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

Translator: Joseph Geni Reviewer: Morton Bast

Translator: Iris Xholi Reviewer: Helena Bedalli

I'll never forget that day

Nuk do ta harroj kurrë atë ditë

back in the spring of 2006.

të pranverës së 2006-ës.

I was a surgical resident

Isha kirurg rezident

at The Johns Hopkins Hospital,

në Spitalin Johns Hopkins

taking emergency call.

në pranim të thirrjeve te urgjences.

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

Rreth orës 2 të mëngjesit u njoftova nga E.R

to come and see a woman with a diabetic ulcer

që të shkoj të shoh një grua me ulcerë diabetike

on her foot.

në këmbën e saj.

I can still remember sort of that smell of rotting flesh

Ende e kujtoj atë lloj ere të gjakut të kalbur,

as I pulled the curtain back to see her.

tek po e tërhiqja perden që ta shoh atë.

And everybody there agreed this woman was very sick

Të gjithë aty mendonim që ajo grua ishte shumë sëmurë

and she needed to be in the hospital.

dhe kishte nevojë të shtrohej në spital.

That wasn't being asked.

Kjo nuk vihej në diskutim.

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

Pyetja qe shtroja ishte një tjetër,

which was, did she also need an amputation?

a kishte ajo nevojë për amputim?

Now, looking back on that night,

Tani, duke kthyer koken pas ne atë natë

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

do të doja dëshperimisht të besoja se e trajtova atë grua,

on that night with the same empathy and compassion

atë natë, me empatinë dhe dhembshurinë e njëjtë

I'd shown the 27-year-old newlywed

që tregova ndaj 27 vjeçares së sapo martuar

who came to the E.R. three nights earlier

e cila erdhi në E.R tri ditë perpara

with lower back pain

me dhimbje mesi

that turned out to be advanced pancreatic cancer.

e cila doli të jetë kancer pankreatik i avancuar.

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

Në rastin e saj, unë e dija se s'kishte asgjë që mund të bëja

that was actually going to save her life.

që do ti shpëtonte jetën.

The cancer was too advanced.

Kanceri ishte shumë i avancuar.

But I was committed to making sure that

Por isha i përkushtuar të sigurohesha që

I could do anything possible to make her stay

do bëja gjithçka të mundshme për ta bërë atë të ndihet

more comfortable. I brought her a warm blanket

më rehat. I solla një batanije të ngrohte

and a cup of a coffee.

dhe një filxhan kafe.

I brought some for her parents.

Solla edhe për prindërit e saj.

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

Por shikoni, më e rëndësishmja eshte qe unë nuk e paragjykova atë,

because obviously she had done nothing

sepse dukej qartë qe ajo s'kishte bërë gjë

to bring this on herself.

qe mund t'ia shkaktonte këtë vetes se saj.

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

Atehere, si eshte e mundur qe disa nete me pas,

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

tek qendroja ne te njejten dhome te urgjences dhe i vendosur

that my diabetic patient did indeed need an amputation,

qe pacientja ime diabetike kish nevoje per amputim,

why did I hold her in such bitter contempt?

perse ja thashe kete ne nje menyre kaq te hidhur?

You see, unlike the woman the night before,

Dallimi eshte qe ne ndryshim me gruan e nje nate me pare,

this woman had type 2 diabetes.

kjo grua vuante nga diabeti i tipit 2.

She was fat.

Ajo ishte e shendoshe.

And we all know that's from eating too much

Dhe te gjithe e dime qe kjo vjen si rezultat i te ngrenit shume

and not exercising enough, right?

dhe mungeses se aktivitetit fizik, apo jo?

I mean, how hard can it be?

Dua te them, sa e veshtire mund te jete?

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

Teksa e shihja te shtrire mendoja me vete,

if you just tried caring even a little bit,

sikur shume pak te te interesonte,

you wouldn't be in this situation at this moment

nuk do te ishe ne kete gjendje tani

with some doctor you've never met

me nje mjek qe nuk e kishe pare kurre me pare

about to amputate your foot.

duke u pergatitur per te te prere kemben.

