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哪个对你更有害:糖还是脂肪? – 译学馆
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哪个对你更有害:糖还是脂肪?

Which is Worse For You: Sugar or Fat?

[♪片头]
[♪ INTRO]
几十年来 我们都听人说脂肪是如何如何的恐怖
We‘ve all heard for decades about how terrible fat is for us,
尤其是饱和脂肪
especially saturated fat.
在二十世纪七八十年代
In the 1970s and 80s,
每个人都被明确告知减少像黄油 芝士
everyone was explicitly told to cut down on foods like butter, cheese,
还有牛肉的摄入 避免心脏疾病和中风
and beef, to avoid heart attacks and strokes.
现在来看 显然它们还行?
But now, apparently, they’re ok?
或者说对你有益?
Or good for you?
或……一些其他的?
Or… something?
并且糖才是罪魁祸首!
And it’s sugar that’s bad!
糖正在杀死我们!
Sugar is what’s killing us!
如果我们在饮食中减少糖的摄取
If we just cut sugar from our diets,
那么 我们不仅能避免心脏疾病
we could rid the world of not only heart disease,
还能远离肥胖 糖尿病 甚至癌症
but also obesity, diabetes, and even cancer!
这一观点的转变看起来有些极端
The change in attitude might seem extreme,
但反对糖的理念已经存在几十年了
but the case against sugar has been building for decades,
然后反对饱和脂肪的声音正在减弱
while the one against saturated fat has been weakening.
尽管 我们都喜欢这个可爱的坏蛋
And yet, though we all love a good villain,
但当涉及到它和你的健康饮食时
when it comes to the health effects of your diet,
事情就没那么简单
things are rarely that simple.
今天 我们回望过去
Today, we’re taking a look back
看看营养学的历史 试图去理解
at the complex history of nutrition science to try to understand
饱和脂肪是如何变成头号人民公敌的
how saturated fat became public enemy NO.1.
当医生把注意力集中在脂肪上时
And how, when doctors zeroed in on fat,
他们忽视了糖的危害
they overlooked the damaging effects of sugar.
那也不意味着饱和脂肪酸成了替罪羊
But that doesn ’ t mean it should be the new saturated fat,
或说脂肪完全无罪
or that fat is entirely exonerated.
这些都难以定论
And while there still isn’t an easy answer
什么是最好的减肥食品
as to what diet is best for losing weight
或者能防止心脏疾病
or preventing heart disease,
减少诸如饱和脂肪
cutting down on things like saturated fats
以及糖的摄入可能是一个好的开始
and refined sugar is probably a good start.
20世纪40年代后期 Ancel Keys
Back in the late 1940s, Ancel Keys,
一位明尼苏达大学的生理学家
a physiologist at the University of Minnesota
他很困惑当时大量的美国商人
was puzzled by the fact that American businessmen seemed to be
死于心脏病
dying at an alarming rate from heart attacks.
这些中年男人有财力吃好的
These middle-aged men made more than enough money to to afford quality food.
但为什么这些人反而死得更早呢?
So why were they the ones keeling over?
他提出了一个概念
He hit upon an idea,
一个叫饮食心脏病的假设
often called the diet-heart hypothesis,
它永远的改变了人们20世纪的饮食习惯
that would forever alter 20th century food habits.
你脂肪的摄入量
That‘s the notion that the amount of fat you eat,
尤其是饱和脂肪酸
specifically saturated fats
就是脂肪碳链和氢一起 通过单键全部连在一起
—the ones where the fatty carbon chains are all connected
到最大 达到饱和
by single bonds, and therefore maxxed out, or saturated,
加上氢 就导致血脂升高
with hydrogens—leads to high levels of fats in your blood,
它会粘在血管壁引起冠心病
which then glom onto the walls of your blood vessels to cause coronary artery disease.
就好比往你的血管里倒入培根的油脂
It’s kind of like how pouring too much bacon fat
它将粘在血管里
down your drain can clog your pipes.
要多留心血液中的脂肪胆固醇浓度
Keys was especially concerned about blood levels of the fat cholesterol.
发现血管里有脂肪形成
Because it’s found in the fatty build ups in blood vessels.
于是他做了一些研究来验证他的想法
So he did a few small studies to test his idea,
决心一定要搞清楚
and then decided to go big or go home.
