ABOUT THE SPEAKER
Peter Attia - Surgeon
Both a surgeon and a self-experimenter, Peter Attia hopes to ease the diabetes epidemic by challenging what we think we know and improving the scientific rigor in nutrition and obesity research.

Why you should listen

Peter Attia has dedicated his medical career to investigating the relationship between nutrition, obesity and diabetes. A surgeon who developed metabolic syndrome himself despite the fact that he ate well and exercised often, Attia realized that our understanding of these important health issues may not actually be correct. From 2012-2015, he devoted himself to using vigorous scientific inquiry to test both our assumptions and new hypotheses through the Nutrition Science Initiative, the nonprofit he co-founded with journalist Gary Taubes. Now in private practice, Attia writes the blog Eating Academy, which charts his own adventures in nutrition and examines scientific evidence surrounding food, weight loss and disease risk. Overall, he hopes to convince others that sharp increases in the rates of obesity and diabetes -- despite the fact that we are more culturally aware of these problems than ever -- might be a result of people being given the wrong information.

Attia came to this calling through an unusual path. While he was studying mechanical engineering as an undergrad, a personal experience led him to discover his passion for medicine. He enrolled at Stanford Medical School, and went on to a residency in general surgery at Johns Hopkins Hospital and a post-doctoral fellowship at the National Cancer Institute. After his residency, he joined the consulting firm McKinsey & Company, where he worked on healthcare and financial system problems. The most valuable skill he learned along the way: to ask bold questions about medical assumptions. 

More profile about the speaker
Peter Attia | Speaker | TED.com
TEDMED 2013

Peter Attia: Is the obesity crisis hiding a bigger problem?

彼得•阿迪: 肥胖症危是否掩盖了更大的问题?

Filmed:
4,258,278 views

作为一个年轻的外科医生,彼得•阿迪曾蔑视了一个糖尿病患者。他认为,她体重过量,最终导致足部截肢也不过是罪有应得。但是多年之后,一场突病使阿迪开始疑惑:我们对于糖尿病的理解是否真的正确?肥胖是不是糖尿病的原因,或者说其病因还有其他?让我们一起来看一下,一个不同的假设将如何带领我们发动一场颠覆错误医学观点的战争。
- Surgeon
Both a surgeon and a self-experimenter, Peter Attia hopes to ease the diabetes epidemic by challenging what we think we know and improving the scientific rigor in nutrition and obesity research. Full bio

Double-click the English transcript below to play the video.

