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?

Peter Attia: Oculta a epidemia de obesidade un problema maior?

Filmed:
4,258,278 views

Cando aínda era un cirurxián moi novo, Peter Attia sentíu desprezo por unha paciente diabética. O sobrepeso da paciente levouno a considerala responsable de que houbese que amputarlle un pé. Anos máis tarde, Attia recibíu unha desagradable sorpresa médica que o fixo pensar: Estaremos entendendo correctamente a diabetes? Será posible que sexan os precursores da diabetes os que causen a obesidade e non ao revés? Nesta charla reflexiona sobre a posibilidade de que as nosas ideas preconcibidas nos estean levando a librar a batalla médica equivocada.
- 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 that day
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Nunca esquecerei ese día.
Era a primavera de 2006.
00:13
back in the spring of 2006.
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00:17
I was a surgical resident
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Eu era residente de cirurxía
00:19
at The Johns Hopkins Hospital,
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no Hospital Johns Hopkins,
00:21
taking emergency call.
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atendendo chamadas de urxencias.
00:23
I got paged by the E.R. around 2 in the morning
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Chamáronme para unha urxencia ás 2 da mañá:
00:26
to come and see a woman with a diabetic ulcer
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unha muller cunha
úlcera diabética no pé.
00:28
on her foot.
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00:30
I can still remember sort of that smell of rotting flesh
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Aínda lembro aquela especie de cheiro
a carne podre
00:34
as I pulled the curtain back to see her.
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mentres apartaba a cortina para vela.
00:38
And everybody there agreed this woman was very sick
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Todos coincidiamos
en que estaba moi enferma
00:40
and she needed to be in the hospital.
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e tiña que estar ingresada
00:41
That wasn't being asked.
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Nin se formulaba a pregunta.
00:43
The question that was being asked of me was a different one,
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O que me estaban a preguntar
era outra cousa:
00:45
which was, did she also need an amputation?
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tamén precisa dunha amputación?
00:49
Now, looking back on that night,
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Agora, mirando cara atrás, aquela noite,
00:52
I'd love so desperately to believe that I treated that woman
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gustaríame tanto crer que aquela noite
00:57
on that night with the same empathy and compassion
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a tratei coa mesma empatía e compaixón
01:00
I'd shown the 27-year-old newlywed
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que mostrara cunha acabada de casar
de 27 anos
01:04
who came to the E.R. three nights earlier
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que chegara 3 noites antes
01:06
with lower back pain
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con dor lumbar,
01:08
that turned out to be advanced pancreatic cancer.
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que resultou ser
cancro de páncreas avanzado.
01:12
In her case, I knew there was nothing I could do
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Sabía que non había nada
que eu puidese facer
01:14
that was actually going to save her life.
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que de verdade lle salvase a vida.
01:16
The cancer was too advanced.
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O cancro estaba moi avanzado.
01:18
But I was committed to making sure that
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Pero empeñeime en garantir
01:21
I could do anything possible to make her stay
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que faría todo o posible
para facer a súa estancia máis cómoda.
01:23
more comfortable. I brought her a warm blanket
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Tróuxenlle un cobertor
01:26
and a cup of a coffee.
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e unha cunca de café.
01:28
I brought some for her parents.
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Tamén para os seus pais.
01:31
But more importantly, see, I passed no judgment on her,
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Pero sobre todo non a xulguei,
01:34
because obviously she had done nothing
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xa que, obviamente, ela non fixera nada
01:36
to bring this on herself.
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para provocar a súa situación.
01:38
So why was it that, just a few nights later,
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Entón, por qué só un par
de noites máis tarde,
01:41
as I stood in that same E.R. and determined
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cando, na mesma sala de urxencias,
01:44
that my diabetic patient did indeed need an amputation,
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determinei que a miña paciente diabética
si precisaba unha amputación,
01:47
why did I hold her in such bitter contempt?
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por que sentín ese desprezo amargo?
01:51
You see, unlike the woman the night before,
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Pois porque, ao contrario
da muller da noite anterior,
01:54
this woman had type 2 diabetes.
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esta muller tiña diabetes tipo 2.
01:56
She was fat.
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Estaba gorda.
