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@Ford Brewer : 我认为牛油果对心脏有益，尽管我一开始并不喜欢它。研究表明，食用牛油果可以降低心脏病死亡和动脉斑块积聚的风险。牛油果富含营养物质，可以降低甘油三酯并增加高密度脂蛋白，这对预防心脏病至关重要。然而，牛油果价格昂贵，容易腐烂，而且很多人不喜欢它的口感。此外，鳄梨产业背后存在剥削等问题。尽管存在这些问题，我仍然会食用牛油果，并尽量选择新鲜和本地的来源。我通常将牛油果切片或制成鳄梨酱，搭配培根或沙拉食用。虽然我无法解决所有伦理问题，但我会尽力选择更可持续的来源。

我热爱牛油果，尽管我一开始并不喜欢它。这并非偶然，而是源于多年来对心脏健康和饮食的深入研究和个人实践。研究表明，每周食用两次半个牛油果，可以将心脏病死亡风险降低高达16%，动脉斑块积聚风险降低21%。牛油果富含营养物质，包括多种维生素、矿物质、胆碱和健康脂肪，能够降低甘油三酯并提高高密度脂蛋白（HDL），这两点对于预防心脏病至关重要。

然而，牛油果并非完美无缺。首先，价格昂贵且易腐烂，这需要频繁购买，增加不便。**其次，许多人并不喜欢牛油果独特的口感和质地。**更重要的是，牛油果产业存在着剥削、恶劣工作条件和童工等问题，这让我在享受美味的同时，也感到不安。

为了解决牛油果易腐烂的问题，真空包装技术应运而生，延长了保鲜时间。但这又带来了新的问题：微塑料污染。面对这些挑战，我的策略是：尽可能经常食用牛油果，选择新鲜牛油果，并尝试从当地农场采购，以支持更可持续的生产方式。我会将牛油果切片或制成鳄梨酱，搭配培根、沙拉或豆类食用。

除了牛油果，我还关注发酵食品，例如希腊酸奶、开菲尔、纳豆、泡菜和酸菜。**发酵食品能够改善血糖、甘油三酯和胆固醇等生物标志物，并具有抗炎作用，降低心脏病风险。**其益处在于改善肠道菌群，维护肠道健康，这对于预防心脏病至关重要。肠道菌群如同一个体内花园，需要精心呵护。食用加工食品会破坏肠道菌群平衡，导致炎症和动脉斑块积聚。而发酵食品则能滋养益生菌，抑制有害菌的生长。

然而，并非所有发酵食品都健康。一些商业化生产的发酵食品可能添加过量糖分，或含有胺类化合物，过量摄入可能增加癌症风险。此外，一些发酵食品可能导致腹胀、胀气甚至腹泻。我的应对方法是仔细阅读标签，选择低糖、低胺的发酵食品，并少量尝试，逐渐增加摄入量。我偏爱纳豆粉和酸菜，通常会搭配佩科里诺罗曼诺奶酪和黄油一起食用。

坚果也是我日常饮食中不可或缺的一部分。**研究表明，坚果（如杏仁、榛子、巴西坚果、核桃、开心果和花生）能够降低心脏病发作的风险。**它们富含健康脂肪、欧米伽-3脂肪酸、纤维、植物甾醇、胆碱和L-精氨酸等营养成分，有助于扩张血管，降低血压，增强血管健康。

然而，**坚果也存在一些问题，例如腹胀、体重增加、硒中毒（过量食用巴西坚果）和氰化物中毒（过量食用杏仁）的风险。**此外，某些坚果的生产也存在伦理问题，例如腰果的生产可能涉及剥削。我的选择是：适量食用各种坚果，避免过量，并尽量选择可持续来源的坚果。我主要食用核桃、杏仁和山核桃，并避免食用糖衣坚果或其他加工坚果。

除了上述食物，我还推荐鲑鱼等富含欧米伽-3脂肪酸的鱼类。**欧米伽-3脂肪酸对心血管健康具有保护作用。**然而，**金枪鱼和剑鱼等大型捕食性鱼类汞含量较高，存在汞中毒的风险。**我更倾向于选择鲑鱼、鲱鱼和沙丁鱼等汞含量较低的鱼类。即使是鲑鱼，也存在价格昂贵、微塑料污染和养殖方式等问题。我选择尽量食用野生鲑鱼，并补充欧米伽-3补充剂。

最后，我还推荐亚麻籽和鸡蛋。**亚麻籽富含ALA（α-亚麻酸），一种欧米伽-3脂肪酸，但其转化率较低，且含有植物雌激素。**对于绝经后女性，植物雌激素可能具有保护心血管的作用，但对于男性，其影响尚不明确。我选择少量食用亚麻籽粉，并将其添加到沙拉中。鸡蛋富含营养，且不含糖，是健康的蛋白质来源。

总而言之，我推荐的这些食物都具有一个共同点：**低碳水化合物、高健康脂肪、未经加工且富含欧米伽-3脂肪酸。**这与传统的低脂、高碳水化合物饮食建议截然相反。我个人的经验表明，控制碳水化合物摄入，并摄入足够的健康脂肪，对于预防心脏病至关重要。 当前的饮食建议存在缺陷，将谷物作为食物金字塔的底部，并妖魔化脂肪，导致了肥胖、糖尿病和心脏病等问题的泛滥。我们需要改变观念，选择更健康、更可持续的饮食方式。

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00:48 我喜欢牛油果，这对我的心脏有好处，但我曾经不喜欢它，而且牛油果也有其问题和阴暗面。

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01:11 我想分享我是如何形成这份食物清单的个人故事。

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01:37 我过去认为自己很健康，但后来我开始质疑我的健康生活方式。

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01:53 尽管我努力实践健康的生活方式，但我仍然在形成动脉斑块，这很可怕。

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02:20 我发现自己在健康习惯上犯了一些错误，就像给花园浇水却一直在浇灌杂草。

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02:20 经过多年的经验和研究，我想分享给大家，为了避免心脏病发作，每个人都应该吃的五种顶级食物。

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02:34 为了避免心脏病发作，每个人都应该吃的第一种食物是牛油果。

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03:00 研究表明，每周吃两次半个鳄梨可以降低高达16%的心脏病死亡风险和21%的动脉斑块积聚风险。

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03:00 鳄梨富含营养物质，可以降低甘油三酯并增加高密度脂蛋白，这两者对于避免心脏病发作至关重要。

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03:26 鳄梨很贵，而且容易腐烂，很多人也不喜欢它的口感。

