18:21): 迈克·汉尼 (00:18:21):

Because it can have short-term effects. You might feel really bad, you’ll probably have a post reactive crash. Also, long-term it can do damage, can cause you to be insulin resistant.
因为这可能产生短期影响。你可能会感觉非常糟糕，你可能会经历一个反应后崩溃。长期来看，它可能会造成损害，导致你对胰岛素产生抵抗。
Can also have some effects on its own like glycation or inflammation that just extra glucose can be having. But in that nuance of what counts as a spike, how many can I have? How tall can they be? These are the questions we get.
也可以自行产生一些影响，比如糖基化或炎症，只是额外的葡萄糖可能产生的。但在这种细微差别中，什么是峰值的定义？我可以有多少？它们可以有多高？这些都是我们得到的问题。
I was just looking at some member questions this week. These are the questions we get all the time from people. And my worry is that in putting out this message, I have freaked a lot of people out about everything they’re eating.
这周我查看了一些会员问题。这些都是我们经常收到的问题。我的担心是，通过发布这条信息，我让很多人对他们在吃的东西感到非常不安。
And what I hear from so many of them is an anxiety that if I’m not going keto, I’m screwed. So I’m curious how you think about the detriment of a glucose spike.
我从他们中的许多人那里听到的是一种焦虑，如果我不进行酮饮食，我就完了。所以我很好奇你如何看待血糖峰值的不利影响。

Rob Lustig (00:19:08): 罗布·卢斯蒂格（00:19:08）:

All right. So I’m going to start with a controversial saying, we’re all going to die. Okay? You’re going to die sometime, everyone dies. And no matter how metabolically healthy you are, you’re still going to die. Now the question is when?
好的。所以我要从一个有争议的言论开始，我们都会死亡。好吧？你总有一天会死，每个人都会死。不管你新陈代谢有多健康，你还是会死。现在问题是何时？
Obviously we all want to put it off for as long as possible. And as George W. Bush famously said, “We all want to die young as late as possible.” For sure. And that’s why Levels does what it does. Again, I’m totally for it. I’m totally in support of it.
显然，我们都想尽可能地推迟它。正如乔治·W·布什曾经著名地说过，“我们都想尽可能地晚死得年轻。”当然。这就是为什么 Levels 会做它所做的事情。再次，我完全支持它。我完全支持它。
You’re going to have glucose spikes. You can’t not have glucose spikes. You can’t freak out about it either. If you do, now you’ve got something called orthorexia, you start worrying about actually what you’re eating all the time.
你将会经历血糖峰值。你无法避免血糖峰值。你也不能对此感到恐慌。如果你这样做，你就会患上一种叫做厌食症的状况，开始担心你一直在吃什么。
Now, we do not want to be contributing to orthorexia, and some people will take this information and use it, shall we say, not for good.
我们现在不希望成为正念饮食症的促成因素，有些人可能会将这些信息用于不好的目的。

(00:20:12):

And we need to protect against that as much as possible. So I’m here to tell you, you’re going to have spikes. The question, how many spikes? Well, preferably three spikes a day called breakfast, lunch, and dinner, or maybe two spikes a day, lunch and dinner.
我们需要尽可能地保护自己。所以我要告诉你，你会有峰值。问题是，有多少个峰值？最好是每天三个峰值，叫做早餐、午餐和晚餐，或者可能是每天两个峰值，午餐和晚餐。
Do you need breakfast? I mean, that’s the concept of intermittent fasting and maybe that’s one of the reasons why intermittent fasting works is because you only have two spikes. We don’t know that yet. I’m just throwing it out there as a possible.
你需要吃早餐吗？也就是说，这就是间歇性禁食的概念，也许这就是间歇性禁食有效的原因之一，因为你只有两个峰值。我们还不知道这一点。我只是提出这作为一个可能。
We do know that intermittent fasting helps if you’re insulin resistant. Now, the reason I think intermittent fasting works is because it gives your liver a chance to metabolize the fat that built up over the previous 16 hours.
我们知道间歇性禁食对胰岛素抵抗的人有帮助。我认为间歇性禁食有效的原因是，它给了你的肝脏一个机会去代谢前 16 小时积累的脂肪。

(00:20:58):

Well, that will help your spike because you’ll be able to process the glucose because you’re less insulin resistant. These things are all related to each other. It’s not like these things work separately. They’re not in silos.
嗯，这将有助于你的峰值，因为你将能够处理葡萄糖，因为你对胰岛素的抵抗性较低。这些事情都是相互关联的。这并不是说这些事情各自独立工作。它们不是孤立存在的。
So what the glucose spike is doing, what the insulin spikes doing, what the fat is doing in both the liver and the muscle, all of these things relate to each other.
所以，血糖的上升，胰岛素的上升，肝脏和肌肉中的脂肪，所有这些事情都相互关联。
Now, if you’re going to have a spike, you want to have a spike that doesn’t go to say 180 or above because that’s when the kidney starts spilling glucose. So that causes damage to the kidney.
现在，如果你要出现峰值，你希望峰值不要达到 180 或以上，因为这时肾脏开始漏糖。这会导致肾脏损伤。

Mike Haney (00:21:38): 迈克·汉尼 (00:21:38):

Unpacked spilling glucose out of the kidneys for a minute.
拆包后，肾脏一分钟内排出葡萄糖。

Rob Lustig (00:21:40): 罗布·卢斯蒂格（00:21:40）: 翻译文本：

So your kidney resorbs glucose, so the glucose filters through it as blood filters through it, and your kidney has a method for pulling the glucose back into the bloodstream instead of it going out in the urine.
所以你的肾脏会吸收葡萄糖，葡萄糖会像血液一样通过肾脏过滤，而你的肾脏有一种方法可以将葡萄糖重新吸收到血液中，而不是让它通过尿液排出。
And that system works until what’s known as the TM, which is basically the maximum amount that you can resorb and that occurs at a blood glucose of 180 milligrams per DL.
直到所谓的 TM 系统工作，TM 基本上是你能吸收的最大量，发生在血糖水平为 180 毫克/分升时。
So at 180 you start spilling glucose into your urine, and when you spill glucose, you take water with it and that dehydrates you. And that’s one of the cardinal signs of diabetes is polyuria and polydipsia, too much peeing, too much drinking and dehydration.
所以在 180 时，你开始在尿液中排泄葡萄糖，当你排泄葡萄糖时，也会带出水分，这会导致脱水。这是糖尿病的一个重要标志，还有多尿和多饮，即尿得多，喝水也多，且有脱水现象。
So you obviously don’t want that. And in addition, the higher the blood glucose goes, and it’s been, glucose has been equated with grains of sand.
所以你显然不想要那个。此外，血糖越高，血糖被比作沙粒。
You can imagine if you had grains of sand running through your arteries, it might do some damage like the finish on your car when you’re out on Pacific Coast Highway just from the sand and the salt water hitting your car.
你可以想象，如果你的动脉里有沙粒在流动，这可能会造成一些损害，就像你在太平洋海岸公路行驶时，沙子和海水击打你的车造成的漆面损伤。

(00:23:00):

Well, if you’re running around with high blood glucose, a lot of the time you’re going to have some endothelial dysfunction, and that may be actually one of the contributions to high blood pressure.
如果你的血糖水平很高，那么很多时候你可能会出现内皮功能障碍，这实际上可能是高血压的一个贡献因素。
So high blood pressure can occur due to sugar, dietary sugar because of the increase in uric acid, which reduces Nitric oxide, which raises blood pressure or it could be because of the endothelial cell dysfunction.
因此，高血糖可能导致血压升高，因为糖和饮食中的糖会导致尿酸增加，从而减少一氧化氮，进而提高血压，也可能是因为内皮细胞功能障碍。
You can see that in the release of hormone called Endothelin-1 that you can measure. Again, it’s a research test for the most part. We don’t do that routinely, but either one of those is a sign of arterial damage, and, ultimately, that would shorten your lifespan.
你可以看到一种称为内皮素-1 的激素的释放，这是你可以测量的。再次，这主要是研究测试。我们通常不做这个，但两者都是动脉损伤的迹象，最终会缩短你的寿命。
It’s been shown that if you can get your blood pressure down by two millimeters of mercury, you have a 10% reduction in risk for stroke. So even a little change in blood pressure has big changes in terms of vascular health.
已经证明，如果你能把血压降低 2 毫米汞柱，中风的风险会减少 10%。所以，即使血压的微小变化，对血管健康的影响也很大。

(00:24:06):

So all of these things are related to each other. Obviously you don’t want your blood glucose to go super high, but more importantly, you don’t want it to hang around. You want it to clear, and that is a sign that your insulin is working. That’s a sign of insulin sensitivity.
所有这些事情都是相互关联的。显然，你不希望血糖水平异常升高，但更重要的是，你不希望它滞留。你希望它清除，这是胰岛素发挥作用的标志。这是胰岛素敏感性的迹象。
That’s a sign that your muscles are working, your liver is working, your whole body is working. I would say that insulin sensitivity is the pathogenic factor most associated with all of the chronic diseases that we have today.
那是你的肌肉在工作，肝脏在工作，你的整个身体都在工作。我认为，胰岛素敏感性是最与我们今天所面临的各种慢性疾病相关的致病因素。
If there’s one thing to fix, it’s your insulin resistance. And so then the question is, okay, how do you measure that? And we’ll get to that in just a minute.
如果要修复一件事，那就是你的胰岛素抵抗。那么问题来了，怎么去衡量呢？我们马上就会谈到这一点。

Mike Haney (00:24:50): 迈克·汉尼 (00:24:50):

Yeah. I just want to go one step further on this story we’re talking about, and I think this is a useful framing of what’s happening to the glucose in the body and how it relates to the sort of height of the spike. So when we talk about, let’s say two people are spiking to 160.
是的。我想在这个我们正在讨论的故事上再进一步，我认为这有助于我们理解身体中葡萄糖的变化以及它与血糖峰值高度的关系。当我们说两个人的血糖峰值达到 160 时，我们可以这样理解。
One is insulin sensitive and the other is less so, and so it’s taking longer to clear it, but when we talk about clearing, where does it go?
一种是胰岛素敏感的，另一种则不那么敏感，因此清除速度较慢，但当我们谈论清除时，它去了哪里？
Even if I’m healthy, is there a difference in where that glucose goes between the insulin sensitive person and the non-insulin sensitive person once they’re back to baseline, has a different thing occurred in each one of them?
即使我健康，敏感于胰岛素的人和不敏感于胰岛素的人在回到基线后，他们的葡萄糖去向是否有区别？在他们每个人身上是否发生了不同的事情？

