摘要：长寿建议似乎总是面向男性，但女性的健康之路有何不同？当更年期遇上“网红”养生法，我们究竟该听谁的？《纽约时报》专访多位专家，揭晓答案：在运动、饮食、睡眠等健康基石上，男女的相似之处远多于差异。文章指出，女性最易忽略的力量训练至关重要，并澄清了关于蛋白质摄入、酒

有趣灵魂说

译文为原创，仅供个人学习使用

The New York Times | 纽约时报

Are the Longevity Rules Different for Women?

女性长寿法则有所不同吗？

We asked experts in health and aging about what women really need to do to live longer.

我们咨询了健康与衰老领域的专家，了解女性要想长寿真正需要做些什么。

By Dana G. Smith

Holly Stapleton

长寿运动中最响亮的声音往往是男性。但现在出现了一个新的专家网红子群体——"更年期姐妹团"——她们就女性应如何保持更长时间健康提出了极其具体的建议。男性和女性的身体真的如此不同，以至于我们需要在运动、营养和睡眠方面制定量身定制的指南吗？

的确， 激素在健康中扮演着重要角色 。而且某些疾病，包括骨质疏松症和痴呆症，对女性的影响大于男性——这种差异被认为（至少部分）是由更年期引起的。

但专家表示，在保持健康的基本行为方面，男性和女性的相似之处远多于差异。

"我认为，关于女性长寿我们已经了解了很多，"加州大学圣地亚哥分校赫伯特·韦特海姆公共卫生与人类长寿科学学院的教授安德里亚·拉克鲁瓦说。"但我们尚未确定的是，在预测长寿的健康行为方面，我们与男性有着根本性的不同。"

我们咨询了妇科学、流行病学、运动、营养和睡眠领域的专家，探讨如何优化女性的衰老过程，以及传统建议在哪些方面可能需要调整。

运动

专家表示，问题不在于男性和女性应该以不同的方式锻炼，而在于他们本应以相同的方式锻炼，但传统上女性并非如此——特别是在力量训练方面。

如果在1980年代有女性举重，"人们看你的眼神会像你长了两个脑袋一样，"旧金山湾区的妇产科医生、《更年期宣言》的作者詹·冈特博士说。

尽管如今女性进行力量训练已更为普遍，但性别差异仍然存在。专家表示，这对女性来说是一个错失的改善健康的机会，尤其是在她们年龄增长的过程中。

男性和女性都从30多岁开始经历渐进的、进行性的肌肉流失 。如果人们本来的肌肉量就较少，那么到60或70岁时，他们患上少肌症（一种具有临床意义的肌肉流失，会影响日常活动）的风险就会更大。绝经后女性患骨质疏松症的风险也显著增加。 力量训练是帮助预防这两种情况的最佳方法之一 。

"限制你晚年生活的不会是心肺适能，而会是力量和爆发力，"加拿大安大略省麦克马斯特大学运动机能学教授斯图尔特·菲利普斯说。

一些网红武断地认为，围绝经期女性应该用非常重的重量进行力量训练。但菲利普斯博士说，研究表明，举任何类型的重量——轻的、中等的或重的——都可以改善男女的骨密度和增强肌肉。

这并不意味着女性应该放弃有氧运动 。《美国人体力活动指南》要求每周至少进行150分钟的中等强度心血管活动，以及两天的力量训练。

饮食与酒精

为了促进肌肉生长，女性，尤其是随着年龄增长，需要摄入足够的蛋白质 。菲利普斯博士说，每天每磅体重0.36克蛋白质的标准推荐量可能太低了。他建议人们——无论男女——以每磅体重0.54克蛋白质为目标。他补充说，没有证据表明摄入远高于此量的蛋白质会带来任何额外益处。（一些网红推荐摄入高达每磅体重一克的蛋白质。）

在更广泛地思考食物和营养时，建议采用地中海饮食，芝加哥大学更年期项目暨女性综合健康中心主任莫妮卡·克里斯马斯博士建议。在男性和女性中进行的大量研究表明，这是降低多种与衰老相关疾病（包括心脏病和糖尿病）风险的最佳方法之一。

当前对男性和女性的建议有所不同的一個領域是酒精。美国膳食指南建议女性每天不超过一杯酒，男性不超过两杯。这种差异是因为 酒精在较低剂量下就会对女性健康产生负面影响 。

睡眠

没有证据表明女性比男性需要更多的睡眠——每晚七到九小时对两种性别都是理想的。但 女性的睡眠质量确实往往比男性差，尤其是在围绝经期期间 ，无论是由于夜间盗汗还是可诊断的睡眠障碍，阿尔伯特·爱因斯坦医学院临床副教授、《女性克服失眠指南》的作者谢尔比·哈里斯说。因此，女性在床上度过的那些小时可能休息效果较差。