在7国的研究中
In the Seven Countries Study,
他和他的同事在13000位中年测试者中
he and his colleagues looked for correlations between diet and coronary artery disease
找寻饮食与冠心病之间的关联
in about 13,000 middle-aged men
这些人来自美国 日本 芬兰 南斯拉夫
in the U.S., Japan, Finland, Yugoslavia,
意大利 希腊 荷兰
Italy, Greece, and the Netherlands.
截止1970 早期的结果是
By 1970, the early results were in,
食用脂肪没有问题
and total dietary fat didn‘t seem to matter.
但摄入饱和脂肪高的人群
But the groups of men with the highest average saturated fat intake
多死于心脏病
tended to die more often from heart attacks,
全球
and across the globe,
血液中胆固醇水平与饱和脂肪摄入相关联
blood cholesterol levels correlated with saturated fat consumption.
另一个流行病学研究
Another large epidemiological study,
弗雷明翰心脏研究所支持这一判断
the Framingham Heart Study, further supported a link between
即血液中的胆固醇与心脏疾病的关联
blood cholesterol and the risk of heart disease.
这些研究表明两者之间有很强的关联
These studies showed robust correlations,
却仅仅是关联
but they were still just that: correlations.
许多人
Many people, though,
假定:减少脂肪的摄入可能会
assumed that these results meant that reducing fat intake would protect
使人们免于冠心病
people against coronary artery disease
那不是一个相关性研究能肯定的
which is not something a correlational study can actually show.
少数的研究者设法
A handful of researchers did try to do
随机控制测试 是医疗干预测试的黄金法则
randomized controlled trials—the gold standard for testing medical interventions
来看低饱和脂肪和低胆固醇饮食是否
—to see if low saturated fat or low cholesterol diets
能帮助预防心因性猝死 如假设预测的一样
actually helped prevent heart attacks and deaths, as the hypothesis predicted.
众所周知 营养学测试是非常困难的
But nutrition trials are notoriously difficult.
有数据支持 减少饱和脂肪摄入还可以预防心脏病
Some of the results suggested lowering saturated fat could help,
但大多数属于小范围研究
but most were small studies
也比较难解释清楚
and they were hard to interpret.
每一组研究采用略微不同的饮食方案
And each one used a slightly different diet,
用不同食物代替饱和脂肪的热量
replacing in the saturated fat calories with different things.
直到70年代后期
So, by the late 70s,
仍然没有确凿的证据证明减少饱和脂肪的摄取
there was still no conclusive proof that reducing saturated fats
确实能保护心脏
could actually protect hearts.
大家都没有停止对饮食-心脏病假设的求证
But that hadn’t stopped the diet-heart hypothesis from becoming mainstream
大部分情况和现有的数据吻合
—it seemed to fit most of the available data.
许多的专家担忧
And many experts felt the danger
高发的心血管疾病
of cardiovascular disease was too high not to recommend some
并没有改变美国人的饮食
change in what Americans were eating.
1977 美国上院选举委员会发布了关于“营养与人类需要”
So in 1977, the US Senate Select Committee on Nutrition and Human Needs
阐释了新的饮食方向
released its new dietary goals,
来自脂肪的热量比例降到40%
— percent of the calories from fat down from 40 %
限制总饱和脂肪摄入不超过10%
— and to limit the saturated fat to 10 % of the total.
指示中建议减少胆固醇和糖
The guidelines also suggested reducing dietary cholesterol and refined sugar,
增加碳水化合物
and increasing complex carbohydrates.
但实际并不是说的那样
But those weren’t really talked about as much.
其他国家跟进 不久
Other countries followed suit, so soon,
人们被告知多用人造黄油少用黄油
pretty much everyone was told to shun butter for margarine,
超市的货架上有了食品的“低脂”选项
and supermarket shelves were quickly stocked with “low fat” options.
但从一开始
But from the beginning,
批评的声音就指出
critics questioned those recommendations, pointing out that
这时髦的特殊饮食 依然没有取得验证
the specific diet now being championed had never been tested in a trial.
有人怀疑精炼糖才是更大的问题
And some suspected refined sugar was a bigger problem.
事实上 那七国的研究
In fact, the Seven Countries Study
说明了糖和心脏病之间的
also showed a strong correlation between the consumption
强关联
of sugar and heart attacks,
但这个发现没有给出其余的研究
but this finding wasn’t given much additional study
因为饱和脂肪占据了人们的视野
because it looked like saturated fat was the better predictor.
一直到本世纪
And it wasn ’ t until this century
我们知道糖
that we learned the sugar industry helped ensure its
一直被忽略
product was overlooked.