00:12
I'll never forget忘记 that day
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我永远忘不了那天
00:13
back in the spring弹簧 of 2006.
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2006年的春天。
00:17
I was a surgical外科 resident居民
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我还是一个外科住院医生
00:19
at The Johns约翰斯 Hopkins霍普金斯 Hospital醫院,
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在约翰霍普金斯医院
00:21
taking服用 emergency call.
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应对急救电话
00:23
I got paged分页 by the E.R. around 2 in the morning早上
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大约凌晨两点左右,我被急诊室叫去
00:26
to come and see a woman女人 with a diabetic糖尿病患者 ulcer溃疡
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看一位女病人,她得了因糖尿病而引起的
00:28
on her foot脚丫子.
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足部溃疡。
00:30
I can still remember记得 sort分类 of that smell of rotting腐烂 flesh
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我至今还能记得当我拉开帘子看到她之后
00:34
as I pulled the curtain窗帘 back to see her.
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闻到的那种肉类腐烂的味道。
00:38
And everybody每个人 there agreed同意 this woman女人 was very sick生病
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显而易见这位女士病得很重
00:40
and she needed需要 to be in the hospital醫院.
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她需要住院治疗。
00:41
That wasn't being存在 asked.
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这是毫无疑问的。
00:43
The question that was being存在 asked of me was a different不同 one,
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但那时我考虑的是另一个问题
00:45
which哪一个 was, did she also need an amputation切断术?
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那就是,她需要截肢吗?
00:49
Now, looking back on that night,
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现在,回想起那夜,
00:52
I'd love so desperately拼命 to believe that I treated治疗 that woman女人
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我很后悔那天夜里面对那位女士时
00:57
on that night with the same相同 empathy同情 and compassion同情
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心中没有带着同样的同情与悲悯
01:00
I'd shown显示 the 27-year-old-岁 newlywed新人
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就像我平时面对其他病人那般
01:04
who came来了 to the E.R. three nights earlier
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三天前的夜里一位27岁的新娘
01:06
with lower降低 back pain疼痛
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因为下背疼痛来看急诊
01:08
that turned转身 out to be advanced高级 pancreatic cancer癌症.
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后来她被诊断为晚期胰腺癌。
01:12
In her case案件, I knew知道 there was nothing I could do
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虽然我知道我对她无能为力
01:14
that was actually其实 going to save保存 her life.
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没办法救她。
01:16
The cancer癌症 was too advanced高级.
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癌症已经是末期了。
01:18
But I was committed提交 to making制造 sure that
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但我还是尽我所能的
01:21
I could do anything possible可能 to make her stay
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做了所有能让她
01:23
more comfortable自在. I brought her a warm blanket
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舒服一点的事情。我帮她找了条毛毯
01:26
and a cup杯子 of a coffee咖啡.
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端了杯咖啡。
01:28
I brought some for her parents父母.
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给她父母送咖啡。
01:31
But more importantly重要的, see, I passed通过 no judgment判断 on her,
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更重要的是,我一点也不觉得这姑娘有错
01:34
because obviously明显 she had doneDONE nothing
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很明显她对自己的病
01:36
to bring带来 this on herself她自己.
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一点责任也没有
01:38
So why was it that, just a few少数 nights later后来,
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但是为什么,仅仅过了几夜
01:41
as I stood站在 in that same相同 E.R. and determined决心
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当我站在同一个急救室并且决定
01:44
that my diabetic糖尿病患者 patient患者 did indeed确实 need an amputation切断术,
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我的这位糖尿病病人需要截肢手术时
01:47
why did I hold保持 her in such这样 bitter contempt鄙视?
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为什么我的心中带着蔑视呢?
01:51
You see, unlike不像 the woman女人 the night before,
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你看,跟那位新娘不一样
01:54
this woman女人 had type类型 2 diabetes糖尿病.
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这位女士有II型糖尿病
01:56
She was fat脂肪.
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她很胖。
01:58
And we all know that's from eating too much
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而且我们都知道肥胖源自
无节制的饮食和缺乏运动,对吧?
01:59
and not exercising行使 enough足够, right?
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而且我们都知道肥胖源自
无节制的饮食和缺乏运动,对吧?
02:02
I mean, how hard can it be?
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我的意思是,节食和运动很难吗?
02:04
As I looked看着 down at her in the bed, I thought to myself,
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我看着她躺在床上,我心说
02:07
if you just tried试着 caring爱心 even a little bit,
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哪怕你稍微注意一点儿自己的身体
02:10
you wouldn't不会 be in this situation情况 at this moment时刻
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你也绝不会落到这步田地
02:13
with some doctor医生 you've never met会见
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跟一个即将给你截肢的陌生在一起
02:14
about to amputate截肢 your foot脚丫子.
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跟一个即将给你截肢的陌生在一起
02:18
Why did I feel justified有理 in judging判断 her?
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为什么当时我能心安理得的责备她呢?
02:22
I'd like to say I don't know.
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我希望我不知道原因。
02:25
But I actually其实 do.
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但是说真的,我知道。
02:27
You see, in the hubris傲慢 of my youth青年,
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你看,我那时年少轻狂
02:29
I thought I had her all figured想通 out.
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我自以为是的觉得 她肯定就是我想到那样。
02:32
She ate too much. She got unlucky不幸的.
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她饮食无度,她运气不好
02:34
She got diabetes糖尿病. Case案件 closed关闭.
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她得了糖尿病,基本就是这个情况。
02:37
Ironically讽刺地, at that time in my life,
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讽刺的是,就在那会儿
02:39
I was also doing cancer癌症 research研究,
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我正在参与癌症的研究
02:41
immune-based免疫为主 therapies治疗 for melanoma黑色素瘤, to be specific具体,
