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: 會不會我們對糖尿病有錯誤的觀念?

Filmed:
4,258,278 views

當時身為年輕的外科醫師, Peter Attia 輕視一位有糖尿病的患患。她當時過重,他認為並決定這位女士需要足部截肢。但幾年後, Attia 罹患了一個令人驚訝的症狀,迫使他去思考:我們對糖尿病的觀念正確嗎?會不會導致糖尿病的前因也導致了肥胖症,而不是肥胖所導致?讓我們來看看,現在的假設如何導致我們打了一場錯誤的醫療戰爭?
- Surgeon
Both a surgeon and a self-experimenter, Peter Attia hopes to ease the diabetes epidemic by challenging what we think we know and improving the scientific rigor in nutrition and obesity research. Full bio

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

00:12
I'll never forget忘記 that day
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我永遠不會忘記那天
00:13
back in the spring彈簧 of 2006.
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在 2006 年春天的時候
00:17
I was a surgical外科 resident居民
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我當時是一位外科住院醫師
00:19
at The Johns約翰斯 Hopkins霍普金斯 Hospital醫院,
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在約翰·霍普金斯醫院工作
00:21
taking服用 emergency call.
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接緊急任務
00:23
I got paged分頁 by the E.R. around 2 in the morning早上
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大約凌晨兩點時急診室叫我過去
00:26
to come and see a woman女人 with a diabetic糖尿病患者 ulcer潰瘍
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幫一名糖尿病足部潰瘍的女士看診
00:28
on her foot腳丫子.
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我還記得當我拉開隔簾看她時
00:30
I can still remember記得 sort分類 of that smell of rotting腐爛 flesh
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00:34
as I pulled the curtain窗簾 back to see her.
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那種肉體腐爛的味道
00:38
And everybody每個人 there agreed約定 this woman女人 was very sick生病
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在場的人一致認為她病得很嚴重
00:40
and she needed需要 to be in the hospital醫院.
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必須住院治療
00:41
That wasn't being存在 asked.
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這大家所認同的
00:43
The question that was being存在 asked of me was a different不同 one,
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但他們問我的是另一個問題
00:45
which哪一個 was, did she also need an amputation切斷術?
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也就是,她需要截肢嗎
00:49
Now, looking back on that night,
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而當我回想起那一晚
00:52
I'd love so desperately拼命 to believe that I treated治療 that woman女人
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我極度地希望當時
我對那位女士的治療態度,
賦予著的同情和憐憫
00:57
on that night with the same相同 empathy同情 and compassion同情
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01:00
I'd shown顯示 the 27-year-old-歲 newlywed新人
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不亞於另一位 27 歲的新婚女士
01:04
who came來了 to the E.R. three nights earlier
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她當晚三天前來到急診室
01:06
with lower降低 back pain疼痛
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說她的下背部疼痛
01:08
that turned轉身 out to be advanced高級 pancreatic cancer癌症.
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後來診斷出是胰腺癌末期
01:12
In her case案件, I knew知道 there was nothing I could do
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她的情況我知道
我無法給她任何醫療幫助
01:14
that was actually其實 going to save保存 her life.
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來挽救她的生命
01:16
The cancer癌症 was too advanced高級.
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那癌症已經末期了
01:18
But I was committed提交 to making製造 sure that
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但我有責任確保
01:21
I could do anything possible可能 to make her stay
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盡量讓她維持在舒適的狀態
01:23
more comfortable自在. I brought her a warm blanket
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我幫她多加一件被子
01:26
and a cup杯子 of a coffee咖啡.
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給她一杯咖啡
01:28
I brought some for her parents父母.
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也幫她父母親買咖啡
01:31
But more importantly重要的, see, I passed通過 no judgment判斷 on her,
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但最重要的是,我不怪她
01:34
because obviously明顯 she had doneDONE nothing
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因為顯然她並沒有做錯什麼事
01:36
to bring帶來 this on herself她自己.
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害她變成這樣
01:38
So why was it that, just a few少數 nights later後來,
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但為什麼,幾天之後
01:41
as I stood站在 in that same相同 E.R. and determined決心
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我站在同一間急診室
01:44
that my diabetic糖尿病患者 patient患者 did indeed確實 need an amputation切斷術,
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決定這位糖尿病患者需要截肢時
01:47
why did I hold保持 her in such這樣 bitter contempt鄙視?
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對她卻持有輕蔑的態度?
