I'll never forget that day back in the spring of 2006. I was a surgical resident at The Johns Hopkins Hospital, taking emergency call. I got paged by the E.R. around 2 in the morning to come and see a woman with a diabetic ulcer on her foot. I can still remember sort of that smell of rotting flesh as I pulled the curtain back to see her. And everybody there agreed this woman was very sick and she needed to be in the hospital. That wasn't being asked. The question that was being asked of me was a different one, which was, did she also need an amputation?
Abidkay ma ilaabayo maalintaas Waxay ahayd gugii 2006 Waxaan dhakhtar qaliin joogta ah Ka ahaa Cusbitaalka John Hopkins, Waxan helay fariin degdeg ah Waxan fariintaka ka hellay E.R-ka ''Qolka degdega'' 2dii saqda dhexe. Si aan u imado una arko haweeynay boog macaan ku leh cagta Weli wan xususan karaa siduu ahaa urtii cadkaa qudhmay markii aan ka qaaday go'a si aan u arko. Qofkastoo meesha joogay waa arkayay in qoftani ad u xanunsanayso weyna u baahnayd inay cusbitaalka ku jirto. Taas lasyma weydiin. Suaasha lay warsaday waxay ahayd mid taas ka duwan, Taaso ahayd, Ma u baahantahay in lugta laga jaro?
Now, looking back on that night, I'd love so desperately to believe that I treated that woman on that night with the same empathy and compassion I'd shown the 27-year-old newlywed who came to the E.R. three nights earlier with lower back pain that turned out to be advanced pancreatic cancer. In her case, I knew there was nothing I could do that was actually going to save her life. The cancer was too advanced. But I was committed to making sure that I could do anything possible to make her stay more comfortable. I brought her a warm blanket and a cup of a coffee. I brought some for her parents. But more importantly, see, I passed no judgment on her, because obviously she had done nothing to bring this on herself. So why was it that, just a few nights later, as I stood in that same E.R. and determined that my diabetic patient did indeed need an amputation, why did I hold her in such bitter contempt?
Hada, markaan dib u eego habenkaas Waxan aad u jeclaan lahaa inaan aamino inaan kula dhaqmay haweeynadaa habeenkas naxariistii iyo dareenkii aan tusay 27-jir dhowaan guursatay taasoo timi ER-ka sadex habeenk a hor iyadoo xumadi ka hayso qaarka danbe taaso markii danbe cadatay inay tahay Kaankaro baahday. Gabadhaa arinkeeda, waan ogaa inaanan qaban karin wax xaqiiqadii badbaadin kara nolosheeda Kaankaradu waxay ahayd mid aad u baahday Laakiin waxa iga go'nayd inaan xaqiijiyo inaan samayn karo wuxuun suurta gal ka dhigi kara inay Nefis hesho. Waxaan u keenay buste diiran iyo koob buna Waxan u keenay oo kale qaar qoyskeeda ah Laakiin ta muhiimka ah bal fiiri hada, wax go'aana kuma ridin gabadhaasa sababtoo ah waxba may galabsan ay isugu keento iyadu arintan. Hadaba wuxu xal sida yahayba, habeno yar kadib anoo taagan isla qolkaa E.R-ka gawrasadayna in bukaankayga macaanka qaba uu u bahanyahay in lugta laga jaro Maxaan ugu hayaa arinka adag dhexidiisa gabadha?
You see, unlike the woman the night before, this woman had type 2 diabetes. She was fat. And we all know that's from eating too much and not exercising enough, right? I mean, how hard can it be? As I looked down at her in the bed, I thought to myself, if you just tried caring even a little bit, you wouldn't be in this situation at this moment with some doctor you've never met about to amputate your foot.
Waxaad arkaysaa, si ka duwan gabadhii habeenkii hore gabadhaan waxay leheed macaanka nooca 2aad Wayna buurneyd Waxaynu dhamaanten ognahay inay tani ka timi cunto layska cuno iyo iyadoon jimicsi dheera la samayn, hagaag? Waxan uga jeeda, siday u adagtahay suurtagalnimadaasi Markii aan hoos u eego iyadoo sariirta saran, anaa isla hadlay Hadii inuun aad isku dayi lahayd inaad inuun taxadartid kumaad sugnaateen xaaladatan waqtigan isaga ah adigoo la jooga dhakhtar aanad weligaa hore u arag kasoo ka shekaynaya inuu lugtada goosto
Why did I feel justified in judging her? I'd like to say I don't know. But I actually do. You see, in the hubris of my youth, I thought I had her all figured out. She ate too much. She got unlucky. She got diabetes. Case closed.