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黑色素瘤的细胞免疫力疗法,具体来说
02:43
and in that world世界 I was actually其实 taught to question everything,
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在那个领域里,我被教着去质疑一切
02:47
to challenge挑战 all assumptions假设
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挑战一切固有的理论成果
02:49
and hold保持 them to the highest最高 possible可能 scientific科学 standards标准.
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并且在研究中严格遵守最高的科研准则。
02:53
Yet然而 when it came来了 to a disease疾病 like diabetes糖尿病
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但当我面对糖尿病
02:57
that kills杀死 Americans美国人 eight times more frequently经常 than melanoma黑色素瘤,
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这种致死几率高于黑色素瘤八倍的疾病时候
03:00
I never once一旦 questioned质疑 the conventional常规 wisdom智慧.
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我从未质疑过传统的理论。
03:04
I actually其实 just assmedassmed the pathologic病理 sequence序列 of events事件
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我当时真的认为糖尿病的发病机理
03:07
was settled安定 science科学.
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早有定论。
03:09
Three years年份 later后来, I found发现 out how wrong错误 I was.
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三年以后,我发现我错了。
03:13
But this time, I was the patient患者.
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但是这次,我自己成了病人。
03:15
Despite尽管 exercising行使 three or four hours小时 every一切 single day,
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尽管我每天运动三四个小时
03:19
and following以下 the food餐饮 pyramid金字塔 to the letter,
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严格遵守健康食谱
03:22
I'd gained获得 a lot of weight重量 and developed发达 something
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我还是体重激增并且得了
03:24
called metabolic新陈代谢 syndrome综合征.
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代谢综合征。
03:26
Some of you may可能 have heard听说 of this.
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你们也许有人听说过它。
03:28
I had become成为 insulin-resistant胰岛素抵抗.
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我的身体对胰岛素产生了抗性。
03:31
You can think of insulin胰岛素 as this master hormone激素
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你们可以把胰岛素想象成一种荷尔蒙
03:34
that controls控制 what our body身体 does with the foods食品 we eat,
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它能控制我们的身体对摄入的食物做出反应
03:38
whether是否 we burn烧伤 it or store商店 it.
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消耗或是储存它们。
03:40
This is called fuel汽油 partitioning分区 in the lingo行话.
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在术语中称之为燃料分区。
03:43
Now failure失败 to produce生产 enough足够 insulin胰岛素 is incompatible不相容 with life.
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缺乏足够的胰岛素是很要命的。
03:46
And insulin胰岛素 resistance抵抗性, as its name名称 suggests提示,
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胰岛素抵抗,就像字面上意思一样
03:49
is when your cells细胞 get increasingly日益 resistant
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意味着你的细胞变得越来越不受
03:51
to the effect影响 of insulin胰岛素 trying to do its job工作.
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胰岛素的指挥正常运作。
03:55
Once一旦 you're insulin-resistant胰岛素抵抗,
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一旦你出现胰岛素抵抗的情况
03:57
you're on your way to getting得到 diabetes糖尿病,
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你离患糖尿病就不远了
03:58
which哪一个 is what happens发生 when your pancreas胰腺
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因为胰岛素抵抗的缘故
04:00
can't keep up with the resistance抵抗性 and make enough足够 insulin胰岛素.
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你无法制造足够的胰岛素。
04:04
Now your blood血液 sugar levels水平 start开始 to rise上升,
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你的血糖开始升高
04:06
and an entire整个 cascade级联 of pathologic病理 events事件
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一系列的病例症状
04:09
sort分类 of spirals螺旋 out of control控制 that can lead to heart disease疾病,
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会突然爆发并且可能导致心脏病
04:13
cancer癌症, even Alzheimer's老年痴呆症 disease疾病,
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癌症,甚至老年痴呆症
04:16
and amputations截肢, just like that woman女人 a few少数 years年份 earlier.
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或者截肢,就像几年前的那位女士一样。
04:21
With that scare, I got busy changing改变 my diet饮食 radically根本,
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我很害怕,我很快改了食谱
04:24
adding加入 and subtracting减法 things most of you would find
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做了一些让大家觉得
04:26
almost几乎 assuredly无疑 shocking触目惊心.
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不可思议的改变。
04:29
I did this and lost丢失 40 pounds英镑, weirdly古怪 while exercising行使 less.
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得益于新的食谱
尽管我锻炼得少了,我还是减掉了40磅
04:33
I, as you can see, I guess猜测 I'm not overweight超重 anymore.
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你们可以看到,我现在没有超重
04:36
More importantly重要的, I don't have insulin胰岛素 resistance抵抗性.
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更重要的是,我没有胰岛素抵抗症了
04:39
But most important重要, I was left
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但是最重要的是,我陷入了
04:41
with these three burning燃烧 questions问题 that wouldn't不会 go away:
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三个亟待解决的问题
04:44
How did this happen发生 to me if I was supposedly按说
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为什么这件事发生在我身上呢?
04:47
doing everything right?
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我已经尽力做到无懈可击了。
04:50
If the conventional常规 wisdom智慧 about nutrition营养 had failed失败 me,
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如果传统的营养理论在我身上失效了
04:53
was it possible可能 it was failing失败 someone有人 else其他?
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在其他人身上会怎样呢?
04:56
And underlying底层 these questions问题,
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通过对考虑这些问题
04:58
I became成为 almost几乎 maniacally发狂 obsessed痴迷
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我着了魔一样的
05:02
in trying to understand理解 the real真实 relationship关系
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希望找到肥胖和胰岛素之间
05:04
between之间 obesity肥胖 and insulin胰岛素 resistance抵抗性.
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真正的关系。
05:08
Now, most researchers研究人员 believe obesity肥胖
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现在,主流观点认为
05:11
is the cause原因 of insulin胰岛素 resistance抵抗性.
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肥胖导致了胰岛素抵抗。
05:14
Logically按道理, then, if you want to treat对待 insulin胰岛素 resistance抵抗性,
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依逻辑来说,如果你想治疗胰岛素抵抗
05:16
you get people to lose失去 weight重量, right?
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你必须减肥,对吧?
