Tag Archives: fructose

The Peter Attia Drive Podcast: Longevity, Lipidology, Fructose, and How To Keep Your Face And Joints Young

Lately while exercising I’ve been binge-listening to podcasts from Peter Attia, a cancer surgeon turned “longevity” doctor.

I first encountered his writing while researching ketosis, the Atkins diet and low carb diets in 2012 and found his writing to be incredibly well-researched, detailed and helpful.

I appreciate how he never opts for oversimplification of a topic as this disclaimer at the begining of his post on ketosis indicates:

If you want to actually understand this topic, you must invest the time and mental energy to do so.  You really have to get into the details.  Obviously, I love the details and probably read 5 or 6 scientific papers every week on this topic (and others).  I don’t expect the casual reader to want to do this, and I view it as my role to synthesize this information and present it to you. But this is not a bumper-sticker issue.  I know it’s trendy to make blanket statements – ketosis is “unnatural,” for example, or ketosis is “superior” – but such statements mean nothing if you don’t understand the biochemistry and evolution of our species.

When I first came across his writing he was obsessively monitoring his beta-hydroxy butyrate levels on a ketogenic diet and was partnering with Gary Taubes to launch “the Manhattan project of nutrition”, the Nutritional Science Institute. (NUSI) . Designed to help fund good nutritional research with the ultimate goal of reducing obesity and testing the hypothesis that “all calories are equal” NUSI, unfortunately has floundered (see here.)

He’s always been very rigorous in his thinking and writing in the areas of nutrition, diet and longevity and he is quite brilliant and knowledgeable down to very basic areas of biology and metabolism.

He has started  a podcast in the last year that has featured in depth conversations with some really interesting physicians and scientists. It’s described thusly : “The Peter Attia Drive is a weekly, ultra-deep-dive podcast focusing on maximizing health, longevity, critical thinking…and a few other things. Topics include fasting, ketosis, Alzheimer’s disease, cancer, mental health, and much more.”

The first one that I listened to was with Thomas Dayspring, M.D., FACP, FNLA, a world-renowned expert in lipidology and a fantastic teacher.  If you’d like to dive deeply into cholesterol metabolism, lipid biomarkers, the mechanism of atherosclerosis and cholesterol treatment options, this is a great way to start. 

It’s a five part, 7 hour series of podcasts with the first one here

Some Eye-opening Thoughts About Processed Foods, Sugar and Fructose

Most patients are not going to be up for deep dives into lipidology but I highly recommend Attia’s discussion with Robert Lustig.

I quoted Lustig in a 2015 post entitled “Fructose and the Ubiquity of Added Sugar”

Robert Lustig, a pediatric endocrinologist has talked and written extensively about fructose as a “toxin.” You can watch him here. He’s also published a lot of books on the topic including one which identifies the 56 names under which sugar masquerades.

Lustig is a passionate, articulate and compelling speaker who has contributed significant research in this area. Most recently he has retired from clinical practice and obtained a law degree with the goal of trying to change US food policy.

Attia does a great job of interviewing him as he helps clarify points and guides  Lustig into specific real world problems such as what to feed your children.

In addition, Attia’s staff do a great job of providing “show notes” which summarize the important points, adding helpful context and links and summarizing the content.

Lustig firmly believes:

‘Fructose and glucose are not the same: the food industry would have you believe a calorie is a calorie, a sugar is a sugar…and it is absolute garbage: they are quite different, and it does matter’

Fructose is a monosaccharide that combines with the monosaccharide glucose to form sucrose, which is what most people recognize as table sugar. Processed foods commonly contain a lot of added fructose-containing sugar but also, increasingly they contain high fructose corn syrup (HFCS) which contains up to 65% fructose.

High intake of fructose goes hand in hand with consumption of processed foods. Approximately 75% of all foods and beverages in the US contain added sugars. Consumption of added sugar by Americans increased from 4 lbs per person per year to 120 lbs per person per year between 1776 and 1994. Thanks to a dramatic increase in sugar-sweetened beverages, American teenagers consume about 72 grams of fructose daily.

There are a substantial amount of observational, short-term basic science, and clinical trial data suggesting that all this added sugar, especially fructose, are posing a serious public health problem and Lustig lays out a compelling narrative in this podcast.

Lustig discusses the  fundamental biochemical differences between glucose and fructose- whereas glucose is the energy of life for all animals, fructose is “vesitigial to all animal life” and is basically a storage form of energy for plants.

