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  • More and more mainstream health authorities are promoting plant-based vegan dietslike

    有越來越多主流健康權威專家,都推崇植物性的純素飲食法

  • Kaiser Permanente, one of the largest HMOs in the U.S. that wants to make plant-based

    像凱澤永久醫療集團—美國最大的健康維護組織之一

  • dietsthe new normal for [its] patients and employees”; or the president of the

    他們希望蔬食能成為病人和員工的新生活常態

  • American College of Cardiology, Dr. Kim Williams, who vigorously promotes a vegan diet; or the

    美國心臟醫學會主席—金·威廉斯醫師,一向極力推崇純素飲食

  • chair of Harvard's Department of Nutrition, Dr. Walter Willett, who recommends choosing plant proteins over animal proteins.

    美國哈佛大學營養學系主任—魏勒特博士,也建議我們以植物性蛋白質取代動物性蛋白質

  • As we see this awareness about plant-based nutrition increase,

    由於大眾對植物營養有越來越多認識

  • concern is sometimes expressed about vegan diets and vitamin B12 deficiencies.

    「純素飲食」與「維生素 B12 缺乏」的相關議題也隨之受到關注

  • Some might ask, “If a vegan diet really is healthy and natural, why do I need to watch

    有些人可能會問「如果純素飲食真的健康又自然,我為何還要

  • my vitamin B12 levels or take vitamin B12 supplements?” And this is a great question.

    留意維生素 B12 水平,或服用維生素 B12 補充劑呢? 」這是個很好的問題

  • So, let's review the current information about vitamin B12, and the causes and prevalence

    現在就讓我們來看看當前一些與維生素 B12 的相關資訊,以及造成

  • of vitamin B12 deficiencies. Vitamin B12, also called cobalamin, is a water-soluble vitamin.

    「維生素 B12 缺乏」和「維生素 B12 普遍攝取不足」的原因,維生素 B12 也叫作鈷胺素—一種水溶性維生素

  • It is produced by bacteria, not animals or plants. So animals, including humans, must

    維生素 B12 是由細菌產生,並非來自動物或植物,所以動物,包含人類

  • obtain vitamin B12 directly or indirectly from bacteria. In the past, vitamin B12 from

    都必須直接或間接經由細菌取得維生素 B12 養分,在過去,來自細菌的維生素 B12

  • bacteria was naturally and more reliably present in plant foods. Today, however, with modern hygienic practices

    會自然存在於植物性食物中,而且該維生素 B12 的來源更為可靠,然而今日,在現代的衛生規範下

  • that more deeply clean and sanitize our produce, along with the soil

    我們的食物得到更徹底的清潔與消毒,加上土壤

  • being exposed to more antibiotics and pesticides, most plant foods are no longer reliable sources

    接觸到抗生素與殺蟲劑,因而導至眼前的情況,這也是大部分的植物都不再是

  • for vitamin B12. And, it's probably not a good idea to go back and reverse sanitary

    維生素 B12 可靠來源的原因,但若為了讓我們的食物保有更多細菌

  • practices just to get more of this bacterial product in our diet. For this reason, we have

    而回頭去撤除食品衛生規範,似乎也不太妥當,因此

  • seen that people who abstain from eating animal foods can have lower levels of vitamin B12.

    我們也有遇過不食用動物性食品的人維生素 B12 水平較低的情況

  • But it's important to also know that vitamin B12 deficiencies are not uncommon in the general

    但我們該了解到的是,在一般人口當中,維生素 B12 缺乏症並不罕見

  • population regardless of diet, even among many those eating large amounts of animal foods.

    無論採用哪種飲食方式,即使是食用大量動物性食品的人,也會有維生素 B12 缺乏的可能

  • As this review in the American Journal of Clinical Nutrition notes, "across studies

    這篇美國臨床營養雜誌的評論指出「由多份研究報告顯示—

  • in Latin America, ≈40% of children and adults [were found to have a] deficient or marginal

    拉丁美洲有大約 40% 的兒童和成人,都有維生素 B12 缺乏

  • status" of vitamin B12. In the U.S., full-blown vitamin B12 deficiencies are estimated to

    或瀕臨缺乏的情況」患有維生素 B12 缺乏症的美國人口當中

  • occur in about "≈4% of those aged 40-59", and "≈6% of those aged ≥60", with approximately

    年齡在 40-59 歲之間者占 4%,60 歲以上則佔了 6%

  • 20% of those over the age of 60 having a marginal status. That's a really high prevalence

