美国肥胖与慢性病危机:深层原因、系统性挑战及解决方案 a16z 2026-02-04

美国健康危机现状

主持人: 看看我们今天的食物系统,人们吃的大部分都是超加工的垃圾食品。普通孩子在户外的时间比最高安全级别监狱里的囚犯还少,而囚犯们每天花八小时以上玩手机。我们正处于国家最大的问题之一。如果我们不解决这个问题,美国将面临更严重的问题。我们所处的环境在结构上就很难保持健康,这就是为什么美国的默认健康结果如此糟糕。为什么不能直接推行全民基本Ozempic呢?为什么它不能解决问题?

Original English

主持人: When you look at our food system today, majority of what people are eating is ultrarocessed crap. The average child spends less time outside than like a maximum security prison where people are spending eight plus hours on phone. We are in the midst of one of the biggest problems in the country. If we don't fix this, like America is going to have even more serious problems. The environment that we exist in is just structurally just hard to be healthy, which is why you see the default health outcomes in the US being so poor. Why not just universal basic ompic? Why doesn't that solve the problem?

嘉宾: 我认为现在的问题是,我们正在给孩子们喂食毒药,他们都生病了。我认为我们许多问题都源于国家大部分人口都生病了。无论我们变得多富有,如果国家大部分人都生病,那还有什么意义呢?

Original English

嘉宾: I think now the problem is we're feeding our kids poison and like all of them are sick. I think many of our problems are downstream of the fact that the majority of the country is just sick. No matter if we get rich or whatever, if most of the country is sick, it's kind of like what is the point?

嘉宾的健康探索之旅

主持人: 过去几年,你一直在努力揭示并解决我们的食物危机、健康危机和疾病危机。你能否追溯一下你的旅程,讲讲你是如何对这个问题如此着迷的?然后我们再谈谈我们正在做的事情。

Original English

主持人: You've been on a quest for the last few years to uncover and make a dent in solving our food crisis, our health crisis, our disease crisis. Why don't you trace your journey a little bit into how you became obsessed with this? Um, and then we'll get into what we're up to.

嘉宾: 是的,彼得·蒂尔Peter Thiel)有一个关于“秘密”的想法,我感觉“你吃什么、你的生活方式以及所有这些因素都会影响你的健康结果、你的精力以及你的感受”这个想法就像一个秘密。我大概在20岁的时候偶然发现了这个想法,感觉就像一个秘密。你知道,如果你看看美国的数据,美国的医疗健康结果非常糟糕。它们很差,而且还在变得更糟。肥胖、心脏病等所有这些疾病基本上都达到了创纪录的水平,并且还在持续上升。当我开始阅读更多关于我们的食物系统、环境毒素以及所有这些事情时,我越来越确信,每个人都在问:“我们的肥胖危机是怎么回事?我们为什么生病?”答案很简单,就是我们生活在一个系统性地制造不健康人群的环境中。而“你可以通过改变食物、改变饮食、改变运动、改变环境,从而自然地获得更好的健康结果”这个想法,对我来说就像一个秘密。你知道,我对此深信不疑,并为此投资,在过去15年里创办了公司。但普通人仍然没有完全内化这个想法。所以,我第一次在20岁左右接触到这个想法时,就对此着迷了。

Original English

嘉宾: Yeah. So, Peter Seal has this idea of like a secret and I I feel like the idea that what you eat, your lifestyle, all these things, they impact your health outcomes, they impact your energy, they impact how you feel. Like, I kind of came across that idea when I was 20 and it felt like this secret where, you know, if you look at any data in the US, US healthcare outcomes are horrible. Like, they're bad, they're getting worse. Like, obesity, you know, heart disease, all of these conditions are basically at record levels and continue to go up. And as I started to read more about our food system, about, you know, uh, environmental toxins, about all these sorts of things, like I just became more and more convinced that the everyone's like, "What's going on with our obesity crisis? Why are we so sick?" And the answer is just like simply that we exist in an environment that systematically outputs unhealthy people. And that this this idea that you could just change your food, change your diet, change your exercise, change your environment and that would lead to to much better health outcomes naturally feels to me like this secret that you know I believed and invested behind and like started companies behind for 15 years uh that still like the average person does not totally fully like internalize. Uh and so it was just like I just became obsessed with this idea uh the first time I came across it when I was like 20 or so.

主持人: 你自己也曾努力在个人生活中逆流而上,试图保持健康,但如今要保持健康非常困难。这就像人们以前在Twitter上经常取消别人时会说:“嘿,自己建一个Twitter吧!”或者“你想要自己的信息,自己建一个就好了!”同样地,你必须建立自己的食物系统。

Original English

主持人: and you yourself have gone out of your way to um go against this the the grain in terms of your own personal life and trying to be healthy but it's very difficult to be healthy today. It it's almost like people used to say when they were cancelling people on on Twitter all the time like hey just build your own Twitter like just you want your own information you could just build your own and similarly like you have to build your own like food totally.

嘉宾: 完全正确。是的,我的意思是,在很多方面,我感觉健康曾经只是我们所处环境的产物。比如我的曾祖母,她活到95岁,直到去世那天都非常健康。她从不购买有机食品,也从不在杂货店要求避免食用种子油。她从未做过我不得不学习、弄清楚和实践的那些“疯狂”事情。这主要是因为她生活和成长在一个不促进疾病的环境中。她没有接触到美国存在的4万种新型化合物,也没有食用那些令人上瘾、让她感觉糟糕并影响健康的食物。因此,我认为我们所处的环境在结构上就很难保持健康,这就是为什么美国默认的健康结果如此糟糕。那么,阿米什人(Amish)是如何免受影响的呢?举个例子,他们有什么不同之处?

Original English

嘉宾: Totally. Yeah. I mean in so many ways I feel like the things like health used to just be an output of the environment that we existed in. Like my my great-g grandandmother you know she lived till she was 95 very healthy until the day that she died. And she never shopped organic. She never like avoided and asked for no seed oils at the grocery store. She never did like any of the insanity that I've kind of had to learn, figure out, and do. Uh that's because primarily she in lived and grew up in an environment that was not sickness promoting. She was not exposed to like 40,000 novel chemical compounds that exist in the US or eating foods that were like addictive and made her feel shitty and and like impacted her health. Uh, and so I think that the environment that we exist in is just structurally just hard to be healthy, which is why you see the default health outcomes in the US being so poor. And how are the Amish exempt from this? Just as an example, like what do they do differently?

主持人: 他们确实……我的意思是,他们做了很多不同的事情。你应该去他们的社区看看。他们做的很多事情都和你我非常不同。但基本上,他们吃的食物都是本地种植、应季的。他们总是待在户外,用手劳动。他们生活在一个紧密的社区中。阿米什人在环境和生活方式上有很多不同之处。所以你可以争论说,是不是必须像阿米什人那样生活才能获得更好的健康结果?但他们确实有更好的健康结果,而且他们的生活方式和你我非常不同。

Original English

主持人: They do I mean they do a lot differently. You should go to one of the communities. There's a lot of things they do very differently than you and I. Uh, but basically they're eating, you know, food that is grown locally, seasonally all the time. They're outside all the time working with their hands. They're existing in a tight-knit community. uh you know they and there's like a whole host of environmental and lifestyle uh differences that the Amish have. Uh so you can argue like is it a 100 you know do you have to live like the Amish to have better health outcomes? But certainly they have much better health outcomes and they live very differently than you or I

嘉宾: 但他们不像我们一样“刷屏”。那他们是怎么做到的呢?他们可能会活得更久。

Original English

嘉宾: but they're not doom scrolling like us. So how do they make it? It's like they might live longer.

主持人: 他们消息不灵通。我知道他们可能活得更久,但代价是什么呢?那么,事情是什么时候开始变得非常糟糕的?或者说,在过去的一个世纪里,情况是一直在恶化,还是有一个时刻事情开始升级,发生了什么?

Original English

主持人: They're uninformed. I know they might live longer but at what cost? Um so when did things start to get really bad or like like um has it just been monotonically for the last century or was there sort of a moment where things started to escalate and and what happened?

