Peter Attia: What if we're wrong about diabetes?

Translator: Joseph Geni Reviewer: Morton Bast

Translator: Abdikani Hassan Reviewer: Ahmed Kadiye

I'll never forget that day

Abidkay ma ilaabayo maalintaas

back in the spring of 2006.

Waxay ahayd gugii 2006

I was a surgical resident

Waxaan dhakhtar qaliin joogta ah

at The Johns Hopkins Hospital,

Ka ahaa Cusbitaalka John Hopkins,

taking emergency call.

Waxan helay fariin degdeg ah

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

Waxan fariintaka ka hellay E.R-ka ''Qolka degdega'' 2dii saqda dhexe.

to come and see a woman with a diabetic ulcer

Si aan u imado una arko haweeynay boog macaan

on her foot.

ku leh cagta

I can still remember sort of that smell of rotting flesh

Weli wan xususan karaa siduu ahaa urtii cadkaa qudhmay

as I pulled the curtain back to see her.

markii aan ka qaaday go'a si aan u arko.

And everybody there agreed this woman was very sick

Qofkastoo meesha joogay waa arkayay in qoftani ad u xanunsanayso

and she needed to be in the hospital.

weyna u baahnayd inay cusbitaalka ku jirto.

That wasn't being asked.

Taas lasyma weydiin.

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

Suaasha lay warsaday waxay ahayd mid taas ka duwan,

which was, did she also need an amputation?

Taaso ahayd, Ma u baahantahay in lugta laga jaro?

Now, looking back on that night,

Hada, markaan dib u eego habenkaas

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

Waxan aad u jeclaan lahaa inaan aamino inaan kula dhaqmay haweeynadaa

on that night with the same empathy and compassion

habeenkas naxariistii iyo dareenkii

I'd shown the 27-year-old newlywed

aan tusay 27-jir dhowaan guursatay

who came to the E.R. three nights earlier

taasoo timi ER-ka sadex habeenk a hor

with lower back pain

iyadoo xumadi ka hayso qaarka danbe

that turned out to be advanced pancreatic cancer.

taaso markii danbe cadatay inay tahay Kaankaro baahday.

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

Gabadhaa arinkeeda, waan ogaa inaanan qaban karin

that was actually going to save her life.

wax xaqiiqadii badbaadin kara nolosheeda

The cancer was too advanced.

Kaankaradu waxay ahayd mid aad u baahday

But I was committed to making sure that

Laakiin waxa iga go'nayd inaan xaqiijiyo

I could do anything possible to make her stay

inaan samayn karo wuxuun suurta gal ka dhigi kara inay

more comfortable. I brought her a warm blanket

Nefis hesho. Waxaan u keenay buste diiran

and a cup of a coffee.

iyo koob buna

I brought some for her parents.

Waxan u keenay oo kale qaar qoyskeeda ah

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

Laakiin ta muhiimka ah bal fiiri hada, wax go'aana kuma ridin gabadhaasa

because obviously she had done nothing

sababtoo ah waxba may galabsan

to bring this on herself.

ay isugu keento iyadu arintan.

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

Hadaba wuxu xal sida yahayba, habeno yar kadib

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

anoo taagan isla qolkaa E.R-ka gawrasadayna

that my diabetic patient did indeed need an amputation,

in bukaankayga macaanka qaba uu u bahanyahay in lugta laga jaro

why did I hold her in such bitter contempt?

Maxaan ugu hayaa arinka adag dhexidiisa gabadha?

You see, unlike the woman the night before,

Waxaad arkaysaa, si ka duwan gabadhii habeenkii hore

this woman had type 2 diabetes.

gabadhaan waxay leheed macaanka nooca 2aad

She was fat.

Wayna buurneyd

And we all know that's from eating too much

Waxaynu dhamaanten ognahay inay tani ka timi cunto layska cuno

and not exercising enough, right?

iyo iyadoon jimicsi dheera la samayn, hagaag?

I mean, how hard can it be?

Waxan uga jeeda, siday u adagtahay suurtagalnimadaasi

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

Markii aan hoos u eego iyadoo sariirta saran, anaa isla hadlay

if you just tried caring even a little bit,

Hadii inuun aad isku dayi lahayd inaad inuun taxadartid

you wouldn't be in this situation at this moment

kumaad sugnaateen xaaladatan waqtigan isaga ah

with some doctor you've never met

adigoo la jooga dhakhtar aanad weligaa hore u arag

about to amputate your foot.

kasoo ka shekaynaya inuu lugtada goosto

Why did I feel justified in judging her?