01:51
You see, unlike不像 the woman女人 the night before,
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大家可以發現,和前三天那位女士不同
01:54
this woman女人 had type類型 2 diabetes糖尿病.
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這位女士有二型糖尿病
01:56
She was fat脂肪.
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她有肥胖的問題
01:58
And we all know that's from eating too much
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我們都知道這是因為吃太多
01:59
and not exercising行使 enough足夠, right?
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而且運動量不足,沒錯吧
02:02
I mean, how hard can it be?
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我的意思是這會有多難呢?
02:04
As I looked看著 down at her in the bed, I thought to myself,
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低頭看著她躺在床上,我心想
02:07
if you just tried試著 caring愛心 even a little bit,
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如果妳能多留意一點
02:10
you wouldn't不會 be in this situation情況 at this moment時刻
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現在就不會處於這種情況
02:13
with some doctor醫生 you've never met會見
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一堆妳沒見過的醫生
02:14
about to amputate截肢 your foot腳丫子.
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即將要幫妳截肢
02:18
Why did I feel justified有理 in judging判斷 her?
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為什麼這樣批評她是合理的
02:22
I'd like to say I don't know.
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我想說我不知道
02:25
But I actually其實 do.
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但其實我明白
02:27
You see, in the hubris傲慢 of my youth青年,
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當時年少輕狂
02:29
I thought I had her all figured想通 out.
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我以為我看透她這種人
02:32
She ate too much. She got unlucky不幸的.
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她吃太多,她運氣不好
02:34
She got diabetes糖尿病. Case案件 closed關閉.
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得了糖尿病,就這樣
02:37
Ironically諷刺地, at that time in my life,
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諷刺的是當時
02:39
I was also doing cancer癌症 research研究,
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我在研究癌症
02:41
immune-based免疫為主 therapies治療 for melanoma黑色素瘤, to be specific具體,
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具體一點是黑色素瘤的免疫治療
02:43
and in that world世界 I was actually其實 taught to question everything,
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在這個領域當中我被教導去質疑一切
02:47
to challenge挑戰 all assumptions假設
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要挑戰所有假設
02:49
and hold保持 them to the highest最高 possible可能 scientific科學 standards標準.
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然後盡可能用最高的科學標準來衡量
02:53
Yet然而 when it came來了 to a disease疾病 like diabetes糖尿病
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然而講到糖尿病這類疾病
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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在美國,致命率比黑色素瘤高八倍
03:00
I never once一旦 questioned質疑 the conventional常規 wisdom智慧.
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我從來不質疑傳統的觀念
03:04
I actually其實 just assmedassmed the pathologic病理 sequence序列 of events事件
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我其實已經假設病理學中的先後順序
03:07
was settled安定 science科學.
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已由科學證實
03:09
Three years年份 later後來, I found發現 out how wrong錯誤 I was.
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三年後,我發現我大錯特錯
03:13
But this time, I was the patient患者.
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但這一次我成了病人
03:15
Despite儘管 exercising行使 three or four hours小時 every一切 single day,
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儘管我每天運動3~4小時
03:19
and following以下 the food餐飲 pyramid金字塔 to the letter,
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飲食也遵循食物金字塔的概念
03:22
I'd gained獲得 a lot of weight重量 and developed發達 something
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仍然體重暴增
03:24
called metabolic新陳代謝 syndrome綜合徵.
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得了新陳代謝症候群
03:26
Some of you may可能 have heard聽說 of this.
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在座可能有些人有聽過
03:28
I had become成為 insulin-resistant胰島素抵抗.
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我身體有了胰島素抗性
03:31
You can think of insulin胰島素 as this master hormone激素
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你們可以把胰島素想成一種主激素
03:34
that controls控制 what our body身體 does with the foods食品 we eat,
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它在我們進食後掌控身體相關的運作
03:38
whether是否 we burn燒傷 it or store商店 it.
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燃燒能量或儲存能量
03:40
This is called fuel汽油 partitioning分區 in the lingo行話.
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行話我們叫做燃料分區
03:43
Now failure失敗 to produce生產 enough足夠 insulin胰島素 is incompatible不相容 with life.
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無法分泌足夠的胰島素有生命危險
03:46
And insulin胰島素 resistance抵抗性, as its name名稱 suggests提示,
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胰島素抗性,顧名思義
03:49
is when your cells細胞 get increasingly日益 resistant
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就是細胞開始
03:51
to the effect影響 of insulin胰島素 trying to do its job工作.
