#87-Rick Johnson, MD: Fructose-the common link in hypertension, insulin resistance, T2D, & obesity?
Вставка
- Опубліковано 13 чер 2024
- Original release date: 1/6/20
In this episode, Rick Johnson, professor of nephrology at the University of Colorado, explains how his research into the causes of blood pressure resulted in a change of research direction to focus more on how fructose has such profound metabolic effects. Rick begins by talking about the relationship between salt and high blood pressure, then provides a masterclass into uric acid, and then expertly reveals the mechanisms and pathways by which sugar (specifically fructose) can profoundly impact metabolic health. From there, he explains how he applies this information to real life patients as well as touches on some of the most promising ideas around pharmacotherapy that are being developed in response to the epidemics of fatty liver, insulin resistance, diabetes, and obesity. Furthermore, Rick gives his take on artificial sweeteners compared to real sugar, discusses cancer’s affinity for fructose, and much more.
We discuss:
-The connection between blood pressure and fructose that shifted Rick’s professional focus [4:00];
-The relationship between salt and blood pressure (and the role of sugar) [5:45];
-Defining fructose, glucose, and sugar [19:30];
-An ancient mutation in apes that explains why humans turn fructose into fat so easily [23:00];
-The problems with elevated uric acid levels, and what it tells us about how sugar causes disease [31:30];
-How sugar causes obesity-explaining the difference in glucose vs. fructose metabolism and the critical pathway induced by fructose [40:00];
-Why drinking sugar is worse than eating it [50:00];
-Unique ability of sugar to drive oxidative stress to the mitochondria, insulin resistance, and diabetes [54:00];
-Why cancer loves fructose [1:00:20];
-The many areas of the body that can use fructose [1:05:00];
-Fructokinase inhibitors-a potential blockbuster? [1:07:15];
-Treating high uric acid levels-Rick’s approach with patients [1:10:00];
-Salt intake-what advice does Rick give his patients? [1:16:30];
-How excess glucose (i.e., high carb diets) can cause problems even in the absence of fructose [1:21:00];
-Artificial sweeteners vs. real sugar-which is better? [1:29:15];
-Umami, MSG, alcohol, beer-do these have a role in metabolic illness? [1:33:45];
-Fructose consumption-Is any amount acceptable? Is fruit okay? Where does Rick draw a hard line? [1:38:45]
-How does Rick manage the sugar intake of his young kids? [1:43:00]; and
-More.
Show notes page: peterattiamd.com/rickjohnson/
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About:
The Peter Attia Drive is a weekly, ultra-deep-dive podcast focusing on maximizing health, longevity, critical thinking…and a few other things. With over 30 million episodes downloaded, it features topics including fasting, ketosis, Alzheimer’s disease, cancer, mental health, and much more.
Peter is a physician focusing on the applied science of longevity. His practice deals extensively with nutritional interventions, exercise physiology, sleep physiology, emotional and mental health, and pharmacology to increase lifespan (delay the onset of chronic disease), while simultaneously improving healthspan (quality of life).
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I am in my sixties, was put on an extreme low sodium diet, I had obesity, kidney disease, high blood pressure, insulin resistance, major gout, inflammations, nerve damage, was put on oxygen, pneumonia multiple times. I went on a very low carb/keto type diet. After a year and a half with almost no processed foods and no juice or pop, everything has disappeared, almost entirely. My doctors are stunned, as am I. My husband is healthier than he has been in 25 years. I lost a hundred and he lost 45 pounds and we don't miss all the junk and processed foods and saved huge amounts of money by not going to restaurants. This is all thanks to all of you doctors on these types of podcasts and videos. Sensible, scientific, logical information. Thank you all!
Keep up the new lifestyle
Wow, congratulations on your determination and recovery. Be well.
Bravo! As a holistic nutritionist, I applaud your tenacity and admire your courage to go "against the grain" and apply the knowledge you are learning from doctors and researchers who also seek to learn the truth and share it among other seekers of truth. Congratulations achieving wellness and a better chance for longevity for you and your husband's life.
amazing. thank you for sharing this.