例如 在1967年
For example, in 1967,
他们给三位哈佛公共健康学者
they paid three Harvard public health researchers what would now
付费五万美金 去写一些相关的评论文章
be about $ 50,000 to write a review article
发表在新英格兰医学月刊上
in The New England Journal of Medicine
这是一本有影响力的杂志
—a highly influential journal
文中夸大了脂肪的作用而对糖却轻描淡写
—that highlighted the role of fat and downplayed any involvement of sugar.
20年后 历经半个世纪对脂肪的敌视
But twenty years later, after a half century of fat-hating,
情势逐渐有所改变
the tide began to slowly turn toward against them,
不管在实验室还是在家里
both in the lab and at home.
不仅研究没有发现
Not only had research not found
关于饱和脂肪就是问题所在的确切证据
conclusive proof that saturated fats were the problem,
最新的分析显示
new analyses of the collective past studies
饱和脂肪和心脏病之间的
showed that the link between saturated fats
联系比以前弱了很多
and heart disease was much weaker than previously assumed.
最新观察到 易消化的碳水化合物
And new observational studies were finding that quickly digestible carbohydrates
再加上糖可能是增加心脏疾病的罪魁祸首
and added sugars were independently associated with an increased risk of heart disease.
同时 认为胆固醇不好
Also, the whole idea that “cholesterol”
证明起来很复杂
was bad turned out to be much more complicated,
关于指责罪恶的脂肪的认识开始式微
undermining part of the premise for why fat was supposed to be so evil.
值得赞赏的是
To their credit,
六七十年代的学者有一个模糊的直觉
researchers in the 60s and 70s had a vague sense that the type
胆固醇有问题
of cholesterol mattered.
但他们不能理解固醇是怎么进到血液里的
But they didn’t fully understand how cholesterol moves in our blood,
包括游离在它周围的脂蛋白所扮演的角色
including the roles of the different lipoproteins that ferry it around.
当医生们检查血液里的胆固醇含量
When doctors look for “ cholesterol ” levels in blood now,
他们倾向于检查甘油三酯
they tend to look at triglycerides
即脂肪总量 和胆固醇的量一样
—the total amount of fat—as well as the total amount of cholesterol.
他们观察是否胆固醇
They also look at whether that cholesterol is being shuttled
被低密度脂蛋白(LDL)运送
by low-density lipoproteins or LDL,
所以叫做“坏”胆固醇
the so-called “bad” cholesterol,
高密度脂蛋白HDL
and high density lipoproteins or HDL,
就是“好”胆固醇
the “good” cholesterol.
高胆固醇是心脏疾病的致病因子
High LDL is a risk factor for heart disease,
HDL多了通常认为是好事
but having more HDL is usually considered good,
学者们一直在思考
though researchers are still trying to understand
不同尺寸和类型的固醇对身体的利弊
the different sizes and subtypes of each and how they help or harm
问题是
The problem is,
高饱和脂肪的食物同时能提高HDL LDL
foods that are high in saturated fat can raise both HDL and LDL,
如果你仅仅关注胆固醇或LDL 它们看上去危害更大
so they might seem more harmful if you just focus on total cholesterol or LDL.
我们来到一个新世纪
So as a new century began,
人们开始重新思考脂肪
people started rethinking the war on fat,
尤其是减少脂肪的摄入似乎也没有帮到人们的健康
especially since the advice to lower fat intake wasn’t helping people stay healthy.
21世纪早期
By the early 2000s,
低脂饮食似乎在大多数人身上也没有起作用
low-fat diets didn’t seem to be doing squat for most people.
肥胖和糖尿病 才是心脏病的危险因素
Obesity and diabetes — both of which are risk factors
而且心脏疾病患者激增
for heart disease — had skyrocketed.
那可能是因为
And that might be because,
很多人选择了低脂饮食
while lots of people embraced low-fat foods, they had opted for
他们选择少吃高脂肪谷物蛋糕
reduced fat snack cakes or cereal
富含糖分或其它碳水化合物
loaded with sugar or other carbs instead of
选择健康食品包括新鲜的水果蔬菜
healthier things like fresh fruits and veggies.
完全不一样的饮食结构:低碳水化合物饮食
So a different diet—the low-carb,
高脂阿氏食谱 开始风行
high-fat Atkins diet—became all the rage,
似乎帮助到人们减重
and it did seem to help people lose weight.