食物系统恶化的转折点:1970年代

嘉宾: 是的,情况在1970年代开始变得糟糕得多。我的观点是,大约从那时起,你开始看到儿童肥胖率上升。肥胖、心脏病等问题也开始出现。在我看来,一个主要原因是当时大型食品公司面临着大量的股东和其他压力。这些公司今天已经有大约150年的历史了。几乎所有大型食品公司都是股东所有的。它们不受首席执行官的运营或控制。它们基本上就像这些笨重的公司,市场只是让它们为了每股收益而优化。这意味着这些公司在过去50年里,一直选择用某种“假冒”版本来替代真正的食材。比如,它们从草莓变成了草莓香精,或者从糖变成了高果糖玉米糖浆。如果你把这个过程推广到50年,再看看我们今天的食物系统,人们吃的大部分都是超加工的垃圾食品,这些食品具有成瘾性,营养密度低,并且充满了环境毒素、化学化合物等,这些东西在人类数百万年的进化过程中从未遇到过。所以我认为这种转变始于70年代。它代代相传。当然,今天的情况也无济于事,普通孩子在户外的时间比最高安全级别监狱的囚犯还少。你知道,今天大多数孩子70%的饮食都是超加工食品。人们每天花八小时以上玩手机。所有这些都是影响因素,但我真的认为我们的食物系统在70年代开始变得特别有毒,这就是为什么你看到,尤其是在美国,许多医疗健康结果开始朝着如此消极的方向发展,特别是相对于世界其他地区而言。那么,有哪些杠杆可以扭转这些与食物系统相关的趋势呢?

Original English

嘉宾: Yeah, things started to get much worse in the 1970s. Uh you know basically I think my my view is that that is around the time when you started to see childhood obesity tick up. You started to see uh obesity, heart disease, things like this kind of start to move. And in my view, a big reason for that is there was a lot of shareholder and other pressure uh specifically geared towards big food companies around that time where basically these companies are today like 150 years old. Almost every big food company is shareholder owned. They are not run controlled or anything by CEOs. They're basically just like these lumbering, you know, corporations that the market is just optim having them optimized for like earnings per share. And what that means is these companies for the last 50 years have consistently decided to trade a real ingredient for something that's like kind of a fake version of that. Like they've moved from strawberries to strawberry flavoring or they've moved from sugar to high fructose corn syrup. And you kind of roll this out over a 50-year period and you you look at our food system today and the majority of what people are eating is ultrarocessed crap that is like addictive, is not nutrient-dense, and is full of like environmental toxins, chemical compounds, um you know, things like this that the human body has in our entire millions of years of evolution never encountered many of these compounds. And so I think that that shift started in the 70s. Um you know, it's compounded generationally. Uh it certainly doesn't help today that the average child spends less time outside than like a maximum security prisoner. Uh you know like most kids today are eating like 70% of their diet is ultrarocessed foods. Uh you know people are spending eight plus hours on phones. Like all these sorts of things are factors but I really think that our food system started to become uniquely poisonous in the 70s and that is why you saw especially in the US that's why you started to see many healthcare and health outcomes trend in such a negative direction especially relative to the rest of the world. What are the levers that could uh make a dent in in reversing some of these trends as relates to the to the food system?

食物系统改革的关键杠杆

主持人: 是的,从食物系统的角度来看,我认为我们能够施加的最大单一杠杆,尽管在政治上极具挑战性,就是修复我们的农作物补贴系统。如果你看,美国政府在过去十年里,在农作物补贴上花费了近千亿美元。他们基本上补贴玉米、大豆和小麦,这样美国农民就可以种植玉米、大豆和小麦。因为有补贴,所以它们人为地便宜,我们种植了很多。因为有补贴,所以它们人为地便宜。因此,这些大型食品公司在所有产品中都使用它们。这些大型食品公司基本上经历了30年的历程,用高果糖玉米糖浆取代糖,或者用大豆油取代橄榄油之类的东西,而大豆油是高度加工和炎症性的,在各种大鼠和人体模型中都会导致肥胖和各种问题。我认为这种大规模的替换,即用最糟糕的、高度加工的成分取代人类传统上食用的成分,是慢性病的根本原因之一。比如今天,普通美国人几乎20%的卡路里摄入来自大豆油。这在历史上是异常的。这不是因为有人想要大豆油。你可能不是大豆油的大消费者。这只是因为它人为地便宜。因为人为地便宜,它最终出现在所有产品中。我认为这是我们今天食物系统出现问题的核心根源之一。

Original English

主持人: Yeah, from a food system standpoint, I think the biggest single lever that we could pull, which would be extraordinarily politically challenging to pull, is fixing our like crop subsidy system. So, if you look, the US government over the last uh I think it's the last decade has spent close to like a hundred billion on crop subsidies. They're basically subsidizing corn, soy, and wheat uh so that American farmers can grow corn, soy, and wheat. because it's subsidized, it's artificially cheap, so we grow a lot of it. Because it's subsidized, it's artificially cheap. And so these big food companies use it in everything. And so these big food companies have basically gone on like a 30-year journey to replace sugar with high fructose corn syrup or to replace um olive oil or something like that with soybean oil, which is highly processed and inflammatory, causes obesity and all sorts of like rat and human models. Um, and and I think that this sort of wholesale swapping of like let's take the the worst ingredients in their most highly processed form and replace them with an ingredient um that that humans traditionally ate is one of the root causes of chronic disease. Like today, the average American gets almost 20% of their caloric intake from soybean oil. Like this is historically anomalous. And it's not because anyone wants soybean oil. Like you're probably not like a big consumer of soybean oil or anything like this. It's just because it's artificially cheap. And because it's artificially cheap, it ends up in everything. And I think that that is one of the core kind of root causes of what is going wrong in our food system today.

嘉宾: 这只是美国特有的问题吗?

Original English

嘉宾: And is that a uniquely US problem or is this

主持人: 是的,这是美国特有的问题。我的意思是,美国与欧洲等地的食物系统相比,欧洲许多国家的规模较小。他们更倾向于本地食物农业系统。他们也没有像美国那样对食物系统进行联邦干预。美国在很多方面对玉米、大豆、小麦等作物的补贴,其初衷是好的。我的意思是,很多农作物补贴始于80年代的《农业法案》(Farm Bill),当时农民面临恶劣天气,影响了作物产量。美国政府介入,说:“好吧,我们将努力帮助这些农民维持生计。”我认为初衷是好的,但现在几年过去了,我们每年花费数十亿美元用于这些农作物补贴,却让美国人生病。我认为我们过去常说,好吧,我们只需要确保种植足够的卡路里,确保美国人不会饿死。他们不会,你知道,确保我们的孩子有足够的食物吃。我认为现在的问题是,我们正在给孩子们喂食毒药,他们都生病了。为什么不能直接推行全民基本Ozempic呢?我的意思是,为什么它不能解决问题?

Original English

主持人: Yeah, it's a uniquely US problem. I mean, the US, our food system relative to like Europe or something like that. Uh Europe, many, you know, their countries are smaller. Uh they tend to lean much more into like a local food agriculture system. They also don't have as much of a like federal intervention on their food system. uh you know the US like in many ways this sort of subsidy of corn, soy, wheat, things like that. It had good intent. I mean in the a lot of this the crop subsidy stuff uh started with a farm bill in the 80s where basically like farmers were exposed to inclement weather, bad weather that was like impacting their their crop yields. The US government stepped in and was like, "Okay, we're going to try and keep these farmers solvent." Um, I think that the intent was good, but now here we are like years later, we have billions a year going towards these crop subsidies that are making Americans sick. And I think that we used to say, okay, we just need to make sure that we're growing enough calories and make sure that Americans are not dying of starvation. They're not like, you know, make sure our kids have enough to eat. I think now the problem is like we're feeding our kids poison and like all of them are sick. Why not just universal basic ompic? I mean, what's what's it why doesn't that solve the problem?

Ozempic并非万能药

嘉宾: 是的。嗯,所以我觉得有两点。第一,我认为GLP-1s可能是一项非常有趣的技术。我认为我们正处于最严重的慢性病危机之中,这是国家最大的问题之一。如果我们不解决这个问题,比如20年后,美国将面临更严重的问题。所以鉴于此,鉴于普通美国人超重,我们看到近80%的肥胖和超重率。我认为让这些人服用GLP-1来帮助他们朝着健康方向迈进是合理的。话虽如此,我完全不认为给所有人普遍提供GLP-1s就一定是一个普遍的解决方案。历史上很少有干预措施能解决我们作为一个物种的所有问题。而且我只是认为,Ozempic不太可能成为万能药。举个例子,Ozempic是如何起作用的?它基本上是抑制食欲,所以你吃得更少。如果你仍然吃着普通美国人今天吃的那些垃圾食品,但你正在服用Ozempic并且吃得更少,那么你几乎肯定会缺乏蛋白质和微量营养素以及许多其他东西,如果长时间摄入不足或接触不到足够的这些营养素,这将对你的健康产生长期影响。所以我认为,如果我们想要一个健康的国家,我们从根本上必须解决食物问题。

Original English

嘉宾: Yeah. Well, so I think there's two things. One, I think that GLP1s are potentially an incredibly interesting technology. Like I I think that we are in the midst of the the worst chronic disease crisis, one of the biggest problems in the country. And if we don't fix this, like America is going to have even more serious problems like 20 years from now. So given that, given that the average American is overweight, we're looking at almost 80% obesity over rate overweight rates. I think that it does make sense to put a bunch of these people on a GLP-1 to try and jumpstart them in a direction where they are moving towards health. Uh that said, I don't at all think that giving universal GLP1s to everyone is like necessarily a universal solve. Like the there's just a very poor history of saying here is an intervention that like is going to solve all of our problems as a species. uh you know and and I just think that it is quite unlikely that ompic is the one thing that is going to be a cure all like just to use one example what is you know how does ompic work uh is it basically it it turns down someone's appetite so you're just eating less if you're still eating the same crap uh that the average American is eating today but you're on ompic and eating less of it like you are almost certainly going to be deficient in protein and micronutrients and a bunch of things that will have like long-term health implications uh if you like undereat or get exposed to not enough of those nutrients for a very long period of time. So I think we fundamentally like have to solve the food issue if we want to have a healthy country.