Maxan isugula haboonahay inaan go'an ku rido gabadhan?

I'd like to say I don't know.

Waxan jecelahay inaan dhaho ma garanayo

But I actually do.

Laakiin xaqiiqdii waan garanayaa

You see, in the hubris of my youth,

Waad arki kartaa dhalinyaranimada i qaaday

I thought I had her all figured out.

Dhibteeda waxa kenay ban iska xisaabsaday

She ate too much. She got unlucky.

Cuntaday iska badisay. Nasiib daraa ku dhacday

She got diabetes. Case closed.

Macaanbay qaaday. Khalaas.

Ironically, at that time in my life,

Si dadban, waqtigas noloshayda kamidka ah

I was also doing cancer research,

Waxaan waday baadhitaan-cilmiyeed cudurka kansarka

immune-based therapies for melanoma, to be specific,

Daawanyn difaac ku salaysan oo loo hello melanomaha, khaas ahaan'

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

Hadaba caalamkaas an ku jiray wax kasta su'aal ban saari jiray

to challenge all assumptions

si aan ula halgamo dhamaan xaqiiqoyinka

and hold them to the highest possible scientific standards.

uguna beego miisaanka cilmiyeed ee ugu sareeya uguna macquulsan

Yet when it came to a disease like diabetes

Laakin markay timado cudurka macaanka oo kale ah

that kills Americans eight times more frequently than melanoma,

Kaaso dila dadka maraykanka sideed jeer in kabadan melanoma-aha

I never once questioned the conventional wisdom.

Weligay ismaan weydiin arintaa laysla wada garanayo

I actually just assumed the pathologic sequence of events

Waxan isaga malaynayay uun in dhacdooyinka cudurada la xidhiidha

was settled science.

ay ahaayeen cilmi hore u degsanaa

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

Saddex sano ka dib, ayaan ogaaday sidaan u khaldanaa

But this time, I was the patient.

Laakiin waqtigaan, anigaa bukaan ahaa.

Despite exercising three or four hours every single day,

Ka sokow anoo saddex ilaa afar saacadood maalin kasta jimicsada

and following the food pyramid to the letter,

raacana qorshaha cunto ee ugu suuban

I'd gained a lot of weight and developed something

Waxaa kordhay miisankayga, waxana igu dhacay wax

called metabolic syndrome.

loogu yeedho" Metobolic syndorome"

Some of you may have heard of this.

Qaarkiin inaad maqasheen ba laga yaabaa.

I had become insulin-resistant.

Dheecanka isulin-ta ayaan difaac u yeeshay

You can think of insulin as this master hormone

Waad filan kartaa in insulin-tu tahay dheecan muhiima

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

kaasoo maamula sida jidhkeenu u go'aamiyo cuntada aynu cuno.

whether we burn it or store it.

hadii aan gubno iyo hadii aan keedinaba

This is called fuel partitioning in the lingo.

Tan afka suuqa waxa loogu yeedhaa habaynta shidaalka

Now failure to produce enough insulin is incompatible with life.

Habada awood u waayida inaad so sartid insulin waafiya waa nolol seegis

And insulin resistance, as its name suggests,

Insulin difaac u yeelashaduna. sida magaceeda ka muuqata

is when your cells get increasingly resistant

waa marka unugyadu difaac u yeeshaan

to the effect of insulin trying to do its job.

saamaynta insulinta shaqadeeda wadata

Once you're insulin-resistant,

markaad insulinta difaac u yeelatid

you're on your way to getting diabetes,

Wadadaadi macaanku kugu dhici lahaa bad haysaa

which is what happens when your pancreas

Taaso ah waxa dhaca marka ganaacaagu

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

uu iska hayn kari waayo iska cabinta samayna kari wayo insulin waafiya

Now your blood sugar levels start to rise,

Markaa sonkorta dhiigaaga ayaa kacda

and an entire cascade of pathologic events

Dhacdooyoin xidhiidha oo xanuuno ah

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

ayaa sidii tusbaxii furma kasoo keensada wadna xanuun

cancer, even Alzheimer's disease,

kansar, ilaa cudurka Alzheimer

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

iyo weliba jidh goyn, sida arinka gabadha sanado yar ka hor

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

Anoo cabsidaas qaba, waxaan ku mashqulay si aan u bedelka cuntadayda

adding and subtracting things most of you would find

anoo ku daraya kana goynaya waxad badankiis u arki kartaan

almost assuredly shocking.

wax xaqiiqadii layaableh,

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

Taasan samaayey waxana lumiyay 40 pound anoon aadna u jimicsan

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

Hadaba sidaa arki kartaanba hada waxan filayaa inan culays xad dhaafa lahayn

More importantly, I don't have insulin resistance.