Why did I feel justified in judging her?

Perse u ndjeva i justifikuar qe gjykoja ndaj saj?

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

Do desha te thoja qe nuk e di.

But I actually do.

Por ja qe nuk eshte e vertete.

You see, in the hubris of my youth,

Me kryelartesine e rinise sime,

I thought I had her all figured out.

mendova se e kisha psikologjisur ate.

She ate too much. She got unlucky.

Ajo ka ngrene shume. Ajo ka qene pa fat.

She got diabetes. Case closed.

U semur me diabet. Kaq qe puna.

Ironically, at that time in my life,

Cuditerisht, ne ate kohe,

I was also doing cancer research,

po hulumtoja rreth kancerit,

immune-based therapies for melanoma, to be specific,

terapite e sistemit imunitar per kancer te lekures, per te qene me ekzakt,

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

nga kisha mesuar se duhej te kisha dyshime per gjithcka,

to challenge all assumptions

te mos merrja te mireqene gje

and hold them to the highest possible scientific standards.

dhe ti masja me standardet me te larta shkencore.

Yet when it came to a disease like diabetes

Nderkohe, kur vjen fjala tek diabeti

that kills Americans eight times more frequently than melanoma,

i cili vret 8 here me shume amerikane se melanoma,

I never once questioned the conventional wisdom.

nuk e vura kurre ne prove dijen e deri atehershme.

I actually just assumed the pathologic sequence of events

Pranova te mireqene,

was settled science.

cdo hallke te zinxhirit te shkaqeve patologjike qe te conte ne te.

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

Tre vite me pas, zbulova se isha shume gabim.

But this time, I was the patient.

Por kete here, isha pacienti.

Despite exercising three or four hours every single day,

Edhe pse beja ushtrime fizike 3-4 ore ne dite,

and following the food pyramid to the letter,

dhe zbatimin i piramides ushqimore me perpikmeri,

I'd gained a lot of weight and developed something

kisha shtuar shume ne peshe dhe kisha zhvilluar

called metabolic syndrome.

dicka te ashtuquajtur sindroma e metabolizmit.

Some of you may have heard of this.

Disa nga ju mund edhe te kene degjuar per te.

I had become insulin-resistant.

Isha bere imun ndaj insulines.

You can think of insulin as this master hormone

Mund ta mendoni insulinen si ky hormon i gjithepushtetshem

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

qe kontrollon se cfare ben trupi yne me ushqimet qe hame,

whether we burn it or store it.

nese i ruajme ose i djegim.

This is called fuel partitioning in the lingo.

Ne gjuhen mjekesore kjo quhet "ndarje e energjise".

Now failure to produce enough insulin is incompatible with life.

Mos prodhimi i mjaftueshem i insulines nuk pajtohet me jeten.

And insulin resistance, as its name suggests,

Dhe rezistence ndaj insulines, sikunder sugjeron dhe emri,

is when your cells get increasingly resistant

ndodh atehere kur qelizat behen gjithnje e me rezistente

to the effect of insulin trying to do its job.

nga efektet e insulines qe perpiqet te beje punen e saj.

Once you're insulin-resistant,

Kur behesh rezistent ndaj insulines,

you're on your way to getting diabetes,

kthehesh ne diabetik,

which is what happens when your pancreas

c'ka ndodh kur pankreasi

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

nuk mund te perballoje rezistencen dhe te prodhoje mjaftueshem insuline.

Now your blood sugar levels start to rise,

FIllon ngritja e sasise se sheqerit ne gjak,

and an entire cascade of pathologic events

dhe nje ujvare problemesh patologjike

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

dalin jashte kontrolli, c'ka mund te cojne ne probleme me zemren,

cancer, even Alzheimer's disease,

kancer, ose edhe Alzaimer,

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

dhe amputim, pikerisht si ajo grua disa vite me pare.

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

Me kete problem, nisa te ndryshoj dieten time ne menyre drastike,

adding and subtracting things most of you would find

duke hequr e shtuar gjera qe ju do ti gjenit

almost assuredly shocking.

padyshim shokuese.

