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你的腰围应该小于身高的二分之一。
Your waist should be less than half your height.
所以，这根绳子的一半长度应该绕在你腹部最粗的地方，这是一个在家就能轻松做的测试。
So half of that string should go around the fattest bit of your belly, and this is a really simple test for everybody at home.
我的意思是，这其实不算。
I mean, it's not
算的。
It is.
你刚刚已经做了。
You've just done it.
你通过了。
You've passed.
腹部的脂肪比腿部或手臂的脂肪更令人担忧。
But fat on your belly is more worrying than fat on your legs or on your arms.
不幸的是，我们开始把‘中年发福’这种体型当成正常现象，却没意识到这根本不是应有的状态。
And, unfortunately, we've started to normalize things like the dad bod without realizing that isn't how you're supposed to be.
全球有三分之一的2型糖尿病患者根本不知道自己患病。
And maybe a third of all the people in the world with type two diabetes don't even know they have it.
但每一年血糖控制不好，你就会损失整整一百天的寿命，这都是因为人们被包装和广告误导了，不了解真相。
But every year that you have poorly controlled type two diabetes, you're losing a hundred days of life, and it's because people don't know the truth being fooled with the packaging and advertising.
咱们聊聊桌上这些食物吧，我原本以为这些——麦片、土豆、白米饭、香蕉和巧克力棒——加起来才这么多糖。
So let's talk about the food we have on this table because this is how much sugar I would have thought was in all of these things here, cereal, a potato, white rice, a banana, and a chocolate bar.
现在我来告诉你真实的数据。
So now I'm gonna give you the correct figure.
这盒玉米片里有八茶匙糖。
The cornflakes is one, two, three, four, five, six, seven, eight.
这块巧克力棒里有七茶匙半。
That chocolate bar is seven and a half.
这根香蕉里有六茶匙。
The banana, that's six.
至于土豆，天哪，居然也有这么多。
And then the potato is actually Oh my gosh.
而150克煮熟的米饭含有
And then 150 grams of boiled rice is
哦，我一直以为米饭是健康的。
Oh, I thought rice was healthy.
但每个人都有不同的健康未来。
But each of us has a number of different health futures.
我关心的是，怎样才能让你选择一种能带你走向理想未来的生活方式？
And what I'm interested in is how do I get you to pick a lifestyle that will get you the future you want?
因为我的工作就是帮助人们改变行为。
Because my job is about behavior change.
现在轮到你了。
The floor is yours.
好的。
Alright.
那我们开始吧。
So off we go.
各位，在这期节目开始之前，我想请大家帮个忙。
Guys, I've got a favor to ask before this episode begins.
算法会根据你是否关注了某个节目，把该节目的优质内容优先推送到你的信息流里。
The algorithm, if you follow a show, will deliver you the best episodes from that show very prominently in your feed.
所以当我们的节目推出最受欢迎、分享最多、评分最高的那些集数时，我希望你们能第一时间看到。
So when we have our best episodes on this show, the most shared episodes, the most rated episodes, I would love you to know.
而你们要做的，就是点一下关注按钮，这很简单。
And the simple way for you to know that is to hit that follow button.
这不仅是举手之劳，而且完全免费，还能帮我们把节目做得更好。
But also, it's the simple, easy, free thing that you can do to help us make the show better.
所以，麻烦你们现在就花一分钟，在正在听节目的这个App里，点一下关注按钮。
And I would be hugely grateful you if could take a minute on the app you're listening to this on right now and hit that follow button.
真的非常非常感谢你们。
Thank you so, so, so much.
大卫·温恩医生。
Doctor David Unwin.
2018年，你被列为英国最具影响力的十位医生之一。
You were named in 2018 among the top 10 most influential doctors in The United Kingdom.
你的成就非常了不起，很多人告诉我，在他们接触过的所有医生里，你可能是最受尊敬的那一位。
You've got an incredible list of accomplishments, and you're held in the highest regard, maybe of all the doctors I've ever had the chance to speak to by many people that I've spoken to.
在开始录制之前，我们聊了聊你最近在想什么、有什么困扰。
We were talking before we started recording about what's on your mind and what's been bothering you.
那现在，话筒交给你了。
And so the floor is yours.
大卫医生，你眼下最关心的是什么？
What is front of mind for you, doctor David?
我最在意的是，每个人其实都拥有多种可能的健康未来。
What's front of mind for me is the the idea that each of us has a number of different health futures.
比如你。
So you have.
在你的未来里，也许会得癌症。
So in your future, I don't know, there could be cancer.
也可能是多发性硬化，或者有其他各种可能的未来。
There could, be multiple sclerosis or there could be many futures.
我关心的是，怎么才能让你选择一种生活方式，帮你实现你想要的未来？
What I'm interested in is how do I get you to pick a lifestyle that will get you the future you want?
现在这个世界想搞清楚什么才是最好的生活方式真的很难，因为给你的建议全都自相矛盾。
And I think that's very difficult in the world now to know what is the best lifestyle because you've given so much conflicting advice.
我特别关注年轻人，因为他们有最长时间去改变，而如今要做出健康的生活选择却越来越难。
And the particular focus for me in terms of picking health futures is around young people because they've got the longest time to make a difference and it's getting harder and harder and harder to make good health choices in your lifestyle.
真的太难了。
It's really hard.
我觉得这简直就是一场代谢健康危机。
I'd say it's a pandemic of poor metabolic health.
昨天在诊所，我看到两个不到二十五岁的人，糖尿病都控制得不好，其中一个体重太重，我都没法称。
Yesterday in clinic, I saw two people under the age of 25 who had poorly controlled diabetes and one of them was too heavy for me actually to weigh.
这种情况以前是从来没有过的。
And this situation is completely new.
我刚当医生那会儿，才二十多岁，那是1986年。
So when I when I was a young doctor, and just starting off in practice, that was in 1986.
真久远了。
Wow.
当年我在利物浦北部的一家诊所开始行医，现在我还在那里。
A long time ago, just North of Liverpool in the practice, I'm still there now.
那时候肥胖特别少见，55岁以下的人里，一个二型糖尿病患者都没有。
Obesity was rare and we didn't have a single case of type two diabetes in anybody 55.
一个都没有。
Not a single case.
那会儿这病几乎没人听说过。
It was quite unknown.
其实二型糖尿病那时候不叫这个名字。
And in fact, type two diabetes had a different name.
因为疫情爆发，我们才不得不改了名字。
We've had to change the name because of the epidemic.
以前叫成人发病型糖尿病。
It used to be called maturity onset diabetes.
意思就是老年人得的病。
That meant old people.
对吧？
Right?
现在我们叫它二型糖尿病，因为得病的年轻人实在太多了。
Now we call it Type two diabetes because we have to include so many young people.
情况真的很严重，人们的预期寿命正在下降。
It's really, really serious, because people are losing their life expectancy.
我亲眼看着这一切发生。
And I'm witnessing this.
我们所有人都在不知不觉中走向一场代谢危机，而承受最大代价的，我认为是年轻人，这简直是个丑闻，我气得不行。
We're all sleepwalking into a metabolic disaster and the people paying the greatest price, in my opinion, are young people and it's a scandal and I'm hopping mad really.
我觉得我们已经开始把‘爸爸肚’当成常态了，就是大肚子，却没意识到，这根本不是正常该有的样子。
I think we've started to normalize the dad bod, you know, the big tummy and without realizing that maybe that isn't how you're supposed to be.
所以这正是我一直在想的事。
So that that's what's on my mind.
年轻人和他们的未来，而他们自己却根本没意识到。
Young people and their future, and they don't even know.
你提到年轻人，是的。
You say young people there Yeah.
因为他们最有希望改变自己未来的健康走向。
Because they've got the biggest opportunity to change the trajectory of their health future.
没错。
Yes.
但对于正在听的观众来说，他们可能已经五十多岁了。
But for the audiences listening, that might be in their fifties now.
这些建议对他们也适用吗？
Is this advice also applicable?
当然适用。
Absolutely.
根据英国政府的数据，每一年血糖控制不佳的二型糖尿病，都会让你少活一百天。
So we know from government figures, UK government figures, that for every year that you have poorly controlled type two diabetes, you're losing a hundred days of life.
这差不多是三分之一年，对吧？
That's about a third of a year, isn't it?
不管你多大年纪，只要糖尿病没控制好，寿命就会缩短。
So whatever age you are, if you, have poorly controlled diabetes, you're losing life expectancy.
世界上可能有三分之一的二型糖尿病患者根本不知道自己患病，因为他们没去做检查。
And and maybe a third of all the people in the world with type two diabetes don't even know they have it because they haven't taken the test, so they don't know.
你觉得二型糖尿病患者通常是怎么死的？
What do you think kills people with type two diabetes?
是因为心血管问题吗？
Is it some cardiovascular issue?
是的。
Yeah.
说得好。
Well done.
干得漂亮。
Well done.
你也没上过医学院吧。
You've not been to medical school either.
