TEDMED 2013
Peter Attia: Is the obesity crisis hiding a bigger problem?
Peter Attia: Po sikur ta kemi gabim rreth diabetit?
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Si një kirurg i ri, Peter Attia kish ndjerë përbuzje për një paciente me diabet. Duke qene se ajo ishte mbipeshë, ai mendoi se ajo ishte rrjedhimisht përgjegjëse për faktin se tashme kishte nevojë për një amputim këmbe. Por vite më vonë, Attia pati një surprizë të pakëndshme mjekësore që e beri të pyes veten: a e kuptojmë drejt diabetin? A mundet qe shenjat lajmeruese te diabetit të shkaktojnë obezitet, dhe jo anasjelltas? Një vështrim ky se si supozimet mund te na çojne të bëjme luftën mjekësore te gabuar.
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. Full bio
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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Nuk do ta harroj kurrë atë ditë
00:13
back in the spring of 2006.
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të pranverës së 2006-ës.
00:17
I was a surgical resident
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Isha kirurg rezident
00:19
at The Johns Hopkins Hospital,
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në Spitalin Johns Hopkins
00:21
taking emergency call.
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në pranim të thirrjeve te urgjences.
00:23
I got paged by the E.R. around 2 in the morning
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Rreth orës 2 të mëngjesit u njoftova nga E.R
00:26
to come and see a woman with a diabetic ulcer
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që të shkoj të shoh një grua me ulcerë diabetike
00:28
on her foot.
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në këmbën e saj.
00:30
I can still remember sort of that smell of rotting flesh
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Ende e kujtoj atë lloj ere të gjakut të kalbur,
00:34
as I pulled the curtain back to see her.
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tek po e tërhiqja perden që ta shoh atë.
00:38
And everybody there agreed this woman was very sick
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Të gjithë aty mendonim që ajo grua ishte shumë sëmurë
00:40
and she needed to be in the hospital.
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dhe kishte nevojë të shtrohej në spital.
00:41
That wasn't being asked.
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Kjo nuk vihej në diskutim.
00:43
The question that was being asked of me was a different one,
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Pyetja qe shtroja ishte një tjetër,
00:45
which was, did she also need an amputation?
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a kishte ajo nevojë për amputim?
00:49
Now, looking back on that night,
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Tani, duke kthyer koken pas ne atë natë
00:52
I'd love so desperately to believe that I treated that woman
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do të doja dëshperimisht të besoja se e trajtova atë grua,
00:57
on that night with the same empathy and compassion
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atë natë, me empatinë dhe dhembshurinë e njëjtë
01:00
I'd shown the 27-year-old newlywed
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që tregova ndaj 27 vjeçares së sapo martuar
01:04
who came to the E.R. three nights earlier
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e cila erdhi në E.R tri ditë perpara
01:06
with lower back pain
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me dhimbje mesi
01:08
that turned out to be advanced pancreatic cancer.
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e cila doli të jetë kancer pankreatik i avancuar.
01:12
In her case, I knew there was nothing I could do
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Në rastin e saj, unë e dija se s'kishte asgjë që mund të bëja
01:14
that was actually going to save her life.
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që do ti shpëtonte jetën.
01:16
The cancer was too advanced.
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Kanceri ishte shumë i avancuar.
01:18
But I was committed to making sure that
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Por isha i përkushtuar të sigurohesha që
01:21
I could do anything possible to make her stay
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do bëja gjithçka të mundshme për ta bërë atë të ndihet
01:23
more comfortable. I brought her a warm blanket
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më rehat. I solla një batanije të ngrohte
01:26
and a cup of a coffee.
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dhe një filxhan kafe.
01:28
I brought some for her parents.
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Solla edhe për prindërit e saj.
01:31
But more importantly, see, I passed no judgment on her,
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Por shikoni, më e rëndësishmja eshte qe unë nuk e paragjykova atë,
01:34
because obviously she had done nothing
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sepse dukej qartë qe ajo s'kishte bërë gjë
01:36
to bring this on herself.
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qe mund t'ia shkaktonte këtë vetes se saj.
01:38
So why was it that, just a few nights later,
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Atehere, si eshte e mundur qe disa nete me pas,
01:41
as I stood in that same E.R. and determined
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tek qendroja ne te njejten dhome te urgjences dhe i vendosur
01:44
that my diabetic patient did indeed need an amputation,
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qe pacientja ime diabetike kish nevoje per amputim,
01:47
why did I hold her in such bitter contempt?
