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@Ford Brewer : 我主持的PrevMed Health播客关注心脏病和中风的预防。我们讨论斑块逆转、胰岛素抵抗、糖尿病前期、糖尿病、胆固醇、补充剂、药物等等。 近一半的美国人定期服用补充剂，其中大部分是多种维生素和矿物质。美国在这方面的投资估计约为500亿美元，但这是一个好投资吗？我们得到了我们所付出的吗？ 最近的两项大型研究表明，多种维生素对大多数人来说无效，至少对大多数人使用它们的目的无效。 人们服用多种维生素和矿物质补充剂的目的是为了增加营养摄入、改善健康和预防慢性疾病，例如癌症和心脏病，以期延长寿命，过上更健康的生活。但证据表明，多种维生素并不能帮助你活得更长。 2024年6月发表在JAMA Network上的一项研究，对40万人进行了多年跟踪，结果表明服用多种维生素与寿命延长无关。 2018年7月发表的另一项大型研究（1800万人年数据）也表明，服用多种维生素与心血管疾病无关。 补充剂不能弥补不良生活方式。如果你的BMI为30，并且体内脂肪过多，那么补充剂，尤其是多种维生素，将无法帮助你摆脱困境。你需要自己努力。 我们自己也使用一些补充剂，例如维生素D3、维生素K2、烟酸、B12、镁、锌和铬。但我们认为，你不能通过补充剂来弥补不良的生活方式。 关于多种维生素的研究存在混杂因素，例如健康使用者效应。服用维生素的人往往拥有更健康的生活习惯，这使得难以评估多种维生素的实际效果。 大多数关于多种维生素的研究都不是随机对照试验，这使得结果的可信度降低。进行大型的随机对照试验来研究多种维生素的有效性成本很高，因此很少有公司愿意进行这样的研究。 与服用多种维生素相比，进行锻炼可能对健康更有益。可以使用应用程序来评估饮食中的营养素，并确定是否需要补充特定的维生素。在饮食非常严格的情况下，例如极低碳水化合物饮食，服用多种维生素可能是有必要的。 随着年龄增长，肌肉力量的下降比肌肉质量的下降更重要。很多人可能已经购买了健身器材，但并没有使用，仍然依赖于补充剂。很多人选择服用多种维生素是因为它比锻炼更方便。 多种维生素在某些情况下可能是有益的，但其他因素对健康的影响更大，例如保持健康肌肉和避免分心驾驶等不良行为。 目前缺乏关于特定饮食或疾病人群服用多种维生素的研究证据。在营养科学中存在很多困惑，因为需要综合考虑各种证据来源，包括研究、专家意见和个人经验。 高LPPLA2水平可能与高LDL胆固醇有关。低碳水化合物饮食可能会导致LDL胆固醇升高，这并不一定意味着不健康。 CRP、髓过氧化物酶和LPPLA2是评估心血管炎症的生物标志物。微量白蛋白肌酐比值也是评估心血管炎症的指标，可以通过尿液检测。 脑钠肽（BNP）水平升高可能与心脏泵血功能有关，需要进一步检查。目前没有足够的证据来确定血清脱氧胆固醇的水平是否可以作为他汀类药物过度抑制大脑胆固醇合成的指标。 补充剂中的纤维素可能与肥胖有关。并非所有多种维生素制造商都能提供相同质量的微量营养素。大多数人可能缺乏镁和维生素D3，因此应该补充这些营养素。 C15是一种脂肪酸，据称与糖尿病和胰岛素抵抗有关，但目前尚无足够的证据支持这一说法。在推荐新的补充剂或药物之前，需要进行充分的研究，以避免消费者被骗。佩科里诺奶酪中含有C15。 大多数多种维生素研究基于问卷调查，因此结果可能存在偏差。医学中的普遍解决方案可能无法满足每个人的需求，因为每个人的身体状况都不同。 @Jesus : 我过去认为补充剂只是昂贵的尿液，但现在我认识到并非所有补充剂都是一样的，有些补充剂是有益的。 一些对心血管疾病有显著改善作用的物质，可能对总死亡率和发病率没有影响，因为心血管疾病只是导致死亡的三分之一原因。 关于多种维生素的研究，其问题在于混杂因素，例如健康使用者效应，很难确定多种维生素本身是否无效。如果一个人已经拥有健康的生活方式和饮食，那么服用多种维生素可能没有必要。 脉压的变化可能与脱水、心力衰竭或动脉钙化等多种因素有关。运动可能会导致脉压降低。 目前缺乏关于特定饮食或疾病人群服用多种维生素的研究证据。在营养科学中存在很多困惑，因为需要综合考虑各种证据来源，包括研究、专家意见和个人经验。 脉压的理想值可能并非30。 @Heather : 服用多种维生素本身并不一定危险，但它不能解决所有健康问题，不能替代健康的生活方式。 我停止服用多种维生素，转而服用一些特定的补充剂，例如维生素D3、K2、锌和辅酶Q10。 很多人选择服用多种维生素是因为它比锻炼更方便。

我主持的PrevMed Health播客致力于心脏病和中风预防。我们深入探讨斑块逆转、胰岛素抵抗、糖尿病前期、糖尿病、胆固醇、补充剂、药物等诸多方面。最近，我们节目讨论了一个备受争议的话题：多种维生素的有效性。

最近的两项大型研究给出了令人震惊的答案：至少对于大多数人期望达到的效果而言，多种维生素并不奏效。

这些研究的结论并非完全出乎意料。人们服用多种维生素的初衷是增加营养摄入，改善健康，预防癌症和心脏病等慢性疾病，从而延长寿命，拥有更健康的生活。然而，证据表明，多种维生素并不能显著延长寿命。

2024年6月发表在JAMA Network上的一项研究追踪了40万人的健康数据多年，结果显示服用多种维生素与寿命长短并无关联。另一项规模更大的研究（2018年7月发表，数据涵盖1800万人年）也证实，服用多种维生素与心血管疾病风险之间没有显著联系。

关键在于：不能用补剂弥补不良生活方式。 BMI为30且体内脂肪过多的人，即使服用多种维生素，也无法解决根本问题。健康的生活方式，包括均衡饮食和规律运动，才是关键。

我们成员也服用一些特定的补充剂，但我们始终强调，补充剂并非万能药，不能替代健康的生活方式。

关于多种维生素的研究存在一些局限性。例如，健康使用者效应是一个重要的混杂因素。服用多种维生素的人往往拥有更健康的生活习惯，这使得难以准确评估多种维生素的独立作用。

此外，大多数关于多种维生素的研究并非随机对照试验，这降低了研究结果的可信度。进行大型的随机对照试验成本高昂，因此很少有公司愿意投资进行这类研究。

与服用多种维生素相比，规律锻炼可能对健康更有益。推荐评估日常饮食中的营养素摄入情况，从而更精准地判断是否需要补充特定的维生素。对于遵循极低碳水饮食等严格饮食方案的人群，服用多种维生素可能有一定的必要性。

随着年龄增长，肌肉力量的下降比肌肉质量的下降更令人担忧。许多人购买了健身器材却闲置不用，仍然依赖于补充剂来弥补健康不足。选择服用多种维生素的一个重要原因是其便捷性，这与坚持锻炼相比，更容易做到。

虽然多种维生素在某些特定情况下可能有所裨益，但其他因素对健康的影响更为显著，例如保持健康的肌肉力量等。

目前，缺乏针对特定人群（例如特定饮食习惯或患有特定疾病的人群）服用多种维生素的研究数据。营养科学领域存在许多困惑，因为需要综合考虑各种证据来源，包括研究结果、专家意见和个体经验。

