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. We discuss:  The connection between blood pressure and fructose that shifted Rick’s professional focus [4:00]; The relationship between salt and blood pressure (and the role of sugar) [5:45]; Defining fructose, glucose, and sugar [19:30]; An ancient mutation in apes that explains why humans turn fructose into fat so easily [23:00]; The problems with elevated uric acid levels, and what it tells us about how sugar causes disease [31:30]; How sugar causes obesity—explaining the difference in glucose vs. fructose metabolism and the critical pathway induced by fructose [40:00]; Why drinking sugar is worse than eating it [50:00]; Unique ability of sugar to drive oxidative stress to the mitochondria, insulin resistance, and diabetes [54:00]; Why cancer loves fructose [1:00:15]; The many areas of the body that can use fructose [1:05:00]; Fructokinase inhibitors—a potential blockbuster? [1:07:15]; Treating high uric acid levels—Rick’s approach with patients [1:10:00]; Salt intake—what advice does Rick give his patients? [1:16:30]; How excess glucose (i.e., high carb diets) can cause problems even in the absence of fructose [1:21:00]; Artificial sweeteners vs. real sugar—which is better? [1:29:15]; Umami, MSG, alcohol, beer—do these have a role in metabolic illness? [1:33:45]; Fructose consumption—Is any amount acceptable? Is fruit okay? Where does Rick draw a hard line? [1:38:45] How does Rick manage the sugar intake of his young kids? [1:43:00]; and More. Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/rickjohnson Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Episode Description: 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: Unique features of fructose metabolism and why it matters [2:45]; A primer on fructose metabolism and uric acid [10:30]; Endogenous fructose production, the polyol pathway, and the effect of non-fructose sugars [22:00]; Findings from animal studies of glucose and fructose consumption [29:00]; What calorie-controlled studies say about the claim that a “calorie is a calorie” [42:15]; Implications for aging and disease [51:15]; Impact of endogenous fructose production on obesity and metabolic syndrome [1:01:30]; Why vulnerability to the negative effects of sugar increases with age and menopause [1:04:30]; Dietary strategies to reduce the negative impact of fructose [1:16:30]; The role of hypertension in chronic disease and tips for lowering blood pressure [1:30:45]; The impact of fructose and uric acid on kidney function and blood pressure [1:39:45]; The potential role of sodium in hypertension, obesity, and metabolic syndrome [1:49:00]; The role of vasopressin in metabolic disease [1:54:00]; More. Sign Up to Receive Peter’s Weekly Newsletter Connect With Peter on Twitter, Instagram, Facebook and YouTube

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. Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/rickjohnson/  Subscribe to receive exclusive subscriber-only content:  https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.