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急劇抗拒胰島素發揮它的功能
03:55
Once一旦 you're insulin-resistant胰島素抵抗,
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一旦身體有了胰島素抗性
03:57
you're on your way to getting得到 diabetes糖尿病,
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就會得糖尿病
03:58
which哪一個 is what happens發生 when your pancreas胰腺
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糖尿病就是你的胰腺
04:00
can't keep up with the resistance抵抗性 and make enough足夠 insulin胰島素.
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無法產生足夠的胰島素
來跟上抗性的程度
04:04
Now your blood血液 sugar levels水平 start開始 to rise上升,
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血糖開始升高
04:06
and an entire整個 cascade級聯 of pathologic病理 events事件
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然後一連串的病理事件
04:09
sort分類 of spirals螺旋 out of control控制 that can lead to heart disease疾病,
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開始失去控制因而導致心臟病
04:13
cancer癌症, even Alzheimer's老年癡呆症 disease疾病,
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癌症,甚至阿茲海默症
04:16
and amputations截肢, just like that woman女人 a few少數 years年份 earlier.
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或者像前幾年那位女士一樣截肢
04:21
With that scare, I got busy changing改變 my diet飲食 radically根本,
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我受到驚嚇並開始徹底改善飲食習慣
04:24
adding加入 and subtracting減法 things most of you would find
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加加減減一些
04:26
almost幾乎 assuredly無疑 shocking觸目驚心.
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你們大部分會滿意外的食物
04:29
I did this and lost丟失 40 pounds英鎊, weirdly古怪 while exercising行使 less.
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我瘦了 40 磅但奇怪的是我運動量有所減少
04:33
I, as you can see, I guess猜測 I'm not overweight超重 anymore.
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你們猜也知道,顯然我不再過重
04:36
More importantly重要的, I don't have insulin胰島素 resistance抵抗性.
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更重要的是我的身體沒有胰島素抗性了
04:39
But most important重要, I was left
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但最重要的是
04:41
with these three burning燃燒 questions問題 that wouldn't不會 go away:
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在這之後我有三個急迫的問題揮之不去
04:44
How did this happen發生 to me if I was supposedly按說
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為什麼這種事會發生在我身上
明明我做的應該都是對的事
04:47
doing everything right?
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04:50
If the conventional常規 wisdom智慧 about nutrition營養 had failed失敗 me,
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如果對營養的傳統觀念不適用在我身上
04:53
was it possible可能 it was failing失敗 someone有人 else其他?
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是不是可能對別人也不適用呢
04:56
And underlying底層 these questions問題,
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因為這些問題
04:58
I became成為 almost幾乎 maniacally發狂 obsessed痴迷
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我幾乎開始瘋狂著迷
05:02
in trying to understand理解 the real真實 relationship關係
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試著找出肥胖與胰島素抗性之間
05:04
between之間 obesity肥胖 and insulin胰島素 resistance抵抗性.
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真正的關聯
05:08
Now, most researchers研究人員 believe obesity肥胖
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現在大部分的研究人員相信
05:11
is the cause原因 of insulin胰島素 resistance抵抗性.
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是肥胖導致身體產生胰島素抗性
05:14
Logically按道理, then, if you want to treat對待 insulin胰島素 resistance抵抗性,
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所以邏輯上來講,要治療胰島素抗性
05:16
you get people to lose失去 weight重量, right?
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就是減重對吧
05:18
You treat對待 the obesity肥胖.
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就是治療肥胖的問題
05:21
But what if we have it backwards向後?
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但如果正好相反呢
05:24
What if obesity肥胖 isn't the cause原因 of insulin胰島素 resistance抵抗性 at all?
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萬一根本不是肥胖導致胰島素抗性呢
05:27
In fact事實, what if it's a symptom症狀 of a much deeper更深 problem問題,
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萬一其實是一個更嚴重的症狀
05:31
the tip小費 of a proverbial諺語 iceberg冰山?
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而它只是眾所皆知的冰山一角而已呢
05:34
I know it sounds聲音 crazy because we're obviously明顯 in the midst中間
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我知道這聽起來有點瘋狂,因為我們明顯地
05:36
of an obesity肥胖 epidemic疫情, but hear me out.
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還在這肥胖問題的流行病之中,但讓我解釋一下
05:40
What if obesity肥胖 is a coping應對 mechanism機制
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會不會其實肥胖是一種應對機制
05:43
for a far more sinister險惡 problem問題 going on
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為了來面對潛藏於細胞中
更嚴重的問題呢
05:46
underneath the cell細胞?