总而言之，虽然多种维生素在某些特定情况下可能有所帮助，但健康的生活方式才是预防慢性疾病的关键。 盲目依赖补充剂而忽视生活方式的改变，并不能带来长期的健康益处。 我们需要根据自身情况，理性选择补充剂，并始终将健康的生活方式放在首位。

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00:45 大多数美国人定期服用补充剂，其中大部分是多种维生素和矿物质，这已经成为一项数十亿美元的产业，但其有效性值得商榷。

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01:17 新的研究表明，多种维生素对大多数人来说并没有效果。

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01:39 人们服用多种维生素和矿物质补充剂是为了增加营养摄入、改善健康和预防慢性疾病，但研究表明这并不总是有效的。

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02:43 2024年的一项研究表明，服用多种维生素与寿命延长无关。

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03:15 2018年的一项大型研究也表明，服用多种维生素与心血管疾病无关。

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05:07 补充剂不能弥补不良生活方式，健康的生活方式才是最重要的。

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06:14 过去，我认为补充剂只是昂贵的尿液，但现在我认识到并非所有补充剂都是一样的，有些补充剂是有益的。

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06:45 一些对心血管疾病有显著改善作用的物质，可能对总死亡率和发病率没有影响，因为心血管疾病只是导致死亡的三分之一原因。

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08:15 服用多种维生素本身并不一定危险，但它不能解决所有健康问题，不能替代健康的生活方式。

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09:00 关于多种维生素的研究，其问题在于混杂因素，很难确定多种维生素本身是否无效。

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09:56 如果一个人已经拥有健康的生活方式和饮食，那么服用多种维生素可能没有必要。

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10:43 在饮食非常严格的情况下，例如极低碳水化合物饮食，服用多种维生素可能是有必要的。

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11:10 许多研究中存在“健康使用者效应”，服用维生素的人往往拥有更健康的生活习惯，这使得难以评估多种维生素的实际效果。

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11:54 大多数关于多种维生素的研究都不是随机对照试验，这使得结果的可信度降低。

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12:42 进行大型的随机对照试验来研究多种维生素的有效性成本很高，因此很少有公司愿意进行这样的研究。

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16:30 与服用多种维生素相比，进行锻炼可能对健康更有益。

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16:45 可以使用应用程序来评估饮食中的营养素，并确定是否需要补充特定的维生素。

◉

17:34 我停止服用多种维生素，转而服用一些特定的补充剂，例如维生素D3、K2、锌和辅酶Q10。

◉

18:12 随着年龄增长，肌肉力量的下降比肌肉质量的下降更重要。

◉

19:00 很多人可能已经购买了健身器材，但并没有使用，仍然依赖于补充剂。

◉

19:33 很多人选择服用多种维生素是因为它比锻炼更方便。

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21:24 多种维生素在某些情况下可能是有益的，但其他因素对健康的影响更大。

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21:55 保持健康肌肉和避免分心驾驶等不良行为对健康的影响远大于服用多种维生素。

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24:16 没有办法确定哪种多种维生素最适合个人的身体。

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24:42 可以使用应用程序来评估饮食中的营养素，并确定是否需要补充特定的维生素。

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25:45 测量血压时，收缩压表示心脏收缩时血压，舒张压表示心脏舒张时血压。脉压是两者之间的差值。

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27:34 脉压的变化可能与脱水、心力衰竭或动脉钙化等多种因素有关。

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31:30 维生素K2可能有助于降低动脉硬化。

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32:24 理想的血压值并非一成不变，近年来研究表明，过去认为理想的血压值可能略高。

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35:16 脉压的理想值可能并非30。

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36:11 运动可能会导致脉压降低。

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36:36 针对特定疾病的多种维生素可能基于某些假设，例如糖尿病患者存在特定维生素缺乏。

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37:03 目前缺乏关于特定饮食或疾病人群服用多种维生素的研究证据。

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37:45 在营养科学中存在很多困惑，因为需要综合考虑各种证据来源，包括研究、专家意见和个人经验。

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38:34 高LPPLA2水平可能与高LDL胆固醇有关。

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38:56 低碳水化合物饮食可能会导致LDL胆固醇升高，这并不一定意味着不健康。

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41:37 CRP、髓过氧化物酶和LPPLA2是评估心血管炎症的生物标志物。

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43:55 微量白蛋白肌酐比值也是评估心血管炎症的指标，可以通过尿液检测。

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44:51 脑钠肽（BNP）水平升高可能与心脏泵血功能有关，需要进一步检查。

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46:41 目前没有足够的证据来确定血清脱氧胆固醇的水平是否可以作为他汀类药物过度抑制大脑胆固醇合成的指标。

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47:27 补充剂中的纤维素可能与肥胖有关。

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48:31 并非所有多种维生素制造商都能提供相同质量的微量营养素。

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49:16 大多数人可能缺乏镁和维生素D3，因此应该补充这些营养素。

◉

51:38 C15是一种脂肪酸，据称与糖尿病和胰岛素抵抗有关，但目前尚无足够的证据支持这一说法。

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52:35 在推荐新的补充剂或药物之前，需要进行充分的研究，以避免消费者被骗。

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53:20 佩科里诺奶酪中含有C15。

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53:40 大多数多种维生素研究基于问卷调查，因此结果可能存在偏差。

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55:47 医学中的普遍解决方案可能无法满足每个人的需求，因为每个人的身体状况都不同。

00:00

- Welcome to the PrevMed Health Podcast with Dr. Brewer, your go-to source for heart attack and stroke prevention. And I am your host, Ford Brewer. Each week, we dive deep into the latest trends, expert insights, and practical tips to help you decrease your risk of heart attack and stroke. 语法解析

00:16

We discuss plaque reversal, insulin resistance, prediabetes, diabetes, cholesterol, supplements, medications, and so much more. So sit back, relax, and have this journey to a long and healthy life together. Almost half of Americans take supplements regularly. In most cases, this means multivitamins and minerals. In the U.S., this has been estimated to be something like $50 billion. 语法解析

00:45

invested, spent on vitamins. And you would think it should be an investment, right? I'm talking about multivitamins. The overall supplement world and expense is more like, what, five times that amount. So $50 billion, is it a good investment? Are we getting what we're paying for? Well, there's evidence that, at least according to Jesus, there's a shocking truth here. And that is multivitamins don't work. 语法解析

01:17

I'm not sure how shocked I am. This is, well, we'll talk about it. These are a couple of new big studies that have come out that say just that. But multivitamins just don't work, at least for what most people use them. 语法解析

01:39

Now, speaking of which, why do people take multivitamin and mineral supplements? You know, the National Institutes of Health, whether you like to bang on federal agencies or not, these guys do have a good supplement space in their website. People take supplements, multivitamins with the expectation that they're going to increase nutrient intake, improve health and prevent chronic disease. 语法解析

02:06

Prevent cancer, prevent heart disease. They're gonna live longer, healthier lives. That's sort of the point to all this, isn't it? Well, here's the shocking truth. Multivitamins won't help you live longer. They just don't, at least according to the evidence. The first study that we will talk about today is that was in June of this year, 2024. It was JAMA Network. 400,000 people 语法解析

02:43

A prospective cohort, actually three prospective cohorts, a cancer screening group, an agricultural group, and another group that I'm blanking on right now while we're talking about. We can get to that in a minute. But they followed these people for years. Use of multivitamins was not associated with any kind of longer life. 语法解析

