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Episode 540
The Doctor's Farmacy

Why Sugar And Fructose Are So Deadly with Dr. Richard Johnson

Open the Podcasts app and search for The Doctor’s Farmacy. If you’re viewing this site on your phone, you can just tap on the

Tap the subscribe button and new shows will be added to your library.

If you’re using a different device, our show is available on the following platforms.

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We’ve been set up for failure when it comes to our metabolic health. 

Eighty-eight percent of people are metabolically unhealthy, and since the 1920s we’ve shamed them into believing it’s their fault—that they should just eat fewer calories and exercise more. 

But the real culprit is sugar and the processed foods that contain it. The majority of foods on our market shelves contain insane amounts of added sugar and high-fructose corn syrup—ingredients that literally slow down our metabolism and turn on our internal fat storage switch. 

That means we have the power to turn that switch off by choosing to use food as medicine. Today, I’m excited to talk to Dr. Richard Johnson about how our biological fat storage process works and what we can do to positively affect it. 

Dr. Johnson and I dive into the real biological problem with sugar and why our bodies are designed to store fat in response to it, especially in the form of high fructose corn syrup. It’s not simply a matter of calories in, calories out. There is a ripple effect happening inside each of us, from our hormones to our microbiome and more, and the quality of information from our food will dictate whether our systems function better or worse.

Mitochondrial function is an essential part of the conversation if we want to support optimal metabolic health and longevity. Dr. Johnson and I discuss how to support these energy factories, along with the importance of reducing oxidative stress and the negative impacts of fructose using key nutrients like vitamin C. 

We live in a food environment that can make it hard to maintain a healthy metabolism, but with the right choices, it’s ultimately in our control. Reducing our sugar intake is a huge step in the right direction.

 

This episode is brought to you by Rupa Health, InsideTracker, and HigherDOSE.

Rupa Health is a place where Functional Medicine practitioners can access more than 2,000 specialty lab tests from over 20 labs like DUTCH, Vibrant America, Genova, and Great Plains. You can check out a free, live demo with a Q&A or create an account at RupaHealth.com.

InsideTracker is a personalized health and wellness platform like no other. Right now they’re offering my community 20% off at insidetracker.com/drhyman.

Right now, get your own Infrared Sauna Blanket or Infrared PEMF Mat at HigherDOSE.com today use my promo code FARMACY15 at check out to save 15% off OR just go to Higherdose.com/hyman to get your 15% off today.

I hope you enjoyed this conversation as much as I did. Wishing you health and happiness,
Mark Hyman, MD
Mark Hyman, MD

Here are more details from our interview (audio version / Apple Subscriber version):

  1. What makes sugar so bad?
    (5:50)
  2. How our body’s fat storage switch works
    (7:25)
  3. Why eating certain foods makes us hungrier
    (15:07)
  4. Eating sugar slows down your metabolism
    (18:08)
  5. Comparing high fructose corn syrup to table sugar
    (27:19)
  6. The physiology of how fructose affects your body’s energy production and weight gain
    (32:45)
  7. The difference between eating a high-carb and low-carb diet, even if calorie intake is the same
    (42:30)
  8. Why mitochondrial function is key to health and longevity
    (53:35)
  9. Supplementing with Vitamin C
    (59:44)
  10. Is salt good or bad for us?
    (1:05:33)

Guest

 
Mark Hyman, MD

Mark Hyman, MD is the Founder and Director of The UltraWellness Center, the Head of Strategy and Innovation of Cleveland Clinic's Center for Functional Medicine, and a 13-time New York Times Bestselling author.

If you are looking for personalized medical support, we highly recommend contacting Dr. Hyman’s UltraWellness Center in Lenox, Massachusetts today.

 
Dr. Richard Johnson

Dr. Richard Johnson is a Professor of Medicine at the University of Colorado in Denver and has been a practicing physician and clinical scientist for over 25 years. He is internationally recognized for his seminal work on the role of sugar and its component fructose, in obesity and diabetes. His work has also suggested a fundamental role for uric acid (which is generated during fructose metabolism) in metabolic syndrome.  

Dr. Johnson is a prolific scientist with research that has been funded by the National Institute of Health since the 1980s. He is a member of the American Society for Clinical Investigation and has published over 700 papers, lectured in over 45 countries, and is a highly cited scientist. He previously authored The Sugar Fix with Timothy Gower in 2008, and The Fat Switch in 2012. His new book, Nature Wants Us to Be Fat was just released.

Get a copy of Dr. Johnson’s book, Nature Wants Us to Be Fat: The Surprising Science Behind Why We Gain Weight and How We Can Prevent–and Reverse, here.

Transcript Note: Please forgive any typos or errors in the following transcript. It was generated by a third party and has not been subsequently reviewed by our team.

Introduction:

Coming up on this episode of The Doctor’s Farmacy.

Dr. Richard Johnson:

A lot of the obesity is driven by the production of fructose. Fructose is actually what’s responsible for activating the switch. It’s what makes the fatty liver and the insulin resistance and all this stuff.

Dr. Mark Hyman:

Welcome to The Doctor’s Farmacy. I’m Dr. Mark Hyman. That’s Farmacy with an F, a place for conversations that matter. If you’ve ever struggled with weight or wondering about what you should be eating to lose weight, and why you can’t lose weight, and what something called the fat switch is, you might pay attention to this conversation because it’s with a key researcher in this field. Someone who has a lot to say about why we are an obese nation and increasingly an obese world. Dr. Richard Johnson, he’s a Professor of Medicine at the University of Colorado in Denver, and has been a practicing doc and clinical scientist over 25 years. He’s recognized for his seminal work on the role of sugar, which you know I care a lot about and its component fructose. We’re going to talk about fructose because we talk about sugar in a general way, but I think we need to get more specific in Dr. Johnson’s work about fructose. It’s so important. It’s how it plays a role in obesity and diabetes particularly.

Dr. Mark Hyman:

He basically has suggested that fructose has a really fundamental role. Particularly in how it affects something called uric acid, which we’ll talk about, and how it’s generated during fructose metabolism in prediabetes or what we call metabolic syndrome which by the way affects about 88% of Americans. It’s almost nine out of 10 of us. You’re listening and probably maybe you. Dr. Johnson has been a prolific scientist doing research that’s been funded by the NIH since the 1980s. He’s a member of The American Society for Clinical Investigation. Over 700 papers, a lot of papers. Lectured over 45 countries. He’s a highly cited scientist. He previously authored a book called The Sugar Fix with Timothy Gower in 2008 and The Fat Switch in 2012. His new book Nature Wants Us to Be Fat is out now. It’s an important book and it’s really quite a different spin on it. The full title Nature Wants Us to Be Fat: The Surprising Science Behind Why We Gain Weight and How We Can Prevent It and Reverse It. You might want to get that book. Welcome Dr. Johnson.

Dr. Richard Johnson:

Hi Mark. It’s just great to be on your show.

Dr. Mark Hyman:

Oh, I’m so glad to have you. Okay. Let’s get right into it. Now we know that sugar is bad and certainly anybody paying attention to my work for the last 25 years has heard me talk about sugar till probably sick of it. How is sugar such a threat? Why is it so deadly? I mean, tell us in your perspective as a scientist doing research on this, what makes sugar so bad?