01:58
And we all know that's from eating too much
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E todos sabemos que iso é de comer de máis
01:59
and not exercising enough, right?
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e non facer exercicio abondo, non si?
02:02
I mean, how hard can it be?
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Quero dicir, é tan difícil?
02:04
As I looked down at her in the bed, I thought to myself,
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Mentres a vía na cama, pensaba:
02:07
if you just tried caring even a little bit,
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se simplemente
intentaras coidarte un pouco
02:10
you wouldn't be in this situation at this moment
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non estarías nesta situación agora,
02:13
with some doctor you've never met
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cun médico ao que nunca viras
02:14
about to amputate your foot.
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a punto de amputarche un pé.
Por que me sentín con dereito a xulgala?
02:18
Why did I feel justified in judging her?
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Gustaríame dicir que non o sei.
02:22
I'd like to say I don't know.
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02:25
But I actually do.
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Pero en realidade si que o sei.
02:27
You see, in the hubris of my youth,
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Co arrogancia da xuventude,
02:29
I thought I had her all figured out.
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pensei que o entendía.
02:32
She ate too much. She got unlucky.
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Comeu de máis. Tivo mala sorte.
02:34
She got diabetes. Case closed.
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Ten diabetes. Caso pechado.
Ironicamente, naquela época na miña vida,
02:37
Ironically, at that time in my life,
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02:39
I was also doing cancer research,
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tamén facía investigación sobre o cancro,
02:41
immune-based therapies for melanoma, to be specific,
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en concreto, terapia inmunolóxica
para o melanoma,
02:43
and in that world I was actually taught to question everything,
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e nese mundo que me ensinou
a cuestionar todo,
02:47
to challenge all assumptions
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a desafiar as presuncións
02:49
and hold them to the highest possible scientific standards.
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e levalas aos máis altos
estándares científicos posibles.
02:53
Yet when it came to a disease like diabetes
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Con todo, cunha enfermidade
como a diabetes
02:57
that kills Americans eight times more frequently than melanoma,
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que mata oito veces máis
estadounidenses que o melanoma,
03:00
I never once questioned the conventional wisdom.
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nin unha vez cuestionei
a sabedoría convencional.
03:04
I actually just assmed the pathologic sequence of events
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Asumín a secuencia patolóxica dos feitos
03:07
was settled science.
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como probada.
03:09
Three years later, I found out how wrong I was.
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Tres anos máis tarde,
descubrín o equivocado que estaba.
03:13
But this time, I was the patient.
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Esta vez, o paciente era eu.
03:15
Despite exercising three or four hours every single day,
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A pesar de facer exercicio
tres ou catro horas todos os días,
03:19
and following the food pyramid to the letter,
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de seguir a pirámide alimentaria
ao pé da letra,
03:22
I'd gained a lot of weight and developed something
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gañei moito peso
e desenvolvín algo chamado
03:24
called metabolic syndrome.
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síndrome metabólica.
03:26
Some of you may have heard of this.
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Algúns escoitarían falar dela.
03:28
I had become insulin-resistant.
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Fixérame resistente á insulina.
03:31
You can think of insulin as this master hormone
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Poden pensar na insulina
como a hormona mestra
03:34
that controls what our body does with the foods we eat,
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que controla o que fai o noso corpo
cos alimentos que comemos,
03:38
whether we burn it or store it.
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queimalos ou almacenalos.
03:40
This is called fuel partitioning in the lingo.
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Separación do combustible no argot.
Non producir
insulina suficiente
03:43
Now failure to produce enough insulin is incompatible with life.
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é incompatible coa vida.
03:46
And insulin resistance, as its name suggests,
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E a resistencia á insulina,
como o propio nome indica,
03:49
is when your cells get increasingly resistant
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é cando as células
opoñen cada vez máis resistencia
03:51
to the effect of insulin trying to do its job.
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ao efecto da insulina tentando
facer o seu traballo.
03:55
Once you're insulin-resistant,
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Cando un é resistente á insulina,
está no camiño a padecer diabetes,
03:57
you're on your way to getting diabetes,
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03:58
which is what happens when your pancreas
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que é o que pasa cando o páncreas
04:00
can't keep up with the resistance and make enough insulin.