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04:22 鳄梨产业背后存在剥削、恶劣的工作条件、不适当的工人工资甚至童工等黑暗面。

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04:48 行业意识到新鲜度是个问题，并提出了自己的解决方案，即塑料真空包装。

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04:48 每个解决方案都会产生一个全新的问题，塑料真空包装会带来微塑料的问题。

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05:07 尽管存在这些问题，我仍然吃鳄梨，并尝试尽可能多地食用，同时尽量购买新鲜的鳄梨。

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05:36 我不试图解决伦理问题，如果你住在农场附近，你可以确保从当地农场采购。

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06:17 大多数希腊酸奶实际上具有欺骗性，因为许多所谓的健康低脂酸奶用糖代替了脂肪，这与我们需要的恰恰相反。

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06:44 健康的希腊酸奶和开菲尔以及其他发酵食品可以改善葡萄糖、甘油三酯和胆固醇等生物标志物。

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06:56 发酵是酵母和细菌分解糖的过程。

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07:25 发酵食品是经过这种受控微生物生长发酵的食品。

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07:36 有证据表明，发酵食品可以改善心血管风险指标，减少炎症，并降低心脏病发作的风险。

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08:04 肠道菌群参与心脏病和中风，我们肠道内大约有一万亿个细菌，它们比你想象的更重要。

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08:33 肠道菌群有助于产生多种维生素、营养物质，保护身体免受有害细菌的侵害，并有助于脂肪代谢和神经递质的产生。

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08:33 摄入加工垃圾食品会导致菌群失调，即有害细菌和其他微生物的生长，这会导致炎症、动脉斑块积聚和心脏病发作。

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09:01 食用发酵食品可以喂养有益细菌，促进抗炎作用并产生健康的微量营养素，从而预防心脏病发作。

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09:45 一些发酵食品，如开菲尔或康普茶，可能含有大量糖分，因为它们在发酵后会添加糖分。

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10:09 发酵食品的第二个问题是胺类，胺类是与氨和蛋白质相关的化合物，过量食用胺类会与一氧化氮混合并转化为亚硝胺，亚硝胺与癌症有关。

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10:54 盐可能会增加血压，但新研究表明，问题可能不在于盐，而在于胰岛素。

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11:38 腹胀、胀气甚至腹泻通常与肠道菌群的变化有关，通常是暂时的，并且是取代不健康肠道菌群的一部分。

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12:20 我会仔细阅读标签，避免食用闻起来发酸或变质或有结块或透明液体的开菲尔，我经常使用纳豆激酶粉，并且经常吃酸菜。

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12:47 胺类可能对某些食物过敏的人来说是个问题，但我建议缓慢地、少量地引入发酵食品，每周一到两次，逐渐增加，以避免腹胀或胀气。

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13:40 许多不健康的蛋白质棒都含有糖和防腐剂，因此我选择坚果。

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14:07 研究表明，食用坚果可以减少心脏病发作，最佳选择包括杏仁、榛子、巴西坚果、核桃、开心果甚至花生。

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14:32 坚果富含健康脂肪、omega-3脂肪酸、纤维、植物甾醇、胆碱甚至L-精氨酸等有益成分。

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15:02 坚果的缺点包括腹胀、体重增加甚至硒中毒，腰果与肯尼亚工人的剥削有关。

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15:08 腹胀实际上是改善微生物群的副作用。

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15:38 坚果可以帮助建立健康的细菌和健康的肠道生物群落。

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15:38 人们通常会责怪坚果中的脂肪，而忽略了他们正在吃大量的糖。

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16:07 我建议每天最多吃两个巴西坚果，并将杏仁限制在每天10到15个。

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16:35 我不吃腰果，因为我找不到一种合乎道德的腰果来源。

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16:35 我主要从亚马逊购买核桃，避免任何含糖的核桃或其他类型的加工坚果。

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17:25 苹果富含营养，但含糖量很高，而且没有足够的纤维来抵消糖的影响。

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17:55 喝苹果汁几乎就像纯果糖一样，就像喝非减肥苏打水一样。

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18:31 仅仅吃鱼就可以降低约5%的心血管死亡率，而且对于那些富含omega-3脂肪酸的鱼类来说，这个比例会更高。

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18:50 Omega-3脂肪酸是最健康的脂肪。

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19:18 这些omega-3脂肪酸已被发现对心血管健康具有非常强的保护作用。

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19:47 金枪鱼或箭鱼等顶级掠食性鱼类中的汞含量很高。

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20:03 汞中毒可能是一个严重的问题。

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20:48 汞暴露会导致儿童智商低、行走困难、说话困难，甚至出现个性和记忆问题。

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20:48 此外，其他鱼类已被证明比金枪鱼含有更多的营养物质，这就是为什么我更喜欢首先推荐鲑鱼。

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21:16 由于水污染，鱼类中存在微塑料，这些塑料最终会进入你的动脉，引起炎症。

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21:43 野生鲑鱼是在自然环境中捕获的，而养殖鲑鱼是由农民在圈养环境中饲养的。

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22:08 我更喜欢野生捕捞的鲑鱼，并尝试每周至少吃几次。

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22:37 吃鱼，即使存在这些挑战，也被证明比不吃鱼要好得多。

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22:52 我还补充omega-3，但omega-3补充剂也有其自身的问题。

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23:19 你必须确保专注于你使用的补充剂类型。

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23:19 如果你不喜欢肉，并且想要添加另一种不涉及补充剂或肉类的omega-3来源，那么可以选择亚麻籽。

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23:47 虽然一些研究表明，菜籽油可以改善心血管指标，但主要的改善是在低密度脂蛋白胆固醇方面。

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24:11 低密度脂蛋白理论正受到越来越多的审查。

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24:47 亚麻籽富含营养物质，尤其是ALA，即α-亚麻酸，它也是一种omega-3脂肪酸。

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24:47 亚麻籽很难消化，你必须把它磨成粉末。

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25:16 你的身体可以利用ALA制造另外两种omega-3，即EPA和DHA。

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25:16 我在沙拉上撒亚麻籽粉，目标是每天四到五汤匙。

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25:40 亚麻籽富含植物雌激素。

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25:40 缺乏雌激素是女性心血管疾病的主要风险因素。

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26:21 亚麻籽已被证明可以提高绝经后妇女的雌激素水平，这与omega-3脂肪酸的益处相结合，可以为女性提供心血管保护。

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26:48 对于男性来说，睾酮是最重要的男性激素。

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27:10 亚麻籽中的高雌激素含量会降低睾酮水平，并导致男性出现问题。