Maxan isugula haboonahay inaan go'an ku rido gabadhan? Waxan jecelahay inaan dhaho ma garanayo Laakiin xaqiiqdii waan garanayaa Waad arki kartaa dhalinyaranimada i qaaday Dhibteeda waxa kenay ban iska xisaabsaday Cuntaday iska badisay. Nasiib daraa ku dhacday Macaanbay qaaday. Khalaas.
Ironically, at that time in my life, I was also doing cancer research, immune-based therapies for melanoma, to be specific, and in that world I was actually taught to question everything, to challenge all assumptions and hold them to the highest possible scientific standards. Yet when it came to a disease like diabetes that kills Americans eight times more frequently than melanoma, I never once questioned the conventional wisdom. I actually just assumed the pathologic sequence of events was settled science.
Si dadban, waqtigas noloshayda kamidka ah Waxaan waday baadhitaan-cilmiyeed cudurka kansarka Daawanyn difaac ku salaysan oo loo hello melanomaha, khaas ahaan' Hadaba caalamkaas an ku jiray wax kasta su'aal ban saari jiray si aan ula halgamo dhamaan xaqiiqoyinka uguna beego miisaanka cilmiyeed ee ugu sareeya uguna macquulsan Laakin markay timado cudurka macaanka oo kale ah Kaaso dila dadka maraykanka sideed jeer in kabadan melanoma-aha Weligay ismaan weydiin arintaa laysla wada garanayo Waxan isaga malaynayay uun in dhacdooyinka cudurada la xidhiidha ay ahaayeen cilmi hore u degsanaa
Three years later, I found out how wrong I was. But this time, I was the patient. Despite exercising three or four hours every single day, and following the food pyramid to the letter, I'd gained a lot of weight and developed something called metabolic syndrome. Some of you may have heard of this. I had become insulin-resistant.
Saddex sano ka dib, ayaan ogaaday sidaan u khaldanaa Laakiin waqtigaan, anigaa bukaan ahaa. Ka sokow anoo saddex ilaa afar saacadood maalin kasta jimicsada raacana qorshaha cunto ee ugu suuban Waxaa kordhay miisankayga, waxana igu dhacay wax loogu yeedho" Metobolic syndorome" Qaarkiin inaad maqasheen ba laga yaabaa. Dheecanka isulin-ta ayaan difaac u yeeshay
You can think of insulin as this master hormone that controls what our body does with the foods we eat, whether we burn it or store it. This is called fuel partitioning in the lingo. Now failure to produce enough insulin is incompatible with life. And insulin resistance, as its name suggests, is when your cells get increasingly resistant to the effect of insulin trying to do its job. Once you're insulin-resistant, you're on your way to getting diabetes, which is what happens when your pancreas can't keep up with the resistance and make enough insulin. Now your blood sugar levels start to rise, and an entire cascade of pathologic events sort of spirals out of control that can lead to heart disease, cancer, even Alzheimer's disease, and amputations, just like that woman a few years earlier.
Waad filan kartaa in insulin-tu tahay dheecan muhiima kaasoo maamula sida jidhkeenu u go'aamiyo cuntada aynu cuno. hadii aan gubno iyo hadii aan keedinaba Tan afka suuqa waxa loogu yeedhaa habaynta shidaalka Habada awood u waayida inaad so sartid insulin waafiya waa nolol seegis Insulin difaac u yeelashaduna. sida magaceeda ka muuqata waa marka unugyadu difaac u yeeshaan saamaynta insulinta shaqadeeda wadata markaad insulinta difaac u yeelatid Wadadaadi macaanku kugu dhici lahaa bad haysaa Taaso ah waxa dhaca marka ganaacaagu uu iska hayn kari waayo iska cabinta samayna kari wayo insulin waafiya Markaa sonkorta dhiigaaga ayaa kacda Dhacdooyoin xidhiidha oo xanuuno ah ayaa sidii tusbaxii furma kasoo keensada wadna xanuun kansar, ilaa cudurka Alzheimer iyo weliba jidh goyn, sida arinka gabadha sanado yar ka hor
With that scare, I got busy changing my diet radically, adding and subtracting things most of you would find almost assuredly shocking. I did this and lost 40 pounds, weirdly while exercising less. I, as you can see, I guess I'm not overweight anymore. More importantly, I don't have insulin resistance.