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non pode superar a resistencia
e producir insulina suficiente.
04:04
Now your blood sugar levels start to rise,
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Os niveis de azucre no sangue
comezan a subir,
04:06
and an entire cascade of pathologic events
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e iniciase unha auténtica fervenza
de eventos patolóxicos,
04:09
sort of spirals out of control that can lead to heart disease,
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unha espiral fóra de control,
que pode levar a enfermidades cardíacas,
04:13
cancer, even Alzheimer's disease,
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cancro, mesmo alzheimer,
04:16
and amputations, just like that woman a few years earlier.
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e amputacións, como aquela muller
uns anos antes.
04:21
With that scare, I got busy changing my diet radically,
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Con este susto, púxenme a cambiar
a miña dieta radicalmente,
04:24
adding and subtracting things most of you would find
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poñendo e quitando cousas que a maioría
04:26
almost assuredly shocking.
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seguramente atoparían chocantes.
04:29
I did this and lost 40 pounds, weirdly while exercising less.
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Fíxeno e perdín 18 quilos,
sorprendentemente facendo menos exercicio.
04:33
I, as you can see, I guess I'm not overweight anymore.
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Como se pode ver,
creo que xa non teño sobrepeso
E sobre todo, tampouco
resistencia á insulina.
04:36
More importantly, I don't have insulin resistance.
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04:39
But most important, I was left
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Pero, o máis importante,
04:41
with these three burning questions that wouldn't go away:
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quedei con estas tres cuestións candentes
que non marchaban:
04:44
How did this happen to me if I was supposedly
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Como me pasou isto se, en teoría,
04:47
doing everything right?
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estaba facendo o correcto?
04:50
If the conventional wisdom about nutrition had failed me,
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A sabedoría convencional
sobre nutrición fallárame.
04:53
was it possible it was failing someone else?
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Estaríalle fallando a alguén máis?
04:56
And underlying these questions,
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E, baixo estas preguntas,
04:58
I became almost maniacally obsessed
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obsesioneime dun xeito case maníaco
05:02
in trying to understand the real relationship
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con tentar entender a relación real
05:04
between obesity and insulin resistance.
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entre obesidade e resistencia á insulina.
05:08
Now, most researchers believe obesity
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A maioría dos investigadores
consideran que a obesidade
05:11
is the cause of insulin resistance.
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é a causa da resistencia á insulina.
Por lóxica, se se quere tratar
a resistencia á insulina,
05:14
Logically, then, if you want to treat insulin resistance,
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05:16
you get people to lose weight, right?
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faise que a xente perda peso, non?
05:18
You treat the obesity.
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Trátase a obesidade.
05:21
But what if we have it backwards?
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Pero, e se imos ó revés?
05:24
What if obesity isn't the cause of insulin resistance at all?
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E se a obesidade non é para nada
a causa da resistencia á insulina?
05:27
In fact, what if it's a symptom of a much deeper problem,
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E se, de feito, é un síntoma
dun problema moito máis profundo,
05:31
the tip of a proverbial iceberg?
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a punta dun iceberg proverbial?
05:34
I know it sounds crazy because we're obviously in the midst
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Sei que parece unha tolería,
porque estamos, obviamente,
05:36
of an obesity epidemic, but hear me out.
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no medio dunha epidemia de obesidade.
Pero, escoiten.
05:40
What if obesity is a coping mechanism
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E se a obesidade é un mecanismo
para afrontar un problema
05:43
for a far more sinister problem going on
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moito máis sinistro baixo todo isto?
05:46
underneath the cell?
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05:48
I'm not suggesting that obesity is benign,
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Non digo que a obesidade sexa benigna,
05:50
but what I am suggesting is it may be the lesser
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o que digo é que pode ser o menor
05:53
of two metabolic evils.
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de dous males metabólicos.
05:55
You can think of insulin resistance as the reduced capacity
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Poden ver a resistencia á insulina
como a capacidade reducida
05:58
of ourselves to partition fuel,
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das nosas células para repartir
o combustible,
06:00
as I alluded to a moment ago,
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como dixen hai pouco,
06:03
taking those calories that we take in
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tomar esas calorías que inxerimos
06:04
and burning some appropriately and storing some appropriately.
