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

View episode show notes here: bit.ly/3ugel18
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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[@shelchicago8997]

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

[@WillPeterson]

as soon as I finished I bought Rick's new book. It's great

[@NoKingsNoGodsOnlyMan]

Might as well add to the lies in Med school

[@billytheweasel]

@@NoKingsNoGodsOnlyMan Not sure if you feel Dr Rick Johnson is lying here or not.

[@NoKingsNoGodsOnlyMan]

​@@billytheweasel either that or intentionally disregarding the actual science. There are many grifters in this world. Praying on people that are tired of the mainstream dogma and are looking for alternatives. There is no shortage of people looking to take advantage of that will false alternatives. If is sounds dogmatic like, just don't eat animal foods (of course that's BS), or just don't eat plants (yes, veggies have toxins but fruits and their juice is very important), or just don't eat a whole macro-nutrient like sugar (pure propaganda), or any number of dogmatic "diets", you should be be more questioning. If you want an approach based on principals of biological energy and proper cellular metabolism look up Ray Peat PhD, Georgi Dinkov, Danny Roddy, etc.

[@NoKingsNoGodsOnlyMan]

@@billytheweasel In his 1957 book, "The Living State with Observations on Cancer," Albert Szent-Györgyi said that a cell needs energy for all its functions, including maintaining its structure. The cell's ability to maintain this high-energy, relaxed state relies on the availability of glucose and oxygen. Because protein, carbohydrate, and fat can provide glucose, oxygen iis the ultimate bottleneck in efficient energy generation through the mitochondria, also known as oxidative metabolism or mitochondrial respiration (or oxidative phosphorylation). Carbon dioxide, often considered a waste product, is another crucial element in this process. It's produced under the direction of good thyroid function and helps dissociate oxygen from the hemoglobin molecule, allowing cells, tissues, and organs to absorb oxygen more effectively. Therefore, carbon dioxide plays a critical role in facilitating oxygen delivery. Essentially, glucose, oxygen, and carbon dioxide are fundamental anti-stress factors, and interfering with their utilization or generation is not advisable. Now, let's talk about one reason why ketosis mimics the stress metabolism. If there's one key takeaway from this video, it's that becoming a "fat burner" or increasing lipolysis through voluntary carbohydrate restriction is a hallmark of aging and disease. For instance, one study found that "free fatty acid levels increase long before hyperglycemia becomes present." Another study stated that "there seems to be little doubt that there are signals for increased mobilization of fat in shock, trauma, and sepsis," and one more quote: "the enhanced mobilization and oxidation of fat is one of the fundamental responses to stress." The mechanism involves an initial short-term increase in adrenaline, squeezing glycogen out of the liver, and liberating free fatty acids into the blood. However, over the long term, cortisol and various other hormones, especially from the pituitary gland, increase the rate of lipolysis. This slows metabolism and brings the organism's renewal process to a halt. Another way ketosis mimics stress metabolism is by producing less carbon dioxide, primarily due to the oxidation of free fatty acids, which provides far less carbon dioxide than glucose oxidation. Apart from being a basic anti-stress factor, carbon dioxide is also a critical cofactor for the assimilation of fat-soluble vitamins. Lastly, ketosis can be considered a hibernation-like state for humans. You can measure the impact of carbohydrate restriction or ketosis on your metabolic rate using self-diagnostics like resting pulse rate and body temperature. Measuring these a few times a day can provide insights into the rhythmic changes of metabolism. In extreme stress situations, the pulse rate can barely be felt, and low body temperature has been associated with various health problems.

[@jefffrederick8648]

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.

[@TrudyContos-gq1bw]

I agree I only wish I can ask questions , but I'm far behind in this post how can I get these love

[@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

[@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

[@balancingthelightbodyheath4824]

I’m not an expert, but I heard there is a sodium potassium pump… that the true issue isn’t necessarily with salt but with the lack of potassium to balance the sodium.

[@resistapathy]

What is your serum sodium level?