Congratulations, this is an amazing accomplishment!
I've heard Dr. Richard Johnson being interviewed on other shows, but this Peter guy ask such good questions! And I like how Peter adds in layman's terms so us dummies understand! Excellent job Peter!
That is why I am Hooked on Attia.
"This Peter guy!" 💟
He summaries at the same time. Excellent.
In one year, my hs-CRP has progressively decreased from 3.48 mg/L to 0.7 mg/L, my HbA1c declined from 6.2% to 5.6%, and SBP reduced to average 130 mm Hg. The simple plan: no processed foods, mostly vegetables, avoid fructose and minimize salt. Weight decreased from 256 lbs to 220 lbs. My nighttime HRV has progressively increased, resting HR decreased and my reaction: gratitude.
Wow - I am so grateful for this session. I have avidly searched for information on dietary contributors to hypertension for upwards of a decade since discovering that my uncontrolled systolic was usually in the range 160 - 200 mm Hg. The ground you have covered today has so powerfully fleshed out a conceptual model of the key metabolic drivers that I should seek to manage. So many gaps / burning questions sorted in a single session - thank you so much - 🙏🏻🔆🌼
I'm gonna need to listen to this one a few times. So much info that's new to me, and I want to make sure I'm understanding it correctly. Great chat.
not sure it needs too much detail, you can go keto with a clear conscience. And/or, if you're going to "cheat", don't take all your fructose and salt at once!
This is one of the most fascinating &,informative podcasts I have found integrating biochemical, evolutional anthropoligical nutrition & medical science research. Absolutely brilliant!
This is incredible. One thing not mentioned (or I missed) is that Fructose metabolism will yield a particular molecule called Diacylglycerol which leads to PKC activation. A few episodes later and Peter is interviewing Gerald Shulmann about DAG causing insulin resistance. Things are piecing together
So I re-listened and at around 55-57 minutes, Rick does allude to how DAG might increase in the cell. Although he doesn’t describe DAG, he does mention how uric acid inhibits Enoyl-CoA-hydratase (enzyme responsible for 2nd step of fatty acid oxidation) AND uric acid inhibits aconitase (enzyme within Krebs cycle to move from citrate to isocitrate). Elevated citrate induces fatty acid genesis. Uric acid is a double-whammy.
Thank you so much Peter and Rick for this first class education opportunity. What i appreciate highly is that all these insights allow us to (dis)solve all the controverses on salt, on keto diet versus ancient asian carb regiment, contoverses that are based on a lack of knowledge of all the factors playing with. Now applying all that to adapt lifestyle will take months but so motivating. Better understand how the body does not react as previously expected.. or reacts surprisingly well to a change, an experiment, we hadn't dare before. Gaining freedom in behavior
Best talk on this subject EVER. Thank you. 👍🏼👍🏼
Doctor Attia, I just listened to Dr. Perlmutter being interviewed by Doctor William Davis. Perlmutter retells how he heard your interview with Doctor Eric Johnson which inspired Permutter’s book “Drop Acid”. All of you are remarkable. And it is remarkable how a podcast can enlighten the medical field about fructose. Keep getting the word out. Thanks
I can't believe I haven't listened before today. Rigorousness for the win. This is best podcast I've ever heard.
Best interview I have ever heard in my life
Fantastic program, Peter. Your contribution is outstanding Rick.
Great interview. Thanks
Great interview. So eye opening. Thank you both very much!
Fascinating, fascinating! I am going to replay this multiple times to connect all the dots those are spinning in my head right now :-)! Absolutely love this podcast!!!!
Another amazing talk! Thanks again Dr Attia and Dr Johnson! Loved the talk and learnt a lot!
The second time I listened to this interview was I absorbed a lot more information. I’m sure the third listen will add significant incremental value.
Very informative. This information you cannot find elsewhere.
Thank you so much for your information! My parents and parent-in-law are having same issue with high blood pressure, high trg and fatty liver even when my father stopped drinking and smoking 15 years ago. The information in your podcast make many myth become so clear and things are piecing together in my mind.