科学家开始关注起来
Scientists started to pay attention to it, too,
起初的效果也不错
and their initial results were promising.
在短期六个月左右
In short-term trials of 6 months or so,
人们减重
people lost a modest amount of weight
甘油三酯降低 HDL升高
and tended to slightly lower triglycerides while boosting HDL.
高糖食品加上精细碳水化合物
Diets high in sugar and refined carbs,
走向饮食的另一面
on the other hand, tended to do the opposite,
升高了甘油三酯 LDL 胆固醇 却降低了HDL
raising triglyceride levels and bad LDL cholesterol, while lowering good HDL.
动物和人一样
And in both animals and people,
糖的摄入导致了血压升高
excess sugar was linked to elevated blood pressure
它是心脏疾病的另一个危险因素
—another risk factor for heart disease.
大量的证据表明
The weight of the evidence
糖在过去的20年间
against sugar over the past twenty years in particular
起了关键的作用
has tipped the scales, and now,
你或许听说过关于糖的坏名声
you‘ve probably heard all about how sugar is the worst thing ever.
它很容易成为攻击的靶子
It sure is an easy target;
糖不提供营养 只提供热量
since sugar provides no nutrients other than calories,
很难防御
it’s hard to defend.
人活着并不依赖糖
You certainly don’t need refined sugar to stay alive.
导致很多人把它叫“毒药”
And that‘s led a lot of people to call it “toxic ”
坏话说尽
and blame almost anything on it,
甚至基因方面的疾病
even diseases with strong genetic links,
如肠炎 癌症
like inflammatory bowel disease or cancer.
科学家谨慎建议
But careful review of the science suggests
这有点扯
that’s taking the backlash a little too far.
大多数的人还是噬甜
While most of us are likely eating too much added sugar,
也没人知道怎样就过量了
no one really knows how much is too much.
有些很明确 和疾病相关
And connections to diseases, even ones that seem clear-cut,
但也没那么简单
are not always so straightforward.
科学家不知道是否吃糖能引起糖尿病
Scientists don ’ t actually know whether eating sugar can cause diabetes,
例如
for example.
吃糖太多导致超重 肥胖
Eating too much sugar can certainly lead to weight gain and obesity,
成为最大的致病因子
which is one of the biggest risk factors for the disease.
但分解吸收糖因人而异
But different people break down and use sugars differently,
许多专家认为
and so right now many experts
糖本身的吸收并不导致糖尿病
think sugar consumption itself isn’t causing diabetes
超重带来的并发症才导致了糖尿病
—complications from being overweight are.
成为心脏病还有其他健康方面的隐忧
Which is also likely the case for heart disease and other aspects of health.
血液中的胆固醇过高
We know that high cholesterol in the blood,
LDL 是心脏疾病的危险因素
specifically LDL, is a risk factor for heart disease,
高血压 肥胖也是
but so is high blood pressure andobesity.
进食多少不是件简单的事
How food fits into all of that isn‘t simple,
脂肪和糖都对身体都有影响
since dietary fat and sugar both affect some risk factors.
其他习惯也是 包括是否体育锻炼 是否吸烟
Other habits matter, too, like whether you exercise or smoke.
学者们试图搞懂 糖对身体起什么作用
And researchers are still trying to understand what sugar actually does to the body.
糖有多种形式
Quote “sugar” comes in various forms,
科学家还在讨论
the relative merits or demerits of which scientists
它的优缺点
are still debating.
脂肪也一样
And the same can be said of quote “fat.”
如果你问一位心脏病学家 饱和脂肪对人是否有害
If you ask a cardiologist today about whether saturated fat is bad for you,
答案是:那要看情况 那是因为是不是饱和脂肪
you may get a surprising answer: it depends. That’s because whether or not saturated fat
导致了心脏疾病研究没有定论
increases cardiovascular disease in any given study
关键要看他们正在研究的那个脂肪类型
seems to change depending on the exact type of fat being studied,
来源于什么
what the source is,
如果从饮食中拿掉 用什么替代
and what it‘s replaced with if it’s removed from the diet.
进而糖和饱和脂肪被指与心脏疾病或
The extent to which sugar and saturated fat are to blame for heart disease,
其他疾病有关
or pretty much any disease,
正被学者们重点谈论
is still being heavily debatedby researchers.
一天完了
At the end of the day, though,
你总得吃饭
you still have to eat,
所有这些尚不能给我们一个满意的答案
and all of this doesn‘t really give us a satisfying answer
你到底该吃些什么
as to what your diet should look like.
