2 Nurses In Tennessee Preach 'Diabetes Reversal'

https://www.npr.org/sections/health-shots/2019/07/22/733748382/2-nurses-in-tennessee-preach-diabetes-reversal

Chains, saws and old logging equipment litter the back field of Wendy Norris' family farm, near the county seat of Altamont, Tenn. Norris used to be part of the local timber industry, and the rusted tools are relics from a time when health woes didn't hold her back from felling hardwoods.

"I was nine months pregnant," Norris says. "Me and my husband stayed about 10 or 15 miles in the middle of nowhere, in a tent, for a long time."

Those outdoor adventures are just a memory now. A few years ago, as Norris turned 40, her feet started going numb. She first assumed it was from standing all day at her job at a nursing home.

几年前，当诺里斯40岁时，她的脚开始麻木了。她首先认为这是因为她整天在养老院工作。

"But it wasn't," she recalls now. "It was that neuropathy, where my [blood] sugar was high and I didn't know it." Norris had developed Type 2 diabetes.

“但事实并非如此，”她现在回忆道。“那是神经病，我的[血]糖很高，我不知道。”诺里斯患上了2型糖尿病。

Grundy County, Tenn., has a long list of public health challenges, and Type 2 diabetes tops the list. The county is stunningly scenic; it also has one of the lowest life expectancy rates in the region.

田纳西州格伦迪县有很多公共卫生挑战，而2型糖尿病名列榜首。该县风景优美;它也是该地区预期寿命最低的国家之一。

Norris was relatively active. She also enjoyed sodas, sweets and frozen dinners. Meanwhile, diabetes runs in her family. So, when her diabetes diagnosis came down, her doctor prescribed insulin shots and told her to watch what she ate.

诺里斯相对活跃。她还喜欢汽水，糖果和冷冻晚餐。与此同时，糖尿病在她的家庭中运行因此，当她的糖尿病诊断结束时，她的医生开了胰岛素注射液并告诉她要看她吃的东西。

"You're sitting there thinking, 'Well, what does that mean?' " Norris says.

Type 2 diabetes can be reversed with weight loss and exercise; but research shows that people need lots of help to achieve control of blood sugar with just a change in diet and lifestyle, and they rarely get enough support. It's easier for doctors and patients to rely primarily on medication.

2型糖尿病可以通过减肥和运动来逆转;但是研究表明，人们需要很多帮助才能通过改变饮食和生活方式来控制血糖，而且他们很少得到足够的支持。医生和患者主要依靠药物治疗更容易。

Norris says trying to overhaul her diet by herself was confusing and difficult. And when things didn't change, the doctor just kept increasing her dosage of insulin.

诺里斯说，试图彻底改变她的饮食习惯是令人困惑和困难的。当事情没有改变时，医生只是不断增加她的胰岛素剂量。

But then Norris lost her health insurance. The injectable insulin cost her hundreds of dollars a month — money she simply didn't have.

但后来诺里斯失去了健康保险。可注射的胰岛素每个月花费数百美元- 她根本没有钱。

Fortunately, that's when a couple of nurses who were members of her community stepped in to help — not with cash, but with crucial support of a different sort.

幸运的是，当她的社区成员中的几位护士介入帮助时- 不是用现金，而是提供不同类型的重要支持。

At the nonprofit Beersheba Springs Medical Clinic, a nonprofit clinic founded in 2010 to bring free or low-cost health care to the area, Norris was introduced to an alternative approach to taming her Type 2 diabetes — and the prospect of reversing her diagnosis altogether.

Retired nurses on a mission

有使命感的退役护士

In a former parsonage near the clinic, Karen Wickham ladles out lentil stew as a handful of participants in the evening's health education session arrive.

She and her husband, Steve, are white-haired, semiretired nurses who have dedicated their lives to what they call "diabetes reversal." They offer six-week seminars to Type 2 patients like Norris, who has also brought along her father and daughter.