🥳This is one of the most thoughtful, valuable interviews I have ever heard-and like most people here, I have long been fanatic about listening to or watching anything regarding dietary wisdom for those of us now successfully. fighting our wonky sugar metabolisms. 👍😋 AND OUR HIGH BLOOD PRESSURE! 😱
Thank you both. So interesting and informative!
Information overload. Thank you for this.
but so sharply presented.. such a mindblowing precision in the how and why step by step.. "Brilliant" as german people say... taking notes... a lot...
I love this because it presents all the “why” behind the results we are observing in our culture. The chemistry of our bodies is such a beautifully balanced dance, but when you insert a problem into the mix, everything begins to shift and result in a myriad of multi-organ problems. One change often solves a sea of problems. Thank you Dr Johnson and Dr Attia for this great podcast!
Great discussion, kudos, Thx
Fantastic information. A great podcast . Thank you.
This was Outstanding Dr Attis and Dr Johnson thank you for making me way smarter for over an hour and a half. Keep up the great work for us lay people who are trying to do our best.
Excellent program today, sir. The best you've ever brought to your audience.
Thank you Dr. Attia. Very helpfull.
These guys did a great job!
So informative. Thank you.
Fascinating and insightful.
Excellent interview and teachings! Thank you!
9
Great interview
Wow …. Wow I’ll have to listen to this again! This was so much information that I need to process, and then change up what I’m doing.
Awesome content here. Thank you.
This is brilliant. One thing I'm fascinated to understand is the intersection of salt and ketosis in this discussion?
I began drinking an extra glass of water before meals the last couple of days. I’ve been keto for 3 years and would run regularly. When I first started the keto diet, I’d get the shakes on my runs and have to stop.
After reading about increased salt excretion with keto, I upped my salt intake, and my runs were solid again almost overnight.
I just upped water intake significantly for the last 48 hours and yesterday for the first time in 3 years, I felt like straight garbage on my run. I stopped at 1 mile and had to walk back with my tail between my legs. It freaked me out bc I’ve felt so good for so long on keto, exercise or not.
This morning again, felt terrible and shaky and hadn’t done any exercise whatsoever. Then I remembered what happened with salt and keto 3 years ago. I added some salt to a warm glass of water and felt much better in ~ 10 minutes.
I’m no doctor, but being keto seemingly changes the salt/fructose calculus somewhat at least in terms of my physical well-being and definitely my athletic performance.
@@Empirical-Skeptic add some potassium to the equation :)
How do you get rid of the uric acid?
@@cherylcheong5616 Not a doctor and this is just me postulating. I know a carbohydrate rich diet tends to make one's body hold on to salt, NaCl. When you do a low carb high fat diet (LCHF), your body purges ketones through the urine. Those ketones are negatively charged and bind with Na+. So, increasing salt on a keto or LCHF diet means the Na+ isn't staying in high enough concentrations to cause uric acid as a byproduct of fructose and purines.
If you're doing the standard American diet, and eating something particularly salty, then drink that extra glass of water before meals because you need to make sure the salt concentration isn't high enough to create excess uric acid.
@@Empirical-Skeptic Carbs raise insulin level which acts on the Na-glucose-ATPase to retain Na ions.
Absolutely outstanding.
First-rate interview and discussion.
Excelent! I listened to this episode twice. Got out extra details the second time. Thank you
So how do you eliminate the fructose in your body. Even if you consume glucose it will turned into fructose.
@@sidmichael1158 The conversion is minimal when the glucose load is low and the body is not dehydrated. Do not get the aldose reductase induced in the first place.
Fantastic Podcast!
terrific, learned so much.
Word of the day.... "Umami". Learn something new everyday!! With this latest release of interviews, Peter Attia appears to have upgraded The Drive to "Plaid" - well done Sir!!!
Nice Spaceballs reference!!
Very informative. Thank you very much.
Answered a pressing question for me. Why does my blood sugar stay up and ketones down even when fasting? I consume a lot of salt when fasting, plenty of water too but lots of salt as it keeps energy up. Salt is facilitating the conversion of fats to sugars for me.
