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: 胖肥問題背後係咪隱藏著更大問題?

Filmed:
4,258,278 views

作為年輕嘅外科醫生,Peter Attia 曾經鄙視過一位糖尿病病人。佢認為,嗰位女士需要為過重而被截肢負責。但幾年之後,一次唔開心嘅診症經歷令佢懷疑:我哋對糖尿病嘅認識啱唔啱架呢?會唔會糖尿病嘅先兆先係導致肥胖,而唔係肥胖嘅先兆導致糖尿病呢?佢會向我哋剖視一下,啲假設點樣令我哋走錯咗對抗疾病嘅呢條路。
- 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唔記得 that day
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2006 年嘅春天
00:13
back in the spring春天 of 2006.
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發生咗一件無辦法忘記嘅事
00:17
I was a surgical外科 resident居民
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我當時係約翰斯 · 霍普金斯醫院
外科駐院醫生
00:19
at The Johns約翰 Hopkins霍普金斯 Hospital醫院,
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00:21
taking採取 emergency緊急 call.
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負責急症
00:23
I got paged by the E.R. around 2 in the morning早上
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有朝凌晨兩點
急症室打嚟,叫我返去醫院
00:26
to come and see a woman女人 with a diabetic糖尿病 ulcer潰瘍
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睇一個隻腳患咗糖尿病潰瘍嘅女病人
00:28
on her foot隻腳.
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00:30
I can still remember記得 sort排序 of that smell氣味 of rotting flesh
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我到而家都仲記得拉開塊簾
00:34
as I pulled the curtain窗簾 back to see her.
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聞到一陣潰爛味
00:38
And everybody大家 there agreed同意 this woman女人 was very sick生病
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所有人都認為呢位女士
病情嚴重,需要留醫
00:40
and she needed需要 to be in the hospital醫院.
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00:41
That wasn't唔係 being asked問吓.
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咁呢當然啦仲使問
00:43
The question個問題 that was being asked問吓 of me was a different不同 one,
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但我當時仲有一個疑問
00:45
which was, did she also need an amputation截肢?
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佢駛唔駛做切肢手術?
00:49
Now, looking back on that night,
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而家,諗返嗰晚嘅事
00:52
I'd love so desperately拼命 to believe that I treated治療 that woman女人
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我拼命令自己相信
我對待呢一位女病人嘅心
00:57
on that night with the same相同 empathy迻情 and compassion同情
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同對另一位女病人嘅心,都係一樣
01:00
I'd shown顯示 the 27-year-old newlywed新婚
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第二位病人 27 歲、結婚冇耐
就喺第一位病人入嚟急症室前嘅三日
01:04
who came to the E.R. three nights晚黑 earlier較早時
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01:06
with lower降低 back pain痛苦
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因為下腰痛嚟到急症室
01:08
that turned打開 out to be advanced先進 pancreatic胰腺 cancer癌症.
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結果驗出比較後期嘅胰腺癌
01:12
In her case情況下, I knew there was nothing I could do
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我知道我做唔到咩保住佢嘅性命
01:14
that was actually講真 going to save her life.
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01:16
The cancer癌症 was too advanced先進.
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癌症已經好後期
01:18
But I was committed承諾 to making決策 sure that
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但我仍然向佢保證
01:21
I could do anything possible可能 to make her stay
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我會盡一切努力令佢更加舒服
01:23
more comfortable自在. I brought her a warm溫暖 blanket毛氈
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我帶咗佢一張毯同一杯咖啡
01:26
and a cup of a coffee咖啡.
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我亦都帶咗啲畀佢父母
01:28
I brought some for her parents父母.
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01:31
But more importantly重要, see, I passed透過 no judgment判斷 on her,
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但更重要嘅係,我冇批評過佢
01:34
because obviously顯然 she had done nothing
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因為好明顯,佢患呢個病係無辜嘅
01:36
to bring this on herself自己.
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01:38
So why was it that, just a few幾個 nights晚黑 later之後,
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咁點解,幾晚之後,我喺同一間急症室
01:41
as I stood in that same相同 E.R. and determined確定
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決定我嘅糖尿病人需要截肢?
01:44
that my diabetic糖尿病 patient病人 did indeed講真 need an amputation截肢,
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01:47
why did I hold舉行 her in such bitter contempt蔑視?
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點解我會咁樣睇低佢呢?
01:51
You see, unlike the woman女人 the night before,
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同第二位女病人唔同
01:54
this woman女人 had type類型 2 diabetes糖尿病.