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

Bera keshtu dhe humba 20 kg, ndonese beja me pak ushtrime fizike.

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

Sikunder mund te shihni, nuk jam me mbipeshe.

More importantly, I don't have insulin resistance.

Cka eshte me e rendesishme eshte qe nuk kam me rezistence ndaj insulines.

But most important, I was left

Por edhe me e rendesishme, jane keto tre pyetjet

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

qe me kane mbetur dhe te cilat nuk duan te me hiqen:

How did this happen to me if I was supposedly

Si me ngjau kjo gje kur une mendohej

doing everything right?

se po beja gjithcka si duhej?

If the conventional wisdom about nutrition had failed me,

Nese shkenca rreth te ushqyerit te shendetshem ka qene e rreme,

was it possible it was failing someone else?

a thua e tille ishte dhe per te tjere?

And underlying these questions,

Dhe ne analizimin e ketyre pyetjeve

I became almost maniacally obsessed

u bera pothuajse i fiksuar

in trying to understand the real relationship

ne te perpjekurit per te kuptuar lidhjen e vertete

between obesity and insulin resistance.

midis obezitetit dhe rezistences se insulines.

Now, most researchers believe obesity

Tanime, shume hulumtues besojne se obeziteti

is the cause of insulin resistance.

eshte si rrjedhoje e resistences ndaj insulines.

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

Logjikisht, kur do te trajtosh rezistencen ndaj insulines,

you get people to lose weight, right?

i detyron njerezit te bien ne peshe, apo jo?

You treat the obesity.

Trajton obezitetin.

But what if we have it backwards?

Po sikur te jete pikerisht e kunderta?

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

Po sikur obeziteti te mos jete shkaku i rezistences ndaj insulines?

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

Ne fakt, po sikur te jete sintoma e nje problemi shume me te madh,

the tip of a proverbial iceberg?

maja e nje ajsbergu?

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

E di qe tingellon pak e cuditshme, pasi jemi ne mesin

of an obesity epidemic, but hear me out.

e nje epidemie obeziteti, por me degjoni pak.

What if obesity is a coping mechanism

Po sikur obeziteti te jete nje kamuflazh

for a far more sinister problem going on

i nje problemi shume me te rende qe

underneath the cell?

i ka rrenjet ne qelize?

I'm not suggesting that obesity is benign,

Nuk jam duke sugjeruar ketu qe obeziteti eshte beninj,

but what I am suggesting is it may be the lesser

por ate qe po sugjeroj eshte qe mund te jete e keqja me e vogel

of two metabolic evils.

e dy te keqijave te metabolizmit.

You can think of insulin resistance as the reduced capacity

Mund ta mendoni rezistencen ndaj insulines si aftesia e limituar

of our cells to partition fuel,

e vetes per te shperndare karburantin,

as I alluded to a moment ago,

sikunder iu referova para nje minute,

taking those calories that we take in

te marresh kalorite qe sigurojme me ushqimin

and burning some appropriately and storing some appropriately.

dhe ne menyre proporcionale te djegim nje pjese e te ruajme tjetren.

When we become insulin-resistant,

Kur behemi rezistent ndaj insulines,

the homeostasis in that balance deviates from this state.

homeostaza ne kete lloj ballancimi prishet.

So now, when insulin says to a cell,

Pra tanime, kur insulina i thote qelizes,

I want you to burn more energy

dua te djegesh me shume energji

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

sesa qeliza e konsideron te sigurt, ne te vertete ajo pergjigjet,

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

"Jo faleminderit, do ta ruaj kete energji."

And because fat cells are actually missing most of

Dhe duke qene se ne qelizat e dhjamit nuk i gjen

the complex cellular machinery found in other cells,

ato makineri komplekse qelizore qe gjendet ne qeliza te tjera,

it's probably the safest place to store it.

eshte vendi me i mire per ti ruajtur.