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queimar algunhas e almacenar outras
adecuadamente.
Cando nos facemos resistentes á insulina,
06:08
When we become insulin-resistant,
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06:10
the homeostasis in that balance deviates from this state.
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a homeostase deste equilibrio
desvíase deste estado.
06:13
So now, when insulin says to a cell,
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Así, cando a insulina
lle di a unha célula:
06:15
I want you to burn more energy
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Quero que queimes máis enerxía
06:17
than the cell considers safe, the cell, in effect, says,
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do que a célula considera seguro,
a célula di:
06:20
"No thanks, I'd actually rather store this energy."
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"Non, grazas, prefiro
almacenar esa enerxía."
E como as células de graxa
carecen da maioría
06:24
And because fat cells are actually missing most of
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06:26
the complex cellular machinery found in other cells,
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da complexa maquinaria
atopada noutras células,
06:29
it's probably the safest place to store it.
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seguramente sexan o lugar
máis seguro para almacenala.
06:31
So for many of us, about 75 million Americans,
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Así, para moitos de nós,
uns 75 millóns de estadounidenses,
06:36
the appropriate response to insulin resistance
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a resposta adecuada
á resistencia á insulina
06:40
may actually be to store it as fat, not the reverse,
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pode ser almacenalo como graxa,
e non ó contrario,
06:45
getting insulin resistance in response to getting fat.
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desenvolver resistencia á insulina
como resultado de engordar.
06:50
This is a really subtle distinction,
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É unha diferenza moi sutil,
06:52
but the implication could be profound.
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pero as implicacións poden ser profundas.
06:56
Consider the following analogy:
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Consideren a seguinte analoxía:
06:58
Think of the bruise you get on your shin
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Pensen nunha mazadura
que se produce nunha canela,
07:01
when you inadvertently bang your leg into the coffee table.
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cando sen darse conta baten
coa mesa do café,
07:05
Sure, the bruise hurts like hell, and you almost certainly
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Por suposto, a lesión doe moitísimo,
e seguramente
07:08
don't like the discolored look, but we all know
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non lle guste a aparencia descolorida,
pero todos sabemos
07:11
the bruise per se is not the problem.
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que a lesión en si non é o problema.
07:14
In fact, it's the opposite. It's a healthy response to the trauma,
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En realidade, é o contrario.
É unha resposta saudable ao trauma,
07:18
all of those immune cells rushing to the site of the injury
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todas as células inmunitarias
correndo ó lugar da lesión
07:21
to salvage cellular debris and prevent the spread
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para salvar os restos celulares
e evitar a propagación
07:24
of infection to elsewhere in the body.
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da infección a outras partes do corpo.
07:26
Now, imagine we thought bruises were the problem,
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Agora imaxinen que pensásemos
que as mazaduras eran o problema,
07:30
and we evolved a giant medical establishment
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e desenvolvésemos un sistema
médico xigante,
07:33
and a culture around treating bruises:
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e unha cultura
arredor do tratamento das mazaduras:
07:36
masking creams, painkillers, you name it,
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cremas de enmascaramento,
analxésicos, de todo,
07:39
all the while ignoring the fact that people
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en todo momento ignorando
o feito de que a xente
07:42
are still banging their shins into coffee tables.
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segue a bater coas canelas
nas mesas do café.
07:45
How much better would we be if we treated the cause --
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Canto mellor sería se tratásemos a causa,
--avisando á xente de que teña conta
07:48
telling people to pay attention
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07:50
when they walk through the living room --
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cando ande pola sala de estar--
07:52
rather than the effect?
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en vez do efecto?
07:55
Getting the cause and the effect right
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Interpretar a causa e o efecto
correctamente
07:57
makes all the difference in the world.
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marca a diferenza por completo.
07:59
Getting it wrong, and the pharmaceutical industry
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Se o interpretamos incorrectamente,
a industria farmacéutica
08:02
can still do very well for its shareholders
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aínda o estaría a facer moi ben
para os seus accionistas
08:05
but nothing improves for the people with bruised shins.
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pero nada mellora para as persoas
con pernas moradas.
08:09
Cause and effect.
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Causa e efecto.