主持人: 顺便问一下,我们是否已经更新了食物金字塔,以便我们对国家层面应该摄入哪些营养有准确的理解?

Original English

主持人: By the way, have we yet updated our food pyramid in the sense that we have an accurate understanding of what we should be getting on a on a country level in terms of nutrients?

嘉宾: 是的,我的意思是,新的食物金字塔比旧的指导方针有了巨大的改进。我的意思是,不仅网站非常吸引人,你知道,乔·吉比亚Joe Gibbia)在这方面做得非常出色,而且最终,人们第一次开始说:“吃全食,多吃蔬菜,吃肉类和其他来源良好的蛋白质、蔬菜、水果。”令人难以置信的是,直到现在才有人说,我们也许不应该给孩子提供15份全谷物,并说两岁以下的孩子吃糖完全没问题。我们甚至建议两岁以下的孩子摄入一定量的糖,这是过去的政府指导方针。所以我认为它们是巨大的、非常积极的一步。

Original English

嘉宾: Yeah, I mean the the new food pyramid is a tremendous improvement over over the old guidelines. I mean, not only is the site super sexy, you know, Joe Gibbia did a great job on that, uh, but finally, for the first time, people are saying like, "Eat whole foods, eat more vegetables, eat, you know, meats and like other other wells sourced sources of protein, vegetables, fruits." It's crazy that it took until now to say maybe we shouldn't be giving kids, you know, 15 servings of whole grain and saying that like sugar is totally fine for kids under two. Like we recommend some amount of sugar for kids on the age of two. uh which was the past you know past administration sort of guidelines. So I think they're a tremendous tremendously positive step.

改变食物系统的直接行动机会

主持人: 那么,对于那些想在食物系统上有所作为的人,你提到了政策建议。那些想直接做些事情的人呢?你显然在True Med之前创办了一家骨汤公司。在这个领域,还有哪些大型公司可以建立,或者有哪些机会可以有所作为?

Original English

主持人: And so for people who want to make a difference in in the food system you you mentioned that policy recommendation. What about people who want to do something direct? You obviously you know before True you started a a bone broth company. What are other big companies that could be built uh in the space or or opportunities to to make a difference?

嘉宾: 是的,我认为有很多机会。我的意思是,在我喜欢的领域里,我认为核心问题是许多生活方式干预措施,比如健康饮食、锻炼、服用某些补充剂、服用肽类药物(如果这对你的个人情况和风险状况有意义的话)。所有这些都可以被视为医疗保健干预措施。然而,如果你看看我们的医疗保健系统,医疗保健系统中没有人认为一个有心脏病风险的人进行锻炼是一种医疗保健干预。没有支付方会为此买单。没有人会激励你去做这些。医生只会说:“是的,你应该改善饮食和锻炼。”所以我认为,对于那些想解决这个问题的人来说,这是一个巨大的机会。弄清楚如何将这些生活方式干预措施纳入医疗保健系统,正是我们Trummed正在做的事情。我们正在激励人们真正投资于自己的健康,投资于预防,投资于那些能够从慢性病角度推动改变的事情。

Original English

嘉宾: Yeah, I think there's a ton of opportunities. I mean within the space that I like I think the core problem is that a bunch of these lifestyle interventions like eating a healthier diet, exercising, uh taking certain supplements, taking like peptides if that makes sense for for your sort of individual person and risk profile. All of these things can be considered healthcare interventions. And yet if you look at our healthare system, nothing in the healthare system thinks about someone who is at risk of heart disease exercising as a healthcare intervention. No payer pays for it. No one incentivizes you to do that. It's just sort of like a doctor is like, "Yeah, you should like clean up your diet and exercise." And so I think that there is a tremendous tremendous opportunity for people that want to make a dent on this problem. Uh figuring out how to make these sorts of lifestyle interventions part of the healthare system is what we're doing at Trummed. Uh and incentivizing people to actually invest in their health, to invest in prevention, uh to invest in things that like move the needle from a chronic disease standpoint.

True Med的理念与实践

主持人: 是的。那么,我们先来谈谈True Med。首先,请稍微追溯一下你的想法迷宫,你对这个问题,这个元问题,这一系列问题一直很着迷,但你从何开始呢?我确信你已经仔细研究了每一个角落。你是如何确定这就是机会的?你还考虑过其他哪些事情?

Original English

主持人: Yeah. So let's get to True Med first. first trace the idea maze a little bit in terms of you know you you've been obsessed with with this this problem this kind of meta problem this series of problems and it's kind of like where do you even start I'm sure you you know picked over every nook and cranny um how did you settle that hey this was the opportunity what was maybe some other things you consider yeah so in in

嘉宾: 是的,在发展Kettle and Fire的时候,我们刚推出时,一盒16盎司的骨汤要16美元,每个人都说这很好,但太贵了。你知道,现在9年过去了,我们已经进入全国所有杂货店,每盒的平均价格是7美元。购买的人更多了,但他们仍然觉得很贵。我有了这样的经历,然后我看到了像CostcoWalmart是全国最大的有机产品销售商。对我来说,这表明人们愿意投资对他们有益的产品。他们想购买能让他们变得更好、更健康的产品,但价格太高了。然后如果你看看医疗保健系统,我们有一个奇怪的动态:如果我面临心血管疾病或心脏病的风险,我基本上可以锻炼,可以吃得好,我可以做所有这些事情来预防急性心脏病发作之类的,但我基本上所有这些都是自费的。我自掏腰包,完全靠自己做所有这些事情。然而,如果你看看那些不做这些事情的人,他们基本上会很早心脏病发作,然后医疗保健系统会花费数十万甚至数百万美元来管理这个人的病情,基本上是他们的余生。所以我认为从根本上说,我们需要激励人们投资于预防,投资于利用生活方式干预措施来解决慢性病问题。这就是我当时考虑在Kettle and Fire之后创办什么公司的视角。当我遇到马克·海曼博士Dr. Mark Hyman)时,他基本上是一位功能医学医生,也是Function的联合创始人。他提到他与许多患者正在做的一件事是,对于那些来就诊的患者,他会推荐生活方式干预措施,并为他们写一封名为“医疗必要性证明信”(letter of medical necessity)的信。这基本上是IRS(美国国税局)认可的一封信,对于某些人,如果某种干预措施(比如生活方式干预措施)与他们正在治疗、逆转或预防的疾病相符,他们就可以获得这封信,并使用免税的HSA(健康储蓄账户)和FSA(弹性支出账户)资金用于助眠、健康饮食、补充剂、锻炼等。所以当马克曼(Markman)告诉我们这个想法时,我就觉得这太有趣了。我们可以尝试建立基础设施,让普通人如果符合条件,就能获得这些要素之一,并利用Himsow等公司在过去几年里建立的远程医疗平台,但我们不是开OzempicTRT(睾酮替代疗法)的处方,而是可以开食物干预、运动等处方。所以这就是这个想法的由来。我还考虑了其他很多事情,比如想过开一家杂货店。还想过开一家人寿保险公司,积极帮助人们延长寿命并进行生活方式干预。但最终觉得这件事情有潜力在未来几年内将数千亿美元导向生活方式干预。所以我觉得这是正确的事情。所以,是的,每个人都知道我们需要更多地从慢性病护理转向预防性护理,而这基本上是一种通过经济激励人们去做这件事的方式。