Rob Lustig (00:25:28): 罗布·卢斯蒂格（00:25:28）: 翻译文本：

Absolutely. So where does it get cleared to? Where does glucose get cleared to? Well, every cell in the body uses glucose for energy, but not every cell in the body is responsive to insulin. Okay?
当然。那么葡萄糖在哪里被清除呢？葡萄糖在哪里被清除？好吧，身体中的每个细胞都使用葡萄糖作为能量来源，但身体中的并非每个细胞都对胰岛素有反应。好吧？
Now, every cell has glucose transporters, but those glucose transporters are not necessarily insulin dependent transporters. Which glucose transporters are the insulin dependent ones? GLUT4. So there’s GLUT1, GLUT2, all the way up to GLUT11. Okay?
现在，每个细胞都有葡萄糖转运蛋白，但这些葡萄糖转运蛋白不一定都是胰岛素依赖的转运蛋白。哪些葡萄糖转运蛋白是胰岛素依赖的？GLUT4。所以有 GLUT1，GLUT2，一直到 GLUT11。好的？
11 different glucose transporters depending on which tissue you’re talking about. Fructose by the way, is handled by GLUT5 and also GLUT7. So the different glucose transporters do different things in different tissues.
11 种不同的葡萄糖转运蛋白，具体取决于你谈论的是哪一种组织。顺便说一下，果糖由 GLUT5 和 GLUT7 处理。因此，不同的葡萄糖转运蛋白在不同的组织中执行不同的功能。
Like for instance, the brain uses GLUT1, no other tissue uses GLUT1, but GLUT4 is the only one that’s insulin sensitive. So where’s GLUT4? Because if your insulin level’s high, that means that the GLUT4 specific tissues are going to be influenced the greatest.
就像 GLUT1 一样，大脑使用 GLUT1，但没有其他组织使用 GLUT1。GLUT4 是唯一对胰岛素敏感的。那么 GLUT4 在哪里呢？因为如果你的胰岛素水平高，这意味着 GLUT4 特定的组织将受到最大的影响。

(00:26:37):

And the answer there is your muscle and your fat. And so you’re going to drive energy into muscle and fat. If you drive energy into muscle that your muscle is not using, you’re going to get fat deposition in your muscle called intramyocellular lipid.
That’s a cardinal feature of insulin resistance. If you drive the glucose into fat cells, well, the fat cell is going to turn that into actual adipose tissue, it’s going to turn it into triglyceride in the adipose tissue.
It’s got all the enzymes to take glucose, turn it into fat, and so you’re going to lay down more fat and now you’ve got obesity. And of course, if it’s visceral fat, you’ll have insulin resistance yet worse. It’ll basically be a vicious cycle.

(00:27:24):

So the higher the insulin, the more your fat and muscle are going to gain fat because of the GLUT4 transporter, it’s not going to make much difference in terms of the GLUT1, the GLUT2, the GLUT3, the GLUT5, and all the way up to 11.
It’s really going to be that GLUT4, but that’s what causes the illness. So getting the insulin down is job one, and the only way to do that is to become insulin sensitive. And the only way to do that is lifestyle.

Mike Haney (00:28:01):

Let me just make sure I understand this. So if I take in the same amount of glucose, but I am insulin sensitive, what is happening such that I’m not getting those fat deposits either in my muscular tissue or in the adipose tissue that are all the risk, if I’m insulin sensitive?
The glucose has to go somewhere, right? If I’ve taken in that amount of glucose load.

Rob Lustig (00:28:25):

If you’re insulin sensitive, it will go into all of your other tissues equally and will be burned by the mitochondria to carbon dioxide and ATP and will fuel all of those metabolic processes, and you will therefore be metabolically healthy.
如果你的胰岛素敏感，它会均匀地进入你身体的其他所有组织，并被线粒体燃烧成二氧化碳和 ATP，为所有这些代谢过程提供动力，因此你会保持代谢健康。
As soon as your insulin goes up, what that’s a sign of is the fact that you’re not burning that glucose to carbon dioxide and ATP. Well, okay, if you’re not burning it, you’re getting a backup and you need insulin then to clear it. What is that saying about your cells?
一旦您的胰岛素上升，这意味着您没有将葡萄糖转化为二氧化碳和 ATP。好吧，如果没在燃烧，那么您需要胰岛素来清除它。这在说您的细胞什么呢？
What that’s saying is that the mitochondria, the little subcellular organelles, and inside each cell, the little energy burning factories inside each cell, what it’s saying, those aren’t working very well.
这表明，线粒体，这些小的亚细胞器，以及每个细胞内部的小能量燃烧工厂，它们的工作状态并不很好。

(00:29:15):

For whatever reason, those mitochondria are fallen behind because if they weren’t fallen behind, your insulin wouldn’t be high and you’d be clearing the glucose well. So insulin resistance and mitochondrial dysfunction are part and parcel of the same phenomenon.
由于某种原因，那些线粒体落后了，如果它们没有落后，你的胰岛素水平就不会高，你也能很好地清除葡萄糖。因此，胰岛素抵抗和线粒体功能障碍是同一种现象的组成部分。
So what that’s telling us is if you’re insulin resistant, you’ve got something wrong with your mitochondria and you need to step up your mitochondria. Well, what’s wrong with your mitochondria? And that’s where the whole question of our environment starts coming in.
所以这告诉我们，如果你的胰岛素抵抗，你的线粒体出了问题，你需要提升你的线粒体。那么，你的线粒体出了什么问题呢？这就是我们整个环境问题开始出现的地方。

Mike Haney (00:29:54): 迈克·汉尼 (00:29:54):

Right. Okay. So let’s go back to this question of timing for a moment because I think this is really helpful in understanding this glucose journey.
好的。好的。所以我们现在回到时间这个问题上，我认为这对我们理解血糖旅程非常有帮助。
And then what I’m seeing about this glucose journey on a glucose graph is telling me, so if I am healthy, I take in a load of glucose, I see it rise, but I’m seeing it clear quickly, which is a sign that my cells are taking it up as efficiently as they possibly can, it’s not then going to be deposited in my muscle and fat tissue as fat.
然后，我在葡萄糖图上看到的血糖旅程告诉我，所以如果我是健康的，我摄入了大量的葡萄糖，我看到它上升，但我看到它很快消失，这是一个信号，我的细胞尽可能高效地吸收它，它不会被存储在肌肉和脂肪组织中作为脂肪。
So if it takes a long time for it to clear, that’s essentially a sign that, in other words, let me see how to phrase this. If it’s being cleared quickly, it means it’s going into the cells.
所以如果它需要很长时间才能清除，那基本上就是一个信号，换句话说，让我看看如何表达这个。如果它被快速清除，这意味着它正在进入细胞。
If it’s not being cleared quickly, that means it’s not going into the cells where I want it go and it’s going to go into this other tissue. Is that right?
如果它没有快速清除，这意味着它没有进入我想要它进入的细胞，而是进入其他组织。是对的吗？

Rob Lustig (00:30:45): 罗布·卢斯蒂格（00:30:45）:

Exactly right.

Mike Haney (00:30:46):

Okay.

Rob Lustig (00:30:47):

Exactly right. The longer it stays in your bloodstream, the worse off you are. And you can’t learn that from a fasting glucose. You actually can’t even learn that from a fasting insulin. Although fasting insulins are much better arbiter of that. Because the fasting insulin basically tells you how well your mitochondria working. If your mitochondria working, your fasting insulin is low. If your mitochondria not working, your fasting insulin is high. It’s our best proxy for mitochondrial function. And so I think that the fasting insulin is the single best marker for metabolic health that we could order. And I routinely suggest it and order it on my patients, and I’m trying to get the medical profession to glom onto this idea. But I will tell you, there are super number of obstacles. One is the insurance industry, they don’t want to pay for it, even though it’s not expensive, runs between $12 and $120, medium, $48.

(00:31:55):

So it’s not that expensive. So then they can learn, patients and their doctors can learn so much from it if they knew how to interpret it. And of course, the food industry. The food industry is not happy about that at all because it’s one of the ways they get away with putting junk in our food. Because if your fasting insulin were going up and the only way to fix it is your food, they don’t want you to know. And then third, the American Diabetes Association. Now, you would think that the American Diabetes Association would be very happy for people to not be insulin resistant. You would think that that would prevent them from getting diabetes. Well, the American Aiabetes Association is really not into prevention, they’re into treatment, they’re into pharmacology, they’re into pharmaceuticals because their entire budget is basically underwritten by big pharma.

(00:32:53):

The fact of the matter is the American Diabetes Association says do not draw a fasting insulin. And that’s one of the reasons by the way that the insurance industry doesn’t cover it because the ADA says that. All right, so why do they say that? Two reasons. And they’re both specious, they’re both wrong. First reason. They say the different assays for fasting insulin are not standardized across platforms. So if you get it done at your local lab, if you get it done at the hospital, if you get it done through a send out, you’re going to get all different results from different assays, not standardized. And there’s some truth to that. I don’t even argue that, that is true. One of the reasons that this occurs, because there ought to be something that you should be able to measure easily, one of the reasons this occurs is because some of the cheap assays use antibodies, use basically what’s either a radioimmunoassay or an ELISA enzyme-linked immunosorbent assay.