Dr. Richard Johnson:

Well, sugar contains glucose and fructose. These are two different sugars that are bound together to make table sugar or sucrose. It turns out that fructose can activate a biological switch that tells a person or sets off a program to gain weight. When you eat sugar, you’re actually triggering this biologic process to gain weight. At the same time, sugar tastes really good. We have these sweet taste buds that really like sugar and we’re eating a ton of sugar. High fructose corn syrup, as you know, like 15% of the diet and it’s being put in all these foods. It can be a real menace. What’s really interesting about sugar just as an aside, is that if you take an animal and you genetically alter it so it can’t taste sweet or it can’t taste at all, it still like sugar. It loses its desire for artificial sugars, but it still will seek out foods that have sugar.

Dr. Mark Hyman:

Really? That’s fascinating.

Dr. Richard Johnson:

And they’ll still get fat from the sugar even though they can’t taste it.

Dr. Mark Hyman:

That’s amazing. So this fat switch you’re talking about is quite interesting. What do you mean when you say fat switch? Literally, is there some kind of metabolic switch that gets turned on that makes us store fat and gain weight? Now how does that work?

Dr. Richard Johnson:

Yeah, so this was one of our big discoveries. Everyone knows that obesity is linked with eating a lot of calories, bad foods. One of the classic theories is that it’s driven by the fact that we eat too much and we exercise too little, and so there’s excess energy that we end up eating that is not used and that gets stored as fat. When this hypothesis came out in the 1920s, we were the ones to blame because it’s overnutrition. We’re eating too much, we’re exercising too little.

Dr. Mark Hyman:

It blames the victim. It blames the victim essentially, right.

Dr. Richard Johnson:

Yeah. Blame the victim.

Dr. Mark Hyman:

You’re at fault if you’re overweight. It’s your fault if you’re overweight.

Dr. Richard Johnson:

Exactly. So quit eating, you know. Why are you getting such a big plate of food? Don’t go back for second. It’s your fault.

Dr. Mark Hyman:

Exactly, exactly.

Dr. Richard Johnson:

You’re taking the escalator when you should be taking the steps. And so this has been the classic teaching, but it turns out that there are certain foods that trigger you to want to eat more and triggering you to not satisfy your appetite so that when you eat, you don’t feel full so you want more. There’s certain foods that actually will reduce how much energy you have. It will actually make you drop your energy metabolism. So the formula is the same. You end up eating more and you exercise less. But the issue turns out not to be because it’s your choice. It’s because you’ve eaten specific foods that activate the switch.

Dr. Mark Hyman:

Your work is very similar to Dr. David Ludwig’s work. The whole idea that it’s our fault we’re overweight is one that is promoted by the food industry, by the government, by most doctors, and certainly most nutritionist which is really about this whole idea the energy balance hypothesis, which is it’s all about calories in, calories out. What you’re saying, I hear you saying what Dr. David Ludwig who’s been on the podcast is saying, is that it’s actually the quality of the calories that matter and the information in the food that matters. And that not all calories are created equal.

Dr. Richard Johnson:

That’s a hundred percent right.

Dr. Mark Hyman:

If you ask a fifth grader if a thousand calories of soda or a thousand calories of broccoli are the same, they would go, no. I’m, by the way, Richard, I have asked this question to the vice chairman of Pepsi, who by the way was a diabetic. Look, I said, “Let me ask you this. Is a thousand calories of Pepsi same as a thousand calories of almonds when you eat them?” He’s like, “Yes.” I’m like, okay. This is a great narrative if you’re selling junk, because it’s just all about moderation, right? There’s no good or bad calories. It’s all about moderation. It’s all about exercising more and eating less.

Dr. Mark Hyman:

What you’re saying is that there’s a different biological imperative, which is that our bodies are designed to store fat under certain circumstances which is a great adaptation to scarcity, but we have a problem of abundance. We don’t have scarcity anymore. We have on every corner in every gas station and pretty much everywhere we look, there’s an overabundance of food. And so what is happening with this ancient mechanism? Tell us exactly how it works. When we eat sugar, we slow our metabolism and we actually want to exercise less because we slow our-

Dr. Richard Johnson:

Exactly. It turns out that normally animals will try to stay at a certain weight. They don’t want to gain a lot of weight. They’ll maintain their weight. If they eat more one day, they’ll eat less the next. If they exercise more one day, they’ll exercise less. They try to keep their weight normal. But there’s some animals that really do want to gain weight. Those animals will gain weight by, you know, like in preparation for hibernation. For example, the winter is coming and they know there’s not going to be much food around. So these animals will suddenly, they’ll be regulating their weight fine for most of the summer. And then sometime in the fall, suddenly they start to eat a lot more. They will eat thousands and thousands of more calories.

Dr. Richard Johnson:

A bear will start gaining 10 pounds a day. It goes crazy. The animal will stay hungry and thirsty and go foraging for food. That’s actually part of this behavioral response. Then they’ll start storing fat and they do it by both synthesizing more fat, but also by breaking down the burning of fat. And so the fat starts to accumulate and they will become insulin resistant as part of this. It’s actually a survival mechanism because it keeps the glucose elevated in the blood, which the brain likes because the brain doesn’t really need a lot of insulin for it to work, whereas the muscles really do need insulin. By making the tissues resistant to insulin, the glucose, instead of going to the muscles is staying in the blood and it’s good for the brain. So it helps shunt the glucose from where it would be used in muscle to the brain.

Dr. Richard Johnson:

Insulin resistance is part of this survival response. Blood pressure goes up because they want you to have strong circulation in this kind of setting. And so all this happens, and we know it in humans as the metabolic syndrome, but it’s actually something that long distance migrating birds do before they migrate, animals do it before they nest. It seems to be triggered. Our big insight, first one was that there was this trigger that created this.

Dr. Mark Hyman:

Is that what you call the fat switch?

Dr. Richard Johnson:

Yes. A biological switch. You know, I also call it the survival switch when it’s for these animals, because it’s the same thing. Initially, it’s there to help you survive. But when you’re chronically activating it, it becomes a fat switch.

Dr. Mark Hyman:

It’s so funny, I remember going to Admiralty Island with my daughter years ago on a kayak trip in Alaska. It was where they had the greatest density of grizzly bears in the world. They were fishing for salmon. We were watching them. There’s this one little postage area, postage stamp area you could stand on with the guy with a shotgun. When their grizzly bears were all over and they were just chowing down on the salmon. Then they go up into the mountains in the end of the summer and they just chowed on the berries and they gain 500 pounds. Unlike the Game of Thrones, for us, winter never comes. Winter never comes. We just keep storing and then winter never comes and we just keep in this process.

Dr. Richard Johnson:

Absolutely right.

Dr. Mark Hyman:

I think the other thing that happens is that if we eat the wrong food, we’re hungrier. I want to talk to you about this because I remember this study, it was I think Kevin Hall where he looked at people that ate ultra-processed food versus whole foods. They could eat as much as they want to buy. There’s two groups. I think it was crossover study. They actually found that people who got to eat the ultra-processed food eat 500 calories more a day. Now in a week, that’s gaining a pound a week. In a year, that’s 52 pounds of extra weight simply by eating processed food, which is 60% of our diet. This is the problem, right.

