Rick Johnson, M.D.: Metabolic Effects of Fructose (Ep. #87 Rebroadcast)

The Peter Attia Drive

Today’s episode of The Drive is a rebroadcast of the conversation with Rick Johnson (originally released January 6th, 2020). This episode was one of the most popular discussions to-date and is a prelude to an upcoming follow-up discussion which will be coming out in February 2022 along with the release of Rick’s new book. 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 [3:00];
• The relationship between salt and blood pressure (and the role of sugar) [4:45];
• Defining fructose, glucose, and sugar [18:30];
• An ancient mutation in apes that explains why humans turn fructose into fat so easily [22:00];
• The problems with elevated uric acid levels, and what it tells us about how sugar causes disease [30:30];
• How sugar causes obesity—explaining the difference in glucose vs. fructose metabolism and the critical pathway induced by fructose [39:00];
• Why drinking sugar is worse than eating it [49:00];
• Unique ability of sugar to drive oxidative stress to the mitochondria, insulin resistance, and diabetes [53:00];
• Why cancer loves fructose [59:20];
• The many areas of the body that can use fructose [1:04:00];
• Fructokinase inhibitors—a potential blockbuster? [1:06:15];
• Treating high uric acid levels—Rick’s approach with patients [1:09:00];
• Salt intake—what advice does Rick give his patients? [1:15:30];
• How excess glucose (i.e., high carb diets) can cause problems even in the absence of fructose [1:20:00];
• Artificial sweeteners vs. real sugar—which is better? [1:28:15];
• Umami, MSG, alcohol, beer—do these have a role in metabolic illness? [1:32:45];
• Fructose consumption—Is any amount acceptable? Is fruit okay? Where does Rick draw a hard line? [1:37:45]
• How does Rick manage the sugar intake of his young kids? [1:42:00]; and
• More.

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