Whole audio was excellent.
I get extra salt taking bullion with butter in hot water, bullion is basically flavored salt.
My weight and blood pressure are great so I’ll keep it up.
Sugar levels are not high just higher than expected while fasting and ketones lower than expected in ketosis.
Awesome chat!
20 Years ago. He has been doing the legit research 2 decades ago.
Very grateful to hear this!
Thank Peter for having him Rick Johnson M.D. on today.
Awesome info
Riveting and fascinating discussion. Many thanks to Peter and Dr Johnson. We may as a species, never come into existence were it not for the ape group returning to Africa.
Simply put. Love u! ❤ Fight the fight🎉
Thank you for bringing this to the forefront! Another path to learn about and just love the content..where were you during the 70’s and 80’s when I was low fat and vegan? Gee, did I pay dearly for that! Thank you
This would make a great movie.
Wow! Just wow! Great job to both of you. Thanks. You have a new subscriber :)
When I eat my piece of salty beef jerky post workout and sauna I will be sure to drink plenty of water. I am low carb yeah Kiwi is back. Thanks
My ears perked up at the kiwi remark, too! LOL🥝
Excellent work! Many thanks!🙏
Thanks for covering fruit consumption!
I turned back my Gout by quit eating sugar and anything with yeast in it. That was over 10 years ago. (late 30, early 40's). I went on a Keto diet afraid that to amount of meat would bring it back, going on 2 years later no signs of any yet. Ty for the great explanation.
Here's a question I'd like answered (relative to discussion at 1:22:10): Does aldose reductase gene expression get switched off on a long term fast? And if so, how long of a fast is necessary?
One detail that is a little bit obscure, during the discussion of the metabolism of fructose, the term "AMP-D" is used. Peter carefully explains the differences between ATP, ADP, and AMP, but does not ever spell out that AMP-D is AMP Deaminase. Rick Johnson, earlier in the conversation, mentions AMP Deaminase but from then on assumes that the reader know that (AMP-D) is AMP Deaminase. The critical fact is that AMP Deaminase (AMP-D) is a competing or alternate metabolic pathway from AMP Kinase. Even though I have listened to this discussion several times, that detail wasn't clear to me until after I had seen the relevant diagram from Rick Johnson's book, The Fat Switch. This, of course, is a critical point, since it is clear from the discussion that it is the activity of AMP-D (and the rest of that metabolic pathway) that leads to the excess production of uric acid and so the constellation of bad outcomes collectively described as the metabolic syndrome.
Interested to hear about fructose intake during sports!
Wonderful podcast!! I'm wondering about Allulose. It's structurally similar to fructose. Will it trigger the same metabolic pathway as fructose? I love baking with it, but will stop if it's causing me harm. Thank you!
Why not increase your ampk to inhibit ampd?
Metformin and berberine can.
Great information.
What happens to the purines that do not become uric acid anymore, under allopurinol?
How are they trsformed and eliminated?
Thank you
Please Dr.Attia do studies and research on this uric acid and fructose and gout.
Would love to hear 'insulin resistance' given greater elucidation and its place and function in the processes of metabolic syndrome given more careful delineation for the uninitiated. I somehow miss something each time it's mentioned. Well done in any case! A bitter/sweet experience to be sure for someone struggling to overcome the early warning signals.
Why does UA increase after a day or more of extended fast then lowers after lessor fast?
I have elevated uric acid levels, kidney function is shite, I don't consume fructose or glucose, or that many carbs at all.......btw over 3 years I've reversed diabetes, fasting insulin levels are awesome, HbA1c really good, fasting glucose fantastic, lost 65lbs and workout most days, but BP is higher than ever!.........so work that out experts
Maybe your having too much protein?
This is huge!
Great info! Now , plain English for the dummies like me . What should we do to live a healthy and long life .
TL;DR version: Don't eat sugar.
Fascinating !
Peter, did you mention that Richard Johnson has a financial interest in the development of FRK inhibitors? He does...
How does the "Randle cycle" play the part? Fat and sugar mixed.