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第一位病人有第二類糖尿病,而且肥胖
01:56
She was fat脂肪.
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01:58
And we all know that's from eating too much
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我哋都知道第二類糖尿病
係因為食太多
同唔夠運動引起,係咪?
01:59
and not exercising行使 enough, right?
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02:02
I mean, how hard努力 can it be?
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我嘅意思係
食少啲同做運動有幾難呢?
02:04
As I looked down at her in the bed, I thought to myself自己,
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我望住佢瞓喺床,心諗
02:07
if you just tried試過 caring關心 even a little bit,
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如果你以前關心自己多啲
02:10
you wouldn't唔會 be in this situation情況 at this moment時刻
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你而家就唔會俾醫生截肢
02:13
with some doctor醫生 you've never met遇到
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02:14
about to amputate切除 your foot隻腳.
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02:18
Why did I feel justified合理 in judging判斷 her?
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點解我會覺得咁樣評價佢係合理呢?
02:22
I'd like to say I don't know.
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我想答我唔知道
02:25
But I actually講真 do.
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但我其實心裏面係有原因
02:27
You see, in the hubris傲慢 of my youth青年,
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你睇下,年輕嘅我幾咁傲慢
02:29
I thought I had her all figured out.
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覺得自己好了解病人
認為病人因為食得太多,同埋唔好彩
02:32
She ate too much. She got unlucky不幸.
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02:34
She got diabetes糖尿病. Case情況下 closed關閉.
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所以患上糖尿病。完
諷刺嘅係我當時做緊癌症研究
02:37
Ironically具有諷刺意味, at that time in my life,
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02:39
I was also doing cancer癌症 research研究,
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研究以免疫系統為本嘅黑色素瘤療法
02:41
immune-based免疫基 therapies療法 for melanoma黑色素瘤, to be specific特定,
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02:43
and in that world世界 I was actually講真 taught to question個問題 everything,
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研究裏面,我學到要凡事問問題
質疑所有假設
02:47
to challenge挑戰 all assumptions假設
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同埋將研究保持喺最高嘅科學標準
02:49
and hold舉行 them to the highest最高 possible可能 scientific科學 standards標準.
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02:53
Yet尚未 when it came to a disease疾病 like diabetes糖尿病
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但講到一啲好似糖尿病咁嘅病
02:57
that kills殺死 Americans美國人 eight times more frequently經常 than melanoma黑色素瘤,
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比黑色素瘤奪去多八倍美國人嘅病
03:00
I never once一旦 questioned質疑 the conventional傳統 wisdom智慧.
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我從未懷疑過前人知識
03:04
I actually講真 just assmedassmed the pathologic病理 sequence序列 of events事件
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我假設咗以前讀到嘅
病理發展次序係成形嘅科學
03:07
was settled解決 science科學.
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03:09
Three years later之後, I found發現 out how wrong I was.
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三年後,我終於明白自己有幾錯
03:13
But this time, I was the patient病人.
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但今次,我係一個病人
03:15
Despite儘管 exercising行使 three or four hours小時 every single day,
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雖然我每日都會做三至四個鐘運動
03:19
and following以下 the food食品 pyramid金字塔 to the letter,
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並且不折不扣跟足食物金字塔
03:22
I'd gained獲得 a lot of weight重量 and developed開發 something
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我嘅體重仍然增加
而且患上咗代謝症候群
03:24
called metabolic代謝 syndrome綜合徵.
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可能在座有人會聽過呢個病
03:26
Some of you may可能 have heard聽到 of this.
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我個身體突然抗拒胰島素
03:28
I had become成為 insulin-resistant胰島素抵抗.
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各位可以想像胰島素係一種主要激素
03:31
You can think of insulin胰島素 as this master主人 hormone激素
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03:34
that controls控制 what our body身體 does with the foods食品 we eat,
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控制身體對食咗嘅食物作出反應
03:38
whether係唔係 we burn燒傷 it or store商店 it.
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話畀身體知消耗定儲存食物
03:40
This is called fuel燃料 partitioning分區 in the lingo行話.
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呢個生理反應叫能量分區
03:43
Now failure to produce生產 enough insulin胰島素 is incompatible兼容 with life.
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產生唔到足夠胰島素係難以令人生活
03:46
And insulin胰島素 resistance電阻, as its name名字 suggests表明,
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而抗胰島素,顧名思義
03:49
is when your cells細胞 get increasingly越黎越 resistant
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就係細胞對胰島素所做嘅嘢愈嚟愈抗拒
03:51
to the effect影響 of insulin胰島素 trying試圖 to do its job工作.