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27:35 我没有看到问题的证据，而且我在沙拉上吃一些亚麻籽，这对男性来说比社交媒体可能暗示的更安全。

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28:30 Attica研究的结果表明，平均每周吃一到三个鸡蛋可以降低45%的心脏病和中风风险。

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28:30 另一项涉及21项研究的荟萃分析表明，每天吃一个以上的鸡蛋与较少的动脉斑块积聚有关。

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28:55 鸡蛋不含糖，富含多种营养物质，包括胆碱、维生素和健康脂肪。

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29:22 一项荟萃分析表明，吃鸡蛋会增加心脏病发作的风险，但问题在于作者假设较高的低密度脂蛋白意味着更高的风险，这就是他们得出结论的方式。

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29:22 科学证据尚未表明饱和脂肪实际上是有害的。

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29:46 只要你避免糖和加工食品和超加工食品，你就可以实现健康的新陈代谢。

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30:28 每个人都应该吃这些食物以避免心脏病发作：鳄梨、发酵食品、坚果、鱼类和亚麻籽，鸡蛋作为奖励。

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30:52 这些食物的共同点是它们都富含脂肪且低糖。

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31:20 我的问题是，我的身体无法处理碳水化合物，不吃糖和碳水化合物对我来说是关键。

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31:54 超加工垃圾食品含糖量高，健康脂肪含量低，不健康脂肪（如反式脂肪）含量高，营养成分非常低，这导致了当前的糖尿病和肥胖症流行。

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32:20 那些避免脂肪并仍然吃大量碳水化合物的人仍然认为胆固醇是导致心脏病发作的原因，但事实并非如此。

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32:47 问题在于代谢疾病或前驱糖尿病和糖尿病，或医生称之为胰岛素抵抗。

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33:34 目前的饮食建议是错误的，谷物不应该是食物金字塔的基础。

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34:01 避免心脏病发作的最健康食物具有相反的成分：它们是低碳水化合物或糖，高健康脂肪，未加工且富含omega-3脂肪酸。

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. I love avocado, and it's a good thing. Avocado is great for your heart. I didn't always love it. I had to teach myself. And avocado has its problems, too, even its dark side. 语法解析

00:48

Before we start, let me share a personal story about how I developed this list of foods. It was the year 2014. I was in the same position as a lot of people in the U.S., Mexico, Brazil, other places in the world. I thought I was healthy. I was thin. I was running marathons and eating what I thought were the right foods at the time. 语法解析

01:11

It was a low-fat diet. It was what I'd been taught. I ran the program in prevention at Johns Hopkins, and that was the best that we knew at that point. I avoided medications and supplements. I thought supplements were just expensive urine or pee. But one thing happened that made me question my healthy lifestyle. In my late 50s, I developed high blood pressure. 语法解析

01:37

I got tested using a CIMT and found out I was building arterial plaque. Now, let me tell you, that's scary. With all the work that I was doing, and I practiced what I preached, I still was developing plaque. 语法解析

01:53

As I dug deeper, I found I'd been making some errors in my health habits. It was like thinking I was growing a beautiful garden, only to realize I'd been watering the weeds the whole time. The weeds. After years of experience, going through the research, going through my own story, I wanted to share with you these top five foods everybody should eat to avoid a heart attack. Let's get started. Now, which would you rather eat? 语法解析

02:20

A bowl of cereal or an avocado? If you chose avocado, you're right, obviously. This is the first food everybody should eat to avoid a heart attack. 语法解析

02:34

Studies show that eating half an avocado twice a week reduces the risk of death by heart attack up to 16%, and the risk of arterial plaque buildup by 21%. But why are avocados so special? They're full of nutrients. Those right there. A bunch of vitamins and minerals, choline, and many healthy fats. Avocados can lower your triglycerides and increase your HDL, 语法解析

03:00

Both things are critical to avoiding heart attacks. But as I mentioned, avocados do have their problems. First, avocados can be pricey, especially with tariffs and some of the fights that go on politically over them. You might have heard of the avocado crisis in 2022 in Texas. That year, guacamole became a luxury item during the Super Bowl. 语法解析

03:26

Second, they can rot quickly. A ripe avocado can go bad in a couple of days. They might lose nutrients and their taste changes. And let's be honest. 语法解析

03:38

Most people just don't like avocados to start with. They've got that waxy consistency. They are an acquired taste for most of us. I didn't like them at the beginning, and I learned to by eating them. Now, if you want fresh avocados, because they rot so quickly, that means multiple trips to the grocery store during the week. And then, in 语法解析

04:00

In addition, there's a very dark side behind the avocado industry. It seems that exploitation is involved. Poor work conditions, inappropriate payment of workers, and even child labor. You know, where there's money, there is conflict and abuse. So what to do about this? 语法解析

04:22

Well, first the problem with freshness. So the industry realized freshness was a problem and they came up with their own solution, a plastic vacuum pack. Now that plastic vacuum pack will keep the avocado fresh for weeks, especially in the fridge. Now, have you ever heard the phrase, every solution creates a whole new problem or even set of problems? 语法解析

04:48

Well, here's the next problem with that solution. Have you heard of microplastics? So, again, a lot of challenges, but I still eat avocados. Here's what I do. I try to eat avocados as often as I can, despite the problems. I eat some slices or guacamole on bacon in a salad. 语法解析

05:07

sometimes with beans. I get fresh avocados when I can, and I just cut them in half and just spoon it out of the peel. I can also buy some ripe and some unripened avocados to have at home, and the unripened ones last a few days longer, again, especially in the fridge. I just don't try to solve the ethical concerns. I don't know how. If you live near a farm, you can make sure to source ethically. 语法解析

05:36

You can try getting some from a local farm if you have that available. Now, enough about avocados. Let's go to the next one. How about yogurt, Greek yogurt versus kefir? 语法解析

05:47

If you chose Greek yogurt, you might be right and wrong at the same time. In the past, I've made the same choice for years. It was my go-to breakfast. But let me explain. Most Greek yogurts are actually deceiving. Once you look at the labels, you find that most Greek yogurts, especially the, quote, healthy low-fat yogurts, end quote, replace fat with sugar. That's the opposite of what we need. 语法解析

06:17

as well as other chemicals from food processes. Now, Greek yogurt can be really healthy. There's evidence it can improve biomarkers such as glucose, triglycerides, and cholesterol. So I'll go with both healthy Greek yogurt and healthy kefir, as well as other fermented foods like natto and kimchi. My favorite go-to is actually sauerkraut. You can find more discussions about natto and kimchi 语法解析