08:12
So what I'm suggesting is
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O que eu suxiro é que,
08:14
maybe we have the cause and effect wrong
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482132
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se cadra entendemos mal
a relación causa-efecto
08:16
on obesity and insulin resistance.
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entre a obesidade
e a resistencia á insulina.
08:19
Maybe we should be asking ourselves,
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Se cadra deberámonos preguntar,
08:21
is it possible that insulin resistance causes weight gain
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489300
3885
é posible que a resistencia á insulina
cause o aumento de peso
08:25
and the diseases associated with obesity,
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493185
2066
e as enfermidades asociadas coa obesidade,
08:27
at least in most people?
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495251
1530
polo menos na maioría das persoas?
08:28
What if being obese is just a metabolic response
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496781
3000
E se ser obeso é só
unha resposta metabólica
08:31
to something much more threatening,
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499781
2221
a algo moito máis ameazante,
08:34
an underlying epidemic,
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502002
2211
unha epidemia subxacente,
08:36
the one we ought to be worried about?
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que é polo que deberiamos
estar preocupados?
08:38
Let's look at some suggestive facts.
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Vexamos uns feitos rechamantes.
08:40
We know that 30 million obese Americans
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508242
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Sabemos que 30 millóns
de estadounidenses obesos
08:42
in the United States don't have insulin resistance.
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2973
non teñen a resistencia á insulina.
08:45
And by the way, they don't appear to be at any
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513701
1937
E, a propósito, non parecen ter
08:47
greater risk of disease than lean people.
185
515638
3080
maior risco de enfermidade
que as persoas delgadas.
Por outra banda, sabemos que seis millóns
de persoas fracas
08:50
Conversely, we know that six million lean people
186
518718
2884
08:53
in the United States are insulin-resistant,
187
521602
3437
nos Estados Unidos
son insulinorresistentes,
08:57
and by the way, they appear to be at even greater risk
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525039
3067
e, por certo, parecen presentar
un risco aínda maior de padecer
09:00
for those metabolic disease I mentioned a moment ago
189
528106
2155
estas enfermidades metabólicas
que mencionaba
09:02
than their obese counterparts.
190
530261
1822
que os seus homólogos obesos.
09:04
Now I don't know why, but it might be because,
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532083
2237
Non sei o porqué, pero podería ser porque
09:06
in their case, their cells haven't actually figured out
192
534320
2690
neste caso, as células non descubriron
09:09
the right thing to do with that excess energy.
193
537010
3285
o correcto que facer co exceso de enerxía.
09:12
So if you can be obese and not have insulin resistance,
194
540295
3319
Entón, pódese ser obeso
e non ter resistencia á insulina,
09:15
and you can be lean and have it,
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543614
1871
e pódese estar delgada e tela.
09:17
this suggests that obesity may just be a proxy
196
545485
4433
Isto suxire que a obesidade
pode ser só un representante
09:21
for what's going on.
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549918
3024
do que está sucedendo.
09:24
So what if we're fighting the wrong war,
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552942
2415
E se estamos loitando
a guerra equivocada,
09:27
fighting obesity rather than insulin resistance?
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555357
3800
a loita contra a obesidade,
no canto da resistencia á insulina?
09:31
Even worse, what if blaming the obese
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559157
3243
Peor aínda, e se culpar ós obesos
09:34
means we're blaming the victims?
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562400
2725
significa que estamos culpando ás vítimas?
09:37
What if some of our fundamental ideas about obesity
202
565125
3719
E se algunha das nosas ideas fundamentais
sobre a obesidade están mal?
09:40
are just wrong?
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568844
1858
09:42
Personally, I can't afford the luxury of arrogance anymore,
204
570702
4123
Persoalmente, xa non me permito
o luxo da arrogancia
09:46
let alone the luxury of certainty.
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574825
2583
e moito menos o luxo da certeza.
09:49
I have my own ideas about what could be at the heart of this,
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577408
2846
Teño as miñas propias ideas sobre isto,
09:52
but I'm wide open to others.
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1912
pero estou aberto a outras.
09:54
Now, my hypothesis, because everybody always asks me,
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582166
2719
A miña hipótese, porque todo o mundo
ma pregunta é:
09:56
is this.