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03:55
Once一旦 you're insulin-resistant胰島素抵抗,
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當你係抗胰島素,糖尿病就會埋你身
03:57
you're on your way to getting得到 diabetes糖尿病,
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which is what happens發生 when your pancreas胰腺
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你嘅胰腺就會因為抗胰島素嘅關係
04:00
can't keep up with the resistance電阻 and make enough insulin胰島素.
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製造唔到足夠嘅胰島素
04:04
Now your blood sugar levels水平 start初時 to rise上升,
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血糖於是會上升
04:06
and an entire整個 cascade級聯 of pathologic病理 events事件
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然後病情就會失控
04:09
sort排序 of spirals螺旋 out of control控制 that can lead導致 to heart disease疾病,
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最終引致心臟病、癌症
阿爾茨海默氏病,同埋截肢
04:13
cancer癌症, even Alzheimer's阿尔茨海默病嘅 disease疾病,
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04:16
and amputations截肢, just like that woman女人 a few幾個 years earlier較早時.
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即係好似幾年前嗰位女士咁樣
因為我好驚會變成咁
04:21
With that scare, I got busy changing my diet飲食 radically從根本上,
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所以我徹底改變咗飲食習慣
04:24
adding添加 and subtracting減去 things most of you would find
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飲食上開始食加同減一啲
大部分人會驚訝嘅嘢
04:26
almost爭 D assuredly穩妥 shocking令人震驚.
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做咗之後令我輕咗 40 磅
04:29
I did this and lost失去 40 pounds, weirdly古怪 while exercising行使 less.
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奇怪嘅係我做少咗運動
04:33
I, as you can see, I guess I'm not overweight超重 anymore.
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大家見到,我已經唔再超重
04:36
More importantly重要, I don't have insulin胰島素 resistance電阻.
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更重要嘅係,抗胰島素無再發生
04:39
But most important重要, I was left
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但最重要嘅係
04:41
with these three burning燃燒 questions個問題 that wouldn't唔會 go away:
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我仲有三個急需解決嘅問題︰
04:44
How did this happen發生 to me if I was supposedly聽講
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假如我嘅生活習慣係健康
04:47
doing everything right?
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咁點解呢個病係會發生喺我身上呢?
04:50
If the conventional傳統 wisdom智慧 about nutrition營養 had failed me,
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如果有關營養嘅舊有知識
對我唔適用嘅話
04:53
was it possible可能 it was failing someone有人 else?
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會唔會對其他人都係咁?
04:56
And underlying基礎 these questions個問題,
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問咗呢啲問題之後
04:58
I became成為 almost爭 D maniacally狂笑 obsessed癡迷
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我更加想了解
肥胖同抗胰島素之間嘅真正關係
05:02
in trying試圖 to understand理解 the real真正 relationship關係
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05:04
between之間 obesity肥胖 and insulin胰島素 resistance電阻.
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05:08
Now, most researchers研究者 believe obesity肥胖
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如今,大部分學者都相信
05:11
is the cause原因 of insulin胰島素 resistance電阻.
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肥胖係抗胰島素嘅原因
咁照邏輯推理,如果想醫好抗胰島素
05:14
Logically邏輯, then, if you want to treat治療 insulin胰島素 resistance電阻,
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我哋就要鼓勵啲人減肥,係咪?
05:16
you get people to lose失去 weight重量, right?
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05:18
You treat治療 the obesity肥胖.
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所以我哋要醫肥胖
05:21
But what if we have it backwards向後?
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但係如果個關係調轉呢?
05:24
What if obesity肥胖 isn't the cause原因 of insulin胰島素 resistance電阻 at all?
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如果肥胖根本唔係抗胰島素嘅原因?
05:27
In fact事實, what if it's a symptom症狀 of a much deeper更深 problem個問題,
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如果肥胖反映緊一個更深嘅問題?
05:31
the tip貼士 of a proverbial眾所周知 iceberg冰山?
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我知咁講好似好癲
05:34
I know it sounds聽上去 crazy because we're obviously顯然 in the midst中間
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因為我哋都經歷梗肥胖流行病嘅爆發
05:36
of an obesity肥胖 epidemic流行, but hear聽到 me out.
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但請先聽我講
05:40
What if obesity肥胖 is a coping應對 mechanism機制
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如果肥胖係一個機制
05:43
for a far more sinister險惡 problem個問題 going on
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畀我哋抵禦更加兇險嘅細胞問題?
05:46
underneath下面 the cell細胞?