Ta muhiimka ah, difaac uma lihi hada insulint-ta

But most important, I was left

Laakiin ta kasii muhiimsan, waxaa isoo baxday

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

sadexdan su'aalood ee dab ka kulul ee aan i seegayn

How did this happen to me if I was supposedly

Siday taasi iigu dhacday hadii aan sii loogu talla gally

doing everything right?

wax kasta u samaynaayay?

If the conventional wisdom about nutrition had failed me,

Hadii arinkii laysla wafaqsanaa ee nafaqadu uu socon waayay

was it possible it was failing someone else?

suurta gal ma tahay inay qof kalena ka socon weyday?

And underlying these questions,

Markaan hoosta ka xariiqay su'aalahaas

I became almost maniacally obsessed

Waxaan si waaliya ugu hamuumay

in trying to understand the real relationship

inaan isku dayo fahanka xidhiidhka runta ah ee

between obesity and insulin resistance.

ka dhexeeya cayilnaanta iyo difaac u yeelashada insulin

Now, most researchers believe obesity

Hada, culimada badankeedu waxay aminsanyihin in cayilaantu

is the cause of insulin resistance.

ay tahay waxa keena difaac u yeelashada insulin

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

Caqli ahaana, hadaad rabtid inaad dawaysid difaac u yeelashada insulin

you get people to lose weight, right?

waa in dadku miisaan lumiyaa, miyaanay ahayn?

You treat the obesity.

Waxaad dawaysay cayilnaantii

But what if we have it backwards?

Laakiin ka waran hadaynu dhanka kale ka eegno?

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

Ka waran hadaynay cayilnaantu ahayn sababta difaac u yeelashada insulin?

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

Ka waran hadii ay calamad u tahay dhibato sii qoto dheer

the tip of a proverbial iceberg?

Figta buur barafa oo la garanayo?

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

Waan garanayaa inay doqonimo tahay waayo xaqiiqadii badhtankaynu kaga jirnaa

of an obesity epidemic, but hear me out.

cayilnaan baahday, laakiin dhegta ii raarici

What if obesity is a coping mechanism

Ka waran hadii cayilnaantu tahay qaab la dagalamaya

for a far more sinister problem going on

dhibaato kaloo qarsoon oo ka socota

underneath the cell?

unuga dhexdiisa si hoose?

I'm not suggesting that obesity is benign,

Ma soo jeedinayo in cayilaantu tahay mid aan dhibaato lahayn

but what I am suggesting is it may be the lesser

laakin waxaan sheegayaa ma laga yaabaya inay tahay

of two metabolic evils.

laba daran ta door roon

You can think of insulin resistance as the reduced capacity

Waxaad u malayn kartaa in difaac u yeelashada insulin ay tahay xadi ka dhinmay

of our cells to partition fuel,

nafaheena oo aynu ku meelayn lahayn shidaal

as I alluded to a moment ago,

sidaan hore usoo carabaabay

taking those calories that we take in

qaadashada kaloriskaa cuntada ah

and burning some appropriately and storing some appropriately.

iyo gubida qaarkood si habsami ah iyadoo qaarna kadyinaysa

When we become insulin-resistant,

Markaynu difaac u yeelano insulin-ta

the homeostasis in that balance deviates from this state.

habkii isu dheelitiranka ayaa xaladiisii ka weecda

So now, when insulin says to a cell,

Hadaba markan, marka insulin ku tiraahdo unuga

I want you to burn more energy

Waxan rabaa inaad tamar gubtid

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

habada markan uu unugu jawaab celin ku dhaho

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

''Maya mahadsandid, marabo inaan tamar gubo, waan keydinayaa''

And because fat cells are actually missing most of

sababtoo ah unugyada duxda ayaa ka maqan

the complex cellular machinery found in other cells,

isku dhiska farsamo unugeed ee unugyada kalle leeyihiin

it's probably the safest place to store it.