06:44

in some of our other videos. And if you're wondering about fermented foods to begin with, here's the thing. Fermentation is a process in which yeast and bacteria break down sugars. 语法解析

06:56

Fermented foods are those that have undergone this controlled microbial growth fermentation. Greek yogurt and kefir are fermented milk. They're using colonies of yeast and bacteria to do the fermentation in which the sugars are eaten by the bacteria and mostly the yeast. Kimchi is a Korean dish made out of fermented vegetables, mostly cabbage and radish. 语法解析

07:25

Natto is fermented soybean. Sauerkraut is fermented cabbage. Evidence shows fermented foods can improve cardiovascular risk markers, decrease inflammation, 语法解析

07:36

and reduce risk of heart attacks. Well, what's so special about fermented foods? This neglected player that we haven't discussed yet. It's involved in heart attacks and strokes, and it's called the gut biome. You see, inside our intestines, we have about one trillion bacteria. So you're not eating for one, you're eating for one trillion. That bacteria, those microbes, are more important than you think. 语法解析

08:04

They help produce multiple vitamins, nutrients. They keep your body safe from harmful bacteria. And they help with fat metabolism and a thing called neurotransmitters. You remember we mentioned that beautiful garden earlier? That's the gut biome. We really are walking around with a garden inside. You need to take care of it. And anytime you eat processed junk, you're causing a fire, burning all the healthy bacteria and bacteria. 语法解析

08:33

watering the weeds. We call that dysbiosis. Dysbiosis is the growth of unhealthy bacteria and other microorganisms. It's very common in people with prediabetes and diabetes, and it leads to inflammation, arterial plaque buildup, and heart attacks. That's why fermented foods are so good. For preventing heart attacks, you eat fermented foods, you feed the good bacteria, 语法解析

09:01

You promote anti-inflammatory effects and produce healthy micronutrients. You're watering your garden and removing the weeds and in the process escaping a heart attack. But just like with avocados, there are problems with fermented foods as well. 语法解析

09:20

First, similar to commercial Greek yogurt, some other fermented foods like kefir or kombucha might have a lot of sugar. Most of the time, they add the sugar back after the fermentation process. Why would they do that? Well, fermented foods also are an acquired taste. Most people don't grow up or naturally like them. 语法解析

09:45

They have sugar, but most of the sugar's already been consumed by the yeast, so they add that sugar back. The second problem is amines. Amines are compounds related to ammonia and related to proteins. Examples include histamine, tyramine. You might not have heard of putrescine or cadaverine, but yes, those are present as well. 语法解析

10:09

These last two are ones that give rotten food its unique smell, and sometimes you can smell that with fermented foods. When amines are consumed in excess, they can mix with nitrogen oxide and turn into nitrosamines. Nitrosamines have actually been linked to cancer. Some research suggests fermented foods might have high levels of amines. 语法解析

10:33

Really, that's only true for some fermented foods, like fermented fish, red meat, and some cheeses, like mish, which is a salty Egyptian cheese, parmesan, which is a very popular cheese, and other hard cheeses. Not so much in kefir, kimchi, or Greek yogurt. Now, there's another problem, salt. 语法解析

10:54

You might hear that a large amount of salt can actually increase your blood pressure. Well, there may be some truth to that. It's been the prevailing wisdom for decades. But newer research is indicating that actually salt may not be so much the problem as insulin. This means that the sodium in fermented foods like natto and kefir, sauerkraut, 语法解析

11:17

Might not be as big a problem as you think. Another problem is bloating, gas, even diarrhea. In my opinion, this has more to do with that change in the gut biome. People who have dysbiosis. Remember that geeky term? People with unhealthy bacteria will experience this, but it's usually temporary. 语法解析

11:38

and is part of replacing an unhealthy gut biome. If you think, gosh, this just sounds like too many problems. Again, slow down. Let me tell you what I do. 语法解析

11:50

I'm careful to read labels. If I buy kefir at the store, I avoid eating it or drinking it if it smells sour or rancid or if it has some clumping or clear liquid in it. And this also applies if you make your own kefir. I often use natto canace powder. And as I said before, I eat a lot of sauerkraut. And usually when I eat sauerkraut, I'll eat it with pecorino cheese, pecorino romano. It thickens that sauerkraut 语法解析

12:20

put some butter on that, and I love it. Now, back to the amines. You remember those things? This can be a problem for some people with allergies to these foods, but allergies to amines are really not that common. I recommend introducing fermented foods slowly in small portions once or twice a week. Increasing it slowly avoids bloating or gas. 语法解析

12:47

Let me know in the comments if you have tried any of these foods, and if so, how you do it. I used to eat Greek yogurt for breakfast every day for years, and it turned out that the yogurts that I liked had way too much sugar. I quit eating them for years, but again, with the evidence supporting fermented foods, I'm going back to those. Now, let's go to another quiz. Which one would you choose for your heart? A protein bar or nuts? 语法解析

13:20

Just to continue the trend of misleading labels, there's a lot of unhealthy protein bars out there that are full of sugar and preservatives. I'm not saying never eat any protein bar. There are some good options, but most of them are not. I have to go nuts for this one. 语法解析

13:40

Pun intended. Research has shown a decrease in heart attacks. The best options include almonds, hazelnuts, Brazil nuts, walnuts, pistachios, and even peanuts. My favorites, my go-to, are walnuts, almonds, and especially macadamia nuts, and most of all, pecans. I live in southeastern U.S., and pecans are grown here. 语法解析

14:07

So I can get and eat a lot of pecans. Macadamias and pecans are very, very good for a low-carb diet as well. So why are nuts in general so good for heart attack prevention? Well, they have plenty of beneficial components from healthy fats, omega-3 fatty acids, fiber, plant sterols, choline, and even L-arginine. Now, that's an amino acid. 语法解析

14:32

It's well known to help produce nitric oxide and therefore opening blood vessels, reducing blood pressure, and boosting vascular health. You may have guessed by now there are some downsides to going completely nuts, at least all the time. Some people have described bloating, weight gain, even poisoning from selenium. Nuts have their own dark side, yes. Cashew nuts have been linked to exploitation of people, of workers in Kenya. 语法解析

15:02

So let's address all of these real quick. Bloating is actually a side effect of improvement in the microbiome. 语法解析