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我唔係講緊肥胖係好事
05:48
I'm not suggesting建議 that obesity肥胖 is benign良性,
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但我認為肥胖係兩種代謝問題之中
05:50
but what I am suggesting建議 is it may可能 be the lesser較小
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05:53
of two metabolic代謝 evils罪惡.
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影響比較輕微嗰個
05:55
You can think of insulin胰島素 resistance電阻 as the reduced減少 capacity能力
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你可以將抗胰島素諗成
細胞獲取能量嘅能力下降
05:58
of ourselves自己 to partition分區 fuel燃料,
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06:00
as I alluded提到 to a moment時刻 ago,
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就好似我頭先提到
06:03
taking採取 those calories卡路里 that we take in
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當我哋攝取卡路里嘅時候
06:04
and burning燃燒 some appropriately適當 and storing儲埋 some appropriately適當.
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我哋會將部分消耗同部分儲存
當我哋患上抗胰島素時
06:08
When we become成為 insulin-resistant胰島素抵抗,
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06:10
the homeostasis稳态 in that balance平衡 deviates偏離 from this state狀態.
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消耗同儲存嘅平衡就會消失
06:13
So now, when insulin胰島素 says to a cell細胞,
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宜家當胰島素同細胞講
06:15
I want you to burn燒傷 more energy能源
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「我要你消耗更多能量」
06:17
than the cell細胞 considers認為 safe安全, the cell細胞, in effect影響, says,
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但因為細胞覺得消耗率大過安全水平
06:20
"No thanks多謝, I'd actually講真 rather store商店 this energy能源."
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所以會話「唔駛啦,我會蓄能量」
06:24
And because fat脂肪 cells細胞 are actually講真 missing失蹤 most of
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而由於脂肪細胞欠缺
其他細胞大部分複雜嘅細胞機制
06:26
the complex複雜 cellular細胞 machinery機械 found發現 in other cells細胞,
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06:29
it's probably可能 the safest安全 place地方 to store商店 it.
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所以佢哋係一個安全嘅地方儲存能量
06:31
So for many好多 of us, about 75 million Americans美國人,
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所以對於我哋好多美國人嚟講
即係七千五百萬人嚟講
06:36
the appropriate適當 response響應 to insulin胰島素 resistance電阻
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對抗胰島素最合適嘅做法
反而係我哋儲存脂肪
06:40
may可能 actually講真 be to store商店 it as fat脂肪, not the reverse反向,
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06:45
getting得到 insulin胰島素 resistance電阻 in response響應 to getting得到 fat脂肪.
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而唔係因為肥胖所以有抗胰島素
06:50
This is a really subtle微妙 distinction區別,
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呢兩個次序雖然分別唔大,但意義深遠
06:52
but the implication意義 could be profound深刻.
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06:56
Consider諗緊 the following以下 analogy類比:
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大家嘗試諗下以下比喻:
06:58
Think of the bruise瘀傷 you get on your shin脛骨
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當你唔小心俾茶几撞到隻腳時
07:01
when you inadvertently無意中 bang爆炸 your leg into the coffee咖啡 table.
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皮膚會有瘀傷
07:05
Sure, the bruise瘀傷 hurts like hell地獄, and you almost爭 D certainly梗係
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當然,瘀傷係好痛
你亦都唔會鍾意變咗色嘅皮膚
07:08
don't like the discolored變色 look, but we all know
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但我哋知道瘀傷唔係問題
07:11
the bruise瘀傷 per se is not the problem個問題.
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07:14
In fact事實, it's the opposite相反. It's a healthy健康 response響應 to the trauma創傷,
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相反,佢係對創傷嘅一個健康反應
07:18
all of those immune免疫 cells細胞 rushing to the site網站 of the injury損傷
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所有免疫細胞趕去受傷嘅地方
07:21
to salvage打撈 cellular細胞 debris碎片 and prevent防止 the spread傳播
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阻止細胞殘骸擴散
同埋防止身體其他部位受到感染
07:24
of infection感染 to elsewhere第二度 in the body身體.
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07:26
Now, imagine想象 we thought bruises瘀傷 were the problem個問題,
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而家,假設我哋覺得瘀傷係一個問題
07:30
and we evolved進化 a giant巨大 medical醫療 establishment建立
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而且研發到一種醫學技術
同埋形成一種文化去治療瘀傷
07:33
and a culture文化 around treating治療 bruises瘀傷:
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07:36
masking掩蔽 creams, painkillers止痛藥, you name名字 it,
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當中包括有掩蔽霜、止痛藥
各種你哋諗到嘅嘢都有
07:39
all the while ignoring忽略 the fact事實 that people
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但係我哋忽略咗
人仍然會撞到茶几呢個事實
07:42
are still banging their佢哋 shins小腿 into coffee咖啡 tables.