大多数医生都会这么说，因为我们知道，长期高血糖会损伤血管。
Most doctors, that's what they'd say because we know that a high blood sugar over time damages your arteries.
这是一点一点累积起来的。
So it's a cumulative thing over time.
但你可能不知道，糖尿病患者死亡的一个日益突出的原因其实是癌症。
But what you may not know is that actually a rising cause of mortality for people with diabetes is cancer.
真的吗？
Oh really?
是的。
Yeah.
有八种癌症与糖尿病密切相关。
So eight forms of cancer are strongly associated with diabetes.
我想先明确一下‘糖尿病’这个概念，因为我以前一直以为糖尿病是天生就有的病。
I wanna just define that term diabetes because I think I went through a lot of my life assuming that diabetes was a disease that some people are born with.
因为我自己没有，就觉得这跟我没关系，不用在意。
And because I didn't have it, I thought I didn't need to worry
这一点真的很重要。
about That's really important.
是的。
Yeah.
首先，糖尿病分一型和二型。
So first of all, there's type one diabetes and type two.
但在解释糖尿病之前，我得先说说胰岛素。
But before I can explain about diabetes, I need to explain about insulin.
这对我们整个讨论来说至关重要。
This is absolutely key to our whole discussion.
我之前已经说过，血糖长期偏高会损伤血管。
So I've already said that a high blood sugar damages your arteries.
事实上，有研究显示，血糖过高会在六小时内损伤动脉内壁的保护层。
And in fact, there's work to show that a very high blood sugar damages the nonstick lining of your arteries within six hours.
天哪，这么快。
Oh, wow.
真的很快。
Really quick.
这层保护膜叫糖萼，损伤发生得非常迅速。
It's called the glycocalyx, the nonstick lining, and, damage is occurring very quickly.
我想问你一个特别傻的问题。
So I'm gonna ask you a really stupid question.
是的。
Yeah.
你说血糖高，我理解就是吃太多糖的时候血糖会升高。
When you say high blood sugar, I get high blood sugar when I eat lots of sugar.
明白了。
Okay.
首先，我们实际上说的是葡萄糖。
So first of all, we're actually talking about glucose.
是的。
Yeah.
糖可能指白糖，也可能指其他很多东西，但我们这里讲的是血液里的葡萄糖。
And sugar can mean table sugar or it could mean many different things, but we're actually talking about blood glucose.
这来自很多种食物。
Which comes from lots of foods.
来自多种食物。
Which comes from many foods.
主要是碳水化合物含量高的食物。
Carbohydrate heavy foods.
对。
Yes.
没错。
Yes.
确实如此。
It does.
确实如此。
It does.
所以这么说没错。
So that that's right.
好的。
Okay.
但你体内有胰岛素这种激素，能帮你抵御不良饮食的影响。
But you have the hormone insulin to defend you from poor dietary choices.
那么问题来了，胰岛素会怎么处理你刚吃进去的糖呢？
So the question is, what does insulin do with the sugar you just ate?
答案在这里。
And here's the answer.
胰岛素是由胰腺分泌的一种激素，它会把血液里的糖分推送到细胞内部，供你活动时作为能量使用。
Insulin, the hormone insulin produced by your pancreas gland, it pushes the sugar and it pushes it out of the bloodstream inside cells where it can be used for energy for you to run around.
但如果你摄入的碳水化合物超过了身体日常所需，会怎么样呢？
But what if you take in, more carbohydrate than you need to run around?
这时候，体内的糖就会被转化成脂肪，因为把糖变成脂肪，比让糖在血液里损伤血管要安全得多。
Well, then that sugar is turned to fat inside cells because it's safer for you to turn that sugar into fat than it is to have it damaging your arteries.
我本人是二型糖尿病患者，所以我们可以拿我来说事。
So I am somebody with Type two diabetes, so we can talk about me.
我以前特别爱吃饼干。
So I had a really heavy biscuit habit.
我是诊所的资深合伙人，工作压力大，病人经常送我饼干当礼物，因为他们希望医生开心。
I was senior partner of the practice and it's stressful and I had Patients used to bring me biscuits all the time as a gift because they, you know, they want the doctor to be happy.
我办公桌抽屉里，堆满了成包成包的饼干。
So in the drawer, in the top of my desk was packets and packets of biscuits.
所以我摄入的糖越来越多，但运动却很少。
So I'm taking in more sugar, and I didn't run around.
渐渐地，我的腰围就越来越粗了。
And gradually, my waist got bigger.
实际上，当我摄入的糖分超过身体所需时，我的胰岛素一直在努力把这些糖分代谢掉。
And what was actually happening was as I took in more sugar than I needed to run around, my insulin was working to get rid of that sugar.
它给我带来了两个结果。
And it was giving me two things.
一是肚子越来越大。
One, a belly.
对。
Mhmm.
我当时还以为只是中年发福而已。
So my you know, and I thought it's just middle aged spread, you know.
另一个是我当时不知道，我的肝脏已经开始堆积脂肪。
And the other was I didn't know, but my liver was filling with fat.
这种情况现在非常普遍。
And that's, that is very common now.
如今，发达国家有三分之一的人都有脂肪肝。
So we have, well, it's a third of everybody in the developed world has fatty liver now.
这可是绝佳的演示道具。
Here we got the wonderful props.
咱们来聊聊这些。
Let's talk about these.
很好。
Great.
脂肪肝。
So fatty liver.
这是健康的肝脏。
This is the healthy liver here.
你瞧这颜色。
And you see the color.
再看看这个。
Look at this one.
它是黄色的。
It's yellow.
颜色不对，是因为脂肪堆积。
It's the wrong color, and it's because of fat.
所以，像我这些年经历的一样，我的肝脏开始堆积脂肪。
So in that case, like has happened to me over years, my liver began to fill with fat.
是因为肝脏负担太重，葡萄糖都被存到那里了吗？
Because it was essentially overworked and glucose was being stored there?
对。
Yes.
我当时摄入的葡萄糖太多了。
So I was taking in too much glucose.
胰岛素尽职尽责地把葡萄糖从血液里清理出来，逼着它进入腹部的细胞，可惜也进了肝脏。
Insulin was doing its good job of taking it out of my bloodstream and forcing it inside cells in my belly, but unfortunately in my liver.
明白了。
Okay.
于是，肝脏里的脂肪就一点点越积越多。
And so there's a progressive laying down of fat in the liver.
我们来看看真正的肝脏，现在系好安全带，因为这是某人真实的肝脏。
If we look at actually some proper liver, so this is the Put on your seat belts now because this is somebody's actual liver.
这是正常的肝脏。
So then that's the normal liver.
但你看这个，它更大了。
But look at this, it's larger.
这确实是人类的肝脏。
That's a real human liver.
是的。
Yes.
这些是人类的肝脏，本来就应该这样。
These are human livers and that's as it should be.
但你看这个肝脏，它更大了。
But this Look at this liver, it's larger.
它变大是因为里面堆积了太多脂肪。
And it's larger because there's so much fat in it.
但故事的转折来了，脂肪肝会干扰胰岛素的正常作用。
Now the twist in the story is fatty liver interferes with the good work of insulin.
于是你就出现了胰岛素抵抗，也就是说，胰岛素的效力大不如前了。
So you develop a thing called insulin resistance, which means your insulin is no longer as powerful as it was.
因为你体内的胰岛素效果变差了，吃碳水化合物和糖就越来越难处理了。
It's beginning to become difficult for you to deal with carbohydrate and sugar because your insulin isn't working as well.
而解决这个问题的唯一办法，就是故事的下一个转折。
And the only way to deal with that is the next twist in the story.
你得开始分泌更多的胰岛素。
You have to start producing more insulin.
明白吗？
Do you see?
因为它没以前那么有效了。
Because it doesn't work as well.
对。
Yeah.
所以你的胰腺得加大分泌量。
So your pancreas has to crank up the supply.
我们需要更多的胰岛素。
We need more insulin.
现在你面临两个问题。
So now you have two things.
你有胰岛素抵抗。
You have insulin resistance.
你的胰岛素效果变差了。
Your insulin isn't working as well.
但与此同时，你的胰腺还在拼命生产更多胰岛素。
But at the same time, you're trying to produce more insulin in the pancreas.
这部分被称为肝脏的长期无声呐喊。
This bit's called the long silent scream from the liver.
这是纽卡斯尔大学的罗伊·泰勒教授的研究成果，他是我的朋友。
This is work by professor Roy Taylor, a friend of mine at Newcastle University.
他指出，你的脂肪肝已经持续了大约十年。
And he pointed out that you've you've got fatty liver for about ten years.
你自己根本察觉不到。
You don't even know.
你根本不会知道，你的肝脏已经变得又肥又黄成那样了。
You wouldn't know that your liver's gone fatty and yellow like that.
但不幸的是，这又是一个转折。
But unfortunately, this is another twist.
脂肪正在胰腺里堆积，而这个腺体正是你靠它生产胰岛素、维持生命的器官，结果你生产足够胰岛素的能力就崩溃了。
Fat is being laid down in the pancreas gland, the very gland that your life depends upon producing insulin, and your ability to produce enough insulin collapses.
