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  • I'll never forget that day

    我永遠忘不了

  • back in the spring of 2006.

    那天 2006年的春天。

  • I was a surgical resident

    我還是一個外科住院醫生

  • at The Johns Hopkins Hospital,

    在約翰霍普金斯醫院

  • taking emergency call.

    應對急救電話

  • I got paged by the E.R. around 2 in the morning

    大約淩晨兩點左右我被急診室叫去

  • to come and see a woman with a diabetic ulcer

    看一位女病人她得了因糖尿病而引起的

  • on her foot.

    足部潰瘍

  • I can still remember sort of that smell of rotting flesh

    我至今還能記得聞到的那種肉類腐爛的味道

  • as I pulled the curtain back to see her.

    當我拉開簾子看到她之後

  • And everybody there agreed this woman was very sick

    顯而易見這位女士病得很重

  • and she needed to be in the hospital.

    她需要住院治療

  • That wasn't being asked.

    這是毫無疑問的

  • The question that was being asked of me was a different one,

    但那時我考慮的是另一個問題

  • which was, did she also need an amputation?

    那就是,她需要截肢嗎?

  • Now, looking back on that night,

    現在,回想起那夜,

  • I'd love so desperately to believe that I treated that woman

    我很後悔那天夜裡面對那位女士時

  • on that night with the same empathy and compassion

    心中沒有帶著同樣的同情與悲憫

  • I'd shown the 27-year-old newlywed

    三天前的夜裡一位27歲的新娘

  • who came to the E.R. three nights earlier

    就像我平時面對其他病人那般

  • with lower back pain

    因為下背疼痛來看急診

  • that turned out to be advanced pancreatic cancer.

    後來她被診斷為晚期胰腺癌

  • In her case, I knew there was nothing I could do

    雖然我知道我對她無能為力

  • that was actually going to save her life.

    沒辦法救她

  • The cancer was too advanced.

    癌症已經是末期了

  • But I was committed to making sure that

    但我還是盡我所能的

  • I could do anything possible to make her stay

    做了所有能讓她

  • more comfortable. I brought her a warm blanket

    舒服一點的事情 我幫她找了條毛毯

  • and a cup of a coffee.

    端了杯咖啡

  • I brought some for her parents.

    給她父母送咖啡

  • But more importantly, see, I passed no judgment on her,

    更重要的是,我一點也不覺得這姑娘有錯

  • because obviously she had done nothing

    很明顯一點責任也沒有

  • to bring this on herself.

    她對自己的病

  • So why was it that, just a few nights later,

    但是為什麼,僅僅過了幾夜

  • as I stood in that same E.R. and determined

    當我站在同一個急救室並且決定

  • that my diabetic patient did indeed need an amputation,

    我的這位元糖尿病病人需要截肢手術時

  • why did I hold her in such bitter contempt?

    為什麼我的心中帶著蔑視呢?

  • You see, unlike the woman the night before,

    你看,跟那位新娘不一樣

  • this woman had type 2 diabetes.

    這位女士有II型糖尿病

  • She was fat.

    她很胖

  • And we all know that's from eating too much

    而且我們都知道肥胖源自

  • and not exercising enough, right?

    無節制的飲食和缺乏運動,對吧?

  • I mean, how hard can it be?

    我的意思是,節食和運動很難嗎?

  • As I looked down at her in the bed, I thought to myself,

    我看著她躺在床上,我心說

  • if you just tried caring even a little bit,

    哪怕你稍微注意一點兒自己的身體

  • you wouldn't be in this situation at this moment

    你也絕不會落到這步田地

  • with some doctor you've never met

    跟一個你從未見過的醫生

  • about to amputate your foot.

    一個即將給你截肢的醫生

  • Why did I feel justified in judging her?

    為什麼當時我能心安理得的責備她呢?

  • I'd like to say I don't know.

    我希望我不知道原因。

  • But I actually do.

    但是說真的,我知道

  • You see, in the hubris of my youth,

    你看,我那時年少輕狂

  • I thought I had her all figured out.

