@@billytheweasel either that or intentionally disregarding the actual science. There are many grifters in this world. Praying on people that are tired of the mainstream dogma and are looking for alternatives. There is no shortage of people looking to take advantage of that will false alternatives. If is sounds dogmatic like, just don't eat animal foods (of course that's BS), or just don't eat plants (yes, veggies have toxins but fruits and their juice is very important), or just don't eat a whole macro-nutrient like sugar (pure propaganda), or any number of dogmatic "diets", you should be be more questioning. If you want an approach based on principals of biological energy and proper cellular metabolism look up Ray Peat PhD, Georgi Dinkov, Danny Roddy, etc.
@@billytheweasel In his 1957 book, "The Living State with Observations on Cancer," Albert Szent-Györgyi said that a cell needs energy for all its functions, including maintaining its structure. The cell's ability to maintain this high-energy, relaxed state relies on the availability of glucose and oxygen. Because protein, carbohydrate, and fat can provide glucose, oxygen iis the ultimate bottleneck in efficient energy generation through the mitochondria, also known as oxidative metabolism or mitochondrial respiration (or oxidative phosphorylation). Carbon dioxide, often considered a waste product, is another crucial element in this process. It's produced under the direction of good thyroid function and helps dissociate oxygen from the hemoglobin molecule, allowing cells, tissues, and organs to absorb oxygen more effectively. Therefore, carbon dioxide plays a critical role in facilitating oxygen delivery. Essentially, glucose, oxygen, and carbon dioxide are fundamental anti-stress factors, and interfering with their utilization or generation is not advisable. Now, let's talk about one reason why ketosis mimics the stress metabolism. If there's one key takeaway from this video, it's that becoming a "fat burner" or increasing lipolysis through voluntary carbohydrate restriction is a hallmark of aging and disease. For instance, one study found that "free fatty acid levels increase long before hyperglycemia becomes present." Another study stated that "there seems to be little doubt that there are signals for increased mobilization of fat in shock, trauma, and sepsis," and one more quote: "the enhanced mobilization and oxidation of fat is one of the fundamental responses to stress." The mechanism involves an initial short-term increase in adrenaline, squeezing glycogen out of the liver, and liberating free fatty acids into the blood. However, over the long term, cortisol and various other hormones, especially from the pituitary gland, increase the rate of lipolysis. This slows metabolism and brings the organism's renewal process to a halt. Another way ketosis mimics stress metabolism is by producing less carbon dioxide, primarily due to the oxidation of free fatty acids, which provides far less carbon dioxide than glucose oxidation. Apart from being a basic anti-stress factor, carbon dioxide is also a critical cofactor for the assimilation of fat-soluble vitamins. Lastly, ketosis can be considered a hibernation-like state for humans. You can measure the impact of carbohydrate restriction or ketosis on your metabolic rate using self-diagnostics like resting pulse rate and body temperature. Measuring these a few times a day can provide insights into the rhythmic changes of metabolism. In extreme stress situations, the pulse rate can barely be felt, and low body temperature has been associated with various health problems.
I think Peter’s questions are exploratory and explanatory in the best sense of those words. I am grateful that I can witness these two excellent physicians converse about topics that are vital to our health and longevity.
What an excellent discussion. My gratitude to both professionals. These are the people who matter and who contribute a lot to this society. Congratulations Peter and Rick
I am a 71yr old male and my average blood pressure average is 110/60 and I use at least 7 grams of salt daily. I also keep carbs low and no vegetable oils. A1c 4.9
I’m not an expert, but I heard there is a sodium potassium pump… that the true issue isn’t necessarily with salt but with the lack of potassium to balance the sodium.
Insulin makes you retain sodium. Since you keep carbs low, then you probably secrete more salt. I believe the "sweet spot" is 4-5 grams of sodium, which is around 10-12 grams of table salt (sodiumchloride).
Peter. So much respect for the cogent information you are putting out there by way of your guests and your own ability to synthesize what they are saying. Thank you!
This is awesome. Your penetrating questions are useful, Dr.Attia. Dr.Johnson gave great answers too! Always fascinating to see scientists having soooo much info stored in their heads.
It's hard to believe that Dr. Johnson could sustain the ever more intrusive interrogations (interruptons to the rest of us) of Peter Attia into this very learned and communicative scientists attempted descriptions of his fascinating work. I had a harder time dealing, and will now go take a break (at approx 1/3 of presentation/minute 47 ish). Dr Johnson is a most gracious and amenable sort, to be sure.
Interesting. I saw this as Dr. Johnson having a rather scattered delivery and Dr. Attia trying to keep him on track, both for the sake of his own sanity and that of his audience.
Peter’s questions were penetrating and relevant to the discussion. He wanted to keep the conversation on track and make sure the lay person could follow along. Johnson’s explanation was a bit scattered. A few times, he was even anti-climactic saying it was a fascinating study but could not recall the end result/conclusion of the study. This says to me that he has his post docs and grad students do most of the grunt work in the lab while he stays busy writing research proposals in his office.
Thx Dr Rick Johnson for sharing with the world your life saving and fascinating knowledge.Your contributions are already recognized and would certainly be even more in the coming years. Thx Dr Peter attia for inviting such prestigious guest. For me the Infos in this video and the previous one were eye opening.
Excellent podcast. Rick has a lot of numbered dots on paper and Peter drew the lines between the dots to create an amazing picture, just like I did when I was a kid(I was pretty sure what the picture would look like but it was a fun experience). Itere was a clear and present respect between you two and I learned so much more than I anticipated. Having listened to it, my diet will now be mainly tree bark and water 😁. Cheers Alan
This is the most helpful information I've had in a long time on diet and health. Rick Johnson is very impressive. His information on fructose explains a lot of questions I've had. A comment: Peter, your occasional summaries and recaps are helpful, but please let experts like this speak with fewer interruptions.
It breaks my heart that alcohol metabolism does this too. I absolutely love drinking but as a long distance runner this explains why drinking alcohol is so devastating to my performance and health… what a shame
😂 if it’s a non-essential, then it’s …poison, like sugar. So. I still 🍺 but I also monitor my glucose, ketones, lactic acid & URIC acid. I take Quercitin, Vit C, Potassium Citrate, magnesium & NAC daily & usually melatonin. I Z2 bike 4H/wk & Z5-6 1h/wk. I’m KetoVore & hard to grill steak 5xwk w/o a cold!😅🍺
@@CarnivoreDMD are u a dentist? If so answer this question to prove it. What % of the time should you expect to find MB+2 in the MB root of an upper 1st molar?