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07:45
How much better would we be if we treated治療 the cause原因 --
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如果我哋根治呢個原因
叫人喺客廳行嘅時候小心啲
07:48
telling話畀 people to pay支付 attention注意
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而唔係對付個後果
07:50
when they walk through透過 the living生活 room間房 --
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07:52
rather than the effect影響?
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你話係咪好得多呢?
07:55
Getting得到 the cause原因 and the effect影響 right
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搞清原因同後果,世界從此會好唔同
07:57
makes使 all the difference差異 in the world世界.
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07:59
Getting得到 it wrong, and the pharmaceutical製藥 industry行業
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攪錯咗嘅話
醫藥行業可以仍然會發展得好好
08:02
can still do very well for its shareholders股東
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08:05
but nothing improves提高 for the people with bruised傷痕累累 shins小腿.
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但人嘅小腿嘅瘀傷點都唔會有改善
08:09
Cause原因 and effect影響.
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講到因果關係
08:12
So what I'm suggesting建議 is
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所以我要講嘅係
08:14
maybe we have the cause原因 and effect影響 wrong
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可能我哋攪錯咗
肥胖同抗胰島素嘅因果關係
08:16
on obesity肥胖 and insulin胰島素 resistance電阻.
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08:19
Maybe we should be asking問吓 ourselves自己,
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我哋可能要問問自己
08:21
is it possible可能 that insulin胰島素 resistance電阻 causes原因 weight重量 gain獲得
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喺至少大部分人當中
抗胰島素有冇可能導致肥胖
同各種同肥胖相關嘅疾病呢?
08:25
and the diseases疾病 associated相關 with obesity肥胖,
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08:27
at least最小 in most people?
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08:28
What if being obese肥胖 is just a metabolic代謝 response響應
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肥胖會唔會只係一樣
對更有威脅嘅嘢嘅反應呢?
08:31
to something much more threatening威脅,
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08:34
an underlying基礎 epidemic流行,
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例如隱性病
咁我哋需唔需要擔心呢?
08:36
the one we ought應該 to be worried about?
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08:38
Let's look at some suggestive暗示 facts事實.
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我哋睇下一啲事實
08:40
We know that 30 million obese肥胖 Americans美國人
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有三千萬肥胖嘅美國人係無抗胰島素
08:42
in the United聯合 States國家 don't have insulin胰島素 resistance電阻.
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佢哋唔會比瘦嘅人有更大嘅疾病風險
08:45
And by the way, they don't appear出現 to be at any
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08:47
greater risk風險 of disease疾病 than lean精益 people.
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08:50
Conversely相反, we know that six million lean精益 people
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相反,美國有六百萬瘦嘅人有抗胰島素
08:53
in the United聯合 States國家 are insulin-resistant胰島素抵抗,
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08:57
and by the way, they appear出現 to be at even greater risk風險
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佢哋比肥胖嘅人更加易患上
剛才提及嘅代謝性疾病嘅風險
09:00
for those metabolic代謝 disease疾病 I mentioned提到 a moment時刻 ago
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09:02
than their佢哋 obese肥胖 counterparts同行.
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09:04
Now I don't know why, but it might可能 be because,
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我唔知原因,但有可能因為
09:06
in their佢哋 case情況下, their佢哋 cells細胞 haven't actually講真 figured out
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佢哋嘅細胞唔知點樣應對多咗嘅能量
09:09
the right thing to do with that excess過剩 energy能源.
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09:12
So if you can be obese肥胖 and not have insulin胰島素 resistance電阻,
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所以,當人可以肥胖而無患上抗胰島素
09:15
and you can be lean精益 and have it,
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而你瘦嘅人都可以患上抗胰島素嘅話
09:17
this suggests表明 that obesity肥胖 may可能 just be a proxy代理
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肥胖可以推斷只係一個身體狀態嘅訊號
09:21
for what's going on.
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如果我哋醫錯咗
09:24
So what if we're fighting戰鬥 the wrong war戰爭,
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剩係醫肥胖而唔係醫抗胰島素
09:27
fighting戰鬥 obesity肥胖 rather than insulin胰島素 resistance電阻?
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咁會有咩後果?
09:31
Even worse更糟, what if blaming the obese肥胖
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更差嘅係,如果肥胖嘅人
其實係受害者嘅話
09:34
means意味着 we're blaming the victims受害者?