15:08

Nuts can help build that healthy bacteria and the healthy gut biome. Is it possible to gain weight with nuts? You've heard people say, oh, if I eat too many nuts, I'll gain weight. They're just fat bombs. Ask those people what else they eat. You usually don't hear that in someone who's on a low-carb or keto diet. Most people blame the fat in nuts and neglect to tell you they're eating a lot of sugar. 语法解析

15:38

Now, let's talk about selenium and cyanide. Selenium poisoning might actually be a thing. I don't recommend eating more than two Brazil nuts in a day. Cyanide poisoning, maybe not so much, but still at least limit your almonds to 10 to 15 a day. And again, selenium and cyanide will not be an issue for you. If you really love cashew nuts, try thinking about ethical sourcing. And again… 语法解析

16:07

I don't eat cashew nuts for that reason because I can't figure out a way to ethically source cashews here. I get mostly walnuts from Amazon. I eat a lot of those. I prefer raw walnuts, but dry burnt ones are good too. I just don't get those very often. Avoid any sugar-coated walnuts or other types of processed nuts. Now, there's one more food that has even more omega-3 fatty acids. 语法解析

16:35

It's a food I've recommended for years, and it was one of the foods I've come to really appreciate once I made my change from low-fat to low-carb. So we have another decision to make. Real quick, don't think about it for very long. Apples or salmon? 语法解析

16:57

If you chose apples, let me tell you, years ago I would have chosen that as well. I liked them. They were nice and sweet. They had a nice crunch. And again, it took me a while to learn to love salmon. And we always used to hear, an apple a day keeps the doctor away, right? So they had to be healthy. Apples did. Well, there's a problem with that. Despite all their nutrients, apples have a lot of sugar. 语法解析

17:25

They're not packed with enough fiber to counteract that sugar. And I'm not saying don't eat apples. I eat maybe a slice or two a month. Just don't eat a lot of them. 语法解析

17:37

If you do eat apples, make sure that you either eat fiber or meat before the apple. Measure your glucose levels and just don't drink apple juice. And drinking apple juice is like almost pure fructose. And it's just like drinking non-diet sodas. 语法解析

17:55

The same thing applies to oranges and most fruits, unfortunately. But we're not comparing apples and oranges here. We're comparing apples and salmon. Salmon wins this one. 语法解析

18:07

Okay, I know salmon can be expensive. I recognize that. So that's why I give you a couple of alternatives in a few minutes that are just not that expensive. But why even consider salmon or other fish to begin with? Just eating fish has been shown to reduce cardiovascular death by about 5%. And that increases for every 5 grams you eat. 语法解析

18:31

especially for those fish with high omega-3 fatty acids. Omega-3 fatty acids are the healthiest fats. They include geek alert, EPA or icosapentaenoic acid, DHA, docosahexaenoic acid. Again, I hate that one. 语法解析

18:50

And there's a third one, ALA. We've mentioned it before when we're talking about nuts. We'll mention it again a little bit later. These omega-3 fatty acids have been found to be very protective for cardiovascular health. Now, guess which fish has the most omega-3? If you guess something like tuna or swordfish, you may be right. Those are followed by salmon with 2.5 milligrams for every 100 grams. 语法解析

19:18

Kippers or kippered herring, almost as much as salmon. And sardines at 1.6. So, wait a minute. I said salmon at the beginning. What's the problem with tuna or swordfish? I used to love tuna or swordfish until we found out the biggest problem with fish products. These top predator fish like tuna and swordfish run high in mercury. 语法解析

19:47

And again, especially true for tuna and swordfish. Mercury poisoning can be a serious issue. Do you remember Alice in Wonderland? You remember that story and you remember the mad header? That was a real thing. 语法解析

20:03

That story was written in England a couple of hundred years ago at a time when hats were very, very popular and especially a specific hat called a beaver felt hat. Those beaver felt hats were made using mercury. So hatters were often crazy. 语法解析

20:22

So, to go back to modern days, we have since discovered that mercury exposure can cause problems. Kids have low IQ, walking problems, problems talking, even personality problems and memory problems like the mad hatter. Additionally, other fish have been shown to have more nutrients than tuna, so that's why I prefer to recommend salmon first, tuna, and 语法解析

20:48

And again, my old favorite, swordfish last. Salmon's not free of its own problems. We mentioned cost. We mentioned mercury. And then you have microplastics, which due to water pollution, it's been seen that fish with significant amounts of plastic being eaten and end up in your arteries, causing inflammation. There's another major problem associated with salmon, and that is how you access it. 语法解析

21:16

You have wild salmon, which is very expensive, and farm salmon, which is less expensive. Wild salmon are caught in their natural environment, such as oceans, rivers, and lakes. They have more natural diets. They have less exposure to animals, to drugs. They've been found to have a better nutrition profile. Farm salmon is raised in captivity by farmers. They control its breeding, its feeding. 语法解析

21:43

They give them medications including antibiotics. And guess what? 75% of salmon consumed is farmed. So when it comes to this question, what can you do with this information? Let's just boil it all down. And let me just tell you what I do. I obviously prefer wild-caught salmon. I try to eat it at least a couple of times a week. 语法解析

22:08

I used to eat it four and five times a week, but I've changed some of my habits now. I'm not worried so much about mercury with salmon or microplastics. Not because they're not a problem. They might be, but eating fish, even with these challenges, has been shown to be a much better bet than not eating fish. I don't eat tuna and swordfish anymore. I hate that. I used to love it. Now, when you cook the salmon like this… 语法解析

22:37

It's a delicious option. I also supplement with omega-3s. That's another option. It won't include plenty of the other nutrients that you find in fish. And as you know, omega-3 supplementation has its own set of problems. 语法解析

22:52

which I'm not going to go down other than to say you've heard of supplements going rancid. So you have to make sure to focus on the type of supplement you use if you supplement with omega-3s. Now, if you don't like meat and you want to add another omega-3 source that doesn't involve supplements or meat, there's another option. What do you think that is? How about canola oil or flaxseed? 语法解析

23:19

If you chose flaxseed, you're right. Canola oil is a type of seed oil. Seed oils are plant-based foods derived from plant seeds. And although some studies suggest canola oil can improve cardiovascular markers, the major improvement is seen in LDL cholesterol. Now, LDL cholesterol used to be thought of, used to be considered the number one risk factor for heart attack and stroke. 语法解析

23:47

That LDL theory is coming under a lot of scrutiny these days. The evidence is beginning to show something very different. In fact, I don't worry too much about LDL. If you have more interest on it, we've got a video on the worst lie about cholesterol. You can also see our perspective on seed oils in this video. 语法解析