03:15

The other study we'll talk about today and we'll refer back to some older studies as well. Like I said before in the intro, this is you could many of us myself for example would argue this is not really new information but sometimes especially in epidemiology and sometimes in what we talk about today, you'll find that there is devil in the details. 语法解析

03:40

In July of 2018, six years ago, there were 18 million person years. Now, wait a minute, what's a person year? It's a person for one year. So 10 people for one year would be 10 person years or one people for 10 years would be 10 person years. 18 million personal or person years. Again, a huge study also associated with the AMA. 语法解析

04:11

Again, both of these are in competitive enough journals, top 10 or 20 journals in medicine in the world. And again, showing multivitamin use just wasn't associated with a critical thing, something that kills about a third of us, cardiovascular disease. But does that mean that supplements are useless? I don't think so. 语法解析

04:39

We use vitamin D3, vitamin K2, niacin, B12, magnesium, zinc, chromium. We use several supplements ourselves and we use them in our practice. Now, I will say this and I've said it before. If you've heard any of our content, you might have actually heard me say it. You cannot out supplement a lifestyle. 语法解析

05:07

So having a BMI of 30 and way too much body fat, supplements, especially multivitamins, are not going to dig you out of that hole. You got to do that yourself. So Jesus and Heather, we've got both of you here today. You ready to join us? Good morning. Good morning. So, Dr. Berg, way to beat up on the supplement industry. You're really our anti-establishment, right? Yeah. 语法解析

05:45

Well, you know, it is what it is. It reminds me of before I came. Gosh, what? Up until about a decade ago, I was one of those folks that felt like supplements were just expensive urine. And it was built on stuff like this. I conflated the multivitamin supplements with everything else. I didn't take time to look at other supplements in terms of their benefits. 语法解析

06:14

their evidence, their history, their background. Another thing that I didn't do and I think people need to stop and consider this, something for example that might have a significant decrease in cardiovascular disease will often show no increase in total mortality and morbidity. And why is that? Well, even though cardiovascular disease is 语法解析

06:45

the number one cause alone of death and strokes, disability, blindness, kidney disease, it's still only a third of deaths. And so therefore, if something is a significant, causes a significant decrease in cardiovascular deaths, in order to have a significant impact on complete mortality, full mortality, 语法解析

07:15

In other words, the bus wrecks, the cancers, the other things that happen in life. In order for a cardiovascular, something that decreases cardiovascular death significantly to decrease overall death, it's got to decrease it by a factor of three. So people often miss that and think, well, you know, what does it do if it doesn't impact overall health? And I think that there may be some of that issue with this multivitamin study. 语法解析

07:46

with the whole issue of multivitamins. - Yeah. What I have seen also, and the reason we wanted to cover this is because part of the health coaches and doctors that work with us were very concerned about this perspective on multivitamins. I personally didn't find strong evidence that say, well, taking multivitamins can be necessarily dangerous, like causing liver disease or kidney disease, which can happen, but it doesn't happen that often just because of the multivitamins. 语法解析

08:15

But I think it's similar to your perspective on stents, where somebody says, okay, I probably have the worst of diets. Probably I still smoke. I probably still drink alcohol. But this pill is going to solve everything. This pill has all the micronutrients I need for my day. That's what they say on the TV. If I take three of these pills every day, I have all my nutrients. I'm good to go. 语法解析

08:39

let's go to McDonald's after this. This just doesn't work. That's not the way this works. And the damage from McDonald's is going to more than outweigh any benefit they got from that. Absolutely. And I'm seeing a couple of comments about what's the quality behind these studies. And I'm going to say it's not the best on the sense of 语法解析

09:00

the studies they included, both of these are meta-analysis, which is studies of studies, a study of studies. And they are including kind of a strong evidence on they follow a group for a lot of years. Very large groups. Very large groups for a lot of years. The problem is exactly that. There are co-founders. It's hard to say multivitamins are useless now 语法解析

09:29

because there are other factors behind that. Like exactly the point we're saying, if you take multivitamins and then you have a poor lifestyle, that's not going to work. It will be interesting to see if there… I didn't find any that suggests that taking multivitamins if you're absolutely metabolically healthy and eating a good diet is going to help you. It sounds like if you're taking multivitamins and you already have a good diet, 语法解析

09:56

That kind of defeats the purpose. A good diet will give you the nutrients you need, but not everybody has that luxury. It's hard to get all the micronutrients on your diet. You brought up a couple of points. One is when you might use it. I think if you're on a very restrictive diet, 语法解析

10:13

Like if you're a Penn Jillette and eating nothing but potatoes, you might want to take a multivitamin. If you're on other restrictive diets, some of those are very popular like the carnivore diet or the lion diet, both very restrictive. You may want to consider that. The other thing you brought up is confounders. And you see with both of these studies and you see it with just about every study out there on multivitamins especially. 语法解析

10:43

It's a healthy user effect. You go back, you look at these studies and the people that were using vitamins, duh, happened to be folks that had healthier habits. There were folks that were less likely to smoke, less likely to smoke. They were higher socioeconomic, more likely to have graduated from college. 语法解析

11:10

More females than males taking multivitamins. And all of these categories are associated with better health. So that's the definition of confounder, when participation in an activity is linked with the outcome. 语法解析

11:30

And so both of the studies did some things to rule that out. But the bigger thing that they saw in which you've seen it is we've seen in most multivitamin studies is it's just too small of an effect. That's why I brought that out in the beginning. All of these tend to be very, very big studies. They're not randomized clinical trials. 语法解析

11:54

I'm not familiar. And I'd love it if somebody who's sitting watching us will go back, maybe Google it and see if they can find significant randomized clinical trials on multivitamins. I can't imagine there aren't any out there. There's just not a lot. And when you're not doing randomized clinical trials, you get the whole issue. You get a lot of issues with these confounders. 语法解析

12:20

It's just hard to do a multivitamin study, a significant one with randomized clinical trials. Who's going to pay for it? And then you have a bunch of different brands, different quality, different amounts, different processes, processes behind how who manufactures the multivitamin. 语法解析

12:42

Although the margins, the money that folks can make in the supplement industry is supposed to be really good. I don't know how high they are in multivitamins themselves. I think they tend to be more focused on a specific marketing niche as opposed to the ability to just compete otherwise in the market. And 语法解析

13:09

I can't imagine a multivitamin provider getting ready to invest enough to do a huge randomized clinical trial in their multivitamin. Yeah. So how much is a Centrum bottle? Well, it depends on what you get. I've got a couple of them right here. I will occasionally take a multivitamin, as we mentioned before, when I'm doing like the carnivore diet. 语法解析

13:42

And maybe that's wrong. You know, they're true carnivore aficionados would say, Ford, you don't have to do that. You get everything you need in a carnivore diet. OK, I got it. Not going to argue. Well, you don't need organs. You don't need liver and stuff like that, though. I do. I do. I had there's a. 语法解析

14:06

A cultural thing you'd love for me to bring in cultural references. I grew up in Spartanburg, South Carolina. One of the top 10 drive-ins in the country was located in my tiny little town. It was called the Beacon Drive-In. It was featured on what was that show? Guy Ferrari drives, dive-ins and dumps or something like that. 语法解析

14:34

one of the top 10 by volume in the country when I was growing up. And they're still there. The reason I went into all of that bunny hole was I had chicken livers from them just two weeks ago. Okay, good. Very good. Chicken livers. Loved them. I used to hate them when I was a kid. But anyhow, as you know, Jesus, I went out and got these specifically for you, specifically for this show. Oh, yeah, I know. 语法解析