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perse ja thashe kete ne nje menyre kaq te hidhur?
01:51
You see, unlike the woman the night before,
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Dallimi eshte qe ne ndryshim me gruan e nje nate me pare,
01:54
this woman had type 2 diabetes.
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kjo grua vuante nga diabeti i tipit 2.
01:56
She was fat.
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Ajo ishte e shendoshe.
01:58
And we all know that's from eating too much
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Dhe te gjithe e dime qe kjo vjen si rezultat i te ngrenit shume
01:59
and not exercising enough, right?
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dhe mungeses se aktivitetit fizik, apo jo?
02:02
I mean, how hard can it be?
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Dua te them, sa e veshtire mund te jete?
02:04
As I looked down at her in the bed, I thought to myself,
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Teksa e shihja te shtrire mendoja me vete,
02:07
if you just tried caring even a little bit,
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sikur shume pak te te interesonte,
02:10
you wouldn't be in this situation at this moment
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nuk do te ishe ne kete gjendje tani
02:13
with some doctor you've never met
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me nje mjek qe nuk e kishe pare kurre me pare
02:14
about to amputate your foot.
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duke u pergatitur per te te prere kemben.
02:18
Why did I feel justified in judging her?
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Perse u ndjeva i justifikuar qe gjykoja ndaj saj?
02:22
I'd like to say I don't know.
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Do desha te thoja qe nuk e di.
02:25
But I actually do.
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Por ja qe nuk eshte e vertete.
02:27
You see, in the hubris of my youth,
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Me kryelartesine e rinise sime,
02:29
I thought I had her all figured out.
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mendova se e kisha psikologjisur ate.
02:32
She ate too much. She got unlucky.
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Ajo ka ngrene shume. Ajo ka qene pa fat.
02:34
She got diabetes. Case closed.
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U semur me diabet. Kaq qe puna.
02:37
Ironically, at that time in my life,
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Cuditerisht, ne ate kohe,
02:39
I was also doing cancer research,
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po hulumtoja rreth kancerit,
02:41
immune-based therapies for melanoma, to be specific,
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terapite e sistemit imunitar per kancer te lekures, per te qene me ekzakt,
02:43
and in that world I was actually taught to question everything,
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nga kisha mesuar se duhej te kisha dyshime per gjithcka,
02:47
to challenge all assumptions
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te mos merrja te mireqene gje
02:49
and hold them to the highest possible scientific standards.
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dhe ti masja me standardet me te larta shkencore.
02:53
Yet when it came to a disease like diabetes
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Nderkohe, kur vjen fjala tek diabeti
02:57
that kills Americans eight times more frequently than melanoma,
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i cili vret 8 here me shume amerikane se melanoma,
03:00
I never once questioned the conventional wisdom.
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nuk e vura kurre ne prove dijen e deri atehershme.
03:04
I actually just assmed the pathologic sequence of events
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Pranova te mireqene,
03:07
was settled science.
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cdo hallke te zinxhirit te shkaqeve patologjike qe te conte ne te.
03:09
Three years later, I found out how wrong I was.
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Tre vite me pas, zbulova se isha shume gabim.
03:13
But this time, I was the patient.
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Por kete here, isha pacienti.
03:15
Despite exercising three or four hours every single day,
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Edhe pse beja ushtrime fizike 3-4 ore ne dite,
03:19
and following the food pyramid to the letter,
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dhe zbatimin i piramides ushqimore me perpikmeri,
03:22
I'd gained a lot of weight and developed something
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kisha shtuar shume ne peshe dhe kisha zhvilluar
03:24
called metabolic syndrome.
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dicka te ashtuquajtur sindroma e metabolizmit.
03:26
Some of you may have heard of this.
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Disa nga ju mund edhe te kene degjuar per te.
03:28
I had become insulin-resistant.
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Isha bere imun ndaj insulines.
03:31
You can think of insulin as this master hormone
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Mund ta mendoni insulinen si ky hormon i gjithepushtetshem
03:34
that controls what our body does with the foods we eat,
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qe kontrollon se cfare ben trupi yne me ushqimet qe hame,
03:38
whether we burn it or store it.
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nese i ruajme ose i djegim.
03:40
This is called fuel partitioning in the lingo.
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Ne gjuhen mjekesore kjo quhet "ndarje e energjise".
03:43
Now failure to produce enough insulin is incompatible with life.