    在 60 歲以上的人口當中,出現維生素 B12 瀕臨缺乏的情況者佔約 20%,在一般人口當中

  • for a vitamin deficiency in the general population. Another review that combined nine studies

    維生素 B12 缺乏是一種很普遍的現象,另一則評論,也綜合分析了九份美國的研究報告

  • in the U.S. found that 40% of patients had unexplained low B12 levels, which the researchers

    發現 40% 的病患,都有不明的維生素 B12 水平偏低的情況,研究人員將此症狀

  • attributed to what's called "food cobalamin malapsorption", where the B12 that is naturally

    稱為「食物維生素 B12 吸收不良症」即食物中所含的維生素 B12

  • present in foods is simply not absorbed. Luckily, these people are still able to absorb the

    無法被正常吸收,所幸這樣的人,仍能夠吸收

  • crystalline form of vitamin B12, which is the form that is used in supplements and B12-fortified foods.

    結晶型的維生素 B12 —它是一種存在於「補充劑」和「 B12 強化食品」中的 B12 形態

  • So, it happens to be the case that there are many things that can go wrong with

    所以不管是哪一種飲食習慣,身體在利用或吸收維生素 B12 時

  • our bodies using or absorbing vitamin B12, regardless of our diet, because the absorption

    有很多環節都可能出差錯,因為吸收維生素 B12 的機制

  • process is fairly complex and requires specific physiologic elements to take place for it to occur adequately.

    相當複雜,並且需要特定的生理條件,才能順利吸收足夠的維生素 B12

  • One crucial factor, for example, is a step where vitamin B12 has to be coupled with a substance

    以這個關健的生理要素為例,維生素 B12 必須先和

  • calledintrinsic factor,” which is produced in the parietal cells in our stomach.

    胃壁細胞分泌的「內在因子」結合

  • Then, most of the absorption for this coupled pair occurs in the third

    接著,大部分的結合物會在小腸的

  • segment of the small intestine (or ileum). As such, any problem in those portions of

    第三部分 (迴腸) 被吸收,因此,若這些部位的消化道出問題

  • our gastrointestinal tract can lead to B12 deficiencies. For example, H. pylori infection,

    即會導致維生素 B12 缺乏的情況,例如幽門桿菌感染、

  • alcohol abuse, smoking, atrophic gastritis, and conditions that slow the movement of food in our gastrointestinal tract

    酗酒、吸菸、萎縮性胃炎,以及一些會造成腸胃蠕動緩慢的病症

  • (such as diabetes, scleroderma, strictures, diverticula) are

    像是糖尿病、硬皮病、食道狹窄、大腸憩室症

  • all associated with vitamin B12 deficiencies. So many conditions that affect the gastrointestinal

    這些都和維生素 B12 的缺乏有關,有很多情況都會影響消化道功能

  • tract can lead to B12 deficiencies, from something big and notorious like a gastric bypass or

    導致維生素 B12 缺乏,大至人們熟悉的胃繞道

  • resection, to something much more common like bacterial overgrowth in the upper intestine.

    或胃切除手術,小至較常見的上腸道細菌過度滋生

  • But, fortunately, here too, with bacterial overgrowth, the crystalline form of vitamin

    但幸運地是,即使有細菌過度滋生的問題

  • B12, which is the form that is added to fortified foods and used in supplements, can still be absorbed okay.

    仍可適當吸收添加於食品和補充劑中的結晶型維生素 B12

  • Some medications can also cause vitamin B12 deficiencies, including long-term

    有些藥物也會造成我們的維生素 B12 缺乏,包括長期使用

  • use of antacids (or acid-suppressing drugs) – which, by the way, have been classified

    制酸劑 (胃酸抑制藥),附帶一提,制酸劑在美國

  • as the most commonly used pharmaceuticals in the U.S. Gastric acid in our stomach is

    是最常被使用的藥物,胃酸是將

  • required to separate vitamin B12 from dietary proteins for it to be absorbed. Thus,

    維生素 B12 與食物蛋白質分離的必要物質,經分離的維生素 B12 才能被人體吸收,因此

  • medications that suppress the production of gastric acid can lead to B12 malabsorption.

    抑制胃酸分泌的藥物,會造成維生素 B12 吸收不良

  • This study concluded, both previous and current antacid use was associated with B12 deficiency. Lastly,

    而這份研究的結論是,維生素 B12 缺乏症與過去或現在使用制酸劑有關,最後要提的是

  • there is also a genetic variant of a B12 transporter in our body that some people have that is

    有些人的體內帶有維生素 B12 轉運子變異基因

  • associated with low B12 levels, and this genetic variant is present in 20% of the population.