Original English

嘉宾: Yeah, so in in growing uh Kettle and Fire basically when we launched it was like $16 a carton for 16 ounces of bone broth and everyone was like this is good but this is like very expensive and you know now 9 years in we're in every grocery store in the country and the average price per box is like $7. Uh people way more people buy it, but they're also like this is very expensive. Uh I kind of like had that experience and then looked at things like Costco and Walmart are the two largest sellers of organic products in the country. To me, that is a signal that like people want to invest in products that are good for them. They want to buy products that leave them off better, healthier, and the like, but it's just cost prohibitive. And then if you look at the healthare system, we have this weird dynamic where if I am at risk of cardiovascular disease or heart disease, like I basically can exercise, I can eat well, uh I can do all of these things that will prevent an acute heart attack or something like that and I'm basically not that's all like cash pay. I'm paying out of pocket. I'm doing all of that kind of stuff totally on my own. Whereas if you take someone that doesn't do any of those things, basically they have a heart attack early and then the health care system will pay hundreds of thousands or millions of dollars to manage that person's condition basically for the rest of their lives. And so I think that fundamentally like we need to incentivize people to invest in prevention to invest in you know leveraging lifestyle interventions that can make a dent on chronic conditions. Um and that was kind of the lens through which I was looking at what's the company that I want to start after Kettle and Fire. When I met um Dr. Mark Kimman who is basically you know he's a functional medicine doctor co-founder of function he mentioned that something he was doing with a bunch of his patients was for patients that would come in he would recommend lifestyle interventions and he would write them something called a letter of medical necessity which is basically a letter that the IRS has said uh for certain people where an intervention matches uh matches like a a lifestyle intervention matches a condition someone's working to treat reverse or prevent um they can spend they can get that letter and use taxfree HSA FSA dollars on sleep aids, healthy, you know, better diet, uh, supplements, exercise, things like that. And so when Markman told us kind of about that idea, I was like, this is a really interesting thing. like we could basically try and build infrastructure that allows the average person to get one of these elements if they qualify uh and use like the tele medicine rails that Himsow and other companies have spent the last several years building but rather than prescribing ompic or prescribing TRT we can actually prescribe food interventions exercise things like that. Uh so that was kind of the kind of the idea and like where it started from. Uh, I looked at a whole host of other things like thought about starting a grocery store. Uh, thought about starting like a life insurance company that would be aggressive in terms of like helping you live longer and making lifestyle interventions. Um, but ultimately felt like this was the type of thing that had the potential to direct hundreds of billions of dollars towards lifestyle interventions over the next couple years. Uh, and so it felt like it was it was the right thing to do. So yeah, everyone knows we need to shift more, you know, from chronic to to preventive care and and this is basically a way to financially incentivize people to do that.

主持人: 完全正确。

Original English

主持人: Exactly.

嘉宾: 是的。

Original English

嘉宾: Yeah.

主持人: 完全正确。

Original English

主持人: Exactly.

基因与环境失配

主持人: 你的一个观点是,许多问题的根源在于我们的基因与环境之间的不匹配。你能否详细阐述一下这一点?

Original English

主持人: What one of your your ideas is that the the root cause of a lot of issues is this mismatch between our genes and our environment. Why don't you flesh that out a little bit more?

嘉宾: 是的。如果你看看动物园里的动物,野外的动物除了少数例外,可能会摔断腿、感染等等,但当动物生活在适合其物种的环境中时,它往往是健康的。环境的健康与动物的健康之间存在一种自然的匹配。当你把动物从其自然栖息地带走,放到动物园里时,动物园里的动物会表现出所有那些野外同类不会得的疾病。它们会有奇怪的抽搐,会变得抑郁。你知道,在一些著名的案例中,动物甚至会自杀,这在野外是看不到的。它们会肥胖,会得各种各样的病。所以我的看法,也是我认为非常真实的一点是,动物的健康基本上反映了其环境的健康。如果动物生活在一个不促进健康的环境中,比如干旱季节或食物匮乏,那动物就会消瘦、死亡。你基本上可以看到那只动物没有生活在一个促进健康的环境中。我认为在过去100年左右的时间里,我们人类基本上已经看到,我们建立了一个不考虑、不重视、不思考什么对人类健康是正确的事情的环境。我们如何促进人类健康和繁荣?所以,我认为当我们思考健康时,我们常常只思考你,埃里克(Eric),这个特定的疾病是怎么回事,而不是思考你所处的环境导致你每天走不到8000步,导致你整天玩手机,导致你饮食糟糕。不,我不是说你,埃里克,但我的意思是,所以,所以我认为这是一个重要的想法,人们没有足够地思考,那就是如何塑造你的环境,使其自然地促进健康,而不是,你知道,不得不自律,做大多数人坦率地说都会失败的事情,包括我自己。

Original English

嘉宾: Yeah. So if you look like think of a an animal in the zoo like you an animal in the wild with few exceptions like they can get break their leg get an infection whatever but when an animal is like exists in a species appropriate environment that animal tends to be healthy like there's a natural match between the the health of the environment and the health of an animal. When you take an animal away from its natural habitat and put it in the zoo or something like that, like zoo animals exhibit all of these diseases that their counterparts in the wild just don't get. They have weird ticks, they get depressed. Um, you know, in some notable cases, like animals have even killed themselves, which is just something you like don't see in the wild. Um, and they get obese, they get all sorts of things. And so my my take and what I think is very true is that the health of an animal is basically a reflection of the health of an animal's environment. If an animal is existing in an environment that is not healthpromoting, like you're in a season of drought or there's not a lot of food, that animal gets skinny, dies, like you you basically can kind of see that that that animal is not existing in an environment that's healthpromoting. I think that over the last 100 years or so, we basically as humans have have seen uh you know, we've built an environment that is not considering or not underwriting, not thinking about what is the right thing to do for human health. Like how do we promote human health and and flourishing? Um, and so I think that so often when we think about health, we think about like what is going on with you, Eric, with this specific condition as opposed to thinking about what is the environment that you exist in that leads to you not getting 8,000 steps a day that leads to you spending all day on your phone that leads to you like eating a a a terrible diet. No, I'm not, you know, not you actually, but I mean, uh, so, so I think that that is like an important idea that people don't think about enough is just how do you shape your environment so that it's naturally healthpromoting as opposed to, uh, you know, having to like discipline yourself and doing all the stuff that most people frankly fail at, myself included.

主持人: 有一个Twitter比赛,奖金一百万美元,看谁能写出最好的文章。有人在写一些点击诱饵的文章,比如“如何一天改变你的生活”、“如何一小时改变你的生活”之类的帖子。有一个帖子非常火,叫做“如何一分钟改变你的生活”,配图是一张砸碎手机的照片。

Original English

主持人: There's this uh, you know, there's this Twitter competition for a million dollars for who gets the best article. And there's this like uh so people are doing kind of clickbait stuff and there's one guy who's like uh you know how to change your life in a day, how to change your life in an hour, like these kinds of posts. And there was one that went super viral that was how to change your life in 1 minute and it was a photo of smashing the phone.

嘉宾: 那很不错。完全正确。嗯,好的,所以我很好奇更多。你知道,你谈到了这个想法,即我们应该像对待国家安全危机一样认真对待这场健康危机。就像,你知道,我们作为一个国家,在健康方面应该有一个像NRA(美国全国步枪协会)那样的组织,或者某种集体努力,因为这是一个市场无法自行解决,甚至还会加剧的问题。

Original English

嘉宾: That's pretty good. Totally. the um okay so I'm curious for more um you know you you've talked about this idea of hey we should take this health crisis as serious as we take sort of our you know national security crisis like you know we as a country have something of a NRA for health or or something of a you know collective effort because it's a it's a you know problem that hey the market might not isn't solving on its own and in fact you know exacerbates

主持人: 那么,你认为最大的杠杆是什么?你举了一个补贴的例子。

Original English

主持人: what would um you know you gave one example of uh and the subsidies What are some of the biggest levers you think?