Suurta gal, inay tahay meesha ugu amnisan ee lagu keydin karo

So for many of us, about 75 million Americans,

Hadaba badankeena, 75 million oo maraykani

the appropriate response to insulin resistance

jawaabta saxda ah ee ay u hayaan difaac u yeelashada insulin

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

inay tahay in loo keydiyo dux ahaan, ka bedelan cagsigeeda

getting insulin resistance in response to getting fat.

insulin difaac loo yeeshaa waxaa keena cayilnaan

This is a really subtle distinction,

Tani runtii waa arin dul ka xaadis ah

but the implication could be profound.

laakiin fahanku intaa wu u ka sii qot dheeryahay

Consider the following analogy:

Bal eeg dhacdadaan isku xidhan ee soo socota

Think of the bruise you get on your shin

Ka fikir haar kaa gaadhay boqonta

when you inadvertently bang your leg into the coffee table.

kadib markii aad lugta gashatay miiskii shaahu saarnaa

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

Xaqiiqadii, haartu way ku dhibaysaa, sida iska cadna

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

ka helaysid midab bedelkaa kugu dhacay, lakiin sidaynu wada ogsoonahay

the bruise per Se is not the problem.

haartu ma aha dhibaatada

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

xaqiiqadii waa taa ka caksigeeda, waa jawaabta caafimaad ee dhibaatada

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

dhamaan unugyda difaaca ee goobta dhawaca kusoo ururay

to salvage cellular debris and prevent the spread

rabana inay badaadiyana unugydada kana hortaga faafitaanka

of infection to elsewhere in the body.

Infection ku baaha jidhka intiisa kale.

Now, imagine we thought bruises were the problem,

Hada ka fikir hadaynu haarta u haysano dhibaatada

and we evolved a giant medical establishment

dhex gallona mu'asaso daaweed weyn

and a culture around treating bruises:

iyo waxyaaba kallaynu ku dhayayno haaraha

masking creams, painkillers, you name it,

ku duugid kareemo, xumad dilayaal, sii wad

all the while ignoring the fact that people

Dhamaan iyadoo layska indha-tirayo in dadku weli

are still banging their shins into coffee tables.

ay lugta ku jiidanayaan miiskii shaahu saarnaa

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

Intebay ka si wanagsanaan lahayd inakoo sababta abaara--

telling people to pay attention

dadka u sheegna inay ka taxadiraan

when they walk through the living room --

markay qolalka fadhiga dhexmarayaan--

rather than the effect?

halkaygu aynu saameynta eegi lahayn?

Getting the cause and the effect right

Iyadoo laysla hello sababta iyo saamaynta si saxa

makes all the difference in the world.

waa waxa farqiga keena aduunkoo dhan

Getting it wrong, and the pharmaceutical industry

Markii si kale loo eego, suuqa samaynta daawadu

can still do very well for its shareholders

weli si fiican buu saamigiisu u shaqayn karaa

but nothing improves for the people with bruised shins.

laakiin waxba uma siyaadayaan dadka lugaha haaraha ku leh

Cause and effect.

Sabab iyo Saamayn

So what I'm suggesting is

Hadaba waxaan soo jeedinaya waxa weeye

maybe we have the cause and effect wrong

laga yaabe inay sabab iyo saamayn khalada tahay

on obesity and insulin resistance.

cayilnaanta iyo difaac u yeelashada insulin

Maybe we should be asking ourselves,

Laga yaabee inaynu is weydiinayno

is it possible that insulin resistance causes weight gain

suurta gal ma tahay in Difaac u yelashada insulin ay sababto miisaan

and the diseases associated with obesity,

cudurkuna lug ma la leeyahay cayilnaanta

at least in most people?

ugu yaraan dadka oo dhan?

What if being obese is just a metabolic response

ka waran hadii cayilnantu ay jawaab jidh ahaneed u tahay

to something much more threatening,

dhibaato sii mug weyn

an underlying epidemic,

baahsanaan heer aan la ogayn ah

the one we ought to be worried about?

Ta ay tahay inaynu ka werwero ah

Let's look at some suggestive facts.