我不想告诉你
And I hate to tell you this,
测试中就采用低脂 低碳水化合物饮食
but head-to-head tests of low-fat and low-carb diets
也没有明显的差异
haven’t identified a clear winner.
低碳水化合物饮食短期来看似乎有一点点优势
While low-carb diets seem to be a teensy bit better in the short term,
当科学家们拉长观察时间
when scientists study people for longer,
差异依然不大
the difference declines.
低碳水化合物似乎导致了
Low-carb diets seem to lead to slightly higher increases
好胆固醇的略微升高以及甘油三酯的颗粒变大
in good cholesterol and bigger drops in triglycerides,
但这两种饮食对其他心脏疾病效果相当
but the two diets perform
对减肥的效果也不佳
And neither is terribly effective for people trying to lose weight.
一般一年减重不超过5公斤
Typical weight loss after a year is barely over 5 kg.
但也有个别人效果不错
But you can always find individuals who respond really well,
掉了近30kg
dropping like 30 kg,
相同饮食 有些人却增重了
and those who gain weight while on the diet.
这使得一些学者认为 部分人
This has led some researchers to think that maybe certain people,
不管由于基因的原因还是代谢的原因
either because of genetics or metabolic reasons,
低碳水化合物效果要好一些
do better on a low-carb diet,
同时 其他人也得益于低脂食品
while others benefit more from a low-fat regimen.
一个非常吸引人的观点是
One especially attractive idea is that
那些对胰岛素抵抗的人群
people who already are a little insulin resistant
即将面临很大的二型糖尿病风险人群
—a huge risk factor for type two diabetes
代谢少量碳水化合物和多的脂肪
—would probably fare better with fewer carbs and more fat.
即使这些细微的推进也似乎站不住脚
But even this more nuanced approach doesn’t seem to hold water.
2018年一个关于600人的研究
In a 2018 study of about 600 people,
基于基因或胰岛素水平而分配饮食 实际上并不管用
assigning diets based on genes or insulin levels didn‘t help.
测试者照做了一年
Everybody did about the same after one year,
不管选择低脂还是低碳水化合物
regardless of whether they went low-fat or low-carb.
科学家仍希望找到其他线索
Scientists are still hoping to find other markers,
就像微生物
like those related to the microbiome,
或特定基因的表达
or how much certain genes are expressed,
就能决定最好吃什么
that could determine what diet is best for you.
现在 我们知之甚少
But for now, what we’re left with is a bit of a draw.
还有待研究
There are some things that can be gleaned from this big,
营养过剩
nutritional mess, though.
通常 医生还是推荐减少饱和脂肪
In general, doctors still recommend cutting down on saturated fats.
但也要留心你吃了什么
But it’s important to pay attention to what you eat instead.
用不饱和脂肪替换饱和脂肪
Swapping out saturated fats for unsaturated ones,
就像坚果中含的那种 对身体有益
like those found in nuts, is usually beneficial.
如果你用谷物替代脂肪也行
That is also often true if you exchange the fat for whole grains,
但如果你用糖替换碳水化合物 就不行
but not if you sub in other carbs, like sugar.
平时少吃糖对身体不会有
And it probably wouldn ’ t hurt to cut down on
伤害
refined sugar in general, too.
如果我们去看看营养学史
But if we ’ ve learned anything from nutrition history,
几乎全面禁止过任何东西
it’s that a blanket prohibition on any one thing
都不是备选答案
isn’t likely to be the answer.
我们要一分为二地看待糖和脂肪
Sugar vs fat is a false dichotomy,
当你想到它 务必讲得通
and when you think about it, that makes complete sense.
太多的脂肪肯定不好
Of course too much fat is a bad idea.
太多的糖也不好
And so is too much sugar.
偶尔吃甜也不会致癌
But just as eating the occasional sweet is not going to give you cancer,
偶尔吃牛排也不会罹患心脏病
and the occasional
感谢观看科学秀的这一集 本集由Complexly提供
Thanks for watching this episode of SciShow, which is produced by Complexly.
如果你想观看其他的精彩节目
If you want to watch other awesome
关于营养和健康调研的
Complexly videos about nutrition and health research,
你可在保健分类浏览Aaron Carroll博士的文章
you might want to go check out Dr. Aaron Carroll over at Healthcare Triage.
[♪片尾]
[♪ OUTRO ]

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