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05:48
I'm not suggesting提示 that obesity肥胖 is benign良性,
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我不是說肥胖是好事
05:50
but what I am suggesting提示 is it may可能 be the lesser較小
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我想表達的是,兩個新陳代謝惡魔相較下
05:53
of two metabolic新陳代謝 evils罪惡.
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肥胖是次要的
05:55
You can think of insulin胰島素 resistance抵抗性 as the reduced減少 capacity容量
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你可以把胰島素抗性想成
我們身體為燃料分區的能力下降了
05:58
of ourselves我們自己 to partition劃分 fuel汽油,
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06:00
as I alluded暗示 to a moment時刻 ago,
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像我剛剛提到的
06:03
taking服用 those calories卡路里 that we take in
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身體將我們攝取的卡路里
06:04
and burning燃燒 some appropriately適當 and storing存儲 some appropriately適當.
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適當的燃燒及儲存
06:08
When we become成為 insulin-resistant胰島素抵抗,
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當我們身體出現胰島素抗性時
06:10
the homeostasis動態平衡 in that balance平衡 deviates偏離 from this state.
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體內的狀態失去平衡
06:13
So now, when insulin胰島素 says to a cell細胞,
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所以現在,當胰島素跟細胞說
06:15
I want you to burn燒傷 more energy能源
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我要你燃燒更多能量
06:17
than the cell細胞 considers考慮 safe安全, the cell細胞, in effect影響, says,
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超過細胞視為安全的程度
06:20
"No thanks謝謝, I'd actually其實 rather store商店 this energy能源."
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細胞會說謝了我要把能量存起來
06:24
And because fat脂肪 cells細胞 are actually其實 missing失踪 most of
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但脂肪細胞缺少
06:26
the complex複雜 cellular細胞的 machinery機械 found發現 in other cells細胞,
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其他細胞中大部分複雜的機制結構
06:29
it's probably大概 the safest最安全 place地點 to store商店 it.
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它可能成了儲存能量最安全的地方
06:31
So for many許多 of us, about 75 million百萬 Americans美國人,
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所以約7500萬美國人,我們大多
06:36
the appropriate適當 response響應 to insulin胰島素 resistance抵抗性
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對胰島素抗性的正常反應
06:40
may可能 actually其實 be to store商店 it as fat脂肪, not the reverse相反,
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事實上都是存成脂肪細胞,而非相反的
06:45
getting得到 insulin胰島素 resistance抵抗性 in response響應 to getting得到 fat脂肪.
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因為肥胖而產生胰島素抗性
06:50
This is a really subtle微妙 distinction分別,
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其實兩者差別不大
06:52
but the implication意義 could be profound深刻.
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但其隱含的意義深遠
06:56
Consider考慮 the following以下 analogy比喻:
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想一想接下來這個的類比
06:58
Think of the bruise挫傷 you get on your shin
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你的腳瘀青了
07:01
when you inadvertently不經意間 bang your leg into the coffee咖啡 table.
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因為不小心撞到咖啡桌
07:05
Sure, the bruise挫傷 hurts傷害 like hell地獄, and you almost幾乎 certainly當然
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當然瘀青讓你痛得要命,你也絕對
07:08
don't like the discolored脫色的 look, but we all know
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不喜歡瘀青的顏色,但我們都知道
07:11
the bruise挫傷 per seSE is not the problem問題.
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瘀青本身不是問題
07:14
In fact事實, it's the opposite對面. It's a healthy健康 response響應 to the trauma外傷,
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事實上相反的,它對傷口是一個好的反應
07:18
all of those immune免疫的 cells細胞 rushing to the site現場 of the injury
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這些免疫細胞衝到受傷部位
07:21
to salvage打撈 cellular細胞的 debris廢墟 and prevent避免 the spread傳播
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為了拯救破損細胞,而避免細胞感染
07:24
of infection感染 to elsewhere別處 in the body身體.
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擴散到身體其他部位
07:26
Now, imagine想像 we thought bruises瘀傷 were the problem問題,
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現在假如我們把瘀青當作問題所在
07:30
and we evolved進化 a giant巨人 medical establishment編制
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我們發展出巨大的醫療機構及文化
07:33
and a culture文化 around treating治療 bruises瘀傷:
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專門在研究如何治療瘀青
07:36
masking掩蔽 creams面霜, painkillers止痛藥, you name名稱 it,
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遮瑕乳液、止痛藥和任何你講得出來的東西
07:39
all the while ignoring無視 the fact事實 that people
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而我們這段時間都忽略了一個事實
07:42
are still banging their shins小腿 into coffee咖啡 tables.