(00:33:52):

And so it’s looking at epitopes, it’s looking at specific areas of the molecule to determine whether or not the molecule is there or not. And that determines the level, and that’s worked for us for a long time.
因此，它在研究表位，即分子的特定区域，以确定该分子是否存在。这决定了水平，这种方法已经为我们工作了很长时间。
But you can have cross reactives, you can have other peptides or proteins that you’re measuring in the same sample that cross-react with the antibody and will give you a fictitiously elevated level. The most common of this is pro-insulin. Now, what’s pro-insulin?
但你可以有交叉反应，你可以在同一样本中测量的其他肽或蛋白质，这些蛋白质会与抗体交叉反应，给你一个虚构的升高水平。最常见的就是胰岛素原。那么，什么是胰岛素原呢？
You’ve heard of insulin, what’s pro-insulin? Pro-insulin is the peptide that has to be cleaved to make insulin. So it is a pro-hormone, it is not a hormone. You should not be releasing pro-insulin.
您听说过胰岛素，那么什么是前胰岛素？前胰岛素是需要被切割以生成胰岛素的多肽。因此，它是一种前激素，而不是激素。您不应该释放前胰岛素。
You should be releasing the mature insulin after the C-peptide is cleaved out of it. Now, there’s an enzyme in your beta cells that cleaves that C-peptide out of it. It’s called pro-hormone convertase 1.
你应该在 C-肽被从胰岛素中切割出来后释放成熟的胰岛素。现在，你的β细胞中有一种酶会将 C-肽从胰岛素中切割出来。这被称为前激素转换酶 1。
Well, when your beta cells are stressed, when they’re working overtime because you’re insulin resistant and you then have a big glucose load, you need to bring that glucose down and that’s insulin’s job.
当你的β细胞受到压力，因为你是胰岛素抵抗的，然后你有大量葡萄糖负荷时，你需要降低葡萄糖水平，这就是胰岛素的工作。

(00:35:10):

And that beta cell is going to work as hard as it can to put out as much as it can, and it doesn’t have time to cleave the piece of C-peptide out. And so it’s going to release the pro-insulin too.
那个β细胞会尽可能努力地释放尽可能多的胰岛素，而没有时间切割 C-肽的部分。因此，它也会释放前胰岛素。
Now, pro-insulin has only 5% of the activity of insulin, but basically, what it’s a sign of is beta cell exhaustion, but it gets measured in the insulin assay because pro-insulin and insulin look a lot alike.
现在，胰岛素原只有胰岛素活性的 5%，但基本上，它表明的是β细胞的耗竭，但它在胰岛素测定中被测量，因为胰岛素原和胰岛素看起来非常相似。
So you’re measuring something that’s not insulin in the insulin assay, and so can throw off the assay.
所以在胰岛素检测中测量的不是胰岛素，这会干扰检测结果。

(00:35:48):

Well, the American Diabetes Association is saying, well, then don’t draw it because it’s not necessarily measuring what you want to measure. And that at a, shall we say, at a common sense level makes sense. But who cares? Who cares?
美国糖尿病协会表示，那么就不要绘制它，因为它不一定能测量你想要测量的东西。从常识的角度来看，这似乎是有道理的。但是，谁在乎呢？谁在乎？
If it’s high it’s a problem, irrespective of whether you’re measuring insulin or pro-insulin or anything else for that matter, if it’s high, it’s a problem.
如果数值高，那就是问题，无论你是在测量胰岛素、胰岛素样生长因子还是其他任何东西，如果数值高，那就是问题。
And as long as you’re using the same assay on the same patient over time, you can still use those to understand dynamic changes. So I think that’s a specious reason that the ADA says [inaudible 00:36:30].
只要您在同一患者身上使用相同的方法在不同时期进行测试，仍然可以使用这些数据来理解动态变化。因此，我认为这是美国糖尿病协会（ADA）提出的不充分理由，这部分内容在录音中可能有所缺失。

Mike Haney (00:36:31): 迈克·汉尼 (00:36:31):

What’s the degree by which that pro-insulin can throw off that reading? Are we talking small, or?
胰岛素原导致读数偏移的角度是多少？我们说的是小范围，还是？

Rob Lustig (00:36:36): 罗布·卢斯蒂格（00:36:36）:

Quite a bit. So we know that there is a phenomenon called hyperproinsulinemia was first espoused by Dr. John S. Yudkin, not the John Yudkin of sugar fame, but his cousin John S. Yudkin, famous British endocrinologist. Wonderful guy.
相当多。所以我们知道存在一种称为高胰岛素血症的现象，首先由约翰·S·尤金医生提出，不是那位以糖而闻名的尤金医生，而是他的堂兄约翰·S·尤金，一位著名的英国内分泌学家。真是个了不起的人。
And he was the one who demonstrated this phenomenon called hyperproinsulinemia. And it is without question, if you’re putting out pro-insulin, it means you are sick. That’s a bad thing to be doing. So no, it’s a very real thing. So that’s the first reason.
他就是展示这种现象——高胰岛素血症的人。毫无疑问，如果你在分泌胰岛素，那就意味着你生病了。这是不好的事情。所以不，这是一个非常真实的事情。这就是第一个原因。
Then the second reason that the American Diabetes Association says don’t draw it. They say fasting insulin levels do not correlate with obesity. That’s exactly right. They do not.
然后第二个原因是美国糖尿病协会说不要这样做的原因。他们说，空腹胰岛素水平与肥胖无关。这完全正确。它们并不相关。

(00:37:24):

They correlate with metabolic health because they correlate with mitochondrial dysfunction. And you can be obese and have normal mitochondria, and you can thin, it can be thin and have crappy mitochondria. And the fasting insulin will tell you that. Of course, it’s not correlated with obesity. That’s exactly why you should draw it because it’s telling you something. Otherwise, you could just get on the scale and you find out the same thing. No, no, no. So the reason they say not to draw it is exactly the reason to draw it, but they don’t get it. So I’m working on them, but boy, oh, boy, I tell you, it’s like pulling teeth.

Mike Haney (00:37:59):

Just to dig into, let’s dig into insulin as a marker a little bit because we do offer it in the blood test that we offer. We include fasting insulin.

Rob Lustig (00:38:07):

Right. We do labs 2.0 and fasting insulin is at the front and center of that.

Mike Haney (00:38:11):

So what’s the best faith argument for maybe not ignoring it entirely, but what’s the context with which I should look at that insulin marker? How should I understand that insulin number in the context of the other things that I’m measuring?
And let’s say for these purposes, the other things that you would like us to measure, not just the things I’m getting at my standard physical.

Rob Lustig (00:38:34):

So fasting insulin is in a dynamic range. So the lower it is, the better off you are. As long as you don’t have type one diabetes, then it’ll be zero, and that would be really bad. You need some insulin.
空腹胰岛素处于动态范围内。所以，数值越低越好。只要不是 1 型糖尿病，应该是 0，这会非常糟糕。你需要胰岛素。
Otherwise, you end up in diabetic ketoacidosis, which will kill you pretty quick if you don’t do something about it. And the only treatment for that is insulin.
否则，你会陷入糖尿病酮症酸中毒，如果不采取措施，这会很快致命。对于这种情况的唯一治疗方法是胰岛素。
So you always need a little insulin, and that’s one of the reasons why we age is because you always need a little insulin. There’s no way to do without it.
所以你总是需要一点胰岛素，这就是我们为什么会老去的原因之一，因为你总是需要一点胰岛素。没有办法可以不使用它。

(00:39:05):

But the lower it is, the more functional it is, the better off you are and the longer you will live. So it’s one of the best longevity markers there is. And the great thing about it is it will change in two weeks.
但它的数值越低，功能越好，你的健康状况就越好，寿命也越长。所以它是衡量长寿的最佳指标之一。而且它的优点在于，只需要两周时间就会发生变化。
Now, it’ll also change back again in two weeks if you stop applying whatever lifestyle modification that you used to get it down. So to me, fasting insulin is where the action is. And it’s cheap, and it’s available, and you can do it tomorrow.
现在，如果你停止应用任何生活方式的调整，它也会在两周后再次改变。所以对我来说，空腹胰岛素是关键。它便宜，可获得，并且你可以明天就开始。
There are even now fasting insulin assays you can do at home. So you don’t even have to go to your doctor, but they cost money. And then the question is, is it reliable? And those are questions that are yet to be answered for each of the different assays that are out there.
现在甚至可以在家中进行空腹胰岛素测试。你甚至不必去看医生，但它们需要花钱。然后问题是，它是否可靠？对于市场上存在的每种不同的测试，这些问题尚未得到解答。

Mike Haney (00:40:03): 迈克·汉尼 (00:40:03):

So the type of question we get all the time when we start talking about markers is when results don’t line up with the story that we are telling, right? With this sort of basic picture of how things work.
所以当我们开始讨论指标时，我们经常遇到的问题是，结果与我们讲述的故事不一致，对吧？对于事物工作原理的基本图景。
And I won’t go through all of them because that could be an hour’s long podcast of what if this and then that?
我不会一一列举，因为这可能是一个小时的播客，讨论如果这样然后那样会怎样？

Rob Lustig (00:40:20): 罗布·卢斯蒂格（00:40:20）:

Yeah, yeah, we’re not doing that.
是的，是的，我们不做那个。

Mike Haney (00:40:21): 迈克·汉尼 (00:40:21):

But just to stick to glucose and insulin for a minute. If my insulin is low, and I’ll be personal here, my insulin is low, it’s under two.
但就拿葡萄糖和胰岛素来说。如果我的胰岛素水平低，我在这里要个人化一下，我的胰岛素水平低，低于 2。

Rob Lustig (00:40:28): 罗布·卢斯蒂格（00:40:28）:

Good for you.

Mike Haney (00:40:29):

I’m a child of the 80s, which means I grew up eating sugar cereal every morning for breakfast for 30 years, which means daily, and I know this now because I have a CGM on. I would spike my glucose to 200 and it would come back down. And yet in my late 40s, my insulin is under 2.

Rob Lustig (00:40:44):

I’m delighted.

Mike Haney (00:40:46):

Explain how that is to me?

Rob Lustig (00:40:47):

It’s very simple. It means that you are insulin sensitive now and it means you have good beta cell reserve and it means you’re fine now. It doesn’t mean you were fine when you were 12.
The fact is we have this pandemic of childhood obesity and childhood type two diabetes, and clearly they’re not okay.
The fact that you escaped that period of Froot Loops, and Cap’n Crunch, and Cracklin Oprah and lived to tell the tale and have a fasting insulin now of two hats off to you.
I wish I were so lucky, but that’s great and it portends good things for the future if you can maintain that.

Mike Haney (00:41:37):

So how should I think then about my A1C, my fasting glucose, my average glucose or sort of glucose stability if I’m wearing a CGM, if those are not, as I remember my last A1C was like borderline pre-diabetes, right?
So I look at my insulin and I go, “I’m great.” Walk away, put the paper down. All good. Nothing to worry about here. I look at that A1C and I go, if this weren’t a member, they would be emailing us going, that looks high, what should I do about it?