Anoo cabsidaas qaba, waxaan ku mashqulay si aan u bedelka cuntadayda anoo ku daraya kana goynaya waxad badankiis u arki kartaan wax xaqiiqadii layaableh, Taasan samaayey waxana lumiyay 40 pound anoon aadna u jimicsan Hadaba sidaa arki kartaanba hada waxan filayaa inan culays xad dhaafa lahayn Ta muhiimka ah, difaac uma lihi hada insulint-ta
But most important, I was left with these three burning questions that wouldn't go away: How did this happen to me if I was supposedly doing everything right? If the conventional wisdom about nutrition had failed me, was it possible it was failing someone else? And underlying these questions, I became almost maniacally obsessed in trying to understand the real relationship between obesity and insulin resistance.
Laakiin ta kasii muhiimsan, waxaa isoo baxday sadexdan su'aalood ee dab ka kulul ee aan i seegayn Siday taasi iigu dhacday hadii aan sii loogu talla gally wax kasta u samaynaayay? Hadii arinkii laysla wafaqsanaa ee nafaqadu uu socon waayay suurta gal ma tahay inay qof kalena ka socon weyday? Markaan hoosta ka xariiqay su'aalahaas Waxaan si waaliya ugu hamuumay inaan isku dayo fahanka xidhiidhka runta ah ee ka dhexeeya cayilnaanta iyo difaac u yeelashada insulin
Now, most researchers believe obesity is the cause of insulin resistance. Logically, then, if you want to treat insulin resistance, you get people to lose weight, right? You treat the obesity. But what if we have it backwards? What if obesity isn't the cause of insulin resistance at all? In fact, what if it's a symptom of a much deeper problem, the tip of a proverbial iceberg? I know it sounds crazy because we're obviously in the midst of an obesity epidemic, but hear me out. What if obesity is a coping mechanism for a far more sinister problem going on underneath the cell? I'm not suggesting that obesity is benign, but what I am suggesting is it may be the lesser of two metabolic evils.
Hada, culimada badankeedu waxay aminsanyihin in cayilaantu ay tahay waxa keena difaac u yeelashada insulin Caqli ahaana, hadaad rabtid inaad dawaysid difaac u yeelashada insulin waa in dadku miisaan lumiyaa, miyaanay ahayn? Waxaad dawaysay cayilnaantii Laakiin ka waran hadaynu dhanka kale ka eegno? Ka waran hadaynay cayilnaantu ahayn sababta difaac u yeelashada insulin? Ka waran hadii ay calamad u tahay dhibato sii qoto dheer Figta buur barafa oo la garanayo? Waan garanayaa inay doqonimo tahay waayo xaqiiqadii badhtankaynu kaga jirnaa cayilnaan baahday, laakiin dhegta ii raarici Ka waran hadii cayilnaantu tahay qaab la dagalamaya dhibaato kaloo qarsoon oo ka socota unuga dhexdiisa si hoose? Ma soo jeedinayo in cayilaantu tahay mid aan dhibaato lahayn laakin waxaan sheegayaa ma laga yaabaya inay tahay laba daran ta door roon
You can think of insulin resistance as the reduced capacity of our cells to partition fuel, as I alluded to a moment ago, taking those calories that we take in and burning some appropriately and storing some appropriately. When we become insulin-resistant, the homeostasis in that balance deviates from this state. So now, when insulin says to a cell, I want you to burn more energy than the cell considers safe, the cell, in effect, says, "No thanks, I'd actually rather store this energy." And because fat cells are actually missing most of the complex cellular machinery found in other cells, it's probably the safest place to store it. So for many of us, about 75 million Americans, the appropriate response to insulin resistance may actually be to store it as fat, not the reverse, getting insulin resistance in response to getting fat.