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人的膝蓋還是會撞到咖啡桌
07:45
How much better would we be if we treated治療 the cause原因 --
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對症下藥會不會更好
07:48
telling告訴 people to pay工資 attention注意
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告訴大家要小心
07:50
when they walk步行 through通過 the living活的 room房間 --
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進出客廳要注意咖啡桌
07:52
rather than the effect影響?
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而不是針對傷害做治療
07:55
Getting入門 the cause原因 and the effect影響 right
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如果我們瞭解因果關係
07:57
makes品牌 all the difference區別 in the world世界.
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會讓世界變得不同
07:59
Getting入門 it wrong錯誤, and the pharmaceutical製藥 industry行業
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弄錯前因後果
藥物產業的股東沒有損失
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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但對瘀青的人沒有任何幫助
08:09
Cause原因 and effect影響.
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這是因果關係的問題
08:12
So what I'm suggesting提示 is
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所以我想表達的是
08:14
maybe we have the cause原因 and effect影響 wrong錯誤
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或許我們搞錯了
肥胖和胰島素抗性的因果關係
08:16
on obesity肥胖 and insulin胰島素 resistance抵抗性.
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08:19
Maybe we should be asking ourselves我們自己,
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我們也許該問問自己
08:21
is it possible可能 that insulin胰島素 resistance抵抗性 causes原因 weight重量 gain獲得
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會不會是因為胰島素抗性而造成體重增加
08:25
and the diseases疾病 associated相關 with obesity肥胖,
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還有其它與肥胖有關的疾病
08:27
at least最小 in most people?
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至少大部分的人是如此
08:28
What if being存在 obese肥胖 is just a metabolic新陳代謝 response響應
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會不會肥胖只是一個新陳代謝的反應
08:31
to something much more threatening危險的,
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用來對付更具威脅性的
08:34
an underlying底層 epidemic疫情,
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潛在流行病
08:36
the one we ought應該 to be worried擔心 about?
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而這流行病才是我們該擔心的問題
08:38
Let's look at some suggestive提示 facts事實.
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我們來看看一些相關的案例
08:40
We know that 30 million百萬 obese肥胖 Americans美國人
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我們知道美國有3000萬肥胖的人
08:42
in the United聯合的 States狀態 don't have insulin胰島素 resistance抵抗性.
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並沒有胰島素抗性的症狀
08:45
And by the way, they don't appear出現 to be at any
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順便一提,他們罹患疾病的風險
08:47
greater更大 risk風險 of disease疾病 than lean people.
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不會比瘦的人還高
08:50
Conversely反過來, we know that six million百萬 lean people
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相反的,我們知道美國有600萬瘦的人
08:53
in the United聯合的 States狀態 are insulin-resistant胰島素抵抗,
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有胰島素抗性
08:57
and by the way, they appear出現 to be at even greater更大 risk風險
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順便跟你們說,他們有更高的風險
09:00
for those metabolic新陳代謝 disease疾病 I mentioned提到 a moment時刻 ago
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會得到我剛剛提到的那些代謝疾病
09:02
than their obese肥胖 counterparts同行.
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而且比那些相對肥胖的人機率更高
09:04
Now I don't know why, but it might威力 be because,
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我不懂為什麼,但有可能他們的情況
09:06
in their case案件, their cells細胞 haven't沒有 actually其實 figured想通 out
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是因為細胞沒有辦法理解
09:09
the right thing to do with that excess過量 energy能源.
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多餘的能量該如何使用
09:12
So if you can be obese肥胖 and not have insulin胰島素 resistance抵抗性,
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所以如果肥胖的人沒有胰島素抗性
09:15
and you can be lean and have it,
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或者瘦的人卻有胰島素抗性
09:17
this suggests提示 that obesity肥胖 may可能 just be a proxy代理
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那代表肥胖
只是問題的代理者
09:21
for what's going on.
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09:24
So what if we're fighting戰鬥 the wrong錯誤 war戰爭,
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所以萬一我們打錯仗了
09:27
fighting戰鬥 obesity肥胖 rather than insulin胰島素 resistance抵抗性?
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我們對付肥胖的問題而非胰島素抗性
09:31
Even worse更差, what if blaming歸咎 the obese肥胖
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假如更糟的,會不會我們把問題歸咎於肥胖
09:34
means手段 we're blaming歸咎 the victims受害者?