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584885
1617
09:58
If you ask yourself, what's a cell trying to protect itself from
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586502
3129
Se te preguntas, de que se intenta
protexer unha célula
10:01
when it becomes insulin resistant,
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589631
1727
cando se fai resistente á insulina?
10:03
the answer probably isn't too much food.
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591358
2675
a resposta probablemente non sexa:
demasiada comida.
10:06
It's more likely too much glucose: blood sugar.
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3650
Probablemente é a glicosa:
azucre no sangue.
10:09
Now, we know that refined grains and starches
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597683
2294
Agora sabemos que
os grans refinados e o amidón
10:11
elevate your blood sugar in the short run,
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599977
2056
elevan o azucre no sangue a curto prazo.
10:14
and there's even reason to believe that sugar
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602033
1908
Hai incluso razóns para crer que o azucre
10:15
may lead to insulin resistance directly.
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603941
2801
poida levar á resistencia
á insulina directamente.
10:18
So if you put these physiological processes to work,
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606742
4095
Se poñemos eses procesos
fisiolóxicos a traballar,
10:22
I'd hypothesize that it might be our increased intake
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610837
3473
a miña hipótese é que é posible
que o aumento na inxesta
10:26
of refined grains, sugars and starches that's driving
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614310
2863
de grans refinados, azucres e amidón
nos estea levando
10:29
this epidemic of obesity and diabetes,
221
617173
4651
á epidemia de obesidade e diabetes,
pero a través da resistencia á insulina,
10:33
but through insulin resistance,
222
621824
1838
10:35
you see, and not necessarily through just overeating and under-exercising.
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623662
3912
e non necesariamente
por exceso de comida
e falta de exercicio.
10:39
When I lost my 40 pounds a few years ago,
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627574
2585
Cando eu perdín os 18 quilos,
10:42
I did it simply by restricting those things,
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630159
2600
fíxeno eliminando estas cousas,
10:44
which admittedly suggests I have a bias
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632759
3456
polo que admito que teño unha inclinación
10:48
based on my personal experience.
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636215
2361
baseada na miña experiencia persoal.
10:50
But that doesn't mean my bias is wrong,
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638576
2655
Pero iso non significa que
o meu prexuízo sexa malo,
10:53
and most important, all of this can be tested scientifically.
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641231
3953
e o máis importante, todo isto pode
ser probado cientificamente.
10:57
But step one is accepting the possibility
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645184
3107
O primeiro paso é aceptar a posibilidade
11:00
that our current beliefs about obesity,
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648291
2372
de que as nosas ideas
actuais sobre obesidade,
11:02
diabetes and insulin resistance could be wrong
232
650663
3006
a diabetes e a resistencia á insulina
poidan ser incorrectas
11:05
and therefore must be tested.
233
653669
2875
e, polo tanto, deben ser comprobadas.
11:08
I'm betting my career on this.
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656544
2391
Aposto a miña carreira nisto.
11:10
Today, I devote all of my time to working on this problem,
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658935
4125
Hoxe, dedico todo o meu tempo
a traballar neste problema,
11:15
and I'll go wherever the science takes me.
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663060
3173
e eu vou cara a onde a ciencia me leva.
11:18
I've decided that what I can't and won't do anymore
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666233
3531
Decidín que o que nin podo
nin vou facer máis
11:21
is pretend I have the answers when I don't.
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669764
3044
é finxir que teño as respostas
cando non as teño.
11:24
I've been humbled enough by all I don't know.
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672808
4108
Xa me humillei o suficiente
con todo o que non sei.
11:28
For the past year, I've been fortunate enough
240
676916
2157
No último ano, tiven a sorte
11:31
to work on this problem with the most amazing team
241
679073
3413
de traballar neste problema
co equipo máis incrible
11:34
of diabetes and obesity researchers in the country,
242
682486
3404
de investigadores en diabetes e obesidade
de todo o país,
11:37
and the best part is,
243
685890
1305
e o mellor é que,
11:39
just like Abraham Lincoln surrounded himself with a team of rivals,
244
687195
3899
tal como Abraham Lincoln
se rodeara de rivais
11:43
we've done the same thing.
245
691094
1496
fixemos o mesmo.