24:11

But let's talk a little bit more about the winner, flaxseed. I know flaxseed might be the preference of a lot of people. 语法解析

24:18

There are challenges with it, though, and I understand, but allow me to elaborate. Flax seeds or linseeds are small seeds from the Middle East. They're packed with nutrients, especially ALA. You remember that omega-3 acid? It's called alpha-linolenic acid. It also has EPA. Both of these are, again, those omega-3 fatty acids. The seed can be hard to digest. You have to ground it into a powder. 语法解析

24:47

I know many people recommend against flaxseed because the conversion of ALA is very low. In fact, ALA is considered to be one of the required fatty acids. And that's because with ALA, your body can make the other two omega-3s, and that is EPA and DHA. Now, regardless, for those that do use flaxseed, I use flaxseed as well. I use it as a powder on my salads. About four to five tablespoons a day is the goal. 语法解析

25:16

And it is a great option. But there's another problem. Again, another problem with flax seeds. For those of you who are familiar with it, you may already be thinking about it. Flax seeds full of plant estrogens. Estrogen is a female hormone. It helps maintain female body characteristics. Lack of estrogen is a major cardiovascular risk factor for women. 语法解析

25:40

So it's no surprise that heart attacks in women can happen during menopause. That's when they happen. And in fact, just as many women die of heart attacks as men. They just die a little bit later, usually a few years to a decade after menopause. 语法解析

25:56

Now, flaxseed has those phytoestrogens or plant estrogens. Do they really impact humans to begin with? And if so, is it really a problem? The answer is yes, flaxseed does have those phytoestrogens. They've been shown to increase estrogen levels in postmenopausal women, which in turn combines with the benefits of omega-3 fatty acids. 语法解析

26:21

And it can provide cardiovascular protection, that is, fewer heart attacks for women. It's great for postmenopausal women who are at big risk for heart attacks. But what about men? Can men get the same benefits or is it bad for men to eat these types of phytoestrogens? For men, testosterone is the most important male hormone. 语法解析

26:48

One of the biggest problems you see online with flaxseed is this high amount of estrogen in flaxseed, lowering testosterone levels and causing problems for men. Problems like difficulty building muscle, sexual performance, maybe some getting blamed for hair loss, even depression and sleep issues in men. 语法解析

27:10

Now, is that the truth? Well, when you look at the evidence, there are two small studies suggesting that this might be a problem for men. But there's a lot more stronger evidence out there that really doesn't indicate that. I've not seen evidence of a problem. And as I mentioned, I do eat some flaxseed on my salads. It's safer for men than what social media might suggest. 语法解析

27:35

tell you. In the end, it's up to you. There are other sources, as we've already mentioned. Salmon, kippers, sardines, even chia seeds, which we didn't discuss. There are other options there for omega-3s. Now, I do have a bonus food on the list just for you. Let's see if you can choose correctly. Would you rather eat margarine or eggs? Well, the right answer most of you know. 语法解析

28:05

is eggs. The result of the Attica study showed that eating an average of one to three eggs a week can decrease the risk of heart attack and stroke by 45%. Another meta-analysis, again, a study of studies involving 21 studies, showed that eating more than one egg a day was associated with less arterial plaque buildup. 语法解析

28:30

There's a clear reason for why eggs are healthy. They have no sugar. They're rich in plenty of nutrients, including things like choline, vitamins, and healthy fats. Now, there are studies that show other things. There's one meta-analysis showing an increased risk of heart attacks when eating eggs. But you've got to dig deeper in any of these studies when you look at them. 语法解析

28:55

The problem with this study was that the authors assumed that higher LDL means more risk, and that was how they based their conclusion. As we've said before, LDL being the major risk for heart attack and stroke, that may have been the biggest cholesterol lie in history. Yes, scientific evidence has not shown that saturated fats… 语法解析

29:22

which many label as unhealthy fats, are actually harmful. That's why I think foods like free-range chicken eggs and unprocessed meats are great for metabolic health. Now, a paradigm shift is necessary to prove that eating red meat and eggs is not dangerous, as you've been told time and time again. 语法解析

29:46

Without going further on the vegan versus carnivore controversy, I do believe as long as you avoid sugar and processed and ultra-processed foods, you can achieve a healthy metabolism. Now, I've covered a whole lot. Let's recap real quick, and then we'll talk about why the list makes sense. 语法解析

30:09

The top five foods. First of all, let's run through the list. Everybody should eat these foods to avoid a heart attack. Avocados, fermented foods like healthy Greek yogurt, kefir, kimchi, natto, sauerkraut, nuts, fish like salmon, herring, kippers, sardines. 语法解析

30:28

Back to nuts, macadamia nuts, almonds, pecans, and especially walnuts. Flaxseed. Eggs as a bonus. But did you notice something about all these that they have in common? Yes, these foods are all high in fat and low in sugar. That's the major lesson that changed my life. 语法解析

30:52

See, my problem is, and what I discovered when I was creating that plaque was, my body cannot process carbs. That happens to all of us as we age. It happened to me in my mid to late 50s. I found out I had prediabetes. Not eating sugars and carbs is key for me. Right now in America, millions of Americans have been doing the exact opposite. 语法解析

31:20

Low fat, high carbs. The base of the food pyramid is grains. But the problem is over half of American adults have prediabetes. Once you get into your 50s and 60s, that increases to 70 to 85%. 语法解析

31:39

Ultra-processed garbage food is high in sugar, low in healthy fats, high in unhealthy fats like trans fats, very low in nutrients, and it leads to the current diabetes and obesity epidemic. 语法解析

31:54

it actually stimulates the insulin that we want to decrease. It results in heart attacks. That's why heart attacks are the number one cause of death. There's another group of people who are living healthier lives, avoiding fats and still eating lots of carbs, sometimes even processed sugar, and thinking that because they're thin, they are healthy. That was me a couple of decades ago. 语法解析

32:20

The problem is they still think that cholesterol is what causes heart attacks, but that's just not true. The problem is metabolic disease or prediabetes and diabetes, or as the doctors call it, insulin resistance. Speaking of doctors, why haven't doctors helped us out with this problem? Well, you know, I mentioned over half of adults in the U.S. have this problem. 语法解析

32:47

But 90% that have it don't know it. Unfortunately, it's because the doctors, the primary care doctors, family practitioners, internists, and cardiologists, three quarters of them don't know how to diagnose insulin resistance. So again, that's where I was about a decade ago, eating a low-fat diet. 语法解析