Rob Lustig (00:42:04): 罗布·卢斯蒂格（00:42:04）: 翻译文本：

Right. Well, understand that the A1C is not the fasting insulin, okay? They’re not necessarily the same. There are various, I won’t say disorders, but conditions that can lead to a slightly elevated hemoglobin A1C and it doesn’t necessarily portend anything bad.
正确。嗯，理解 A1C 并不等同于空腹胰岛素，好吧？它们并不一定相同。存在各种情况，我不会说疾病，但是一些条件可能导致 HbA1C 略微升高，并不一定预示着不好的结果。
Example, there’s a disorder. It’s really a condition because needs no treatment and has no downstream side effects. This condition is called MODY2, M-O-D-Y2, mature onset diabetes of youth II. Now, MODY is a set of diseases that are all genetic defects in the beta cell.
例如，有一种疾病。它实际上是一种状况，因为它不需要治疗，也没有下游副作用。这种状况被称为 MODY2，M-O-D-Y2，青年成熟期糖尿病 2 型。现在，MODY 是一组疾病，所有这些疾病都是β细胞的遗传缺陷。
There are 14 of them, 14 different MODYs, and some of them are really bad. Some of them will ultimately cause significant diabetes, very intractable to treatment and will ultimately, lead to early aging and death. No argument. MODY2 is a defect in the sensing of the beta cell.
有 14 种，14 种不同的 MODY，其中一些确实很糟糕。一些最终会导致严重的糖尿病，难以治疗，并最终导致早衰和死亡。毋庸置疑，MODY2 是β细胞感应的缺陷。
The level of glucose in the blood has to get a little higher before the beta cell will start kicking out insulin.
血液中的葡萄糖水平必须稍微升高，β细胞才会开始分泌胰岛素。

(00:43:25):

It just basically means that the gain has been reset. The threshold for releasing insulin has been reset. So these people run higher blood glucoses routinely, but they still get an insulin spike when their blood glucose goes up, they still clear glucose just as quickly.
这基本上意味着血糖的升高已经被重置。释放胰岛素的阈值已经被重置。所以这些人经常有较高的血糖水平，但当他们的血糖上升时，他们仍然会有胰岛素的峰值，他们仍然能够快速清除葡萄糖。
They just run a higher blood glucose. So their hemoglobin A1C is higher, has absolutely no implications for aging or for disease. It’s just a factitious. It’s not spurious. It makes sense. But it’s a factitious biomarker that’s out of range and means nothing.
他们只是血糖水平较高。所以他们的血红蛋白 A1C 较高，这完全与老化或疾病无关。这只是人为制造的指标，不是错误的。这有道理。但它是一个超出范围的伪生物标志，没有任何意义。
So it only means something if the physiology is consistent. So if you have a high fasting insulin and a high glucose and a high A1C, that means something because they’re all going in the same direction.
所以只有当生理学一致时才有意义。所以如果你的空腹胰岛素水平高，血糖水平高，A1C 水平也高，这意味着某些问题，因为它们都在朝着同一个方向发展。
So you can point to the path of physiology and say, yeah, that’s what’s going on. We need to do something about that.
所以你可以指出现理学的道路，说，是的，这就是情况。我们需要对此做些什么。
But if you see one lab test that’s out of whack and it doesn’t make sense with all the others that are in the same pathway, probably best to ignore it or possibly it’s even lab error, maybe it needs to be redrawn.
但如果你看到一个实验室测试结果异常，与其他在同一路径上的测试结果不一致，可能最好忽略它，或者可能是实验室错误，可能需要重新抽取血样。

Mike Haney (00:44:48): 迈克·汉尼 (00:44:48):

Yeah, let’s stay on that for a minute.
嗯，我们再聊一分钟。

Rob Lustig (00:44:49): 罗布·卢斯蒂格（00:44:49）:

Remember, 5% of all lab tests are errors.
记住，所有实验室测试中有 5%是错误的。

Mike Haney (00:44:55): 迈克·汉尼 (00:44:55):

That’s exactly what I was just going to ask is how reliable labs tend to be in general, and does it vary among markers? Are there some we can trust more than others?
那正是我刚刚想问的问题，即一般实验室的可靠性如何，指标之间是否有差异？有些我们是否可以比其他指标更信任？

Rob Lustig (00:45:02): 罗布·卢斯蒂格（00:45:02）:

It depends on the marker. Yeah. So some are much tighter than others. Like glucose is a pretty tight one, although CGM glucose has a much wider variation than lab glucose, so we need to keep that in mind. But some of the other assays, there are things that can interfere with it.
这取决于标记。是的。所以有些比其他的一些更紧。比如葡萄糖是一个相当紧的标记，尽管连续葡萄糖监测（CGM）葡萄糖的波动范围比实验室葡萄糖大得多，所以我们需要记住这一点。但有些其他的测试，可能会有干扰物。
Hey, somebody spits in the tube. There’s all sorts of stuff that goes on in laboratories, and I know because I used to work in a laboratory and you do the best you can, but stuff happens.
嘿，有人在管子里吐痰。实验室里会发生各种各样的事情，我知道，因为我以前在实验室工作过，你尽力去做，但事情总会发生。

Mike Haney (00:45:37): 迈克·汉尼 (00:45:37):

So given how rapidly insulin can change, for instance, in response to our lifestyle and what we’re doing, how often should we be testing it?
因此，考虑到胰岛素如何快速响应我们的生活方式和我们在做的事情而发生变化，我们多久应该测试一次胰岛素呢？
How frequently should I look at my insulin to understand, let’s just focus on metabolic health for now, and we’ll get back to the sort of broader health markers, but how should I keep a pulse on my metabolic health? What are the things I can be looking at?
如何频繁查看我的胰岛素以了解，让我们先专注于代谢健康，然后我们会回到更广泛的健康指标，但我要如何保持对代谢健康的关注？我应该关注哪些事情？

Rob Lustig (00:45:59): 罗布·卢斯蒂格（00:45:59）: 翻译文本：

Personally, I think that everyone should get their fasting insulin done once a year along with their standard lab draw, but they need them to be fasting. Because if you’re not fasting, you don’t know where you are on the insulin curve, and then it’s useless.
我个人认为，每个人都应该每年在进行常规实验室检查时，同时进行空腹胰岛素检测，但需要是空腹状态。因为如果不空腹，你就无法知道你在胰岛素曲线上的位置，那么检测就毫无意义。
But if you’re fasting, then you should get it done once a year.
但如果你在禁食，那么你应该每年做一次。
And if you’re changing diet or exercise or some lifestyle or environmental intervention that you think is going to improve metabolic health, I would strongly suggest getting a second fasting insulin four weeks after the change so that you can monitor it, know that you’re doing the right thing, that the fasting insulin is coming down so that you’ll number one, be positively reinforced and continue to, on your weight loss or metabolic health journey and be rewarded for your efforts.
如果你正在改变饮食、运动或某些生活方式或环境干预，认为这将改善代谢健康，我强烈建议在改变后的四周后进行第二次空腹胰岛素检测，以便监测情况，确保你正在做正确的事情，空腹胰岛素水平正在下降，这样你就可以在减肥或代谢健康旅程中得到正面的强化，继续努力并因你的努力而得到奖励。
And it’ll give your physician a new baseline to work off of. So I think that once a year and four weeks after change, changing your lifestyle.
这将为您的医生提供一个新的起点。所以我认为，每年一次，在生活方式改变后的四周，进行这样的调整。

Mike Haney (00:47:04): 迈克·汉尼 (00:47:04):

And how should I read it then? In conjunction with, let’s say I’m wearing a CGM or occasionally I’m wearing a CGM, how should I think about it in conjunction with the kinds of curves that I’m seeing relative to what I’m eating and what I’m doing?
然后我应该如何阅读它？比如说，如果我戴着 CGM 或者偶尔戴着 CGM，我应该如何考虑它与我所吃的食物和所做的活动之间的曲线关系？

Rob Lustig (00:47:17): 罗布·卢斯蒂格（00:47:17）:

Well, if you’re insulin resistant, then the thing you want to look at is not necessarily the peak glucose, but you want to see how quickly it returns to baseline. If it returns to baseline in 30 to 45 minutes, you’re doing great. If it takes an hour, not as great.
如果你是胰岛素抵抗，那么你应该关注的不是血糖峰值，而是看它如何快速回到基线。如果在 30 到 45 分钟内回到基线，你做得很好。如果需要一小时，就没那么好了。
If it takes 90 minutes, clearly not as great. And so you should look at your fasting insulin in that context. If you’re fasting, insulin is say above 10, and you’re clearing your glucose slowly, that is an hour or greater, you still have some work to do.
如果需要 90 分钟，显然没有那么好。因此，你应该从这个角度来看你的空腹胰岛素。如果你空腹，胰岛素水平在 10 以上，并且你的血糖清除缓慢，即超过一小时，你仍然需要做一些工作。
If you are clearing your glucose rapidly and your fasting insulin is low, you’re in great shape. Keep doing it. So you should look at the trends. You should look at the pathophysiology. You should understand that each of the markers doesn’t exist in isolation.
如果你的血糖清除速度很快，且空腹胰岛素水平低，那么你的身体状况很好。继续保持这种状态。所以你应该关注趋势。你应该了解病理生理学。你应该明白，每个指标都不是孤立存在的。
They’re not siloed. They work together.
他们不是孤立的。他们一起工作。

Mike Haney (00:48:21): 迈克·汉尼 (00:48:21):

So if I have relatively low fasting insulin and I’m seeing generally a trend of pretty quick return to baseline, am I somebody who can then take in more carbs without worrying too much about what that actual glucose I’m taking in is going to be?
所以，如果我空腹胰岛素相对较低，并且通常可以看到快速回到基线的趋势，那么我是否可以摄入更多的碳水化合物而不需要太担心我实际摄入的血糖会是多少？
What kind of long-term damage that might be causing my body? Can I be more tolerant of spiking 50 points as opposed to trying to stay under 30 or whatever the sort of guidance is?
我身体可能遭受的长期损害是什么？我是否能更容忍血糖上升 50 点，而不是试图保持在 30 点以下或其他指导建议的水平？

Rob Lustig (00:48:47): 罗布·卢斯蒂格（00:48:47）: 翻译文本：

Yeah, absolutely. Because you’re clearing it. And the clearing is much more important than the spiking. That we’re very sure of.
是的，绝对如此。因为你正在清除它。而清除远比激增更为重要。这是我们非常确定的。
Yeah, the spiking tells you about reserve, but the clearing it tells you about sensitivity, and the sensitivity is the thing that is associated with disease.
是的，激增告诉你关于储备的信息，但是清除告诉你关于敏感性的信息，而敏感性与疾病有关联。