Dr. Richard Johnson:

It is a big problem. Because processed food is often filled with sugar and it’s also filled with salt. I know we’re going to talk about that later, because it turns out that this fructose pathway can be activated by many different foods. It’s not just the sugar we eat. But anyway, so yes. What our discovery was was that this switch is activated by fructose. When we gave fructose to animals, they got the very exact switch. They start foraging. They get hungry. They’re thirsty, all the things that we talk about in the biological switch. And so fructose turned out to be it. One of the big questions we asked was, is the weight gain because they’re eating more? Is it this energy balance? Or is there another thing besides? The way you do that is you actually feed animals the exact same number of calories. One group gets sugar and another group gets other foods that don’t have sugar and everybody eats the same.

Dr. Richard Johnson:

If one guy doesn’t eat very much, then all the guys can’t eat very much. We did the study multiple times. But one time we did it, there was a little guy that did not eat much food. And so everybody was eating less than normal. All these laboratory rats were eating about two thirds what they normally eat. But one of them was eating a high sugar diet and one was not. The high sugar diet rats, they became diabetic. They all became diabetic, everyone of them. They all developed fatty liver. They had fat in their tissues. Their blood pressure was high. So the sugar was activating this switch even though they weren’t gaining weight because they were on a caloric restriction. Now when we looked at weight-

Dr. Mark Hyman:

So metabolically they were fat, even though they weren’t overweight.

Dr. Richard Johnson:

Yes. Right. Weight is driven, it is related to energy balance. When we measure their metabolism, their resting energy metabolism was lower. So even though they were eating the same amount of food, they were spending less energy so they tended to be a little higher. They were like 10%, maybe 5% higher in weight.

Dr. Mark Hyman:

You just said something really important. I want to highlight it and I want to let you continue because what you said was so important. When you eat sugar, your metabolism slows down. Is that what you just said?

Dr. Richard Johnson:

That’s correct.

Dr. Mark Hyman:

That is mind blowing, right? If you eat sugar, your metabolism slows down. That should get everybody to pay a lot of attention.

Dr. Richard Johnson:

Yes, it absolutely does. But it’s your resting energy metabolism actually. When you’re foraging, nature didn’t want you to not be able to forage for food because they’re worried that… You’re preparing for a bad time ahead so they want the sugar. The fructose still allows you to forage. It’s when you’re resting, instead of moving around. I tend to jiggle in my seat and so forth when I’m just sitting because I have a lot of energy. Right. But when you’re eating a lot of sugar, your resting energy metabolism falls. Your net energy metabolism drops. And so even though these rats were eating exactly the same amount, the one group actually started was losing weight. But the other group actually gained a little weight because of that. The sugar group gained a little weight, but it wasn’t significant. The bottom line is that the major thing driving weight gain is the number of calories you eat. That’s what drives weight gain. And so the energy balance, people always focus on the weight, but if you look at what the specific calories are doing, this metabolic switch includes blood pressure, fatty liver, fat. Those things and insulin resistance, they’re not driven by excess calories.

Dr. Mark Hyman:

In other words, your blood pressure, your cholesterol, your blood sugar, fatty liver, inflammation, diabetes, prediabetes, all are driven by the quality of the food you’re eating, by the quality of the calories. Because in the sense that we’re eating really crappy quality calories, that’s what’s driving this problem.

Dr. Richard Johnson:

A hundred percent.

Dr. Mark Hyman:

Reminds me of a study that David literally did years ago where he took rats and he gave them either a high fat, low starch sugar diet, or a regular high carb diet, which is what we all recommended. In fact, it’s what we’re recommending for the diabetics, eating a lot of carbohydrates, which is crazy. Anyway, he found that basically he had to keep reducing. He had to keep increasing the caloric intake of the low starch sugar rats, the high fat rats, because they were losing too much weight. Then at the end of the experiment, it was kind of awful, but he opened them up. They were eating exactly the same calories. The ones that were eating the high sugar diet had all this fatty liver and fat on their organs, all this visceral fat, belly fat. And the other ones didn’t, even though they were eating exactly the same calories because they were eating high fat, low starch sugar.

Dr. Richard Johnson:

Yep. You’re a hundred percent right. Dave Ludwig, that was a beautiful study.

Dr. Mark Hyman:

It’s not overeating that makes you fat. It’s being fat that makes you overeat. That’s flipping everything on its upside down.

Dr. Richard Johnson:

That’s pretty cool. I hadn’t heard that. That’s really cool. Well, one of the questions we asked, I mean, which was a question that actually Ludwig… So a lot of people say that the primary problem with carbs is that they stimulate insulin. Then the insulin drives the glucose into the tissues, then that causes the fat accumulation. That turns out from our research, that’s partly true, but it’s not completely the story. What we did is we had animals that could metabolize fructose, normal animals. But we also had animals that we genetically modified so that they could not metabolize fructose but they could still metabolize glucose. They could still produce insulin, all that kind of stuff. What we did was we gave them fructose. We could block the effects of fructose in the animals eating fructose.

Dr. Richard Johnson:

But then we gave them sugar. We gave them soft drinks, high fructose corn syrup. And so when we gave high fructose corn syrup, that contains both glucose and fructose, so we could see which was the more important player. What we found was that if we block fructose metabolism, they still drank a lot of high fructose corn syrup but they did not get fat. They did not get fatty liver. They did not even gain weight very much and that they gained a little but very little. And so that told us that it wasn’t really the insulin that was causing the obesity, but really it was the fact that the fructose present in the high fructose corn syrup was really what was driving obesity.

Dr. Mark Hyman:

Well, this is really a remarkable statement because we… This was like a common belief among nutritionists and doctors was that fructose was good for diabetics because it doesn’t raise blood sugar.

Dr. Richard Johnson:

Right. Exactly.

Dr. Mark Hyman:

Then the other thing about fructose is that in regular sugar, it’s bound tightly with glucose. In high fructose corn syrup, it’s free fructose, and the high fructose corn syrup may be 55 to 75% fructose. We’ve never seen this before. Now the other thing that’s so fascinating about fructose, and I want to unpack what, and take us down the fructose conversation, how it works to actually generate fatty liver, insulin resistance, obesity, diabetes in a minute. But what really what struck me years ago is, you know, Dr. Bruce Ames is a researcher. Very famous guy. I hope he’s alive. I don’t even know.

Dr. Richard Johnson:

Yeah. I think he is.

Dr. Mark Hyman:

I think he’s still, he’s like really old. He writes about aging now. But he basically said that they were doing studies looking at fructose requiring a lot of energy to be absorbed. The high fructose corn syrup leads to ATP depletion in the gut, meaning that the energy source that we need to actually keep our gut intact preventing leaky gut was impaired. Because when you have a lot of fructose in your diet, the energy gets depleted and the little tight junctions that keep our cells together in our gut, the little lining together preventing leaky gut starts to break down. So then you get all these proteins from food and bacteria, crap actually in your bloodstream causing inflammation, which causes even more insulin resistance and more weight gain. Can you talk about that? And talk about why is high fructose corn syrup so bad? Because if you listen to the food industry and everybody else like, oh, it’s just the same, it’s all the same high fructose corn syrup sugar. There’s no difference. I wrote an article years ago called 5 Reasons High Fructose Corn Syrup Will Kill You.