Waxaad u malayn kartaa in difaac u yeelashada insulin ay tahay xadi ka dhinmay nafaheena oo aynu ku meelayn lahayn shidaal sidaan hore usoo carabaabay qaadashada kaloriskaa cuntada ah iyo gubida qaarkood si habsami ah iyadoo qaarna kadyinaysa Markaynu difaac u yeelano insulin-ta habkii isu dheelitiranka ayaa xaladiisii ka weecda Hadaba markan, marka insulin ku tiraahdo unuga Waxan rabaa inaad tamar gubtid habada markan uu unugu jawaab celin ku dhaho ''Maya mahadsandid, marabo inaan tamar gubo, waan keydinayaa'' sababtoo ah unugyada duxda ayaa ka maqan isku dhiska farsamo unugeed ee unugyada kalle leeyihiin Suurta gal, inay tahay meesha ugu amnisan ee lagu keydin karo Hadaba badankeena, 75 million oo maraykani jawaabta saxda ah ee ay u hayaan difaac u yeelashada insulin inay tahay in loo keydiyo dux ahaan, ka bedelan cagsigeeda insulin difaac loo yeeshaa waxaa keena cayilnaan
This is a really subtle distinction, but the implication could be profound. Consider the following analogy: Think of the bruise you get on your shin when you inadvertently bang your leg into the coffee table. Sure, the bruise hurts like hell, and you almost certainly don't like the discolored look, but we all know the bruise per Se is not the problem. In fact, it's the opposite. It's a healthy response to the trauma, all of those immune cells rushing to the site of the injury to salvage cellular debris and prevent the spread of infection to elsewhere in the body. Now, imagine we thought bruises were the problem, and we evolved a giant medical establishment and a culture around treating bruises: masking creams, painkillers, you name it, all the while ignoring the fact that people are still banging their shins into coffee tables. How much better would we be if we treated the cause -- telling people to pay attention when they walk through the living room -- rather than the effect? Getting the cause and the effect right makes all the difference in the world. Getting it wrong, and the pharmaceutical industry can still do very well for its shareholders but nothing improves for the people with bruised shins. Cause and effect.
Tani runtii waa arin dul ka xaadis ah laakiin fahanku intaa wu u ka sii qot dheeryahay Bal eeg dhacdadaan isku xidhan ee soo socota Ka fikir haar kaa gaadhay boqonta kadib markii aad lugta gashatay miiskii shaahu saarnaa Xaqiiqadii, haartu way ku dhibaysaa, sida iska cadna ka helaysid midab bedelkaa kugu dhacay, lakiin sidaynu wada ogsoonahay haartu ma aha dhibaatada xaqiiqadii waa taa ka caksigeeda, waa jawaabta caafimaad ee dhibaatada dhamaan unugyda difaaca ee goobta dhawaca kusoo ururay rabana inay badaadiyana unugydada kana hortaga faafitaanka Infection ku baaha jidhka intiisa kale. Hada ka fikir hadaynu haarta u haysano dhibaatada dhex gallona mu'asaso daaweed weyn iyo waxyaaba kallaynu ku dhayayno haaraha ku duugid kareemo, xumad dilayaal, sii wad Dhamaan iyadoo layska indha-tirayo in dadku weli ay lugta ku jiidanayaan miiskii shaahu saarnaa Intebay ka si wanagsanaan lahayd inakoo sababta abaara-- dadka u sheegna inay ka taxadiraan markay qolalka fadhiga dhexmarayaan-- halkaygu aynu saameynta eegi lahayn? Iyadoo laysla hello sababta iyo saamaynta si saxa waa waxa farqiga keena aduunkoo dhan Markii si kale loo eego, suuqa samaynta daawadu weli si fiican buu saamigiisu u shaqayn karaa laakiin waxba uma siyaadayaan dadka lugaha haaraha ku leh Sabab iyo Saamayn
So what I'm suggesting is maybe we have the cause and effect wrong on obesity and insulin resistance. Maybe we should be asking ourselves, is it possible that insulin resistance causes weight gain and the diseases associated with obesity, at least in most people? What if being obese is just a metabolic response to something much more threatening, an underlying epidemic, the one we ought to be worried about?
Hadaba waxaan soo jeedinaya waxa weeye laga yaabe inay sabab iyo saamayn khalada tahay cayilnaanta iyo difaac u yeelashada insulin Laga yaabee inaynu is weydiinayno suurta gal ma tahay in Difaac u yelashada insulin ay sababto miisaan cudurkuna lug ma la leeyahay cayilnaanta ugu yaraan dadka oo dhan? ka waran hadii cayilnantu ay jawaab jidh ahaneed u tahay dhibaato sii mug weyn baahsanaan heer aan la ogayn ah Ta ay tahay inaynu ka werwero ah
Let's look at some suggestive facts. We know that 30 million obese Americans in the United States don't have insulin resistance. And by the way, they don't appear to be at any greater risk of disease than lean people. Conversely, we know that six million lean people in the United States are insulin-resistant, and by the way, they appear to be at even greater risk for those metabolic diseases I mentioned a moment ago than their obese counterparts. Now I don't know why, but it might be because, in their case, their cells haven't actually figured out the right thing to do with that excess energy. So if you can be obese and not have insulin resistance, and you can be lean and have it, this suggests that obesity may just be a proxy for what's going on.