"It's our purpose," Karen says. "Our purpose in life is to try to help make a difference — first in our community."

With slide presentations, the Wickhams explain the difference between sucrose and glucose and the science behind the fact that foods like potatoes spike blood sugar, while sweet potatoes don't. They preach eating as much fiber as a stomach can stand and dropping almost every kind of sweetened beverage.

Then they demonstrate ways to burn all those calories. On one evening, Steve invents the "Beersheba Boogie" on the spot, asking participants to raise their knees and pump their fists in place.

All these people will have to find a way to get active at home, because there's no gym anywhere close. There's not a proper grocery store nearby either, so healthy cooking can become a real chore. These communitywide obstacles reveal why it can be a struggle for people to maintain their health in rural America. But the Wickhams are working to overcome those barriers.

Steve calls out for applause as participants share their latest health stats — "Her blood sugar is going down! Give her a hand."

If it sounds like a revival meeting, it kind of is. Steve and Karen Wickham feel compelled to do this work as part of their Christian faith as Seventh-day Adventists — members of a denomination known for a focus on health.

"I think God holds us responsible for living in the middle of this people and doing nothing," Steve says.

The Wickhams originally moved to Grundy County to take care of ailing parents, and they ended up building their dream home there. They planted vast orchards, vegetable gardens and berry patches to help satisfy their vegetarian diet — a diet common among Seventh-day Adventists.

But once settled in their mountain retreat, the Wickhams grew disturbed by Grundy County's national health ranking: The county of 13,000 people ranks as the least healthy in Tennessee, by one annual measure. Grundy County has the shortest life expectancy in the state and an elevated rate of diabetes (16 percent of adults), which can eventually result in blindness, kidney failure and amputations.

"I had taken care of diabetic patients for so long, and I knew the progression," Karen says. "If you truly want the people to get better, you have to treat it with lifestyle interventions."

Overhauling one's diet and activity level is the obvious answer, but those changes are hard to start and even harder to maintain.

"Nobody, actually, will make all of the lifestyle changes that we recommend," Steve says. "But if you're making the kind of choices that lead you to a healthier lifestyle, then you get better."

“实际上，没有人会改变我们推荐的所有生活方式，”史蒂夫说。“但如果你做出那种能让你过上更健康生活方式的选择，那么你就会变得更好。”

A more hopeful message

一个更有希望的信息

Along with their lifestyle counseling, the Wickhams always give a disclaimer, advising people to consult with their doctors about their condition and its treatment. They also acknowledge that their seminars are not yet "evidence based" or backed by peer-reviewed scientific literature. It's one of the reasons they haven't been able to get government grants to fund their program directly.

随着他们的生活方式咨询，Wickhams总是给出免责声明，建议人们咨询他们的医生，了解他们的病情和治疗方法。他们还承认，他们的研讨会尚未“以证据为基础”或得到同行评审的科学文献的支持。这是他们无法获得政府补助直接资助其计划的原因之一。

But there are studies showing that people with blood sugar levels in the "prediabetes" range can get back to normal blood sugar by losing 5% of their body weight.

但是有研究表明，血糖水平在“前驱糖尿病”范围内的人可以通过减掉5％的体重来恢复正常的血糖。

And weight loss and exercise have already been shown to lower hemoglobin A1c levels, which physicians use to monitor a patient's blood sugar over two to three months.

In addition, new research from Dr. Roy Taylor of Newcastle University in the United Kingdom shows promise for true remission.

减肥和运动已被证明可降低血红蛋白A1c水平，医生用这两个月来监测患者的血糖。此外，英国纽卡斯尔大学的Roy Taylor博士的新研究显示了真正缓解的希望。

"There just hasn't been the information about the possibility of reversing diabetes," Taylor says.

Most studies do show Type 2 diabetes, in most patients, marching in pretty much one direction. But Taylor says those studies also involve people who continue to gain weight, which is typical among diabetics.