Dr. Richard Johnson:

I remember reading that. Actually, I have to compliment you on your knowledge and what you’ve been doing and how you’ve been helping people.

Dr. Mark Hyman:

Oh, thank you. Thank you. I appreciate that.

Dr. Richard Johnson:

I really, really mean that. We actually did studies where we compared high fructose corn syrup to sucrose or table sugar. And in general, even when you level the playing field by giving, so high fructose corn syrup is free fructose and free glucose mixed together. Sucrose, they’re bound together. One will be absorbed more differently, more rapidly, the high fructose corn syrup. When we give them, so that the high fructose corn syrup is 50% fructose and 50% glucose and you give exactly the same amount of food, the animals that get high fructose corn syrup will get worse fatty liver. So there’s something beyond. It’s more than just the fact that there’s more fructose, but it’s also the problem that-

Dr. Mark Hyman:

It’s free fructose.

Dr. Richard Johnson:

That it’s free fructose. We also have done studies. Actually, I was one of the first ones to show that fructose affects the gut, causes a gut leak syndrome. Actually, there were people who were doing studies before me, but it was one of the early studies. We showed that fructose could disrupt the intestine and cause what’s called a leaky gut. I’ll tell you the story.

Dr. Mark Hyman:

People used to make fun of me for that. I mean, honestly, Richard, I was in conversation with doctors 20 years ago talking about leaky gut and they just thought I was a nut job.

Dr. Richard Johnson:

You were ahead of everybody. You were totally ahead of everybody.

Dr. Mark Hyman:

I made a little about that topic.

Dr. Richard Johnson:

I’m serious about that. Well, I’ll tell you a pretty cool story. What happened was I went to a lecture where Steve Dreskin, an allergist, was very interested in this why peanut allergies and shrimp allergies are affecting all these children and it’s been increasing over years. And so the question is, what’s driving this allergy? He had an animal model where he could create a leaky gut by giving cholera toxin. This is a really bad toxin, right? Then he would give peanut, a little peanut protein. They call them antigens, but they’re protein. And so when he gave the peanut protein to this special mouse that had a leaky gut, the mice would anaphylax. It had these terrible allergic reactions to peanuts. So I knew that I had just shown that giving sugar or fructose could cause this leaky gut. So I went up to them and said, “Hey, do you really need to give cholera toxin? Why don’t you just put these guys on fruit juice?”

Dr. Mark Hyman:

Fruit juice, which we give all our kids.

Dr. Richard Johnson:

Yeah, exactly what you would give to our children.

Dr. Mark Hyman:

Juice boxes.

Dr. Richard Johnson:

Exactly. He did that experiment without the cholera toxin or with very minimal amounts of cholera toxin and the animals anaphylaxed. We actually put in a patent to see if blocking sugar would be a way to prevent food allergies. We ended up not following through with the patent or anything.

Dr. Mark Hyman:

Well, I think that’s amazing. That’s amazing. It ties into some other work, which I don’t know if you know about, but Dr. Alessio Fasano who’s a world expert on gluten and celiac disease at Harvard basically discovered that cholera… Reminded me of cholera actually incites the production of something called zonulin, which is a protein that causes leaky gut. He actually figured out this whole idea of zonulin. Then he discovered was that gluten also triggers the production of zonulin, which is what cholera does. What’s happened to our wheat is that we have way more gliadin proteins because of the hybridization of wheat so we’ve got way more inflammatory gliadin proteins, which is why we see a 400% increase in celiac. You take the dwarf wheat.

Dr. Richard Johnson:

Yeah, sugar and wheat.

Dr. Mark Hyman:

I mean, it’s no wonder sugar and flour are driving this metabolic syndrome. The thing that is going on for most people is this phenomena we call metabolic endotoxemia, which essentially means that there are toxins in the gut. I mean, it’s poop basically after all, it’s crap. It’s actually leaking into your bloodstream. Right underneath your gut is all your immune system and it’s creating all this inflammation, which then just creates this vicious cycle of more insulin resistance because inflammation causes obesity independent of anything else.

Dr. Richard Johnson:

Absolutely. You’re totally right. And if you give sugar to an animal or fructose to an animal, you can measure endotoxemia. So that’s been shown because it’s part of that gut leak syndrome.

Dr. Mark Hyman:

Wait, wait, wait. So just back up. You just said that if you drink your can of soda or have your high fructose corn syrup in all the food, it’s in everything by the way. What did Robert Lustig say? There’s probably like 600,000 food products on the market and 80% of them have sugar high fructose corn syrup. We didn’t even eat, we didn’t even have high fructose corn syrup till about 40 years ago. Right? And that’s when you saw the hockey stick spike in the diabetes and obesity epidemic. Right?

Dr. Richard Johnson:

Right. That’s exactly right.

Dr. Mark Hyman:

It’s crazy. And so really, we’re seeing that this elevations in fructose in our diet are causing these problems. Take us through how fructose actually causes a problem. You eat fructose and how does it get all the way down? Take us on the scientific pathways.

Dr. Richard Johnson:

It turns out that almost all, basically anytime you eat calories, the calories then go in and they’re used to help produce energy. You produce energy. Energy is called ATP. A lot of it is produced by these energy factories called mitochondria. When you eat food, you’re trying to make energy and that energy is used to help us do whatever we want. There’s really two, maybe three types of energy. Really, there’s the immediate energy that we make, which is called ATP. That’s what we’re using to, you know, what I’m using to talk to you is my brain is using ATP, et cetera. If there’s excess energy, it can be stored as fat. Stored fat is a stored form of energy. The production of energy can also generate heat, and heat is a wasted or dissipated energy.

Dr. Richard Johnson:

But anyway, basically when you eat food, you’re trying to make energy. When we eat fructose, instead of making all the ATP we normally would make, we actually dampen the production of ATP and produce more stored fat. So the mitochondria which are normally making the ATP are suppressed. There’s a suppression of the mitochondria and so they make less ATP, and so more of the calories that we’re eating go into fat. This is associated with a fallen ATP in the cell. I call it a fallen energy. It’s true, it’s not a true fallen total energy because more stored energy is being formed. More fat is being made as there’s less ATP being made. And so it’s shunting the calories to fat and reducing the amount of ATP. Now, when that happens, you have a lower ATP in the cell and so your body reacts to that by saying, hey, I don’t have enough energy. I’m going to eat more. I’m thirsty. I’m going to drink more. I’m going to forage for food. It triggers these biologic responses that makes you end up eating more and so forth and eventually-

Dr. Mark Hyman:

And exercising less. Right?

Dr. Richard Johnson:

And exercising less. Yes.

Dr. Mark Hyman:

Wait, wait, wait. What you’re saying is being overweight and storing the fat makes you eat more and exercise less?

Dr. Richard Johnson:

Yes. I guess [inaudible 00:30:38] Ludwig-

Dr. Mark Hyman:

Exactly what David said. Yeah.

Dr. Richard Johnson:

Yeah. Anyway, so the way it works is that when fructose is metabolized, there is this production of uric acid.