@@thepatternforms859 Haha, I spent 15 years not looking for MB2 & wondering why some still were symptomatic! Now I ALWAYS look for MB2 in 1st Molars to prove it’s there or not. My personal clinical experience is that it’s 50% but some have hypothesized much more. Of that, some of those MB2’s end up non treatable due to dilaceration so just end up using 3-Mix-MP or BioRoot Flow. I’m a co-author of an endo paper on post-op sensitivity of endo tx teeth thru DPBRN.
Dr Atia, thank you for bringing on such interesting discussants. However, please, please consider your audience and pause , on occasion , &/or don’t interrupt the answers to your questions by rapid-fire verbal inserts . Not all of us have been involved directly as e.g. assistants to research in question. We listen to your invited guests for their knowledge and need the space and breath of their independently conveyed presentation. Thank you, V. A. B.
I have to commend Johnson on managing to field some tough questions, calmly and succinctly, and Attia for following the answers closely enough to to unpack and re-pack what is being said, and all off the cuff.
Yes, tough questions, and I can tell this was prior to the host's personal epiphany about anger. I gave up on his podcast during the early period because I was picking up on that anger undercurrent (Abbott which he's been very forthcoming since his new book). This one is very hard to get through, and yes, the guest is very gracious but I can see the tendency Attia has to get others tho "play defense"...especially watching this on 2x speed.
I get the fructose eliminating . I don’t understand the limit on Umami proteins -red meats organ meats shellfish and shrimp . They’ve been the staple of my diet along with eggs poultry and Greek yogurt. Only study I have is my own Uric acid lab results which was recently 4.2 on a 4-8 range . I find it illogical to restrict these healthy foods as I’ve been eating them regularly for years. I apparently have no issues with Uric acid . I also maintain a fasting insulin under 2 and a A1c of 4.8 . I eliminated fructose ,seed oils ,processed foods as I find them the culprit in poor metabolic health . From my health history anyway.
The purines you get from food is basically insignificant. If someone has a gout attack though the thing to do is fast and take baking soda or better yet potassium bicarbonate, to help the kidneys deacidify.
Dr. Johnson says the umami trigger is the least thing to be concerned about. Many times he also specifies processed red meats should be watched, but not sure how much fresh red meat he would think is problematic. He makes it pretty clear that sugar/glucose/fructose/starches are the bigger problems.
I can't convince you to drop what you've been doing your whole life, but the large majority of the science says that the red meat isn't great for longevity. Alcohol makes you feel good too, but they doesn't mean it's good for you. I expect a similar thing is happening with diets high in red meat. The longest lived people eat a Mediterranean diet. I don't know what other evidence you need.
It's common sense. Fruit is seasonal and ripens in mid/late summer in most climates. We eat the fruit to generate and store fat for the harsh winter that's looming on the horizon.
@@miltonbates6425 In Thailand they sell mango's year round but out of season they are the green mango's. They might also have sweet mango's but then they let them flower offseason. Papaya "trees" will produce almost continuously throughout the year. ( fruit at almost every stage, and flowering at same time ) banana coconuts Some others you can get most of the year, like avocado and citrus. There's some fruit all year round....
@@claudiucosar Fruit is a sub-optimal source of nutrition for the human body, even for those living along the equator. Prolonged overconsumption is potentially very damaging to those who's primate ancestry migrated away from the eqator millions of years ago and now live in northern climates, as they are more genetically adapted to utilize the bioavailable proteins and fats that are present in other animals.
@@miltonbates6425 i would avoid classifying things using a thin layer of literature you point out. We're going the rabbit hole(paleo>what did ancestors ate...and so on...) Fruit is delicious, healthy and is robbed away from the chemicals most plants do contain. The poison is in the dose....I often see promoters that fruit is bad and will gonna kill you, or does make you fat and sick...well if you do train yourself, do one of the pivots that dr. Peter pointed out in his framework(i do eTRF and often WHAT axis), you sleep well, eating fruits instead of processed food desert is one of the most healthy way of living ... FYI i am not more interested in continuing this discussion please.
I have developed a man crush on Drs. Johnson, Perlmutter and Attia. Finished "Nature wants you to be fat" and currently reading "Drop Acid". I was a poster child of all the downstream effects of fructose consumption. HTN, elevated lipids, NAFLD, pre-diabetes and gout.
Tiffany Rolex OP! I want to be a doctor! But seriously I loved this ‘interrogation’. Bit of a geek-off between two titans. Wish it had been better summarised so I could understand more of what is clearly hugely important work. Can we have a synopsis of all the findings please? Keep up the great work. And let’s see your watch collection at some point ha.
There's a discussion of a metabolic pathway that drives the majority of chronic diseases that are cumulatively responsible for millions of deaths and trillions of dollars in economic damage every year, and you are sycophantically fixated on a wristwatch; asking for a bullet-point summary of the discussion to save you time, perhaps so you can keep hustling away towards that coveted Rolex, which apparently would be superior motivation for you to become a doctor as opposed to, say, wanting to help people. Sometimes I feel like we need to bomb ourselves back into the stone age so our species can collectively reorganize its priorities.
I have a continuous glucose monitor & though I try to maintain an extremely low carbohydrate diet, I am shocked that my glucose spikes with one tablespoon of milk!
Happy to see a new R_Jo. episode. Yesterday I went through the previous Rick Jonhnson, L.Cantley. Robert Lustig and the great cancer / autophagy talk with Eileen White. We have a close family member that drinks every day SSBs'. She has metastatic colorectal cancer and I remember Rick talking about fructose fermenting too far in the colon, further than it should, thus possibly being a contributor to abnormal cell respiration and growth. Robert Lustig says that when PI3K+, AMPK-, mTOR+ are expressed together = growth. In the case of chronic insulin resistance this spells cancer. She does not listen and her doctor does not know. I see this happening even in those who are younger than myself i.e 55y.
@@highfades2594 Sorry I was thinking of them separately. I do not know of White and Lustig having a discussion over the topic with eachother. It would be awesome though. The Lustig 3 metabolic and energy sensing enzymes is in YT under the topic: Prof. Robert Lustig - 'Sugar, metabolic syndrome, and cancer'
Tbabk you Peterfor slowing things down, recapping and asking questions with the layman in mind. This is science and I love it. Many are under the impression fructose is only metabolized in the liver. Brilliant discussion! Liked and shared.