Hada aynu eegno xaqiiqooyin wax ina tusinaya Waxaynu ognahay in 30 million oo Maraykan cayilani oo ku nool wadanka aanay lahayn difaaca insulin sida oo ay tahayna, uma muuqato inay inaba uga khatar badanyihiin cudurka dadka dhuudhuuban Taa cagsigeeda,waxaynu ognahay in 6Milyan oo dad dhuudhuuban ah oo dalka maraykanka ku nool inay difaaca insulinta leeyihiin sida aawadedna. u muuqda inay uga khatar badan yihiin cudur jidh cunteedka aan hore usoo sheegay mar loo eego dhigooda cayilan hada ma garanyo sababta laakiin laga yaabe inay tahay unugyadooda oo aan gawrasan wixii saxda ahaa ee ku qaban lahayeen tamarta dheeriga ah Hadaba hadii aad cayilnan karto difaacna u yelan kartid insulin caatana ahaan kartid oo aad yeelan kartid, Waxay tusaysaa in cayilnaantu noqonkarto lagu khadamaha waxa socda
So what if we're fighting the wrong war, fighting obesity rather than insulin resistance? Even worse, what if blaming the obese means we're blaming the victims? What if some of our fundamental ideas about obesity are just wrong?
Ka waran hadaynu dagaalkii khaladka ahaa ku dirirayno la dirirayno cayilnaan halkii difaac u yeelashada Insulin Kasii darane, ka waran hadaynu hiifayno cayilnaha oo micneheedu yahay dhibanahoo la hiifay Ka waran hadii fikirka asaasiga ee cayilnaanta aynu ka qabnaa uu khaldanyahay
Personally, I can't afford the luxury of arrogance anymore, let alone the luxury of certainty. I have my own ideas about what could be at the heart of this, but I'm wide open to others. Now, my hypothesis, because everybody always asks me, is this. If you ask yourself, what's a cell trying to protect itself from when it becomes insulin resistant, the answer probably isn't too much food. It's more likely too much glucose: blood sugar. Now, we know that refined grains and starches elevate your blood sugar in the short run, and there's even reason to believe that sugar may lead to insulin resistance directly. So if you put these physiological processes to work, I'd hypothesize that it might be our increased intake of refined grains, sugars and starches that's driving this epidemic of obesity and diabetes, but through insulin resistance, you see, and not necessarily through just overeating and under-exercising.
Qof ahaan, uma sii dul yeelan karo guracnantan baas Xaqiiqadu waa inay gees u baxdaa Fikirkaygaan ka qabaa ku dhexjirka arinkan Laakiin cid kasta waan u furan ahay Markan, mala-awaalkayga, sababtoo ah qof kasti wuu weydiiyaa wuxu yahay Hadaad isweydiisid, muxu unugu inuu ilaaliyo isku dayaya marka ay difaac u yeelato insulin sabatoo malahayga ma aha cunta badan waxay u badantahay glucose farabadan; dhiig macaan waxaynu hada ognahay macmaanka la miiray inuu kor qaadi karo macaanka dhiiga waqti kooban sababaana jirta lagu aamina karo in sonkortu ay toos u keento difaac u yeelashada insulin Hadaba hadaad qaabkan maskaxeed ka shaqaysiisid waxaan filayaa in ay suurta gal tahay korodhka qaadashada macmaanada la miiray ay keenayso baahitaanka cayilnaanta iyo macaanka iyadoo keenayso difaac u yeelasha insulin bal eeg, ma aha cunta badsasho iyo ciyaar badsasho toona
When I lost my 40 pounds a few years ago, I did it simply by restricting those things, which admittedly suggests I have a bias based on my personal experience. But that doesn't mean my bias is wrong, and most important, all of this can be tested scientifically. But step one is accepting the possibility that our current beliefs about obesity, diabetes and insulin resistance could be wrong and therefore must be tested. I'm betting my career on this. Today, I devote all of my time to working on this problem, and I'll go wherever the science takes me. I've decided that what I can't and won't do anymore is pretend I have the answers when I don't. I've been humbled enough by all I don't know.