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就是在責怪受害者呢
09:37
What if some of our fundamental基本的 ideas思路 about obesity肥胖
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會不會我們對肥胖症的
09:40
are just wrong錯誤?
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基本觀念完全錯誤?
09:42
Personally親自, I can't afford給予 the luxury豪華 of arrogance傲慢 anymore,
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我個人無法再承受傲慢要付出的奢侈代價
09:46
let alone單獨 the luxury豪華 of certainty肯定.
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更別說下定論要付出的代價了
09:49
I have my own擁有 ideas思路 about what could be at the heart of this,
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我對這個個問題有自己的一套想法
09:52
but I'm wide open打開 to others其他.
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但我也接受別人的想法
09:54
Now, my hypothesis假設, because everybody每個人 always asks me,
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因為大家總會問,我的假設是什麼
09:56
is this.
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是這樣子的
09:58
If you ask yourself你自己, what's a cell細胞 trying to protect保護 itself本身 from
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問問看自己,如果身體有胰島素抗性的時候
10:01
when it becomes insulin胰島素 resistant,
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細胞會試著遠離什麼東西
10:03
the answer回答 probably大概 isn't too much food餐飲.
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答案絕對不是遠離過量的食物
10:06
It's more likely容易 too much glucose葡萄糖: blood血液 sugar.
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而是遠離血液中過量的葡萄糖,也就是血糖
10:09
Now, we know that refined精製 grains穀物 and starches澱粉
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我們都知道精緻的穀物及澱粉
10:11
elevate提升 your blood血液 sugar in the short run,
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會在短時間內提高血糖
10:14
and there's even reason原因 to believe that sugar
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我們甚至很有理由相信
10:15
may可能 lead to insulin胰島素 resistance抵抗性 directly.
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就是糖分直接導致了胰島素抗性
10:18
So if you put these physiological生理 processes流程 to work,
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所以這些生理過程
10:22
I'd hypothesize或推測 that it might威力 be our increased增加 intake錄取
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我推測是因為我們攝取了過多
10:26
of refined精製 grains穀物, sugars and starches澱粉 that's driving主動
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精緻穀物、糖分、澱粉
這些導致肥胖及糖尿病這類流行病的東西
10:29
this epidemic疫情 of obesity肥胖 and diabetes糖尿病,
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10:33
but through通過 insulin胰島素 resistance抵抗性,
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但這是因為胰島素抗性造成的
10:35
you see, and not necessarily一定 through通過 just overeating暴飲暴食 and under-exercising下行使.
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而不是暴飲暴食或運動量不足所致
10:39
When I lost丟失 my 40 pounds英鎊 a few少數 years年份 ago,
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我前幾年減了40磅 (約18.14公斤)
10:42
I did it simply只是 by restricting限制 those things,
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只是藉由少吃那些東西
10:44
which哪一個 admittedly固然 suggests提示 I have a bias偏壓
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這等於是承認我因為個人經驗
10:48
based基於 on my personal個人 experience經驗.
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而有所偏見
10:50
But that doesn't mean my bias偏壓 is wrong錯誤,
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但這不代表我的偏見是錯的
10:53
and most important重要, all of this can be tested測試 scientifically科學.
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更重要的是,這些都能經過科學證實
10:57
But step one is accepting驗收 the possibility可能性
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但第一步是接受
11:00
that our current當前 beliefs信仰 about obesity肥胖,
231
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可能我們現在對於肥胖、糖尿病及胰島素抗性
11:02
diabetes糖尿病 and insulin胰島素 resistance抵抗性 could be wrong錯誤
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想法是錯的
11:05
and therefore因此 must必須 be tested測試.
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因此還需要證實
11:08
I'm betting博彩 my career事業 on this.
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我以我的職業生涯為賭注
11:10
Today今天, I devote奉獻 all of my time to working加工 on this problem問題,
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現在我將我所有時間投入於研究這個問題
11:15
and I'll go wherever哪裡 the science科學 takes me.
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而我會依科學測試的結果來定論
11:18
I've decided決定 that what I can't and won't慣於 do anymore
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我已經決定我沒有答案時
11:21
is pretend假裝 I have the answers答案 when I don't.
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我不能假裝,也不會再去假裝我知道答案
11:24
I've been humbled自愧不如 enough足夠 by all I don't know.