15:03

And to take some pictures for you for the thumbnail. This is Centrum men's silver 50 plus 200 tablets. The 200 tablets, I think it's about 50 bucks. So there goes any ad, 语法解析

15:19

Google Adsense money we're gonna make off of this show plus some not promoting them we're actually bashing them so I mean I think that's a problem I can't believe they want to sponsor this show huh no well no don't do it uh syndrome don't do it so if uh do you know how much a pair of dumbbells cost 语法解析

15:46

About the same thing. Oh, really good point. I've got I don't have dumbbells, but I have kettlebell. I have a couple of dumbbells, but I've got kettlebells at here in Athens and in Spartanburg. Weights tend used to be about a dollar per pound. Now they're since things have inflated their what? A dollar thirty dollar fifty depending on what you're getting. But I just get old cheap iron. Yeah. 语法解析

16:15

Where are you going with that now? Well, I mean, for the same bucks, you can get some dumbbells. I know dumbbells, kettlebells, it requires a little bit more discipline and going through the pain of exercising and building muscle, but… 语法解析

16:30

Even if your diet is not 100% nutrient dense, I'll probably guess there's more benefit on that than on a pill of multivitamins. Not to say don't take them. I mean, we also use another option called chronometer. 语法解析

16:45

an app that will kind of give you an estimation of how many nutrients you're eating on your diet and that can help you understand which vitamins you actually need if you want to supplement or it can also tell you where you can find those minerals and nutrients that you're lacking. 语法解析

17:03

But I understand. I mean, I can sympathize with the idea that a pill is sometimes more convenient. I do that myself. This is just my vitamin D3 and I have some omega-3s over here, but not necessarily multivitamins. How about you, Heather? I quit doing my multi a while ago. So I do similar supplements. I'll do zinc and CoQ10, the omega-3s. 语法解析

17:34

vitamin D3. That's what I do. Now I don't know what I'm going to do with these men's silver centrum. The show's going to be over in an hour. Well, some expensive urine if you want. Expensive urine, that's right. Yep. 语法解析

17:52

But I couldn't agree more. To me, I think one of the biggest things that we see, especially once you get past your mid-60s, is loss of muscle. And it's not so much loss of muscle mass. Everybody wants to have big, big muscles. It's loss of muscle strength. Right. Yeah. 语法解析

18:12

Fantastic. So this was kind of a short introduction, Dr. Brajot, getting better for those who want to know the answer ASAP. And I don't know how shocked you are about that. But I mean, almost half of the U.S. take them because they believe they work. So I'll suspect that from all those millions of people, some people will be shocked, I guess. 语法解析

18:34

Before you finish that, let me interrupt you. If they ever see this video, though. Let me ask you a question. How many of those people that maybe they bought weights and maybe they're sitting in their garage and not being used, and maybe they're still buying supplements, multivitamins, and they're saying, 语法解析

19:00

I'm still going to take the multivitamin. And then how many of them you think are truly surprised to hear this? I don't know. You give me an estimation of that. What do you think, Heather? I don't think it's surprising. Oh, man. OK, I'll take it. My point is, I don't I don't think that the audience is going to be that surprised. I think a lot of them are going to say, look, I am not going to get up every morning or every night or before I go to bed every night and go work out with dumbbells. 语法解析

19:33

That's not fun. It's not easy and it's something I'd rather just… I know I'm not doing what I need to do, but at least I'll take a pill. It's just like what you were saying, Rachel. Yeah. Convenience of having the multivitamin in lieu of putting in a little extra work two or three times a week even. Well, doing this, using your muscle to flex like this and put a pill in your mouth, it's easier, right? 语法解析

20:04

- Yeah, that's how you get big biceps, huh? - Oh yeah, one pill a day grow your biceps, right? Okay, so let's– - We'll see in the comments. We're getting a lot of comments about this. - Let's go dive in because that's key. - Well, we gotta do the water ball first. - I know you want it. Can you do the $35? - I paid $35 for that thing. - $35 water ball, please. 语法解析

20:32

Well, Jesus, I have to say I got a lot more out of that $35 for that water ball than I did for this $50 for that centrum. Oh, yeah. Yeah. 语法解析

21:03

Well, what can I say? I think we already discussed that. Their position is kind of clear. But again, we might be wrong. Somebody come up and say, well, I found a randomized controlled violence test otherwise. That will be interesting. I'll tell you what I suspect. I suspect they actually do help in some situations, like we mentioned. And I suspect that they actually do help. 语法解析

21:24

But not so much. There are so many other things that are so much more important to your health. For example, you already mentioned the failure to maintain healthy muscles. I'll mention something else. Texting when you're driving, you know, you get those kind of things involved in terms of your risk factors. And they just totally outweigh what you would get from multivitamins, at least in the market. 语法解析

21:55

In the U.S. Definitely. So real quick, a shout out to our new channel members. Thank you so much. Thank you so much. And I think they're using those names just to mess up with me. 语法解析

22:17

I'd love to hear where they're from. Oh, yeah. Well, please give us a comment. Just so you know, if you're new to the channel or YouTube, I mean, I need to say this. We love you all. If you're not a subscriber, if you're just a viewer, we love you. I hope you're enjoying the show. But for those who are members… 语法解析

22:37

I do. So we appreciate that they're going the extra mile supporting the channel. And we have some perks for them. One of those is we will answer your questions in the chat on the live shows first. We see an icon, so we go to that icon and we answer your questions. The other one is if you comment on any video, we're now making videos every Wednesday to answer questions from premium members. 语法解析

23:03

And standard members will have access to that as well. 语法解析

23:08

So we already have posted a couple of those videos. Go check them out if you haven't already. And if you want to support the channel, make sure Dr. Brewer can pay me and can pay Heather. That helps. I know. They're very expensive. Please help. Please help. And you're retired already. Well, we did this for years. Basically, just the channel has grown enough now. It's a lot of growth, especially over the past year. 语法解析

23:36

It's grown enough now to where it's… I don't know that it's quite paying for itself yet, but maybe it is. It's certainly getting close. Okay, good to know. So if you want to know how to become a member, go to where it says Dr. Ford Brewer on the homepage of the channel and click on that button that says join. 语法解析

23:57

uh we'll be happy to have you as a member uh so let me start like keith lawson over here as some supplements should not be taken together how can we know what multi would be best for one's body that's exactly the question there's there's no way to know 语法解析

24:16

You can do some assumptions like, I'm going to go back and talk about that chronometer app. We're not sponsored by them. I just have found personally that is useful for me and we recommend that to our patients. It's like a food log and we'll give you an estimation. That's the best we can do, an estimation of how many nutrients you're getting. It's not exact, but it can give you a notion of what you're getting. 语法解析

24:42

Hi, Keith. I just wanted to say hello. Rick Poglia, good morning from Georgia. And good morning from Arizona. Heat is settling down, cooling down for the fall. That's great. Yo, I saw something saying that, what is it? 语法解析

25:00

Blood pressure, pulse. Oh, okay. So, yeah, this is very, very geeky. Dr. Burr, do you want to talk about that? Why don't you go first? Do you want me to try to explain? Okay. I want to see how you explain that. Well, I mean, it's not that hard. It's hard to put it on simple words, so let me try it. 语法解析

25:25

So when you when you measure your blood pressure, you have two numbers, right? The high number, which is named systolic, and then you have the low number, which is called diastolic. Systolic number means it's the moment in which your heart has produced a beat, pushed the blood through your arteries. 语法解析