11:44
We've recruited a team of scientific rivals,
246
692590
3263
Xuntamos un equipo de científicos rivais
11:47
the best and brightest who all have different hypotheses
247
695853
3445
o mellor e máis brillante
entre os que teñen distintas hipóteses
11:51
for what's at the heart of this epidemic.
248
699298
1614
sobre o centro desta epidemia.
11:52
Some think it's too many calories consumed.
249
700912
2381
Algúns pensan que é o exceso de calorías.
11:55
Others think it's too much dietary fat.
250
703293
2379
Outros cren que é moita graxa na dieta.
11:57
Others think it's too many refined grains and starches.
251
705672
3470
Outros pensan que é o exceso
de grans refinados e amidón.
12:01
But this team of multi-disciplinary,
252
709142
2608
Pero este equipo multidisciplinario
12:03
highly skeptical and exceedingly talented researchers
253
711750
2984
de investigadores altamente escépticos
e de gran talento,
12:06
do agree on two things.
254
714734
2288
puxéronse de acordo en dous puntos.
12:09
First, this problem is just simply too important
255
717022
3649
En primeiro lugar, este problema é
demasiado importante
12:12
to continue ignoring because we think we know the answer.
256
720671
2743
para seguir ignorándoo,
crendo que sabemos a resposta.
12:15
And two, if we're willing to be wrong,
257
723414
2784
E dous, se estamos dispostos
a estar equivocados,
12:18
if we're willing to challenge the conventional wisdom
258
726198
2537
a desafiar a sabedoría convencional,
12:20
with the best experiments science can offer,
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728735
3063
coas mellores probas científicas,
12:23
we can solve this problem.
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731798
2305
podemos solucionar este problema.
12:26
I know it's tempting to want an answer right now,
261
734103
3055
Sei que é tentador
querer unha resposta inmediata,
12:29
some form of action or policy, some dietary prescription --
262
737158
4497
algún tipo de acción ou política,
algunha prescrición dietética
12:33
eat this, not that —
263
741655
1729
--come isto, deixa isto--
12:35
but if we want to get it right,
264
743384
1680
pero se queremos facelo ben,
12:37
we're going to have to do much more rigorous science
265
745064
2234
imos ter que facer
unha ciencia máis rigorosa
12:39
before we can write that prescription.
266
747298
2853
antes de prescribir nada.
12:42
Briefly, to address this, our research program
267
750151
2599
En resumo, para abordar isto,
o noso programa de investigación
está centrado arredor de tres piares.
12:44
is focused around three meta-themes, or questions.
268
752750
3243
12:47
First, how do the various foods we consume
269
755993
2895
En primeiro lugar,
como impacta o que consumimos
12:50
impact our metabolism, hormones and enzymes,
270
758888
2801
no noso metabolismo, hormonas e encimas,
12:53
and through what nuanced molecular mechanisms?
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761689
2818
e a través de que matices
nos mecanismos moleculares?
12:56
Second, based on these insights,
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764507
2250
En segundo lugar, en base a estas ideas,
12:58
can people make the necessary changes in their diets
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766757
2959
a xente pode facer os cambios
necesarios nas súas dietas
13:01
in a way that's safe and practical to implement?
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769716
3731
de forma que sexa
seguro e práctico facelo?
13:05
And finally, once we identify what safe
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773447
3009
E, finalmente, unha vez identificados
os cambios prácticos e seguros
13:08
and practical changes people can make to their diet,
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776456
3028
13:11
how can we move their behavior in that direction
277
779484
3675
como modificamos o noso comportamento
13:15
so that it becomes more the default
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783159
2253
para que isto se converta no corrente
13:17
rather than the exception?
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785412
1856
e non na excepción?
13:19
Just because you know what to do doesn't mean
280
787268
2420
Porque xa saben que saber
o que se debe facer
13:21
you're always going to do it.
281
789688
1509
non sempre significa facelo.
13:23
Sometimes we have to put cues around people
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791197
2128
Ás veces hai que poñer pistas,
13:25
to make it easier, and believe it or not,
283
793325
2303
para facelo máis doado, e créano ou non,
13:27
that can be studied scientifically.