到了这个时候，你就再也无法控制血糖了。
And at that point, you can't regulate blood sugar anymore.
但在那之前，问题早就出现了。
But upstream of that, you have a problem.
你早就有了这个问题。
You've got that.
但你根本不知道。
But you don't even know.
你说到我心里去了。
You're talking about what's in my mind.
为什么非要等到你真得了二型糖尿病才行动呢？
Why are we waiting until you actually have all the problems of type two diabetes?
从2013年起，我跟踪了数百名患者，记录他们的初始数据和最新随访情况。
So since 2013, I've got hundreds of patients and I'm monitoring the baseline and latest follow-up.
那他们后来怎么样了？
So what happens to them?
这非常关键。
It's really important.
现在我有了一个庞大的数据集，可以用来分析和回答各种问题。
And now I have a huge dataset that I can interrogate and answer questions.
第一个问题，我们来谈谈前期糖尿病。
So number one question, let's think about prediabetes.
这事儿得等很久才能看到效果。
So this is in the long silent screen.
我可以告诉你，在利物浦北部我的患者里，患有前期糖尿病的人，只要低碳饮食，93%的人都能恢复正常血糖。
Well, I can tell you that the people with prediabetes in my practice North Of Liverpool, ninety three percent of them will get a completely normal blood sugar if they go low carb.
93%的逆转率，而且效果能持续好几年，我都跟踪过。
Ninety three percent resolution, and that will last for years because I've checked.
明白了。
Okay.
那我们干脆等十年，等史蒂文你真得了二型糖尿病，再开始低碳饮食，怎么样？
How about we wait for the ten years and Steven until Steven, you've got type two diabetes and then you go low carb.
到那时候，如果我能早点介入，还有73%的几率让你血糖恢复正常。
At that point, if I can get you early, I've got a seventy three percent chance of you having a normal blood sugar.
再拖几年吧，反正你舍不得放弃面包、薯片和披萨。
Let's wait another few years because you don't want to give up bread and you don't want to give up chips and pizza.
说得通。
Fair enough.
那我等吧。
I'll wait.
但如果你等五年，你恢复正常血糖的几率就只剩一半了。
But, you know, if we wait five years, you only stand a fifty percent chance.
所以你看，从九十三 percent 到七十 percent，再到五十 percent，几率是越来越低。
So do you see it goes ninety three over seventy percent, fifty percent.
所以，我越晚干预，就越难帮你摆脱药物，也越难给你最好的治疗。
So the chances of me not needing drugs and be able to do a good job for you are diminishing.
所以说，早做早安心。
So really, it's a stitch in time.
对。
Mhmm.
很多人根本不知道这些事。
And so much of this, don't even know.
你根本不清楚情况有多严重。
You don't even know what's going on.
其中一个
One of the
让我惊讶的是，我们对食物里到底有什么了解得太少了。
things that shocks me is, is how little we know about what's in our food.
是的。
Yes.
你知道，我觉得大家都明白，像饼干这种食物的升糖指数很高。
You know, because I think we all know that, like, biscuits are a food that has a high glycemic index.
说得好。
Well done.
‘升糖指数’这个词是我从这个播客里学到的，意思是
Which is a term that I've learned from this podcast, which means
有些碳水化合物比其他更含糖。
Some carbohydrates are more sugary than others.
所以这就是升糖指数。
And then So that's the glycemic index.
它实际上是把不同碳水化合物和纯葡萄糖做对比。
What that is doing is comparing different carbohydrates with pure glucose.
哦，原来如此。
Oh, okay.
纯葡萄糖是100，其他糖类的数值就低一些。
So you see pure glucose is a 100, and then other sugars come further down.
但其实有个比血糖指数更好的指标，叫血糖负荷。
But there is there's something better than the glycemic index, and that's called the glycemic load.
血糖负荷会考虑食物的分量，预测这一份食物实际会对你的血糖造成什么影响。
The glycemic load takes portions of food and predicts how will that portion of food actually affect your blood sugar.
我理解得对吗？血糖负荷会考虑食物中的营养成分吗？
And am I right in thinking the glycemic load would factor in the amount of nutrients in the food?
没错。
Exactly.
比如蛋白质和膳食纤维。
So like protein, fiber.
是的。
Yeah.
因为如果你吃西瓜，是的。
Because if you took watermelon Yeah.
它主要是水，对吧？
Well, it's mainly water, isn't it?
对。
Mhmm.
所以你得考虑进去。
So you have to factor in.
你得吃很多西瓜，才能相当于一块巧克力棒。
You can have quite a lot of watermelon, to equal a chocolate bar.
对。
Mhmm.
所以你还要看糖的密度。
So the density you're all you're looking at the density of sugar in it as well.
好的。
Okay.
所以这就是为什么血糖负荷这个指标更靠谱。
So that's why the glycemic load is better.
在你的职业生涯中，有没有哪个时刻让你开始怀疑你之前听到的说法？
Was there was there a moment in your career where you started to question what you had been told?
是的。
Yeah.
你知道，刚当医生的时候。
You know, so you start as a young doctor.
我想加入一个小社区，留在那里，真正帮上忙。
I wanted to be part of a small community and stay there and make a difference.
但后来，真正让人难过的事情来了。
And then comes the sad bit really.
所以头二十五年，我一直按指南上的说法去做。
So I for the first twenty five years, I was trying to do what's in the guidelines.
我只是想做个好医生。
I was trying to be a good doctor.
但我注意到了两件事。
But what I noticed, I noticed two things.
第一点，我已经跟你说过，我负责的那群人的健康状况在不断下滑。
Number one, I noticed what I've already said to you that the health of the population I cared for was deteriorating.
情况并没有好转。
It wasn't getting better.
如果我是负责这家诊所、照顾这些人的医生，而健康状况却越来越差，那我不该承担责任吗？
So if I'm the doctor in charge of the practice looking after these people and health is deteriorating, am I not responsible?
我当初指望能带来的那些改变，到底去哪儿了？
And where's where is all this difference I was hoping to make?
结果根本没达到预期。
It just wasn't panning out.
同时，我心里也总觉得，动不动就开一大堆药，有点不对劲。
At the same time, I'd in my heart felt that prescribing lots of drugs felt a bit wrong.
这感觉就像一次小小的失败，一个人每天吃六片药，怎么能算健康呢？
It felt like a mini failure because how is somebody well if they're taking six tablets a day?
你有没有遇到过特别印象深刻的病人？
Was there one particular patient that you met?
有两位。
There were two.
发生了两件事，都跟两位非常有主见的女性有关。
Two things happened, both to do with very powerful women.
第一位是位我认识了十多年的老患者。
The first powerful woman was a lady I'd known for over ten years.
她和她丈夫都由我照看。
She and her husband had cared for them both.
两人都有控制不佳的糖尿病，而且体重都很重。
They both had poorly controlled diabetes and they were both very heavy.
那时候，我还能追踪病人吃药的依从性。
At the time, I could monitor how my how compliant my patients were with their medication.
说实话，这部分收入确实跟这个有关。
And if I'm to be truthful, in part, that was how I was paid.
我的一部分收入，就来自这些患者都在服用二甲双胍——这是治疗二型糖尿病最常用的药。
So part of my payment was to do with all the patients having, in this case, metformin, the most commonly used drug for type two diabetes.
你的收入的一部分？
Part of your payment?
是的。
Yeah.
对。
Yeah.
你什么意思？
What do mean?
因为政府鼓励我们给二型糖尿病患者开药，会设定一个指标，要求一定比例的患者必须使用二甲双胍，这算作规范诊疗。
Well, because there's a you're supposed to the government approve of the fact that we give drugs that are needed for type two diabetes so that you're given a sort of quota where it's it's regarded as good practice that such a a certain percentage of your patients will be on metformin.
什么？
What?
是的。
Yeah.
确实如此。
It's true.
所以可以说，你有动力让病人服用二甲双胍吗？
So is it fair to say that you were somewhat incentivized to give people metformin?
对。
Yes.
没错。
That would be true.
但我们也得承认，当时的研究证据表明，给二型糖尿病患者开二甲双胍是合理的做法，而不开反而属于不当医疗——这点我们后面再细说。
But I think we should also be fair to say that the body of evidence at the time would say, that it's good practice to give metformin to people with type two diabetes and conversely poor practice not to use metformin but we'll develop that.
所以背景是，我们会追踪那些停用二甲双胍的病人，因为这不仅属于不当医疗，还会直接让我蒙受损失。
So the backdrop is we're monitoring the patients who stop taking their metformin because that, is number one, poor practice, and number two, actually cost me.
于是我给那位女士写了封信，亲爱的某某太太，我注意到您似乎没有在继续服用二甲双胍，我很担心。
So I wrote to the person, dear missus so and so, I'm concerned that, you're not you don't seem to be taking your metformin.
请尽快安排时间来见我。
Please make an appointment with me at your earliest convenience.
很英式，也很有礼貌。
Very British, very polite.