Hada aynu eegno xaqiiqooyin wax ina tusinaya

We know that 30 million obese Americans

Waxaynu ognahay in 30 million oo Maraykan cayilani

in the United States don't have insulin resistance.

oo ku nool wadanka aanay lahayn difaaca insulin

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

sida oo ay tahayna, uma muuqato inay inaba

greater risk of disease than lean people.

uga khatar badanyihiin cudurka dadka dhuudhuuban

Conversely, we know that six million lean people

Taa cagsigeeda,waxaynu ognahay in 6Milyan oo dad dhuudhuuban ah

in the United States are insulin-resistant,

oo dalka maraykanka ku nool inay difaaca insulinta leeyihiin

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

sida aawadedna. u muuqda inay uga khatar badan yihiin

for those metabolic diseases I mentioned a moment ago

cudur jidh cunteedka aan hore usoo sheegay

than their obese counterparts.

mar loo eego dhigooda cayilan

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

hada ma garanyo sababta laakiin laga yaabe

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

inay tahay unugyadooda oo aan gawrasan

the right thing to do with that excess energy.

wixii saxda ahaa ee ku qaban lahayeen tamarta dheeriga ah

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

Hadaba hadii aad cayilnan karto difaacna u yelan kartid insulin

and you can be lean and have it,

caatana ahaan kartid oo aad yeelan kartid,

this suggests that obesity may just be a proxy

Waxay tusaysaa in cayilnaantu noqonkarto lagu khadamaha

for what's going on.

waxa socda

So what if we're fighting the wrong war,

Ka waran hadaynu dagaalkii khaladka ahaa ku dirirayno

fighting obesity rather than insulin resistance?

la dirirayno cayilnaan halkii difaac u yeelashada Insulin

Even worse, what if blaming the obese

Kasii darane, ka waran hadaynu hiifayno cayilnaha

means we're blaming the victims?

oo micneheedu yahay dhibanahoo la hiifay

What if some of our fundamental ideas about obesity

Ka waran hadii fikirka asaasiga ee cayilnaanta aynu ka qabnaa

are just wrong?

uu khaldanyahay

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

Qof ahaan, uma sii dul yeelan karo guracnantan baas

let alone the luxury of certainty.

Xaqiiqadu waa inay gees u baxdaa

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

Fikirkaygaan ka qabaa ku dhexjirka arinkan

but I'm wide open to others.

Laakiin cid kasta waan u furan ahay

Now, my hypothesis, because everybody always asks me,

Markan, mala-awaalkayga, sababtoo ah qof kasti wuu weydiiyaa

is this.

wuxu yahay

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

Hadaad isweydiisid, muxu unugu inuu ilaaliyo isku dayaya

when it becomes insulin resistant,

marka ay difaac u yeelato insulin

the answer probably isn't too much food.

sabatoo malahayga ma aha cunta badan

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

waxay u badantahay glucose farabadan; dhiig macaan

Now, we know that refined grains and starches

waxaynu hada ognahay macmaanka la miiray

elevate your blood sugar in the short run,

inuu kor qaadi karo macaanka dhiiga waqti kooban

and there's even reason to believe that sugar

sababaana jirta lagu aamina karo in sonkortu

may lead to insulin resistance directly.

ay toos u keento difaac u yeelashada insulin

So if you put these physiological processes to work,

Hadaba hadaad qaabkan maskaxeed ka shaqaysiisid

I'd hypothesize that it might be our increased intake

waxaan filayaa in ay suurta gal tahay korodhka qaadashada

of refined grains, sugars and starches that's driving

macmaanada la miiray ay keenayso

this epidemic of obesity and diabetes,

baahitaanka cayilnaanta iyo macaanka

but through insulin resistance,

iyadoo keenayso difaac u yeelasha insulin

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

bal eeg, ma aha cunta badsasho iyo ciyaar badsasho toona

When I lost my 40 pounds a few years ago,

Markaa lumiyay 40 pound sanad yar ka hor

I did it simply by restricting those things,

SI fudud waxaan yareeyay waxyaabahaa

which admittedly suggests I have a bias

Tasoo qiraal ahaan keentay inaan dhinac u jeesto

based on my personal experience.

anoo ku salleeyay khibaraday shakhsiga ah

But that doesn't mean my bias is wrong,

Taasi maaha in dhinac u baydhidaydu ay khalad tahay

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

ku darsoo muhiimku waa in wax kasta si cilmi ah loo sugi karo

But step one is accepting the possibility

laakiin ta koowaad waa aqbalida suurtagalnimada ah

that our current beliefs about obesity,

in fikirkeena hada ee cayilnaanta

diabetes and insulin resistance could be wrong

macaanka iyo insulta ku saabsani uu khalad yahay

and therefore must be tested.

sidaa awaadeedna waa inay tijaabo galla arinku

I'm betting my career on this.

