（来源：千龙网） 什么才是适合中国人的饮食策略？从白粥、精面到肉类、内脏，有哪些被误解的饮食真相？请听帆书创 始人樊登对话北京安贞医院临床营养科创始人、著名营养医学专家夏萌，告诉我们到底应该怎么吃。 "被动"关注营养学 樊登：您原来是神经内科医生，请问您是从什么时候开始关注营养学的？ 夏萌：其实我是被动关注营养学的。我原来在北京安贞医院工作，突然有一天发现自己血尿了。我去肾 内科检查，被诊断为肾炎。我以为休息一阵就能好，结果三个月后再检查，尿蛋白和尿红细胞仍明显偏 高。我到处看病，但当时医生的建议都是"观察观察"，翻译成大白话就是：暂时没有办法控制病情，等 指标恶化了再说。 2004年，听说我们医院旁边有个营养培训班，我的一个同学提出和我一起去学习。我其实很不屑，我们 学医的还不懂营养知识吗？但是进培训班后我才发现，在营养学领域我确实是个"小白"。就这样，我坚 持了4个月，最后顺利通过了考试。 我最想解决的一个问题就是怎么治好我自己的病。我到底该多吃蛋白质还是多吃粗粮？我吃什么才是对 的？我慢慢开始琢磨，逐渐调整自己的日常饮食。没想到3个月后，我的尿蛋白和潜血指标都正常了。 樊登：您到底是怎么吃的呢？ 夏萌： ...

Core Viewpoint - Carbohydrates can be categorized into "good" and "bad," and the quality of carbohydrates consumed is more important than the quantity for weight management [1][3]. Group 1: Good Carbohydrates - Good carbohydrates come from minimally processed, nutrient-dense plant-based foods, characterized by low glycemic index (GI), high dietary fiber, and high nutritional density [4]. - They provide sustained energy, help stabilize blood sugar levels, and reduce the risk of diabetes and cardiovascular diseases [4]. Group 2: Bad Carbohydrates - Bad carbohydrates are often found in highly processed foods or those with added sugars, which are low in nutritional value and can lead to rapid spikes and drops in blood sugar levels [6]. - Long-term consumption of bad carbohydrates increases the risk of obesity, diabetes, and cardiovascular diseases [6]. Group 3: Scientific Approach to Carbohydrate Consumption - It is recommended to choose whole grains, tubers, and legumes as good carbohydrates while reducing the intake of refined grains and sugary beverages [11]. - The 2022 Dietary Guidelines for Chinese Residents suggest that carbohydrates should provide 50% to 65% of total energy intake, with specific recommendations for different food types [12]. - Combining good carbohydrates with high-quality proteins and healthy fats can further stabilize blood sugar and enhance satiety [13]. Group 4: Dietary Variety - A diverse diet is encouraged, including three types of grains, tubers, and legumes, along with four varieties of fresh vegetables and fruits to ensure comprehensive nutrition [15].

Core Insights - The study reveals that glucose metabolism is a critical energy source for tumor proliferation, and targeting glucose metabolism through low-carbohydrate diets is a promising strategy to inhibit tumor growth [2][9] - However, extreme carbohydrate restriction may suppress tumor growth while simultaneously promoting lung metastasis, indicating the need for careful evaluation of metabolic intervention strategies [3][9] Mechanism of Action - Glucose deprivation induces endoplasmic reticulum (ER) stress in tumor cells, activating HRD1 to catalyze the ubiquitination of TRAIL at the K63 site, which is then packaged into exosomes [4] - These exosomes release TRAIL in the lungs, polarizing PVR⁺ macrophages and depleting lung NK cells, thus creating a favorable immune microenvironment for tumor colonization [4] Clinical Implications - The research confirms that low glucose metabolism is associated with higher recurrence rates within two years post-surgery across 15 cancer types [5] - Plasma exosomal TRAIL levels serve as an effective biomarker for predicting lung metastasis after liver cancer surgery, outperforming traditional biomarkers like alpha-fetoprotein (AFP) [6] Key Findings - Low-carbohydrate diets or impaired glucose metabolism can promote lung metastasis [7] - Glucose deprivation creates a pre-metastatic microenvironment dominated by lung macrophages [7] - Exosomal TRAIL leads to the polarization of PVR⁺ macrophages, resulting in the depletion of lung NK cells [7] - Plasma exosomal TRAIL levels can accurately predict early postoperative lung metastasis [7] Research Value - The study systematically elucidates how glucose restriction reshapes distal immune environments and promotes tumor metastasis through an exosome-immune regulatory axis, highlighting the TIGIT pathway as a potential target for combined interventions [9]

Group 1 - The article discusses the dual nature of carbohydrates, highlighting that they can be both beneficial and detrimental depending on their quality [1][5] - Carbohydrates are essential nutrients categorized into simple sugars, complex carbohydrates, and dietary fibers, playing a crucial role in energy supply for the brain and muscles [3][5] - The distinction between "good" and "bad" carbohydrates is emphasized, with "good" carbohydrates being those that are minimally processed and nutrient-dense, while "bad" carbohydrates are often refined and high in added sugars [5][8] Group 2 - Good carbohydrates include whole grains, starchy vegetables, legumes, and low-GI fruits, which provide sustained energy and lower the risk of chronic diseases [6][10] - Bad carbohydrates are primarily found in refined grains and sugary foods, which can lead to rapid spikes in blood sugar and increased risk of obesity and diabetes [8][11] - Recommendations for carbohydrate consumption include optimizing food choices, controlling total intake, pairing with quality proteins and healthy fats, and ensuring dietary variety for comprehensive nutrition [10][12][13] Group 3 - The article concludes that carbohydrates should not be viewed as harmful but rather as beneficial when chosen wisely, suggesting practical dietary changes such as substituting white bread with whole grain options [15]