[@StangspringDK]

Insulin makes you retain sodium. Since you keep carbs low, then you probably secrete more salt. I believe the "sweet spot" is 4-5 grams of sodium, which is around 10-12 grams of table salt (sodiumchloride).

[@camronRD]

Im confused though, the AHA recommends sodium of 2300 mg a day otherwords; 2-3 grams not 5.

[@StangspringDK]

@@camronRD Observational study on sodium and all-cause mortality: www.ncbi.nlm.nih.gov/pmc/articles/PMC8169157/

[@user-pr5tx9ep4m]

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

[@FelixBizaoui]

I agree though I still find his method challenging.

[@nunheadamerican6179]

I love that Peter is grilling this guy. We need to question the 'experts'

[@TheIgnacio777]

More than usual. Wecan all have a bad day😂

[@TrudyContos-gq1bw]

Who said he's a jerk!? He is the opposite.

[@roughout]

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

[@tmchugh]

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

[@eugeniebreida1583]

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.

[@joecal2360]

Yup, and it's cringe-inducing every time; I had to break at 40 min, you beat me by 7 min

[@mosesramirez6330]

Interesting. I saw this as Dr. Johnson having a rather scattered delivery and Dr. Attia trying to keep him on track, both for the sake of his own sanity and that of his audience.

[@mohanish]

Peter’s questions were penetrating and relevant to the discussion. He wanted to keep the conversation on track and make sure the lay person could follow along. Johnson’s explanation was a bit scattered. A few times, he was even anti-climactic saying it was a fascinating study but could not recall the end result/conclusion of the study. This says to me that he has his post docs and grad students do most of the grunt work in the lab while he stays busy writing research proposals in his office.

[@barkeater7867]

He may not have been ready to respond like he was i court. Attia said obviously to one of his discoveries. What an ass

[@jeffreyharrison4045]

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

[@Bungifun]

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

[@kenyaalure4524]

I came to say this lol please stop interrupting so frequently

[@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!

[@davidwright586]

Kmp cc k k kk me a yyi

[@righustle6859]

Wow what a grilling … he did really well to handle this volley of technical questions

[@dineshverma9097]

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

[@joshuastephenkingsly]

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.

[@benikramer5115]

Biochemistry is exactly what makes the lecture so interesting!

[@MandalaBunnyhome]

Really interesting conversation, I took a few biochem/metabolism classes in college but I forgot a lot, you broke everything down very well 👏👏👏

[@abdelilahbenahmed4350]

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.

[@FrankyFrankster]

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

[@vivi4140]

thanks!!!!!!

[@MrDannyhealy1]

Awesome. Cheers.🎉

[@robertoperaza2683]

Thanks for bringing Rick back to the show / Awesome episode

[@jayalanlife5926]

Excellent podcast. Rick has a lot of numbered dots on paper and Peter drew the lines between the dots to create an amazing picture, just like I did when I was a kid(I was pretty sure what the picture would look like but it was a fun experience). Itere was a clear and present respect between you two and I learned so much more than I anticipated. Having listened to it, my diet will now be mainly tree bark and water 😁. Cheers Alan

[@888jucu]

Go easy on the tree bark mate 👍🤣

[@StangspringDK]

@@888jucu The bark of cassia trees are high in coumarine. Can cause liver damage. Cassia bark is used to produce cheap cinnamon.

[@kevinsmith8799]

This is a fantastic podcast. Real World application. Thank you.

[@user-ov6ux7pj9t]

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

[@7hills812]

Peter is a genius!! He can distill hard concepts and make it easy to understand for an average person!!! Rick’s awesome too - handled tough questions well!!

[@Greg_Chock]

Thanks for this interview - there was so much to digest that I bought the book to get the full details.

[@DavidsZalansMuzika]

Amazing. I checked the research regarding endogenous fructose production and its simply amazing. Also salt. Superb.

[@veramentegina]

my goodness!! this was amazing!! thank you much!!

[@chazwyman8951]

I have to commend Johnson on managing to field some tough questions, calmly and succinctly, and Attia for following the answers closely enough to to unpack and re-pack what is being said, and all off the cuff.