So for many of us, about 75 million Americans,

Shume prej nesh, rreth 75 milion Amerikane,

the appropriate response to insulin resistance

pergjigja e rezistences ndaj insulines

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

mund te jete qe ta ruaj ne formen e dhjamit e jo e kunderta,

getting insulin resistance in response to getting fat.

te kesh rezistence insuline ne pergjigje te dhjamosjes.

This is a really subtle distinction,

Kjo eshte ne te vertete nje ndryshim i vogel,

but the implication could be profound.

por me pasoja te renda.

Consider the following analogy:

Konsideroni analogjine e meposhtme:

Think of the bruise you get on your shin

Mendoni per gerricjet qe pesoni ne lekure

when you inadvertently bang your leg into the coffee table.

kur ne menyre rastesore perplasni gjurin ne tavolinen e kafes.

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

Padyshim qe plaga dhemb shume dhe

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

ju nuk e pelqeni faktin qe eshte nxire, por te gjithe e dime

the bruise per Se is not the problem.

qe plaga ne vetvete nuk eshte problemi.

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

Ne fakt, eshte e kunderta, eshte nje pergjigje e shendetshme ndaj nje traume,

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

jane qelizat imunitare qe vrapojne aty ku ndodhi demtimi

to salvage cellular debris and prevent the spread

qe te ndihmojne qelizat e atyshme dhe te ndalojne

of infection to elsewhere in the body.

perhapjen e infeksionit ne pjese te tjera te trupit.

Now, imagine we thought bruises were the problem,

Tani, imagjinoni sikur ne te mendonim se plaga eshte faktikisht problemi,

and we evolved a giant medical establishment

dhe zhvillojme cdo kerkim

and a culture around treating bruises:

dhe kulture mjeksore rreth trajtimit te plageve:

masking creams, painkillers, you name it,

krem maskimi, ilace kunder dhimbjes, e shume te tjere,

all the while ignoring the fact that people

duke injoruar teresisht faktin qe njerezit

are still banging their shins into coffee tables.

jane ende duke perplasur kercirin ne tavolina kafeje.

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

Sa me mire do te ish po te trajtonim shkaqet--

telling people to pay attention

duke i thene njerezve te jene me te kujdesshem

when they walk through the living room --

teksa ecin neper sallon--

rather than the effect?

ne vend te efektit qe krijohet?

Getting the cause and the effect right

Te kuptosh shkakun dhe efektin,

makes all the difference in the world.

ben te gjithe diferencen e mundshme.

Getting it wrong, and the pharmaceutical industry

Ta kesh gabim, industria farmaceutike

can still do very well for its shareholders

mund te vazhdoje te jete fitimprurese per investuestit e saj

but nothing improves for the people with bruised shins.

por per njerezit me kerci te vrare nuk permiresohet asgje.

Cause and effect.

Shkaku dhe efekti.

So what I'm suggesting is

Ajo c'ka jam duke sugjeruar eshte

maybe we have the cause and effect wrong

se ndoshta kemi shkakun dhe efektin e gabuar

on obesity and insulin resistance.

kur falsim per obezitet dhe rezistence ndaj insulines.

Maybe we should be asking ourselves,

Ndoshta duhet ta pyesim veten,

is it possible that insulin resistance causes weight gain

a eshte e mundur qe rezistenca ndaj insulines shkakon rritje ne peshe

and the diseases associated with obesity,

dhe semundje qe lidhen me obezitetin,

at least in most people?

te pakten ne shumicen e njerezve?

What if being obese is just a metabolic response

Po sikur te qenit obez eshte thjesht nje pergjigje e metabolizmit

to something much more threatening,

ndaj dickaje shume me teper kercenuese,

an underlying epidemic,

nje epidemi e fshehur,

the one we ought to be worried about?

ajo per cka duhet te shqetesohemi me shume?

Let's look at some suggestive facts.

Le ti hedhim nje sy fakteve.

We know that 30 million obese Americans

E dime qe 30 milion amerikane obeze

in the United States don't have insulin resistance.

ne USA nuk vuajne nga rezistenca e insulines.