不过，那天早上发生的事完全出乎我的意料，从那以后，我的人生彻底改变了。
Anyway, nothing prepared me for what was gonna happen that morning and it's changed my entire life on that point.
那位女士，我们叫她琼斯夫人吧——其实不是她真名——她直接冲进来，对我说：‘你是不是想训我一顿啊，厄温医生？’
So the lady, let's call her missus Jones, that wasn't her name, she marches in and, she said to me, you think you're gonna tell me off, don't you doctor Unwin?
我得让你明白一件事。
Well, I've got news for you.
该被训的人是你。
I'm gonna tell you off.
我当时吓坏了。
I was scared.
这到底怎么回事？
Like, what's going on?
她以前从没这样过。
She'd never been like this before.
她一向很有礼貌。
She was a a polite person.
不过，她接着解释道。
Anyway, she went on to explain.
她说，你给我做的血糖检测会显示，即使我没吃你的二甲双胍，我的血糖也完全正常。
She said, when you do my blood tests, you will find that my blood glucose is completely normal despite not taking your metformin.
她还说，我怀疑你到底有没有资格当医生——过去十年里，你有没有哪一次告诉过我，面包是糖，早餐麦片也是糖？
And she said, I'm wondering if you're actually qualified as a doctor because in the last ten years did you ever once tell me that bread was sugar or breakfast cereals were sugar?
我后来自己上网查了，才知道面包是糖，米饭是糖，早餐麦片也是糖，我一戒掉这些食物，就根本不需要你的二甲双胍了。
I had to learn online, that bread is sugar, that rice is sugar, that breakfast cereals are sugar, and when I cut those foods, I don't need your metformin now.
她还火上浇油。
And she she made it worse.
她说，这可是初中生物课的内容。
She said, this is schoolboy biology.
你十六岁的时候就该懂这个了。
You should have learned that when you were 16.
我特别害怕，你知道，作为全科医生被投诉可不是小事。
I was dead scared because, you know, complaints as a GP is really bad.
这种事能记好多年呢。
They're gone for years and years.
但我最怕的是，她说的每一句话都对。
But mainly I was scared because every word she said was true.
我后来明白了一点，当医生年纪大了，就得认真听病人说话。
And one thing I had learned about when you're an older doctor is you've got to listen to people properly.
如果病人有意见，别否认。
If they're complaining, don't deny it.
别为自己辩解。
Don't defend yourself.
先认下来。
Take it.
所以我跟她说，好吧。
So I said, okay.
我想了解清楚，如果真是这样，你愿意再跟我见一面吗？
I've got I want to learn what you You know, if this is true, will you meet me again?
我们来做个血液检查吧。
Let's do the blood test.
于是我们就做了血液检查。
So we did the blood test.
结果是真的。
It was true.
这是我见过的第一例不用药物控制的二型糖尿病病例。
It was the first case of drug free type two diabetes I had ever seen.
二十五年来，我从没见过一个病人能停药的。
I'd never seen a single case in twenty five years where people came off medication.
我特别着迷，因为她做到了，简直像奇迹一样。
I was fascinated because she'd done it like a miracle.
但我还刚跟你说过另一个细节。
But there was another detail I just shared with you.
她是四万名在线学习者中的一员，大家互相交流怎么做这件事。
She was one of 40,000 people online learning from each other how to do it.
我一看，发现这些人都被医疗专业人士贬低了。
And when I looked, they were being rubbished by the health care professionals.
像我这样的人告诉他们：你会死的。
So people like me were telling them you'll die.
你这么做太危险了。
What you're doing is dangerous.
我感到很羞愧，真的非常羞愧。
And I was ashamed, really ashamed.
但这纯属巧合。
And it's complete coincidence.
就在同一个月，我们得介绍一下我妻子，珍。
But in the same month, we we have to introduce my wife, Jen.
有照片吗？
Is there a photo?
来吧，让我们看看珍。
Come on, let's see Jen.
这是珍。
This is Jen.
哦。
Oh.
她可能是世界上最聪明的女人。
She's probably the cleverest woman in the world.
她真的太聪明了。
She's so clever.
我爱这个女人。
I love that woman.
珍是临床健康心理学家，她特别关注希望在疾病中的作用，以及它能带来怎样的改变。
So Jen, so her back, she is a clinical health psychologist and she specializes She's fascinated by the role of hope in disease and the difference it can make.
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她一生都在研究希望对临床结果产生的影响。
She spent her life researching the difference that hope makes to clinical outcomes.
巧的是，有一天她在超市里看到一本打折的减肥书。
So it just so happened that she was in a supermarket and she saw some a discounted diet book.
就是这本。
That and that's the book.
《摆脱节食试验》，作者是约翰·布里弗医生。
Escape the Diet Trial by doctor John Brifer.
是的。
Yeah.
约翰·布里弗医生。
Doctor John Brifer.
真是个讨人喜欢的人。
What a lovely guy.
就在我和她聊起那位病人的时候，珍买了这本书。
So Jen bought that book just around the time I'm telling her about this patient.
她说，你得读读这本书，讲的是低碳水饮食如何应对胰岛素抵抗和二型糖尿病。
So she said, you have to read this book about a low carbohydrate approach to insulin resistance to type two diabetes.
书里写的，全是我那个病人跟我讲过的事，只不过用的是医学语言，我一下子就明白了。
And in the book, everything that my patient had told me was there but it was done in a medical way and I understood.
她对我说，大卫，为什么呢？
She said, David, why?
你为什么总是做不好呢？
Why are you sort of failing?
在你退休之前，为什么不试一件小事？
Why don't you do one thing before you retire?
为什么不做点你真心相信、能让人开心的事呢？
Why can't you do a cheerful something you really believe in?
你为什么不亲自试试低碳饮食呢？
Why don't you have a go at this low carb?
就从你自己开始。
Yourself.
是的。
Yeah.
她说，你和我一起试试这个饮食法，看看有没有病人愿意跟着我们一起做？
She said, why don't you and me go on this diet, see if some patients would volunteer and do it with us?
我跟其他合伙人提了，他们不同意。
I mentioned it to the partners and they said no.
这些都是其他医生。
These are other doctors.
是的。
Yeah.
我是资深合伙人。
So I'm senior partner.
按理说我是负责人。
I'm supposedly the boss.
但那时候，低碳饮食还不被认可，他们都不喜欢这个主意。
But at the time, low carb was not respectable and they didn't like it.
他们说，我们不希望你做这件事。
And they said, We don't want you to do this.
部分原因是他们问，这么做真的符合诊所的资源利用吗？
And partly because they said, Well, how You know, is that a good use of the resources of the practice?
如果你专心做这个，大卫，那是不是就没时间处理肺炎或者其他病患了？医疗系统那边压力也大。
Because if you're doing this, David, maybe you're not treating chest infections or other things and there's pressure on the health service.
他们觉得这有点太自我放纵了。
This felt a bit They felt it was a bit self indulgent.
于是我回家跟妻子说，合伙人不同意。
So I got back to my wife and said, The partners say no.
她却说，我告诉你我们该怎么办。
And she said, I'll tell you what we're gonna do.
咱们俩都免费干，自己把这事做了。
We're both gonna work for free and we'll do it.
为什么不趁晚上诊所没人的时候，用我们自己的时间来做？
Why don't we do this in our own time in an evening when the practice no resources?
所以我们就这么做了。
So that's exactly what we did.
我们从病人里找到了18个愿意参与的人，加上珍和我，一共20个人，每周一晚上聚在一起，聊低碳饮食，学着怎么做饭、怎么操作。
We found 18 volunteers who were interested amongst the patients and then Jen and I, so that was 20 of us, we started meeting every Monday night talking about low carb, learning how do you cook stuff, how do you do it.
我们一起干的。
We did it together.
有一位护士特别激动，她叫希瑟，咱们给希瑟点个赞吧。
And one of the nurses was so excited, Heather is her name, let's give her a, you know, thumbs up to Heather.
希瑟说，我免费帮忙。
Heather said, I'll work for free.
我来帮你们。
I'll help you.
我特别想参与这个事。
I'd love to do this.
我想相信自己在做的事。
I want to I want to believe in what I do.
然后，奇迹就开始了。
And then the magic begins.
结果出来的时候，我简直不敢相信。
The results, I couldn't believe it.
我真的从来没见到过这样的情况。
I could not You know, I'd never seen anything like it.
我最先注意到的是肝功能在改善。
And the first thing the first thing I saw was the liver function improving.
因为我一直在做血液检查，我知道自己在做点不寻常的事。
You see, because I'm doing blood tests because I know I'm doing something weird.
我做的事可能会被人批评。
I'm doing something that I would be criticized for.
所以如果你要做点与众不同的事，就得拿数据说话。
So if you're gonna do a weird thing, you need to measure stuff.
这些可是病人啊，你不能随便试验，得想想会不会害了他们。
You can't You know, these are patients, so you can't just experiment and not be, am I doing harm?
胆固醇和血脂指标有什么变化？
What's happening what's happening to the cholesterol and the lipid profiles?