33:07

Healthier than most people by staying thin but still developing arterial plaque. So the key message here, the current dietary recommendations are just wrong. Grains should not be the base of the food pyramid. Putting grain products like bread, cereal, and rice and pasta as the base of the food pyramid and demonizing fats is what got us to the point where we are now. 语法解析

33:34

Half of us are obese, pre-diabetic. The healthiest foods to avoid a heart attack share the opposite in composition. They're low in carbohydrates or sugars, high in healthy fats, not processed, and rich in omega-3 fatty acids. If you don't know what's healthy to eat, look for the characteristics that we just described that made up this list, the patterns. Low carbs, high 语法解析

34:01

Higher fats. 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

</markdown>

D:2025.10.23<markdown>

他介绍了一项他所见过的、唯一试图通过减少碳水化合物来逆转心脏病（即减少动脉斑块）的临床试验。他指出，这项试验在社交媒体上从未被讨论过，他预先警告，该试验存在一些重大的局限性。尽管如此，他认为这项试验也带来了一些非常有趣的启示，其结果可能会让许多人感到惊讶。

试验名称与目标

这项研究的名称是“通过饮食干预逆转颈动脉粥样硬化”。颈动脉是颈部为大脑供血的动脉，而动脉粥样硬化即指动脉中的斑块，是心血管疾病的一种表现。因此，该研究的目标是通过给予参与者不同的饮食方案，观察是否能够缩小动脉中的斑块，从而实现逆转心脏病或心血管疾病的效果。

参与者特征

研究招募了140名年龄在40至65岁之间的参与者。他们要么体重指数（BMI）至少为27，要么患有2型糖尿病或冠心病。这是一项旨在减轻体重的试验，因此所有参与者都处于超重或肥胖状态。

值得注意的是，参与者中有88%是男性。为什么许多临床试验中男性比例偏高。他指出，这并非研究人员的性别偏见，而是因为在招募患有特定疾病（尤其是用于“逆转”试验）的“病情较重”的人群时，从统计学上看，男性往往比女性更不健康。他半开玩笑地提到，男性寿命较短，这部分因为基因，部分则是因为男性往往更倾向于做出不健康的行为 —— 饮食更不健康、运动量更少、吸烟饮酒更频繁。

这140名参与者被随机分为三组，分别接受不同的饮食指导：

1. 碳水减少组
2. 脂肪减少组
3. 地中海饮食组

宏量营养素目标与实际摄入

• 脂肪减少组：目标是将脂肪摄入量控制在总热量的30%左右。为了避免关于“低脂”定义的语义之争，选择将其称为“脂肪减少”或“较低脂肪”饮食，因为该组的脂肪摄入确实低于其他组。最终成功地将脂肪摄入量维持在30%左右。
• 地中海饮食组：脂肪摄入量约为总热量的33%。
• 碳水减少组：其脂肪摄入量最高，约为38-39%。最初的指导是在头几个月每天摄入约20克碳水，之后逐渐增加到每天最多120克。然而，参与者未能完全遵守这一严格的限制。最终实际的碳水摄入量约占总热量的40%，而另外两组则约为50%。因此，尽管该组确实减少了碳水摄入，但并未达到严格的低碳水标准。

热量限制与实际摄入

一个重要的设计差异是，地中海饮食组和脂肪减少组有明确的热量上限（女性约1500卡，男性约1800卡），而碳水减少组则没有热量限制，被告知可以随心所欲地吃。

然而，尽管设计不同，最终三个组的参与者都自发地减少了热量摄入，并且三组的最终总热量摄入量大致相同。

理解实际食用的食物种类至关重要。

• 脂肪减少组与地中海饮食组：饮食建议非常典型，主要由全谷物、水果、蔬菜、豆类等完整的碳水化合物构成，限制添加脂肪和甜食。地中海饮食组在此基础上增加了更多的橄榄油和坚果。
• 碳水减少组：该组的饮食建议非常有趣。研究人员推荐了素食来源的脂肪和蛋白质（如植物、乳制品或鸡蛋），建议避免反式脂肪。这一建议导致该组的饱和脂肪摄入量与其他两组非常接近（约为12%，而其他两组为10%），远低于许多高饱和脂肪的低碳水饮食。同时，该组摄入了比其他两组更多的不饱和脂肪（如橄榄油、鱼和坚果）。

示例菜单对比

通过展示三个组的示例菜单，三者之间存在很多共性，都主要由高质量的健康食物构成，如蔬菜、低脂或高脂乳制品、鸡胸肉、鱼肉等。主要区别在于：碳水减少组去掉了面包，用高脂乳制品代替了低脂乳制品，并且有些食物是油炸而非烘烤的。他总结说，这三种饮食中的任何一种，对于大多数西方人来说，都将是“天赐的福音”。

该试验的随访期为两年，期间各组的体力活动没有显著差异，因此饮食是主要的干预措施。

体重减轻

• 初期（6个月内）：低碳水组（蓝线）的体重下降速度最快。
• 中期（1年）：低碳水组出现体重反弹，与地中海饮食组（黄线）的减重效果持平。
• 末期（2年）：两者依然持平。脂肪减少组（红线）的效果最差，但所有三组都实现了并在两年内维持了一定程度的体重减轻。

载脂蛋白B（ApoB）

这是一个令人惊讶的结果。

• 初期（6个月内）：低碳水组的ApoB下降幅度最大。
• 末期（2年）：所有组都出现了反弹。地中海饮食组和脂肪减少组的ApoB水平基本回到了基线，甚至略有升高。而低碳水组是唯一一个在两年后仍然保持了ApoB水平有所降低的组。

这颠覆了“低碳水饮食会搞乱胆固醇”的普遍看法。关键不在于碳水的多少，而在于饮食的构成和脂肪的质量。如果低碳水饮食充满了培根和黄油，ApoB很可能会升高；但如果富含多脂鱼、发酵乳制品、蔬菜、橄榄油和坚果，结果则可能完全不同。他还深入解释了背后的机制：不饱和脂肪与饱和脂肪的比例是影响胆固醇和ApoB的强大驱动力，不饱和脂肪能增加肝脏上清除ApoB的受体，而饱和脂肪则会减少。

动脉斑块（主要结果）

• 总动脉壁厚度：所有参与者合在一起，颈动脉的总壁厚度平均减少了5%。具体到各组，碳水减少组的减少量最大（84立方毫米），其次是脂肪减少组（61）和地中海饮食组（38）。然而，各组之间的差异没有统计学意义。这可能意味着三者效果相似，也可能意味着研究的统计功效不足以检测出差异。
• 内中膜厚度（IMT）：这是一个更具体地测量动脉内两层壁厚度的指标。所有参与者合在一起，IMT下降了1.1%，但这一结果没有统计学意义。研究人员并未报告各组的具体IMT下降值。