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

Dhe meqenese ra fjala, ato nuk duket te jene ne

greater risk of disease than lean people.

ndonje rrezik me te madh per semundje se njerezit e dobet.

Conversely, we know that six million lean people

Nderkohe, dime qe 6 milione njerez te dobet

in the United States are insulin-resistant,

ne USA jane rezistent ndaj insulines,

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

dhe meqenese ra fjala, ata mendohet te jene ne rrezik me te madh per

for those metabolic diseases I mentioned a moment ago

ato semundje metabolike qe permenda me siper,

than their obese counterparts.

ne dallim nga grupi i obezeve.

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

Une nuk e di pse, por ndoshta kjo vjen si rezultat i faktit qe

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

ne rastin e tyre, qelizat nuk e kane kuptuar ende

the right thing to do with that excess energy.

se c'duhet te bejne me tepricen e energjise.

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

Pra nqse nje njeri mund te jete obez dhe mund te mos kete rezistence ndaj insulines,

and you can be lean and have it,

ose mund te jete i dobet e ta kete,

this suggests that obesity may just be a proxy

kjo tregon se obeziteti mund te jete nje kamuflazh

for what's going on.

per ate qe po ndodh.

So what if we're fighting the wrong war,

Pra, po sikur te jemi duke luftuar nje lufte te gabuar,

fighting obesity rather than insulin resistance?

te luftojme obezitetin ne vend te rezistences ndaj insulines?

Even worse, what if blaming the obese

Edhe me keq, po sikur fajesimi i obezeve

means we're blaming the victims?

do te thote qe po fajesojme viktimat?

What if some of our fundamental ideas about obesity

Po sikur disa nga idete tona thelbesore mbi obezitetin

are just wrong?

jane gabim?

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

Personalisht, nuk mund ta kem me luksin e arrogances

let alone the luxury of certainty.

mos flasim pastaj per luksin e sigurise se plote.

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

Kam idete e mia te asaj c'ka mund te jete problemi,

but I'm wide open to others.

por jam e hapur per sugjerime.

Now, my hypothesis, because everybody always asks me,

Hipoteza ime, sepse te gjithe me pyesin,

is this.

eshte kjo.

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

Nese e pyesni veten, se nga se perpiqet te mbrohet qeliza

when it becomes insulin resistant,

kur behet rezistente ndaj insulines,

the answer probably isn't too much food.

pergjigja ndoshta nuk eshte, teprice ushqimore.

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

Por me gjasa, teprice glukoze: sheqeri ne gjak.

Now, we know that refined grains and starches

E dime qe dritherat e perpunuara

elevate your blood sugar in the short run,

e ngrene nivelin e sheqerit ne gjak ne nje kohe afatshkurter,

and there's even reason to believe that sugar

dhe ka edhe arsye per te besuar se sheqeri

may lead to insulin resistance directly.

mund te coje direkt ne rezistence ndaj insulines.

So if you put these physiological processes to work,

Nqse keto procese psikologjike vihen ne pune,

I'd hypothesize that it might be our increased intake

hedh hipotezen qe mund te jete shkaku i marrjes se

of refined grains, sugars and starches that's driving

drithrave te perpunuara, sheqerit ne mase, ajo cka sjell

this epidemic of obesity and diabetes,

epidemine e obezitetit dhe diabetit,

but through insulin resistance,

por nepermjet rezistences ndaj insulines,

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

dhe jo si efekt i mbingopjes ose mos berjes ushtrime fizike.

When I lost my 40 pounds a few years ago,

Kur humba 20 kg disa vite me pare,

I did it simply by restricting those things,

e bera thjesht duke kufizuar keto gjera,

which admittedly suggests I have a bias

cka sugjeron qe kam nje anesi

based on my personal experience.

bazuar ne eksperiencen time personale.

But that doesn't mean my bias is wrong,

Por kjo nuk do te thote qe anesia ime eshte e gabuar,

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

dhe me e rendesishmja, te gjitha keto mund te provohen shkencerisht.