所以我一直在密切监测各种数据。
So I was monitoring stuff really closely.
不过，史蒂文，肝脏功能才是关键。
The liver function though, Steven.
我原本以为那些人喝酒，肝功能异常是酒精造成的。
I got people who I thought they were drinking alcohol and I thought their liver problem was due to alcohol.
他们肝功能异常都十年了，结果几周内就明显好转，常常提升了三分之一甚至一半。
And they'd had abnormal liver function for ten years and suddenly within weeks, the liver function was improving often by a third or 50%.
我简直太兴奋了。
I was so excited.
你能想象吗？
Can you imagine?
我坐在那儿，化验单一张张出来，我都惊呆了。
I'm sitting there and the laboratory results are coming in and they're like, wow.
然后是一个又一个。
And then another and another.
所以这是第一件事。
So that was the first thing.
然后是体重。
Then the weight.
我们每周一晚上都聚在一起，备了秤，每个人每周一晚上都称体重，结果体重开始往下掉。
So we're all meeting every Monday night and we got the scales and everybody gets weighed every Monday night and the weight started falling off people.
真的掉得很明显。
It really did.
接着各种奇怪的现象也开始出现，有些现象我好几年都搞不明白。
And then all sorts of other weird stuff started happening, some of which I couldn't make sense of for years.
第一个是，有人问我：你饿吗？因为我一点都不饿。
First one was people said, are you hungry because I'm not?
然后他们开始问：非得吃早餐吗？
And they started saying things like, do you have to eat breakfast?
我也不觉得饿。
Where And I also, I wasn't hungry.
我一点都不饿。
I wasn't hungry.
他们说的是真的，因为我跟他们有同样的感受。
They were telling me the truth because I was experiencing this with them.
我们怎么就不饿了呢？
Why are we not hungry?
这太奇怪了。
That's so odd.
我开始不碰早餐了，干脆就不吃。
And I was starting I not bothering with breakfast so I didn't eat it.
根本不用吃早餐。
You don't have to have it.
我的肚子也慢慢瘪下去了。
And my and my belly went away.
接下来我注意到，从桌子前站起来时，我感到头晕。
Next thing was I noticed when I stood up from my desk, I felt dizzy.
真奇怪。
Weird.
我一直没跟任何人说，但我多年以来血压偏高。
Now I hadn't told anybody but I had moderate high blood pressure for years.
但我讨厌当病人，是的。
But I didn't like to be a patient Mhmm.
所以我从不去看医生。
So I never went to a doctor.
我就假装没这回事，血压高了好多年。
I just put my head in the sand, so I had high blood pressure for years.
我量血压的时候，结果却是正常偏低。
When I took my blood pressure, it was low normal.
这是为什么？
Why?
我当时根本不知道。
I didn't know.
但对病人我也在做同样的事。
But on the patients as well, I'm doing that as well.
我一直在测血压，情况在好转。
I'm measuring all the blood pressure and it's improving.
事情越来越奇怪了。
So it's getting weirder and weirder.
肝功能在改善，体重在下降，血压也在好转。
Liver function improving, weight going down, blood pressure improving.
那时候我们做的血液检查叫糖化血红蛋白A1C。
In those days, we were the blood test that we we did was a thing called the hemoglobin a one c.
在美国，A1C反映的是过去三个月里你血液里的平均血糖水平。
The A1C in America, this is the average sugariness of your blood for the preceding three months.
所以结果出来得比较慢。
So the results take a while.
但当糖化血红蛋白A1C的结果出来时，真相就摆在眼前了。
But then when the hemoglobin A1C came in, there it was.
我们看到患者的平均血糖水平出现了惊人的改善。
We were getting really spectacular improvements in average blood sugar.
事情就是这么开始的。
And that's kind of how it began.
那是2013年，也就是十三年前了。
So that's 2013, so that's thirteen years ago.
之后的事大家都知道了，但我当时真的被震撼到了。
And the rest is history, but that I was completely blown away.
我对其他各种现象充满了好奇，想知道到底是怎么回事。
And I was full of curiosity about all these other things and how was it.
为什么这些指标都在好转？
Why were these things improving?
在这十三年里，
So in those thirteen years,
你的体能和健康状况有什么变化？
how has your fitness, your health changed?
我的思维能力明显变强了。
My mental powers were much greater.
我能更专注了。
I could concentrate better.
我不再那么容易焦躁了，这一点我注意到了。
I wasn't fretty, so I noticed that.
接下来我发现，我需要的睡眠少了很多。
Next thing I noticed was I needed a lot less sleep.
刚开始的时候，我每天中午都得在医生的沙发上小睡一会儿。
So yeah, in the beginning, I used to have to have a little sleep on my doctor's couch every lunchtime.
我是资深合伙人，所以我会把门禁用上，拉上窗帘，在自己的沙发上小睡二十分钟。
So I'm a senior partner, so you press do not disturb and you put the curtains round and have a little nap on my own couch for twenty minutes.
那时候，这几乎是让我撑完一天的唯一办法。
It was the only way I could get through the day.
我不再需要午睡了。
I didn't need that nap anymore.
我也没那么困了。
I was less sleepy.
每天少睡一个小时就够了。
I needed an hour's less sleep a day.
我思考得更清晰了。
I could think better.
面对同样的问题，我能应对得更好了。
I was I could cope with the same problems.
这真是太奇怪了。
And this is so weird.
在精神上，我变得更强大了。
Mentally, I was stronger.
感觉就像回到了年轻的时候。
It was like being a younger man.
我也不太清楚是怎么回事。
The way I don't know.
对。
Yeah.
我觉得你有一种心理上的爆发力。
I think you have a sense of mental horsepower.
我们回到刚才的话题，你提到现在听我们说话的每个人，未来健康状况都会不一样。
Going back to the top of this conversation, you talked about how everybody listening right now has a variety of different health futures.
是的。
Yeah.
而他们最终会走向哪种健康状态，取决于每天所做的选择。
And which which health future they end up in is gonna be determined by the everyday decisions they make.
没错。
Yes.
没错。
Yes.
我想重点聊聊这些日常选择。
So I wanna really zoom in on some of those everyday decisions.
我们之前说到你和你的饼干。
We talked about you and your biscuits.
那时候你说，作为医生，你可能相当缺乏运动，是吧。
And at the time, you said you were you were probably quite sedentary as a doctor Yeah.
整天坐在椅子上，接待病人，是吧。
Sitting in a chair, patients Yeah.
你那时候根本不锻炼吗？
Coming You weren't doing exercise?
没有。
No.
我根本不觉得锻炼能有多大影响。
I didn't fundamentally believe it would make that much difference.
这真是个特别好的观点。
And this is such a great point.
你这个观点真的特别到位。
You've you've really great point.
那我们来聊聊减重这件事。
So let's think about weight loss.
我以前给病人提减重建议时，总说少吃点、多动点。
So I would give advice on weight loss to my patients and I would say eat less and move more.
有时候我甚至还会提一句布痕瓦尔德的事，你知道的，那儿没人胖过。
And I'd even sometimes say that Belsen thing, you know, the no fat people came out of Belsen.
我从来没听过这种说法。
I've never heard that before.
对病人说这种话，是不是太残忍了？
But it's a horrible thing to say to a patient, isn't it?
布痕瓦尔德是什么地方？
What's Belsen?
那是二战时期，那儿的人都饿得不行。
Well, that's in World War II where they all starved
哦，原来如此。
by Oh, okay.
所以你的意思是，你对有肥胖问题的人说
So the point is you're saying to somebody with an obesity problem
这是他们的错。
It's their fault.
是的。
Yes.
你在怪他们。
You're blaming them.
这正是关键所在。
That's exactly the point.
而我以前就是这样做的。
And that's what I did.
更糟的是，我给了他们这些建议，但几乎从来不管用。
And it's worse than that because I give them that advice and it just about never works.
我做了一件很糟糕的事。
I did a horrible thing.
我以前老对他们说，对吧。
I used to say to them, right.
那你每天就吃两勺全麦麸片不好吗？
So why don't you just have two tablespoons of all bran a day?
就是早餐麦片。
Oh, breakfast cereal.
是的。
Yeah.
配上脱脂牛奶，再建议他们吃点复合维生素，每天喝两品脱脱脂牛奶。
With skimmed milk, and I would advise a few multivitamins and a couple of pints of skimmed milk a day.
这就是我的建议。
That was my advice.
结果没效果的时候，你觉得我怪谁？
And then when it didn't work, who do you think I blamed?
是他们。
Them.
对。
Yeah.
这都是我顿悟的一部分。
This was all part of my epiphany.
我从来没意识到，问题不在他们身上。
I never joined the dots that the failure was not theirs.
问题在我自己。
It was mine.
这真的很糟糕，对吧？
And that's horrible, isn't it?
想象一下，二十五年来我一直把患者减重失败归咎于他们，其实错在我，因为我给他们的建议根本没用。
Imagine twenty five years of I was blaming patients for their failure to lose weight And it was my failure because I didn't give them advice that worked.