MASTERCLASS 👏👏👏👏👏👏
I settled in an enjoyable listen to nerdy details. Instead I got new important new info.
One of the best interviews I have heard so far. But I have to admit, that the micro management (salt, potatoes etc.) is a bit discouraging...
Excellent discussion. Thank you. Early on Professor Johnson stated there was "good epidemiological" data linking higher levels of blood pressure with certain conditions. That's bothersome as epidemiology cannot establish causality. Thank you.
No statistical method will ever truly demonstrate causality. Epidemiology is one more tool in the toolbox, and refusing to use it because each datum is not as valuable as its counterpart in, say, a clinical trial, is foolish behavior. Epidemiology is the only way to study extremely large sample sizes, and well designed epidemiological studies are sure to further our knowledge about things.
@@fedegroxoEvery tool has an area where it is appropriate. Epidemiology and causality are incongruous. Random placebo controlled clinical trials can show causality infinitely more than epidemiology.
@@geopietro So what's even the purpose of epidemiology, then? There is one, only, and that's helping to establish causalities.
@@fedegroxo You are correct to say "helping." A primary use of such studies is to establish hypotheses for further research into causation.
Does anyone know if coconut water is ok? Say 250ml or less.
Of those without fructose kinase is it known what type of ApoE they are? 2 or 3 maybe?
How does potassium play into the salt fructose issue?
As Doctor Gundry says, “Give fruit the boot.” Only in small amounts when in season.
The best ever.
Honestly Rick’s book should just be called “Fructose is the cause of Metabolic Syndrome”. We’ve been searching for the primary cause of metabolic syndrome for 50 years and now we appear to have a mechanism that explains it. If true that is Nobel Prize territory and will likely save millions of lives.
Sugar glucose and salt can be converted to fructose?
Peter Attia, what if in addition to (or in place of) Fructose kinase inhibitors, one we’re to take an ATP booster (Swanson PeakATP for example) to prevent the activation of the nutrient sensing pathway that initiates the need for conversion of fructose into fat and the subsequent storage of that fat following the depletion of ATP during fructose metabolism?
Why not boost ampk?
Just started getting gout in the past year. And I’ve been Keto during that time. Any suggestions on eliminating it without continually taking indomethacin when it flares up? I take Allopurinol daily but it doesn’t seem to help.
Go carnivore
Are you doing strict keto? Many of these supposed keto diets and products are NOT true keto.
Fantastic informative exchange. TY!!! What I don't fully understand is why the body manufactures fructose in the first place. I get that the body may need to hoard energy and that FR facilitates that but wouldn't glucose be a more metabolically efficient way of doing that?
Fructose was what was available while we were evolving. Fruit. He said the apes were pretty much fructarians.
08:00 and further: BP such a useful and precious information for a lay person!! (BP: 14:00 / 90) I will finally get the ability to regulate it down by further life style adaptations...
18:00 but why must our system have a path converting glucose into fructose in the first place? How is it that the evolution has led to select for such a reaction? (Salt triggers an enzyme)
45:00 AMP at a fork between two pathways 1) AMPD (Deaminase.) => uric acid or 2) AMPK (kinase) => ADP ATP. 1) no need of burning nutrients that then may be stored. 2) burning stores to produce ATP. 1) because of depletion of intracellular P through Fructose-phosphorylation (concentration and speed of intake (overwhelmed cells) trigger this AMPD path. How cynically are studies designed to hide the harm!!
1:05 Fructose-kinase in different tissues, particularly in the intestine, but also in the pancreas, the brain...
No fructose-kinase a good thing? Fructosekinase inhibitor. They omitted to mention the oxydation of proteins of the blood (Maillard reaction) as fructose accumulates in the blood stream before being peed ? Or does it not, as hexokinase does the job....
1:17 again topic on salt.. balance water/salt is the point. Excess salt concentration in blood Salt => fructose endogene => lipids => burning lipids => endogene water (salt whales, desert animals) => osmolality restored.
New: endogene Fructose produced out of glucose after an enzyme "aldo.. reductase" is induced. (Induction by hyperglycemia, by hypernatriumia , by hyperuricemia ). The primarily induction, the presence of this enzyme in the liver explains why some folks get NAFLD with starches, other folks not.
