#87 - Rick Johnson, M.D.: Fructose—The common link in high blood pressure, insulin resistance, T2D, & obesity?

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Jan 6, 2020

Rick Johnson, a Professor of Nephrology at the University of Colorado, dives deep into the surprising effects of fructose on metabolic health. He reveals how fructose metabolizes differently than glucose, contributing to weight gain and insulin resistance. Johnson explains the alarming connection between fructose and high blood pressure, as well as its link to conditions like fatty liver and diabetes. He also shares insights on uric acid levels and the potential benefits of fructokinase inhibitors, challenging common beliefs about sugar and artificial sweeteners.

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INSIGHT

Dangers of High Blood Pressure

High blood pressure increases the risk of heart failure, stroke, heart attacks, and general heart disease.
A significant inflection point around 160-180 mmHg significantly increases stroke risk and mortality due to the body's inability to autoregulate blood pressure.

INSIGHT

Breakthroughs in Hypertension

Recent breakthroughs reveal inflammation in the kidney, driven by T cells and macrophages, can cause persistent high blood pressure.
This inflammation can be an autoimmune reaction, potentially triggered by an immune response to heat shock proteins.

ANECDOTE

The Uricase Mutation Story

Apes in Europe faced starvation due to climate change and the disappearance of fig trees, leading to a mutation in uric acid metabolism.
This mutation allowed for increased fat storage from fruit, aiding survival during food scarcity, and may explain how a European ape became the ancestor of humans and great apes.

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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.

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