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Mos prodhimi i mjaftueshem i insulines nuk pajtohet me jeten.
03:46
And insulin resistance, as its name suggests,
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Dhe rezistence ndaj insulines, sikunder sugjeron dhe emri,
03:49
is when your cells get increasingly resistant
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ndodh atehere kur qelizat behen gjithnje e me rezistente
03:51
to the effect of insulin trying to do its job.
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nga efektet e insulines qe perpiqet te beje punen e saj.
03:55
Once you're insulin-resistant,
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Kur behesh rezistent ndaj insulines,
03:57
you're on your way to getting diabetes,
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kthehesh ne diabetik,
03:58
which is what happens when your pancreas
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c'ka ndodh kur pankreasi
04:00
can't keep up with the resistance and make enough insulin.
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nuk mund te perballoje rezistencen dhe te prodhoje mjaftueshem insuline.
04:04
Now your blood sugar levels start to rise,
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FIllon ngritja e sasise se sheqerit ne gjak,
04:06
and an entire cascade of pathologic events
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dhe nje ujvare problemesh patologjike
04:09
sort of spirals out of control that can lead to heart disease,
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dalin jashte kontrolli, c'ka mund te cojne ne probleme me zemren,
04:13
cancer, even Alzheimer's disease,
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kancer, ose edhe Alzaimer,
04:16
and amputations, just like that woman a few years earlier.
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dhe amputim, pikerisht si ajo grua disa vite me pare.
04:21
With that scare, I got busy changing my diet radically,
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Me kete problem, nisa te ndryshoj dieten time ne menyre drastike,
04:24
adding and subtracting things most of you would find
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duke hequr e shtuar gjera qe ju do ti gjenit
04:26
almost assuredly shocking.
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padyshim shokuese.
04:29
I did this and lost 40 pounds, weirdly while exercising less.
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Bera keshtu dhe humba 20 kg, ndonese beja me pak ushtrime fizike.
04:33
I, as you can see, I guess I'm not overweight anymore.
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Sikunder mund te shihni, nuk jam me mbipeshe.
04:36
More importantly, I don't have insulin resistance.
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Cka eshte me e rendesishme eshte qe nuk kam me rezistence ndaj insulines.
04:39
But most important, I was left
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Por edhe me e rendesishme, jane keto tre pyetjet
04:41
with these three burning questions that wouldn't go away:
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qe me kane mbetur dhe te cilat nuk duan te me hiqen:
04:44
How did this happen to me if I was supposedly
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Si me ngjau kjo gje kur une mendohej
04:47
doing everything right?
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se po beja gjithcka si duhej?
04:50
If the conventional wisdom about nutrition had failed me,
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Nese shkenca rreth te ushqyerit te shendetshem ka qene e rreme,
04:53
was it possible it was failing someone else?
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a thua e tille ishte dhe per te tjere?
04:56
And underlying these questions,
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Dhe ne analizimin e ketyre pyetjeve
04:58
I became almost maniacally obsessed
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u bera pothuajse i fiksuar
05:02
in trying to understand the real relationship
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ne te perpjekurit per te kuptuar lidhjen e vertete
05:04
between obesity and insulin resistance.
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midis obezitetit dhe rezistences se insulines.
05:08
Now, most researchers believe obesity
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Tanime, shume hulumtues besojne se obeziteti
05:11
is the cause of insulin resistance.
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eshte si rrjedhoje e resistences ndaj insulines.
05:14
Logically, then, if you want to treat insulin resistance,
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Logjikisht, kur do te trajtosh rezistencen ndaj insulines,
05:16
you get people to lose weight, right?
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i detyron njerezit te bien ne peshe, apo jo?
05:18
You treat the obesity.
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Trajton obezitetin.
05:21
But what if we have it backwards?
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Po sikur te jete pikerisht e kunderta?
05:24
What if obesity isn't the cause of insulin resistance at all?
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Po sikur obeziteti te mos jete shkaku i rezistences ndaj insulines?
05:27
In fact, what if it's a symptom of a much deeper problem,
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Ne fakt, po sikur te jete sintoma e nje problemi shume me te madh,
05:31
the tip of a proverbial iceberg?
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maja e nje ajsbergu?
05:34
I know it sounds crazy because we're obviously in the midst
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E di qe tingellon pak e cuditshme, pasi jemi ne mesin
05:36
of an obesity epidemic, but hear me out.
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e nje epidemie obeziteti, por me degjoni pak.