The idea of the “15 year” isocaloric mouse study and the mice staying the same weight says nothing of their adiposity. Even though they ended up close to the same weight it is more important to know if their body comp was the same. Any chance for a mouse dexa? I’m willing to be the fructose mice had at the very least, more visceral adiposity and likely more adiposity overall
i love pa and thank you for exposing me to this top-notch info with incredible organization... but the interruptions on this interview were a bit hard on the listener
Peter is a genius!! He can distill hard concepts and make it easy to understand for an average person!!! Rick’s awesome too - handled tough questions well!!
Salt confuses me. So many health pundits now claim salt is good for you and now it's bad again? Would be nice to know how to strike a balance, signs of hypo/hyper and what trade-offs are on the line. Anybody else up for a really salty Peter dishing out some flavorful high sodium content?
Too much salt is bad, not enough will kill you. BTW Johnson says high salt blood concentration is bad, not total salt. You can lower the blood concentration of salt by drinking water.
you want a balance of sodium potassium and magnesium salt contains other trace minerals you may not get from food produced on deprived soils balance is always key
This dude is like the healthier doppelgänger of David Lynch…! 👀🤣🤓 it’s meant to be a compliment, he looks and even sounds just like him! Another excellent interview, love your questions bro!
I’ve bought the book “Nature wants us to be fat” right after watching this video. The book is mind blowing, just turned my understanding of nutritional value of fructose upside down!
So helpful; thank you! So is preloading with protein a work around if you do want to eat some of those higher fructose fruits or drink wine to reduce the spike or does it not matter?
Regarding how kidney inflammation (and salt sensitivity) goes up with age , and causes high blood pressure, and therefore it's important to keep blood pressure between 120/80 - 140/90 , low uric acid levels (< 5 mg/dl?), and GFR high (ex. 107 for a 40 year old).. how important is the albumin to Creatinine ratio? i.e. normal eGFR but microalbuminuria of 30? Regarding how some glucose can metabolize fructose to glycogen, but the real enzyme responsible is Fructokinase... and those born without this enzyme don't seem to get T2D... how does that compare with hereditary fructose intolerance? Regarding how a high carb/glycemic -> liver glucose + salt -> Aldose reductase -> sorbitol -> fructose -> fructokinaise (stimulated by uric acid)... and that ~5g can be metabolized in the gut, the rest goes to the liver.. it would be interesting to see if lowering uric-acid via Alpuerenol lowers the amount of fructose metabolism that occurs. Any thoughts on Robert Lustig's work that suggests fructose causes cellular energy ATP to go down the AMPD pathway (rather than AMPK), and that it can fuel tumors by knocks out the APC gene (via Fructokinase , lowering atp, AGES etc).. and how insulin resistance in the liver (only one insulin receptor) disrupts the FOXO phosphorylation pathway but not always the SREBP-1c pathway.
Peter is a smart guy and knows a ton of stuff, but on this topic, Rick Johnson is THE MAN. He talks off the top of his head like he's reading a textbook, all with a happy attitude like he's talking about picking apples on a beautiful fall day. Meanwhile, Peter sits there with a scowl on his face looking to poke holes. Dr. Johnson had brilliant answers for all Peters side tracks, but it would have been better if Peter challenged less and let this brilliant doctor talk more freely about what he has learned. I know its just Peter's style and he means no harm, but jeez, scowl scowl scowl, chill dude. A Type A++ guy like Peter could die young despite all his exercise and nutrition knowledge.
As theDiscussion goes on it seems to me that these rat studies are seriously flawed in multiple ways. They all end in high caloric state. Which is ALWAYS the most harmful component. Without peters questioning you never would’ve gotten to the many flaws of these studies.
Rat studies don't prove anything, so they don't have to be perfect. They just give you ideas of what to study in humans. BTW, evolution will tell you more about the truth than science will many times...
In the conference of ketogenic diet and such that Peter said didnt have the brightest people there were like two conferences of people explaining this. They must be undiscovered geniuses.
What about studies that showed the liver harm from ethanol alcohol required Linoleic acid in the diet. Ethanol metabolism and fructose have much overlap. Makes me wonder if the harms from fructose are also affected. I bring this up because rat chow often contains high levels of Linoleic Acid.
What most people don’t realize is that the more sunshine you get the better your body handles fruits. If you live at the equator and eat in-season fruit - no problem. The problem is that most of us DO NOT LIVE AT THE EQUATOR.
All the risk items noted are relatable to causative to endothelial injury which arguably begins and promotes progressive arterial pathologic changes related to the cerebrovascular, cardiovascular, and renovascular diseases you mention.
Me * Consumes fruit * * T3 values increase * * stops fruit, went on keto diet * * t3 drops, reverse t3 increases, and TSH skyrockets * Can you please explain this??
I have Graves’ disease and Prostate cancer and I’m on all fruits berries and melons diet as per Dr Robert Morse protocol it’s all very confusing now that I hear this video
Do you have thyroid disease? T3 and T4 will go down on keto but it works better so you need less if you lose weight. Thyroid is very closely related to metabolism, triglycerides and ldl. How do you feel? If crappy then stop the keto diet. I feel good on it. One of the first things i noticed when my thyroid went bad was rising ldl and triglycerides. I have trouble with insulin now too. Hence i do keto.
Agreed, he does make good points but comes across condescending sometimes. And should highlight nutrition more than drug solutions of which long term effects are always unknown.
Please some people stop moaning that you think PA is interjecting too much on RJ. Honestly I hardly noticed and we shud be grateful we have such a useful tool to be a fly on the wall and listen in on two well known figures in Metabolic syndrom just going through it and discussing where it is at and what new can be derived from it etc etc, I find it fascinating at the very least 👍
this is interesting: Rick Johnson was on Tom Bilyeu recently. Layne Norton made a video about how wrong the episode was. Layne Norton was on here recently, and now Rick Johnson 😅. We need everyone on at once to figure this out.
Wish I'd known these Fructose/Uric Acid phenomena 50 years ago. Thousands could have been saved form Insulin Resistance & T2D... Instead... we forced Plasma Insulin levels ever higher... because the alternative was worse.
I am listening again, I am 69, drank case of Dr. Pepper when I worked nights to stay awake. I guarantee that fructose caused my weight gain which lead to diabetes, insulin resistance. This explanation is what I lived.