    我自以為是的覺得她肯定就是我想到那樣。

  • She ate too much. She got unlucky.

    她飲食無度,她運氣不好

  • She got diabetes. Case closed.

    她得了糖尿病,基本就是這個情況。

  • Ironically, at that time in my life,

    諷刺的是,就在那會兒

  • I was also doing cancer research,

    我正在參與癌症的研究

  • immune-based therapies for melanoma, to be specific,

    黑色素瘤的細胞免疫力療法,具體來說

  • and in that world I was actually taught to question everything,

    在那個領域裡,我被教著去質疑一切

  • to challenge all assumptions

    挑戰一切固有的理論成果

  • and hold them to the highest possible scientific standards.

    並且在研究中嚴格遵守最高的科研準則。

  • Yet when it came to a disease like diabetes

    但當我面對糖尿病

  • that kills Americans eight times more frequently than melanoma,

    這種致死幾率高於黑色素瘤八倍的疾病時候

  • I never once questioned the conventional wisdom.

    我從未質疑過傳統的理論

  • I actually just assumed the pathologic sequence of events

    我當時真的認為糖尿病的發病機理

  • was settled science.

    早有定論

  • Three years later, I found out how wrong I was.

    三年以後,我發現我錯了。

  • But this time, I was the patient.

    但是這次,我自己成了病人

  • Despite exercising three or four hours every single day,

    儘管我每天運動三四個小時

  • and following the food pyramid to the letter,

    嚴格遵守健康食譜

  • I'd gained a lot of weight and developed something

    我還是體重激增並且得了

  • called metabolic syndrome.

    代謝綜合征

  • Some of you may have heard of this.

    你們也許有人聽說過它

  • I had become insulin-resistant.

    我的身體對胰島素產生了抗性

  • You can think of insulin as this master hormone

    你們可以把胰島素想像成一種荷爾蒙

  • that controls what our body does with the foods we eat,

    它能控制我們的身體對攝入的食物做出反應

  • whether we burn it or store it.

    消耗或是儲存它們

  • This is called fuel partitioning in the lingo.

    在術語中稱之為燃料分區

  • Now failure to produce enough insulin is incompatible with life.

    缺乏足夠的胰島素是很要命的

  • And insulin resistance, as its name suggests,

    胰島素抵抗,就像字面上意思一樣

  • is when your cells get increasingly resistant

    意味著你的細胞變得越來越不受

  • to the effect of insulin trying to do its job.

    胰島素的指揮正常運作

  • Once you're insulin-resistant,

    一旦你出現胰島素抵抗的情況

  • you're on your way to getting diabetes,

    你離患糖尿病就不遠了

  • which is what happens when your pancreas

    因為胰島素抵抗的緣故

  • can't keep up with the resistance and make enough insulin.

    你無法製造足夠的胰島素

  • Now your blood sugar levels start to rise,

    你的血糖開始升高

  • and an entire cascade of pathologic events

    一系列的病例症狀

  • sort of spirals out of control that can lead to heart disease,

    會突然爆發並且可能導致心臟病

  • cancer, even Alzheimer's disease,

    癌症,甚至老年癡呆症

  • and amputations, just like that woman a few years earlier.

    或者截肢,就像幾年前的那位女士一樣

  • With that scare, I got busy changing my diet radically,

    我很害怕,我很快改了食譜

  • adding and subtracting things most of you would find

    做了一些的改變得益於新的食譜

  • almost assuredly shocking.

    讓大家覺得不可思議

  • I did this and lost 40 pounds, weirdly while exercising less.

    儘管我鍛煉得少了,我還是減掉了40磅

  • I, as you can see, I guess I'm not overweight anymore.

    你們可以看到,我現在沒有超重

  • More importantly, I don't have insulin resistance.

    更重要的是,我沒有胰島素抵抗症了

  • But most important, I was left

    但是最重要的是,我陷入了

  • with these three burning questions that wouldn't go away:

    三個亟待解決的問題

  • How did this happen to me if I was supposedly

    為什麼這件事發生在我身上呢?