Important how fructose drives the behavior in the real world: we eat more, weight gain.
UMAMI taste (Glutamine, purine) MSG Monosodium glutamate (in cheese and tomatoes. How cheese is addictive?).
How does sodium chloride drive fructose production ?
Febuxostat is the generic of Uloric - and cost me $6.77; however Febuxostat has a black box warning (2018) re: Stevens Johnson Syndrome. I got SJS from both Allopurinol then Febuxostat
Unfortunately no words about omega6, not even when mentioned potato chips.... You MUST bring Tucker Goodrich to talk about it urgently.
Awesome information, thank you. Please do a show on PAM enzyme and how it activates all signaling hormones via - C terminal correction/snip and add - making them functional. Never new hormones could be present and at correct levels but not at all functional due to lack of PAM activation - Richard Maines and Betty Eiper 40+ years fully funded research on PAM.
1:00:10 that's an important take away.
I am low Carb Carnivore weight 126 lbs 5’7” almost 80. Still run 3 miles then step race six or more/ day. I do light weights machines and barbells. Afterwards when I rest, I get this wave of heating is this the shock protein in action?
No not at all heat shock proteins only activated when the body gets really close to physiological limits when core body temperature gets close to 40 centigrade that is even hard to achieve with a sauna. Probably their function is more closely related to infection and fewer as a protective mechanism not to cook the body rather than the pathogen.
Thank you for loading UA-cam.
So thrilled with the punchline on fruit! But dates are my sweetener of choice. What say you?
Dates are not a good choice (exceedingly high Glycaemic index).
Get off all sweetening foods. They are truly not a necessary part of human nutrition.
Kiwis and raspberries all round! 🙌🏼
I don’t even know anymore how to avoid fructose. I check every label and mostly don’t even eat things that have labels, and finding out my body can produce fructose i just don’t know what to do. I don’t eat sugar and very very few carbs, like 5 crackers if i have cheese. Usually under 30 grams of carbs.
It sounds like you are doing the right things. Rick Johnson notes that the body can produce fructose, but it does so from existing glucose and in response to specific short-term states, like a high level of sodium in the blood. If you only eat small amounts of fructose (and or, sugar) and make sure to drink water before meals, it seems clear that you are doing all that you can and that you likely won't often be in the state when your body produces fructose.
24:50 So we were fruitarians? Then cold climate selected the ones with a genetic mutation that allowed fructose to trigger more fat storage?
Nothing better than a qualified intelligent interviewer (seeking personal growth), having an inquisitive conversation with another intelligent expert. We are lucky to be flys on the wall irrespective of Peter’s big apple fetish : )
Another good talk Peter. Thanks
In my recent experiments to gain weight for lean muscle mass I did the following:
Firstly, I gained weight by adding sucrose in some form and also added a beer. But not so much of fructose. I added 4 kilos, increased muscle mass, and then finally manage to reduce 3 kg's in a 20 days cycle.
Second, which is this time, I gained weight by adding sucrose and fructose. I also had sucrose in high calorie foods like oats/nuts chocolate and via fruit like grapes. Both the days when I had mixed this I felt more bloated and I increased my weight in just 3/4 days. The point of contention here is I felt it this time. I took a week to add same weight last time. I felt bloated this time around and I can visualise the food getting stored than it getting consumed for energy.
So yes...I can confirm one thing for sure - its different when you have sucrose or fructose empty stomach where it works genuinely as a source of energy. But the moment you add both on top of your regular meals, even when the calorie intake is same...it stores fat and adds weight faster than over eating your regular food. It could be perhaps because 'metabolic basal rate' works on the food in transition whereas with fructose it could be that it gets stored as fat straight away if we have enough glucose in our system.
Another reading for me which is coming through via this is....if it adds weight so quickly then its equally easier to lose fat when you drop both. And therefore it is no sin to have little bit of fructose or sucrose in our diets...its just the management of the two that matters.
What makes the sweet go away in soft drinks? It's the salt.