05:18
You treat对待 the obesity肥胖.
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先对付肥胖。
05:21
But what if we have it backwards向后?
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但是如果我们反过来想一下?
05:24
What if obesity肥胖 isn't the cause原因 of insulin胰岛素 resistance抵抗性 at all?
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假如肥胖并不会导致胰岛素抵抗?
05:27
In fact事实, what if it's a symptom症状 of a much deeper更深 problem问题,
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实际上,假如它只是一个征兆
05:31
the tip小费 of a proverbial谚语 iceberg冰山?
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一个更深层次的问题的冰山一角?
05:34
I know it sounds声音 crazy because we're obviously明显 in the midst中间
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这听起来很疯狂 因为我们很正身处
05:36
of an obesity肥胖 epidemic疫情, but hear me out.
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一个肥胖症泛滥的时代,不过请耐心听我解释。
05:40
What if obesity肥胖 is a coping应对 mechanism机制
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假如肥胖是身体的某种应对机制
05:43
for a far more sinister险恶 problem问题 going on
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用来对付一个潜藏在细胞深处
05:46
underneath the cell细胞?
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更加凶险的问题?
05:48
I'm not suggesting提示 that obesity肥胖 is benign良性,
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我不认为肥胖是无害的
05:50
but what I am suggesting提示 is it may可能 be the lesser较小
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但是我觉得肥胖在两种新陈代谢疾病中
05:53
of two metabolic新陈代谢 evils罪恶.
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是比较次要的那个。
05:55
You can think of insulin胰岛素 resistance抵抗性 as the reduced减少 capacity容量
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大家可以把胰岛素抵抗症看作
05:58
of ourselves我们自己 to partition划分 fuel汽油,
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我们身体燃料箱变小了
06:00
as I alluded暗示 to a moment时刻 ago,
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就像我刚刚假设的那样
06:03
taking服用 those calories卡路里 that we take in
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正常情况下我们摄入的热量
06:04
and burning燃烧 some appropriately适当 and storing存储 some appropriately适当.
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会被适量消耗并且适量储存。
06:08
When we become成为 insulin-resistant胰岛素抵抗,
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当我们得了胰岛素抵抗的时候
06:10
the homeostasis动态平衡 in that balance平衡 deviates偏离 from this state.
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这个平衡就会偏离正常情况。
06:13
So now, when insulin胰岛素 says to a cell细胞,
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于是乎,当胰岛素告诉细胞
06:15
I want you to burn烧伤 more energy能源
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我需要你消耗一些能量,假如
06:17
than the cell细胞 considers考虑 safe安全, the cell细胞, in effect影响, says,
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细胞认为消耗太大,那些细胞就会回应到
06:20
"No thanks谢谢, I'd actually其实 rather store商店 this energy能源."
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“不了,我更想把这些能量储存起来。”
06:24
And because fat脂肪 cells细胞 are actually其实 missing失踪 most of
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因为脂肪细胞不同于其它细胞
06:26
the complex复杂 cellular细胞的 machinery机械 found发现 in other cells细胞,
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它没有那么多复杂的结构和组织
06:29
it's probably大概 the safest最安全 place地点 to store商店 it.
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所以能量都被储藏在那。
06:31
So for many许多 of us, about 75 million百万 Americans美国人,
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因此对我们中许多人,大约7500万美国人来说
06:36
the appropriate适当 response响应 to insulin胰岛素 resistance抵抗性
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胰岛素抵抗应被视作
06:40
may可能 actually其实 be to store商店 it as fat脂肪, not the reverse相反,
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肥胖的成因,而非相反的,
06:45
getting得到 insulin胰岛素 resistance抵抗性 in response响应 to getting得到 fat脂肪.
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将胰岛素抵抗归因于肥胖。
06:50
This is a really subtle微妙 distinction分别,
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这虽然是个相当微妙的区别,
06:52
but the implication意义 could be profound深刻.
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但是它的含义却是相当深刻的。
06:56
Consider考虑 the following以下 analogy比喻:
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举个例子来说,
06:58
Think of the bruise挫伤 you get on your shin
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想象一下你小腿上的乌青,
07:01
when you inadvertently不经意间 bang your leg into the coffee咖啡 table.
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那是你不小心撞上咖啡桌时留下的。
07:05
Sure, the bruise挫伤 hurts伤害 like hell地狱, and you almost几乎 certainly当然
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毫无疑问,这乌青疼得要命。
07:08
don't like the discolored脱色的 look, but we all know
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而且你肯定不喜欢腿上多个斑,但是我们都知道
07:11
the bruise挫伤 per seSE is not the problem问题.
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乌青本身并不是个问题。
07:14
In fact事实, it's the opposite对面. It's a healthy健康 response响应 to the trauma外伤,
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恰恰相反,这是对外伤的一个正常生理反应。
07:18
all of those immune免疫的 cells细胞 rushing to the site现场 of the injury
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所有的免疫细胞都会迅速前往受伤的部位
07:21
to salvage打捞 cellular细胞的 debris废墟 and prevent避免 the spread传播
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去清理坏死细胞的碎片并且防止
07:24
of infection感染 to elsewhere别处 in the body身体.
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感染扩散到身体其他部位。
07:26
Now, imagine想像 we thought bruises瘀伤 were the problem问题,
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好了,想象一下如果我们把乌青当作一个问题,
07:30
and we evolved进化 a giant巨人 medical establishment编制
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我们发展出了一个庞大的医疗体系
07:33
and a culture文化 around treating治疗 bruises瘀伤:
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以及文化来对待乌青:
07:36
masking掩蔽 creams面霜, painkillers止痛药, you name名称 it,
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遮蔽霜,止疼药,等等。
07:39
all the while ignoring无视 the fact事实 that people
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而所有这一切都掩盖了一个事实
07:42
are still banging their shins小腿 into coffee咖啡 tables.
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那就是人们依旧会撞到咖啡桌
07:45
How much better would we be if we treated治疗 the cause原因 --
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如果我们可以从问题的根源入手
07:48
telling告诉 people to pay工资 attention注意
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告诉人们注意一下
07:50
when they walk步行 through通过 the living活的 room房间 --
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从客厅走过的时候小心咖啡桌
07:52
rather than the effect影响?
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这会比处理撞伤来的有效果的多
07:55