  • doing everything right?

    我已經盡力做到無懈可擊了。

  • If the conventional wisdom about nutrition had failed me,

    如果傳統的營養理論在我身上失效了

  • was it possible it was failing someone else?

    在其他人身上會怎樣呢?

  • And underlying these questions,

    通過對考慮這些問題

  • I became almost maniacally obsessed

    我著了魔一樣的

  • in trying to understand the real relationship

    真正的關係

  • between obesity and insulin resistance.

    希望找到肥胖和胰島素之間

  • Now, most researchers believe obesity

    現在,主流觀點認為

  • is the cause of insulin resistance.

    肥胖導致了胰島素抵抗

  • Logically, then, if you want to treat insulin resistance,

    依邏輯來說,如果你想治療胰島素抵抗

  • you get people to lose weight, right?

    你必須減肥,對吧?

  • You treat the obesity.

    先對付肥胖。

  • But what if we have it backwards?

    但是如果我們反過來想一下?

  • What if obesity isn't the cause of insulin resistance at all?

    假如肥胖並不會導致胰島素抵抗?

  • In fact, what if it's a symptom of a much deeper problem,

    實際上,假如它只是一個徵兆一個更深層次的問題

  • the tip of a proverbial iceberg?

    的冰山一角?

  • I know it sounds crazy because we're obviously in the midst

    這聽起來很瘋狂因為我們很正身處

  • of an obesity epidemic, but hear me out.

    一個肥胖症氾濫的時代,不過請耐心聽我解釋

  • What if obesity is a coping mechanism

    假如肥胖是身體的某種應對機制

  • for a far more sinister problem going on

    用來對付一個潛藏在細胞深處

  • underneath the cell?

    更加兇險的問題?

  • I'm not suggesting that obesity is benign,

    我不認為肥胖是無害的

  • but what I am suggesting is it may be the lesser

    但是我覺得肥胖在兩種新陳代謝疾病中

  • of two metabolic evils.

    是比較次要的那個

  • You can think of insulin resistance as the reduced capacity

    大家可以把胰島素抵抗症看作

  • of ourselves to partition fuel,

    我們身體燃料箱變小了

  • as I alluded to a moment ago,

    就像我剛剛假設的那樣

  • taking those calories that we take in

    正常情況下我們攝入的熱量

  • and burning some appropriately and storing some appropriately.

    會被適量消耗並且適量儲存

  • When we become insulin-resistant,

    當我們得了胰島素抵抗的時候

  • the homeostasis in that balance deviates from this state.

    這個平衡就會偏離正常情況

  • So now, when insulin says to a cell,

    於是乎,當胰島素告訴細胞

  • I want you to burn more energy

    我需要你消耗一些能量

  • than the cell considers safe, the cell, in effect, says,

    假如 細胞認為消耗太大,那些細胞就會回應到

  • "No thanks, I'd actually rather store this energy."

    “不了,我更想把這些能量儲存起來。”

  • And because fat cells are actually missing most of

    因為脂肪細胞不同於其它細胞

  • the complex cellular machinery found in other cells,

    它沒有那麼多複雜的結構和組織

  • it's probably the safest place to store it.

    所以能量都被儲藏在那

  • So for many of us, about 75 million Americans,

    因此對我們中許多人,大約7500萬

  • the appropriate response to insulin resistance

    美國人來說 胰島素抵抗應被視作

  • may actually be to store it as fat, not the reverse,

    肥胖的成因,而非相反的,

  • getting insulin resistance in response to getting fat.

    將胰島素抵抗歸因於肥胖。

  • This is a really subtle distinction,

    這雖然是個相當微妙的區別

  • but the implication could be profound.

    但是它的含義卻是相當深刻的

  • Consider the following analogy:

    舉個例子來說,

  • Think of the bruise you get on your shin

    想像一下你小腿上的烏青,

  • when you inadvertently bang your leg into the coffee table.