如果你一直对人重复同样的建议，却始终不见效，难道不该反思吗？但整个社会都没人这么做。
And if you keep giving the same advice to people and it doesn't work, shouldn't I have questioned, but it's not happening in society overall.
我们现在怎么样？
How are we doing?
我们的健康状况如何？
How are we doing with health?
情况进展得怎么样？
How's it going?
这简直是一团糟，对吧？
It's a disaster, isn't it?
所以我们得换个方法了。
So we need to do something different.
但过去二十五年，我一直不觉得生活方式是关键，现在我才明白。
But for me, for twenty five years, I did not believe that lifestyle was key and now I do.
所以我以前根本没觉得饼干的影响有多大。
And that's why I didn't I didn't think that the biscuits made that much difference.
当然，我懂基本营养，知道得保证蛋白质、铁这些成分。
Obviously, I knew basic nutrition, I made sure there's protein and there's iron and stuff.
我一直以来都坚信，治病就得靠药物和医疗，生活方式不过是锦上添花而已。
I fundamentally believed that drugs is what I should be using, medication, and that lifestyle was a sort of add on.
这难道不可怕吗？
Isn't that terrible?
我觉得这一点特别重要，因为它正好反映了普通人的真实想法。
I I think this is so important because it really gets to what I believe the average person thinks as well.
对。
Yeah.
没错。
Yeah.
在正式录音之前，我们聊到了我一些朋友的事。
We were talking before we started recording about some of my friends.
我提到了两个朋友。
They are there's there's two friends I mentioned.
其中一个是个非常成功的企业家。
One of them is a very, very successful businessman.
人人都知道这个人是谁。
Everybody knows who this person is.
这个周末他们问我，披萨健康吗？
And they asked me this weekend, is pizza healthy?
我简直不敢相信，这太让人震惊了。
And I just couldn't believe I it It's gobsmacking.
就是，什么披萨？
It's like, oh, what pizza?
什么？
What?
因为他们通常要选一份大号的十二英寸披萨当午餐。
Because they were choose trying to choose between they usually have a big 12 inch pizza Yeah.
当午餐。
For lunch.
他问我，斯蒂文，哪个更健康？
And and he was asking me, what's healthier, Steven?
是选Nando's的鸡肉，还是他打算吃的那张12英寸的披萨？
Nando's chicken or this 12 inch pizza he was gonna get?
我盯着他，简直像看见了幽灵一样。
And I literally looked at him, like, I was looking at a ghost.
我当时就想，你是不是在逗我？
I was like, are you winding me up?
但他真是认真的。
And he was genuinely serious.
他快六十岁了，居然不知道鸡胸肉比一张12英寸的披萨更健康。
He's almost 60 years old now, and he doesn't know if a chicken breast is healthier than a 12 inch pizza.
我之前跟你说过的另一个例子，是位著名的英超足球巨星，你肯定会觉得他从小在青训营待了十几年，当了职业运动员，肯定清楚哪些东西含糖、哪些不含。
And the other example that I mentioned to you before we start recording is a very famous Premier League football superstar legend who you would assume had gone through those sort of fifteen, twenty years of of being an academy player and then a a pro athlete knows what has sugar in and what doesn't.
他居然问我，一大份意大利肉酱面，那算健康食品吗？
And he was asking me, is is a big spaghetti carbonara, is that healthy?
那算健康餐吗？
Is that health food?
他说在踢球的时候，球队一直让他们多吃碳水化合物。
Because he said to me during his football years, they were told always to carb load.
这让我特别有同理心，因为我突然意识到，虽然现在有这么多讨论健康的播客，互联网上信息也这么丰富，但普通人就是接收不到这些知识，原因不明。
And again, this it it gave me a huge amount of empathy because it made me realize how even though there's podcast like this where we talk so much about health and even though there's the Internet now, the app this information is not getting through to the average person for some reason.
我相信，他们也和你刚才说的一样，这么想。
And they too, I believe, think exactly what you just said.
他们觉得健康不过是个附加品，反正命运早就注定了。
That health is, you know, it's this sort of accessory where my fate is determined anyway.
就算做点健康的事儿，麻烦还不少，可这些珀西小猪糖吃起来真香啊。
And if I do this health stuff, which is a bit of an inconvenience because these Percy pigs taste great Yeah.
这些糖果味道确实好，吃了可能外形会好看一点，但归根结底，命运早就定了。
Or these these these candies taste great, then I might be able to look a little bit better, a little bit more aesthetically pleasing, but my fate is determined.
简单来说，营养知识我们根本没在教。
The simple point, yeah, nutrition, we're not teaching it.
其实就三种宏量营养素。
So there's only three macronutrients.
就只有蛋白质、脂肪和碳水化合物这三种。
There's only protein, fats, and carbohydrate.
可你的那些朋友，连这三种基本营养素都不清楚，但他们照样成功又聪明。
And yet, your friends there haven't even got the three macronutrients, and they are successful, intelligent people.
对。
Mhmm.
这说明我们 somewhere 走偏了，不是吗？
So somewhere, we're going badly wrong, aren't we?
我脑子里还有一个特别明显的例子，我现在正在参加《龙穴》节目，有个人来推销一个水果零食项目。
There is another example that's really front of mind to me, which was, you know, I'm in Dragon's Den at the moment, and someone came in and pitched a fruit snack business.
其实就是把水果烘干做成的小块。
And it's basically dried out fruit pieces.
你看啊，
Now, looked
背后一看。
at the back.
我越听越觉得有意思。
I'm loving this already.
对。
Yeah.
我看了背面，确实如此。
I looked at the back Yes.
上面写着糖分含量在百分之六十到七十之间。
And it said, in the range of 60 to 70% sugar.
因为他们用的是芒果这类热带水果，对。
Because what they've done is they've taken exotic fruits like mangoes Yeah.
把水果烘干后，就成了这种小片状的芒果干。
Dried them out, and now you have this little chip, which is this this piece of mango.
糖分占了六到七成。
Sixty, 70% sugar.
我盯着包装背面想，这根本就是糖果。
So I'm looking at the back of this thing thinking, this is candy.
是的
Yeah.
这其实就是糖果。
This is basically candy.
谢谢。
Thank you.
但我环顾四周，因为上面写了‘水果’这个词，
But I'm looking around and every because it because it uses the word fruit
对。
Yes.
大家就自然而然觉得，只要是标着‘水果’的，比如水果汁、水果零食，
People have this sort of halo assumption that if the word fruit is on it, fruit juice, fruit snack.
肯定卖得出去。
It'll sell.
对。
Yeah.
而且谁在乎后果呢？反正能赚大钱。
And who and also, it's a sort of who cares about the consequence, but will make a pile of money Yeah.
卖那些干果，人们却忽略了背面写的成分。
Selling dried up fruit, and they miss what you read on the back.
对。
Yeah.
含糖量高达百分之六十七。
It's 67% sugar.
我当时就想，
I was
这怎么就不是呢？
like, this is How's not that?
你想想，要是有人得了二型糖尿病怎么办？
You know, what if somebody had Type 2 diabetes?
至于孩子，反正就给他们吃呗。
What For kids, we'll just give them yeah.
你刚才提到的，其实还涉及另一个问题，就是现在哪里出了错。
And I You've touched on another thing about what's going wrong.
当我观察我的临床实践和这种现象时，就像我之前说的，这根本不是什么流行病，而是一场全球大流行。
So when we look at my practice and this epidemic, and really as I've said already, it's not an epidemic, it's a pandemic.
到处都是。
It's everywhere.
我走遍世界各地，肥胖、二型糖尿病、代谢健康恶化，无处不在。
I go all over the world and obesity, type two diabetes, poor metabolic health is in it's everywhere.
到处都是。
It's everywhere.
我觉得，跟你刚才说的有关，你早上醒来，第一件事就是吃麦片当早餐。
And I think one of the things touching on what you just said is so you you wake up and you have your cereals for breakfast.
你这儿就有。
You've got some here.
我们这儿也有几款麦片。
Which we have some cereals there.
然后你还会喝一大杯新鲜橙汁，对吧？
And then, you'll have Why don't why don't you have a big glass of fresh orange juice as well?
这主意不错。
Great idea.
好了，这就是你的早餐了。
And then, okay, that's your breakfast.
但上班路上你还会吃点小零食，很多人都这样。
But then on the way in, you have a little snack and people do.
他们会买一根能量棒、一包薯片，或者类似的东西。
They buy a bar or some crisps or something like that.
甚至在学校，上午中间还可能吃个松饼。
And then even at school, they might get a muffin midmorning.
这倒也正常。
That's fair enough.
然后他们可能再吃个苹果。
They might then have an apple.
到了午餐时间，你会吃三明治，吃完之后，可能还会再吃块蛋糕或者来点冰淇淋。
At lunchtime, you're gonna have some sandwiches and then you've eaten your sandwich so you'll I don't know, you might have might have a cake or something or some ice cream.
回家后，到了该吃点东西的时候，可能是薯条或者披萨。
Then you go home and then it's time for you know, maybe your chips or your pizza.