如果问题是夜间盗汗，有一些治疗方法可能会有帮助，例如更年期激素疗法或非激素药物Veozah。对于更一般的睡眠问题，可以考虑尝试针对失眠的认知行为疗法。

女性，尤其是在绝经后，需要注意的另一种情况是阻塞性睡眠呼吸暂停 。在较年轻的年龄段，男性更易患病，但绝经后性别差距会缩小。睡眠呼吸暂停"在女性中一直被漏诊，"哈里斯博士说，因为医生刻板地将其与"超重、打鼾声很大的老年男性"联系在一起。

得到诊断和治疗尤其重要，因为睡眠呼吸暂停随着时间的推移会增加患痴呆症的风险。

药物

更年期激素疗法已被批准用于帮助缓解与更年期相关的一些症状——最显著的是潮热、夜间盗汗和阴道干燥——并降低骨质疏松症的风险。

至于它是否也能帮助保护女性抵御其他衰老性疾病，特别是那些在绝经后风险增加疾病——如心脏病和痴呆症——则更为不明朗。

一些研究表明， 接受更年期激素疗法的女性患这两种疾病的风险较低 。其他研究发现该疗法没有益处或实际上增加了风险。结果的差异可能归结于所提供疗法的类型以及女性开始治疗的年龄等因素。

因此，专家们对于是否应有更多女性服用该疗法意见不一。

一些专家更看重积极的发现。"默认情况应该是，当你达到一定年龄并且出现围绝经期症状时，你可能应该接受激素疗法，"加州大学旧金山分校细胞与分子药理学系教员詹妮弗·加里森说，她研究卵巢。

其他人则采取更谨慎的态度，并表示数据过于混杂，无法向所有人推荐该疗法。"人们可能会想当然地认为，既然衰老或许多心血管风险、骨骼风险、认知风险在绝经后加速，那么那就意味着每个人都应该接受激素疗法，"克里斯马斯博士说。不幸的是，尚不清楚激素疗法能否减轻这些风险，她说。

对冈特博士而言，还有一种药物可能对一些女性有益但她们可能没有服用：治疗高胆固醇的他汀类药物。"社交媒体上有些人告诉女性他汀类药物对她们无效，这是一种令人担忧的趋势，"她说。"而我们实际上有很好的数据表明他汀类药物是有效的。"

此外， 带状疱疹疫苗可能对女性特别有益 。一方面，女性患带状疱疹的风险更高。而且最近有证据表明，该疫苗可能会降低患痴呆症的风险。

归根结底，无论你是女性还是男性，"基本原则之所以是基本原则是有原因的，"冈特博士说。 你摄入足够的蛋白质了吗？你白天活动吗？你睡得好吗？ "这些事情没有一件是超级性感的，"她补充说，"但它们确实有效。◾

Dana G. Smith is a Times reporter covering personal health, particularly aging and brain health.

达娜·G·史密斯是《纽约时报》记者，负责报道个人健康，特别是衰老和大脑健康。

The loudest voices in the longevity movement tend to be male. But a new subset of expertinfluencers— the “menoposse”— has cropped up, with hyper-specific recommendations for what women should do to stay healthy longer. Are male and female bodies really so different that we need tailored guidelines around exercise, nutrition and sleep?

It’s true that hormones play an important role in health. And certain diseases, including osteoporosis and dementia, affect women more than men — a disparity thought to be caused (at least in part) by menopause.

But when it comes to the basic behaviors that keep us healthy, experts say there are more similarities between men and women than there are differences.

“We have learned a lot about longevity in women, I think,” said Andrea LaCroix, a professor at the Herbert Wertheim School of Public Health and Human Longevity Science at the University of California, San Diego. “What we haven’t ascertained is that we’re fundamentally different than men in the health behaviors that predict longevity.”

We asked experts in gynecology, epidemiology, exercise, nutrition and sleep about how to optimize women’s aging, and where the conventional recommendations may need a tweak.

Exercise

The issue isn’t that men and women should be working out differently, the experts say. Rather, they should be exercising in the same way but traditionally haven’t — specifically when it comes to strength training.

If a woman lifted weights in the 1980s, “people would look at you like you’d grown a second head,” said Dr. Jen Gunter, an OB-GYN based in the San Francisco Bay Area and the author of “The Menopause Manifesto.”

Though it’s much more acceptable for women to engage in strength training today, a gender divide still exists. Experts say it’s a missed opportunity for women to improve their health, particularly as they age.