Dr. Mark Hyman:

Now we’re getting into it.

Dr. Richard Johnson:

Yes. And so uric acid is a breakdown product of energy. What happens is we always use a little bit of energy to make energy. You have to use some energy to absorb the food you eat. You have to use some energy to break down the food we eat. All food is this way. But the enzyme that breaks down fructose breaks it down so rapidly and it uses a little energy in the process that there’s a drop in the ATP in the cell to about, it goes down 30%. That’s not true for other foods. This is unique about fructose. Alcohol does it too, by the way. But fructose is really the only food that really does it. When that happens and the energy drops, it triggers a reaction. That reaction of all things tends to remove, ATP gets converted to AMP. Then AMP goes back to ATP. But there’s a reaction that sweeps away the AMP and makes uric acid from it. Now you can’t rejuvenate your ATP very well. It’s hard to make it because you’ve removed, it broke down and then you can’t repair it so well because you’ve removed it to make uric acid.

Dr. Mark Hyman:

Okay. That’s a lot. Hold on, hold on. That’s a lot. I just want to unpack that because people are listening. I’m trying to follow you. This is my thing. Just let me unpack it a little bit. Basically you’re saying you absorb fructose, you eat fructose. By the way, when you eat fructose, it uses extra energy to be absorbed, so that causes an energy deficit, right? Then you store fat, which actually causes you to actually want to eat more but exercise less. But then when you’re depleted the energy in the cell, you create AMP, which is basically the byproduct of actually-

Dr. Richard Johnson:

Yeah. Well, let me take you through this again. What happens is when you eat fructose, you burn ATP faster than normal. And so that ATP level drops. Then there’s the generation of uric acid from that. When the energy drops, that triggers a reaction to make uric acid.

Dr. Mark Hyman:

Got it.

Dr. Richard Johnson:

Then the uric acid goes into where the energy factories are, what we call the mitochondria and causes oxidative stress to those mitochondria. That’s the key. That suppresses the mitochondria from making more ATP. So there’s an initial consumption and then there’s decreased production.

Dr. Mark Hyman:

So it’s a double whammy.

Dr. Richard Johnson:

It’s a double whammy. It lowers the ATP, but then doesn’t let you bring it back up very quickly. And so everything’s kind of suppressed. Now you have a low ATP. When that oxidative stress occurs to the mitochondria, it blocks the mitochondria from working, but opens the pathways to make fat. It also blocks the burning of fat. There’s this shunting of calories into fat, and now the fat can’t get burned so it starts to accumulate. But your energy is still low so you’ve been eating all this food but your energy is still low so you keep eating. You keep eating until it repairs, but what’s happened is you’ve lost your control, your normal amount that you would eat. Now you’re going to eat more and you’re going to be accumulating fat. It’s this brilliant system.

Dr. Richard Johnson:

By reducing the ATP, it keeps that ATP level low and no other nutrient does that. It’s just fructose. It drops the energy level and it makes you feel hungry, makes you thirsty, make you want to eat more. But instead of the food making the ATP levels go back up, the energy is going into the fat. So the energy balance is maintained. Energy balance is maintained, but the energy is going into stored energy, which is fat. The law of thermodynamics is true. But what’s happening is your energy levels are low and you’re still hungry so you’re going to keep eating. And so this is the trick.

Dr. Mark Hyman:

But the key here is that thermodynamics, who can argue with that, it’s physics. I’m not about to overturn the laws of physics in the mind of God. What people don’t realize about the first law of thermodynamics is basically all energy is conserved. Right?

Dr. Richard Johnson:

Right.

Dr. Mark Hyman:

It means all energy is conserved in a closed system. So in a vacuum, a thousand calories of broccoli, a thousand calories of soda are exactly the same. They basically release the same amount of energy, which a calorie is the amount of energy required to raise one liter of water one degree Celsius, that’s it. Right. And so you literally create the same rise in temperature of the water with a thousand calories of broccoli or soda. But when you eat them, there’s all this other stuffs happening. You’re talking about leaky gut and metabolic toxemia, how it affects your liver, and how it affects fat storage and ATP. So it’s not a closed system. The energy balance doesn’t quite work in a metabolic-

Dr. Richard Johnson:

If you give a thousand calories of sugar and a thousand calories of broccoli and you clamp me so that I don’t eat anymore, because if I eat the sugar, I’m going to stay hungry. I would eat more. But you clamp me so that I don’t eat anymore. The fat, the calories from sugar are going to activate, cause oxidative stress to my mitochondria and I’m going to start making fat from glucose and so forth that I have in my blood. It’s going to start working to make fat from what I have. Even though both groups got a thousand calories, I’m going to start getting fatty liver and I’m going to become insulin resistant and I’m going to get a leaky gut. All that thing from the sugar, even though they’re the exact same number of calories. But if I measure my weight, it’s going to reflect the fact that each group got a thousand calories. The only difference is that the sugar also drops my energy metabolism so it’s going to make me gain a little bit more weight than the other one because-

Dr. Mark Hyman:

Is that true? Because that David Ludwig study where he took, he did this with rats, then he did with humans. It was a feeding study where they took insulin resistant patients and they created a basic equalization in the patients. And then they had them do a crossover trial where they ate a high fat, low carb diet, or a high carb, low fat diet. The ones, when they were eating the high fat, low carb diet, they burned 400 more calories a day, even eating the same amount of calories. They’re eating the same amount of calories. So the energy balance thing, I just wonder how does that work in that way.

Dr. Richard Johnson:

No, no, no.

Dr. Mark Hyman:

Explain that. I don’t understand.

Dr. Richard Johnson:

On the low carb diet, they’re going to burn more calories. And on a high carb diet, they’re going to burn less calories. Even if they’re getting the same number of calories. The energy balance equation says that my weight is going to reflect how much I eat and how much I burn. If we have everyone eat the same amount but one’s a low carb, high fat, the low carb is going to cause more calories to be burned. So the burning, it doesn’t relate to how much comes in. It relates to what you’re eating, right? When you have a high carb diet, you want to eat more and you want to burn less. If you eat a low carb diet, you’re going to want to eat less and burn more. A low carb diet is great. You and I both know this. A low carb diet is going to create more satiety. You’re going to feel more full easily.

Dr. Mark Hyman:

For argument’s sake, let’s say, okay. I mean, obviously we shouldn’t be eating high fructose corn syrup. We shouldn’t be eating junk food, processed food. Most people are aware of that. But let’s talk about carbs in the context of this fructose conversation, because it wasn’t that David was feeding these people a high fructose corn syrup diet, they were eating like a high starch diet, which was beans, grains, healthier starches. And yet when you look at the data with vegans and meat eaters, it’s super confusing. I think people are trying to sort through what makes sense and is a vegan diet a healthy diet or not, and how does this relate to this conversation about fructose and insulin resistance.

Dr. Richard Johnson:

Well, there is a big story here which we haven’t really talked about. That is originally when I was studying this, I was focused on sugar and high fructose corn syrup because they contained fructose. But people pointed out to me that things like bread and starch can also cause obesity. And so how can I account for that if the story is about fructose? If you look in the wild, there are a lot of animals that will get fat that are not eating fruit or fructose. How does the whale get fat?