Thanks yet again Dr Attia. I searched many times for this and never found it again after my first viewing. '140/90 = meds. But 135/85 meds are questionable -so nutrition, no salt, and exercise' I just had an eGFR of 61.5 and am awake. After decades of protein in my urine that DR's figured was physical work and lifting weights.
I have to admit as a layperson who cares about health and diet, it is frustrating to listen to doctors disagree about what we should be eating. I read Dr. Gregor’s book How Not To Die and the only sweetener he green-lighted was whole dates ground up (fiber mitigating the sugar spike). But at 1:34 of this talk, dates are said to be bad… and sports drinks are “ok.”
Please don't let one doctor's opinion convince you that fruit is bad for you. Just don't eat only watermelon and pineapple. Mix in lots of berries and you'll thrive.
Such an interesting conversation - but jeepers, the constant interruptions from Peter bordered on rude - which I'm sure he didn't mean. Let the guest speak :-)
Over 3.5 billion people live on a rice staple diet. Most of them aren't suffering acute calorie deprivation, but they don't suffer the metabolic syndrome endemic to people on the Western diet.
I'm almost halfway through this. How does a malfunctioning gallbladder come into play? My husband has been carnivore for four years, started at 330 lbs and initially began because of what we thought was Cyclic Vomiting Syndrome. It helped him lose 80 lbs and reverse his prediabetes (A1C went from 6.4 to 5.1) but didn't help with the CVS. He started amitriptyline which didn't help and made him gain back 30 lbs. Now he can't lose weight (been off ami for almost 3 years now). Got a HIDA scan, and his gallbladder has 11% EF (and that was a good day when he wasn't feeling sick) and was diagnosed with biliary dyskinesia (so not CVS). U/S shows severe fatty liver as well (and liver enzyme tests slightly elevated). He is a metabolic (and digestive) mess. Canadian healthcare is slow, and we may be waiting quite some time for him to get his gallbladder removed. So how exactly does gallbladder play a role here? Would that be the reason he is "stuck" in his weight and has severe fatty liver? He did eat very unhealthy since childhood (juice, ramen noodles, cereal, all the terrible stuff), and had undiagnosed Celiac Disease (been gluten free for the last 8 years), as well as used PPIs (rabeprazole) from 2005-2015.
He should get in touch with Dr. Paul Mason in Australia (you can find Dr. Mason's videos on youtube - he has a channel and is part of the lowcarbdownunder channel).
I binge-listened to this episode 3 times in a row!!! This should be required listening for all med school students and especially clinicians.
as soon as I finished I bought Rick's new book. It's great
Might as well add to the lies in Med school
@@NoKingsNoGodsOnlyMan Not sure if you feel Dr Rick Johnson is lying here or not.
@@billytheweasel either that or intentionally disregarding the actual science. There are many grifters in this world. Praying on people that are tired of the mainstream dogma and are looking for alternatives. There is no shortage of people looking to take advantage of that will false alternatives. If is sounds dogmatic like, just don't eat animal foods (of course that's BS), or just don't eat plants (yes, veggies have toxins but fruits and their juice is very important), or just don't eat a whole macro-nutrient like sugar (pure propaganda), or any number of dogmatic "diets", you should be be more questioning. If you want an approach based on principals of biological energy and proper cellular metabolism look up Ray Peat PhD, Georgi Dinkov, Danny Roddy, etc.
@@billytheweasel In his 1957 book, "The Living State with Observations on Cancer," Albert Szent-Györgyi said that a cell needs energy for all its functions, including maintaining its structure. The cell's ability to maintain this high-energy, relaxed state relies on the availability of glucose and oxygen. Because protein, carbohydrate, and fat can provide glucose, oxygen iis the ultimate bottleneck in efficient energy generation through the mitochondria, also known as oxidative metabolism or mitochondrial respiration (or oxidative phosphorylation).
Carbon dioxide, often considered a waste product, is another crucial element in this process. It's produced under the direction of good thyroid function and helps dissociate oxygen from the hemoglobin molecule, allowing cells, tissues, and organs to absorb oxygen more effectively. Therefore, carbon dioxide plays a critical role in facilitating oxygen delivery. Essentially, glucose, oxygen, and carbon dioxide are fundamental anti-stress factors, and interfering with their utilization or generation is not advisable.
Now, let's talk about one reason why ketosis mimics the stress metabolism. If there's one key takeaway from this video, it's that becoming a "fat burner" or increasing lipolysis through voluntary carbohydrate restriction is a hallmark of aging and disease. For instance, one study found that "free fatty acid levels increase long before hyperglycemia becomes present." Another study stated that "there seems to be little doubt that there are signals for increased mobilization of fat in shock, trauma, and sepsis," and one more quote: "the enhanced mobilization and oxidation of fat is one of the fundamental responses to stress."
The mechanism involves an initial short-term increase in adrenaline, squeezing glycogen out of the liver, and liberating free fatty acids into the blood. However, over the long term, cortisol and various other hormones, especially from the pituitary gland, increase the rate of lipolysis. This slows metabolism and brings the organism's renewal process to a halt.
Another way ketosis mimics stress metabolism is by producing less carbon dioxide, primarily due to the oxidation of free fatty acids, which provides far less carbon dioxide than glucose oxidation. Apart from being a basic anti-stress factor, carbon dioxide is also a critical cofactor for the assimilation of fat-soluble vitamins.
Lastly, ketosis can be considered a hibernation-like state for humans. You can measure the impact of carbohydrate restriction or ketosis on your metabolic rate using self-diagnostics like resting pulse rate and body temperature. Measuring these a few times a day can provide insights into the rhythmic changes of metabolism. In extreme stress situations, the pulse rate can barely be felt, and low body temperature has been associated with various health problems.
I think Peter’s questions are exploratory and explanatory in the best sense of those words. I am grateful that I can witness these two excellent physicians converse about topics that are vital to our health and longevity.
I agree I only wish I can ask questions , but I'm far behind in this post how can I get these love
What an excellent discussion. My gratitude to both professionals. These are the people who matter and who contribute a lot to this society. Congratulations Peter and Rick
I am a 71yr old male and my average blood pressure average is 110/60 and I use at least 7 grams of salt daily. I also keep carbs low and no vegetable oils. A1c 4.9
I’m not an expert, but I heard there is a sodium potassium pump… that the true issue isn’t necessarily with salt but with the lack of potassium to balance the sodium.
What is your serum sodium level?