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我不知道的事已經足以讓我謙虛了
11:28
For the past過去 year, I've been fortunate幸運 enough足夠
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過去一年,我很幸運
11:31
to work on this problem問題 with the most amazing驚人 team球隊
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能和一個非常優秀的團隊一起工作
11:34
of diabetes糖尿病 and obesity肥胖 researchers研究人員 in the country國家,
242
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他們是我國最有權威的
糖尿病及肥胖問題的研究人員
11:37
and the best最好 part部分 is,
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最棒的是
11:39
just like Abraham亞伯拉罕 Lincoln林肯 surrounded包圍 himself他自己 with a team球隊 of rivals對手,
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就像林肯總統一樣,他選擇被一群對手圍繞
11:43
we've我們已經 doneDONE the same相同 thing.
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我們也做同樣的事情
11:44
We've我們已經 recruited應徵 a team球隊 of scientific科學 rivals對手,
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我們招募了一群最優秀的對手來組成科學團隊
11:47
the best最好 and brightest who all have different不同 hypotheses假設
247
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他們對這個流行病的起因
11:51
for what's at the heart of this epidemic疫情.
248
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也各有不同的假設
11:52
Some think it's too many許多 calories卡路里 consumed消費.
249
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有些人認為是因為消耗太多的卡路里
11:55
Others其他 think it's too much dietary膳食 fat脂肪.
250
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有些人認為是攝取過多膳食脂肪
11:57
Others其他 think it's too many許多 refined精製 grains穀物 and starches澱粉.
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有些人則認為是食用過量的
精緻穀物及澱粉所致
12:01
But this team球隊 of multi-disciplinary多學科,
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不過在這個多方訓練的團隊中
12:03
highly高度 skeptical懷疑的 and exceedingly非常 talented天才 researchers研究人員
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這些容易起疑又非常有才華的研究人員
12:06
do agree同意 on two things.
254
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都同意兩件事
12:09
First, this problem問題 is just simply只是 too important重要
255
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第一,這個問題實在太重要了
12:12
to continue繼續 ignoring無視 because we think we know the answer回答.
256
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因此我們不能繼續忽略
以為我們知道問題的解答
12:15
And two, if we're willing願意 to be wrong錯誤,
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第二,如果我們願意認錯
12:18
if we're willing願意 to challenge挑戰 the conventional常規 wisdom智慧
258
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我們願意去挑戰傳統的觀念
12:20
with the best最好 experiments實驗 science科學 can offer提供,
259
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應用科學上最頂尖的研究方法
12:23
we can solve解決 this problem問題.
260
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我們可以改善這個問題
12:26
I know it's tempting誘人的 to want an answer回答 right now,
261
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我知道大家現在就想要有答案
12:29
some form形成 of action行動 or policy政策, some dietary膳食 prescription處方 --
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一些實際行動及措施或飲食上的建議
12:33
eat this, not that —
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該吃什麼,不該吃什麼
12:35
but if we want to get it right,
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但如果我們想得到正確的答案
12:37
we're going to have to do much more rigorous嚴格 science科學
265
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我們必須先經歷過更多嚴格的科學檢驗
12:39
before we can write that prescription處方.
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才能給大家飲食上的建議
12:42
Briefly簡要地, to address地址 this, our research研究 program程序
267
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簡單來說,為了解決這個問題,我們研究計畫
12:44
is focused重點 around three meta-themes元主題, or questions問題.
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主要圍繞於三個重要的主題及問題
12:47
First, how do the various各個 foods食品 we consume消耗
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第一,我們攝取的各類食物
12:50
impact碰撞 our metabolism代謝, hormones激素 and enzymes,
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是如何影響我們的代謝、激素及酵素
12:53
and through通過 what nuanced細緻入微 molecular分子 mechanisms機制?
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又是透過什麼細微的分子機制來影響的
12:56
Second第二, based基於 on these insights見解,
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第二,由我們的見解為基礎
12:58
can people make the necessary必要 changes變化 in their diets飲食
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人們是否能在飲食上做出必要的改善
13:01
in a way that's safe安全 and practical實際的 to implement實行?
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是否能用安全又實際的方式來達成
13:05
And finally最後, once一旦 we identify鑑定 what safe安全
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最後,了解飲食上我們能夠
13:08
and practical實際的 changes變化 people can make to their diet飲食,
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做出哪些安全且實際的改變之後
13:11
how can we move移動 their behavior行為 in that direction方向
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我們又將如何使飲食習慣
朝正確的方向來改善
13:15
so that it becomes more the default默認
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讓這樣的飲食習慣變成自然反應
13:17
rather than the exception例外?