Getting入门 the cause原因 and the effect影响 right
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正确理解事情的表象和本因
07:57
makes品牌 all the difference区别 in the world世界.
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将使这个世界产生巨大的不同。
07:59
Getting入门 it wrong错误, and the pharmaceutical制药 industry行业
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即使治标不治本,制药行业
08:02
can still do very well for its shareholders股东
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依旧可以为股东们带来利润,
08:05
but nothing improves提高 for the people with bruised伤痕累累 shins小腿.
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但是对于受伤的人们来说,这没有任何帮助
08:09
Cause原因 and effect影响.
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原因及结果。
08:12
So what I'm suggesting提示 is
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所以我想指出的是
08:14
maybe we have the cause原因 and effect影响 wrong错误
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在我们讨论肥胖和胰岛素抵抗的问题时
把原因和结果弄反了。
08:16
on obesity肥胖 and insulin胰岛素 resistance抵抗性.
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在我们讨论肥胖和胰岛素抵抗的问题时
把原因和结果弄反了。
08:19
Maybe we should be asking ourselves我们自己,
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也许我们需要问问我们自己了,
08:21
is it possible可能 that insulin胰岛素 resistance抵抗性 causes原因 weight重量 gain获得
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有没有可能胰岛素抵抗导致了体重增加
08:25
and the diseases疾病 associated相关 with obesity肥胖,
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以及随肥胖带来的并发症,
08:27
at least最小 in most people?
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至少对于大多数人来说
08:28
What if being存在 obese肥胖 is just a metabolic新陈代谢 response响应
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有没有可能肥胖只是胰岛抵抗的一个代谢反应
08:31
to something much more threatening危险的,
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相较于其他更大的威胁,
08:34
an underlying底层 epidemic疫情,
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例如一些相关的疫病,
08:36
the one we ought应该 to be worried担心 about?
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它们才是我们真正应该去担心的。
08:38
Let's look at some suggestive提示 facts事实.
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让我们来看些有暗示性的建议。
08:40
We know that 30 million百万 obese肥胖 Americans美国人
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我们知道在美国有3千万肥胖症患者
08:42
in the United联合的 States状态 don't have insulin胰岛素 resistance抵抗性.
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并未患胰岛素抵抗。
08:45
And by the way, they don't appear出现 to be at any
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同时,没有证据显示他们
08:47
greater更大 risk风险 of disease疾病 than lean people.
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比非肥胖症患者更容易贻患其他疾病。
08:50
Conversely反过来, we know that six million百万 lean people
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恰恰相反,在美国有6百万非肥胖症患者
08:53
in the United联合的 States状态 are insulin-resistant胰岛素抵抗,
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存在胰岛素抵抗,
08:57
and by the way, they appear出现 to be at even greater更大 risk风险
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而他们却被证实
09:00
for those metabolic新陈代谢 disease疾病 I mentioned提到 a moment时刻 ago
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易患那些我之前提到的糖尿病并发症,
09:02
than their obese肥胖 counterparts同行.
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同时几率较肥胖人士来的更高。
09:04
Now I don't know why, but it might威力 be because,
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虽然现在我还不知道为什么,但是一个可能的原因是,
09:06
in their case案件, their cells细胞 haven't没有 actually其实 figured想通 out
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对他们而言,他们的细胞无法正确的
09:09
the right thing to do with that excess过量 energy能源.
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对体内多余能量做出反应。
09:12
So if you can be obese肥胖 and not have insulin胰岛素 resistance抵抗性,
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你可以是肥胖症患者,却没患胰岛素抵抗,
09:15
and you can be lean and have it,
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或者你可以不肥胖,却患有胰岛素抵抗,
09:17
this suggests提示 that obesity肥胖 may可能 just be a proxy代理
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这都表明肥胖只不过是一个表征
09:21
for what's going on.
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而胰岛素抗拒才是根源。
09:24
So what if we're fighting战斗 the wrong错误 war战争,
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所以如果我们斗争搞错了对象,
09:27
fighting战斗 obesity肥胖 rather than insulin胰岛素 resistance抵抗性?
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我们一直与肥胖战斗着,而非胰岛素抵抗?
09:31
Even worse更差, what if blaming归咎 the obese肥胖
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而且更糟的是,如果指责过胖者
09:34
means手段 we're blaming归咎 the victims受害者?
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其实确是在指责胰岛素抵抗的受害者?
09:37
What if some of our fundamental基本的 ideas思路 about obesity肥胖
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如果我们对于肥胖症的一些基本认识本身
09:40
are just wrong错误?
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就存在误差?
09:42
Personally亲自, I can't afford给予 the luxury豪华 of arrogance傲慢 anymore,
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就我个人而言,我没有办法继续保持傲慢的态度,
09:46
let alone单独 the luxury豪华 of certainty肯定.
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让我把那种过剩的确信感放在一边。
09:49
I have my own拥有 ideas思路 about what could be at the heart of this,
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对于这些问题的核心为何,我有我自己的认识,
09:52
but I'm wide open打开 to others其他.
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同时我也愿意将它与其他人分享
09:54
Now, my hypothesis假设, because everybody每个人 always asks me,
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我的假设是这样的,因为老有人问我
09:56
is this.
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我的假设是这样的,因为老有人问我
09:58
If you ask yourself你自己, what's a cell细胞 trying to protect保护 itself本身 from
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试问,一个细胞到底在畏惧什么
10:01
when it becomes insulin胰岛素 resistant,
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当它处于胰岛素抗拒状态时。
10:03
the answer回答 probably大概 isn't too much food餐饮.
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问题的答案可能不是摄入过多的食物。
10:06
It's more likely容易 too much glucose葡萄糖: blood血液 sugar.
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答案更有可能是摄入过量葡萄糖而导致血糖过高。
10:09
Now, we know that refined精制 grains谷物 and starches淀粉
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精制的谷物和淀粉
10:11
elevate提升 your blood血液 sugar in the short run,
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将在短时间内抬到你的血糖含量,
10:14
and there's even reason原因 to believe that sugar
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而且我们有理由相信
10:15
may可能 lead to insulin胰岛素 resistance抵抗性 directly.
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糖分将直接导致胰岛素抵抗症。
10:18
So if you put these physiological生理 processes流程 to work,