Markaa lumiyay 40 pound sanad yar ka hor SI fudud waxaan yareeyay waxyaabahaa Tasoo qiraal ahaan keentay inaan dhinac u jeesto anoo ku salleeyay khibaraday shakhsiga ah Taasi maaha in dhinac u baydhidaydu ay khalad tahay ku darsoo muhiimku waa in wax kasta si cilmi ah loo sugi karo laakiin ta koowaad waa aqbalida suurtagalnimada ah in fikirkeena hada ee cayilnaanta macaanka iyo insulta ku saabsani uu khalad yahay sidaa awaadeedna waa inay tijaabo galla arinku Waan ugu khamaarayaa xirfadayda arinkaas Maanta waxan u huriyaa waqtigaya arintaas Waana aadayaa meelkastoo cilmigu ila gallo Waxaan goaansaday waxanan dib u samayn doonin iska dhigida mid jawaabo haysta anoon haysan In badan waan isla baxay anoon garanayn
For the past year, I've been fortunate enough to work on this problem with the most amazing team of diabetes and obesity researchers in the country, and the best part is, just like Abraham Lincoln surrounded himself with a team of rivals, we've done the same thing. We've recruited a team of scientific rivals, the best and brightest who all have different hypotheses for what's at the heart of this epidemic. Some think it's too many calories consumed. Others think it's too much dietary fat. Others think it's too many refined grains and starches. But this team of multi-disciplinary, highly skeptical and exceedingly talented researchers do agree on two things. First, this problem is just simply too important to continue ignoring because we think we know the answer. And two, if we're willing to be wrong, if we're willing to challenge the conventional wisdom with the best experiments science can offer, we can solve this problem.
Laakiin sanadii danbe, waxan nasiib u yeeshay inaan arinkan kalla shaqyeeyo kooxda ugu yaabka badan ee macaanka iyo cayilnaanta baadha ee dalka Arinka ugu wanaagsanina wuxu yahay Sidii Abraham Lincoln markuu isku gedaamay koox kuwii kasoo horjeeday ah Anagana sidoo kale ayaan sameynay Waxaynu shaqalaysiinay koox saynisyahano iska horjeeda Kuwa ugu wanaagsan uguna sareeya lehna fikiro kalla duwan Kala badhka arinka baahay Qaarkood sababtu waaa Kalooris fara badan oo la qaatay Qaar kale waa cunta dux leh oo fara badan Qaar kale waa jadhiidha macaanka ah ee la miiray Laakiin kooxdan xirfadaha badan baadhayaal xirfad sare lehna ah mid bay isku waafaqsanyihiin Kow, dhibaatadani si fudud waa mid ay muhiim tahay inaynu sii wadno is dhaafinteeda waayo waxaynu u haysanaa inaynu ognahay jawaabta Ta labaad, hadaynu rabno inaynu khaldano hadaynu rabno inaynu ka hor nimaadno xikmada caalamiga ah Haysanana tijaaboyinka ugu fiican oo saynisku ina siin karo waynu xalin karnaa dhibaatadan
I know it's tempting to want an answer right now, some form of action or policy, some dietary prescription -- eat this, not that — but if we want to get it right, we're going to have to do much more rigorous science before we can write that prescription.
Waan hubaa in hada jawaab la doono loo bahanyahay nooc siyaada ha noqoto, cunto qorid ha noqoto-- tan cun, tan ha cunin ha noqoto--- Laakiin hadaynu u baahnahay inaynu saxano Waa inaynu ka shaqaysiinaa cilmiga si xirfad badan ka hor inta aynaan daawo qorin
Briefly, to address this, our research program is focused around three meta-themes, or questions. First, how do the various foods we consume impact our metabolism, hormones and enzymes, and through what nuanced molecular mechanisms? Second, based on these insights, can people make the necessary changes in their diets in a way that's safe and practical to implement? And finally, once we identify what safe and practical changes people can make to their diet, how can we move their behavior in that direction so that it becomes more the default rather than the exception? Just because you know what to do doesn't mean you're always going to do it. Sometimes we have to put cues around people to make it easier, and believe it or not, that can be studied scientifically.