05:40
What if obesity is a coping mechanism
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Po sikur obeziteti te jete nje kamuflazh
05:43
for a far more sinister problem going on
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i nje problemi shume me te rende qe
05:46
underneath the cell?
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i ka rrenjet ne qelize?
05:48
I'm not suggesting that obesity is benign,
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Nuk jam duke sugjeruar ketu qe obeziteti eshte beninj,
05:50
but what I am suggesting is it may be the lesser
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por ate qe po sugjeroj eshte qe mund te jete e keqja me e vogel
05:53
of two metabolic evils.
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e dy te keqijave te metabolizmit.
05:55
You can think of insulin resistance as the reduced capacity
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Mund ta mendoni rezistencen ndaj insulines si aftesia e limituar
05:58
of ourselves to partition fuel,
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e vetes per te shperndare karburantin,
06:00
as I alluded to a moment ago,
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sikunder iu referova para nje minute,
06:03
taking those calories that we take in
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te marresh kalorite qe sigurojme me ushqimin
06:04
and burning some appropriately and storing some appropriately.
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dhe ne menyre proporcionale te djegim nje pjese e te ruajme tjetren.
06:08
When we become insulin-resistant,
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Kur behemi rezistent ndaj insulines,
06:10
the homeostasis in that balance deviates from this state.
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homeostaza ne kete lloj ballancimi prishet.
06:13
So now, when insulin says to a cell,
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Pra tanime, kur insulina i thote qelizes,
06:15
I want you to burn more energy
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dua te djegesh me shume energji
06:17
than the cell considers safe, the cell, in effect, says,
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sesa qeliza e konsideron te sigurt, ne te vertete ajo pergjigjet,
06:20
"No thanks, I'd actually rather store this energy."
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"Jo faleminderit, do ta ruaj kete energji."
06:24
And because fat cells are actually missing most of
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Dhe duke qene se ne qelizat e dhjamit nuk i gjen
06:26
the complex cellular machinery found in other cells,
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ato makineri komplekse qelizore qe gjendet ne qeliza te tjera,
06:29
it's probably the safest place to store it.
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eshte vendi me i mire per ti ruajtur.
06:31
So for many of us, about 75 million Americans,
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Shume prej nesh, rreth 75 milion Amerikane,
06:36
the appropriate response to insulin resistance
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pergjigja e rezistences ndaj insulines
06:40
may actually be to store it as fat, not the reverse,
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mund te jete qe ta ruaj ne formen e dhjamit e jo e kunderta,
06:45
getting insulin resistance in response to getting fat.
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te kesh rezistence insuline ne pergjigje te dhjamosjes.
06:50
This is a really subtle distinction,
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Kjo eshte ne te vertete nje ndryshim i vogel,
06:52
but the implication could be profound.
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por me pasoja te renda.
06:56
Consider the following analogy:
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Konsideroni analogjine e meposhtme:
06:58
Think of the bruise you get on your shin
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Mendoni per gerricjet qe pesoni ne lekure
07:01
when you inadvertently bang your leg into the coffee table.
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kur ne menyre rastesore perplasni gjurin ne tavolinen e kafes.
07:05
Sure, the bruise hurts like hell, and you almost certainly
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Padyshim qe plaga dhemb shume dhe
07:08
don't like the discolored look, but we all know
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ju nuk e pelqeni faktin qe eshte nxire, por te gjithe e dime
07:11
the bruise per se is not the problem.
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qe plaga ne vetvete nuk eshte problemi.
07:14
In fact, it's the opposite. It's a healthy response to the trauma,
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Ne fakt, eshte e kunderta, eshte nje pergjigje e shendetshme ndaj nje traume,
07:18
all of those immune cells rushing to the site of the injury
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jane qelizat imunitare qe vrapojne aty ku ndodhi demtimi
07:21
to salvage cellular debris and prevent the spread
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qe te ndihmojne qelizat e atyshme dhe te ndalojne
07:24
of infection to elsewhere in the body.
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perhapjen e infeksionit ne pjese te tjera te trupit.
07:26
Now, imagine we thought bruises were the problem,
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Tani, imagjinoni sikur ne te mendonim se plaga eshte faktikisht problemi,
07:30
and we evolved a giant medical establishment
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dhe zhvillojme cdo kerkim
07:33
and a culture around treating bruises:
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dhe kulture mjeksore rreth trajtimit te plageve:
07:36
masking creams, painkillers, you name it,
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krem maskimi, ilace kunder dhimbjes, e shume te tjere,
07:39
all the while ignoring the fact that people
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duke injoruar teresisht faktin qe njerezit
07:42
are still banging their shins into coffee tables.