将健康危机视为国家安全问题

嘉宾: 是的。嗯,我来回答这个问题,但首先我想阐述一下我对这个问题的看法。你知道,如果例如中国或我们的某个对手部署了一种生物武器,导致我们75%的人口肥胖或超重,45%的儿童肥胖或超重,并且医疗保健突然成为国家最大的开支,因为所有人都生病了,那么美国的所有人都会群情激愤,试图找出如何解决这个问题。这是一场生存危机。这就像一个国家安全问题,我们必须解决它。你知道,无论我们是否赢得人工智能竞赛,是否变得富有等等。如果国家大部分人都生病了,那还有什么意义呢?你知道,我们作为一个国家并没有繁荣发展。我认为我们许多政治问题都源于国家大部分人口都生病了。所以,如果我能挥舞魔杖做任何事情,我认为修复补贴肯定是我会做的一件事。其次,我会让我们的医疗保健系统在预防方面投入更多。你看其他一些人均健康结果非常好的国家,新加坡就是一个很好的例子。他们基本上有一些人,他们不完全是医生,但更像是教练之类的,他们会与你沟通,并试图引导你做出更好的选择。然后,我会在环境毒素、化学品法规等方面采取更强硬的立场,更类似于欧洲的做法。比如在美国,我们基本上采取的方法是,如果一家公司生产或制造一种全新的环境化学品,只要他们根据现行法规告诉我们,这是一种“普遍认为安全”(GRAS)的物质,只要他们告诉我们这种化学品是安全的,我们就可以将其引入我们的食物系统。这就是所谓的“永久化学品”(forever chemicals)之类的东西如何进入我们的食物系统,现在基本上遍布全球。因为3M公司在大约60年前发明了它们,然后他们就开始使用它们。在欧盟,这些新型化学化合物必须经过一个更类似于今天在美国批准药物的过程,他们必须进行多年的安全测试。他们必须证明它不会造成急性伤害。而且他们基本上必须在产品上市前获得批准。最终结果是,美国有大约6万到8万种化学化合物在欧盟是不允许使用的。我认为这种监管方法是导致如此多人患病的隐藏原因之一。我认为这也是美国人接触到的有毒化合物和新型化学化合物比世界上任何国家都多的原因之一。我认为这是我们慢性病危机中一个巨大的、隐藏的部分。在未来几年里,你会听到更多关于它的讨论。

Original English

嘉宾: Yeah. Um, so I'll answer that, but like just to frame how I think about the problem, you know, if if for example like China or one of our adversaries deployed a boweapon that made 75% of our population obese or overweight, 45% of kids obese or overweight, like and and healthcare like the the largest cost in the country all of a sudden because everyone was sick, everyone in America would be up in arms and trying to figure out like how do we solve this? This is an existential crisis. this is like a matter of national security that we make a dent on that. You know, no matter if we win the a I race, get rich or whatever. If most of the country is sick, it's kind of like what is the point? You know, we're not thriving as a nation. I think many of our political problems are downstream of the fact that many the majority of the country is just sick. And so, if I was like able to wave a magic wand and do anything, I think fixing the subsidies would be one thing for sure that I would do. Um secondly, I would have our health care system just invest far more in prevention. Uh you look at other countries that have incredible like health outcomes on a per capita basis. Uh Singapore is a good example. They basically have these people that are not quite doctors but are are like coaches or something like that that will check in with you and try and like nudge you towards making better better choices. uh then I I would take a much stronger stance one much much more similar to that that Europe takes um when it comes to like certain environmental toxins, chemical regulation, things like that. Like in the US, we basically take the approach that if a company makes or manufactures a totally novel environmental chemical that as long as they tell us under current, you know, regulations, something called grass generally recognized as safe. as long as they tell us, hey, this chemical is safe, we can introduce it into our food system. Uh this is how like you've heard of the forever chemicals and stuff like this got into our food system and basically are all over the planet now. Uh because 3M invented them something like 60 years ago and basically they just started using them. uh in the EU, these novel chemical compounds have to go through something that is much more like what it takes to like unleash or uh you know get a pharmaceutical approved in the in the US today where they have to do many years of safety testing. They have to show that it doesn't cause acute harm. Uh and they basically have to approve it before it's allowed on the market. And the the end result is we have between like 60 and 80,000 chemical compounds in the US that are not allowed in in the EU. And I think that that regulatory approach is one of like the hidden reasons why so many people are sick. And I think it's one of the reasons that, you know, the the US uh Americans are exposed to more toxic compounds and novel chemical compounds than basically any nation in in the world. And I think that is like a big kind of hidden part of our chronic disease crisis. And it's something you're going to hear a lot more about in the coming years.

主持人: 是的。太棒了。我有一位大学教授。我不知道这是否准确,但他们坚信孟山都Monsanto)是邪恶的。不仅因为它的健康影响,他们还认为孟山都参与了各种对外战争,影响了我们的外交政策等等。我只是想说,这些大型企业是否有竞争对手?初创公司能否出现并开始挑战它们,还是说这在结构上就不可能?

Original English

主持人: Yeah. Fascinating. I had one college professor. I I have no idea if this is even remotely accurate, but they were they were convinced that Monsanto was evil. Um, not just in terms of its uh, you know, health impacts, but they thought they thought they were sort of like getting involved in all sorts of foreign wars and like influencing our foreign policy and stuff. And I just say that to say could there be competitors to some of these like mega play like could startups even emerge that would begin to or is it just like structurally unsound?

嘉宾: 我认为在结构上确实很难,但这并不意味着它不会发生,希望它会发生。但你看到的一件事是,以孟山都为例,农药游说团体和化学品游说团体是美国最强大的游说团体之一。他们所做的一大部分工作是,例如几个月前,孟山都大力游说,花费了数千万美元,试图在一项法案中加入一项条款,确保没有人可以因为他们最受欢迎的产品之一——草甘膦glyphosate)——的潜在健康影响而起诉他们。这种事情就是,这些公司做大后,提供大量化学品。孟山都尤其做了很多我认为道德上非常可疑的事情。然后一旦他们足够大,一旦他们开始销售数十亿美元的产品,他们就会花费大量资金进行游说,确保他们免受这些有毒产品造成的任何伤害和健康影响。比如,草甘膦是美国喷洒最多的农药,其最大的生产商正在尽其所能,确保草甘膦——你知道,已经有140亿美元的赔偿金判给了因接触草甘膦而患癌症或其他疾病的人——孟山都正在尽其所能,试图购买农药责任保护盾和其他保护他们免受竞争或保护他们免受其化合物造成的疾病行为和后果的东西。我认为当这些公司能够以这种方式操纵游戏时,初创公司就很难介入并真正有所作为了。

Original English

嘉宾: I think it's really hard structurally and I think that that doesn't mean that it's not going to happen and hopefully it will but one of the things that you have seen is with Monsanto for example like the the pesticide lobby and the the chemical and a lobby is one of the strongest in America and a big part of what they're doing is like for example a couple months ago uh Monsanto was lobbying hard spent tens of millions of dollars to get a a writer in a bill that would basically make sure that no one could ever sue them for the potential health impacts of one of their most popular products, glyphosate. Uh that sort of thing is like these companies get big, they provide a bunch of chemicals. Monsanto specifically has done a lot of things that uh you know I think are incredibly like morally dubious. Um and and then once they get big enough, once they like start selling billions and billions of dollars of these products, they spend a lot of that money on lobbying and making sure that they are immune from any of the harms and health impacts uh that come from some of the some of these like toxic products that they spray everywhere. uh like glyphosate is the number one pesticide sprayed in the US and the largest maker of it is spending as much as they possibly can to make sure that glyphosate which you know there's been 14 billion of damages awarded to people that have gotten cancer or other diseases from glyphosate exposure. Monsanto is spending as much as they can to try and like buy basically pesticide liability shields and other things that shield them from competition and or that shield them from the actions and the consequences of like the diseases their compounds have caused. Uh I think that when when these companies can kind of rig the game in that way, it becomes very very challenging for a startup to kind of come along and make a real play at some of these things.

杂货店的健康干预机会

主持人: 是的。你提到了杂货店,只是一个简单的想法。全食超市Whole Foods)在他们尝试做的事情上,还有哪些机会没有抓住呢?

Original English

主持人: Yeah. You mentioned a grocery store just as a simple idea. Is there what's the opportunity that Whole Foods hasn't done with with with what they've tried to do?

嘉宾: 是的。我的意思是,全食超市非常棒,约翰·麦基John Mackey)是一位真正的先驱和传奇企业家。我认为杂货店真正没有做到的事情是——这也是Trummed的理念——将食物视为一种医疗保健干预措施。对我来说,我认为人们有很多潜力,例如,通过查看他们的生物标志物,然后让杂货店或其他实体负责改善你的健康。我的意思是,如果你越来越多地将食物、杂货视为一种健康干预,视为个人医疗保健的一部分,以及对抗慢性病的一部分,你就会以与今天截然不同的方式看待杂货店,今天杂货店基本上只是解决采购问题,然后人们可以买任何他们想要的东西。所以,我认为,我的想法是,杂货店有很多空间可以成为你健康更积极的参与者,告诉你吃某些东西,跟踪你的宏量营养素,所有这些我认为可以解决人们很多问题的事情。

Original English

嘉宾: Yeah. I mean, Whole Foods is amazing and so uh I think that John Mackey was like a total pioneer and like legendary entrepreneur. I think that the thing that grocery stores have not really done is and this is kind of the thesis for Trummed is like think about food as like a healthcare intervention. And to me, I think there's a ton of potential for people to, for example, like look at their biomarkers and have a grocery store or some other entity that is responsible for improving your health. Like I think that if you think increasingly about food, grocery as a health intervention, as like part of one's healthare and you know part of the fight against chronic disease, you would think about a grocery very a grocery store very differently than today which is basically just like let's figure out the sourcing and then people can buy whatever they want. Um, so I think there's like, you know, my idea was that I think there's a ton of room for a grocery store that is a more active participant in your in your health, telling you to eat certain things, you know, tracking your macros, like all these sorts of things that I think would solve a lot of problems for people.