[@agarnierable]

Yes, tough questions, and I can tell this was prior to the host's personal epiphany about anger. I gave up on his podcast during the early period because I was picking up on that anger undercurrent (Abbott which he's been very forthcoming since his new book). This one is very hard to get through, and yes, the guest is very gracious but I can see the tendency Attia has to get others tho "play defense"...especially watching this on 2x speed.

[@anonymousanonymous7304]

Very interesting conversation. Starts to answer some of my questions.

[@jimgillert20]

Peter's clarifying questions helped my questions from Dr.'s book .

[@adf2M]

This is not for the average person not studying medicine but still a good podcast.

[@brookstorm9789]

Priceless. I can now approach weight loss and health issues with relevant knowledge. Thanks so much!

[@HH-gn9qt]

Tbabk you Peterfor slowing things down, recapping and asking questions with the layman in mind. This is science and I love it. Many are under the impression fructose is only metabolized in the liver. Brilliant discussion! Liked and shared.

[@hamdiel-sissi7760]

Great discussions in immense depth!

[@johnny7808]

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

[@juukame]

His interruptions at least tend to be good questions which shed more light on an idea..... but, it still annoys me lol

[@bwild7483]

Interesting how we all differ. I didn't think Peter interupted at all. Rather he questions to clarify. I,for one, really appreciate his 'interuptions'

[@tmcnicho]

I admire Peter interrupting and asking for more layman's style examples, otherwise most of this is over my head.

[@pavelchorda8425]

Peter is doing great, helping to transmit the essence of the research and making the guest think and reflect and learn how to explain better.

[@trevorrogers95]

Your amygdala is showing!

[@pytheus]

Thank you Peter! And, thank you Rick!

[@shaleel]

im against banning substances for a variety of reasons, but I def think sugary drinks should probably be behind the counter.

[@nadernayo]

Amazing video as usual.. couldnt absorb all this information in one session.. Thanks

[@TheCeo_]

Tiffany Rolex OP! I want to be a doctor! But seriously I loved this ‘interrogation’. Bit of a geek-off between two titans. Wish it had been better summarised so I could understand more of what is clearly hugely important work. Can we have a synopsis of all the findings please? Keep up the great work. And let’s see your watch collection at some point ha.

[@ktakashismith]

There's a discussion of a metabolic pathway that drives the majority of chronic diseases that are cumulatively responsible for millions of deaths and trillions of dollars in economic damage every year, and you are sycophantically fixated on a wristwatch; asking for a bullet-point summary of the discussion to save you time, perhaps so you can keep hustling away towards that coveted Rolex, which apparently would be superior motivation for you to become a doctor as opposed to, say, wanting to help people. Sometimes I feel like we need to bomb ourselves back into the stone age so our species can collectively reorganize its priorities.

[@iss8504]

I am a lawyer and Peter treated Rick a little like a hostile witness. Would have preferred Peter letting the guest talk.

[@eugeniebreida1583]

@@iss8504 I am afraid my experience listening to Peter is that he frequently leans toward this communication style. Too bad.

[@udonloews1301]

Thank you for this presentation👍.

[@annehaight4530]

Have their been any studies in regards to “non artificial sweeteners”, such as Stevia and Organic monk fruit?

[@chleoi4160]

Wow this is an amazing podcast, it made so much information so much clearer & more precise 👍

[@cattleprods911]

Fantastic interview, thank you Peter.

[@faimohkihfaimohkih8223]

The idea of the “15 year” isocaloric mouse study and the mice staying the same weight says nothing of their adiposity. Even though they ended up close to the same weight it is more important to know if their body comp was the same. Any chance for a mouse dexa? I’m willing to be the fructose mice had at the very least, more visceral adiposity and likely more adiposity overall

[@andreeanitescu9026]

That's such an excellent point!

[@applebutter4036]

shout out to all my finny bro's out there.

[@sohanpaliwal9134]

Great discovery .deserved for noble prize 🏆

[@pradipkumarbhandigare4986]

Great conversation between two genius and brilliant personalities.