Dr. Mark Hyman:

Not just eating berries, right? The whales are eating [inaudible 00:40:47].

Dr. Richard Johnson:

They’re not eating too many berries, I don’t think. So the question was, what is that? We realized that the body can also make fructose. It isn’t just about the fructose that you eat but it’s also that the body has one way it can make fructose. It makes fructose from glucose. What we did is we did a study where we gave glucose in the drinking water to mice, and lo and behold, they became fat and insulin resistant and diabetic, all these things. They weren’t eating fructose, they were eating starch or glucose.

Dr. Mark Hyman:

Pure glucose.

Dr. Richard Johnson:

Pure glucose. And so we said, how can this be? Maybe it’s the glucose insulin pathway. And so what we did is we looked in their bodies and we found that when they’re eating a lot of glucose, that they were making fructose in their bodies. And so what we did is we gave the glucose to animals that could not metabolize fructose. These mice are eating glucose, they’re making insulin, but they’re not able to metabolize fructose. And they were, guess what? They still gained weight but not as much, it was much less. They still got a little bit of fat but not as much as the control animals, even though the control animals were eating the same amount. But what was striking was the fructose resistant or the animals that could not metabolize fructose, they were completely protected from insulin resistance. They were completely protected from fatty liver.

Dr. Mark Hyman:

Really? Even if they had a lot of glucose?

Dr. Richard Johnson:

Yeah. And they were not eating fructose. They were making fructose from the glucose. And so what we now know is that high glycemic carbs cause obesity two ways. One way is because when the glucose goes up in the blood after you eat these things like bread, rice potatoes, it makes your glucose go up in the blood and that triggers the production of fructose as well as the secretion of insulin. The insulin is driving a little bit of the obesity. This is what David Ludwig’s work has shown. But a lot of the obesity is driven by the production of fructose and fructose is actually what’s responsible for activating the switch. It’s what makes the fatty liver and the insulin resistance and all this stuff. Then we said, oh my God, there’s another way to get fat from fructose, and that’s to make fructose.

Dr. Mark Hyman:

Wow. Basically you’re screwed, because if you’re eating bread, whatever, you think, oh, it’s got no fructose. But actually starch is basically a lot of glucose molecules stuck together. That in itself can generate through this pathway more fructose in the body which then causes more fatty liver, more weight gain and the vicious cycle of prediabetes and diabetes.

Dr. Richard Johnson:

So now the high fructose corn syrup and the table sugar is a double whammy because they contain fructose but they also contain glucose. As you mentioned earlier, if you eat fructose, it’s a little hard to absorb it. But if you mix it with glucose, you can absorb the fructose really easily. The fructose also increases the glucose absorption. You’re getting a double whammy. When you’re drinking a soft drink, you’re getting the fructose in the soft drink and then the glucose is coming in and it’s stimulating insulin which isn’t so good, but it’s also being converted to fructose. Then the fructose causes insulin resistance, and then that makes the insulin levels high all the time and that helps block the fat from burning too. Now you’ve got this big story where, and then you realize why low carb diets are so beneficial. Why you can go in a low carb, high fat diet and not gain weight, because the low carb is blocking both the starches and the fructose which are really key for activating the switch.

Dr. Mark Hyman:

Take us back to the vegan conversation then, because the theory is that if you’re a vegan, you’ll be healthier, you’ll reverse diabetes, you’ll lose weight. And yet I don’t always see that in my practice. I often see vegans struggle with more insulin resistance and obviously nutritional deficiencies. What’s your perspective on that?

Dr. Richard Johnson:

There are different types of vegan diets, right. My understanding is that vegan diets, they can eat bread. Right.

Dr. Mark Hyman:

Yeah. But let’s say it’s a healthy vegan diet. Let’s say you’re eating whole grains and whole beans and you’re eating lots of vegetables and nuts and seeds. Is that a problem in the scheme of glucose? Just for people listening, we used to think about carbohydrates as simple and complex, right? Simple is sugar, complex is bread. That is a terrible definition that really has no scientific relevance and it really is about the glycemic index for load of the carbs and how quickly they’re absorbed. Bread is actually worse than table sugar in this context, just for people to understand.

Dr. Richard Johnson:

Well, so it turns out like most vegetables, even if they have a little bit of fructose, usually the… You know, work by one of my collaborators, Josh Rabinowitz, showed that the intestines can inactivate about four or five grams of fructose. That’s what you see in a lot of vegetables. If you do have a low glycemic vegetable and it has a little bit of fructose in it, probably it’s safe because your intestines will inactivate small amounts of fructose. Natural fruits have a lot of fiber and they have a lot of good things. If you eat a small amount of natural fruit, if you have one or two fruits, you’re probably only getting seven or eight grams of fructose and five of that is going to be inactivated so you’re going to get very, very small amount. Then you get fiber which slows the absorption.

Dr. Mark Hyman:

[inaudible 00:47:17] antioxidants.

Dr. Richard Johnson:

Vitamin C. Vitamin C blocks some of the effects of fructose, so natural fruits are actually fine. We did studies where we did put people on a low fructose diet, where we reduce sugar and high fructose corn syrup and fruits. Then one group got back natural fruit supplements. Both groups did great. The natural fruits won’t affect us, whereas things like fruit juice and so forth aren’t good because then you get a lot of sugar and a lot of fructose in a short period of time. You know the way the switch works, it’s the concentration that the body sees. If you drink a soft drink rapidly, you’re taking a lot of sugar in a short period of time so the liver gets a big wave and the switch is activated. But if you took that same soft drink and you sipped it very slowly over three hours, it would be more like just the calories because you wouldn’t get the concentration of fructose to activate the switch.

Dr. Mark Hyman:

Yeah. But people listening, don’t get any ideas about this.

Dr. Richard Johnson:

Yeah. Don’t do that.

Dr. Mark Hyman:

He’s not saying just drink your Coca-Cola over three hours. No, don’t do that.

Dr. Richard Johnson:

Yeah. Don’t do that. First off, it’s almost impossible. Have you ever tried to eat a piece of cake over four hours? No way. It doesn’t happen. But anyway, yeah, you’re totally right on that Mark.

Dr. Mark Hyman:

Let’s talk about this uric acid because I just think it’s so interesting. I’ve been measuring this for years in my patients. You always see people who are insulin resistant, diabetic, overweight, they often have very high uric acid levels as part of this whole phenomena. I think you’re finally explaining why and how it’s a byproduct of energy depletion in the cells. The energy depletion is a problem because the mitochondria are so critical to how we feel, to how we age. It is our metabolism. When we say our metabolism is slow, that’s where this all happen. That’s where you metabolize food. It’s where you breathe oxygen and eat calories and they get burned. It is one of the central things that goes wrong with aging.

Dr. Richard Johnson:

Absolutely right.

Dr. Mark Hyman:

Richard, I’m working on a book called Young Forever about longevity. One of the central features of all of the age-related initiatives to extend life and improve health and reverse disease is really about optimizing mitochondrial function. What you’re saying here just in a nutshell is that fructose, especially high fructose corn syrup, not necessarily fruit but basically junk food fructose and sugar, even just regular sugar drives the pathways that deplete our energy, which is so fascinating to me. I just want to say it again because it’s such a flip on its head idea. We don’t get fat by overeating. We basically overeat because we’re fat and we exercise less because we’re fat. Once you start accumulating a little bit of belly fat, that fat is driving everything. It’s driving your metabolism, it’s going to be slower. It’s driving you to eat more. It’s driving you to exercise less. This is essential problem we’re having. It’s why 80% of Americans are so overweight and also metabolically unhealthy.