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咁點算呢?
09:37
What if some of our fundamental基本 ideas想法 about obesity肥胖
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如果我哋對肥胖嘅認識根本係錯架呢?
09:40
are just wrong?
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09:42
Personally, I can't afford the luxury豪華 of arrogance傲慢 anymore,
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個人嚟講,我承受唔起自大嘅後果
09:46
let alone一手一腳 the luxury豪華 of certainty塙定性.
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更受唔起做事絕對嘅後果
09:49
I have my own自己 ideas想法 about what could be at the heart of this,
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我對呢件事有我自己一套睇法
但我亦都樂意聽其他人意見
09:52
but I'm wide open打開 to others.
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09:54
Now, my hypothesis假設, because everybody大家 always asks問吓 me,
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由於每個人都問我
所以我會講講我嘅假定
09:56
is this.
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如果你問我
09:58
If you ask問吓 yourself自己, what's a cell細胞 trying試圖 to protect保護 itself本身 from
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當一個細胞抵抗胰島素嘅時候
究竟佢係遠離緊啲咩
10:01
when it becomes成為 insulin胰島素 resistant,
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10:03
the answer回答 probably可能 isn't too much food食品.
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答案應該唔係過多嘅食物
10:06
It's more likely可能 too much glucose葡萄糖: blood sugar.
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而係過多嘅葡萄糖 ,亦即係血糖
10:09
Now, we know that refined精製 grains穀物 and starches澱粉
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我哋知道加工嘅穀物同澱粉
會短時間內增加血糖
10:11
elevate提高 your blood sugar in the short run運行,
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10:14
and there's even reason原因 to believe that sugar
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而且有理由相信
糖份可能會直接導致抗胰島素
10:15
may可能 lead導致 to insulin胰島素 resistance電阻 directly直接.
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10:18
So if you put these physiological生理 processes過程 to work,
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所以,如果思考整個生理過程
10:22
I'd hypothesize假設 that it might可能 be our increased增加 intake攝入
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我會假設增加攝取
加工穀物、糖份同埋澱粉
10:26
of refined精製 grains穀物, sugars and starches澱粉 that's driving
220
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10:29
this epidemic流行 of obesity肥胖 and diabetes糖尿病,
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會透過抗胰島素嘅現象
導致肥胖同埋糖尿病
10:33
but through透過 insulin胰島素 resistance電阻,
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10:35
you see, and not necessarily必然 through透過 just overeating暴飲暴食 and under-exercising運動不足.
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而唔一定剩關食過多同太少運動
10:39
When I lost失去 my 40 pounds a few幾個 years ago,
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幾年前,我只係控制食量同運動量
10:42
I did it simply淨係 by restricting制約 those things,
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我就輕咗 40 磅
10:44
which admittedly誠然 suggests表明 I have a bias偏見
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我承認呢一個係偏見嚟
10:48
based基於 on my personal experience經驗.
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因為係我嘅個人經歷
10:50
But that doesn't mean my bias偏見 is wrong,
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但咁樣唔代表我嘅偏見係錯
10:53
and most important重要, all of this can be tested測試 scientifically科學.
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最重要係,全部嘢都可經得起科學驗證
10:57
But step one is accepting接受 the possibility可能性
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不過首要接受
我哋現有對肥胖、糖尿病
同埋抗胰島素嘅觀念可能係錯
11:00
that our current當前 beliefs信仰 about obesity肥胖,
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11:02
diabetes糖尿病 and insulin胰島素 resistance電阻 could be wrong
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11:05
and therefore因此 must必須 be tested測試.
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所以呢啲觀念都要驗證埋
11:08
I'm betting博彩 my career職業 on this.
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我亦為呢樣嘢賭上我嘅生涯
11:10
Today今日, I devote投入 all of my time to working工作 on this problem個問題,
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今日,我用我所有時間去研究呢個問題
11:15
and I'll go wherever無論 the science科學 takes me.
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我會跟著科學嘅指引去做
11:18
I've decided決定 that what I can't and won't唔會 do anymore
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當我決定無辦法或者唔去做一件事
11:21
is pretend假裝 I have the answers答案 when I don't.
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其實係假扮知道答案
11:24
I've been humbled謙卑 enough by all I don't know.