[@albertdowrn]

I have developed a man crush on Drs. Johnson, Perlmutter and Attia. Finished "Nature wants you to be fat" and currently reading "Drop Acid". I was a poster child of all the downstream effects of fructose consumption. HTN, elevated lipids, NAFLD, pre-diabetes and gout.

[@thepatternforms859]

It breaks my heart that alcohol metabolism does this too. I absolutely love drinking but as a long distance runner this explains why drinking alcohol is so devastating to my performance and health… what a shame

[@limitisillusion7]

What did you expect? It's quite literally poison.

[@CarnivoreDMD]

😂 if it’s a non-essential, then it’s …poison, like sugar. So. I still 🍺 but I also monitor my glucose, ketones, lactic acid & URIC acid. I take Quercitin, Vit C, Potassium Citrate, magnesium & NAC daily & usually melatonin. I Z2 bike 4H/wk & Z5-6 1h/wk. I’m KetoVore & hard to grill steak 5xwk w/o a cold!😅🍺

[@thepatternforms859]

@@CarnivoreDMD are u a dentist? If so answer this question to prove it. What % of the time should you expect to find MB+2 in the MB root of an upper 1st molar?

[@CarnivoreDMD]

@@thepatternforms859 Haha, I spent 15 years not looking for MB2 & wondering why some still were symptomatic! Now I ALWAYS look for MB2 in 1st Molars to prove it’s there or not. My personal clinical experience is that it’s 50% but some have hypothesized much more. Of that, some of those MB2’s end up non treatable due to dilaceration so just end up using 3-Mix-MP or BioRoot Flow. I’m a co-author of an endo paper on post-op sensitivity of endo tx teeth thru DPBRN.

[@kathleenstewart44]

We have also known about the Randle cycle since 1963, but many don’t want to discuss that.

[@baaaaaa2898]

Ray Peat follower ? ( :

[@miltonbates6425]

It's common sense. Fruit is seasonal and ripens in mid/late summer in most climates. We eat the fruit to generate and store fat for the harsh winter that's looming on the horizon.

[@claudiucosar]

yeah? what about ecuatorials? seasonal….

[@miltonbates6425]

@@claudiucosar They're still seasonal at the equator, with most fruiting trees flowering twice per year.

[@claudiucosar]

@@miltonbates6425 In Thailand they sell mango's year round but out of season they are the green mango's. They might also have sweet mango's but then they let them flower offseason. Papaya "trees" will produce almost continuously throughout the year. ( fruit at almost every stage, and flowering at same time ) banana coconuts Some others you can get most of the year, like avocado and citrus. There's some fruit all year round....

[@miltonbates6425]

@@claudiucosar Fruit is a sub-optimal source of nutrition for the human body, even for those living along the equator. Prolonged overconsumption is potentially very damaging to those who's primate ancestry migrated away from the eqator millions of years ago and now live in northern climates, as they are more genetically adapted to utilize the bioavailable proteins and fats that are present in other animals.

[@claudiucosar]

@@miltonbates6425 i would avoid classifying things using a thin layer of literature you point out. We're going the rabbit hole(paleo>what did ancestors ate...and so on...) Fruit is delicious, healthy and is robbed away from the chemicals most plants do contain. The poison is in the dose....I often see promoters that fruit is bad and will gonna kill you, or does make you fat and sick...well if you do train yourself, do one of the pivots that dr. Peter pointed out in his framework(i do eTRF and often WHAT axis), you sleep well, eating fruits instead of processed food desert is one of the most healthy way of living ... FYI i am not more interested in continuing this discussion please.

[@wocket42]

Amazing. This is what youtube is good for.

[@Millo1868]

More gold from this channel.

[@3377ftw]

Wonderful info, so worth the 2 hours

[@happyzonealways]

Both participants have the knowledge in real depth! I wish my professors in college and med school were that good!

[@paulhelman2376]

All the risk items noted are relatable to causative to endothelial injury which arguably begins and promotes progressive arterial pathologic changes related to the cerebrovascular, cardiovascular, and renovascular diseases you mention.