25:45

It's really quick, so it reaches your pulse. So what you feel as the artery is expanding, that's actually when the heart pumped the blood out. Diastolic is the process where the heart is kind of resting. When you feel a very, very strong pulse, like you touch it on your arm, you touch it on your neck, and it's really, really strong, 语法解析

26:12

What it means is your systolic might be too high, your diastolic might be too low. So it's a big gap between the two of those. That's blood pressure pulse. That's what Joe is talking about right here. People who are dehydrated or are in some type of shock, that difference gap will become really, really small. So there's not so much difference and your pulse is not going to be as strong as it could be. 语法解析

26:42

Well, you didn't mess that up as bad as I expected you would. I've been teaching on colleges and schools for a while, Dr. Brewer. Oh, that's right. I forgot your faculty. You've been faculty for a while. So after Jesus giving us time to think through it, you got anything to add to it? No, I appreciated him kind of giving it in more layman's terms. But I know you're going to kind of geek that up, so let's do it. 语法解析

27:10

Well, I don't know. Are you? Go ahead. I'm not going to geek it out too much, but as I listened to you, I thought about there are a couple of places where you see differences. Like you said, when somebody's dehydrated, you tend to see lower. If they have heart failure, you tend to see a lower pulse pressure. When do we tend to see higher pulse pressures? 语法解析

27:34

Well, one of the most common problems with high blood pressure is what we call isolated systolic high blood pressure, which is your highest number, your heartbeat is just too strong, goes up really high. But the diastolic, the bottom one, is too low. So that's a big, big difference. And that happens when people have calcification of the aorta, which is the first artery that comes out from the heart. 语法解析

28:02

So that's actually what the heart needs to beat up. Like if you have a water hose and you put your finger on it and block the water, the pressure is going to accumulate. And you need to put more pressure to beat your finger that you're putting right there on the hole of the water hose. That happens on your heart as well. Like if you block the aorta, 语法解析

28:25

where the blood is coming out from the heart, it's going to require more pressure and your heart has to do more effort to put that out. So that's hard. And let me do something real quick. This might help. I do have this for my patients. I have kind of an anatomic model over here, a beautiful heart. So this is on the inside. Look at that. I used to have one of those. I can't remember where it is now. You don't have a heart. I know. So… 语法解析

28:52

Just kidding. This is where the blood accumulates and gets pumped out. This is the aorta, the big, big red one. And this is that place that I'm talking about, right here. This little hole over here, that little hole, sorry, it got blurred. But that's where the blood comes out from. So if this valve is calcified, is really hard, strong, the heart needs to make some extra effort to put the blood out. 语法解析

29:20

and that's what we call heart well that causes heart failure the heart gets tired of beating too much so just a small demonstration right there i'm going to go down a bunny hole too uh so if you look at my neck you it you get what we call a like a turkey neck and basically what aging yeah okay i'm sorry i'm getting distracted go ahead yeah i'm an old man much older you see it wrinkles here and now why do those happen 语法解析

29:48

because I'm losing, as we age, we lose a part of our protein in there called elastin. It's got an elastic effect. You look at Jesus, he's got a nice smooth neck. Despite all the chemicals that my new PR person has me using on my neck, it's a lost cause. Now, the reason I bring that up is 语法解析

30:14

One of the places where we tend to see higher pulse pressure is with aging and it's because people lose that elastin in their aorta just like they're losing elastin in the skin and you'll typically see somebody like a 语法解析

30:31

80-year-old female with a systolic going up to like 140, 150, and then the diastolic being 70 or 60 or something. Big increase in the pressure when that heart pumps into the aorta and the arteries. They don't have the elastin that a younger person has to expand and receive that bolus of blood. So the pressure increases a lot more 语法解析

31:00

in older people. They get stiffer. Stiffer arteries. That's right. And guess what helps with that? I'm just going to spoil the beans a little bit for the show for this Saturday. Well, there you go. Spoil them. It seems like we're beating up too much on vitamins, but we like vitamin K2. And there's one specific study done in postmenopausal women where they found vitamin K2 can decrease artery stiffness. 语法解析

31:30

just one study not to say something else but i would have even spoiled more beans so i'm gonna back up yeah i'm not gonna say it well that will be a first uh let me just go real quick to the to the last last part of the question on the osxm uh so it says it should be that that uh blood pressure pulse should be between 30 and 40 but suppose perfect will be 语法解析

31:54

120 over 70 would be the pulse pressure of 50. So, okay. So if you see there's some math in here, and I know we have a couple of engineers. You're way better than me on math. The first assumption is that 120 over 70 is a good blood pressure. I don't think that's the right number. For years, it was 120 over 80. And that's what a really, really nice story I have is 语法解析

32:24

I used to work in a small clinic when I was doing kind of a social service to get my medical degree. And there's a bad thing that happens in Mexico. Heather, you can tell me if this happens in the US or not. OK. Poorly trained nurses who just to take care of the patients, because there are a lot of patients, 语法解析

32:45

They don't even listen to the blood pressure correctly. And they just will say 120 over 80. It's normal. Yes. Does that happen in the US? Oh, man. I've never, ever seen that happen. Okay. Well, I have seen. And then I had a patient that. Never. They put me on the vital signs. 120 over 80. Heart rate of 80. 语法解析

33:08

The perfect patient, right? That's the normal. I went to see that patient. Patient was pale as a ghost, weak, tired. Blood pressure was like 80 over 40. Oh, my gosh. And his heart rate was something closer to 40. 语法解析

33:26

He was having a very, very severe case of bradycardia. And I'm like, this doesn't look like 120 over 80. The whole point is 120 over 80 has been thought as being the normal blood pressure for years. Now, recent research, like a couple of years ago, they found out like if you have 120 over 80, you might be actually a little bit on the higher spectrum. 语法解析

33:49

So I will say, if you ask me, the average normal blood pressure has to be something between 110 over 70 and no less than 90 over 60. 语法解析

34:03

Some thin people might have 90 over 60, 85 over 55, and that might be normal for them. But for most people, it's on that range. But how do you get that blood pressure pulse? So 120 minus 80, that's 40. That's why Joe is saying that that's kind of the difference, right? The difference between the high and the low? 40, that's normal. 110 minus 70, 语法解析

34:31

that's 40. So if you have 40, 50 might not be such a big deal, but it can be a sign though. If you have 120 over 70, that can be a sign that you're hard doing some extra effort for some reason. What do you think, Dr. Burr? 语法解析

34:49

I think that's true. Now, I would also say… You don't think anything I say is true? No, I don't. Actually, I work very, very hard, Jesus, to find things that you say that I think are true, and I just mentioned those. You just do that because I like to fact-check you as well. I know. But one thing I would say is I don't think 30 is the greatest pulse pressure. 语法解析

35:16

OK. Yeah. The other thing I would say is when you exercise, it's classic to see the you'll get some decrease in pulse pressure. Classically, both systolic and diastolic will increase a little bit and then diastolic will start to drop down. That's correct. 语法解析

35:42

All right. Just a quick shout out to Moroni Holm. What he did here is called a super chat. So you can do that as well. $5. Thank you so much. That helps a lot. Really. Thank you very much. Serious. Thank you so much. Yes, thank you. Alive is a diabetic multivitamin supplement. I'm a carnivore. Okay. That will be interesting to check out. Like a specific multivitamin for any specific disease might have a specific composition. But again, 语法解析

36:11

There might be a couple of assumptions right there, like the assumption that people with diabetes has a specific vitamin deficiency. Deficiency. Right. And that's an assumption. I don't think all diabetics are the same. All people with diabetes have the same. And the other assumption is that there's some restriction on a carnivore diet. Right. 语法解析