Dr. Richard Johnson:

Yeah. I mean, the uric acid that’s generated from these foods goes into the energy factories and stunts them, causes oxidative stress. Initially, that activates the switch. Then what happens is over time the repeated oxidative stress caused the mitochondria to start to function less and less well, even when you’re not eating fructose or making fructose. Then what happens is you start making less mitochondria, you have less mitochondria. At that point, you have chronically low energy, you’re aging, and you’re fatigued, Mark. You don’t have the energy you want and you’re overweight. Now when you lose weight, there’s this big push to go right back to that increased weight you’ve been carrying for a while. The problem is the mitochondria, they’ve been damaged. What’s wonderful is you can rejuvenate those mitochondria. When we put people on a low fructose diet, we could show an improvement in their mitochondria within one month.

Dr. Mark Hyman:

That’s amazing.

Dr. Richard Johnson:

That’s wonderful. When we block fructose metabolism in a normal animal, we can block aging changes in the kidneys. We can block aging associated to hypertension. Even when those animals are not fed fructose, just from blocking the effects of low grade production of fructose in the body. It turns out that this pathway is very much linked with aging. When you go on a caloric restriction, I believe that the way caloric restriction blocks aging is through this pathway. Anyway, what’s cool is that you can rejuvenate those mitochondria. One of the very, very best ways is by exercise. The benefit of exercise is not really to burn calories so much as it is to help those mitochondria regenerate. It really requires exercise in a specific way.

Dr. Richard Johnson:

You have to do it 30 to 60 minutes of what we call zone two exercise. You want to exercise just enough so that you’re not really accumulating lactic acid. You need to bring your heart rate up. As my friend Iñigo San-Millán says, what you want to do is you want to be able to exercise where you can talk to the person next to you but it’s a little difficult to talk.

Dr. Mark Hyman:

Yeah, yeah, yeah. Right. It’s called aerobic exercise as opposed to anaerobic. But also sprinting and anaerobic bursts of exercise do seem to stimulate mitochondrial function to improve and be made and actually increase overall metabolic rate.

Dr. Richard Johnson:

Both systems worked. I think that the aerobic one is really been proven very well. The other one definitely is good. It’s good to mix that up a little bit, but the aerobic one really has been shown I know by a number of people to really help the mitochondria.

Dr. Mark Hyman:

Let’s make this super practical. One, nobody should ever eat anything with high fructose corns ever, ever, ever, ever, ever again. Number one, two, three, never do that. It’s like if you get rid of that and trans fat, which the government said is not safe to eat about seven years ago. But I literally went in the grocery store the other day and it’s all over the place still. I don’t know how that works, but it’s like a loophole or something, I don’t know. Those two things will save your life. Then second, make sure you exercise and do both cardio. I think also strength training because that also helps you build muscle which is where your mitochondria are and more mitochondria. Third, be really conscious of where you’re getting your starch. If it’s whole grains and beans and whole fruit, it’s probably okay. But if it’s bread and flour and quickly absorbable starch, probably not so good.

Dr. Richard Johnson:

A hundred percent. The other thing might be to just talk a little bit about salt. I don’t know-

Dr. Mark Hyman:

Before we do that, I want to ask you one question you talked about in your book, which is the idea of antioxidants. Because what you just said is that uric acid is produced when we eat too much fructose and it’s produced in this chemical pathway that depletes our energy and that is compounded by the fact that the uric acid then goes into the mitochondria and poisons them by oxidative stress or rusting or free radicals. Right. And so there’s a lot of data that’s been published that contradicts the notion that antioxidants are good. We thought, well, people should take beta carotene or vitamin C or vitamin E. All those studies seem to not show a significant benefit. And yet you say that we should be taking vitamin C to help.

Dr. Mark Hyman:

I’m wondering what is the data behind that. How do we think about this? Because should we all be taking antioxidants now? Because we know that our body has its own antioxidant systems like catalases, superoxide dismutases and so forth. Glutathione peroxidases. These are our body’s own antioxidants which actually are more powerful than anything you can take, I think. You do say try vitamin C. Tell us about the data about vitamin C.

Dr. Richard Johnson:

Yeah, not all antioxidants are equal. Some antioxidants like vitamin E really have not panned out, in fact can be sometimes associated with complications. Part of it is where the accident gets to, does it get to the site where it’s really important? Our work really suggests that oxidative stress to the mitochondria really is where the action is and that’s where you want your antioxidants to get. Vitamin C does get there. And so it turns out that we are all vitamin C deficient and we lost the ability to make vitamin C a long, long time ago, right around the time of the dinosaur extinction.

Dr. Mark Hyman:

Us and the guinea pigs, right?

Dr. Richard Johnson:

Yeah, us and the guinea pigs. That’s right. But it turns out that some early primates were living at the time of the great asteroid impact, and those primates appeared to have acquired vitamin C mutation right around that time. And that we think that there was a benefit to that. It turns out that vitamin C can naturally block the oxidative stress to some extent in the mitochondria. And so we were thinking that when that vitamin C mutation occurred, that these poor primates probably didn’t have a lot of access to fruit because of the terrible holocaust like the impact, winter, and the dust that went into the air and a lot of life became extinct.

Dr. Richard Johnson:

And so we wanted to test that and we were thinking to ourselves, well, maybe what happened is when you lost the vitamin C, the ability to make it, then when you ate fruit, that you could generate more oxidative stress to the mitochondria and that would lead to more fat production for the same amount of fructose. And so what we did is we took mice that do not, a special type of mouse that does not make vitamin C. And of course these mice, when they have no vitamin C, they will develop scurvy. So you have to give them a small amount of vitamin C so they don’t get sick.

Dr. Mark Hyman:

Scurvy, right?

Dr. Richard Johnson:

Right. What we had is we had these mice on either low doses of vitamin C and so that they had vitamin C levels close to what people who are overweight tend to have. And then we gave them a higher dose of vitamin C which correlates better with the kinds of blood levels that lean people tend to have. Then we gave them high fructose corn syrup. Both groups drank the same amount. But the group that had the low vitamin C levels got a lot fatter than the control animals. We haven’t published that paper yet, but that study was very strong and it tells us that vitamin C actually can block some of the effects of fructose.

Dr. Mark Hyman:

What would be the dose for a human?

Dr. Richard Johnson:

500 milligrams.

Dr. Mark Hyman:

That’s all?

Dr. Richard Johnson:

Yeah.

Dr. Mark Hyman:

So maybe Linus Pauling wasn’t crazy?

Dr. Richard Johnson:

No, he wasn’t crazy enough. It’s possible-

Dr. Mark Hyman:

I mean, he won two Nobel prizes. He was pretty smart guy.