Waan ugu khamaarayaa xirfadayda arinkaas

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

Maanta waxan u huriyaa waqtigaya arintaas

and I'll go wherever the science takes me.

Waana aadayaa meelkastoo cilmigu ila gallo

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

Waxaan goaansaday waxanan dib u samayn doonin

is pretend I have the answers when I don't.

iska dhigida mid jawaabo haysta anoon haysan

I've been humbled enough by all I don't know.

In badan waan isla baxay anoon garanayn

For the past year, I've been fortunate enough

Laakiin sanadii danbe, waxan nasiib u yeeshay

to work on this problem with the most amazing team

inaan arinkan kalla shaqyeeyo kooxda ugu yaabka badan

of diabetes and obesity researchers in the country,

ee macaanka iyo cayilnaanta baadha ee dalka

and the best part is,

Arinka ugu wanaagsanina wuxu yahay

just like Abraham Lincoln surrounded himself with a team of rivals,

Sidii Abraham Lincoln markuu isku gedaamay koox kuwii kasoo horjeeday ah

we've done the same thing.

Anagana sidoo kale ayaan sameynay

We've recruited a team of scientific rivals,

Waxaynu shaqalaysiinay koox saynisyahano iska horjeeda

the best and brightest who all have different hypotheses

Kuwa ugu wanaagsan uguna sareeya lehna fikiro kalla duwan

for what's at the heart of this epidemic.

Kala badhka arinka baahay

Some think it's too many calories consumed.

Qaarkood sababtu waaa Kalooris fara badan oo la qaatay

Others think it's too much dietary fat.

Qaar kale waa cunta dux leh oo fara badan

Others think it's too many refined grains and starches.

Qaar kale waa jadhiidha macaanka ah ee la miiray

But this team of multi-disciplinary,

Laakiin kooxdan xirfadaha badan

highly skeptical and exceedingly talented researchers

baadhayaal xirfad sare lehna ah

do agree on two things.

mid bay isku waafaqsanyihiin

First, this problem is just simply too important

Kow, dhibaatadani si fudud waa mid ay muhiim tahay

to continue ignoring because we think we know the answer.

inaynu sii wadno is dhaafinteeda waayo waxaynu u haysanaa inaynu ognahay jawaabta

And two, if we're willing to be wrong,

Ta labaad, hadaynu rabno inaynu khaldano

if we're willing to challenge the conventional wisdom

hadaynu rabno inaynu ka hor nimaadno xikmada caalamiga ah

with the best experiments science can offer,

Haysanana tijaaboyinka ugu fiican oo saynisku ina siin karo

we can solve this problem.

waynu xalin karnaa dhibaatadan

I know it's tempting to want an answer right now,

Waan hubaa in hada jawaab la doono loo bahanyahay

some form of action or policy, some dietary prescription --

nooc siyaada ha noqoto, cunto qorid ha noqoto--

eat this, not that —

tan cun, tan ha cunin ha noqoto---

but if we want to get it right,

Laakiin hadaynu u baahnahay inaynu saxano

we're going to have to do much more rigorous science

Waa inaynu ka shaqaysiinaa cilmiga si xirfad badan

before we can write that prescription.

ka hor inta aynaan daawo qorin

Briefly, to address this, our research program

Si kooban, si tan looga jawaabo, barnaamijkayagu

is focused around three meta-themes, or questions.

wuxu abaarayaa sadex hogood ama su'aalood

First, how do the various foods we consume

Kow, sidee baa cuntooyinka kala duwan ee aynu cunaa

impact our metabolism, hormones and enzymes,

u saameeyaan shaqa-jidheedkeena, iyo dheecanadeena

and through what nuanced molecular mechanisms?

iyo waxa duwa qaab molukuyeleedka

Second, based on these insights,

Ta labaad, waxay ku salaysan tahay aragti,

can people make the necessary changes in their diets

dadku ma ku samayn karaan isbedelka loo bahanyahay cuntadooda

in a way that's safe and practical to implement?

Qaab hufan oo hadana amaan ah?