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所以如果把这些生理过程也列入考虑,
10:22
I'd hypothesize或推测 that it might威力 be our increased增加 intake录取
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我认为是大量的不断摄入
10:26
of refined精制 grains谷物, sugars and starches淀粉 that's driving主动
220
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精制谷物,糖类以及淀粉类食物导致了
10:29
this epidemic疫情 of obesity肥胖 and diabetes糖尿病,
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肥胖症和糖尿病的流行,
10:33
but through通过 insulin胰岛素 resistance抵抗性,
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但其病因是胰岛素抵抗症
10:35
you see, and not necessarily一定 through通过 just overeating暴饮暴食 and under-exercising下行使.
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而不是由于暴饮暴食以及缺乏运动。
10:39
When I lost丢失 my 40 pounds英镑 a few少数 years年份 ago,
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在我几年前减去40磅时,
10:42
I did it simply只是 by restricting限制 those things,
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我只是简单的限制了精制谷物,糖,和淀粉的摄入,
10:44
which哪一个 admittedly固然 suggests提示 I have a bias偏压
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诚然这也表明我存在一些偏见,
10:48
based基于 on my personal个人 experience经验.
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而这些主要源自我的个人经验。
10:50
But that doesn't mean my bias偏压 is wrong错误,
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但是这并不意味着我的偏见是错误的,
10:53
and most important重要, all of this can be tested测试 scientifically科学.
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更重要的是,所有这些偏见都是可以被科学验证的。
10:57
But step one is accepting验收 the possibility可能性
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但是第一步就是要接受一种可能性
11:00
that our current当前 beliefs信仰 about obesity肥胖,
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那就是我们当前关于肥胖症,
11:02
diabetes糖尿病 and insulin胰岛素 resistance抵抗性 could be wrong错误
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糖尿病以及胰岛素抗拒症的理解可能存在偏差
11:05
and therefore因此 must必须 be tested测试.
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并需要被验证。
11:08
I'm betting博彩 my career事业 on this.
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我把我的事业都赌在了这个可能性上。
11:10
Today今天, I devote奉献 all of my time to working加工 on this problem问题,
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现在,我把所有的时间花在了这个问题的研究上,
11:15
and I'll go wherever哪里 the science科学 takes me.
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而且我将不会停止知道找到真正的答案。
11:18
I've decided决定 that what I can't and won't惯于 do anymore
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我已经决定有一件事是我不能也不会再做的,
11:21
is pretend假装 I have the answers答案 when I don't.
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那就是在我不知道答案的时候却假装知道。
11:24
I've been humbled自愧不如 enough足够 by all I don't know.
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对所有我不知道的事情,我都相当谦虚。
11:28
For the past过去 year, I've been fortunate幸运 enough足够
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在过去一年里,我很幸运
11:31
to work on this problem问题 with the most amazing惊人 team球队
241
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可以和国内最优秀的糖尿病和肥胖症专家团队一起研究
11:34
of diabetes糖尿病 and obesity肥胖 researchers研究人员 in the country国家,
242
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可以和国内最优秀的糖尿病和肥胖症专家团队一起研究
11:37
and the best最好 part部分 is,
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同时最好的事情莫过于,
11:39
just like Abraham亚伯拉罕 Lincoln林肯 surrounded包围 himself他自己 with a team球队 of rivals对手,
244
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就如亚伯拉罕•林肯将自己
置身于由对手组成的团队中
11:43
we've我们已经 doneDONE the same相同 thing.
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我们也做了一样的事情。
11:44
We've我们已经 recruited应征 a team球队 of scientific科学 rivals对手,
246
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我们找来了另一个科学家团队作为竞争对手,
11:47
the best最好 and brightest who all have different不同 hypotheses假设
247
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3445
他们也都是极为优秀的科学家,
11:51
for what's at the heart of this epidemic疫情.
248
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但却对这个流行病的核心成因有着不同的假设
11:52
Some think it's too many许多 calories卡路里 consumed消费.
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有一些认为是过量的卡路里摄入
11:55
Others其他 think it's too much dietary膳食 fat脂肪.
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有一些认为是过量的脂肪摄入
11:57
Others其他 think it's too many许多 refined精制 grains谷物 and starches淀粉.
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也有些人为是过量的精制谷物和淀粉摄入。
12:01
But this team球队 of multi-disciplinary多学科,
252
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这个由多学科,
12:03
highly高度 skeptical怀疑的 and exceedingly非常 talented天才 researchers研究人员
253
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具有高度怀疑精神以及相当聪明的研究者团队
12:06
do agree同意 on two things.
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至少同意两件事情。
12:09
First, this problem问题 is just simply只是 too important重要
255
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其一,这个问题相当重要,
12:12
to continue继续 ignoring无视 because we think we know the answer回答.
256
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以至于我们不能再假装我们知道答案而对它视而不见。
12:15
And two, if we're willing愿意 to be wrong错误,
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其次,如果我们愿意去犯错误,
12:18
if we're willing愿意 to challenge挑战 the conventional常规 wisdom智慧
258
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2537
如果我们愿意通过科学实践探究去挑战传统观念
12:20
with the best最好 experiments实验 science科学 can offer提供,
259
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如果我们愿意通过科学实践探究去挑战传统观念
12:23
we can solve解决 this problem问题.
260
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我们终将解决这个问题。
12:26
I know it's tempting诱人的 to want an answer回答 right now,
261
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我知道我们都希望现在就能得到一个答案,
12:29
some form形成 of action行动 or policy政策, some dietary膳食 prescription处方 --
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一些可以参照行为方式或者规则,一些饮食菜单
12:33
eat this, not that —
263
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告诉我们该吃什么,不该吃什么,
12:35
but if we want to get it right,
264
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但是如果我们想找到一个正确的答案,
12:37
we're going to have to do much more rigorous严格 science科学
265
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我们就不得不进行严谨的科学尝试,
12:39
before we can write that prescription处方.
266
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不然我们是给出真正的答案的。
12:42
Briefly简要地, to address地址 this, our research研究 program程序
267
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简而言之,为了找到这个答案,我们的研究项目
12:44
is focused重点 around three meta-themes元主题, or questions问题.
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主要围绕着三个方面或者问题展开。
12:47
First, how do the various各个 foods食品 we consume消耗