But step one is accepting the possibility

Por, shkalla e pare eshte te pranosh mundesine

that our current beliefs about obesity,

se besimi yne rreth obezitetit,

diabetes and insulin resistance could be wrong

diabetit dhe rezistences ndaj insulines mund te jene te gabuara

and therefore must be tested.

dhe si rrjedhoje duhen testuar.

I'm betting my career on this.

Ve bast karrieren time ne kete gje.

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

Sot, ja dedikoj te gjithe kohen time punes mbi kete problem,

and I'll go wherever the science takes me.

dhe do te shkoj kudo te me coje shkenca.

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

Kam vendosur qe ajo c'ka nuk mundem dhe nuk do te bej me

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

eshte te pretendoj qe i kam pergjigjet kur nuk i kam ato.

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

Kam qene i perulur per gjithcka nuk njoh

For the past year, I've been fortunate enough

Vitin e fundit, kam qene mjaf me fat

to work on this problem with the most amazing team

qe kam punuar mbi kete problem me nje grup te mrekullueshem

of diabetes and obesity researchers in the country,

hulumtuesish te obezitetit dhe diabetit ne vend,

and the best part is,

dhe pjesa me e bukur eshte qe,

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

sikunderse Abraham Lincoln e rrethoi veten me nje grup pune rivalesh,

we've done the same thing.

dhe ne kemi bere te njejten gje.

We've recruited a team of scientific rivals,

Kemi rekrutuar nje grup pune me shkencetare rival,

the best and brightest who all have different hypotheses

me te miret dhe me te ndriturit por qe te gjithe kane hipotezat e veta

for what's at the heart of this epidemic.

rreth asaj cka mund te jete ne zemer te epidemise.

Some think it's too many calories consumed.

Disa mendojne qe eshte sasia e madhe e kalorive te konsumuara.

Others think it's too much dietary fat.

Te tjere mendojne se eshte konsumi i madh i nje diete te yndyrshme.

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

Per te tjere problemi qendron te konsumi i drithrave dhe niseshtese.

But this team of multi-disciplinary,

Por ky grup pune i hulumtuesve multi disiplinor,

highly skeptical and exceedingly talented researchers

mjaft te edukuar dhe mjaft te talentuar,

do agree on two things.

jane dakort ne dy gjera.

First, this problem is just simply too important

E para, ky problem eshte shume i rendesishem

to continue ignoring because we think we know the answer.

per te vazhduar ta injorojme thjesht sepse ne mendojme se i dime pergjigjet.

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

Dhe e dyta, nese pranojme te jemi gabim,

if we're willing to challenge the conventional wisdom

nese pranojme te sfidojme njohurine e deritanishme

with the best experiments science can offer,

me eksperimentet me te mira ofruar nga shkenca,

we can solve this problem.

problemi mund te zgjidhet.

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

E di qe eshte mjaft joshese te dashurit te mesosh pergjigjen qe tani,

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

politikat dhe masat, rekomandimet dietike--

eat this, not that —

ha kete, jo ate--

but if we want to get it right,

por nese duam ta idenitfikojme ekzaktesisht,

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

na duhet te bejme nje shkence mjaft rigoroze

before we can write that prescription.

para se te nisim te japim rekomandime.

Briefly, to address this, our research program

Shkurtimisht, per te adresuar kete, programi yne i kerkimit

is focused around three meta-themes, or questions.

eshte i fokusuar rreth tre temave ose pyetjeve kryesore.

First, how do the various foods we consume

Se pari, si ndikojne ushqimet e ndryshme qe konsumojme

impact our metabolism, hormones and enzymes,

ne metabolizem, hormone dhe enzima,

and through what nuanced molecular mechanisms?

dhe nepermjet cfare mekanizmi molekular?

Second, based on these insights,

Se dyti, duke u bazuar ne keto te dhena,

can people make the necessary changes in their diets

a munden njerezit te bejne ndryshimet e nevojshme ne dieten e tyre

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

ne nje menyre qe te jete e sigurt dhe praktike implementimi?