Si kooban, si tan looga jawaabo, barnaamijkayagu wuxu abaarayaa sadex hogood ama su'aalood Kow, sidee baa cuntooyinka kala duwan ee aynu cunaa u saameeyaan shaqa-jidheedkeena, iyo dheecanadeena iyo waxa duwa qaab molukuyeleedka Ta labaad, waxay ku salaysan tahay aragti, dadku ma ku samayn karaan isbedelka loo bahanyahay cuntadooda Qaab hufan oo hadana amaan ah? Ugu danbaynu markaynu ogaano waxa amaanka ah Iyo isbedelka ay dadku ku samayn karaan cuntadooda iyo sida ay uga dhigi karaan dabeecad arinkaas markaasoo ay noqon karto arin dega halkii ay wax mara noqon lahayd Sabatoo ah waxad ogtahay in garashada waxaad qabanaysid anay la micna ahay inaad mar kasta samaynaysid Mararka qaar waa inaynu dadka tusnaaa bidhaan si ay ugu fududaato, inay aaminaan ama aanay aaminin in arintaa si cilmi ah loo baadhi karo.
I don't know how this journey is going to end, but this much seems clear to me, at least: We can't keep blaming our overweight and diabetic patients like I did. Most of them actually want to do the right thing, but they have to know what that is, and it's got to work. I dream of a day when our patients can shed their excess pounds and cure themselves of insulin resistance, because as medical professionals, we've shed our excess mental baggage and cured ourselves of new idea resistance sufficiently to go back to our original ideals: open minds, the courage to throw out yesterday's ideas when they don't appear to be working, and the understanding that scientific truth isn't final, but constantly evolving. Staying true to that path will be better for our patients and better for science. If obesity is nothing more than a proxy for metabolic illness, what good does it do us to punish those with the proxy?
Ma garanayo sida geedigani ku dhamaan doono laakiin tanaa ii cad aniga, ugu yaraan: Ma sii wadi karo canaanta bukaankeena macaanta qaba ama cayilan sidaan sameeyay oo kale. Badankooda waxay rabaan samaynta waxa saxda ah Laakiin waa inay ogaadaan waxay taasi tahay kana shaqaysiiyaan Waxaan ku rajo weynahay mar bukaankeenu ay awoodi doonan inay iska daadiyaan culays badan naftooda ka daweyaan difaac u yeelashada insulin sababtoo ah xirfadlay caafimaad ahaan anagu waxaan iska saarnay xamuulkii maskaxeed nafteenana waxan ku daweeynay difaac fikir oo waafi ah si aan dib ugu noqono asalkeenii hore Fur maskaxda, geesinimada tuurista fikirkii shalay markuu shaqayn waayay iyo fahanka in xaqiiqada cilmigu aanay dhamaan laakiin si joogto ah ay isu bedelayso Ku sugnaanta wadadaii waxay u wanaagsan tahay bukaankeena waxay kaloo u wanaagsan tahay sayniska. Hadii cayilnaantu wax lagu khaldamay mooyay anay wax kale ahayn markay cudurka habsamida jidhka noqoto Maxay micno inoo samaynaysa inu ciqabno dadka lagu khaldamaha la dhinac ah
Sometimes I think back to that night in the E.R. seven years ago. I wish I could speak with that woman again. I'd like to tell her how sorry I am. I'd say, as a doctor, I delivered the best clinical care I could, but as a human being, I let you down. You didn't need my judgment and my contempt. You needed my empathy and compassion, and above all else, you needed a doctor who was willing to consider maybe you didn't let the system down. Maybe the system, of which I was a part, was letting you down. If you're watching this now, I hope you can forgive me.
Mararka qaar waxaan dib uga fekera habeenka E.R-ka todobo sano ka hor waan jeclaan lahaa inan haweynadaa mar labad la hadlo waxan rabi lahaaa inan u sheego san uga xumahay Aan dhaho, dhakhtar ahaan, waan bixiyay daryeelkii caafimaad ee ugu wanaagsana ee an awooday Laakiin insaan ahaan waan ku dayacay umaad baahnayn go'aankayga iyo is qanciskayga waxaad u baahnayd naxariis iyo beer-jileec Intasoo dhan ka kaallay, waxad u baahnayd dhakhtar Kaasoo garawsada arinka laga yaabee nidaamkaan ku jiray inaad dayicin adigu laakiin nidaamka ka qaybta ahaa ayaa ahaa kii ku dayacay Hada hadaad i daawanaysid waxaan kaa tuugayaa inaad i cafidid
(Applause)
Sacab