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首先,我们摄入的各种各样的食物是如何
12:50
impact碰撞 our metabolism代谢, hormones激素 and enzymes,
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影响我们的代谢,激素和酶的,
12:53
and through通过 what nuanced细致入微 molecular分子 mechanisms机制?
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并且这些影响是通过何种细微的分子机制发生的?
12:56
Second第二, based基于 on these insights见解,
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其二,基于这个视角,
12:58
can people make the necessary必要 changes变化 in their diets饮食
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人们有没有办法对他们的饮食做出必要的调整,
13:01
in a way that's safe安全 and practical实际的 to implement实行?
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使它更安全且更易实践
13:05
And finally最后, once一旦 we identify鉴定 what safe安全
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最终,一旦我们找到既安全、
13:08
and practical实际的 changes变化 people can make to their diet饮食,
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又能安全应用到饮食中的方法
13:11
how can we move移动 their behavior行为 in that direction方向
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我们又如何改变他们的习惯,
13:15
so that it becomes more the default默认
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使之变得更为自然,
13:17
rather than the exception例外?
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而非一种刻意行为?
13:19
Just because you know what to do doesn't mean
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你知道应该去做什么并不意味着
13:21
you're always going to do it.
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你可以坚持这么做。
13:23
Sometimes有时 we have to put cues线索 around people
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有时我们不得不给人们一些诱因
13:25
to make it easier更轻松, and believe it or not,
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使这种坚持变得更简单,不管你信不信
13:27
that can be studied研究 scientifically科学.
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这都可以经过科学研究
13:31
I don't know how this journey旅程 is going to end结束,
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我不知道这个研究最终会将我带向何处,
13:33
but this much seems似乎 clear明确 to me, at least最小:
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但是对我而言,至少有一点是可以肯定地:
13:38
We can't keep blaming归咎 our overweight超重 and diabetic糖尿病患者 patients耐心
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我们不能继续指责肥胖症和糖尿病患者
13:43
like I did.
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就像曾经的我那样。
13:45
Most of them actually其实 want to do the right thing,
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他们中的大部分其实都想做正确的选择,
13:48
but they have to know what that is,
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但前提是他们必须知道到底什么是正确的,
13:51
and it's got to work.
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而且它们切实可行。
13:54
I dream梦想 of a day when our patients耐心 can
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我们梦想有一天当我们的患者可以
13:59
shed their excess过量 pounds英镑
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减去多余的重量
14:01
and cure治愈 themselves他们自己 of insulin胰岛素 resistance抵抗性,
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治好胰岛素抵抗症,
14:03
because as medical professionals专业人士,
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因为作为医学专家,
14:06
we've我们已经 shed our excess过量 mental心理 baggage行李
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我们已经抛开了多余的思想包袱,
14:08
and cured治愈 ourselves我们自己 of new idea理念 resistance抵抗性 sufficiently充分地
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并完全治好了自己的新观点抵抗症
14:11
to go back to our original原版的 ideals理想:
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从而使我们回归我们最初的理想:
14:15
open打开 minds头脑, the courage勇气 to throw out yesterday's昨天的 ideas思路
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开放的思维,抛弃那些不再有效的陈旧观念的勇气
14:19
when they don't appear出现 to be working加工,
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开放的思维,抛弃那些不再有效的陈旧观念的勇气
14:22
and the understanding理解 that scientific科学 truth真相 isn't final最后,
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相信科学的真理没有终点,
14:25
but constantly经常 evolving进化.
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只有不断的进化。
14:28
Staying入住 true真正 to that path路径 will be better for our patients耐心
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忠于这条追求真理的道路
对患者和科学来说都是更好的选择
14:31
and better for science科学.
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忠于这条追求真理的道路
对患者和科学来说都是更好的选择
14:35
If obesity肥胖 is nothing more than a proxy代理
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如果肥胖只是
14:38
for metabolic新陈代谢 illness疾病,
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代谢疾病的一个替罪羊,
14:40
what good does it do us to punish惩治 those with the proxy代理?
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那么我们去指责这些替罪羊又有什么好处呢?
14:45
Sometimes有时 I think back to that night in the E.R.
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我有时会回想到七年前急救室的那个夜晚
14:49
seven years年份 ago.
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我有时会回想到七年前急救室的那个夜晚
14:52
I wish希望 I could speak说话 with that woman女人 again.
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我希望我可以再和那位女士聊聊。
14:55
I'd like to tell her how sorry I am.
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我想向她道歉。
14:59
I'd say, as a doctor医生, I delivered交付
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我想说,作为一个医生,我提供了
15:02
the best最好 clinical临床 care关心 I could,
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我所能提供的最好的治疗,
15:05
but as a human人的 being存在,
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但是最为一个人,
15:09
I let you down.
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我让你失望了。
15:11
You didn't need my judgment判断 and my contempt鄙视.
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你需要的不是我的判定和我的鄙视。
15:16
You needed需要 my empathy同情 and compassion同情,
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你需要的是我的同情和怜悯,
15:20
and above以上 all else其他, you needed需要 a doctor医生
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1995
而且无论如何,你需要的是一个医生
15:22
who was willing愿意 to consider考虑
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愿意相信
15:25
maybe you didn't let the system系统 down.
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也许你没有辜负我们的医疗系统。
15:28
Maybe the system系统, of which哪一个 I was a part部分,
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也许是医疗系统,包括我在内的这个医疗系统,
15:31
was letting出租 you down.
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辜负了你。
15:34
If you're watching观看 this now,
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如果你现在正在看这个演讲,
15:36
I hope希望 you can forgive原谅 me.
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我希望你可以原谅我。
15:41
(Applause掌声)
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(掌声)
Translated by Weichen Cai
Reviewed by Shengwei Cai