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jane ende duke perplasur kercirin ne tavolina kafeje.
07:45
How much better would we be if we treated the cause --
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Sa me mire do te ish po te trajtonim shkaqet--
07:48
telling people to pay attention
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duke i thene njerezve te jene me te kujdesshem
07:50
when they walk through the living room --
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teksa ecin neper sallon--
07:52
rather than the effect?
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ne vend te efektit qe krijohet?
07:55
Getting the cause and the effect right
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Te kuptosh shkakun dhe efektin,
07:57
makes all the difference in the world.
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ben te gjithe diferencen e mundshme.
07:59
Getting it wrong, and the pharmaceutical industry
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Ta kesh gabim, industria farmaceutike
08:02
can still do very well for its shareholders
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mund te vazhdoje te jete fitimprurese per investuestit e saj
08:05
but nothing improves for the people with bruised shins.
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por per njerezit me kerci te vrare nuk permiresohet asgje.
08:09
Cause and effect.
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Shkaku dhe efekti.
08:12
So what I'm suggesting is
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Ajo c'ka jam duke sugjeruar eshte
08:14
maybe we have the cause and effect wrong
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se ndoshta kemi shkakun dhe efektin e gabuar
08:16
on obesity and insulin resistance.
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kur falsim per obezitet dhe rezistence ndaj insulines.
08:19
Maybe we should be asking ourselves,
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Ndoshta duhet ta pyesim veten,
08:21
is it possible that insulin resistance causes weight gain
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a eshte e mundur qe rezistenca ndaj insulines shkakon rritje ne peshe
08:25
and the diseases associated with obesity,
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dhe semundje qe lidhen me obezitetin,
08:27
at least in most people?
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te pakten ne shumicen e njerezve?
08:28
What if being obese is just a metabolic response
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Po sikur te qenit obez eshte thjesht nje pergjigje e metabolizmit
08:31
to something much more threatening,
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ndaj dickaje shume me teper kercenuese,
08:34
an underlying epidemic,
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nje epidemi e fshehur,
08:36
the one we ought to be worried about?
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ajo per cka duhet te shqetesohemi me shume?
08:38
Let's look at some suggestive facts.
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Le ti hedhim nje sy fakteve.
08:40
We know that 30 million obese Americans
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E dime qe 30 milion amerikane obeze
08:42
in the United States don't have insulin resistance.
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ne USA nuk vuajne nga rezistenca e insulines.
08:45
And by the way, they don't appear to be at any
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Dhe meqenese ra fjala, ato nuk duket te jene ne
08:47
greater risk of disease than lean people.
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ndonje rrezik me te madh per semundje se njerezit e dobet.
08:50
Conversely, we know that six million lean people
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Nderkohe, dime qe 6 milione njerez te dobet
08:53
in the United States are insulin-resistant,
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ne USA jane rezistent ndaj insulines,
08:57
and by the way, they appear to be at even greater risk
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dhe meqenese ra fjala, ata mendohet te jene ne rrezik me te madh per
09:00
for those metabolic disease I mentioned a moment ago
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ato semundje metabolike qe permenda me siper,
09:02
than their obese counterparts.
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ne dallim nga grupi i obezeve.
09:04
Now I don't know why, but it might be because,
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Une nuk e di pse, por ndoshta kjo vjen si rezultat i faktit qe
09:06
in their case, their cells haven't actually figured out
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ne rastin e tyre, qelizat nuk e kane kuptuar ende
09:09
the right thing to do with that excess energy.
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se c'duhet te bejne me tepricen e energjise.
09:12
So if you can be obese and not have insulin resistance,
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Pra nqse nje njeri mund te jete obez dhe mund te mos kete rezistence ndaj insulines,
09:15
and you can be lean and have it,
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ose mund te jete i dobet e ta kete,
09:17
this suggests that obesity may just be a proxy
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kjo tregon se obeziteti mund te jete nje kamuflazh
09:21
for what's going on.
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per ate qe po ndodh.
09:24
So what if we're fighting the wrong war,
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Pra, po sikur te jemi duke luftuar nje lufte te gabuar,
09:27
fighting obesity rather than insulin resistance?
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te luftojme obezitetin ne vend te rezistences ndaj insulines?