36:36

I think a lot of that gets into that confusion of definition. I think with a lion diet, you have more, it's more, there's more exclusion there and you got more opportunity for vitamin deficiencies. But this brings up the other thing. There's no evidence one way or another, at least that I've seen. I haven't seen anything on people on a lion diet. I haven't seen anything where it said, okay, let's just look at diabetics alone. 语法解析

37:03

It's just not out there. Yeah, and that's a problem, you know, and that's the whole point behind research. Like, okay, we know research can be biased. We know research has a lot of problems. We know research is not probably the best source. And then you can rely on expert opinion. That's not the best either, unfortunately. 语法解析

37:23

And then you cannot just only base on personal experiences here and there because that also is not best. So that's when you have to look at everything that is involved and see what the strongest evidence is out there and try to follow that. When there is no strong evidence, well, you can go to the next step. It's hard. We understand. That's why there is so much confusion in nutrition science. 语法解析

37:45

- Trial dad? - Trial dad. Probably a hiker on the trail. - Oh yeah. - Nice. - Thank you so much. I'm 65 years old. 语法解析

37:57

Male with two stents keto one and a half years lost 70 pounds. Look at that Congratulations CRP is optimal LPP la - it's up. I mean, yeah, I agree with that a little bit higher Just just a little MPO is really low. Is that a good result for me? We cannot I'm sorry trial that I know you're a member But there's a difference now between a member and a patient so we can just can't provide Kind of this type of assessments over here. I can just say I 语法解析

38:26

For somebody who has an LPPLA2 on 141, I bet there is an LDL number above 120. 语法解析

38:34

That's where I look at us both of us over here smiling and nodding. We're all three thinking the same thing. We see a ton of people who restrict their carbs quite a bit when they do their some folks. I'm now included in that group called lean mass hyper responders. Decrease your carbs way down like 20 or less per day. 语法解析

38:56

Your triglycerides look great. Your HDL looks great. Your LDL tends to shoot up. Yeah. So, and the recent paper from Dave Feldman and the team, only 100 people we know, but it's on explore the space. And I agree with them. I even pushed them a little bit on that interview we had with them on how many people actually have this phenotype since very few people are doing keto or low carb. 语法解析

39:27

A lot of you guys who are on this channel probably are doing that, but most people in the US and in the world are not doing a low carb diet. Most people are on the standard set American diet or eating a lot of processed foods, just that. And so we don't know how many of these people really exist because anytime you see an LDL increase, doctors out there will blame that high LDL on saturated fats and meat. 语法解析

39:55

and on eggs, and that's not always the case. - So Jesus, I left out maybe the biggest component. Go back to Trail Dad's comment. I didn't say why you thought he probably had, or all the reasons. - I'm sorry, I'm making assumptions myself as well. I'm sorry, go ahead. - Tell us why. What was the other reason I didn't mention? - I don't know. - Is it the DLA-2? 语法解析

40:28

LPPLA2 is minimally elevated and we tend to see that in our lean mass hyper responders and yes it's - I used to say that I see that all the time and Jesus used to say well 语法解析

40:41

Dr. Brewer, at least he would say Dr. Brewer. He'd say, well, Dr. Brewer, you know, that's what you, that's quote expert opinion and you're a self-appointed expert. So I'm not sure how much credit I put there. Even now, even now, or now Jesus is saying, yeah, you know, you get these little bit minimally elevated LPPLA2s. You may be a lean mass hyper, that, that goes up with the LDL. Yeah, yeah, exactly. So just, just to, 语法解析

41:10

Put it down into perspective because we're also making the assumption that people know what we're talking about and maybe some of you might not be familiar with. So what trial that trial that has been on the channel on enough to know that's the standard inflammation panel we look at. There's another valuable out there that I'm not seeing, but let's focus on these three. CRP, C-reactive protein, which is one of those biomarkers of inflammation overall. 语法解析

41:37

But research like the one done by Paul Ritger, the first paper published on cardiovascular inflammation, he was studying CRP. So elevated CRP correlates with cardiovascular inflammation. There are plenty of other reasons to see an elevation of CRP, but that's one. 语法解析

41:55

Myeloperoxidase, it's also another biomarker that is actually produced by immune cells when they're on the plaque and causing that inflammatory goo within the arterial plaque. So that's why we look at it as well. And LPPLA2, it's another enzyme that actually gets produced when a small dense LDL gets oxidized. 语法解析

42:18

which to our perspective is not saying that LDL causes heart disease and inflammation. It's just saying that small dense LDL can get oxidized and promote for further inflammation. That can happen. I don't think anybody can argue with that. And that's the thing with LPPLA2. LPPLA2 is pretty much attached to the amount of LDL. So what we have seen is that in most cases, the higher LDL you have, 语法解析

42:48

Somebody's typing over there. We can hear it. I'm sorry. If I'm typing as well, let me know when I do. I had no idea it was that loud. 语法解析

42:59

It is. Yeah, I did not either. So yeah, better to say because we love you and we don't want you to drop the video just because of the typing. Anyhow, whenever you have a high LDL, you're going to have a bunch of LDL particles. Like a bunch of LDL particles are going to be increased with that LDL cholesterol. And when you have a lot of LDL particles, you might have also an increase on small dense LDL particles. 语法解析

43:24

And when you have an increase on a small dense LDL particles, you might have an increase in oxidation as well. So that's why you see that LPPLA2 going higher whenever your LDL cholesterol is high as well. Quick pop quiz, Heather. Which one's missing? Cardiovascular inflammation indicator. The MACR, the microalbumin creatinine ratio. There you go. Yeah. That's a urine test, by the way. So if you only did blood tests, it might not be there. 语法解析

43:55

So sorry if we got a little bit geeky. Gilbert came up with the banner for the practice. We can order this for you if your doctor doesn't want to. You can become a patient. Dr. Burr is licensed in all 50 states, and he can help you with that. I'm a physician, but I'm on a role of a health coach, and Heather also sees patients. She is licensed in most of the states we have patients on as a registered nurse practitioner. Nurse practitioner. Yes. 语法解析

44:23

Just another shout out, RLCG, thank you so much. $9.99. BNP 945, other cardio numbers are in good range. Trying to solve. Thank you for your info. We don't discuss that much BNP and we don't really measure BNP that much. Do you have any comments? I don't. I used to measure that prior to you guys coming on board. Okay. 语法解析

44:51

Brain natriuretic protein is something that you see. It was discovered with the brain but people use it more often in terms of what they call happy heart hormone or a reactant indicator and that's a good question, Carol. We would have to dig much much deeper than what we see here. 语法解析

45:18

I can tell you something. Again, not medical advice. We can do that on YouTube. One thing I personally do with my patients in Mexico whenever I see a high-end BNP is to get an echocardiogram. To me, that's kind of the first step. Of course, we want to measure other stuff, but BNP doesn't necessarily correlate with heart attacks. It correlates with heart mechanic pumping function. 语法解析

45:48

So that's what I can say. That's what I do with my patients over here. Let me see. We have a bunch of comments. I'm sorry. I'm searching for members. We love you all, but I apologize. That's my role over here. I'll get the hate from Dr. Brewer's instructions. Thanks for the super way to answer that question. Of course, we're happy. That's a good topic. I don't think we ever talked that deep into blood pressure. So it's good. Yeah. 语法解析

46:20

Any idea what level of serum desmostral will indicate that statin is over suppressing cholesterol synthesis in the brain? Joe, you might be one of the geekiest members on the channel. I'm not familiar with desmostral. I don't think we measure that. I don't think there's enough evidence to say this is a follow-up marker to be done. 语法解析