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我對於唔知嘅嘢一直好謙虛
11:28
For the past過去 year, I've been fortunate好彩呀 enough
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過去嘅一年裡面,我好幸運
11:31
to work on this problem個問題 with the most amazing驚人 team團隊
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能夠同國內最優秀嘅
研究糖尿病同肥胖嘅團隊
11:34
of diabetes糖尿病 and obesity肥胖 researchers研究者 in the country國家,
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共同探索呢一個問題
11:37
and the best最好 part部分 is,
243
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最美好嘅部分係我哋好似林肯咁
11:39
just like Abraham亚伯拉罕 Lincoln林肯 surrounded包圍 himself自己 with a team團隊 of rivals競爭對手,
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被同時係競爭對手嘅隊員包圍
11:43
we've我哋都 done the same相同 thing.
245
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11:44
We've我哋都 recruited招募 a team團隊 of scientific科學 rivals競爭對手,
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我哋其實請嚟一班最頂尖最優秀
11:47
the best最好 and brightest who all have different不同 hypotheses假設
247
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又對呢一個病各有見解嘅科學團隊
11:51
for what's at the heart of this epidemic流行.
248
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11:52
Some think it's too many好多 calories卡路里 consumed消耗.
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其中有啲認為原因係攝取過多卡路里
11:55
Others think it's too much dietary膳食 fat脂肪.
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有啲認為係飲食高脂
11:57
Others think it's too many好多 refined精製 grains穀物 and starches澱粉.
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有啲認為係進食太多加工嘅穀物和澱粉
12:01
But this team團隊 of multi-disciplinary多學科,
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呢個團隊雖然嚟自多個範疇
12:03
highly高度 skeptical懷疑 and exceedingly極其 talented天才 researchers研究者
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又有好高批判能力同又係好叻
12:06
do agree同意 on two things.
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但佢哋同意兩樣嘢
12:09
First, this problem個問題 is just simply淨係 too important重要
255
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第一,因為我哋以為知道答案
12:12
to continue繼續 ignoring忽略 because we think we know the answer回答.
256
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所以可以繼續忽視呢個重要問題
12:15
And two, if we're willing to be wrong,
257
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第二,如果我哋願意接受自己係錯
12:18
if we're willing to challenge挑戰 the conventional傳統 wisdom智慧
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並且願意利用最好嘅科學實驗
去挑戰舊有概念
12:20
with the best最好 experiments實驗 science科學 can offer提供,
259
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12:23
we can solve解決 this problem個問題.
260
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我哋就可以解決問題
12:26
I know it's tempting誘人 to want an answer回答 right now,
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我哋都好想即刻有一個答案
12:29
some form形式 of action行動 or policy政策, some dietary膳食 prescription處方 --
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雖然宜家有各種形式嘅行動同政策
同埋一啲飲食配方
例如食呢樣,唔好食嗰樣
12:33
eat this, not that —
263
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12:35
but if we want to get it right,
264
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但如果我哋真係想對症下藥
12:37
we're going to have to do much more rigorous嚴格 science科學
265
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我哋喺處方之前
我哋需要更嚴格嘅科學校證
12:39
before we can write that prescription處方.
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簡單嚟講,我哋嘅研究計劃
12:42
Briefly簡要, to address地址 this, our research研究 program程序
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12:44
is focused集中 around three meta-themes元主題, or questions個問題.
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針對三個大主題或者問題
12:47
First, how do the various各種 foods食品 we consume消費
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第一,我哋食嘅各種食物點樣
透過精密嘅的分子機制
12:50
impact影響 our metabolism代謝, hormones激素 and enzymes,
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12:53
and through透過 what nuanced細緻入微 molecular分子 mechanisms機制?
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影響新陳代謝、激素同埋酶呢?
12:56
Second第二, based基於 on these insights見解,
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第二,根據以上答案
12:58
can people make the necessary必要 changes變化 in their佢哋 diets飲食
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人可唔可以對飲食習慣
作出安全而又實際嘅改變呢?
13:01
in a way that's safe安全 and practical實際 to implement實現?
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13:05
And finally最後, once一旦 we identify識別 what safe安全
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最後,當我哋搵到安全又實際嘅
飲食習慣畀人去跟嘅時候
13:08
and practical實際 changes變化 people can make to their佢哋 diet飲食,
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13:11
how can we move移動 their佢哋 behavior行為 in that direction方向
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我哋點樣普及呢一批人嘅行為
13:15
so that it becomes成為 more the default默認
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而唔係畀人覺得係另類嘅一群呢?
13:17
rather than the exception例外?
279
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13:19
Just because you know what to do doesn't mean
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我哋知道應該去做咩嘢
唔代表我哋會做
13:21
you're always going to do it.