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而不是一個例外的選擇
13:19
Just because you know what to do doesn't mean
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只是因為知道要做什麼
13:21
you're always going to do it.
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並不代表我們就會這麼做
13:23
Sometimes有時 we have to put cues線索 around people
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有時候我們必須給大家一些線索
13:25
to make it easier更輕鬆, and believe it or not,
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讓這件事容易做到,不管你們相不相信
13:27
that can be studied研究 scientifically科學.
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這都是科學能夠證實的
13:31
I don't know how this journey旅程 is going to end結束,
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我不知道這趟科學之旅會有什麼結局
13:33
but this much seems似乎 clear明確 to me, at least最小:
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但至少有件事我很清楚
13:38
We can't keep blaming歸咎 our overweight超重 and diabetic糖尿病患者 patients耐心
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我們不該再責備肥胖及糖尿病患者
13:43
like I did.
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不該像我以前一樣
13:45
Most of them actually其實 want to do the right thing,
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他們大部分也想做對的決定
13:48
but they have to know what that is,
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但是他們需要知道如何改善
13:51
and it's got to work.
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而且是有效的改善方法
13:54
I dream夢想 of a day when our patients耐心 can
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我夢想有一天我們的病人
13:59
shed their excess過量 pounds英鎊
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能減掉多餘的重量
14:01
and cure治愈 themselves他們自己 of insulin胰島素 resistance抵抗性,
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並治好胰島素抗性
14:03
because as medical professionals專業人士,
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因為身為醫療專家
14:06
we've我們已經 shed our excess過量 mental心理 baggage行李
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1970
我們已經卸下心中多餘的包袱
14:08
and cured治愈 ourselves我們自己 of new idea理念 resistance抵抗性 sufficiently充分地
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然後充分地改善自己曾對新理念
有所抵抗的行為
14:11
to go back to our original原版的 ideals理想:
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而回歸到我們原本的理念
14:15
open打開 minds頭腦, the courage勇氣 to throw out yesterday's昨天的 ideas思路
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心胸開闊,當舊有的陳見不再正確的時候
14:19
when they don't appear出現 to be working加工,
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我們能有拋下它的勇氣
14:22
and the understanding理解 that scientific科學 truth真相 isn't final最後,
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了解科學事實不是最後一步
14:25
but constantly經常 evolving進化.
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而是應該不斷的研究
14:28
Staying入住 true真正 to that path路徑 will be better for our patients耐心
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堅持站在真理的道路上
能幫助我們的病患
14:31
and better for science科學.
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對科學也有更大的好處
14:35
If obesity肥胖 is nothing more than a proxy代理
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如果肥胖症只不過是
代謝問題的代罪羔羊
14:38
for metabolic新陳代謝 illness疾病,
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14:40
what good does it do us to punish懲治 those with the proxy代理?
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責怪他們有什麼好處呢
14:45
Sometimes有時 I think back to that night in the E.R.
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有時候我回想七年前
14:49
seven years年份 ago.
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在急診室的那晚
14:52
I wish希望 I could speak說話 with that woman女人 again.
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我希望我能再次跟那女士講話
14:55
I'd like to tell her how sorry I am.
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我想跟她說我多麼對不起她
14:59
I'd say, as a doctor醫生, I delivered交付
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我會說,身為一位醫生,
15:02
the best最好 clinical臨床 care關心 I could,
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我是盡全力的去照顧病人
15:05
but as a human人的 being存在,
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但身為一個人
15:09
I let you down.
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我讓你失望了
15:11
You didn't need my judgment判斷 and my contempt鄙視.
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你並不需要我的批判及輕視的眼光
15:16
You needed需要 my empathy同情 and compassion同情,
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妳需要的,是我的同理心和憐憫之心
15:20
and above以上 all else其他, you needed需要 a doctor醫生
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1995
最重要的是,妳需要的是一位醫生
15:22
who was willing願意 to consider考慮
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他能夠了解或許不是
妳讓這個醫療體制失望
15:25
maybe you didn't let the system系統 down.
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15:28
Maybe the system系統, of which哪一個 I was a part部分,
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而是這個體制,我也參與其中的這個體制
15:31
was letting出租 you down.
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讓妳失望了
15:34
If you're watching觀看 this now,
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如果妳正在看這部影片
15:36
I hope希望 you can forgive原諒 me.
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我希望妳能原諒我
15:41
(Applause掌聲)
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(掌聲)
Translated by Pei-Chin (Patty) Chuang
Reviewed by Iris Chung

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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