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The Peter Attia Drive
Rick Johnson, M.D.: Metabolic Effects of Fructose (Ep. #87 Rebroadcast)
Nov 22, 2021
01:49:48
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Quick takeaways
- Fructose metabolism links to issues like blood pressure, insulin resistance, and obesity.
- Salt concentration affects blood pressure regulation, emphasizing the need for monitoring salt intake.
- Elevated uric acid levels from fructose metabolism impact health conditions like gout and fatty liver.
- Fructose plays a role in cancer development through supporting cancer cell growth and survival.
Deep dives
Fructose and its Impact on Blood Pressure, Uric Acid, and Metabolic Effects
Fructose metabolism has significant implications for blood pressure and uric acid levels. Studies have shown that high fructose intake can lead to elevated blood pressure, insulin resistance, type 2 diabetes, and obesity. The metabolism of fructose can cause uric acid levels to rise, triggering oxidative stress and affecting mitochondrial function. This process leads to metabolic effects such as fatty liver, elevated triglycerides, and insulin resistance.
Salt Concentration and Its Influence on Blood Pressure
Research suggests that salt concentration plays a crucial role in blood pressure regulation. Consuming salty foods increases serum sodium levels, which can lead to a transient rise in blood pressure. Studies have shown that the concentration of salt in the blood, rather than the total amount consumed, triggers blood pressure elevation. Monitoring salt intake and understanding its impact on blood pressure regulation is essential for cardiovascular health.
Effects of Uric Acid on Health and Disease
Uric acid, generated in the metabolism of fructose, has diverse effects on health and disease. Elevated uric acid levels are linked to conditions such as gout, insulin resistance, metabolic syndrome, and fatty liver disease. Studies have shown that uric acid can induce oxidative stress in mitochondria, inhibit fat oxidation, and contribute to the development of diabetes. Understanding the role of uric acid in various diseases is crucial for preventive and therapeutic interventions.
Fructose's Role in Cancer Growth and Metabolism
Fructose plays a significant role in cancer development and progression by supporting cancer cell growth and survival in low-oxygen environments. Studies have indicated that cancers preferentially utilize fructose as a fuel source for their metabolism. Inhibition of fructose metabolism, particularly through blocking the fructokinase pathway, has shown promise in hindering cancer cell proliferation and metastasis. Targeting fructose metabolism in cancer cells could be a potential strategy for anti-cancer therapies.
Understanding the Impact of Fructocines in Different Organs
Fructocines can affect various organs such as the brain, islets, adipose tissue, and potentially muscles. Studies indicate that the heart, during a low oxygen state like during a heart attack, can produce fructocines, potentially influencing cardiac remodeling. Insights suggest that fructos metabolism could be linked to disorders like Alzheimer's. People with mutations rendering them deficient in fructocines seem to be genetically immune to sugar-related harm.
Addressing Uric Acid Levels and the Role of Alapurinol
Uric acid levels above 5.5 indicate increased risks for conditions like prediabetes, hypertension, and kidney disease. Alapurinol, a xanthine oxidase inhibitor, is used to lower uric acid levels. Studies show benefits in kidney disease and blood pressure control. It is essential to consider the risk-benefit profile of alapurinol and monitor potential reactions, particularly in Asian and African American populations.
Balancing Sugar Intake and Health Implications
Managing sugar intake is crucial for overall health. Recommendations include limiting liquid sugars and processed foods, educating children about sugar content in foods, and advocating for mindful fruit consumption based on the fructose content in fruits like grapes and apples. Understanding the impact of umami, dried fruit, and high-fructose foods like trail mix can guide individuals in making healthier dietary choices.
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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