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13:23
Sometimes有時 we have to put cues線索 around people
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有時候,我哋需要引導人
13:25
to make it easier容易, and believe it or not,
283
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令研究更加科學化地進行
13:27
that can be studied研究 scientifically科學.
284
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13:31
I don't know how this journey旅程 is going to end結束,
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我唔知呢一個旅程嘅終點係點
13:33
but this much seems好似 clear清楚 to me, at least最小:
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但最少有一件事係好清楚
13:38
We can't keep blaming our overweight超重 and diabetic糖尿病 patients患者
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就係我哋唔可以好似我以前咁
鬧嗰啲過重同埋患上糖尿病嘅人
13:43
like I did.
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2912
13:45
Most of them actually講真 want to do the right thing,
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佢哋大部分人都想糾正自己
13:48
but they have to know what that is,
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但佢哋需要知道方向點樣行
同埋方向係要可行
13:51
and it's got to work.
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3046
我夢想有一日我哋嘅病人
能夠卸下過重嘅罪名
13:54
I dream夢想 of a day when our patients患者 can
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13:59
shed their佢哋 excess過剩 pounds
293
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1735
14:01
and cure治療 themselves自己 of insulin胰島素 resistance電阻,
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同埋醫好佢哋嘅抗胰島素
14:03
because as medical醫療 professionals專業人士,
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因為作為醫學專家
我哋已經卸下心理包袱
14:06
we've我哋都 shed our excess過剩 mental心理 baggage行李
296
834642
1970
同埋醫好咗抗拒新見解嘅毛病
14:08
and cured治癒 ourselves自己 of new新增功能 idea想法 resistance電阻 sufficiently充分
297
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3326
我哋返返去我哋原本嘅理想:
14:11
to go back to our original源語言 ideals理想:
298
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3090
14:15
open打開 minds頭腦, the courage勇氣 to throw out yesterday's噚日嘅 ideas想法
299
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4417
開放諗法
當昨日嘅觀念唔再啱用
就要有勇氣捨棄昨日嘅觀念
14:19
when they don't appear出現 to be working工作,
300
847445
3328
同埋要明白科學無永遠嘅事實
而係不斷演變緊嘅
14:22
and the understanding理解 that scientific科學 truth真理 isn't final最後,
301
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14:25
but constantly係咁 evolving進化.
302
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2748
14:28
Staying true真係 to that path路徑 will be better for our patients患者
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緊守呢個諗法對我哋病人
同埋科學都有好處
14:31
and better for science科學.
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3248
14:35
If obesity肥胖 is nothing more than a proxy代理
305
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如果肥胖只係代謝性疾病嘅徵兆
14:38
for metabolic代謝 illness疾病,
306
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1926
懲罰呢啲有徵兆嘅人
對我哋有咩好處呢?
14:40
what good does it do us to punish懲罰 those with the proxy代理?
307
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5297
14:45
Sometimes有時 I think back to that night in the E.R.
308
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4544
有時我會諗返起七年前
喺急症室嗰一晚
14:49
seven years ago.
309
877941
2313
14:52
I wish希望 I could speak with that woman女人 again.
310
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3624
我好想再同嗰一位女士傾偈
14:55
I'd like to tell her how sorry I am.
311
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3255
我想同佢講我有幾咁內疚
14:59
I'd say, as a doctor醫生, I delivered交付
312
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我會講,作為一個醫生
15:02
the best最好 clinical臨床 care護理 I could,
313
890020
3660
我提供咗最好嘅臨床護理
15:05
but as a human人類 being,
314
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3897
但作為一個普通人
15:09
I let you down.
315
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2408
我令到你失望
15:11
You didn't need my judgment判斷 and my contempt蔑視.
316
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4245
你唔需要我嘅批評同埋蔑視
15:16
You needed需要 my empathy迻情 and compassion同情,
317
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4498
你需要嘅係我嘅同情同憐憫
15:20
and above以上 all else, you needed需要 a doctor醫生
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1995
除此之外,你仲需要一個醫生
15:22
who was willing to consider諗緊
319
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佢願意考慮︰
15:25
maybe you didn't let the system系統 down.
320
913352
3064
未必係你令社會失望
15:28
Maybe the system系統, of which I was a part部分,
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3218
而係個社會,包括我在內,令你失望
15:31
was letting you down.
322
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2439
15:34
If you're watching this now,
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如果你而家睇緊呢一個講座
15:36
I hope希望 you can forgive原諒 me.
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希望你會原諒我
15:41
(Applause掌聲)
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4000
(掌聲)
Translated by Wu Wing Chee
Reviewed by Michael Ge 葛叔

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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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