[@user-pr5tx9ep4m]

I love the view from over Peter's shoulder of his blurry ear.

[@jysix]

it is so good that Peter can ask the critcal questions, that most podcasters out there can not.

[@silviahayakawa6655]

So helpful; thank you! So is preloading with protein a work around if you do want to eat some of those higher fructose fruits or drink wine to reduce the spike or does it not matter?

[@RobertJMsc]

all this talk and not a single RCT is discussed that proves the relevance of this discussion IN HUMANS

[@LoriSavingWild]

where is the table of fruits that you both mention you would put in show notes? Thanks.

[@AngelaAStantonPhD]

Excellent! Thank you!

[@andrewtaylor9799]

This is the most helpful information I've had in a long time on diet and health. Rick Johnson is very impressive. His information on fructose explains a lot of questions I've had. A comment: Peter, your occasional summaries and recaps are helpful, but please let experts like this speak with fewer interruptions.

[@Marx1963]

I get the fructose eliminating . I don’t understand the limit on Umami proteins -red meats organ meats shellfish and shrimp . They’ve been the staple of my diet along with eggs poultry and Greek yogurt. Only study I have is my own Uric acid lab results which was recently 4.2 on a 4-8 range . I find it illogical to restrict these healthy foods as I’ve been eating them regularly for years. I apparently have no issues with Uric acid . I also maintain a fasting insulin under 2 and a A1c of 4.8 . I eliminated fructose ,seed oils ,processed foods as I find them the culprit in poor metabolic health . From my health history anyway.

[@LTPottenger]

The purines you get from food is basically insignificant. If someone has a gout attack though the thing to do is fast and take baking soda or better yet potassium bicarbonate, to help the kidneys deacidify.

[@LTPottenger]

Caffeine is also a purine to watch out for. I realize you said you don't have gout, just putting this out so people can see the correct information.

[@Marx1963]

@@LTPottenger I drink a ton of coffee.

[@Terri_2.0]

Dr. Johnson says the umami trigger is the least thing to be concerned about. Many times he also specifies processed red meats should be watched, but not sure how much fresh red meat he would think is problematic. He makes it pretty clear that sugar/glucose/fructose/starches are the bigger problems.

[@limitisillusion7]

I can't convince you to drop what you've been doing your whole life, but the large majority of the science says that the red meat isn't great for longevity. Alcohol makes you feel good too, but they doesn't mean it's good for you. I expect a similar thing is happening with diets high in red meat. The longest lived people eat a Mediterranean diet. I don't know what other evidence you need.

[@v.annabonac2913]

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.

[@MsTony1402]

This is way above what I can understand. Sadly I don’t have a biology/chemistry degree...

[@ceciliaferraro6360]

Brought me back to Kerb cycle way back then.thank you Peter.

[@RostockIndustrial]

This guy is amazing!

[@WillPeterson]

If you take people with high blood pressure, put one group on a low sugar diet, and another group on a low salt diet, which one has a stronger effect?

[@Mr-hn2bp]

Sugar has a greater effect. Salt effect can be neutralized with increased water intake.

[@knight9464]

Just wow... Thank you

[@annewilby5558]

I have a continuous glucose monitor & though I try to maintain an extremely low carbohydrate diet, I am shocked that my glucose spikes with one tablespoon of milk!

[@limitisillusion7]

Eat more fibrous carbs then. You don't have the gut microbiome to handle carbs, so you're probably bordering on insulin resistance.

[@annewilby5558]

@@limitisillusion7 Thank you

[@OIOnaut]

Happy to see a new R_Jo. episode. Yesterday I went through the previous Rick Jonhnson, L.Cantley. Robert Lustig and the great cancer / autophagy talk with Eileen White. We have a close family member that drinks every day SSBs'. She has metastatic colorectal cancer and I remember Rick talking about fructose fermenting too far in the colon, further than it should, thus possibly being a contributor to abnormal cell respiration and growth. Robert Lustig says that when PI3K+, AMPK-, mTOR+ are expressed together = growth. In the case of chronic insulin resistance this spells cancer. She does not listen and her doctor does not know. I see this happening even in those who are younger than myself i.e 55y.