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ABOUT THE SPEAKER
Peter Attia - Surgeon
Both a surgeon and a self-experimenter, Peter Attia hopes to ease the diabetes epidemic by challenging what we think we know and improving the scientific rigor in nutrition and obesity research.

Why you should listen

Peter Attia has dedicated his medical career to investigating the relationship between nutrition, obesity and diabetes. A surgeon who developed metabolic syndrome himself despite the fact that he ate well and exercised often, Attia realized that our understanding of these important health issues may not actually be correct. From 2012-2015, he devoted himself to using vigorous scientific inquiry to test both our assumptions and new hypotheses through the Nutrition Science Initiative, the nonprofit he co-founded with journalist Gary Taubes. Now in private practice, Attia writes the blog Eating Academy, which charts his own adventures in nutrition and examines scientific evidence surrounding food, weight loss and disease risk. Overall, he hopes to convince others that sharp increases in the rates of obesity and diabetes -- despite the fact that we are more culturally aware of these problems than ever -- might be a result of people being given the wrong information.

Attia came to this calling through an unusual path. While he was studying mechanical engineering as an undergrad, a personal experience led him to discover his passion for medicine. He enrolled at Stanford Medical School, and went on to a residency in general surgery at Johns Hopkins Hospital and a post-doctoral fellowship at the National Cancer Institute. After his residency, he joined the consulting firm McKinsey & Company, where he worked on healthcare and financial system problems. The most valuable skill he learned along the way: to ask bold questions about medical assumptions. 

More profile about the speaker
Peter Attia | Speaker | TED.com