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

**Peter Attia** (0:11)
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Now, without further delay, here's today's episode.
My guest this week is Dr. Rick Johnson. Rick is a professor of medicine in the Department of Nephrology at the University of Colorado, where he's been since 2008 He's basically spent the last 17 years being a division chief across three very prestigious medical schools.
He's unbelievably prolific as an author. He has well over 700, approaching 800 publications, seemingly every week in JAMA, New England Journal of Medicine, Science, et cetera. He's lectured across 40 countries, authored two books, one of which we discuss in great detail in this podcast called The Fat Switch, which he wrote about seven or eight years ago. He's been funded extensively by NIH, and in fact has received the most prestigious grants that NIH has to offer. His primary focus in research has been on the mechanisms causing kidney disease, but it was doing this that he became really interested in obesity, diabetes, heart disease. And what connected me to Rick, I guess about seven years ago now, maybe a bit longer, was his work on fructose and fructose metabolism. And that's really what we talk a lot about in this podcast. So we start by talking about high blood pressure, the relationship between salt and high blood pressure, which is something that is incredibly controversial, and I actually learned a lot in this podcast. I'm really glad we had this discussion because I kind of thought I had this thing figured out and I clearly don't. We talk about one of the most interesting bifurcations in evolution with respect to an enzyme that allowed us to use fructose in a certain way that was obviously advantageous millions of years ago today, not so much. We talk a lot about uric acid, which you've probably heard me talk about on other podcasts. This will then be the master's class in it. We talk about artificial sweeteners and we sort of touch on some of the most promising ideas around pharmacotherapy that are being developed in response to the epidemics of metabolic disease, especially in response to sugar. So this episode gets a little bit deep on some of the biochem. We're gonna have, obviously the show notes will, as usual, provide a great background and a list of references. And I hope you enjoy my discussion with Dr. Rick Johnson.
Hey, Rick, thanks so much for opening up your office today and making time.

**Rick Johnson** (3:03)
It's great. I'm very happy to have you here.

**Peter Attia** (3:06)
I've wanted to sit down with you for about a year in this format, because I guess we've probably known each other for maybe about six years now.
And every discussion has been one of those discussions where at the end of the discussion, I think, man, how am I ever gonna remember all of this stuff? And how will I be able to sort of synthesize this to translate it into sort of what I'm doing? And I've said this sort of many times before, but that was the whole kind of reason that I started a podcast, was I just found myself every week having a discussion with someone, usually scientists, where I thought, this something's gotta be shared. So you would certainly be one of the three or four people in indirectly that was a real catalyst for the podcast because of the frequency with which we would either have these dinner discussions or discussions over the phone. And so anyway, for that, I wanna thank you, and hopefully the listeners do as well. But in the introduction, I've set this up a little bit as to why this is such an important discussion.
And because there's so much to talk about, I just kinda wanna jump right into the meat of things. It would be not an exaggeration to say you were one of the world's experts on fructose. And I guess I would just start with the why. Where did that interest come from? You've obviously been doing this for a long time, and that passion has been sustained. So what brought you to this point?