Insulin makes you retain sodium. Since you keep carbs low, then you probably secrete more salt. I believe the "sweet spot" is 4-5 grams of sodium, which is around 10-12 grams of table salt (sodiumchloride).
Im confused though, the AHA recommends sodium of 2300 mg a day otherwords; 2-3 grams not 5.
@@camronRD Observational study on sodium and all-cause mortality:
www.ncbi.nlm.nih.gov/pmc/articles/PMC8169157/
Peter. So much respect for the cogent information you are putting out there by way of your guests and your own ability to synthesize what they are saying. Thank you!
Kmp cc k k kk me a yyi
Peter is not really a jerk, he just comes off that way sometimes. He really wants to understand things.
I agree though I still find his method challenging.
I love that Peter is grilling this guy. We need to question the 'experts'
More than usual. Wecan all have a bad day😂
Who said he's a jerk!?
He is the opposite.
This is awesome. Your penetrating questions are useful, Dr.Attia. Dr.Johnson gave great answers too! Always fascinating to see scientists having soooo much info stored in their heads.
Rick is a gem, love the work and love the info that you bring! Please let him finish when asking a question ;)
I came to say this lol please stop interrupting so frequently
It would be interesting to look at a flow chart of Ricks intended presentation over laid with Attia's constant wanderings.
It's hard to believe that Dr. Johnson could sustain the ever more intrusive interrogations (interruptons to the rest of us) of Peter Attia into this very learned and communicative scientists attempted descriptions of his fascinating work. I had a harder time dealing, and will now go take a break (at approx 1/3 of presentation/minute 47 ish).
Dr Johnson is a most gracious and amenable sort, to be sure.
Yup, and it's cringe-inducing every time; I had to break at 40 min, you beat me by 7 min
Interesting. I saw this as Dr. Johnson having a rather scattered delivery and Dr. Attia trying to keep him on track, both for the sake of his own sanity and that of his audience.
Peter’s questions were penetrating and relevant to the discussion. He wanted to keep the conversation on track and make sure the lay person could follow along. Johnson’s explanation was a bit scattered. A few times, he was even anti-climactic saying it was a fascinating study but could not recall the end result/conclusion of the study. This says to me that he has his post docs and grad students do most of the grunt work in the lab while he stays busy writing research proposals in his office.
He may not have been ready to respond like he was i court. Attia said obviously to one of his discoveries. What an ass
Wow! Dr. Johnson is brilliant! Glad to be introduced to his views!
I admire Rick's patience with Peter's constant interruptions
His interruptions at least tend to be good questions which shed more light on an idea..... but, it still annoys me lol
Interesting how we all differ. I didn't think Peter interupted at all. Rather he questions to clarify. I,for one, really appreciate his 'interuptions'
I admire Peter interrupting and asking for more layman's style examples, otherwise most of this is over my head.
Peter is doing great, helping to transmit the essence of the research and making the guest think and reflect and learn how to explain better.
Your amygdala is showing!
Thx Dr Rick Johnson for sharing with the world your life saving and fascinating knowledge.Your contributions are already recognized and would certainly be even more in the coming years.
Thx Dr Peter attia for inviting such prestigious guest. For me the Infos in this video and the previous one were eye opening.
Excellent podcast. Rick has a lot of numbered dots on paper and Peter drew the lines between the dots to create an amazing picture, just like I did when I was a kid(I was pretty sure what the picture would look like but it was a fun experience). Itere was a clear and present respect between you two and I learned so much more than I anticipated. Having listened to it, my diet will now be mainly tree bark and water 😁. Cheers Alan
Go easy on the tree bark mate 👍🤣
@@888jucu The bark of cassia trees are high in coumarine. Can cause liver damage. Cassia bark is used to produce cheap cinnamon.
Rick Johnson, thank you for educating us, you have done the work to enlighten us with the science behind metabolic syndrome. Thank you!!!
Really interesting conversation, I took a few biochem/metabolism classes in college but I forgot a lot, you broke everything down very well 👏👏👏
I must say I really appreciated Peter challenging Rick on his points. It really elevates the conversation.
Another fantastic show with wealth of practical suggestions and in-depth background of underlying mechanisms.Gratitude.
45:07-45:47 this summarizes how fructose contributes to weight gain and metabolic syndrome! Thank you!
thanks!!!!!!
Awesome. Cheers.🎉
Wow what a grilling … he did really well to handle this volley of technical questions
Biochemistry is exactly what makes the lecture so interesting!
Thanks for bringing Rick back to the show / Awesome episode
This is the most helpful information I've had in a long time on diet and health. Rick Johnson is very impressive. His information on fructose explains a lot of questions I've had. A comment: Peter, your occasional summaries and recaps are helpful, but please let experts like this speak with fewer interruptions.
This is a fantastic podcast. Real World application. Thank you.
It breaks my heart that alcohol metabolism does this too. I absolutely love drinking but as a long distance runner this explains why drinking alcohol is so devastating to my performance and health… what a shame
What did you expect? It's quite literally poison.
😂 if it’s a non-essential, then it’s …poison, like sugar. So. I still 🍺 but I also monitor my glucose, ketones, lactic acid & URIC acid. I take Quercitin, Vit C, Potassium Citrate, magnesium & NAC daily & usually melatonin. I Z2 bike 4H/wk & Z5-6 1h/wk. I’m KetoVore & hard to grill steak 5xwk w/o a cold!😅🍺
@@CarnivoreDMD are u a dentist? If so answer this question to prove it. What % of the time should you expect to find MB+2 in the MB root of an upper 1st molar?
@@thepatternforms859 Haha, I spent 15 years not looking for MB2 & wondering why some still were symptomatic! Now I ALWAYS look for MB2 in 1st Molars to prove it’s there or not. My personal clinical experience is that it’s 50% but some have hypothesized much more. Of that, some of those MB2’s end up non treatable due to dilaceration so just end up using 3-Mix-MP or BioRoot Flow. I’m a co-author of an endo paper on post-op sensitivity of endo tx teeth thru DPBRN.
Amazing. I checked the research regarding endogenous fructose production and its simply amazing. Also salt. Superb.
im against banning substances for a variety of reasons, but I def think sugary drinks should probably be behind the counter.
Dr Atia, thank you for bringing on such interesting discussants. However, please, please consider your audience and pause , on occasion , &/or don’t interrupt the answers to your questions by rapid-fire verbal inserts . Not all of us have been involved directly as e.g. assistants to research in question. We listen to your invited guests for their knowledge and need the space and breath of their independently conveyed presentation. Thank you, V. A. B.
