View episode show notes here: https://bit.ly/3ugel18 Sign up to receive Peter's email newsletter: https://bit.ly/4c602k2 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 -------- 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). Learn more: https://bit.ly/3AU1GlM Subscribe to receive exclusive subscriber-only content: https://bit.ly/3IYxadj Sign up to receive Peter's email newsletter: https://bit.ly/3Ghrh9i Connect with Peter on: Facebook: http://bit.ly/PeterAttiaMDFB Twitter: http://bit.ly/PeterAttiaMDTW Instagram: http://bit.ly/PeterAttiaMDIG Subscribe to The Drive: Apple Podcast: http://bit.ly/TheDriveApplePodcasts Overcast: http://bit.ly/TheDriveOvercast Spotify: http://bit.ly/TheDriveSpotify Google Podcasts: http://bit.ly/TheDriveGoogle