你一整天都在不停地吃糖，糖，糖，糖，糖，全是糖。
What you've actually done is has sugar with your sugar, with your sugar, sugar, sugar, sugar, sugar all day long.
那蛋白质去哪儿了？你成长需要的蛋白质，几乎都没摄入。
There's hardly any protein going back then to those macro where was the protein to grow you?
你明白吧？
You know?
问题就在这儿。
And that that's the thing.
过去可不是这样，现在孩子整天吃零食。我见过很多年轻人，妈妈都说：‘我怎么都让他吃不下正经饭。’
That that's changed over time that we are the snacking so I've I come across a lot of young people and their mother is saying, I can't get him to eat any proper food.
他一天到晚就吃零食，根本吃不下富含蛋白质的食物，有些孩子甚至都瘦得厉害。
He just eats snacks all day long, and it he won't I can't They can't get protein in them, and some of them are actually thin kids.
他们并不都胖。
They're not all fat.
我们来聊聊你刚才说的，顺着一天的时间线过一遍吧。
Let's talk about what you just said there, and we can walk through the day using Yes.
我们桌上这些食物。
The food we have on this table.
不过我要提醒一下，有些听众可能正在遛狗，看不见画面，所以我们得做个语音说明。
Now, I just wanna caution that we do have some people that are probably out walking their dog listening and can't see, so we're gonna have to do a bit of a voice over
好的。
Okay.
解释一下现在的情况。
As to what's going on.
对。
But Yeah.
你说早上醒来，吃的是麦片。
You said wake up in the morning, you have your cereal.
是的
Yeah.
小时候，我觉得早餐麦片是健康食品。
Now, cereal, growing up, I thought was a health food.
我也是。
Me too.
是的
Yeah.
我也是。
Me too.
一碗普通的糖霜麦片里到底有多少糖？
How much sugar is in the average standard bowl of, let's say, frosted cereal?
我们可以换种方式来讨论，史蒂文。
Well, we can do this different way, Steven.
对
Mhmm.
这其实是给你设的一个小测试。
This is actually like a test for you laid out here.
天哪。
Oh gosh.
这样可以吗？
Is that okay.
可以。
Yeah.
这是给你做的一个测试，我来解释一下：你面前有一碗，我们叫它玉米片。
This is a test for you and I'll describe So what you've got, you've got a bowl of we'll call them they're cornflakes.
对。
Mhmm.
还有一颗土豆，烤土豆。
Then you've got a potato, a baked potato.
还没烤呢，不过你想烤的话随时可以。
It isn't baked yet, but you could bake it if you want.
你这里有150克煮熟的米饭。
You've got a 150 grams, and this is boiled rice.
所以不是干的。
So it's not dry.
这是煮熟的米饭。
It's boiled rice.
你还有一个非常熟的香蕉。
You've got a very ripe banana.
最后呢，还有一块看着挺诱人的巧克力棒。
And at the end there, you've got a delicious looking chocolate bar.
是的。
Yeah.
你这儿还有一些方糖，这就是测试的部分了。
So you've got there, some cubes of sugar, and this is the test bit Okay.
你看我待会儿怎么给你评分。
You can see as to how I'm gonna give you we'll score you in the end.
好的。
Okay.
我希望你能把这些食物相对着来比较一下。
So what I'd like you to do is consider these relatively.
每一块方糖代表四克糖，也就是一茶匙的量。
And each of those cubes of sugar represents a four gram teaspoon of sugar.
对。
Yeah.
现在你依次看看这些食物，把每样对应的糖分量用茶匙数标出来，之后我会给你打分，看看你猜得怎么样。
So if you could now just go along these and put beside each food what you believe to be the equivalent in terms of teaspoons of sugar, and then I'll give you a score and see how you do.
好的。
Okay.
这些就是正确答案了，我先把它们调低，免得你偷看。
And and those are the answers, so I'm going to turn it down so you don't cheat.
好的。
Okay.
那我就按两年前自己的想法来打分吧。
So I'm gonna score them as I would have thought two years ago.
谢谢。
Thank you.
对。
Yes.
因为这两年我采访了很多专家，所以对这些数据我都挺震惊的。
Because because two years I've interviewed a lot of experts, so I'm I'm generally quite shocked by all these things.
不过呢。
But Yeah.
我要按两年前我31岁时的想法来打分。
I'm gonna score them as I would have thought when I was 31 years old two years ago.
所以是的。
So Yes.
很好。
That's great.
麦片啊，说实话，我以为没糖。
Cereal, honestly Yeah.
而且还有
I And there's
里面一点糖都没有。
no sugar on it.
这不是含糖麦片。
It's not a sugared cereal.
就是单纯的干麦片。
It's just the dry flakes.
我真没想到这里面会有糖。
I honestly didn't think there was sugar in that.
对。
Yeah.
所以如果你逼我说的话，我会觉得
So if you had pushed me, I would've
我们给它打一分吧，
We'll give it one,
我给它打一分。
I'll give it one.
谢谢。
Thank you.
但我真没觉得这里面有糖。
But I didn't think there was sugar in that.
一分。
One.
再说土豆，我根本没想到土豆里会有糖。
Again, a potato, I didn't think there was any sugar in a potato.
就算给它打一分，我也觉得是在说谎，因为我压根儿不觉得土豆里有糖。
So even giving it one feels like I'm lying because I didn't think there was sugar in potato.
说实话，米饭我也以为里面没糖。
And I'll be honest, rice, I didn't think there was any sugar in rice.
行。
K.
一根香蕉，嗯。
A banana Uh-huh.
尝起来是甜的。
It tastes sweet.
对。
Yes.
所以我的第一反应会是给一分。
So my brain would have said one.
是的。
Yeah.
但眼前这块巧克力，我会给两分。
But this this chocolate bar that's in front of me, I would have said, I'm gonna say two.
好的。
Okay.
我觉得是两个，或者我选三个。
Two or I'm gonna say three.
对。
Right.
我选三个。
I'm gonna say three.
其实我觉得是两个，没错。
I actually think it was two, but Right.
我本来以为这些东西加起来会有这么多糖。
That's how much sugar I would have thought was in all of these things here.
麦片、一个土豆、白米饭、一根香蕉，还有一块巧克力。
Cereal, a potato, white rice, a banana, and a chocolate bar.
对。
Right.
嗯，
Well
说真的，我到现在还是有点这么想，不过我明白这不对。
To be fair, I still kinda do, but I know better.
现在我来告诉你正确的数字。
So now I'm gonna give you the correct figure.
这个数字是根据我们之前讨论过的血糖负荷算出来的。
Now, this is worked out from the glycemic load that we already discussed.
我之前已经解释过血糖负荷了。
So I explained about the glycemic load.
在实际临床中，我遇到了一个问题。
And then so in clinical practice, I had a problem.
我的问题是，怎么在十分钟内让你明白该怎样吃、为什么要换种吃法。
My problem was in ten minutes, to explain to you how you could eat differently and why you should eat differently.
所以我需要一种快速的方式，向孩子、老人、老师这些不同人群，说明饮食选择的后果。
And so I needed a way of quickly communicating with children, with old people, with a teacher, the consequences of dietary choices.
于是我想出了一个新办法：与其用没人懂的葡萄糖克数来表示血糖负荷，不如重新计算，改用四克一勺的糖勺数来表示。
So I came up with a new idea which was, why don't we represent the glycemic load and instead of using grams of glucose, which nobody understands, and what's glucose anyway, instead of doing that, we redid the calculations, redoing it for t four gram teaspoons of sugar.
这就是我设计的以茶匙糖当量来表示的方法，现在我用它来给你准确的答案。
And that's my teaspoon of sugar equivalent system, and I'm using that now to give you the correct answer.
明白了。
Okay.
对。
Right.
所以玉米片的数值是八茶匙糖。
So the the cornflakes is 1245678.
八茶匙糖。
12345678.
还不算加糖霜。
With no frosting.
没加糖霜。
No frosting.
天啊。
On earth.
不加牛奶。
No milk.
什么都没有。
Nothing.
土豆的话，明显要看它的大小。
The potato, obviously, it depends on its size.
这个可真不小。
That's quite a big one.
这个是1234，还多着呢。
So that one is 1234, and there's more.
56加起来是9。
56, is 9.
就这样了。
There they go.
9。
9.
九块方糖。
Of nine sugar cubes.
是吗。
Is that Yeah.
对。
Right.
我打算把米饭留到最后。
I'm gonna leave the rice to last.
那条巧克力其实你可以帮我分一下。
That chocolate bar is actually you can do it for me.
七块半。
Is 7 and a half.
那你就给七块吧。
So you you can give it 7.
七块。
Seven.
七。
Seven.
香蕉的话，得看大小和熟度。
Now the banana depends on the size and how ripe it is.
熟透的香蕉糖分更高，你吃的时候应该能感觉到。
A ripe banana has more sugar in it, you probably know when you eat it.
但假设这个香蕉挺熟的吧。
But that, let's say that banana is quite a ripe one.