    該基因和體內的 B12 水平偏低也有關係,有 20% 的人口都帶有這種變異基因

  • So, as you can see, vitamin B12 adequacy is a delicate matter, and deficiencies are fairly

    由此可見,攝足維生素 B12 是人人都得多加留意的環節,而維生素 B12 的缺乏

  • common in the general population. So, regardless of one's diet, it's something that

    對大眾來說則是相當普遍的現象,因此,不管採用哪種飲食方式

  • people need to be mindful of. Now moving on to other issueswhere can we find vitamin B12?

    都須要留意維生素 B12 的水平,現在繼續下一個問題「維生素 B12 該由哪裡取得?」

  • Well, let's remember it's made from bacteria. Our own intestinal tract contains

    請記得,維生素 B12 是來自細菌,我們腸道內有

  • feces and B12-producing bacteria. However, we think that the majority of the B12 produced

    排泄物以及製造維生素 B12 的細菌,但這些能製造維生素 B12 的細菌

  • by bacteria in our gut occurs in the large intestine, which is further down from the

    大部分都存於大腸之中,而位於大腸下端的小腸末端 (迴腸)

  • small intestine where most of the B12 absorption takes place. So, a lot of the B12 produced

    則是大部分的 B12 被吸收的地方,所以許多腸道內所產生的 B12

  • in our intestine is excreted in our feces. Some studies have shown though that bacteria

    都會隨著排泄物被排出體外,不過根據一些研究的顯示

  • in our small intestines may also synthesize significant amounts of vitamin B12, but it's

    位於小腸內的細菌,也能合成非常大量的維生素 B12

  • not clear whether sufficient amounts are made and absorbed to meet our nutritional needs.

    但該數量是否能達到我們營養上的需求,目前尚不明確

  • So our own human feces contain large quantities of vitamin B12. As unpleasant as this may

    人類的排泄物含有大量的維生素 B12,接下來的部分可能會讓人感到不舒服

  • sound, we actually do end up inadvertently eating feces sometimes. Which brings me to

    其實我們有時候會不小心吃進排泄物,這件事要帶入

  • another source that has B12 from bacteriaanimal foods. Now, just like us, animals

    另一個源自細菌的維生素 B12 來源—動物性食品,動物就和我們一樣

  • don't make vitamin B12. They obtain it either directly or indirectly from the bacteria that makes it.

    本身不會製造維生素 B12,牠們是透過直接或間接的方式,從細菌獲得維生素 B12

  • Also adding manure usually results in higher vitamin B12 levels. Scientists even found

    在食物中添加糞便就能使維生素 B12 的含量上升,科學家甚至發現

  • that adding manure to the soil where spinach was growing added B12 to the spinach leaves.

    「添加糞便的土壤所長出的菠菜葉含有維生素 B12」

  • And, many animal foods have significant amounts of manure and thus bacterial contamination.

    許多動物性食品中,都含有大量被細菌汙染的糞便

  • Thanks to the FDA retail meat monitoring program, we know that 98% of chicken breasts sampled

    感謝 FDA (美國食品藥物管理局) 的肉品監測記畫讓我們得知,在收集超過七年的肉品樣本中

  • over seven years were contaminated with fecal bacteria; ground turkey 94%; ground beef 93%;

    含有糞便細菌的樣本比例,雞胸肉佔 98%、火雞絞肉佔 94%、牛絞肉佔 93%

  • and pork chops, a little bit lower at 86.9%, but still very high. Manure from some animals

    豬排肉的比例稍低,佔 86.9%,但含量仍非常高,畜牧業甚至會

  • is even used to feed other animals in the livestock industry. And while this can raise

    使用某些動物的糞便來飼養其他動物,雖然這樣

  • B12 levels in the animal fed the manure, it also raises some serious health concerns.