284
795628
3641
isto pode estudarse cientificamente.
13:31
I don't know how this journey is going to end,
285
799269
2584
Non sei como vai rematar esta viaxe
13:33
but this much seems clear to me, at least:
286
801853
4213
pero, polo menos para min,
unha cousa está clara,
13:38
We can't keep blaming our overweight and diabetic patients
287
806066
4996
Non podemos seguir culpando ós nosos
pacientes con sobrepeso e diabéticos
13:43
like I did.
288
811062
2912
como fixen eu.
13:45
Most of them actually want to do the right thing,
289
813974
2279
A maioría deles queren facer o correcto,
13:48
but they have to know what that is,
290
816253
3369
pero teñen que saber o que é,
13:51
and it's got to work.
291
819622
3046
e así vai saír ben.
13:54
I dream of a day when our patients can
292
822668
4696
Soño co día no que os pacientes,
13:59
shed their excess pounds
293
827364
1735
poidan perder os quilos de máis,
14:01
and cure themselves of insulin resistance,
294
829099
2813
e autocurarse da resistencia á insulina
14:03
because as medical professionals,
295
831912
2730
grazas a que os profesionais médicos
deixamos o noso exceso
de ideas preconcibidas
14:06
we've shed our excess mental baggage
296
834642
1970
14:08
and cured ourselves of new idea resistance sufficiently
297
836612
3326
e autocurámonos da resistencia
ás novas ideas
14:11
to go back to our original ideals:
298
839938
3090
para volver ós nosos ideais orixinais:
14:15
open minds, the courage to throw out yesterday's ideas
299
843028
4417
mente aberta, valor
para tirar as ideas de onte
14:19
when they don't appear to be working,
300
847445
3328
cando parecen non funcionar,
14:22
and the understanding that scientific truth isn't final,
301
850773
3119
e entender que a verdade científica
non é definitiva,
14:25
but constantly evolving.
302
853892
2748
se non que evoluciona constantemente.
14:28
Staying true to that path will be better for our patients
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856640
3292
Manterse fiel a ese camiño
será mellor para os pacientes,
14:31
and better for science.
304
859932
3248
e mellor para a ciencia.
14:35
If obesity is nothing more than a proxy
305
863180
2994
Se a obesidade non é máis
que un representante
14:38
for metabolic illness,
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866174
1926
das enfermidades metabólicas,
14:40
what good does it do us to punish those with the proxy?
307
868100
5297
en que axuda castigar ao representante?
14:45
Sometimes I think back to that night in the E.R.
308
873397
4544
Ás veces penso naquela noite en urxencias
14:49
seven years ago.
309
877941
2313
de hai sete anos.
14:52
I wish I could speak with that woman again.
310
880254
3624
Gustaríame poder falar
con aquela muller de novo.
14:55
I'd like to tell her how sorry I am.
311
883878
3255
Gustaríame dicirlle cando o sinto.
14:59
I'd say, as a doctor, I delivered
312
887133
2887
Diríalle que, como médico
lle dei os mellores coidados que puiden,
15:02
the best clinical care I could,
313
890020
3660
15:05
but as a human being,
314
893680
3897
pero que como ser humano
a decepcionei.
15:09
I let you down.
315
897577
2408
15:11
You didn't need my judgment and my contempt.
316
899985
4245
Non precisabas nin o meu xuízo
nin o meu desprezo.
15:16
You needed my empathy and compassion,
317
904230
4498
Precisabas empatía e compaixón
15:20
and above all else, you needed a doctor
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908728
1995
e por riba de todo, precisabas un médico
15:22
who was willing to consider
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910723
2629
que estivese disposto a considerar
15:25
maybe you didn't let the system down.
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913352
3064
que se cadra non eras ti
a que lle estaba fallando ó sistema.
15:28
Maybe the system, of which I was a part,
321
916416
3218
Se cadra era o sistema,
do que eu era parte,
15:31
was letting you down.
322
919634
2439
o que che estaba fallando.
15:34
If you're watching this now,
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2801
Se estás vendo isto,
15:36
I hope you can forgive me.
324
924874
4238
Espero que me poidas perdoar.
15:41
(Applause)
325
929112
4000
(Aplausos)

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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

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