    那是你不小心撞上咖啡桌時留下的

  • Sure, the bruise hurts like hell, and you almost certainly

    毫無疑問,這瘀青疼得要命

  • don't like the discolored look, but we all know

    而且你肯定不喜歡腿上多個斑,但是我們都知道

  • the bruise per se is not the problem.

    瘀青本身並不是個問題

  • In fact, it's the opposite. It's a healthy response to the trauma,

    恰恰相反,這是對外傷的一個正常生理反應

  • all of those immune cells rushing to the site of the injury

    所有的免疫細胞都會迅速前往受傷的部位

  • to salvage cellular debris and prevent the spread

    去清理壞死細胞的碎片並且防止

  • of infection to elsewhere in the body.

    感染擴散到身體其他部位

  • Now, imagine we thought bruises were the problem,

    好了,想像一下如果我們把烏青當作一個問題

  • and we evolved a giant medical establishment

    我們發展出了一個龐大的醫療體系

  • and a culture around treating bruises:

    以及文化來對待瘀青:

  • masking creams, painkillers, you name it,

    遮蔽霜,止疼藥,等等

  • all the while ignoring the fact that people

    而所有這一切都掩蓋了一個事實

  • are still banging their shins into coffee tables.

    那就是人們依舊會撞到咖啡桌

  • How much better would we be if we treated the cause --

    如果我們可以從問題的根源入手

  • telling people to pay attention

    告訴人們注意一下

  • when they walk through the living room --

    從客廳走過的時候小心咖啡桌

  • rather than the effect?

    這會比處理撞傷來的有效果的多

  • Getting the cause and the effect right

    正確理解事情的表像和本因

  • makes all the difference in the world.

    將使這個世界產生巨大的不同

  • Getting it wrong, and the pharmaceutical industry

    即使治標不治本,製藥行業

  • can still do very well for its shareholders

    依舊可以為股東們帶來利潤,

  • but nothing improves for the people with bruised shins.

    但是對於受傷的人們來說,這沒有任何幫助

  • Cause and effect.

    原因及結果

  • So what I'm suggesting is

    所以我想指出的是

  • maybe we have the cause and effect wrong

    在我們討論肥胖和胰島素抵抗的問題時

  • on obesity and insulin resistance.

    把原因和結果弄反了

  • Maybe we should be asking ourselves,

    也許我們需要問問我們自己了,

  • is it possible that insulin resistance causes weight gain

    有沒有可能胰島素抵抗導致了體重增加

  • and the diseases associated with obesity,

    以及隨肥胖帶來的併發症

  • at least in most people?

    至少對於大多數人來說

  • What if being obese is just a metabolic response

    有沒有可能肥胖只是胰島抵抗的一個代謝反應

  • to something much more threatening,

    相較於其他更大的威脅

  • an underlying epidemic,

    例如一些相關的疫病

  • the one we ought to be worried about?

    它們才是我們真正應該去擔心的

  • Let's look at some suggestive facts.

    讓我們來看些有暗示性的建議

  • We know that 30 million obese Americans

    我們知道有3千萬肥胖症患者

  • in the United States don't have insulin resistance.

    在美國並未患胰島素抵抗

  • And by the way, they don't appear to be at any

    同時,沒有證據顯示他們

  • greater risk of disease than lean people.

    比非肥胖症患者更容易貽患其他疾病

  • Conversely, we know that six million lean people

    恰恰相反,有6百萬非肥胖症患者

  • in the United States are insulin-resistant,

    在美國存在胰島素抵抗,

  • and by the way, they appear to be at even greater risk

    而他們卻被證實易患

  • for those metabolic disease I mentioned a moment ago

    那些我之前提到的糖尿病併發症

  • than their obese counterparts.

    同時幾率較肥胖人士來的更高

  • Now I don't know why, but it might be because,

    雖然現在我還不知道為什麼,但是一個可能的原因是

  • in their case, their cells haven't actually figured out

    對他們而言,他們的細胞無法正確的

  • the right thing to do with that excess energy.