[@highfades2594]

where can i find the Lustig/White interview?

[@ljs94]

Can you link the talk please?

[@OIOnaut]

@@highfades2594 Sorry I was thinking of them separately. I do not know of White and Lustig having a discussion over the topic with eachother. It would be awesome though. The Lustig 3 metabolic and energy sensing enzymes is in YT under the topic: Prof. Robert Lustig - 'Sugar, metabolic syndrome, and cancer'

[@OIOnaut]

@@ljs94 see my response below. Apologies for being a bit vague on my behalf.

[@drpuma19]

God,how kind are you two sharing such deep knowledge.

[@msforbes500]

Hi Peter I love your content and your podcast. I studied finance and i’m glad to learn great things in science. Hello from Montreal, Canada 🇨🇦🇺🇸

[@charles20asselin]

I just preorder your book thank you

[@rskar]

i love pa and thank you for exposing me to this top-notch info with incredible organization... but the interruptions on this interview were a bit hard on the listener

[@swenic]

Why do you keep on interrupting him?

[@billytheweasel]

Thanks yet again Dr Attia. I searched many times for this and never found it again after my first viewing. '140/90 = meds. But 135/85 meds are questionable -so nutrition, no salt, and exercise' I just had an eGFR of 61.5 and am awake. After decades of protein in my urine that DR's figured was physical work and lifting weights.

[@nunheadamerican6179]

What is the role of the heart rate in blood pressure ? I've had high blood pressure 170/100 but have had a consistently low heart rate of 50 and below. When I exercise my pressure goes up to 210/120 with a max rate of 70 BPM. An amazing video. thank you!

[@laylapersia]

Get yourself to a nephrologist or cardiologist - maybe get on Spironolactone? Your BP is statistically putting you at very high risk for multiple diseases...

[@triluve]

thanks for creating real content on youtube.

[@IvicaOS]

what a great pod, and what a great guest…fantastic!

[@bennguyen1313]

Regarding how kidney inflammation (and salt sensitivity) goes up with age , and causes high blood pressure, and therefore it's important to keep blood pressure between 120/80 - 140/90 , low uric acid levels (< 5 mg/dl?), and GFR high (ex. 107 for a 40 year old).. how important is the albumin to Creatinine ratio? i.e. normal eGFR but microalbuminuria of 30? Regarding how some glucose can metabolize fructose to glycogen, but the real enzyme responsible is Fructokinase... and those born without this enzyme don't seem to get T2D... how does that compare with hereditary fructose intolerance? Regarding how a high carb/glycemic -> liver glucose + salt -> Aldose reductase -> sorbitol -> fructose -> fructokinaise (stimulated by uric acid)... and that ~5g can be metabolized in the gut, the rest goes to the liver.. it would be interesting to see if lowering uric-acid via Alpuerenol lowers the amount of fructose metabolism that occurs. Any thoughts on Robert Lustig's work that suggests fructose causes cellular energy ATP to go down the AMPD pathway (rather than AMPK), and that it can fuel tumors by knocks out the APC gene (via Fructokinase , lowering atp, AGES etc).. and how insulin resistance in the liver (only one insulin receptor) disrupts the FOXO phosphorylation pathway but not always the SREBP-1c pathway.

[@szymonbaranowski8184]

good regular blood pressure end at 120-80 everything above is meaning you are sick

[@sky.the.infinite]

This dude is like the healthier doppelgänger of David Lynch…! 👀🤣🤓 it’s meant to be a compliment, he looks and even sounds just like him! Another excellent interview, love your questions bro!

[@ralphbuschmann740]

Thanx!

[@oldroscoe2590]

Goodness, I heard a lot and learned a lot. I sure didn't have the best health habits but like they say, if I'd a known I was going to live so long....