大多数研究确实显示2型糖尿病，在大多数患者中，几乎朝着一个方向前进。但泰勒表示，这些研究还涉及那些继续体重增加的人，这在糖尿病患者中很常见。

"Doctors tell their patients, 'You've got a lifelong condition. We know it's going to steadily get worse.' Then they turn around, and their patients aren't losing weight or doing exercise, but they've given them this utterly depressing message," he says.

“医生告诉他们的病人，'你已经终生了。我们知道它会逐渐恶化。'然后他们转过身来，他们的病人没有减肥或做运动，但他们给了他们这种完全令人沮丧的信息，“他说。

评论：翻译得不太好。意思是医生给糖尿病人“定了死刑”。其实，病人还是可以通过减肥、运动改变血糖的。

Taylor's research finds that if a patient loses 30 pounds or so, diabetes can be reversed in its early stages. Taylor prescribes a strict liquid diet and limited exercise — at first — so as not to stimulate the appetite. People with Type 2 diabetes need to lose fat from the liver and pancreas.

泰勒的研究发现，如果患者减掉30磅左右，糖尿病可以在早期阶段逆转。泰勒规定了严格的流质饮食和有限的运动- 起初- 以免刺激食欲。患有2型糖尿病的人需要从肝脏和胰腺中减掉脂肪。

评论：不是所有人都能减掉30磅的！应该看看原文。

Ultimately, Taylor hopes better nutrition will become the preferred response to high blood sugar in the next decade.

最终，泰勒希望更好的营养将成为未来十年高血糖的首选。

"I think the main headwinds [against progress] are just conceptual ones — of scientists and doctors believing this is an irreversible condition because of what we've seen," he says.

Even the American Diabetes Association has been changing its views. The advocacy group has a new position on Type 2 reversal: "If a patient wishes to aim for remission of type 2 diabetes, particularly within 6 years of diagnosis, evidence-based weight management programs are often successful."

甚至美国糖尿病协会也在改变其观点。倡导小组对2型逆转提出了新的立场：“如果患者希望瞄准2型糖尿病的缓解，特别是在诊断后的6年内，基于证据的体重管理计划通常是成功的。”

John Buse, chief of endocrinology at the University of North Carolina medical school, helped write the American Diabetes Association's revised guidance. "We've known, literally since the 17th century, that diet is the key to managing diabetes," he says.

But it's hard to write a prescription for lifestyle change.

北卡罗来纳大学医学院内分泌科主任John Buse帮助编写了美国糖尿病协会的修订指南。 “从17世纪开始，我们就知道，饮食是控制糖尿病的关键，”他说。

但是很难为生活方式改变开处方。

"Doctors don't have the time to do it well, so we have often used the sort of short shrift," he says. " 'Eat less carbohydrates and walk every day.' That has basically no impact."

“医生没有时间做得好，所以我们经常使用那种短暂的吝啬，”他说。 “'少吃碳水化合物，每天走路。'这根本没有影响。“

评论：'少吃碳水化合物，每天走路。'这根本没有影响？

The Wickhams are doing their part to add to the scientific data, tracking the blood sugar of the participants in their program. And even the anecdotal, short-term evidence they've gathered so far is resonating far beyond Grundy County, and they've been traveling more and more lately.

The couple just sold their retirement home so they can say yes to all the invitations they've received, mostly through Seventh-day Adventist groups, to present their program to other communities around the United States.

Meanwhile, Wendy Norris says the prospect of turning back Type 2 diabetes already has changed her entire outlook on health.

与此同时，Wendy Norris表示，扭转2型糖尿病的前景已经改变了她对健康的整体看法。

"I felt like I was stuck having to take three or four shots a day the rest of my life," she says. "I've got it down to one already."

她说：“我觉得我一生都不得不每天打3-4针。” “我已经只需要打1针了。”

评论：（机器翻译不过关，必须介入。）文章的头、尾不错，中间有点乱。

This story is part of NPR's reporting partnership with Nashville Public Radio and Kaiser Health News.