09:31
Even worse, what if blaming the obese
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Edhe me keq, po sikur fajesimi i obezeve
09:34
means we're blaming the victims?
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do te thote qe po fajesojme viktimat?
09:37
What if some of our fundamental ideas about obesity
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Po sikur disa nga idete tona thelbesore mbi obezitetin
09:40
are just wrong?
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jane gabim?
09:42
Personally, I can't afford the luxury of arrogance anymore,
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Personalisht, nuk mund ta kem me luksin e arrogances
09:46
let alone the luxury of certainty.
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mos flasim pastaj per luksin e sigurise se plote.
09:49
I have my own ideas about what could be at the heart of this,
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Kam idete e mia te asaj c'ka mund te jete problemi,
09:52
but I'm wide open to others.
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por jam e hapur per sugjerime.
09:54
Now, my hypothesis, because everybody always asks me,
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Hipoteza ime, sepse te gjithe me pyesin,
09:56
is this.
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eshte kjo.
09:58
If you ask yourself, what's a cell trying to protect itself from
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Nese e pyesni veten, se nga se perpiqet te mbrohet qeliza
10:01
when it becomes insulin resistant,
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kur behet rezistente ndaj insulines,
10:03
the answer probably isn't too much food.
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pergjigja ndoshta nuk eshte, teprice ushqimore.
10:06
It's more likely too much glucose: blood sugar.
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Por me gjasa, teprice glukoze: sheqeri ne gjak.
10:09
Now, we know that refined grains and starches
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E dime qe dritherat e perpunuara
10:11
elevate your blood sugar in the short run,
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e ngrene nivelin e sheqerit ne gjak ne nje kohe afatshkurter,
10:14
and there's even reason to believe that sugar
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dhe ka edhe arsye per te besuar se sheqeri
10:15
may lead to insulin resistance directly.
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mund te coje direkt ne rezistence ndaj insulines.
10:18
So if you put these physiological processes to work,
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Nqse keto procese psikologjike vihen ne pune,
10:22
I'd hypothesize that it might be our increased intake
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hedh hipotezen qe mund te jete shkaku i marrjes se
10:26
of refined grains, sugars and starches that's driving
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drithrave te perpunuara, sheqerit ne mase, ajo cka sjell
10:29
this epidemic of obesity and diabetes,
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epidemine e obezitetit dhe diabetit,
10:33
but through insulin resistance,
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por nepermjet rezistences ndaj insulines,
10:35
you see, and not necessarily through just overeating and under-exercising.
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dhe jo si efekt i mbingopjes ose mos berjes ushtrime fizike.
10:39
When I lost my 40 pounds a few years ago,
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Kur humba 20 kg disa vite me pare,
10:42
I did it simply by restricting those things,
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e bera thjesht duke kufizuar keto gjera,
10:44
which admittedly suggests I have a bias
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cka sugjeron qe kam nje anesi
10:48
based on my personal experience.
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bazuar ne eksperiencen time personale.
10:50
But that doesn't mean my bias is wrong,
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Por kjo nuk do te thote qe anesia ime eshte e gabuar,
10:53
and most important, all of this can be tested scientifically.
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dhe me e rendesishmja, te gjitha keto mund te provohen shkencerisht.
10:57
But step one is accepting the possibility
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Por, shkalla e pare eshte te pranosh mundesine
11:00
that our current beliefs about obesity,
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se besimi yne rreth obezitetit,
11:02
diabetes and insulin resistance could be wrong
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diabetit dhe rezistences ndaj insulines mund te jene te gabuara
11:05
and therefore must be tested.
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dhe si rrjedhoje duhen testuar.
11:08
I'm betting my career on this.
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Ve bast karrieren time ne kete gje.
11:10
Today, I devote all of my time to working on this problem,
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Sot, ja dedikoj te gjithe kohen time punes mbi kete problem,
11:15
and I'll go wherever the science takes me.
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dhe do te shkoj kudo te me coje shkenca.
11:18
I've decided that what I can't and won't do anymore
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Kam vendosur qe ajo c'ka nuk mundem dhe nuk do te bej me
11:21
is pretend I have the answers when I don't.
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eshte te pretendoj qe i kam pergjigjet kur nuk i kam ato.
11:24
I've been humbled enough by all I don't know.