Dr. Richard Johnson:

Exactly. Yeah. I would back him up. He was an amazing person. But you know, it’s possible that higher doses might be more beneficial, but there’s two problems with high doses. One is it can increase the formation of kidney stones and we don’t want that. Then the second problem is there’s some controversial data in the literature that high doses of vitamin C can block the effects of exercise to stimulate mitochondrial growth.

Dr. Mark Hyman:

Oh wow.

Dr. Richard Johnson:

We don’t want to block that. So the data where there’s a little bit of evidence that it might is with high doses greater than a gram a day. In my book I recommend 500 milligrams because I know that’s a safe dose and I know that it will provide some benefits.

Dr. Mark Hyman:

Yeah. Okay. Well, this is so fascinating. Basically just to summarize quickly, fructose is bad for you. Don’t eat high fructose corn syrup. Make sure you exercise. Take 500 milligrams of vitamin C. That’s really clear. I think your book Nature Wants Us to Be Fat really unpacks all this in great detail for people who want to know. I just want to close with this conversation about salt. Because there’s a connection between salt and blood osmolality which is the concentration of your blood and the fat switch and obesity. There’s so much controversy about salt. Some people say it’s not as bad as we thought, or it is bad. Oh, don’t worry about it. Can you talk about it? Because I think there’s a lot of confusion about it.

Dr. Richard Johnson:

So I spent a lot of my career studying salt. It looks like a lot of people, in the early part of my career, I became convinced that some people have trouble with salt where they have trouble excreting it. When they have that trouble excreting it, it can increase their risk for hypertension. We actually did all kinds of studies to try to figure out how that happens. And so that’s its own story in a sense. I do believe that salt is important if you have high blood pressure and particularly if you’re over age 50. Salt is associated with hypertension.

Dr. Mark Hyman:

There’s genes that make you more likely to have hypertension from eating salt. So it’s not everybody.

Dr. Richard Johnson:

Right. It’s not everybody. But then when we discovered that the body can make fructose, we realized that eating salty food might also trigger the production of fructose. That’s because when you increase salt concentration in the blood from eating salt, that triggers that same polyol pathway, this enzyme pathway that can convert glucose to fructose. So when you eat French fries that are very salty.

Dr. Mark Hyman:

That’s terrible then, right?

Dr. Richard Johnson:

Or salted pretzels, the salt.

Dr. Mark Hyman:

Don’t tell me French fries are bad for you.

Dr. Richard Johnson:

It turns out that the salt turns on the enzyme to convert the glucose to fructose. So if you’re in a low carb diet and you’re not eating a lot of glucose, salt is not going to do it. But if you’re in the regular world eating lots of carbs, salty food may actually enhance the production of fructose. And so we actually did studies where we gave salt to animals, and initially they didn’t gain weight, but after several months they became hugely fat and obese. We could show that it was due to the fructose. Then we went and looked at people who are overweight and obese and we found that the vast majority of people who are overweight are eating a lot of salt. And not only that, when you look at their blood tests, they have about a two and a half to 12 times more likely to be dehydrated.

Dr. Richard Johnson:

When you eat salt and you get thirsty, you’re actually creating dehydration. And so when we went on and studied it more, and it turns out that salty foods stimulate fructose which could create fat. And then we had a big insight, that the fat was actually nature’s way of storing water. Because when you burn fat, you not only make calories, which bears like when they’re hibernating, but you produce water. When an animal hibernates or it migrates long distance, it gets its water from burning the fat. When you’re out in the desert, you need to have some fat to make water. So the camel is chronically a little bit dehydrated and he makes fat so that when he gets really dehydrated, he can break it down and get the water.

Dr. Richard Johnson:

The whale is one of the fattest animals in the world and it doesn’t drink sea water. So it gets about one third of its water from its fat. It turns out that this survival pathway is also driven by very, very mild dehydration. And that mild dehydration stimulates the production of fat as another way to help it survive. Salty foods, and the reason deer like salt licks and things like that, maybe to stimulate the conversion of this grass and stuffs that they’re eating.

Dr. Mark Hyman:

That’s so funny.

Dr. Richard Johnson:

So that they can get more calories. They can get more fat from it by stimulating this enzyme that converts glucose to fructose.

Dr. Mark Hyman:

It’s kind of a double whammy. When you eat salt, you actually retain more concentrated blood, right?

Dr. Richard Johnson:

Yeah, exactly.

Dr. Mark Hyman:

That makes you thirsty and makes you turn on this fat switch and makes you gain weight. But it’s interesting when you look at the other side of it, insulin actually causes you to store more fluid and actually salt. When you stop eating sugar and starch, people dump a lot of fluid. They just pee a lot of fluid because they’re dumping all this fluid because the insulin levels go down.

Dr. Richard Johnson:

Yeah. If you go on a low carb diet and the insulin levels fall, what happens is you first you burn all the glycogen in your body. The glycogen also holds a lot of water. When you burn it, you get this very rapid increase in urine output which is the water being released from the glycogen. Then when you’re burning fat, you will also release some water when you’re burning fat, but glycogen actually has the most water. When we store energy, we store some of the energy as starch or what we call glycogen. Most of the energy stored is fat. When we fast or go in a little [inaudible 01:06:18], you first burn off the glycogen and then you burn the fat. There is this initial water. It’s all coming from the fat and the glycogen.

Dr. Richard Johnson:

Anyway, we did a study where we gave salty soup to people. We gave salty soup and we could show that it activated their biologic switch just from drinking the soup. Their blood pressure went up immediately along with the salt concentration. But if we gave them water with the soup, we could block that switch activation. So if we could keep the serum salt concentration-

Dr. Mark Hyman:

Drink a lot of water, basically.

Dr. Richard Johnson:

Yeah. Actually, drink the water before you eat.

Dr. Mark Hyman:

That’s fascinating. I have a friend who’s obsessed with drinking water and she drinks so much water and she lost all this weight. I was like, wow, this is really cool. Richard, your work is so important. You published 700 scientific papers. We’re just scratching the surface. Everybody should get the book, Nature Wants Us to Be Fat, basically about how to fix it and turn off the fat switch. Thank you so much for what you do. It’s such a light in the world. If anybody’s listening to this podcast and they love what they heard, share with your friends and family. If you know anybody who’s overweight and probably you don’t, because who’s overweight, right? Make sure you share with them. How have you struggled with your weight? What have you found works? Let us know about it. Leave a comment, subscribe wherever you get your podcast, and we’ll see you next time on The Doctor’s Farmacy. Thank you so much for being with us today, Dr. Johnson.

Dr. Richard Johnson:

Thank you so much, Mark. It was just a pleasure.

Closing:

Hi everyone. I hope you enjoyed this week’s episode. Just a reminder that this podcast is for educational purposes only. This podcast is not a substitute for professional care by a doctor or other qualified medical professional. This podcast is provided on the understanding that it does not constitute medical or other professional advice or services. If you’re looking for help in your journey, seek out a qualified medical practitioner. If you’re looking for a functional medicine practitioner, you can visit ifm.org and search their find a practitioner database. It’s important that you have someone in your corner who’s trained, who’s a licensed healthcare practitioner and can help you make changes, especially when it comes to your health.

If you are looking for personalized medical support, we highly recommend contacting Dr. Hyman’s UltraWellness Center in Lenox, Massachusetts today.

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