Both men and women experience gradual, progressive muscle loss starting in their 30s. If people have less muscle to begin with, by age 60 or 70 they can be at a greater risk for developing sarcopenia, clinically significant muscle loss that can affect daily activities. Postmenopausal women also have a substantially increased risk for osteoporosis. Strength training is one of the best ways to help protect against both of these conditions.

“It’s not going to be aerobic fitness that limits you in later life, it’s going to be strength and power,” said Stuart Phillips, a professor of kinesiology at McMaster University in Ontario, Canada.

Some influencers are dogmatic that perimenopausal women should be strength training with very heavy weights. But studies show that lifting any type of weight — light, moderate or heavy — can improve bone density and build muscle in women and men, Dr. Phillips said.

This doesn’t mean women should abandon aerobic exercise. The Physical Activity Guidelines for Americans call for at least 150 minutes of moderate-intensity cardiovascular activity a week, along with two days of strength training.

Diet and Alcohol

To help with muscle growth, women, particularly as they age, need adequate protein. And the standard recommendation of 0.36 grams per pound of body weight per day is probably too low, Dr. Phillips said. He advised people — men and women alike — to aim for 0.54 grams of protein per pound. There is no evidence that consuming substantially more protein than that offers any additional benefit, he added. (Some influencers recommend consuming as much as one gram per pound.)

When thinking about food and nutrition more broadly, consider adopting a Mediterranean diet, advised Dr. Monica Christmas, the director of the Menopause Program and the Center for Women’s Integrated Health at the University of Chicago. Large studies in both men and women show that it is one of the best ways to reduce the risk of several diseases related to aging, including heart disease and diabetes.

One area where the current advice for men and women differs is alcohol. The U.S. dietary guidelines recommend no more than one drink per day for women and two drinks for men. That discrepancy is because alcohol negatively affects women’s health at lower doses.

Sleep

There is no evidence that women need more sleep than men — seven to nine hours a night is ideal for both genders. But women do tend to have worse sleep than men, especially during

perimenopause, whether because of night sweats or a diagnosable sleep disorder, said Shelby

Harris, a clinical associate professor at the Albert Einstein College of Medicine and the author of “The Women’s Guide to Overcoming Insomnia.” As a result, those hours spent in bed may be less restful for women.

If night sweats are the problem, there are treatments that can help, such as menopause hormone therapy or the nonhormonal drug Veozah. For more general sleep issues, consider trying cognitive behavioral therapy for insomnia.

Another condition to look out for in women, especially after menopause, is obstructive sleep apnea. At younger ages, men are more likely to have it, but the gender gap narrows after menopause. Sleep apnea “gets missed all of the time in women,” Dr. Harris said, because doctors stereotypically associate it with “an older male who’s overweight and snoring really loud.”

Being diagnosed and treated is especially important since sleep apnea can increase the risk for dementia over time.

Medications

Menopause hormone therapy is approved to help relieve some of the symptoms associated with menopause — most notably hot flashes, night sweats and vaginal dryness — and to reduce the risk of osteoporosis.

Whether it can also help protect women against other diseases of aging, particularly those that increase after menopause — like heart disease and dementia — is murkier.

Some studies show that women on menopause hormone therapy have a lower risk of developing these two diseases. Other research has found that the treatment has no benefit or actually increases the risk. The difference in outcomes may come down to the type of therapy offered and the age women start it, among other factors.

Consequently, the experts were divided on whether more women should take it.

Some experts put more weight on the positive findings. The default should be “that when you reach a certain age and you’re having symptoms of perimenopause, you should probably go on hormone therapy,” said Jennifer Garrison, a faculty member in the Department of Cellular and Molecular Pharmacology at the University of California, San Francisco, who researches the ovaries.

Others took a more cautious approach and said the data is too mixed to recommend the treatment to everyone. “One would want to logically make a jump to say, well, if aging or many of these cardiovascular risks, bone risks, cognitive risks are accelerated after menopause, then that should mean that everybody should just be on hormone therapy,” Dr. Christmas said. Unfortunately, it’s not clear that hormone therapy is able to mitigate those risks, she said.

To Dr. Gunter, there is another medication some women may not be taking that they could benefit from: statins to treat high cholesterol. “There’s been a worrying trend of some people on social media telling women that statins don’t work for them,” she said. “And we actually have good data to show statins work.”

And the shingles vaccine may be particularly beneficial to women. For one, women are at a higher risk for shingles. And there is recent evidence that the vaccine may lower the risk for dementia.

At the end of the day, regardless if you’re a woman or a man, “the basics are the basics for a reason,” Dr. Gunter said. Are you eating a good amount of protein? Are you moving during the day? Are you sleeping well? “None of these things are super sexy,” she added, but they work.

来源：左右图史