这项试验存在几个致命的局限性。

1. 测量指标的模糊性：无论是“总动脉壁厚度”还是“IMT”，测量的都是动脉壁的结构层，而不是特异性地测量斑块本身。动脉壁变薄可能来自斑块的减少，也可能来自肌肉层的萎缩。因此不能确定地说斑块被减少了。
2. 缺乏临床终点事件：该试验没有报告实际的心脏病发作、中风等临床事件。动脉壁厚度等指标终究只是事件风险的“替代终点”。

最终结论

尽管存在局限性，仍可以得出一些有价值的结论：

• 所有三种高质量饮食都显示出益处：三组都减轻了体重，并使动脉壁厚度有变薄的趋势。
• 精心设计的低碳水饮食是安全的，甚至可能是有益的：在改善ApoB和减轻体重方面，精心设计的、富含不饱和脂肪的较低碳水饮食表现出了与地中海饮食相当甚至更优的趋势，并未像担心的那样恶化血脂。
• 饮食质量重于宏量营养素比例：这项研究最重要的启示是，所有三种饮食模式都压倒性地由高质量的健康食物构成。这才是关键。宏量营养素的分配（脂肪和碳水的比例）可以根据个人偏好和身体反应来调整，只要整体的饮食模式是促进健康的。

他总结道，对于个体而言，如果喜欢低碳水饮食，并且这种饮食（在良好构成的前提下）能帮助降低ApoB、减重并维持在理想范围内，那就没有问题。如果不能，就应该寻找其他适合自己的方法。

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对一项复杂的营养学研究进行了非常细致和审慎的解读，其观点展现了高度的科学素养和批判性思维。他不仅呈现了研究结果，还深入剖析了其方法论上的多个重大局限性，这种平衡的呈现方式本身就是其观点的最大优势。然而，即便是如此严谨的分析，在面向大众传播时，仍然存在一些值得进一步探讨的方面。

1. 核心观点问题不大，但研究本身的缺陷是致命的

他已经指出了研究的大部分核心问题，但这些问题的严重性可能比他所描述的还要大，以至于这项研究几乎无法得出任何关于“逆转心脏病”的有效结论。

• 替代终点的不可靠性（已指出）：使用“动脉壁总厚度”和“IMT”作为斑块的替代指标是该研究的致命缺陷。动脉壁的厚度变化可以由多种因素引起，包括平滑肌细胞的增生或萎缩、细胞外基质的变化等，这些都与斑块的脂质核心无关。因此，声称这项研究“逆转了动脉粥样硬化”是完全没有根据的，这是一个具有严重误导性的标题。
• 依从性失败导致研究问题偏移（已指出）：所谓的“低碳水组”实际上并未执行低碳水饮食，而是中等碳水饮食（40%）。这意味着，这项研究从根本上没有测试声称要测试的干预措施（即严格的低碳水饮食）。实际上是在比较一种中等碳水、高不饱和脂肪的饮食与其他两种饮食，这完全改变了研究的性质和结论的适用范围。
• 体重减轻作为强大的混杂因素：所有三个组都减轻了体重。体重减轻本身就是改善几乎所有心血管代谢指标（包括血脂、血压、炎症和血管功能）的最强大干预措施之一。因此无法将观察到的任何积极变化（如ApoB下降或动脉壁厚度变薄）明确归因于特定的宏量营养素分布，还是仅仅归因于热量赤字和体重减轻这一共同结果。这项研究的设计未能有效地将这两个因素分离开来。

2. 对ApoB结果的解读可能过于乐观

他正确地指出了“较低碳水组”在降低ApoB方面的出色表现，将其归因于高品质的不饱和脂肪。这一解释在机理上是合理的，但也需要更审慎的看待。

• 统计学波动 vs. 临床意义：虽然在两年终点时，只有较低碳水组的ApoB仍低于基线，但所有组都经历了显著的反弹。需要考虑这种微小的、在统计上可能并不显著的终点差异，是否具有真正的临床意义。在缺乏临床事件数据的情况下，过分强调这一微小差异可能是在“矮子里面拔将军”。
• 对饱和脂肪的立场可能被误解：他正确地强调了不饱和脂肪的重要性，并指出该研究中较低碳水组的饱和脂肪含量并不高。然而，这可能会被一些人误解为“只要多吃不饱和脂肪，饱和脂肪就没关系”。主流观点仍然认为，对于大多数人来说，用不饱和脂肪替代饱和脂肪是降低心血管风险的关键，而不仅仅是简单地“多加”不饱和脂肪。

3. 对“饮食质量”的结论虽然正确，但可能削弱了研究的特定价值

他最终得出的“饮食质量至上”的结论是明智且安全的。然而，这也暴露了这类研究的一个普遍困境。

• 问题所在：当所有干预组都采用高质量的全食物饮食时，各组之间的差异往往会变得非常小，难以在统计上检测出来。这使得研究在回答“哪种宏量营养素分布更优”这一具体问题上变得无力。最终的结论往往会回归到“吃真正的食物很重要”这一虽正确但宽泛的公共卫生信息上，而这并不需要耗资巨大的随机对照试验来证明。
• 潜在的虚无主义：如果所有精心设计的饮食都差不多，可能会让一些人觉得“怎么吃都无所谓”，从而忽视了在个体层面，某些宏量营养素的调整可能确实会带来更显著的益处。

结论

总而言之，该分析本身几乎没有什么问题，他是一位非常出色和负责任的科学传播者。他没有夸大其词，而是以一种教育性的方式引导理解一项复杂且充满缺陷的研究。该内容真正的问题不在于他的观点，而在于他所分析的研究本身质量不高，其设计上的致命缺陷使得任何基于它的结论都必须持极大的保留态度。

他已经尽其所能地从一份“有瑕疵”的原材料中提取了最合理、最审慎的“黄金”。他成功地利用这项研究作为一个“教学案例”，阐明了比研究本身更重要的原则：区分相关性与因果性、注意混杂变量（如体重减轻）、理解替代终点的局限性，以及最终，认识到饮食的整体质量远比纠结于单一宏量营养素的比例更重要。

Can you Unclog your Arteries by Cutting Carbs？!？ (VBWwkgPYjis)

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D:2025.10.23

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