[@odinthehungryhusky4569]

this podcast is priceless

[@PERFECTWORKOUT]

As a personal health coach, I fundamentally gained the conviction with this conversation for the first time that if „it fits your macros“, apart from the usual reasons (such as intestinal health, etc.), in the long term for clients, especially in adulthood and without intensive sport, can not lead to successful weight management. In contrast to common phrases like: the metabolism gets worse with age, these facts are extremely refreshing! 😊

[@limitisillusion7]

You don't need to redline your exercise routine. But id your heart rate isn't getting to zone 2 for extended periods of time, you simply are never going to reach optimal health for longevity. Exercise is necessary for health

[@quity919]

facinating!

[@patriciap5918]

Fascinating information into the mechanisms that drive metabolic disease. Just to confirm, the most actionable things people can do with this information right now is follow a low carb diet, & keep uric acid levels low?

[@evanrosenlieb8819]

RE: dried fruit -- I imagine vitamin c and flavanols are degraded a lot due to oxidation during the dehydration process

[@Unsensitive]

What about studies that showed the liver harm from ethanol alcohol required Linoleic acid in the diet. Ethanol metabolism and fructose have much overlap. Makes me wonder if the harms from fructose are also affected. I bring this up because rat chow often contains high levels of Linoleic Acid.

[@djevlhelvete]

A table of fruits (regarding sugar content) was promised to be shared in the show notes...where is it?

[@nolanwardy7409]

What about pure dextrose prior to exercise? I have a hard time grasping that dextrose, which is glucose, which is what the body converts all carbs you eat into for use; would be trouble for the body?

[@carolinelewis952]

❤️Thank you for this information as I keep trying to keep away from carbs and sugar. I'm going to listen to this once a week until it gets in my head.

[@user-nm6rd2mb2g]

Yeah, you have to cause to someone like me, who mostly want questioned answered like, “what should I eat?” What foods should I stay away from? Exactly what foods contain fructose? As I read the comments I notice they are from pretty smart people who are grasping all these explanations and scientific language. I had some college and some biology, but learning all these terms. ATP and so forth. I only got up to 42:39 and the answers I’m looking for haven’t come up. I will fast forward. This is the second interview with Dr. Johnson that I’ve watched and still the language is for Dr.’s, chemists and biologists. I’m into nutrition and am always looking for suggestions on what to eat. If you check out “Freely The Banana Girl”. You will see that she is a fruitarian. I remember watching her eat at least 15 bananas ( and more) in a blender with coconut water. Maybe because she went riding right after, but she never had any health problems and still eats plenty of fruit.

[@user-nm6rd2mb2g]

Sorry, I didn’t mean to put all that info to one person.

[@888jucu]

Please some people stop moaning that you think PA is interjecting too much on RJ. Honestly I hardly noticed and we shud be grateful we have such a useful tool to be a fly on the wall and listen in on two well known figures in Metabolic syndrom just going through it and discussing where it is at and what new can be derived from it etc etc, I find it fascinating at the very least 👍

[@paulhelman2376]

What effect does fructose have on advanced glycation end products in his mice and their relation to aging?

[@rajeshasher9769]

Excellent discussion, can you please explain whether consumption of walnuts, cashews and almonds is bad for health?

[@paulhelman2376]

What is the effect of ketosis on aldose reductase activity?

[@chleoi4160]

Where is the list for the fruit that is mentioned on the show by Rick Johnson, I could not find a link in here or in the show notes?!!

[@aa-xn5hc]

Fantastic interview

[@headholio]

Peter is a smart guy and knows a ton of stuff, but on this topic, Rick Johnson is THE MAN. He talks off the top of his head like he's reading a textbook, all with a happy attitude like he's talking about picking apples on a beautiful fall day. Meanwhile, Peter sits there with a scowl on his face looking to poke holes. Dr. Johnson had brilliant answers for all Peters side tracks, but it would have been better if Peter challenged less and let this brilliant doctor talk more freely about what he has learned. I know its just Peter's style and he means no harm, but jeez, scowl scowl scowl, chill dude. A Type A++ guy like Peter could die young despite all his exercise and nutrition knowledge.

[@annewilby5558]

How do seed oils in processed food contribute to oxidative stress of mitochondria? If they contribute at all?