Mike Haney (00:49:05): 迈克·汉尼 (00:49:05):

So if I’m in good metabolic health, how do you think about how flat my glucose curve should be? You mentioned earlier that we can expect to see spikes or maybe rises is the word we want to use instead, three times a day when I eat.
所以，如果我的新陈代谢健康状况良好，你认为我的血糖曲线应该有多平坦？你之前提到，当我们进食时，每天可能会看到血糖峰值或可能上升，大约三次。
But we also know, and we see this in a lot of our members, they’re trying to eat to keep that glucose line as flat as possible. How flat do you want to see that line?
但我们也知道，我们在很多会员身上看到了这一点，他们试图通过饮食来保持血糖曲线尽可能平坦。你希望看到这条曲线有多平坦？

Rob Lustig (00:49:28): 罗布·卢斯蒂格（00:49:28）: 翻译文本：

It’s going to undulate. If it doesn’t undulate, that means either you’re not consuming glucose or you’re fasting, one or the other, it’s going to change. We don’t know. We don’t have the data to tell you, oh, the amount of change predicts when you’re going to die.
它会波动。如果它不波动，这意味着你可能没有消耗葡萄糖，或者你在禁食，无论哪种情况，它都会改变。我们不知道。我们没有数据告诉你，变化的量预测你何时会死亡。
We don’t have that. I don’t think we’ll ever have that. What I can say is the longer it stays up, the more problem it is. That’s really what I can say. You should be able to clear your glucose within an hour. That’s what I can say.
我们没有那个。我认为我们永远也不会有那个。我能说的只是，它停留得越久，问题就越大。这就是我能说的。你应该能在一小时内清除血糖。这就是我能说的。
Now, different foods will give you different rises and different foods will probably have different effects on how fast that glucose gets cleared as well. Those are called Kraft Curves, K-R-A-F-T for Dr. Kraft who first utilized them.
现在，不同的食物会给你带来不同的血糖上升，而且不同的食物可能对血糖清除的速度有不同的影响。这些被称为 Kraft 曲线，K-R-A-F-T，是为了纪念首先使用它们的 Kraft 博士。

(00:50:26):

So different will provide you with different information, and that’s one of the reasons why CGMs are so great, because then you can determine, well, what gives you the lowest glucose excursion?
因此，不同的信息将为您提供不同的信息，这就是 CGMs 如此出色的原因之一，因为那样您就可以确定，什么能给您最低的血糖波动？
What gives you the best Kraft Curve for your personal body habitus and your personal biochemistry? You can get that out of the CGM. Now, the Kraft Curve, of course, measures insulin. It doesn’t measure glucose.
什么能给你提供最适合你个人体型和个人生物化学的 Kraft 曲线？你可以从 CGM 中得到这个。当然，Kraft 曲线测量的是胰岛素，而不是葡萄糖。
So you’re not getting that, but you’re getting a proxy because if you’re clearing your glucose fast, that means your insulin’s in good shape. So we have to understand, we’re measuring glucose, but really what you want to know about is the insulin.
所以你没有得到那个，但你会得到一个代理，因为如果你的血糖快速清除，这意味着你的胰岛素状况良好。所以我们需要理解，我们在测量血糖，但实际上你想要了解的是胰岛素。

Mike Haney (00:51:13): 迈克·汉尼 (00:51:13):

So if I’m having those rapid returns to baseline, how much do you care about glycemic variability over the course of the day? If my line is still moving quite a bit, but it’s coming back down, or if I’m spiking every time I eat?
所以，如果我快速回到基线，你对一天中血糖波动的关心程度是多少？如果我的线仍然在移动，但它正在恢复，或者每当我吃饭时我都会突然升高，你对此有何看法？

Rob Lustig (00:51:26): 罗布·卢斯蒂格（00:51:26）:

Not that much. As long as it’s coming down. If it goes up, it goes up. If it’s coming down, that means your body’s okay.
不多。只要是在下降。如果上升，就会上升。如果在下降，这意味着你的身体状况良好。

Mike Haney (00:51:35): 迈克·汉尼 (00:51:35):

So let’s go back then a little bit out of the, actually, there’s one more thing I want to follow up on the glucose and insulin side. This is maybe a bit of a tangent, but I want to go back to diabetes.
那么，让我们稍微回到血糖和胰岛素的话题上。实际上，我还有一个关于血糖和胰岛素的问题想要跟进。这可能有点偏题，但我想要回到糖尿病的话题上。
We talk about diabetes is diagnosed via glucose, via a fasting glucose test or an AIC, but as I understand it, what diabetes is describing is a state of insulin resistance.
我们讨论的是糖尿病的诊断通过血糖，通过空腹血糖测试或 AIC，但据我理解，糖尿病描述的是胰岛素抵抗的状态。

Rob Lustig (00:51:58): 罗布·卢斯蒂格（00:51:58）:

Well, not necessarily. Type one diabetes is not a state of insulin resistance. It’s a state of defective insulin reserve. So if you can’t make insulin, doesn’t matter how sensitive you are. So it’s a combination of the two.
不一定。1 型糖尿病不是胰岛素抵抗的状态，而是胰岛素储备缺陷的状态。所以，如果你不能产生胰岛素，不管你多么敏感都没有关系。这是两种情况的结合。
It’s like two levers that are working in concert with each other, and the more defective one lever is the harder the other one has to work in order to keep it stable. So that’s why you need both pieces of information. You need the spike to tell you about the reserve.
就像两个杠杆一起工作，而且，如果其中一个杠杆更缺陷，那么另一个杠杆就必须更努力工作以保持稳定。这就是为什么你需要这两方面的信息。你需要这个峰值来告诉你关于储备的信息。
You need the rate of clearance to tell you about the sensitivity. There’s information in both of those, and they’re related to each other.
你需要清除率来告诉你敏感性。这两者都包含信息，并且彼此相关。

Mike Haney (00:52:40): 迈克·汉尼 (00:52:40):

So why do we diagnose diabetes with glucose and not insulin?
为什么我们用血糖而不是胰岛素来诊断糖尿病？

Rob Lustig (00:52:44): 罗布·卢斯蒂格（00:52:44）： 翻译文本：

Well, because some people will have high insulin for a certain glucose, and some people will have low insulin for a certain glucose. Where are you going to draw the line? It’s not going to tell you.
因为有些人对于特定的血糖水平会有高的胰岛素，有些人则会有低的胰岛素。你打算在哪里划线？它不会告诉你。
And in addition, because the glucose is doing damage, it’s obviously the thing to measure. And in addition, because your kidney is now excreting the glucose, it’s an easy to measure in the urine.
而且，由于葡萄糖正在造成损害，显然需要测量。此外，因为你的肾脏现在正在排泄葡萄糖，尿液中很容易测量。
So that’s a better marker for diabetes, but it’s not necessarily a biomarker with dynamic range for metabolic health. Insulin’s much better for that.
所以这更适合用于糖尿病的指标，但不一定能动态反映代谢健康。胰岛素在这方面要好得多。
And because insulin changes early and glucose changes late, like I said, if you’re waiting for the glucose to change, horse is out of the barn.
因为胰岛素的变化早，而血糖的变化晚，就像我说的，如果你在等待血糖变化，那就已经晚了。

Mike Haney (00:53:32): 迈克·汉尼 (00:53:32):

Right. One more question on diabetes. How arbitrary is 125?
正确。关于糖尿病的一个问题。125 是什么意思？

Rob Lustig (00:53:37): 罗布·卢斯蒂格（00:53:37）:

It’s pretty arbitrary. It depends on where you are in the curve. If you’re at the baseline, then 125 is diabetes. If you are in the middle of metabolizing your meal and that’s your peak, you’re doing great. So a blood glucose out of context tells you nothing.
这相当随意，取决于你在曲线的位置。如果你在基线，那么 125 是糖尿病。如果你正在代谢你的餐食，这是你的峰值，你做得很好。所以，脱离上下文的血糖值告诉你什么都没有。
That’s why you need it to be fasting. But it’s the last thing to change because your body’s doing everything it can to maintain a normal blood glucose. It’s the absolute last thing to change. The hemoglobin A1C is the second to last thing to change.
这就是为什么你需要空腹。但它是最后要改变的事情，因为你的身体正在尽一切可能保持正常的血糖水平。这是最后要改变的事情。糖化血红蛋白是第二个要改变的事情。
It will start to rise before the fasting glucose will. So if you’ve got an hemoglobin A1C of 5.4, you’ve got a little bit of defective glucose clearance.
它会在空腹血糖之前开始上升。所以，如果你的糖化血红蛋白是 5.4，你的葡萄糖清除能力有些缺陷。
If it goes to 5.5, you’ve got a little bit more defective glucose clearance and up and up and up until you hit six, when now you’ve got pre-diabetes. And when it hits 6.5, that’s full-fledged diabetes.
如果达到 5.5，你的葡萄糖清除能力稍微有点缺陷，然后越来越高，直到达到 6，这时你已经有了前期糖尿病。当达到 6.5 时，这就是完全的糖尿病。

(00:54:45):

So you can actually see the problem before the fasting glucose changes in the hemoglobin A1C, but even that is late in the game, the fasting insulin will change before that. And how do I know that?
所以你实际上可以在血糖在血红蛋白 A1C 中改变之前看到问题，但即使那样也已经太晚了，空腹胰岛素会在那之前改变。那我怎么知道呢？
Because you can go into any metabolic syndrome clinic in this country and see patients who have normal glucose tolerance but are obese and insulin resistant. So they are not hyperglycemic. They do not have an abnormal glucose tolerance test, but they’re insulin resistant.
因为你可以在这个国家的任何代谢综合征诊所看到患者，他们有正常的葡萄糖耐量，但肥胖且对胰岛素抵抗。所以他们没有高血糖。他们的葡萄糖耐量测试没有异常，但他们对胰岛素有抵抗性。
Their fasting insulin is high to keep them at that glucose level, and they are already spilling protein in their urine. They already have metabolic kidney disease because the insulin caused the metabolic kidney disease, not the glucose.
他们的空腹胰岛素水平很高以维持那个血糖水平，他们的尿液中已经开始出现蛋白质流失。他们已经患有代谢性肾病，因为胰岛素导致了代谢性肾病，而不是血糖。
So there are things you can look at to tell you as an early diagnostic, and I’m actually giving a talk at Stanford in two weeks on early diagnostics and fasting insulin is job one.
所以有一些事情你可以观察，作为早期诊断的指标，两周后我在斯坦福大学的演讲主题就是早期诊断和空腹胰岛素，这是首要任务。