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Kam qene i perulur per gjithcka nuk njoh
11:28
For the past year, I've been fortunate enough
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Vitin e fundit, kam qene mjaf me fat
11:31
to work on this problem with the most amazing team
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qe kam punuar mbi kete problem me nje grup te mrekullueshem
11:34
of diabetes and obesity researchers in the country,
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hulumtuesish te obezitetit dhe diabetit ne vend,
11:37
and the best part is,
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dhe pjesa me e bukur eshte qe,
11:39
just like Abraham Lincoln surrounded himself with a team of rivals,
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sikunderse Abraham Lincoln e rrethoi veten me nje grup pune rivalesh,
11:43
we've done the same thing.
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dhe ne kemi bere te njejten gje.
11:44
We've recruited a team of scientific rivals,
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Kemi rekrutuar nje grup pune me shkencetare rival,
11:47
the best and brightest who all have different hypotheses
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me te miret dhe me te ndriturit por qe te gjithe kane hipotezat e veta
11:51
for what's at the heart of this epidemic.
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rreth asaj cka mund te jete ne zemer te epidemise.
11:52
Some think it's too many calories consumed.
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Disa mendojne qe eshte sasia e madhe e kalorive te konsumuara.
11:55
Others think it's too much dietary fat.
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Te tjere mendojne se eshte konsumi i madh i nje diete te yndyrshme.
11:57
Others think it's too many refined grains and starches.
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Per te tjere problemi qendron te konsumi i drithrave dhe niseshtese.
12:01
But this team of multi-disciplinary,
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Por ky grup pune i hulumtuesve multi disiplinor,
12:03
highly skeptical and exceedingly talented researchers
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mjaft te edukuar dhe mjaft te talentuar,
12:06
do agree on two things.
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jane dakort ne dy gjera.
12:09
First, this problem is just simply too important
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E para, ky problem eshte shume i rendesishem
12:12
to continue ignoring because we think we know the answer.
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per te vazhduar ta injorojme thjesht sepse ne mendojme se i dime pergjigjet.
12:15
And two, if we're willing to be wrong,
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Dhe e dyta, nese pranojme te jemi gabim,
12:18
if we're willing to challenge the conventional wisdom
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nese pranojme te sfidojme njohurine e deritanishme
12:20
with the best experiments science can offer,
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me eksperimentet me te mira ofruar nga shkenca,
12:23
we can solve this problem.
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problemi mund te zgjidhet.
12:26
I know it's tempting to want an answer right now,
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E di qe eshte mjaft joshese te dashurit te mesosh pergjigjen qe tani,
12:29
some form of action or policy, some dietary prescription --
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politikat dhe masat, rekomandimet dietike--
12:33
eat this, not that —
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ha kete, jo ate--
12:35
but if we want to get it right,
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por nese duam ta idenitfikojme ekzaktesisht,
12:37
we're going to have to do much more rigorous science
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na duhet te bejme nje shkence mjaft rigoroze
12:39
before we can write that prescription.
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para se te nisim te japim rekomandime.
12:42
Briefly, to address this, our research program
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Shkurtimisht, per te adresuar kete, programi yne i kerkimit
12:44
is focused around three meta-themes, or questions.
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eshte i fokusuar rreth tre temave ose pyetjeve kryesore.
12:47
First, how do the various foods we consume
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Se pari, si ndikojne ushqimet e ndryshme qe konsumojme
12:50
impact our metabolism, hormones and enzymes,
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ne metabolizem, hormone dhe enzima,
12:53
and through what nuanced molecular mechanisms?
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dhe nepermjet cfare mekanizmi molekular?
12:56
Second, based on these insights,
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Se dyti, duke u bazuar ne keto te dhena,
12:58
can people make the necessary changes in their diets
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a munden njerezit te bejne ndryshimet e nevojshme ne dieten e tyre
13:01
in a way that's safe and practical to implement?
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ne nje menyre qe te jete e sigurt dhe praktike implementimi?
13:05
And finally, once we identify what safe
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Dhe si perfundim, kur e identifikojme
13:08
and practical changes people can make to their diet,
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se cfare jane ndryshimet e sigurta dhe praktike qe njerezit mund ti bejne dietes se tyre,
13:11
how can we move their behavior in that direction
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si mund ta drejtojme sjelljen e tyre drejt atij drejtimi
13:15
so that it becomes more the default
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qe te behet e perditshmja
13:17
rather than the exception?
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dhe jo perjashtimi?
13:19
Just because you know what to do doesn't mean
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Te diturit se cfare duhet te besh nuk do te thote
13:21
you're always going to do it.