And finally, once we identify what safe

Dhe si perfundim, kur e identifikojme

and practical changes people can make to their diet,

se cfare jane ndryshimet e sigurta dhe praktike qe njerezit mund ti bejne dietes se tyre,

how can we move their behavior in that direction

si mund ta drejtojme sjelljen e tyre drejt atij drejtimi

so that it becomes more the default

qe te behet e perditshmja

rather than the exception?

dhe jo perjashtimi?

Just because you know what to do doesn't mean

Te diturit se cfare duhet te besh nuk do te thote

you're always going to do it.

qe ti gjithomone do ta besh ate.

Sometimes we have to put cues around people

Ndonjehere eshte e nevojshme te vendosim te dhena rreth njerezve

to make it easier, and believe it or not,

per ta bere me te lehte, dhe besojeni ose jo,

that can be studied scientifically.

kjo gje mund te studjohet shkencerisht.

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

Nuk e di se si do te perfundoje ky udhetim,

but this much seems clear to me, at least:

por kaq gje me duket e qarte te pakten:

We can't keep blaming our overweight and diabetic patients

Nuk mund te vazhdojme te fajesojme pacientet mbipeshe dhe diabetike

like I did.

sic bera une.

Most of them actually want to do the right thing,

Shumica prej tyre faktikisht duan te bejne gjene e duhur,

but they have to know what that is,

por ata duhen te dine se cfare eshte kjo,

and it's got to work.

dhe duhet te funksionoje.

I dream of a day when our patients can

Enderroj per diten kur pacientet tane

shed their excess pounds

do mund te dobesohen

and cure themselves of insulin resistance,

dhe ta kurojne veten nga rezistenca e insulines,

because as medical professionals,

pasi si profesionist mjekesie,

we've shed our excess mental baggage

ne e kemi djersitur bagazhin tone mendor

and cured ourselves of new idea resistance sufficiently

dhe e kemi sheruar veten nga rezistenca ndaj ideve mjaftueshem

to go back to our original ideals:

per t'ju kthyer idealeve tona te origjines:

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

mendje hapur, me kurajon per te hedhur tutje idete e djeshme

when they don't appear to be working,

kur ato nuk japin rezultate,

and the understanding that scientific truth isn't final,

dhe te kuptuarit qe e verteta shkencore nuk eshte fjala e fundit,

but constantly evolving.

por ne evolim i vazhdueshem.

Staying true to that path will be better for our patients

Ti qendrosh besnik asaj rruge do jete me mire per pacientet tane

and better for science.

dhe me mire per shkencen,

If obesity is nothing more than a proxy

Nese obeziteti nuk eshte gje tjeter vec kamuflazhi

for metabolic illness,

i semundjeve te metabolizmit,

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

c'e mire na vjen duke i ndeshkuar ato qe vuajne prej saj?

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

Me ndodh te mendoj per naten ne urgjence

seven years ago.

7 vite me pare.

I wish I could speak with that woman again.

Do desha te mund te flisja serish me ate grua.

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

Do te desha ti thoja se sa keq me vinte.

I'd say, as a doctor, I delivered

Do ti thoja qe si mjeke, i dhashe

the best clinical care I could,

sherbimin me te mire klinik qe munda,

but as a human being,

por si qenie njerezore,

I let you down.

nuk e trajtova si duhej.

You didn't need my judgment and my contempt.

Nuk kishe nevoje per gjykimin tim.

You needed my empathy and compassion,

Ti kishe nevoje per simpatine dhe keqardhjen time,

and above all else, you needed a doctor

dhe mbi te gjitha kishe nevoje per nje mjek

who was willing to consider

i cili te ishte i gatshem te konsideronte

maybe you didn't let the system down.

faktin qe ti mund te ishe jashte kornizave te sistemit.

Maybe the system, of which I was a part,

Ndoshta sistemi, pjese e se cilit isha dhe une,

was letting you down.

nuk ju ndihmoi.

If you're watching this now,

Nese jeni duke e pare kete tani,

I hope you can forgive me.

shpresoj te mund te me falni.

(Applause)

(Duartrokitje)