I have to commend Johnson on managing to field some tough questions, calmly and succinctly, and Attia for following the answers closely enough to to unpack and re-pack what is being said, and all off the cuff.
Yes, tough questions, and I can tell this was prior to the host's personal epiphany about anger. I gave up on his podcast during the early period because I was picking up on that anger undercurrent (Abbott which he's been very forthcoming since his new book). This one is very hard to get through, and yes, the guest is very gracious but I can see the tendency Attia has to get others tho "play defense"...especially watching this on 2x speed.
I get the fructose eliminating . I don’t understand the limit on Umami proteins -red meats organ meats shellfish and shrimp . They’ve been the staple of my diet along with eggs poultry and Greek yogurt. Only study I have is my own Uric acid lab results which was recently 4.2 on a 4-8 range . I find it illogical to restrict these healthy foods as I’ve been eating them regularly for years. I apparently have no issues with Uric acid . I also maintain a fasting insulin under 2 and a A1c of 4.8 . I eliminated fructose ,seed oils ,processed foods as I find them the culprit in poor metabolic health . From my health history anyway.
The purines you get from food is basically insignificant. If someone has a gout attack though the thing to do is fast and take baking soda or better yet potassium bicarbonate, to help the kidneys deacidify.
Caffeine is also a purine to watch out for. I realize you said you don't have gout, just putting this out so people can see the correct information.
@@LTPottenger I drink a ton of coffee.
Dr. Johnson says the umami trigger is the least thing to be concerned about. Many times he also specifies processed red meats should be watched, but not sure how much fresh red meat he would think is problematic. He makes it pretty clear that sugar/glucose/fructose/starches are the bigger problems.
I can't convince you to drop what you've been doing your whole life, but the large majority of the science says that the red meat isn't great for longevity. Alcohol makes you feel good too, but they doesn't mean it's good for you. I expect a similar thing is happening with diets high in red meat. The longest lived people eat a Mediterranean diet. I don't know what other evidence you need.
It's common sense. Fruit is seasonal and ripens in mid/late summer in most climates. We eat the fruit to generate and store fat for the harsh winter that's looming on the horizon.
yeah?
what about ecuatorials? seasonal….
@@claudiucosar They're still seasonal at the equator, with most fruiting trees flowering twice per year.
@@miltonbates6425 In Thailand they sell mango's year round but out of season they are the green mango's. They might also have sweet mango's but then they let them flower offseason.
Papaya "trees" will produce almost continuously throughout the year. ( fruit at almost every stage, and flowering at same time )
banana
coconuts
Some others you can get most of the year, like avocado and citrus. There's some fruit all year round....
@@claudiucosar Fruit is a sub-optimal source of nutrition for the human body, even for those living along the equator. Prolonged overconsumption is potentially very damaging to those who's primate ancestry migrated away from the eqator millions of years ago and now live in northern climates, as they are more genetically adapted to utilize the bioavailable proteins and fats that are present in other animals.
@@miltonbates6425 i would avoid classifying things using a thin layer of literature you point out. We're going the rabbit hole(paleo>what did ancestors ate...and so on...) Fruit is delicious, healthy and is robbed away from the chemicals most plants do contain. The poison is in the dose....I often see promoters that fruit is bad and will gonna kill you, or does make you fat and sick...well if you do train yourself, do one of the pivots that dr. Peter pointed out in his framework(i do eTRF and often WHAT axis), you sleep well, eating fruits instead of processed food desert is one of the most healthy way of living ... FYI i am not more interested in continuing this discussion please.
I have developed a man crush on Drs. Johnson, Perlmutter and Attia. Finished "Nature wants you to be fat" and currently reading "Drop Acid". I was a poster child of all the downstream effects of fructose consumption. HTN, elevated lipids, NAFLD, pre-diabetes and gout.
Thanks for this interview - there was so much to digest that I bought the book to get the full details.
all this talk and not a single RCT is discussed that proves the relevance of this discussion IN HUMANS
Wow and wow
Tiffany Rolex OP! I want to be a doctor! But seriously I loved this ‘interrogation’. Bit of a geek-off between two titans. Wish it had been better summarised so I could understand more of what is clearly hugely important work. Can we have a synopsis of all the findings please? Keep up the great work. And let’s see your watch collection at some point ha.
There's a discussion of a metabolic pathway that drives the majority of chronic diseases that are cumulatively responsible for millions of deaths and trillions of dollars in economic damage every year, and you are sycophantically fixated on a wristwatch; asking for a bullet-point summary of the discussion to save you time, perhaps so you can keep hustling away towards that coveted Rolex, which apparently would be superior motivation for you to become a doctor as opposed to, say, wanting to help people. Sometimes I feel like we need to bomb ourselves back into the stone age so our species can collectively reorganize its priorities.
I am a lawyer and Peter treated Rick a little like a hostile witness. Would have preferred Peter letting the guest talk.
@@iss8504 I am afraid my experience listening to Peter is that he frequently leans toward this communication style. Too bad.
Have their been any studies in regards to “non artificial sweeteners”, such as Stevia and Organic monk fruit?
I have a continuous glucose monitor & though I try to maintain an extremely low carbohydrate diet, I am shocked that my glucose spikes with one tablespoon of milk!
Eat more fibrous carbs then. You don't have the gut microbiome to handle carbs, so you're probably bordering on insulin resistance.
@@limitisillusion7 Thank you
Happy to see a new R_Jo. episode. Yesterday I went through the previous Rick Jonhnson, L.Cantley. Robert Lustig and the great cancer / autophagy talk with Eileen White. We have a close family member that drinks every day SSBs'. She has metastatic colorectal cancer and I remember Rick talking about fructose fermenting too far in the colon, further than it should, thus possibly being a contributor to abnormal cell respiration and growth. Robert Lustig says that when PI3K+, AMPK-, mTOR+ are expressed together = growth. In the case of chronic insulin resistance this spells cancer. She does not listen and her doctor does not know. I see this happening even in those who are younger than myself i.e 55y.
where can i find the Lustig/White interview?
Can you link the talk please?
@@highfades2594 Sorry I was thinking of them separately. I do not know of White and Lustig having a discussion over the topic with eachother. It would be awesome though. The Lustig 3 metabolic and energy sensing enzymes is in YT under the topic: Prof. Robert Lustig - 'Sugar, metabolic syndrome, and cancer'
@@ljs94 see my response below. Apologies for being a bit vague on my behalf.
