<p>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 discusses the relationship between salt and high blood pressure, provides a masterclass into uric acid, and 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.</p> <p>We discuss: </p> <ul> <li><span style="color: #333333;">The connection between blood pressure and fructose that shifted Rick's professional focus [4:00];<br /></span></li> <li><span style="color: #333333;">The relationship between salt and blood pressure (and the role of sugar) [5:45];<br /></span></li> <li><span style="color: #333333;">Defining fructose, glucose, and sugar [19:30];<br /></span></li> <li><span style="color: #333333;">An ancient mutation in apes that explains why humans turn fructose into fat so easily [23:00];<br /></span></li> <li><span style="color: #333333;">The problems with elevated uric acid levels, and what it tells us about how sugar causes disease [31:30];<br /></span></li> <li><span style="color: #333333;">How sugar causes obesity—explaining the difference in glucose vs. fructose metabolism and the critical pathway induced by fructose [40:00];<br /></span></li> <li><span style="color: #333333;">Why drinking sugar is worse than eating it [50:00];<br /></span></li> <li><span style="color: #333333;">Unique ability of sugar to drive oxidative stress to the mitochondria, insulin resistance, and diabetes [54:00];<br /></span></li> <li><span style="color: #333333;">Why cancer loves fructose [1:00:15];<br /></span></li> <li><span style="color: #333333;">The many areas of the body that can use fructose [1:05:00];<br /></span></li> <li><span style="color: #333333;">Fructokinase inhibitors—a potential blockbuster? [1:07:15];<br /></span></li> <li><span style="color: #333333;">Treating high uric acid levels—Rick's approach with patients [1:10:00];<br /></span></li> <li><span style="color: #333333;">Salt intake—what advice does Rick give his patients? [1:16:30];<br /></span></li> <li><span style="color: #333333;">How excess glucose (i.e., high carb diets) can cause problems even in the absence of fructose [1:21:00];<br /></span></li> <li><span style="color: #333333;">Artificial sweeteners vs. real sugar—which is better? [1:29:15];<br /></span></li> <li><span style="color: #333333;">Umami, MSG, alcohol, beer—do these have a role in metabolic illness? [1:33:45];<br /></span></li> <li><span style="color: #333333;">Fructose consumption—Is any amount acceptable? Is fruit okay? Where does Rick draw a hard line? [1:38:45]<br /></span></li> <li><span style="color: #333333;">How does Rick manage the sugar intake of his young kids? [1:43:00]; and<br /></span></li> <li><span style="color: #333333;">More.</span></li> </ul> <p><span style="color: #333333;">Learn more: <a href="https://peterattiamd.com/">https://peterattiamd.com/</a><br /> <br /> Show notes page for this episode: <a href="https://peterattiamd.com/rickjohnson">https://peterattiamd.com/rickjohnson</a><br /> <br /> Subscribe to receive exclusive subscriber-only content: <a href="https://peterattiamd.com/subscribe/">https://peterattiamd.com/subscribe/</a><br /> <br /> Sign up to receive Peter's email newsletter: <a href="https://peterattiamd.com/newsletter/">https://peterattiamd.com/newsletter/</a><br /> <br /> Connect with Peter on <a href="http://Facebook.com/PeterAttiaMD"><u>Faceboo</u></a><u>k</u> | <a href="http://Twitter.com/PeterAttiaMD"><u>Twitter</u></a> | <a href="http://Instagram.com/PeterAttiaMD"><u>Instagram</u></a>.<br /></span></p>
Actionable Insights
1. Eliminate Fructose-Containing Liquids
Strictly avoid all liquids containing fructose, such as fruit juice, sodas, and sports drinks, because their rapid absorption and high concentration dramatically increase metabolic harm and the risk of obesity and related diseases.
2. Reduce High Glycemic Carbohydrates
Limit intake of high glycemic carbohydrates like bread, potatoes, chips, and rice, as they can induce an enzyme (aldose reductase) in the liver to convert glucose into fructose, driving metabolic disease even without direct fructose consumption.
3. Increase Water Intake Daily
Drink plenty of water, such as six glasses a day, to help suppress some of the negative metabolic effects of fructose and potentially aid in weight management and kidney health.
4. Pair Salt with Water
Consume water with or before salty foods to prevent a rapid rise in serum sodium and osmolality, which can trigger blood pressure increases and the body’s internal production of fructose.
5. Test Serum Uric Acid Levels
Get your serum uric acid levels measured, as risks for pre-diabetes, insulin resistance, hypertension, and kidney disease begin to increase when levels are consistently above 5.5 mg/dL.
6. Consider Allopurinol for High Uric Acid
Discuss with your doctor the option of taking allopurinol if your uric acid levels are 8 mg/dL or higher, or even 5.5-8 mg/dL, especially with kidney disease, to lower uric acid and mitigate metabolic risks.
7. Limit Whole Fruit Consumption
While whole fruit offers benefits, limit intake, especially of large or very sweet fruits, to avoid consuming excessive fructose; for those with conditions like NAFLD, aim for around 10 grams of fructose per day from whole fruit.
8. Avoid Dried Fruit
Steer clear of dried fruit because it is a concentrated source of fructose, often lacking many of the beneficial components found in fresh, whole fruit.
9. Prioritize Low-Fructose Fruits
Choose fruits with lower fructose content, such as kiwi, lime, lemon, and all types of berries (blueberries, raspberries, strawberries), as they are generally considered safe and beneficial.
10. Be Wary of Umami-Rich Foods
Exercise caution with high umami foods, especially those containing MSG or high purine content (like shrimp or beer), as they may contribute to obesity and raise uric acid levels through pathways distinct from sugar.
11. Limit Beer Consumption
Be aware that beer is particularly effective at inducing metabolic syndrome, including abdominal obesity, fatty liver, and high blood pressure, due to its umami-activating brewer’s yeast and alcohol content.
12. Choose Diet Soda Over Regular
If a sweetened beverage is desired, opt for diet soda over regular soda, as regular soda’s sugar content makes it metabolically more dangerous than artificial sweeteners.
13. Educate Children on Sugar Harms
Teach children about the negative health impacts of sugar, encourage them to read food labels, and avoid giving them regular soft drinks and fruit juice, while allowing occasional treats with artificial sweeteners.
14. Maintain Optimal Blood Pressure
Aim for an optimal blood pressure of 120/80 mmHg, as even slightly elevated pressures (e.g., 140/90 mmHg) confer an increased risk for heart failure, stroke, and other cardiovascular diseases.
15. Continue Regular Exercise
Maintain a regular exercise routine, as its broad benefits for mitochondrial function, vascular health, and kidney function far outweigh any theoretical concerns about heat shock protein induction related to hypertension.
Keep an eye on the development of fructokinase inhibitors, as these drugs are showing promise in clinical trials for treating conditions like fatty liver and could become a significant future therapeutic option.
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