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qe ti gjithomone do ta besh ate.
13:23
Sometimes we have to put cues around people
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Ndonjehere eshte e nevojshme te vendosim te dhena rreth njerezve
13:25
to make it easier, and believe it or not,
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per ta bere me te lehte, dhe besojeni ose jo,
13:27
that can be studied scientifically.
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kjo gje mund te studjohet shkencerisht.
13:31
I don't know how this journey is going to end,
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Nuk e di se si do te perfundoje ky udhetim,
13:33
but this much seems clear to me, at least:
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por kaq gje me duket e qarte te pakten:
13:38
We can't keep blaming our overweight and diabetic patients
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Nuk mund te vazhdojme te fajesojme pacientet mbipeshe dhe diabetike
13:43
like I did.
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sic bera une.
13:45
Most of them actually want to do the right thing,
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Shumica prej tyre faktikisht duan te bejne gjene e duhur,
13:48
but they have to know what that is,
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por ata duhen te dine se cfare eshte kjo,
13:51
and it's got to work.
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dhe duhet te funksionoje.
13:54
I dream of a day when our patients can
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Enderroj per diten kur pacientet tane
13:59
shed their excess pounds
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do mund te dobesohen
14:01
and cure themselves of insulin resistance,
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dhe ta kurojne veten nga rezistenca e insulines,
14:03
because as medical professionals,
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pasi si profesionist mjekesie,
14:06
we've shed our excess mental baggage
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ne e kemi djersitur bagazhin tone mendor
14:08
and cured ourselves of new idea resistance sufficiently
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dhe e kemi sheruar veten nga rezistenca ndaj ideve mjaftueshem
14:11
to go back to our original ideals:
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per t'ju kthyer idealeve tona te origjines:
14:15
open minds, the courage to throw out yesterday's ideas
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mendje hapur, me kurajon per te hedhur tutje idete e djeshme
14:19
when they don't appear to be working,
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kur ato nuk japin rezultate,
14:22
and the understanding that scientific truth isn't final,
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dhe te kuptuarit qe e verteta shkencore nuk eshte fjala e fundit,
14:25
but constantly evolving.
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por ne evolim i vazhdueshem.
14:28
Staying true to that path will be better for our patients
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Ti qendrosh besnik asaj rruge do jete me mire per pacientet tane
14:31
and better for science.
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dhe me mire per shkencen,
14:35
If obesity is nothing more than a proxy
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Nese obeziteti nuk eshte gje tjeter vec kamuflazhi
14:38
for metabolic illness,
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i semundjeve te metabolizmit,
14:40
what good does it do us to punish those with the proxy?
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c'e mire na vjen duke i ndeshkuar ato qe vuajne prej saj?
14:45
Sometimes I think back to that night in the E.R.
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Me ndodh te mendoj per naten ne urgjence
14:49
seven years ago.
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7 vite me pare.
14:52
I wish I could speak with that woman again.
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Do desha te mund te flisja serish me ate grua.
14:55
I'd like to tell her how sorry I am.
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Do te desha ti thoja se sa keq me vinte.
14:59
I'd say, as a doctor, I delivered
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Do ti thoja qe si mjeke, i dhashe
15:02
the best clinical care I could,
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sherbimin me te mire klinik qe munda,
15:05
but as a human being,
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por si qenie njerezore,
15:09
I let you down.
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nuk e trajtova si duhej.
15:11
You didn't need my judgment and my contempt.
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Nuk kishe nevoje per gjykimin tim.
15:16
You needed my empathy and compassion,
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Ti kishe nevoje per simpatine dhe keqardhjen time,
15:20
and above all else, you needed a doctor
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dhe mbi te gjitha kishe nevoje per nje mjek
15:22
who was willing to consider
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i cili te ishte i gatshem te konsideronte
15:25
maybe you didn't let the system down.
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faktin qe ti mund te ishe jashte kornizave te sistemit.
15:28
Maybe the system, of which I was a part,
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Ndoshta sistemi, pjese e se cilit isha dhe une,
15:31
was letting you down.
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nuk ju ndihmoi.
15:34
If you're watching this now,
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Nese jeni duke e pare kete tani,
15:36
I hope you can forgive me.
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shpresoj te mund te me falni.
15:41
(Applause)
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(Duartrokitje)
ABOUT THE SPEAKER
Peter Attia - SurgeonBoth 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.
Peter Attia | Speaker | TED.com