Tbabk you Peterfor slowing things down, recapping and asking questions with the layman in mind. This is science and I love it. Many are under the impression fructose is only metabolized in the liver. Brilliant discussion! Liked and shared.
The idea of the “15 year” isocaloric mouse study and the mice staying the same weight says nothing of their adiposity. Even though they ended up close to the same weight it is more important to know if their body comp was the same. Any chance for a mouse dexa? I’m willing to be the fructose mice had at the very least, more visceral adiposity and likely more adiposity overall
That's such an excellent point!
shout out to all my finny bro's out there.
We have also known about the Randle cycle since 1963, but many don’t want to discuss that.
Ray Peat follower ? ( :
i love pa and thank you for exposing me to this top-notch info with incredible organization... but the interruptions on this interview were a bit hard on the listener
it is so good that Peter can ask the critcal questions, that most podcasters out there can not.
Amazing. This is what youtube is good for.
where is the table of fruits that you both mention you would put in show notes? Thanks.
If you take people with high blood pressure, put one group on a low sugar diet, and another group on a low salt diet, which one has a stronger effect?
Sugar has a greater effect. Salt effect can be neutralized with increased water intake.
Peter is a genius!! He can distill hard concepts and make it easy to understand for an average person!!! Rick’s awesome too - handled tough questions well!!
Salt confuses me. So many health pundits now claim salt is good for you and now it's bad again? Would be nice to know how to strike a balance, signs of hypo/hyper and what trade-offs are on the line. Anybody else up for a really salty Peter dishing out some flavorful high sodium content?
Just what I was thinking as I add salt to my drinking wster!!
Too much salt is bad, not enough will kill you. BTW Johnson says high salt blood concentration is bad, not total salt. You can lower the blood concentration of salt by drinking water.
you want a balance of sodium potassium and magnesium salt contains other trace minerals you may not get from food produced on deprived soils
balance is always key
I love the view from over Peter's shoulder of his blurry ear.
Very interesting conversation. Starts to answer some of my questions.
Priceless. I can now approach weight loss and health issues with relevant knowledge. Thanks so much!
Why do you keep on interrupting him?
This dude is like the healthier doppelgänger of David Lynch…!
👀🤣🤓 it’s meant to be a compliment, he looks and even sounds just like him!
Another excellent interview, love your questions bro!
I’ve bought the book “Nature wants us to be fat” right after watching this video. The book is mind blowing, just turned my understanding of nutritional value of fructose upside down!
This is not for the average person not studying medicine but still a good podcast.
So helpful; thank you! So is preloading with protein a work around if you do want to eat some of those higher fructose fruits or drink wine to reduce the spike or does it not matter?
Just wow... Thank you
Wow this is an amazing podcast, it made so much information so much clearer & more precise 👍
Regarding how kidney inflammation (and salt sensitivity) goes up with age , and causes high blood pressure, and therefore it's important to keep blood pressure between 120/80 - 140/90 , low uric acid levels (< 5 mg/dl?), and GFR high (ex. 107 for a 40 year old).. how important is the albumin to Creatinine ratio? i.e. normal eGFR but microalbuminuria of 30?
Regarding how some glucose can metabolize fructose to glycogen, but the real enzyme responsible is Fructokinase... and those born without this enzyme don't seem to get T2D... how does that compare with hereditary fructose intolerance?
Regarding how a high carb/glycemic -> liver glucose + salt -> Aldose reductase -> sorbitol -> fructose -> fructokinaise (stimulated by uric acid)... and that ~5g can be metabolized in the gut, the rest goes to the liver.. it would be interesting to see if lowering uric-acid via Alpuerenol lowers the amount of fructose metabolism that occurs.
Any thoughts on Robert Lustig's work that suggests fructose causes cellular energy ATP to go down the AMPD pathway (rather than AMPK), and that it can fuel tumors by knocks out the APC gene (via Fructokinase , lowering atp, AGES etc).. and how insulin resistance in the liver (only one insulin receptor) disrupts the FOXO phosphorylation pathway but not always the SREBP-1c pathway.
good regular blood pressure end at 120-80 everything above is meaning you are sick
Peter's clarifying questions helped my questions from Dr.'s book .
Peter is a smart guy and knows a ton of stuff, but on this topic, Rick Johnson is THE MAN. He talks off the top of his head like he's reading a textbook, all with a happy attitude like he's talking about picking apples on a beautiful fall day. Meanwhile, Peter sits there with a scowl on his face looking to poke holes. Dr. Johnson had brilliant answers for all Peters side tracks, but it would have been better if Peter challenged less and let this brilliant doctor talk more freely about what he has learned. I know its just Peter's style and he means no harm, but jeez, scowl scowl scowl, chill dude. A Type A++ guy like Peter could die young despite all his exercise and nutrition knowledge.
Thank you Peter! And, thank you Rick!
Peter did not like hearing that the kidney expert thinks 135/85 is an acceptable healthy BP target.
As theDiscussion goes on it seems to me that these rat studies are seriously flawed in multiple ways. They all end in high caloric state. Which is ALWAYS the most harmful component. Without peters questioning you never would’ve gotten to the many flaws of these studies.
Rat studies don't prove anything, so they don't have to be perfect. They just give you ideas of what to study in humans.
BTW, evolution will tell you more about the truth than science will many times...
Agreed
In the conference of ketogenic diet and such that Peter said didnt have the brightest people there were like two conferences of people explaining this. They must be undiscovered geniuses.
This feels more like an interrogation instead of conversation
What about studies that showed the liver harm from ethanol alcohol required Linoleic acid in the diet.
Ethanol metabolism and fructose have much overlap. Makes me wonder if the harms from fructose are also affected.
I bring this up because rat chow often contains high levels of Linoleic Acid.
What most people don’t realize is that the more sunshine you get the better your body handles fruits. If you live at the equator and eat in-season fruit - no problem. The problem is that most of us DO NOT LIVE AT THE EQUATOR.
All the risk items noted are relatable to causative to endothelial injury which arguably begins and promotes progressive arterial pathologic changes related to the cerebrovascular, cardiovascular, and renovascular diseases you mention.
Thank you for asking how they measure a *mouse's blood pressure* because I was wondering the same thing.