46:41

on anyone who's taking statins. But I can understand it is specialized for people who are concerned about low levels of cholesterol in the brain. Any idea, Dr. Brewer? No, I don't. Sorry. We don't really look for that often. So that's a good topic for us to research. 语法解析

47:03

And Tree Lady, remember we met Tree Lady in San Diego. I think I'm going to mention that every time I see a comment from Tree Lady. Trying to avoid supplements with cellulose, vegetarian capsules, as these contribute to obesity according to intestine research in Georgia. That's a great point. And I think we have mentioned that a couple of times when we talk about supplements. Cellulose is probably the most used supplement. 语法解析

47:27

filler for the supplements. And it's interesting because I don't think there are enough papers to see the impact of cellulose. Of course, we can go ahead and take a look at that. That will be a very interesting topic to cover. It is interesting. I've heard that before and just never got around to looking at it. Yep. So… 语法解析

47:54

No more questions from members. We still have like a couple of minutes. I would like to, oh, and to idioma, let us know where you are. That's Frank Spanish. Gilbert, if you can put the banner, anyone who wants to see Dr. Brewer or the team as a patient, go ahead and call us or visit the website, brevmethale.com. 语法解析

48:15

JMK, do most multivitamin manufacturers provide the same quality of micronutrients in their product? Short answer, I'll say no. And sometimes JMK, I think, correct me if I'm wrong, sometimes JMK is really good at putting questions that I think he or she already knows the answer to. 语法解析

48:31

But it wants to highlight that for the people to have that kind of knowledge and they can also have some questions about that. So really good question. I would say no. That's called a rhetorical question. Yes. 语法解析

48:47

And I'm glad you mentioned it and I'm glad you read it off because that's one of the big issues. Supplement industry is just not regulated. Yeah. I think I do something similar to what does. I stopped taking multivitamins years ago and just take a few vitamins now, like D3, K2, Zinc, and Magnesium, of course. We know most people are deficient on Magnesium. Most people are deficient on vitamin D3. K2 has some specific uses. 语法解析

49:16

uh, sink as well. So we're not, that's the key problem with multivitamins. You need to know what you need. I know there are some specific special testing for micronutrients in the blood. I don't know how expensive those are and I don't know if anybody should do those. Um, but I do think that there are some specific supplements that most people will probably benefit, will benefit of. Speaking of which I'm going to put John C's comment on. Oh, 语法解析

49:43

Keto MCT latte. It reminds me of a patient that you and I met with yesterday, Jesus, that's all excited about C15. Oh, yeah. We'll cover that at some point. If you've heard of C15 and you're interested, you'd like to hear about it, let us know in the comments. Yeah, definitely. It's not like it's new. It's just that it's getting popular now. 语法解析

50:11

I'll give you a hint. It has to do with bottlenose dolphin milk. Okay. That's odd. I saw that website from the doctor who promotes that. So, yeah. And I think she has a background on something more related to, how do you call that, veterinary? She's a veterinary epidemiologist. She was called by the Navy to, 语法解析

50:45

because to check on the health of the dolphins, the Navy uses trained dolphins in activities. Cindy and I were talking about this morning. She said, what do they use them for? They're not milking them. And I said, you know what? I had to look it up. I'm not sure. Are you talking about milking dolphins or what are you talking about? I'm not. 语法解析

51:12

So C15 is found in dolphin milk, and there's a long story behind that. And it's being purported as one of the causes, lack of C15 is one of the causes of diabetes and insulin resistance. Now, I mean, just let me ask you this. So we all say all the time, you need to get your foods as organic and as homegrown as possible if you can. Right. 语法解析

51:38

You don't have a dolphin in your backyard? No, I need to have a dolphin in my backyard to get enough C15 from a good quality. What are you talking about? That's right. And you don't want one of these cheap commercial supplements. You need to have a dolphin in your backyard. 语法解析

51:55

Yeah, exactly. Yeah. Patients tell me about fatty 15. So I'm thinking. Yeah, that's it. Okay. It's in a specific fatty acid. Yep. Well, interesting. I mean, I think it's interesting. And we're going to also cover another topic in a few weeks. Uh, 语法解析

52:13

I won't say popular, but it's popular within our own patients who come on and ask us about there's a new supplement or a new drug that claims to do this and claims to do that. And we like to take our time to analyze because we don't want you to get scammed also and just spend some extra $100 for something that is not going to work. Right. 语法解析

52:35

And I have the website saved because I need to do some more research on that too. I know Nick Norwood talked about it. I don't know if he talked about the supplement. He talked about C15. But I mean, we're going to do our due diligence before we give a strong opinion on that. You're on mute, Dr. Brewer. 语法解析

52:54

Yeah, because I was getting ready to type the answer to a question. After I heard how loud it was, I started muting myself. But Nick's recommending it from Pecorino cheese, which if you're not a Pecorino cheese aficionado, it's a sheep's cheese. Interesting. It's easier to have sheep's cheese on your bike than dolphins. 语法解析

53:20

What's that? It's easier to have sheep on your backyard than dolphins. I think so. Yes. All right. “Vape King” about the research on the multivitamins. Now the question is, did they check the whole food quality vitamins or synthetic like most? I don't think they said and I'm going to tell you one thing that is going to say, well, I don't know if I'm going to believe this evidence. 语法解析

53:40

Most of the studies were based on questionnaires. Like, are you taking multivitamins and how often? Not necessarily the brand, not necessarily the composition. But most brands of multivitamins are synthetic. So when you have a large population of people, the assumption is most people are taking that. And I think that's a safe assumption to make. Like millions of people are taking the synthetic ones. All right, Dr. Brewer. 语法解析

54:08

I can banter with you, but I'll never call you forward. That's right. We reached the 15-minute mark. Thank you so much for staying here with us today. Take a look at the rest of the videos. Show some love. I was really sad the last two weeks because we posted a video about what happens if you quit sugar for 30 days. Nobody saw that. 语法解析

54:31

Well, nobody to our standards. Nobody. Tens of thousands of people saw that. You're just mad because it wasn't as many as you wanted. I'm a greedy YouTube channel manager, so I would love to see those videos explode. And also when you ate 100 videos, I think what happened… I did, I ate 100 eggs. I'm sorry, 100 eggs. 语法解析

54:55

I think what happened is everybody was so impressed with Nick that they say, well, he ate 720, 100 eggs. Nothing. That's nothing. But again, I think we provide some extra perspective on that. That's not on Nick's video. So I think they both complement it. 语法解析

55:14

So go show some love, check them out and share those with anybody you are worried about. And if you don't like them, share them with somebody you hate so they waste their time. Any closing remarks? I have one. It's a question. Ranjana Narawatne says, I've often wondered how general solutions for everyone can help in medicine. Everything's a chemical reaction and everybody is different. That's true. 语法解析

55:47

But I think it's a good, a really, really good point. People are different. We all have different genetics, but we have far more similarities than differences. And that's what this is all about, trying to figure out where this issue is similar and where it's different. That's what creates jobs for all of us. Dr. Brewer, 2024. 语法解析

56:13

Let's put that on a t-shirt. All right. There you go. All right. Well, next week we have an experience from a patient who was able to stabilize his plaque, reduce his inflammation, and he has a really good exercise routine that we would love you to see. He's a patient of ours and he's going to be live on the show. Let me see if it's next week. I'm sorry. It's not next week. 语法解析