主持人: 是的。那么,我们再多谈谈,如果我们完全将健康危机确定为我们的主要国家优先事项之一,我们还会做些什么?也许我们可以从一些支柱或主要原则的角度来看待它,并谈谈它们目前进展如何。

Original English

主持人: Yeah. So, let's talk more about if we, you know, fully identified the health crisis as one of our main sort of national priorities, what what else we would do? Maybe we could start looking at it in the light of like what were some of the pillars or main principles and maybe talk about where they are so far.

嘉宾: 是的。嗯,所以我认为你在所有医疗保健领域,所有食品领域,都看到了企业对我们的食品指南、健康指南以及所有这些事情的控制。比如,前FDA(美国食品药品监督管理局)局长,你知道,他们管理FDA的既定目标,首要目标是打击错误信息。现任局长的目标是让美国人健康。这意味着GRAS改革,也就是清理我们如何监管化学品。这意味着修复学校午餐、修复军队午餐。基本上就是我们给孩子们吃什么。你知道,80%的学校与汽水公司有合同。这些汽水公司真的会付钱给学区,让这些自动售货机遍布学校。这有助于资助学校,但代价是让孩子们生病。所以,我认为清理学校午餐、清理军队午餐、清理食品指南是很重要的。第二件事是改进和简化我们监管药物的方式。加快公司投入和推出创新疗法,以应对慢性病危机。并且努力将常识带回到我们思考健康、思考食物的方式中,并努力在慢性病危机中有所作为。这些成分、食物或汽水之类的东西,它们是否如此令人上瘾、如此危险或如此诱人,以至于应该被取缔?或者我们应该如何思考?

Original English

嘉宾: Yeah. Uh so I think that you have seen across all of healthcare, across all of food, just corporate capture of our food guidelines, of our health guidelines, of all these sorts of things. Like the previous FDA commissioner, uh you know, their stated goal with running the FDA, their number one goal was to combat misinformation. The current one is to like make Americans healthy. That means grass reform, so cleaning up like how we regulate chemicals. Uh that means fixing school lunches, fixing like military lunches. Basically what we feed kids, you know, 80% of schools have contracts with soda companies. These soda companies literally like will pay a school district to put these vending machines all over the schools. It helps fund schools, but it also like comes at the cost of getting kids sick. Um so I think like cleaning up school lunches, cleaning up military lunches, uh cleaning up like the food guidelines. Second thing is like improving and streamlining the way that we look at regulating drugs. make it faster for companies to like lean in and launch innovative therapies that can make a dent on the chronic disease crisis. Uh, and just trying to like bring common sense back into the way that we think about health, the way that we think about food, uh, and try and make a dent in the chronic disease crisis. are are some of these ingredients that we're we're discussing or or or foods or or you know soda or what like so d so so addicting or so dangerous or so appeasing that they should be outlawed or so like how do we think about

消费选择与监管

主持人: 不,我实际上不认为这些东西中的许多应该被取缔。我确实认为消费者选择是一件非常重要的事情。但是,你知道,我们有针对儿童的指导方针,我们已经不认为儿童应该有自由选择权,比如我们不让他们喝酒。所以我认为汽水在这个国家有其存在的空间,但我同时也认为,如果你想一直喝汽水,我们可能不应该通过补贴高果糖玉米糖浆来补贴它。我们可能不应该让可口可乐在过去15年里花费1.4亿美元来影响我们的营养指南。我认为正是这些事情,很多时候,大型食品公司和人们会退回到消费者选择这个想法上。我认为这非常重要,但我们也正在应对一场极其重要的慢性病危机,如果我们不努力独特地解决这个问题,我认为美国在未来10年、20年、30年将处于极其艰难的境地。我想问你关于迷幻药的问题,它是否在这次讨论中?它是否会影响结果?它是否真的不重要?

Original English

主持人: No I I actually don't think that many of these things should be outlawed like I I do actually think that consumer choice is a very important thing um you know but we have like specifically with kids we have guidelines and we already don't think that kids should have free choice like we don't let them drink so I think that there is a place for soda in this country I just also think that if you want to drink soda all the time that probably we shouldn't be subsidizing it by subsidizing high fructose corn syrup. Probably we should not have Coca-Cola spending $140 million to influence our our nutrition guidelines like they have over the last, you know, 15 years. Uh and I think that it's things like that where a lot of times the big food companies and people will sort of fall back on this idea of consumer choice. I think it's very important but we also are like currently grappling with an incredibly important chronic disease crisis and like if we don't take effort to uniquely like address this thing I think that the US is like in an incredibly tough spot 10 20 30 years from now. I want to ask you about psychedelics um and I'm like is that in this discourse at all? Does that move outcomes for is that kind of not really not really?

迷幻药与心理健康

嘉宾: 我认为,如果你只看数据,迷幻药是一种极其强大的干预手段。比如氯胺酮ketamine)疗法,氯胺酮辅助疗法在许多情况下比SSRIs(选择性血清素再摄取抑制剂)效果更好,特别是对于治疗非常严重的疾病,如治疗抵抗性抑郁症、PTSD(创伤后应激障碍)等。我认为对于许多患有PTSD和严重抑郁症的退伍军人及其他人来说,迷幻药应该成为我们乐意提供给人们的治疗方案之一。你知道,我认为我们可能对它们的投资严重不足。我认为有很多非常有前景的研究表明它们的疗效等等。我认为这是一个悬而未决的问题,即普通美国人是否准备好将这些东西视为重要的心理健康疗法,而不是像60年代在金门公园吸食迷幻药的一群人。我非常支持,你知道,再次强调,将迷幻药视为另一种可以解决我们国家许多心理健康和抑郁问题的疗法。如果你仅仅从这个角度来看待它,一种几乎没有副作用的疗法,尤其是在医生监督下进行时,我认为它们应该成为我们治疗和解决当今许多心理健康危机的一部分。

Original English

嘉宾: I think that if you just look at the data, psychedelics are an incredibly powerful intervention. Like ketamine therapy, ketamine assisted therapy works better than SSRIs in many cases, especially for treating things that are very intense like treatment resistant depression, PTSD, things like this. Um, I think that for many of our veterans and others that suffer from PTSD and like intense depression, psychedelics should be part of a menu of treatments that we like are open to giving people. uh you know I I think that we probably vastly underinvest in them. I think that there's a ton of really promising research around their efficacy and things like this. Um I think it's an open question of like how ready the average American is to think about these things not as like a group of people dropping acid in Golden Gate Park in the 60s but as like a vital mental health therapy for people that are really really struggling. I'm very supportive of, you know, again, just looking at psychedelics as another therapy that can address the many mental health and depression issues that we have in this country. And if you look at it just as that through that lens, a therapy that has few to no side effects, um, especially when done, you know, with doctor oversight and things like this, I think they should be part of how we treat and address many of the mental health crises that we see today.

主持人: 是的。如果你的主要目标之一是解决心理健康危机,还有哪些真正重要的杠杆是你会关注的?

Original English

主持人: Yeah. Are there any other really big levers that you would focus on if if if one of your main goals was to target the mental health crisis?

生物健康与心理健康的关联

嘉宾: 我认为我们严重低估了生物健康及其与心理健康的关系。有一些非常有趣的研究表明,采用功能医学方法,当你来就诊并说你抑郁时,与其进行谈话疗法等对许多人来说效果不佳的治疗,我们不如专注于减少你的炎症并修复你的肠道。有研究表明,仅仅通过专注于功能医学方法,即关注睡眠、肠道健康、通过饮食和运动降低炎症,这种综合疗法比仅仅进行谈话疗法等效果更好。所以我认为我们严重低估了我们作为生物有机体的程度,我们的心理健康与我们的身体健康紧密相连。因此,我认为我们应该大力资助更多关于代谢精神病学metabolic psychiatry)的研究,这基本上是这样一种观点:我们归入心理健康范畴的许多疾病,比如癫痫、抑郁症、精神分裂症,其中许多的根源实际上是代谢性的。例如,对于精神分裂症、癫痫甚至许多双相情感障碍患者,如果让他们采用生酮饮食ketogenic diet),这些疾病在许多情况下就会自行缓解。这并不是我们当前心理健康领域真正认可的事情。

Original English

嘉宾: I think that we are hugely underestimating the impact of uh biological health and how that is tied to mental health. Like there's some really interesting studies out there around taking a functional medicine approach where you know you come in and say you're depressed and rather than like doing talk therapy and things like this that statistics show like sort of don't work very well for many people. uh we focused just on like reducing your inflammation and fixing your gut. Uh and there have been studies that show just by focusing and taking a functional medicine approach uh you know focusing on sleep, focusing on gut health, focusing on lowering your inflammation through diet and exercise that combination of therapies works better than you know just talk therapy and things like that. So I think that we massively under underestimate the degree to which we are you know human beings. for our biological organisms and like our mental health is very tightly coupled to our emotional um you know sorry to our physical health and so I would have much I think that we should fund much much more of research along these lines of what's called metabolic psychiatry uh which is basically this idea that many diseases that we put in the mental health bucket thing like epilepsy depression uh schizophrenia many of these things have causes that are actually metabolic in root and like for example one of the best therapies for someone that is schiz schizophrenic or epileptic or even in many cases bipolar. If you put them on a ketogenic diet, these things will in many cases just resolve. That is not a thing that our current like mental health world really underwrites.