    對體內多餘能量做出反應

  • So if you can be obese and not have insulin resistance,

    你可以是肥胖症患者,卻沒患胰島素抵抗,

  • and you can be lean and have it,

    或者你可以不肥胖,卻患有胰島素抵抗

  • this suggests that obesity may just be a proxy

    這都表明肥胖只不過是一個表徵 而胰島素抗拒才是根源。

  • for what's going on.

    所以如果我們鬥爭搞錯了物件

  • So what if we're fighting the wrong war,

    我們一直與肥胖戰鬥著

  • fighting obesity rather than insulin resistance?

    而非胰島素抵抗?

  • Even worse, what if blaming the obese

    而且更糟的是,如果指責過胖者

  • means we're blaming the victims?

    其實確是在指責胰島素抵抗的受害者?

  • What if some of our fundamental ideas about obesity

    如果我們對於肥胖症的一些基本認識本身

  • are just wrong?

    就存在誤差?

  • Personally, I can't afford the luxury of arrogance anymore,

    就我個人而言,我沒有辦法繼續保持傲慢的態度

  • let alone the luxury of certainty.

    讓我把那種過剩的確信感放在一邊

  • I have my own ideas about what could be at the heart of this,

    對於這些問題的核心為何,我有我自己的認識

  • but I'm wide open to others.

    同時我也願意將它與其他人分享

  • Now, my hypothesis, because everybody always asks me,

    我的假設,因為老有人問我

  • is this.

    是這樣的

  • If you ask yourself, what's a cell trying to protect itself from

    試問,一個細胞到底在畏懼什麼

  • when it becomes insulin resistant,

    當它處於胰島素抗拒狀態時

  • the answer probably isn't too much food.

    問題的答案可能不是攝入過多的食物

  • It's more likely too much glucose: blood sugar.

    答案更有可能是攝入過量葡萄糖而導致血糖過高

  • Now, we know that refined grains and starches

    精製的穀物和澱粉

  • elevate your blood sugar in the short run,

    將在短時間內抬到你的血糖含量

  • and there's even reason to believe that sugar

    而且我們有理由相信

  • may lead to insulin resistance directly.

    糖分將直接導致胰島素抵抗症

  • So if you put these physiological processes to work,

    所以如果把這些生理過程也列入考慮,

  • I'd hypothesize that it might be our increased intake

    我認為是大量的不斷攝入

  • of refined grains, sugars and starches that's driving

    精製穀物,糖類以及澱粉類食物導致了

  • this epidemic of obesity and diabetes,

    肥胖症和糖尿病的流行,

  • but through insulin resistance,

    但其病因是胰島素抵抗症

  • you see, and not necessarily through just overeating and under-exercising.

    而不是由於暴飲暴食以及缺乏運動。

  • When I lost my 40 pounds a few years ago,

    在我幾年前減去40磅時,

  • I did it simply by restricting those things,

    我只是簡單的限制了精製穀物,糖,和澱粉的攝入,

  • which admittedly suggests I have a bias

    誠然這也表明我存在一些偏見,

  • based on my personal experience.

    而這些主要源自我的個人經驗。

  • But that doesn't mean my bias is wrong,

    但是這並不意味著我的偏見是錯誤的,

  • and most important, all of this can be tested scientifically.

    更重要的是,所有這些偏見都是可以被科學驗證的

  • But step one is accepting the possibility

    但是第一步就是要接受一種可能性

  • that our current beliefs about obesity,

    那就是我們當前關於肥胖症,

  • diabetes and insulin resistance could be wrong

    糖尿病以及胰島素抗拒症的理解可能存在偏差

  • and therefore must be tested.

    並需要被驗證

  • I'm betting my career on this.

    我把我的事業都賭在了這個可能性上

  • Today, I devote all of my time to working on this problem,

    現在,我把所有的時間花在了這個問題的研究上,

  • and I'll go wherever the science takes me.

    而且我將不會停止知道找到真正的答案

  • I've decided that what I can't and won't do anymore

    我已經決定有一件事是我不能也不會再做的,