Mike Haney (00:55:59): 迈克·汉尼 (00:55:59):

And do you watch insulin on the way down? If you’re treating a diabetic patient and you’re trying to get that fasting glucose down, are you also testing their insulin as you’re treating them and expecting that to also be coming down? How do they move on the reverse side?
并且你会观察胰岛素的下降情况吗？如果你在治疗糖尿病患者，试图降低空腹血糖，同时也在测试他们的胰岛素水平，期望胰岛素水平也会下降吗？他们在反向操作时是如何进行的？

Rob Lustig (00:56:15): 罗布·卢斯蒂格（00:56:15）:

If you are improving their metabolic health then their fasting insulin should be coming down. Now, if you are giving metformin, you’ll be improving insulin sensitivity. So the fasting insulin should come down.
如果你改善了他们的新陈代谢健康，那么他们的空腹胰岛素水平应该会下降。现在，如果你给他们服用二甲双胍，你将提高胰岛素敏感性。因此，空腹胰岛素水平应该会下降。
If you are giving thiazolidine diones to improve their diabetes, their fasting insulin might actually not change. So it depends on how you’re doing it. If you’re doing it with diet, it definitely should be coming down. And if it’s coming down, then that’s a good thing.
如果你使用噻唑烷二酮来改善糖尿病，他们的空腹胰岛素实际上可能不会改变。这取决于你是如何进行的。如果你通过饮食来进行，它肯定应该下降。如果下降了，那是一件好事。

Mike Haney (00:56:45): 迈克·汉尼 (00:56:45):

Okay. So let’s leave the world of glucose and insulin for a moment so we have time for some other markers.
好的。那么，让我们暂时离开葡萄糖和胰岛素的世界，以便我们有时间考虑其他一些指标。

Rob Lustig (00:56:48): 罗布·卢斯蒂格（00:56:48）:

All right. 好的。

Mike Haney (00:56:49): 迈克·汉尼 (00:56:49):

You mentioned earlier uric acid. That’s also included in our current Levels labs panel. Does uric acid fit this criteria that we were talking about in terms of a marker that reveals something about underlying physiology is titratable and can actually be moved?
您之前提到了尿酸，这也在我们当前的水平实验室面板中包含。尿酸是否符合我们讨论的标准，即作为揭示潜在生理状态的指标，可以调整并实际上可以移动？

Rob Lustig (00:57:04): 罗布·卢斯蒂格（00:57:04）:

Yes. And it’s also got a dynamic range, and the higher it is, the more problem it is. So yes, then that’s another reason why we include uric acid in our biomarker panel for just that reason. The question of course, is what does uric acid mean?
是的。它还有动态范围，数值越高，问题越大。所以，是的，这就是为什么我们将尿酸包括在我们的生物标志物面板中的另一个原因。当然，问题是尿酸意味着什么？
People don’t even know what it means. It is a breakdown product of energy generation. It is a breakdown product of ATP. So when ATP, the energy’s in the phosphate bonds, when ATP cleaves a phosphate off to generate energy, it becomes ADP, adenosine diphosphate.
人们甚至不知道这是什么意思。这是能量生成的分解产物。这是 ATP 的分解产物。所以当 ATP 在磷酸键中储存能量时，当 ATP 释放一个磷酸来产生能量时，它会变成 ADP，腺苷二磷酸。
So the energy gets released, it gets used power molecular motors within the cells so that the cells can do their job. Then the ADP goes to AMP, adenosine monophosphate, which then goes to IMP inositol monophosphate, which then finally goes to uric acid.
因此，能量被释放，它被细胞内的动力分子电机使用，使细胞能够完成它们的工作。然后，ADP 转化为 AMP（腺苷单磷酸），然后转化为 IMP（肌醇单磷酸），最终转化为尿酸。
And uric acid is then excreted in the urine. So it is a measure of how fast your body is generating energy.
尿酸然后在尿液中排出。所以这是衡量你的身体产生能量速度的一个指标。

Mike Haney (00:58:24): 迈克·汉尼 (00:58:24):

So marker of cellular health?
细胞健康指标？

Rob Lustig (00:58:26): 罗布·卢斯蒂格（00:58:26）:

Marker of cellular health. Now, the problem is that uric acid does two things that you wish it didn’t do. One is it is the inhibitor of an enzyme in your arteries called endothelial nitric oxide synthase or eNOS.
细胞健康指标。现在的问题是，尿酸做了两件事，你希望它不做。一是它抑制了你动脉中称为内皮一氧化氮合酶或 eNOS 的酶。
And it’s the enzyme that makes nitric oxide and nitric oxide is your endogenous blood pressure lower. It’s the thing that causes your blood vessels to relax. Therefore, it’s the thing that keeps your blood pressure down.
这就是制造一氧化氮的酶，而一氧化氮是你的体内血压降低的物质。它是使你的血管放松的东西。因此，它是保持血压稳定的关键。
And so if you’re inhibiting it, means your blood pressure’s going to go up. So it is a primary contributor to hypertension. Well-known, been known since 1967 that uric acid is a driver of hypertension.
如果你抑制它，意味着你的血压会上升。因此，它是高血压的主要贡献者。自 1967 年以来，就已知尿酸是高血压的驱动因素。
The second thing it does, and this was work from Rick Johnson from University of Colorado, he showed that uric acid inhibits an enzyme that’s necessary for mitochondria to do their job called CPT1, carnitine palmitoyltransferase 1. Now, what is that?
第二件事，这是来自科罗拉多大学的 Rick Johnson 的工作，他表明尿酸抑制了一种酶，这种酶对于线粒体执行其功能是必要的，称为 CPT1，肉碱棕榈酰转移酶 1。那么，这是什么？

(00:59:37):

That’s an enzyme that regenerates this compound in your cells called carnitine. And carnitine is a shuttle mechanism for bringing fatty acids into the mitochondria so that they can be burned.
这是一种酶，可以再生您细胞中称为肉碱的化合物。而肉碱是一种将脂肪酸带入线粒体的转运机制，以便它们可以被燃烧。
If you don’t have enough carnitine, you can’t cleave fatty acids into two carbon fragments and use them for burning, in which case you end up with fatty liver. And so if you inhibit CPT1, you can’t transport the fat.
如果你的肉碱不足，你就无法将脂肪酸分解为两个碳原子的片段并利用它们进行燃烧，这会导致脂肪肝。因此，如果你抑制 CPT1，你就无法运输脂肪。
Good reason for fat buildup, which causes insulin resistance and clearly mitochondrial dysfunction because it’s interfering with ATP generation because it’s interfering with mitochondrial function. So keeping your uric acid down is super important.
脂肪堆积的好理由，导致胰岛素抵抗和明显线粒体功能障碍，因为它干扰了 ATP 生成，干扰了线粒体功能。所以保持尿酸水平低是非常重要的。
Now, what makes uric acid go up? Well, obviously kidney disease, because you have to excrete it. But what else? Because kidney disease you can’t do much about, at least not, I mean, you could improve your metabolic health, that’ll help.
现在，是什么让尿酸升高？很明显，是肾脏疾病，因为你需要排出它。但还有其他原因吗？因为肾脏疾病你很难改变，至少在某种程度上，你可以改善你的新陈代谢健康，这会有帮助。
But it’s not like you can fix that from one day to the next.
但你不能在一天之内就解决这个问题。

(01:00:45):

What makes uric acid? Well, two things make uric acid. The first is purines, because purines are adenosine and guanosine. They are nucleosides that are in meat. So Benjamin Franklin knew that his meat habit was the cause of his gout, and he wrote an ode to his gout back in 1785.
尿酸是如何形成的？有两个因素会形成尿酸。第一个是嘌呤，因为嘌呤是腺嘌呤和鸟嘌呤。它们是存在于肉类中的核苷。所以本杰明·富兰克林知道他的肉类习惯是导致他痛风的原因，并在 1785 年写了一首关于他的痛风的颂歌。
So it’s been known for a long time that uric acid is a driver of gout, and that meat is a primary driver of uric acid. But the other thing that causes uric acid is not so well known and it’s sugar. And why does sugar increase uric acid?
所以，长期以来都知道尿酸是痛风的驱动因素，而肉类是尿酸的主要驱动因素。但导致尿酸升高的另一个因素不太为人所知，那就是糖。为什么糖会增加尿酸呢？
And that’s a complicated one, but let me explain it. Remember, sugar is two molecules, glucose and fructose. The glucose will get metabolized in every cell in the body, fructose only in the liver.
这是一个复杂的概念，但让我来解释一下。请记住，糖由两种分子组成，葡萄糖和果糖。葡萄糖会在身体的每一个细胞中被代谢，而果糖只在肝脏中被代谢。
The fructose enters the liver, and the first thing that happens is that the fructose gets phosphorylated.
果糖进入肝脏，发生的第一件事是果糖被磷酸化。

(01:01:52):

A phosphate is added to the fructose, so it can then go on its biochemical journey to either energy utilization or more likely fat storage. When it’s phosphorylated, a phosphate has to be given to it. Well, where does the phosphate come from? It comes from ATP.
磷酸被添加到果糖中，以便它可以开始其生物化学旅程，要么用于能量利用，更有可能用于脂肪储存。当它被磷酸化时，需要提供一个磷酸。那么磷酸来自哪里？它来自 ATP。
So ATP has to go to ADP in order to metabolize fructose, which starts the uric acid. That’s the pathway to uric acid. So sugar consumption increases uric acid too. So both meat and sugar consumption both increase uric acid.
因此，ATP 必须转化为 ADP 才能代谢果糖，这开始产生尿酸。这就是尿酸的生成途径。因此，糖的摄入也会增加尿酸。所以，无论是肉类还是糖的摄入，都会增加尿酸。
If you want to get your uric acid down, you have to cut your meat, you have to cut your sugar consumption. It’s just that simple.
如果你想降低尿酸，就必须减少肉类的摄入，减少糖分的摄入。就是这么简单。

(01:02:38):