56:41

is on October the 31st. Next week is going to be Dr. Brewer all by himself. So you'll have him without somebody messing up with his train of thought. Let's see if we can manage that. See if I can get that ear in there. There you go. Oh, yeah. It's going to be a YouTube live. So you can see that on your TV, on your couch, or on your bed as you're doing right now, or you can see that on your phone. Any of those work. But it's going to be the old Dr. Brewer style. 语法解析

57:08

shaky paper and all of that for those who have seen that before so you'll enjoy it that's right as jesus has said it's um it's old a little bit old school we're gonna see if we can get some more shaky paper in there and i'm doing a real good job of messing up the technology each time i have a show you're the best 语法解析

57:30

All right. See you next week, Ben. Thanks so much. We hope you found today's episode informative and useful. Be sure to subscribe to our podcast to stay updated on all our latest episodes. For more information about becoming a patient or participating in our exclusive events, visit PrevMedHealth.com or call 859-721-1414. 语法解析

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美国几乎一半的人定期服用补充剂，主要是多维生素和矿物质。这在美国是个大约500亿美元的产业。整个补剂市场的规模大概是这个数字的五倍，也就是2500亿美元。这么大的投入值得吗？花的钱真的有回报吗？根据一些研究，这里有个令人震惊的事实：多维生素其实没用。最近有几项大型研究明确指出，多维生素对大多数人的预期用途没效果。

人们为什么吃多维生素和矿物质补剂？

美国国立卫生研究院的网站上有个不错的补剂板块，提到人们吃这些是为了增加营养摄入、改善健康、预防慢性疾病，比如癌症、心脏病，希望活得更长、更健康。这不就是吃补剂的初衷吗？但真相是，多维生素并不会活得更久，至少证据上是这样。今天要聊的第一项研究是2024年6月发表在JAMA Network上的，涉及40万人，包含三个前瞻性队列：一个癌症筛查组、一个农业组，还有一个。他们跟踪这些人多年，发现服用多维生素跟寿命延长没有任何关联。

另一项研究是2018年7月的，涉及1800万个“人年”。什么是人年？就是一个人观察一年，10个人一年就是10人年，或者一个人10年也是10人年。这项研究规模巨大，也跟美国医学会有关，发表在顶尖医学期刊上，同样发现多维生素跟心血管疾病没关系，而心血管疾病是三分之一死亡原因之一。这是不是意味着补剂完全没用？我觉得不是。我们自己也在用一些补充剂，比如维生素D3、K2、烟酸、维生素B12、镁、锌、铬，在我们的实践中也会推荐这些。但我得强调一点，你可能听我提过：补剂代替不了健康的生活方式。

十年前我还觉得补充剂就是“昂贵的尿液”，因为我把多种维生素跟其他补充剂混为一谈，没仔细研究其他补充剂的证据和背景。还有一点很多人没意识到，比如某种东西能显著降低心血管疾病风险，但对总死亡率和发病率可能没影响。为什么？因为心血管疾病虽然是头号死因，但也只占三分之一的死亡原因。如果某物显著降低心血管死亡，要影响整体死亡率，得降低三倍的幅度。所以有些人对多种维生素研究失望，觉得没改善整体健康，可能忽略了这点。

我个人没看到强有力的证据说多种维生素一定有害，比如导致肝病或肾病，虽然这些情况可能发生，但不常因为多种维生素引起。就像你对支架的看法，有人觉得自己饮食烂透了，还抽烟喝酒，但觉得一颗药丸能解决一切，电视上说这药丸有所有微量营养素，每天吃三颗就够了，然后就去吃麦当劳。这行不通，麦当劳的伤害远超补充剂的好处。有人问这些研究质量如何？这两项研究是元分析，也就是研究合集，跟踪了大规模人群很多年，证据算强，但有个问题：混杂因素。比如你吃多种维生素但生活方式糟糕，那没用。也没有研究明确说，如果你代谢健康、饮食良好，多种维生素会有帮助。如果饮食已经很好，补充剂可能就多余了。

但不是所有人都有完美的饮食。如果饮食受限，比如像Penn Jillette那样只吃土豆，或者流行的一些极限制性饮食，像肉食或狮子饮食，可能需要多种维生素。还有个问题叫“健康使用者效应”，研究发现吃维生素的人往往有更健康的生活习惯，吸烟少、收入高、学历高、女性多，这些都跟更好健康相关。这就是混杂因素，参与某活动跟结果相关联。这些研究尽量控制了这些因素，但效果还是太小。这也是为什么这些研究规模都很大，但都不是随机对照试验。随机试验成本高，谁来付钱？而且不同品牌、质量、剂量、制造工艺都不同，补充剂行业利润高，但多维生素这块可能更偏向细分市场营销，没人愿意花大钱做大型随机试验。

我偶尔会吃多维生素，比如在肉食时，虽然纯肉食爱好者会说不用，吃肉就够了。我不争论这个。我小时候在南卡罗来纳州Spartanburg长大，那里有个全美销量前十的Beacon Drive-In，两周前我还吃了他们的鸡肝。小时候讨厌，现在爱吃。说到多维生素，我买了瓶，200片，大概50美元。比起这个，买对哑铃或壶铃可能更划算。哑铃以前一磅一美元，现在大概1.3到1.5美元。花差不多的钱，锻炼比吃多维生素可能更有益。即便饮食不完美，锻炼的好处也更大。

Heather说她早就停了多维生素，现在吃锌、辅酶Q10、欧米伽-3、维生素D3。我也差不多，维生素D3、欧米伽-3为主。那些瓶子怎么办？可能就是“昂贵的尿液”了。尤其60岁以后，肌肉力量下降比肌肉量下降更严重，锻炼比吃补充剂重要得多。很多人吃多维生素是因为方便，觉得不用费力锻炼，吞颗药丸就行。就像举哑铃太累，吞药丸只用动动手指。

聊到血压力和脉压，收缩压是心脏收缩时的压力，舒张压是心脏休息时的压力，脉压是两者的差值，正常在40左右。比如120/80，脉压是40；120/70，脉压是50，可能说明心脏在额外用力。脱水或休克时，脉压会变小，脉搏弱。心力衰竭也可能脉压低。脉压高常见于主动脉钙化，比如老年人，主动脉弹性蛋白减少，血管变硬，收缩压高，舒张压低。维生素K2可能帮血管软化，有项研究在绝经后女性中发现这点。理想血压以前认为是120/80，但近年研究觉得偏高，正常范围更可能是110/70到90/60，瘦的人可能更低。

有人提到糖尿病患者的肉食补充剂，假设糖尿病有特定维生素缺乏，但不是所有糖尿病患者都一样，肉食也可能缺某些营养。狮子饮食更严格，可能更容易缺维生素，但没针对这些人群的研究。营养科学很复杂，研究有偏见，专家意见和个人经验也不完美，得综合看证据。有人问怎么知道哪种多维生素适合自己？没法完全知道，APP能帮你估算营养缺口。补充剂行业不受严格监管，不同品牌质量差很多。大多数人缺镁和维生素D3，K2、锌也有特定用途，针对性补充比多种维生素可能更好。

还有人提到C15，一种脂肪酸，据说跟糖尿病和胰岛素抵抗有关，存在于海豚奶和佩科里诺羊奶酪中。听起来有趣，但证据不够，我们得再研究。补剂得小心，别花冤枉钱。研究多是问卷调查，没具体到品牌或成分，大多测的是合成维生素，这可能影响结果。总之，健康生活方式比补剂重要，锻炼、少分心驾驶比吃多维生素影响大。

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