主持人: 是的。是的。这让我想起了我曾经和丹尼尔·格罗斯Daniel Gross)的一次对话,他说:“嘿,每当有人感到沮丧时,他们最好在将其归因于某种心理缺陷或进行深入的心理分析之前,先问问自己:我睡得好吗?我吃得好吗?我锻炼了吗?”

Original English

主持人: Yeah. Yeah. It reminds me of a conversation I once had with Daniel Gross when he he was saying, "Hey, anytime someone is feeling depressed, it would behoove them to, you know, before attributing it to some psychological, you know, defect or making some deep psycho, you know, analysis about it, first just saying, hey, am I sleeping well? Am I eating well? Am I exercising?"

嘉宾: 完全正确。我最近有没有出门?是的。

Original English

嘉宾: Totally. Have I been outside recently? Yeah.

主持人: 是的。完全正确。嗯,最后我想转到另一个你一直非常好奇的话题,那就是意识。你的直觉或好奇心是什么驱动的?你的思考把你引向了何方?

Original English

主持人: Yeah. Totally. the um I want to shift lastly to another topic um that you've just been really curious about um for a while which is which is consciousness. Um what what has sort of your driven your your hunch or or curiosity there and and and where is your thinking drawn you?

意识的探索

嘉宾: 是的,我一直对“健康意味着什么?”这个想法很感兴趣。过一种人们感到兴奋、充满活力、精力充沛的生活意味着什么?在身体和精神上感觉良好意味着什么?我认为意识是这个问题的根本层面,即“活着、体验生命意味着什么?”坦率地说,我们现在还没有一个很好的答案。你知道,我们很多关于意识的理论和哲学都不够好。它们不具有预测性。你问普通人,甚至问那些对此思考了很多的哲学家,也没有达成共识。所以我认为,这是一个我非常感兴趣的领域。我认为我们将在未来十年中学到很多东西。我希望能够结交朋友,并在探索和学习更多关于意识是什么、如何改变它、如何改善它等方面发挥一些作用。但,是的,我会把它放在“个人兴趣”这个类别里。我现在没有围绕它做任何事情。

Original English

嘉宾: Yeah, I think that I have just been interested in this idea of like what what does it mean to be healthy? What does it mean to live a life that people are like excited about, have energy with, you know, have energy and are just like what does it mean to like feel great in your body and your in your mind and everything? Um, and I think that consciousness is sort of this root layer of like what does it mean to what is your experience of being alive of of of life? Uh, and frankly like we don't really have a great answer to this right now. Um, you know, like a lot of our a lot of our theories and philosophies and things of like what is consciousness are are not great. they're not predictive and and you ask the average person, you ask even like philosophers that have thought a lot about this. Um, and there's not there's nothing near consensus. And so I think that I don't it is an area that I'm very interested in. I think we're going to learn a lot about in the next decade. I hope to like have friends and like play somewhat of a role in like exploring and learning more about uh about what consciousness is, like how to change it, how to improve it, you know, all these sorts of things. Um but yeah, I would put it very much in like personal pet interest bucket. Uh not like I'm doing anything around it right now.

主持人: 是的。好吧,你显然专注于建立True Med,我们就在这里结束。但是,如果你能无限地复制自己,对于那些也对这个问题着迷的听众,你认为还有哪些未被充分探索的领域,无论是研究领域、公司想法还是某种政策,没有足够多的人关注,我们还没有讨论过,但你希望更多人投入精力?

Original English

主持人: Yeah. Well, to obviously you're focused on building True Med, we'll close there. But if if you could scale yourself, you know, infinitely like for people listening who are like also obsessed with this problem. Is is there something else you think is underexplored under whether it's a research area or a company idea or or or or some sort of policy thing that not enough people are looking into that we haven't yet discussed that you want more people to spend?

未被充分探索的领域:社区健康

嘉宾: 是的。我最近一直在思考的一个想法是,我们一开始就提到,一个有机体的健康就像你所处环境的健康。在我看来,这意味着如果我们开始思考的不是仅仅改善埃里克的健康,而是改善你所有朋友、社区和周围生活在相同环境中的人的健康,那么干预和改善你的环境可能会对健康产生比仅仅优化你自己的健康更大的影响。所以我认为,可能存在一些有趣的模式来改善一个人的环境,无论是建设一个健康导向的城市、城镇或郊区,你知道,开发项目之类的。无论是针对那些决定以不同方式生活并采取不同干预措施的人的团体健康保险,并投资于根本性的生活方式干预。我认为当你开始通过社区或数十、数百人的视角来思考健康时,而不是仅仅通过我作为一个个体的视角,可能会出现很多有趣的事情。所以,如果我能复制自己,我会朝着这个方向探索公司。

Original English

嘉宾: Yeah. An idea I've been thinking about recently is uh like and we mentioned at the beginning that the health of an organism is like the health of your environment. And in my view, what that means is that if we started thinking about not improving just Eric's health, but improving the health of like all of your friends and community and people around you that exist in the same environment, like in in intervening and improving your environment could have a much larger impact on health than just like optimizing your own health. And so I think that there's like potentially interesting models of improving one's environment, whether that's building like a health oriented city or town or like suburb, you know, development or something like that. Um whether that's like group health insurance for people that are deciding to live differently and like make have different interventions uh and invest in in sort of like root cause lifestyle interventions. I think there's a lot of interesting things that could come about when you start thinking about health through the lens of a community or like tens hundreds of people, not just through the lens of like me as an individual. So, if I had copies of myself, I would I would explore companies in that in that direction.

主持人: 是的,我喜欢这个想法。让我们来深入探讨一下True Med,因为我们显然,这家公司做得非常出色。我们显然非常幸运能参与其中。对于那些不了解的人,请多介绍一下实际产品以及它的发展方向。

Original English

主持人: Yeah, I love that. Let's um let's close on on on True Med and and go deeper into it in the sense of we're obviously uh the company's done phenomenally. We're obviously very lucky to to be a part of it. um say more for for for people who are not in terms of the the actual product and and uh and the direction in terms of where it's going.

True Med的产品与未来方向

嘉宾: 当然。是的。所以,TRMED基本上是这样的:对于符合条件的人,我们允许他们将免税的HSAFSA资金用于治疗、逆转和预防疾病的生活方式干预类别中的事物。所以,我们与Eight SleepPelotonMomentousLifetime Fitness等品牌合作。对于那些致力于治疗、逆转或预防心脏病或肥胖等疾病的人来说,这些生活方式干预就是医疗保健。所以我们建立了一个支付集成系统,允许人们将免税的HSA资金用于这些干预措施,并且正在扩大规模。我认为在未来十年,这可以发展到:每个有风险或患有某种慢性病的美国人都应该被激励——免税资金是一个很好的激励——将自己的钱用于治疗、逆转或预防疾病的事情。而今天的医疗保健系统中,没有人能够以低于标价的价格获得健身房会员资格,或者让雇主或保险公司支付健身房会员资格。所以这就是我思考我们正在建设的东西的方式,即建设基础设施,允许并激励人们投资于生活方式干预,以避免和预防各种慢性病。

Original English

嘉宾: Sure. Yeah. So, TRMED uh basically what it is is we for people that qualify, we allow them to spend uh taxfree HSA and FSA dollars on things that treat, reverse, and prevent disease that fall within like the lifestyle intervention category. So like we're partners with Eight Sleep, we're partnered with Pelaton, we're partnered with Momentous Lifetime Lifetime Fitness. All of these brands that you know for someone that is working at treat versus prevent heart disease or obesity or things like this, these lifestyle interventions are healthcare. And so we've built a payment integration that allows people to spend their taxfree HSA dollars on these interventions um and are scaling that up. Like I think that where this can go over the next decade is every American that is at risk or has some sort of chronic condition should be incentivized and taxfree money is a great incentive to spend their own money, their dollars on things that treat, reverse or prevent disease. And there's no mechanisms in today's health care system for someone to actually spend uh you know for someone to get like a gym membership for cheaper than the list price or to get a gym membership covered uh by their employer by an insurance provider like that. Uh and so that's kind of the thing the way that I think about what we're building is building infrastructure that allows people and incentivizes them to invest in lifestyle interventions to save off and prevent different chronic conditions.