But because of the effects on blood pressure and because of the effects on this carnitine transport that, ultimately, leads to mitochondrial dysfunction and fat deposition, uric acid is a bad player in metabolic health, and the goal is to keep it down.
但因为对血压的影响，以及对这种影响肉碱运输的影响，最终导致线粒体功能障碍和脂肪沉积，尿酸在代谢健康中是一个坏角色，目标是将其保持在较低水平。
All right, so how down should it be? If you look at the lab slip, it’ll tell you that the cutoff for high uric acid is at seven. That’s wrong. That’s wrong. Okay? The cutoff should be at 5.5. Now, why do I say 5.5 and the lab slip says seven? Clearly they know something.
好吧，那么它应该降多少？如果你查看实验室单据，它会告诉你高尿酸的临界值是 7。这是错误的。这是错误的。好吧？临界值应该是 5.5。那么，为什么我说 5.5 而实验室单据显示是 7？显然他们知道一些事情。

Mike Haney (01:03:20): 迈克·汉尼 (01:03:20):

I’m guessing gout is the answer.
我猜痛风可能是答案。

Rob Lustig (01:03:22): 罗布·卢斯蒂格（01:03:22）:

Well, no, no, no. It has to do with the normal distribution. It has to do with the Gaussian curve.
嗯，不是，不是，不是。这与正态分布有关。这与高斯曲线有关。

Mike Haney (01:03:29): 迈克·汉尼 (01:03:29):

Okay? 好的？

Rob Lustig (01:03:30): 罗布·卢斯蒂格（01:03:30）:

So today, if you take 100,000 “healthy” and we know that they’re not healthy because 93% of Americans manifest some form of metabolic dysfunction, but they may not know it and they say they’re healthy, but they go into this assay, you’re going to generate a bell-shaped curve, and then you get the mean.
所以今天，如果你有 100,000 个“健康”的人，我们知道他们并不健康，因为 93%的美国人表现出某种形式的代谢功能障碍，但他们可能并不知道这一点，他们会说自己是健康的，但一旦进行这种测试，你就会生成一个钟形曲线，然后得到平均值。
And then what we say is two standard deviations from the mean, that’s what we consider abnormal. That’s just a statistical fudge is two standard deviations from the mean. So if you do that for 100,000 “normal” healthy adults who are not healthy, that number’s going to be seven.
然后我们所说的，是从平均值出发的两个标准差，这是我们认为异常的。这只是在统计学上，从平均值出发的两个标准差。所以如果你对 10 万个“正常”的健康成年人进行这样的操作，这个数字将是 7。

(01:04:17):

But if you did that 50 years ago, the number would’ve been 5.5. And the reason is because we were healthy then and we’re not healthy now. The entire bell shaped curve has shifted to the right.
但如果你 50 年前那样做，数字会是 5.5。原因是那时我们很健康，而现在我们不那么健康。整个钟形曲线已经向右移动。
And of course, there’s no way to know that just doing that today, you have to actually look at what happened before to show that. And we have, so this is true for insulin. This is true for uric acid. It’s true across the board for hosts of things.
当然，没有办法知道仅仅今天这样做是否有效，你必须回顾过去的情况来证明这一点。我们确实做到了，所以这适用于胰岛素。这适用于尿酸。对于众多事物来说，这都是普遍适用的。
It’s true for ALT, which is a liver function test because everyone has fatty liver now.
这适用于 ALT，因为它是一个肝功能测试，因为现在每个人都有脂肪肝。

Mike Haney (01:04:59): 迈克·汉尼 (01:04:59):

So maybe let’s wrap this up by coming back to where we started, which is what is our set of markers? What kinds of things we want to look at? We’ve talked about insulin a lot. That being a really key one.
所以，让我们总结一下，回到我们开始的地方，即我们的一组指标是什么？我们想关注的是哪些方面？我们已经讨论过胰岛素很多次，这是一个非常关键的方面。
We’ve talked about uric acid, which I think is still pretty much on the fringes of what people are measuring. We’ve talked about some way of looking at glucose in relation to your insulin, whether it’s with the CGM or whether it’s with testing. What else do you want to see?
我们讨论过尿酸，我认为这仍然在人们测量的边缘。我们讨论过如何通过 CGM 或测试来查看血糖与胰岛素的关系。你还想看到什么？
What other markers fit these criteria we’ve talked about? And give us some indication of our health.
其他符合我们讨论标准的指标是什么？并给我们一些健康状况的指示。

Rob Lustig (01:05:30): 罗布·卢斯蒂格（01:05:30）:

Right. So you had mentioned cholesterol at the very beginning. Let’s turn to cholesterol for a minute. Everyone thinks cholesterol is important. It’s not.
对。所以你一开始提到了胆固醇。让我们暂时讨论一下胆固醇。每个人都认为胆固醇很重要。其实不然。
Now, there are different kinds of cholesterol, and some of them are important, but the total cholesterol doesn’t tell you that. So the amount of cholesterol on the side of the package, they took it off because they know, the FDA knows that’s not valuable. That’s number one.
现在，胆固醇有不同种类，其中一些很重要，但总胆固醇并不能告诉你这一点。所以包装上胆固醇的含量，他们已经取消了标注，因为他们知道这并不重要。这是第一条。
Number two, your total cholesterol on your lab slip is not valuable. It shouldn’t even be listed because all it does is confuse people and it’s spurious. So what does matter? Well, there’s this thing called LDL. Does that matter? And the answer is no. It doesn’t matter either.
第二，你实验室报告单上的总胆固醇没有价值，甚至不应该列出，因为它只会混淆人们，而且是毫无根据的。那么，什么是有价值的呢？有这个叫做低密度脂蛋白的东西，它重要吗？答案是否定的，它也不重要。
And here’s why. Because there’s not one LDL, there’s two. And the LDL on the lab slip measures both at the same time, and they’re not the same.
因为不是只有一个 LDL，而是有两个。实验室报告单上的 LDL 同时测量了两者，但这两者并不相同。

(01:06:26):

Now, if we had a way of separating, and we do, the two different LDLs, you can actually learn something.
现在，如果我们有一种方法来分离，我们确实能做到，两种不同的 LDL，你实际上可以学到一些东西。
So that’s called a VAP analysis or lipoprotein electrophoresis, where you basically can distinguish the LDL that causes heart disease called small dense LDL from the LDL that doesn’t cause heart disease, which is called large buoyant LDL.
这就是所谓的 VAP 分析或脂蛋白电泳，你基本上可以区分导致心脏病的 LDL，称为小而致密的 LDL，与不导致心脏病的 LDL，称为大而浮力的 LDL。
Then you can learn something, but insurance isn’t paying for that. That’s a $500 test to figure that out. So people don’t know. Now, if you can afford it, great, but that’s not helping the masses. So we still have a problem there.
然后你可以学到一些东西，但是保险不支付这个费用。这是一个需要花费 500 美元来弄清楚的事情。所以人们并不知道。现在，如果你能负担得起，那就太好了，但这对大众并没有帮助。所以我们仍然存在这个问题。
Triglyceride turns out to be a more egregious lipid than LDL ever was. The hazard risk ratio for LDL in heart disease is 1.3. Meaning if you have a high LDL, you have a 30% increased risk of having a heart attack.
甘油三酯比低密度脂蛋白更糟糕。低密度脂蛋白在心脏病中的风险比为 1.3。这意味着如果你的低密度脂蛋白水平高，你的心脏病发作风险会增加 30%。
Whereas the hazard risk ratio for triglyceride and heart disease is 1.8.
甘油三酯和心脏病的危险风险比为 1.8。

(01:07:30):

So if you have a high triglyceride, you have an 80% increased risk for having a heart attack. 50% increased over the LDL, but we don’t even talk about it. We don’t pay it any heed. And there are two reasons why.
所以，如果你的甘油三酯水平高，你的心脏病发作风险会增加 80%。这是 LDL 水平的 50%增加，但我们甚至不讨论它。我们不给予它任何关注。原因有两个。
First reason is because a lot of people get their blood drawn not fasting. And you need to be fasting for a triglyceride to mean something because as soon as you eat, your triglycerides go up. Just like your glucose and your insulin have to be fasting in order to mean something.
第一个原因是很多人在未禁食的情况下进行血液检查。对于甘油三酯来说，你需要禁食，因为一进食，甘油三酯就会升高。就像血糖和胰岛素一样，在禁食状态下测量才有意义。

(01:08:02):

And number two, the triglyceride doesn’t just stay triglyceride. The triglyceride circulates in the bloodstream, goes to your fat cell, offloads the lipid into your fat tissue, and then it becomes the small dense LDL.
其次，甘油三酯并不只是停留在甘油三酯的状态。甘油三酯在血液中循环，进入你的脂肪细胞，将脂质卸载到你的脂肪组织中，然后它变成小而致密的低密度脂蛋白。
So your triglyceride and your small dense LDL are related to each other. So what you care about is your LDL, but you care about it in the face of your serum triglyceride. So high LDL, low triglyceride, not a big deal. High LDL, high triglyceride, very big deal.
所以你的甘油三酯和小而密的 LDL 是有关联的。你关心的是你的 LDL，但这是在考虑到你的血清甘油三酯的情况下。所以高 LDL，低甘油三酯，没什么大不了。高 LDL，高甘油三酯，非常严重。
Now, at Levels, we understood this. And so we are not measuring LDL or triglyceride. We are measuring something called ApoB, Apolipoprotein B. And the reason is because LDL and triglyceride both have ApoB. Because one’s an evolution of the other.
现在，在 Levels，我们理解了这一点。所以我们不再测量 LDL 或甘油三酯。我们测量的是被称为 ApoB，载脂蛋白 B 的东西。原因是 LDL 和甘油三酯都含有 ApoB。因为一个是另一个的进化。
And so that’s a way of figuring it out. So that’s another reason why Labs 2.0 for Levels includes ApoB as one of the markers.
因此，这就是计算方法。这就是为什么 Labs 2.0 for Levels 将 ApoB 作为指标之一的另一个原因。

(01:09:07):

Okay. So that’s basically what Levels is doing right now. With tests that are normally and routinely available and coverable by insurance. Is that all? Are there other tests? Are there things that we could get that would give us information as well?
好的。基本上，这就是 Levels 目前在做的事情。使用通常可用且可以通过保险覆盖的测试。这全部吗？还有其他测试吗？有没有其他可以获取的信息？
And the answer is, yeah, there are. Let me give you an example. There’s a test called homocysteine. Now we are not getting it. Now, it turns out homocysteine is a metabolic metabolite of protein.
答案是，是的，有这种测试。让我给你举个例子。有一种叫做同型半胱氨酸的测试。现在我们没有得到它。原来，同型半胱氨酸是蛋白质的代谢产物。
It’s part of the TCA cycle, but it’s also in the protein cycle, and it is responsive to B vitamins and omega-3 fatty acids. When you’re B vitamin deficient and when you’re omega-3 fatty acid deficient, your homocysteine goes up.
这是 TCA 循环的一部分，但它也在蛋白质循环中，且对 B 族维生素和ω-3 脂肪酸有响应。当你缺乏 B 族维生素和ω-3 脂肪酸时，你的同型半胱氨酸会上升。

