How Fructose Drives Metabolic Disease | Rick Johnson, M.D.

Rick Johnson, Professor of Nephrology at the University of Colorado and a previous guest on The Drive, returns for a follow-up about unique features of fructose metabolism, and how this system that aided the survival of human ancestors has become potentially hazardous based on our culture’s dietary norms. In this episode, Rick explains how the body can generate fructose from glucose and how circulating glucose and salt levels can activate this conversion. He discusses the decline in metabolic flexibility associated with aging, as well as how factors such as sugar intake or menopause-associated hormone changes can alter responses to sugar across a lifetime. In addition, Rick lays out strategies for combating the development of metabolic illness using dietary changes and pharmaceutical therapies, and he discusses the impact of fructose metabolism and uric acid on kidney function and blood pressure. He concludes with a discussion of vasopressin, a hormone that facilitates fructose’s effects on weight gain and insulin resistance.

We discuss:
00:00:00 - Intro
00:00:10 - Unique features of fructose metabolism and why it matters
00:09:00 - A primer on fructose metabolism and uric acid
00:21:04 - Endogenous fructose production, the polyol pathway, and the effect of non-fructose sugars
00:28:20 - Findings from animal studies of glucose and fructose consumption
00:45:06 - What calorie-controlled studies say about the claim that a “calorie is a calorie”
00:56:45 - Implications for aging and disease
01:08:58 - Impact of endogenous fructose production on obesity and metabolic syndrome
01:12:43 - Why vulnerability to the negative effects of sugar increases with age and menopause
01:26:43 - Dietary strategies to reduce the negative impact of fructose
01:43:56 - The role of hypertension in chronic disease and tips for lowering blood pressure
01:54:16 - The impact of fructose and uric acid on kidney function and blood pressure
02:04:50 - The potential role of sodium in hypertension, obesity, and metabolic syndrome
02:11:18 - The role of vasopressin in metabolic disease

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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 35 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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[jenn]

How fortune are we to have such brilliant fellas sharing the plethora of information with us?! Absolutely incredible minds holding so much knowledge! Thank you Peter & Rick!

[shelchicago]

I binge-listened to this episode 3 times in a row!!! This should be required listening for all med school students and especially clinicians.

[WIJESINGHEARIYAKUMAR]

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

[jefffrederick]

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.

[flagstaffrandy]

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

[tmchugh]

I must say I really appreciated Peter challenging Rick on his points. It really elevates the conversation.

[prtxepm]

Peter is not really a jerk, he just comes off that way sometimes. He really wants to understand things.

[jeffreyharrison]

Wow! Dr. Johnson is brilliant! Glad to be introduced to his views!

[insightfool]

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!

[eugeniebreida]

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.

[FrankyFrankster]

45:07-45:47 this summarizes how fructose contributes to weight gain and metabolic syndrome! Thank you!

[FRANCISJULIEN-zu]

Rick Johnson, thank you for educating us, you have done the work to enlighten us with the science behind metabolic syndrome. Thank you!!!

[beemo]

For who didn't study biochemistry, just skip to 45:04 for the key points.

[johnny]

I admire Rick's patience with Peter's constant interruptions

[joshua]

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.

[Bungifun]

Rick is a gem, love the work and love the info that you bring! Please let him finish when asking a question ;)

[abdelilahbenahmed]

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.

[dineshverma]

Another fantastic show with wealth of practical suggestions and in-depth background of underlying mechanisms.Gratitude.

[v.annabonac]

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.

[roughout]

It would be interesting to look at a flow chart of Ricks intended presentation over laid with Attia's constant wanderings.