主持人: 是的。我实际上必须问你,你对肽类药物有什么看法?以及对它有什么预测?

Original English

主持人: Yeah. Uh and I actually I have to ask u what are your thoughts on peptides and any predictions as it relates to Oh man,

肽类药物的颠覆性潜力

嘉宾: 我认为肽类药物将对我们当前的医疗保健系统产生巨大的颠覆性影响。你知道,我认为如果你看看肽类药物,还需要进行更多的研究。我还没有完全成为肽类药物的信徒。但确实需要更多的研究,但从早期迹象来看,甚至仅仅是人们服用和使用这些东西的实际情况来看,这似乎是一类非常有效的化合物。它们是不能申请专利的。你知道,你基本上可以相当便宜地购买这些东西,我会把它们归入“人类增强公司”的范畴。我们当前的医疗保健系统和大多数药物都属于“不要死”的范畴,比如“这是他汀类药物,别死,吃这个药”。我认为这些肽类药物属于不同的类别,其中许多可以给你更多能量,提高你的性欲,降低你的炎症,改善你的肠道健康。它们只是一类不同的化合物。我认为随着越来越多的人开始尝试和使用它们,你会看到非常有趣的积极医疗保健结果,来自一类长期以来没有人关注的化合物。我认为它将对制药业和医疗保健系统中的许多其他参与者产生极大的颠覆性影响。

Original English

嘉宾: I think peptides are going to be so disruptive to our current healthare system. You know, I think that if you look at peptides, uh there needs to be way more research. I'm like not totally yet a peptide believer. Uh but there needs to be way more research, but from early early signs and even just like NF1 people taking these things and using them, uh this seems like a class of compounds that are very effective. uh they are not patentable. Um you know like you can basically buy these for fairly cheap and I would put them in the bucket of like human enhancement companies like our current health care system and most of our pharmaceuticals are kind of like don't die like oh here's a statin like don't die take this pill. Uh I think that the pep these peptides are in a different class where many of them are like give you more energy, improve your sex drive, lower your inflammation, improve your gut health. Like they're just a different category of compound. And I think that as many people start to experiment with them and try them and things like this, you're going to see like really interesting positive healthcare, you know, um outcomes from a class of compounds that like no one has thought about for for a long period of time. I think it's gonna be exceptionally disrupt disruptive to pharma and to like a bunch of other players in the health health care system.

营养优化与饮食实验

主持人: 我也很好奇,你或者我们整体上是否正在更多地了解如何优化我们的营养?你提到了雷·皮特Ray Peat)饮食,或者你正在写关于它的文章。你对此有何更广泛的看法?

Original English

主持人: And I'm also curious for you or just or collectively like are we learning more about um you know optimizing our nutrition? You you got into the the rape diet uh or you were writing about it. What what what are your thoughts there more broadly?

嘉宾: 我认为营养科学可能是美国目前最糟糕的科学之一。你知道,大多数营养科学都由大型食品公司资助。他们在营养科学上的资助,至少从历史上看,是NAH(美国国立卫生研究院)的11倍。希望这正在改变。我认为存在所有这些不同的饮食部落。彼得斯(Peters),也就是雷·皮特Ray Peat)的追随者,我认为是一个特别有趣的群体,他们专注于提高你的新陈代谢。但我认为对于许多人来说,你应该尝试并实验一种让你感觉良好的饮食。我们现在有实验室测试,你可以通过Function之类的公司获得,以显示这种饮食如何影响你的精力、你的生物标志物等等。你有可穿戴设备,可以实际为你提供关于你的睡眠、你的HRV(心率变异性)、你的静息心率在改变饮食或以不同方式做事后的反馈。我认为这种结合,即了解这些事情实际上如何让你感觉以及它们如何影响你的生物标志物,意味着人们应该更开放地进行实验,看看“嘿,我将尝试皮特(Peat)饮食90天,看看我感觉如何。”所以我非常看好人们进行个体饮食探索和实验。我认为皮特(Peat)社区对我来说可能是目前最有趣的。嗯,为什么呢?因为基本上有两种思想流派。一种是布莱恩·约翰逊Brian Johnson)的思想流派,即我们已经做了所有研究。我们知道你需要吃植物性饮食。我们知道你需要进行卡路里限制,所有这些都是为了长寿。这在很多方面是当前的教条。彼得斯(Peters)则完全相反。你知道,布莱恩·约翰逊会说糖是坏的。你不应该吃碳水化合物等等。彼得斯则说你应该尽可能多地吃糖,主要以蜂蜜和水果等形式。你应该尽量避免种子油,尽量避免会损害你新陈代谢的东西。但如果布莱恩·约翰逊说:“我想少吃,降低我的新陈代谢,这意味着我可以活得更久。”彼得斯则说:“尽可能提高它。”而且你拥有的能量越多,你就能在更长的时间内使用这些能量。所以,这与一百年来营养学教条——糖是坏的,应该避免——是如此对立的观点,以至于我认为这是一个非常有趣的想法,皮特(Peat)社区的许多人都看到了惊人的结果。比如我开始早上喝橙汁和吃水果,我感觉很好,我的生物标志物甚至比以前更好了,你知道,我过去十多年来主要采用低碳水化合物的原始人饮食,所以这只是一个非常有趣的、不同的视角,值得尝试。是的。嗯,不,我基本上会去看看彼得斯。你知道,布莱恩·约翰逊在很多话题上显然都非常有趣。我有一个问题,我很好奇,如果我交了女朋友,我应该拍一个发布视频吗?

Original English

嘉宾: I think the nutrition science is probably among the worst of the sciences uh in the US right now. You know, most of nutrition science is funded by a big food company. Uh they outfund the NAH, like 11 to1 on nutrition science, at least historically. That's hopefully changing. Um I think that there are all of these different diet tribes out there. The the Peters, the Ray Pete crowd, I think, is one that's particularly interesting that's focused on like ramping up your metabolism. Um but I think that for for many people, you should just kind of try and experiment with the diet that where you feel good. like we now have lab tests that you can get, you know, via function or something like that to show how does this diet impact your energy, your biomarkers, things like this. You have wearables that can actually give you feedback around how is your sleep, how's your HRV, how's your resting heart rate, uh since switching your diet or since doing things differently. And I think that that combination of like getting insight into how these things are actually making you feel uh and how they're impacting your biomarkers means that people should be just way more open to experimenting and seeing like hey I'll try a peing diet for like 90 days and just see how I feel. Uh so I'm I'm very bullish on like people doing end of one dietary like exploration and experimentation. And I think that the peing community is like probably the most interesting one out there for me right now. Um, and and why is that? Because there is like two schools of thought basically. There's like the Brian Johnson school of thought, which is we've done all the research. We know that you need to eat a plant-based diet. We know that you need to do caloric restriction all in the name of longevity. Um, that is like the current dogma in many ways. The Peters are the exact opposite. And you know, and Brian Johnson would say like sugar is bad. You should not eat carbohydrates, all this. The Peters are like you should eat as much sugar as you possibly can, mostly in the form of like honey and fruit and stuff like this. Um, you should try and avoid like hugely avoid seed oils, hugely avoid things that are going to impair your metabolism. But if Brian Johnson is like, I want to eat less and ramp down my metabolism, it means I can live longer. The Peters are like, ramp it up as much as you can. And like the more energy you have, the longer you are able to use that energy over a long period of time. Uh and so it is like such a contrarian view to 100 years of nutrition dogma that says sugar is bad should be avoided that I think it's a very interesting idea and a lot of the people in the peing community have seen phenomenal results like I I've started drinking orange juice and like eating fruit in the morning and like I feel great and my biioarkers have gotten even better from you know I've been doing probably a decade plus of like mostly low carb kind of paleo and so it's just a very interesting different lens that is worth playing with. Yeah. Um, no, essentially I'll have to check out the Peters. You know, Brian Johnson's obviously been so interesting on so many topics. One question I I was curious if if I, you know, if I get a girlfriend, should I make a launch video?

主持人: 嗯,贾斯汀(Justin),公司是True Med。非常感谢你来参加播客。

Original English

主持人: Um, Justin, uh, the company is True Med. Thank you so much for coming on the podcast.

嘉宾: 谢谢邀请。

Original English

嘉宾: Thanks for having me.

主持人: 很高兴能参与其中。

Original English

主持人: Lucky to be involved.

📌 文中提及的人物和组织

关键字: food-system-reform chronic-disease-prevention lifestyle-intervention environmental-toxins metabolic-health