它看起来确实很熟了。
It looks quite ripe.
那就算六吧，因为个头比较大。
Let's say that's six because it's a big banana.
天哪。
Oh my gosh.
好的。
Okay.
那最后一个，明显是最厉害的，对吧？
Then the final one, obviously, is gonna be the killer, isn't it?
我以为米饭是健康的。
I thought rice was healthy.
嗯，我觉得这得看情况。
Well, I've thought was depends.
确实挺健康的。
Was really healthy.
这要看情况。
It depends.
比如，这150克是煮熟的米饭。
So one, this is a 150 grams of boiled rice.
三、四、五、六、七、八、九、十。
Three, four, five, six, seven, eight, nine, and ten.
所以这个才是冠军。
So that's the winner.
我认为这可以说是全球范围内最核心的事实。
And I would say that's the single fact around the world.
所以，我这一茶匙的糖，就在这里。
So my my teaspoon of sugar there we are.
这是我的其中一个糖分茶匙对照图。
That's one of my teaspoon of sugar charts.
你看到的这些信息包括：食物本身、血糖指数、份量，还有对应的糖分茶匙数。
So what you've got there is the food, the glycemic index, the the serving size, and then the teaspoons of sugar there.
这些资料都是公开可查的。
So this is available.
公共健康合作组织是我十年前和拉甘·查特吉医生一起创办的慈善机构。
The Public Health Collaboration is a charity I helped set up with doctor Rangan Chatterjee ten years ago.
明天就是我们成立十周年的纪念日。
It's our tenth anniversary tomorrow.
这些信息图实际上远不止这些。
These infographics, there are actually far more than this.
这里还有七个。
This is there's seven more.
它们已经被翻译成35种语言。
They're available in 35 languages.
志愿者们把它们翻译成各种语言，传播到世界各地。
Volunteers have translated this to go all over the world.
这些资料没有版权保护。
It's not copyrighted.
我希望大家尽管拿去用。
I want people to steal it.
拿去吧。
Take it.
好好用吧。
Use it.
关于白米饭的这个数据，让全世界的人都感到震惊，也让我变得广为人知。
So the the white rice fact, I would say, has astonished people all over the world and led to me becoming far better known.
那橙汁呢？
What what about orange juice?
很多家长，包括我父母，都给我喝橙汁。
A lot of, parents, including my parents, give me gave me orange juice.
是的。
Yeah.
我以前一直以为橙汁是健康食品。
And I used to think that orange juice was a health food.
所以我常常打开冰箱，拿一瓶 Sunny Delight 之类的饮料就喝。
So I would literally, I'd go to the fridge, I'd get open the Sunny Delight or whatever it was.
Sunny Delight。
Sunny Delight.
然后我就喝它。
And I would drink that.
对。
Yeah.
我觉得我会变得更强壮、更健硕，我的身体也会喜欢我。
And I think I'm gonna be strong and big and my body's gonna love me.
好吧，我们来谈谈。
Well, let's
橙汁里含糖量其实很高。
so the there's a lot of sugar in orange juice.
橙汁里的糖分真的很多。
It's a lot of sugar in orange juice.
你把橙子榨成果汁之后，就把原本天然的纤维都去掉啦，糖分一下子就冲上来了。
And you've taken away all the once you take it from the fruit as it was meant to be and you juice it, the sugar hit is fast.
对。
Mhmm.
如果再回过头来看胰岛素的问题，你喝下橙汁后，血糖会迅速飙升。
So what that does is if you think if we go back to insulin again, so you you you drink the orange juice, your blood sugar goes up rapidly.
于是身体就会立刻大量分泌胰岛素来应对。
So your body responds rapidly with insulin.
那接下来会发生什么？
Then you what happens?
血糖降下来了，可你又饿了。
Your blood sugar falls, but then you're kind of hungry again.
这不就是我吃饼干时的情况吗？
And that's what happened to me with the biscuits, wasn't it?
我吃了饼干。
I ate biscuits.
我的血糖就升高了。
My blood sugar is up.
然后胰岛素大量分泌，虽然来得慢，但量太多了。
Then insulin comes in heavy and slow but too much.
后来我以为自己是恐慌发作，其实是因为血糖太低。
Then I thought I was having a panic attack because I had low blood sugar.
那该怎么解决这个问题？
And what's the answer to that?
再来点饼干。
More biscuits.
然后你就又陷入这个循环了。
And round you go.
不停地转。
Round.
这就是为什么你如果不加思考，早上吃含糖量高但蛋白质不足的早餐，就会让你一直觉得饿。
And that's how without thinking, you'd start the day starting the day with a sugary breakfast without enough protein in it is driving hunger.
然后你就会纳闷，为什么到了十点肚子饿得发慌。
And then you wonder why you're ravenously hungry at 10:00.
还有几件事让我特别震惊。
There was a few others that shocked me.
其中一件是我在秘鲁的时候，是的。
One of them was I was in Peru Yeah.
而且大家都知道，秘鲁因为可可豆之类的东西，巧克力很有名。
And obviously, Peru's quite famous for chocolate because of the cacao and all that stuff.
是的。
Yeah.
于是我们去参加了一个巧克力制作课，他让我们分别制作黑巧克力、普通巧克力和白巧克力。
And so we went to a chocolate making class, and he told us to make dark chocolate, normal chocolate, and then white chocolate.
是的。
Yeah.
当我做白巧克力的时候，那个人给了我一个大玻璃圆筒。
And when I made the white chocolate, this guy got me this big glass cylinder.
他说：‘来，这是白砂糖。’
And he goes, here's some white sugar.
他让我：‘倒进去。’
He goes, pour it in.
于是我拿起来倒了一些，他连忙说：‘不不不不，朋友，别这样。’
So I, you know, I get it and I pour some in and I and he goes, no no no no, my friend.
倒进去。
Pour it in.
是的
Yeah.
我就一直倒啊倒啊倒啊，真的没骗你。
And I pour it and pour it and pour it and pour it and pour it and pour And I'm not kidding you.
我觉得我得核实一下事实，社区笔记请显示在屏幕上，Barab CEO团队。
I feel like and I have to check the facts here, so community note me on the screen, Barab CEO team.
我觉得我把整整一大玻璃筒都倒满了。
I feel like I poured into this huge glass cylinder Yep.
百分之八十都是白砂糖。
80% of white sugar.
对。
Yes.
你肯定会，这确实是真的。
You would It's true.
没错。
Yeah.
然后你刚才说，加点糖浆进去。
And then and then you said, put some syrup in.
什么？
I what?
糖浆。
Syrup.
这个是这个……
This is this
这是白砂糖。
is white sugar.
我当时以为是那种黏糊糊的东西，像油一样的东西。
It was like some syrupy stuff, some oil stuff.
我就想，白砂糖，白巧克力里头差不多80%都是它，确实如此。
And I was like, so white sugar so white chocolate is like 80% It is.
白砂糖。
White sugar.
是的
Yeah.
自从那以后，我就再没吃过白巧克力了
I've never eaten white chocolate since Yeah.
从来没有
Ever.
你这么做真的很重要
You've that's so important.
很多人觉得自己是巧克力成瘾者
So very often, think they're a chocoholic.
经常有人跟我说，我就是对巧克力上瘾
That's really common that people say to me, I'm I'm addicted to chocolate.
如果你仔细看看牛奶巧克力里的糖分，其实含糖量很高
If you look at if you actually look at how much sugar there is in milk chocolate, you know, there's many teaspoons of sugar in milk chocolate.
如果你吃90%的黑巧克力，一块里大概只有两茶匙糖
If you eat 90% dark chocolate, there's only about two teaspoons of sugar in a bar.
你发现那些巧克力成瘾的人呢，我会说，既然你对巧克力上瘾，干嘛不选含糖少的黑巧克力，来得更过瘾呢？
And what you find with the chocoholics is I say, well, if you're addicted to chocolate, why don't you get a bigger hit and have the dark chocolate?
他们就说，哎呀，那种我吃不了。
And they say, oh, I couldn't eat that.
太苦了。
It's too bitter.
他们真正上瘾的其实是糖。
What they're addicted to is the sugar.
所以我才做了这个。
What they're so I've done that.
家里人可能不知道，我做了一张关于巧克力含糖量的图表，就是想让大家明白自己吃下去的到底是什么。
There is for the the folks at home, there is one of these sugar infographics on chocolate on that subject of chocolate because I want people to understand the consequences of what they do.
我刚查了下数据，来给大家举个例子。
So just to illustrate this, because I've just we've just looked up the stats.
对吧？
Right?
是的
Yeah.
我觉得这正是我看到的那样。
I think this is this is this is what I saw.
是的
Yeah.
我刚查了相关数据
I've just looked up the facts to
要确保一点是
make sure one When thing is
我在秘鲁做的那块白巧克力，是的。
I made that bar of white chocolate in Peru Yeah.
这是全部成分，他们让我在里面加了这么多糖。
This was the total ingredients, and this is how much sugar I they asked me to put into it.
天哪。
Blimey.
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