International Circlation: A lot of your focus is on lifestyle and cardiovascular health.  Can you give a brief overview of the long term effects of diet drinks， of tea， on alcohol or other beverages on cardiovascular health?

　　《国际循环》：您一直关注生活方式对心血管健康的影响。能否请您简要概述一下饮用茶、酒精及其他饮料对心血管健康的长期影响?

　　James O’Keefe : I think as physicians we underestimate the power and importance of diet and exercise.  To be honest with you， at least in America， I went to school until I was 32 and straight up had zero training on nutrition， which is a big mistake.  Nutrition is extremely important for long term cardiovascular health and longevity.  There is no getting around it.  You can not just rely on drugs and procedures to keep you health if you are eating a bad diet， it just does not work.  We really focus a lot on diet， we think it is very important granted there is a lot of confusion， at least in America， about the right diet because there is so much noise out there but there is growing consensus of enlightened individuals who are emphasizing commonalities such as avoiding process foods， staying away from things with added sugar in it， avoiding processed carbohydrates and eating more fruits and vegetables， at least 5 to 9 servings per day.  The average American eats 2.  I think in China they are better than that.  My wife is a Registered Dietician and emphasizes eating at least 2 colors in every meal and a modest amount of health protein like something the size and thickness of the palm of your hand.  Non fat， unsweetened yogurt for example， or a chicken breast， or a piece of fish.  Even small amounts of red meat a couple times a week are not the problem.  The problem is too much processed food， too many calories， too much sugar， and too much hot processed junky starchy food.  It is very important and regarding beverages， this is common sense， at least for most people， but water – you can’t beat it as a beverage.  8 glasses a day or about 2 liters a day of water.  After that， coffee and tea turn out to be really healthy beverages.  They are low calories and loaded with antioxidants.  Good observational studies showing coffee and tea correlate strongly with reduced cardiovascular deaths and reduced cardiovascular events also reduce risk of new diabetes， stroke， and probably improve long term cognition in respect to lower rates of neurodegenerative disease.  Over in China， here and in Japan， the cultures for millennia， where it is really where tea and green tea originated which personally is one of my favorite beverages， I learned that from my grand grandmother who lived to be 94 and she drank a lot of green tea， but green tea and coffee are very health beverages.  Best to avoid adding sugar and too much things like cream but it is like drinking your vegetables and no calories in it.  Alcohol， is another controversial topic but there is more and more strong observational data， not too much randomized data because we are never going to have long term outcome with randomized data with alcohol but the observational data is pretty strong.  It has shown that light to moderate alcohol consumption improves cardiovascular risk and probably reduces alcohol’s mortality but we do not know for sure.  What we do know for sure about alcohol is that too much is catastrophic.  The number 1 cause of premature death among 15 to 59 year old males in America is related to excess alcohol with things like accidents， violence， cirrhosis， strokes， atrial fibrillation， it is a disaster.  It is a slippery slope， a very sharp double edged sword.  One drink a day is almost as good as anything else you can do for yourself from a cardiovascular standpoint and can obviously improve quality of life for people too.  Another grandmother of mine never missed a happy hour.  She lived to be 102.  She drank whiskey， 1.5oz of whiskey， one shot a day as did one of the healthiest American presidents Harry Truman， he did that his whole life.  One shot of alcohol a day.  I think red wine is the best of all the different alcohol based drinks based on observational data and the fact that tea and coffee are loaded with antioxidants.  The other thing that we learned is that we do not recommend people who do not drink to start drinking because it is hard to predict who might develop a problem.  If you can drink light to moderate amounts of alcohol ideally it is done on a daily basis with or before your largest meal， usually your evening meal， because it helps to reduce post prandial glucose spike which turns out to be really important.  Small amounts of alcohol， red wine would be ideal， but the key is the dose.  Not more than 1 drink per day for women， 2 drinks per day for men and avoiding binge drinking too which can be problem even if you are otherwise a non drinker or drink moderately.  Binge drinking really can increase cardiovascular risk.

