Rick Johnson, M.D.: Metabolic Effects of Fructose (Ep. #87 Rebroadcast)

**Peter Attia** (0:11)
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Now, without further delay, here's today's episode.
Welcome to a special episode of The Drive. For this week's episode, we are going to rebroadcast one of our most popular episodes, which is my conversation with Rick Johnson, which was recorded in the fall of 2019 and released in January 2020 As Rick has a new book coming out in February, I'm going to sit down again with Rick for round two of this podcast shortly. And because of this, we want to ensure that everyone is aware of our original discussion. Additionally, if there are any follow-up questions or topics that you think Rick and I should discuss, we'd love to hear those as well going into this. You can help make my prep easier by giving me some questions to ask. As a reminder, Rick is a professor of medicine and nephrology in the renal medicine disease, hypertension division at the University of Colorado. He attended medical school at the University of Minnesota and did his internship and fellowship at the University of Washington in this episode. We talk about all things fructose. We talk about how it relates to high blood pressure, insulin resistant, type two diabetes and obesity. We also talk about why drinking sugar is worse than eating it, why cancer loves fructose. We talk about uric acid, salt, artificial sweeteners and more. So without further delay, please enjoy or re-enjoy my conversation with Rick Johnson prior to round two.
Hey Rick, thanks so much for opening up your office today and making time.

**Rick Johnson** (2:05)
It's great, I'm very happy to have you here.

**Peter Attia** (2:07)
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 is something that'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?

**Rick Johnson** (3:19)
Well, I'm a kidney doctor. So normally we wouldn't be studying sugar. So it was kind of a circuitous way that I got there. I was very interested in the cause of high blood pressure and had been known for a long time that high blood pressure is linked with kidney.
And in fact, the going theory is for years was that the kidney in high blood pressure has a defect in its ability to excrete salt. And so that you end up retaining salt and that leads to elevated blood pressure. And when we were studying, trying to understand how the kidney handles salt in high blood pressure and so forth, we were trying to understand potential pathways. And we stumbled on the fact that hyperuricemia or elevated uric acid could be a very significant risk factor for high blood pressure.