And finally, once we identify what safe

Ugu danbaynu markaynu ogaano waxa amaanka ah

and practical changes people can make to their diet,

Iyo isbedelka ay dadku ku samayn karaan cuntadooda

how can we move their behavior in that direction

iyo sida ay uga dhigi karaan dabeecad arinkaas

so that it becomes more the default

markaasoo ay noqon karto arin dega

rather than the exception?

halkii ay wax mara noqon lahayd

Just because you know what to do doesn't mean

Sabatoo ah waxad ogtahay in garashada waxaad qabanaysid anay la micna ahay

you're always going to do it.

inaad mar kasta samaynaysid

Sometimes we have to put cues around people

Mararka qaar waa inaynu dadka tusnaaa bidhaan

to make it easier, and believe it or not,

si ay ugu fududaato, inay aaminaan ama aanay aaminin

that can be studied scientifically.

in arintaa si cilmi ah loo baadhi karo.

I don't know how this journey is going to end,

Ma garanayo sida geedigani ku dhamaan doono

but this much seems clear to me, at least:

laakiin tanaa ii cad aniga, ugu yaraan:

We can't keep blaming our overweight and diabetic patients

Ma sii wadi karo canaanta bukaankeena macaanta qaba ama cayilan

like I did.

sidaan sameeyay oo kale.

Most of them actually want to do the right thing,

Badankooda waxay rabaan samaynta waxa saxda ah

but they have to know what that is,

Laakiin waa inay ogaadaan waxay taasi tahay

and it's got to work.

kana shaqaysiiyaan

I dream of a day when our patients can

Waxaan ku rajo weynahay mar bukaankeenu ay awoodi doonan

shed their excess pounds

inay iska daadiyaan culays badan

and cure themselves of insulin resistance,

naftooda ka daweyaan difaac u yeelashada insulin

because as medical professionals,

sababtoo ah xirfadlay caafimaad ahaan

we've shed our excess mental baggage

anagu waxaan iska saarnay xamuulkii maskaxeed

and cured ourselves of new idea resistance sufficiently

nafteenana waxan ku daweeynay difaac fikir oo waafi ah

to go back to our original ideals:

si aan dib ugu noqono asalkeenii hore

open minds, the courage to throw out yesterday's ideas

Fur maskaxda, geesinimada tuurista fikirkii shalay

when they don't appear to be working,

markuu shaqayn waayay

and the understanding that scientific truth isn't final,

iyo fahanka in xaqiiqada cilmigu aanay dhamaan

but constantly evolving.

laakiin si joogto ah ay isu bedelayso

Staying true to that path will be better for our patients

Ku sugnaanta wadadaii waxay u wanaagsan tahay bukaankeena

and better for science.

waxay kaloo u wanaagsan tahay sayniska.

If obesity is nothing more than a proxy

Hadii cayilnaantu wax lagu khaldamay mooyay anay wax kale ahayn

for metabolic illness,

markay cudurka habsamida jidhka noqoto

what good does it do us to punish those with the proxy?

Maxay micno inoo samaynaysa inu ciqabno dadka lagu khaldamaha la dhinac ah

Sometimes I think back to that night in the E.R.

Mararka qaar waxaan dib uga fekera habeenka E.R-ka

seven years ago.

todobo sano ka hor

I wish I could speak with that woman again.

waan jeclaan lahaa inan haweynadaa mar labad la hadlo

I'd like to tell her how sorry I am.

waxan rabi lahaaa inan u sheego san uga xumahay

I'd say, as a doctor, I delivered

Aan dhaho, dhakhtar ahaan, waan bixiyay

the best clinical care I could,

daryeelkii caafimaad ee ugu wanaagsana ee an awooday

but as a human being,

Laakiin insaan ahaan

I let you down.

waan ku dayacay

You didn't need my judgment and my contempt.

umaad baahnayn go'aankayga iyo is qanciskayga

You needed my empathy and compassion,

waxaad u baahnayd naxariis iyo beer-jileec

and above all else, you needed a doctor

Intasoo dhan ka kaallay, waxad u baahnayd dhakhtar

who was willing to consider

Kaasoo garawsada arinka

maybe you didn't let the system down.

laga yaabee nidaamkaan ku jiray inaad dayicin adigu

Maybe the system, of which I was a part,

laakiin nidaamka ka qaybta ahaa

was letting you down.

ayaa ahaa kii ku dayacay

If you're watching this now,

Hada hadaad i daawanaysid

I hope you can forgive me.

waxaan kaa tuugayaa inaad i cafidid

(Applause)

Sacab