　　James O’Keefe教授：我认为，作为医生，我们低估了饮食及运动的作用及重要性。说实话，至少在美国，我的体重指数达到32并进一步直线上升前没有得到任何有关营养方面的培训，而这一点是非常大的一个错误。营养其实对人体的长期心血管健康及长寿是非常重要的，但我们却常常忽视了它。人们不能仅靠药物及治疗来保持健康，如果无法采用健康的饮食，药物及其他治疗的作用会大打折扣。一直以来，我和我的研究团队比较关注饮食，我们认为目前来说就饮食问题而言，至少在美国有关何为正确的饮食还尚存很多争议。虽然还存在一些争议，但现在已经有越来越多的人开始达成共识，强调要避免加工食品、添加了糖的食品、避免食用加工的碳水化合物，需要多吃水果和蔬菜（至少每天5~9份），但目前美国的平均食用量却仅有2份。我认为，在中国这种情况要比美国好些。我的妻子是一名注册营养师，她强调每餐至少要吃两种颜色的食物以及适量（大小及厚度如手掌大小）的健康蛋白质如脱脂无糖酸奶、鸡胸肉或一块鱼。每周吃几次每次吃少量红肉也没有问题。但如果食用太多加工食品以及含过多热量、过多糖分及毫无价值的淀粉类加工食品的话，就有问题了。至少对大多数人的生活而言，饮料都已经成为不可或缺的一部分，但是我们决定不能用其来完全替代水。每人每天需要引用8杯或大约两升水。咖啡及茶是比较健康的饮品，其热量较低，富含抗氧化剂。观察性研究显示，咖啡及茶可显著降低心血管事件、心血管死亡及新发糖尿病、卒中的发生风险，并可能有助于改善患者的长期认知功能、降低神经退行性疾病的发生率。中国及日本是茶及绿茶文化的起源地。受我祖母的影响，茶及绿茶是我本人非常喜欢的饮品之一。我的祖母活到了94岁，她每天喝很多绿茶，绿茶及咖啡都是非常健康的饮品。我们在饮用时最好不要额外添加糖及太多其他东西就行，单纯喝茶就像是喝不喝热量的蔬菜汁一样非常健康。饮酒对心血管健康的影响则是一个尚存争议的问题。有关饮酒对心血管健康的影响获得了越来越多的观察性研究数据，但缺乏大量随机试验数据。我们现在尚无有关饮酒对心血管长期健康结局的随机试验数据，但获得了很多观察性研究数据。观察性研究数据表明，少量及适量饮酒能减少心血管风险，并可能降低死亡率。不过，对此我们还缺乏明确的随机试验证实，无法做确定结论。目前我们唯一明确的是，过量饮酒是对健康是非常不好的。在美国15~50岁男性中，过量饮酒所致的交通事故、暴力冲突、肝硬化、卒中、心房颤动是导致过早死亡的首要原因。饮酒对心血管健康而言可能是个双刃剑。每天饮用一杯酒可能有助于改善心血管健康，提高生活质量。我的另一个祖母活到了102岁且生活得非常好。她与美国最健康的总统哈里·杜鲁门一样一生中每天都要喝1.5盎司的威士忌。我认为，从观察性数据来看，红酒是所有酒类饮品中最好的。而茶及咖啡富含大量抗氧化物质也是非常不错的。但是，我们并不推荐不饮酒的人们开始饮酒，因为目前我们还很难预测哪些人饮酒后会出问题。如果平时就少量和适量饮酒的话，最好在每天吃主餐那顿饭通常是晚餐时饮用，因为这有助于降低餐后血糖，而餐后血糖对健康而言是至关重要的。少量饮酒尤其是红酒应该还是非常理想的选择，但问题的关键是饮用的剂量。对女性而言每天不要超过1标准杯，男性每天最好不要超过2标准杯，并避免暴饮，则能避免很多问题。因为暴饮真的会增加心血管疾病的发生风险。