Me * Consumes fruit *
* T3 values increase *
* stops fruit, went on keto diet *
* t3 drops, reverse t3 increases, and TSH skyrockets *
Can you please explain this??
I have Graves’ disease and Prostate cancer and I’m on all fruits berries and melons diet as per Dr Robert Morse protocol it’s all very confusing now that I hear this video
Do you have thyroid disease? T3 and T4 will go down on keto but it works better so you need less if you lose weight. Thyroid is very closely related to metabolism, triglycerides and ldl. How do you feel? If crappy then stop the keto diet. I feel good on it.
One of the first things i noticed when my thyroid went bad was rising ldl and triglycerides. I have trouble with insulin now too. Hence i do keto.
Overall, excellent! I felt like Peter could have dialed down his badgering of the witness, however.
Interesting how we all differ. I didn't think Peter interupted at all. Rather he questions to clarify. I,for one, really appreciate his 'interuptions'
Lol, I agree. Was Dr. Johnson told he could have an attorney present?
Agreed, he does make good points but comes across condescending sometimes. And should highlight nutrition more than drug solutions of which long term effects are always unknown.
Great discussions in immense depth!
Please some people stop moaning that you think PA is interjecting too much on RJ. Honestly I hardly noticed and we shud be grateful we have such a useful tool to be a fly on the wall and listen in on two well known figures in Metabolic syndrom just going through it and discussing where it is at and what new can be derived from it etc etc, I find it fascinating at the very least 👍
this is interesting: Rick Johnson was on Tom Bilyeu recently. Layne Norton made a video about how wrong the episode was. Layne Norton was on here recently, and now Rick Johnson 😅. We need everyone on at once to figure this out.
my goodness!! this was amazing!! thank you much!!
Wonderful info, so worth the 2 hours
RE: dried fruit -- I imagine vitamin c and flavanols are degraded a lot due to oxidation during the dehydration process
A table of fruits (regarding sugar content) was promised to be shared in the show notes...where is it?
Wish I'd known these Fructose/Uric Acid phenomena 50 years ago. Thousands could have been saved form Insulin Resistance & T2D... Instead... we forced Plasma Insulin levels ever higher... because the alternative was worse.
I am listening again, I am 69, drank case of Dr. Pepper when I worked nights to stay awake.
I guarantee that fructose caused my weight gain which lead to diabetes, insulin resistance. This explanation is what I lived.
More gold from this channel.
Great conversation between two genius and brilliant personalities.
This guy is amazing!
God,how kind are you two sharing such deep knowledge.
Attia is interrupting in an aggressive way!
Let the guest finish the thought before asking for clarification.
Thanks yet again Dr Attia. I searched many times for this and never found it again after my first viewing.
'140/90 = meds. But 135/85 meds are questionable -so nutrition, no salt, and exercise'
I just had an eGFR of 61.5 and am awake. After decades of protein in my urine that DR's figured was physical work and lifting weights.
Brought me back to Kerb cycle way back then.thank you Peter.
He is so argumentative. Same questions but asked better would have made it great. It was hard to watch. Great questions just came across as rude imo.
I have to admit as a layperson who cares about health and diet, it is frustrating to listen to doctors disagree about what we should be eating. I read Dr. Gregor’s book How Not To Die and the only sweetener he green-lighted was whole dates ground up (fiber mitigating the sugar spike). But at 1:34 of this talk, dates are said to be bad… and sports drinks are “ok.”
@@baybaymaus thanks- I’m not sure why, in this talk, they speak ill of dried fruits, which retain the fiber, specifically dates and figs.
@@baybaymaus ok- thank you
Sports drinks are ok when used for what they are designed for i.e. exercise but are not good if consumed when just loafing around watching TV etc
Please don't let one doctor's opinion convince you that fruit is bad for you. Just don't eat only watermelon and pineapple. Mix in lots of berries and you'll thrive.
This is way above what I can understand. Sadly I don’t have a biology/chemistry degree...
Bring on Ray Peat friend.
Both participants have the knowledge in real depth! I wish my professors in college and med school were that good!
How do seed oils in processed food contribute to oxidative stress of mitochondria? If they contribute at all?
Such an interesting conversation - but jeepers, the constant interruptions from Peter bordered on rude - which I'm sure he didn't mean. Let the guest speak :-)
💯%‼️
Interesting how we all differ. I didn't think Peter interupted at all. Rather he questions to clarify. I,for one, really appreciate his 'interuptions'
Over 3.5 billion people live on a rice staple diet. Most of them aren't suffering acute calorie deprivation, but they don't suffer the metabolic syndrome endemic to people on the Western diet.
You can get fat on sugar alone diet, easier still on a fat alone diet and most easiest on a fat + sugar diet (what many westerners consume)
except they don't eat full grains as in past and it's slowly kills them too they get stuff they na ever ate before too
Until Coca-Cola moves in
I'm almost halfway through this. How does a malfunctioning gallbladder come into play? My husband has been carnivore for four years, started at 330 lbs and initially began because of what we thought was Cyclic Vomiting Syndrome. It helped him lose 80 lbs and reverse his prediabetes (A1C went from 6.4 to 5.1) but didn't help with the CVS. He started amitriptyline which didn't help and made him gain back 30 lbs. Now he can't lose weight (been off ami for almost 3 years now). Got a HIDA scan, and his gallbladder has 11% EF (and that was a good day when he wasn't feeling sick) and was diagnosed with biliary dyskinesia (so not CVS). U/S shows severe fatty liver as well (and liver enzyme tests slightly elevated). He is a metabolic (and digestive) mess. Canadian healthcare is slow, and we may be waiting quite some time for him to get his gallbladder removed. So how exactly does gallbladder play a role here? Would that be the reason he is "stuck" in his weight and has severe fatty liver? He did eat very unhealthy since childhood (juice, ramen noodles, cereal, all the terrible stuff), and had undiagnosed Celiac Disease (been gluten free for the last 8 years), as well as used PPIs (rabeprazole) from 2005-2015.
He should get in touch with Dr. Paul Mason in Australia (you can find Dr. Mason's videos on youtube - he has a channel and is part of the lowcarbdownunder channel).
Milk thistle is really good for fatty liver. I hope he is doing better now
Hi Peter I love your content and your podcast. I studied finance and i’m glad to learn great things in science. Hello from Montreal, Canada 🇨🇦🇺🇸
Great discovery .deserved for noble prize 🏆
Peter, you must let your guest finish his point. You keep cutting him off before he makes his conclusion. Very frustrating.