(01:10:02):

And it turns out homocysteine levels predict cardiovascular disease and heart attack as well. And now we’ve also learned that homocysteine levels also predict Alzheimer’s disease. Now, we’ve known for years about a disease called homocystinuria.
同型半胱氨酸水平预测心血管疾病和心肌梗死。现在，我们还了解到同型半胱氨酸水平也预测阿尔茨海默病。多年来，我们已经知道一种叫做同型半胱氨酸尿症的疾病。
This is a disorder of the enzyme that clears homocysteine in the body. If you have this disease, you’re tall and you’re actually kind of gangly and you’re mentally retarded and you get very early heart disease.
这是一种体内清除半胱氨酸的酶的疾病。如果你有这种疾病，你很高，实际上有点瘦长，而且智力低下，并且会很早出现心脏病。
It’s a disease I used to take care of as a pediatric endocrinologist. Well, people have now done a lot of work on whether or not that homocysteine was the cause of the mental retardation and the cause of the heart disease.
这是一种我过去作为儿科内分泌学家处理的疾病。嗯，人们现在做了大量的工作，探讨同型半胱氨酸是否是智力迟钝和心脏病的原因。
And we now understand that that is a primary risk factor. It’s part of the pathogenesis, and it may even be part of the pathogenesis of Alzheimer’s routinely. So could we get total homocysteine in our patients and learn something about their metabolic status?
我们现在理解，这是一项主要的风险因素。它是病因学的一部分，甚至可能是阿尔茨海默病常规病因学的一部分。那么，我们能否在患者中获得总同型半胱氨酸，并了解他们的代谢状态呢？
And would that be fixable? And the answer is yes.
这能修复吗？答案是，可以。

(01:11:16):

It’s also on a dynamic range, and it’s also modulable. It means something, but it’s not covered by insurance today. Should that change? I think so. So that’s an example. What other tests could you do that would be valuable? One of the cardinal features of aging is methylation.
它也是动态范围，并且是可以调整的。这意味着一些事情，但今天保险不覆盖。如果这种情况发生变化呢？我认为应该会。这就是一个例子。还有哪些测试可以做，会很有价值呢？衰老的一个关键特征是甲基化。
So your DNA gets methylated, and the longer you live, the more methylated your DNA gets. Well, it turns out the degree of methylation predicts the degree of aging. You can measure methylation status by measuring something we now have a test for called epigenetic age.
所以你的 DNA 会甲基化，你活得越久，DNA 的甲基化程度就越高。原来，甲基化的程度预测了衰老的程度。你可以通过测量我们现在有测试的称为表观遗传年龄的东西来衡量甲基化状态。
Can you measure epigenetic age? Yeah, but insurance is not paying for it. It’s relatively still expensive. Our colleague, David Sinclair offers a methylation test known as the DunedinPACE method. And you can determine that.
你能测量表观年龄吗？是的，但保险不支付它。它相对仍然昂贵。我们的同事，大卫·辛克莱提供了一种名为邓迪 PACE 方法的甲基化测试。你可以确定这一点。

(01:12:20):

And we know from other studies, like for instance, my colleague Bruce Blumberg at UC Irvine has shown that the methylation status of an enzyme called insulin degrading enzyme predicts insulin resistance because you can’t clear the insulin because of its methylation status.
我们从其他研究中知道，例如，我的同事布鲁斯·布兰格在加州大学欧文分校的研究显示，一种名为胰岛素降解酶的酶的甲基化状态预测胰岛素抵抗，因为无法清除胰岛素，这是由于其甲基化状态造成的。
And that is a primary hallmark of obesity and aging. So the problem with the DunedinPACE is you have to chop up all the DNA. So you don’t know which enzyme it’s with, or which gene it’s with.
这就是肥胖和衰老的主要特征。所以 DunedinPACE 的问题在于你必须切割所有的 DNA。你不知道它与哪个酶相关，或者与哪个基因相关。
So it lacks a certain, shall we say, specificity, but it gives you a sense of how you’re doing from an aging standpoint.
所以它缺乏某种，我们可以说，特定性，但它让你从衰老的角度感受到自己的状态。
And my colleagues at UC Berkeley and UCSF, Barbara Laraia and Elissa Epel just showed a cross-sectional study showing that the degree of ultra-processed food that you eat predicts your epigenetic age compared to your biological age.
我的伯克利大学和 UCSF 的同事，芭芭拉·拉利亚和伊丽莎·埃珀尔刚刚展示了一项横断面研究，显示你摄入的超加工食品的量预测你的表观年龄与你的生物年龄相比。

(01:13:21):

Now, does that mean you could fix your food and fix your epigenetic age? We don’t know that yet. No one’s done that. But is that something to look at for the future? And could that ultimately be a good marker for us to be able to draw? Very possibly.
现在，这意味着你可以修复你的食物并修复你的表观遗传年龄吗？我们还不知道。还没有人这样做过。但这是否是未来值得考虑的事情？并且最终这是否能成为我们能够绘制的良好指标？很有可能。
That’s an exciting place to go. And then the last thing is inflammation. So the degree of inflammation that’s going on in the body, how do you determine that? Because the more inflammation, the sicker you are without question. And where’s the inflammation coming from?
那是一个令人兴奋的地方去。然后最后一件事是炎症。所以身体中炎症的程度，你怎么确定？因为炎症越多，毫无疑问你的病情就越重。炎症是从哪里来的？
It’s almost always coming from the gut, gut inflammation. So are there tests for gut inflammation? And the answer is not good ones, unfortunately.
几乎总是来自肠道，肠道炎症。那么有肠道炎症的测试吗？不幸的是，答案不是很好的测试。

(01:14:04):

But we can look at systemic inflammation. We can look at high-sensitivity C-reactive protein. So that’s a test that’s immediately available. It doesn’t cost too much. The problem is it doesn’t have quite the dynamic range that the others do.
但我们可以看看全身性炎症。我们可以看看高敏感度 C 反应蛋白。所以这是一个立即可用的测试。它不太昂贵。问题是它的动态范围不如其他测试。
It’s not quite as good a biomarker, but it still tells you whether there’s inflammation going on or not. And so if you know that your HSCRP is low, that’s a good sign.
这不是非常优秀的生物标志，但它仍然告诉你是否存在炎症。所以，如果你知道你的 HSCRP 水平低，这是一个好的迹象。
It means that you’re doing something right and if it’s high, it means clearly things are not right and you need to start thinking about what it is you’re eating in order to get that HSCRP down. It doesn’t tell you what’s wrong, just tells you something’s wrong.
这意味着你在做正确的事情，如果数值高，这意味着很明显有些地方不对劲，你需要开始思考你所吃的食物，以降低 HSCRP。它不告诉你具体问题是什么，只是告诉你有些地方出了问题。

(01:14:47):

So that’s another potential test that can be added to the armamentarium and it’s not too expensive and it’s available now. So this is an evolution. We’re working on it. We’re getting there.
因此，这又是一项可以添加到工具箱中的潜在测试，而且成本不高，现在就可以使用。这是进化的表现。我们正在努力，正在接近目标。
We need the science in order to be able to justify the cost and the expense and certainly the insurance coverage. Because they’re not going to pay for anything unless it works. So we’re still working on those things.
我们需要科学，以便能够证明成本、费用和当然保险覆盖的合理性。因为除非它有效，否则他们不会支付任何费用。所以我们仍在处理这些问题。
But for me today, the things to know are your fasting insulin and your uric acid and your ApoB, and then we can talk about the rest.
但对我而言，今天需要了解的是你的空腹胰岛素、尿酸和 ApoB，然后我们再讨论其他内容。

Mike Haney (01:15:30): 迈克·汉尼 (01:15:30):

Well, maybe last question on this then, which I think this leads into is we do now have companies like Function Health from our friend, Dr. Hyman, and other companies like his that are offering these very broad arrays of tests. I think they do over 100 annual markers.
好吧，那么关于这个问题的最后一个问题了，我认为这引导我们进入的是我们现在确实有了像 Function Health 这样的公司，这是我们的朋友，Dr. Hyman 的公司，以及其他像他这样的公司，它们提供了这些非常广泛的测试。我认为它们每年提供的指标超过 100 个。
What do you think about the utility of tests like that?
你觉得那样的测试有用吗？
Are there things that would be on your wish list, either because they’re precursors or because a good indication that somebody’s going to get as part of that large set that you’re just not going to get at your doctor setting cost aside because that is the barrier to getting those larger arrays.
你的愿望清单上有什么东西，无论是因为它们是前驱物，还是因为它们是作为那个大型集合的一部分，你可能在医生那里无法获得的良好指示，因为那是获取那些更大规模数组的障碍。
But if one has the means, what do you think about people getting that amount of data?
但如果你有这个能力，你觉得人们获取这么多数据怎么样？

Rob Lustig (01:16:09): 罗布·卢斯蒂格（01:16:09）:

I think it’s probably premature. And the reason is because we don’t know what to do with it. We don’t know how to analyze it. We don’t know what goes with what pathway, because you’re trying to influence a pathway. You’re not trying to influence a specific biomarker.
我认为这可能还为时过早。原因是我们不知道如何处理它，如何分析它，也不知道什么与什么途径相关，因为你是在影响一个途径，而不是特定的生物标志物。
The biomarker is a marker for the pathway. When we have some more data and we know that those things are actually manipulable and that the manipulation actually results in clinical benefit, then I’ll be ready to support those. I think it’s a little too early for those.
生物标志物是路径的标记。当我们有一些更多的数据，并且知道那些事情实际上是可操作的，并且操作实际上导致临床益处时，我才会准备好支持这些。我认为现在对这些还为时过早。
I think that’s a little premature. It’s nice to think about. It’s definitely a hot research topic and I’m for that. But in terms of clinical utility, I think don’t put the cart before the horse.
我认为这有点过早。想想很好。这确实是一个热门的研究话题，我支持。但在临床应用方面，我认为不要本末倒置。