    可提高肉品的維生素 B12 含量,但同時也會造成嚴重的健康問題

  • But apart from infectious disease related concerns with bacterial contamination, animal

    除了由細菌汙染所造成的相關感染性疾病外

  • productsregardless of how clean they may beare not the best source for vitamin

    動物性食品—不管多衛生,都不是最好的維生素 B12 來源

  • B12, because consuming them results in us having increased levels of cancer promoting

    因為食用動物性食品,會造成體內某些物質的增加

  • hormone IGF-1, as well as cholesterol, TMAO, phosphorus, heme-iron, and other substances

    如促癌激素 IGF-1、膽固醇、氧化三甲胺、磷、血基質鐵,以及其他

  • that are problematic for our health. Better sources of B12 are fortified plant foods,

    會影響健康的物質,添加維生素 B12 的植物性食品,才是較理想的維生素 B12 來源

  • like non-dairy milks, nutritional yeast and the like. And apparently some plant foods

    像非動物性的植物奶和營養酵母之類的食品,而某些植物

  • can have considerable amounts of vitamin B12 due to bacterial contamination during the

    也富含維生素 B12,這是因為在生產的過程中

  • production process, or because they live a symbiotic relationship with bacteria. For

    遭到了細菌的汙染,或是因為它們和細菌共生的關係

  • example, this article in the journal Nutrients found the following plant foods to contain vitamin B12:

    例如,這篇營養雜誌的文章,指出以下幾種含有維生素 B12 的食物:

  • tempe, which is a fermented soybean-based food, due to bacterial process in its production;

    天貝—一種黃豆發酵食品,其生產需藉細菌來發酵

  • vegetable products that are fermented with bacteria; various types of tea leaves; fruiting

    以及藉細菌發酵的蔬菜產品、各式各樣的茶葉、

  • bodies of shitake and another types of mushrooms; and, apparently, the most widely-consumed algae

    香菇的子實體,與其他類型的蕈類,當然,還有被大量食用的藻類

  • also contains levels of vitamin B12. B12 can also be found in lakes if the water has not been sanitized.

    都含有或多或少的維生素 B12,在未經消菌的湖水中,也可以發現維生素 B12

  • And although it's not a good idea to drink un-sanitized water in general,

    雖然一般來說,我們不鼓勵生飲湖水

  • we really get the picture of how this is a bacterial and not an animal product.

    但我們也能藉由這件事再次了解到,維生素 B12 源自細菌,而非來自動物

  • Again, it's not a good idea to go back and reverse sanitary practices in order to get

    再重複一次,若為了讓飲食中出現更多能夠製造維生素 B12 的細菌

  • more of this bacterial product in our diet, since bacteria can also cause disease.

    而回頭撤除食品衛生規範恐怕不恰當,因為細菌也可能導致疾病

  • It's also not a good idea to get vitamin B12 from animal foods, given the problematic

    而透過動物性食品來取得維生素 B12 也不是一種好方法

  • health issues associated with consuming animal foods that I mentioned earlier.

    因為它會造成前面所提到的那些問題,經由動物性食品而產生的健康問題

  • From a health standpoint, it's best to go with a plant-based vegan diet. Just like Harvard's Healthy

    就健康的角度而言,以植物性食品為主的「純素飲食」才是最理想的,如同哈佛

  • Eating Plate recommends, “Go with plants. Eating a plant-based diet is [best].” So,

    「健康飲食餐盤」的建議—選擇蔬食,以植物為主的飲食方式是最佳的

  • what I recommend is to monitor vitamin B12 levels or take a B12 supplement, or both,

    所以我的建議是:定期檢驗維生素 B12 水平,或服用補充劑,或者兩者並行

  • and include plant-based B12-fortified foods in your diet. I personally don't take a

    還有,食用添加維生素 B12 的食品,我個人並沒有

  • B12 supplement, but I have my B12 levels checked every year. I've been eating a plant-based

    服用維生素 B12 補充劑,但我每年都會做維生素 B12 水平檢驗,我採蔬食為主的純素飲食

  • vegan diet with no animal products for about 5 years now. And, at my most recent insurance-required

    不吃任何動物製品,已有五年之久,而我最近期的

  • annual checkup, my B12 level was 884 pg/mL, which is within the normal range.

    年度健康檢查報告顯示,維生素 B12 水平為 884 pg/mL (每毫升含 884 皮克) 在正常範圍內

  • If it wasn't within normal range, then I would just take a supplement, which is an easy fix.

    假使數值不在正常範圍內,我只要服用補充劑即可,這很容易解決

  • But, I definitely keep an eye on my levels, and I recommend both vegans

    當然我也會持續留意我的維生素 B12 水平,也建議所有的純素者

  • and non-vegans alike to do the same. Thank you very much.

    與非純素者都這麼做,非常感謝大家

More and more mainstream health authorities are promoting plant-based vegan dietslike

有越來越多主流健康權威專家,都推崇植物性的純素飲食法

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認識維生素 B12 (Vitamin B12: Questions Answered)

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    羊奶 發佈於 2018 年 04 月 06 日
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