Your gut bacteria are more adept at metabolizing fructose than you are

Ludwig points out that fructose accelerates the Amadori rearrangement: the browning of your body tissues and potentially contributing to aging. Fructose does not suppress the hunger hormone ghrelin as glucose dose thus “When you consume a lot of fructose your brain doesn’t know you’ve eaten and so you end up consuming more”.

Finally, Ludwig notes, fructose in contrast to glucose behaves like cocaine on the brain. Fructose specifically lights up the reward center ‘and now has been shown to induce the same physiology in the brain that cocaine, heroin, nicotine, alcohol, or any hedonic substance also generates’

There is not a clear scientific consensus on many of Lustig’s points to be honest but he is a very convincing advocate of avoiding sugar in general and fructose in particular from non-real food sources.

There’s a whole lot more in this discussion that is important to at least think about:

-A detailed discussion of NASH and NAFLD (fatty liver disease that is becoming common in obese Americans.)

-Why you need both soluble and insoluble fiber together as opposed to added soluble fiber in a supplement or processed food adition.

-How to change the food system in which 10 companies control almost 90% of the calories consumed in the US

-the importance of eliminating government food subsidies which make junk food cheap. 

-How eliminating food subsidies wouldn’t change the price of wheat or soy, only corn and sugar which where most of our dietary sugar comes from.

Maintaining Youthful Appearance And Function-The Face and The Joints

Attia’s other podcasts touch on many other issues related to longevity. I found his interview with Brett Kotlus, a New York City oculofacial plastic surgeon who specializes in both non-surgical and surgical cosmetic and reconstructive procedures of the eyes and face (How to look younger while we live longer) to be surprisingly enlightening and engrossing.

Attia’s website and podcasts are refreshingly free of advertising and any annoying teasers. This description of the Kotlus podcast is about as close to a mass-market teaser as you will see:

“Using these powerful basics, I’ve seen amazing changes.” —Brett Kotlus, referring to the 3 simple tools people can utilize to protect and rejuvenate their skin

I will not reveal the “3 simple tools” here but the show notes indicate you can skip to the 46 minute mark to hear about them.

Most recently I’ve been listening to his podcast with Dr. Eric Chehab, orthopedic surgeon and sports medicine specialist (Eric Chehab, M.D.: Extending healthspan and preserving quality of life (EP.36).)  As Attia points out, longevity is related to both healthspan and lifespan and our joint health is a major contributor to healthspan.

In this episode, Chebab “explains the measures we can take to live better and maintain our physical health through exercise and the avoidance of common injuries that prove to be the downfall for many. He also provides valuable insight for those weighing their treatment options from physical therapy to surgery to stem cells.”

Because the show notes are so detailed you can read exactly what is discussed in these podcasts and when. For example, if you wanted to skip the early discussion on Eric’s training, fellowship with the New York Giants, and the risk vs. reward of playing football (39:15) and listen to the discssion on The knee joint: common injuries, knee replacements, and proper exercise ” you know to skip to [1:00:00].

Personally, I found all of the preliminary discussion on Springsteen, Pearl Jam  and Chebab’s pre-medical school adventures fascinating.

I highly recommend recommend Attia’s podcasts: they are always enlightening, unbiased, objective and mentally stimulating.

In the world of longevity doctors he is unique in offering solid science-based recommendations and information free of hype,  bias and woo.

Skeptically Yours,

-ACP

Fructose and the Ubiquity of Added Sugar

Since realizing that sugar, and not fat, was the major problem in the modern Western diet, The Skeptical Cardiologist has been ratcheting down how much sugar he consumes to the smallest possible amount.

This has lowered what I like to call my “sugarstat,” and has made me exquisitely sensitive to the presence of added sugar in foods.

With this sensitivity comes the heightened realization that added sugar is everywhere.

The obvious sources are soft drinks and other sweetened beverages, candy, cakes, pies, cookies, donuts and fruit juices. Once you mostly eliminate such things from your diet you become aware of the “background” levels of added sugar in other foods.

For example, when I consume what many Americans probably perceive as a “healthy” granola bar (from even the most natural or organic of manufacturers), all I can taste is a sickly sugar taste overwhelming all the other ingredients.

Low-fat yogurt (which I have compared unfavorably to a Snickers Bar here) tastes like pure sugar mixed with odd chemicals and a vague dairy flavor.

Seemingly healthy sushi tastes too sweet to me as it turns out to have lots of sugar mixed in  the rice and the popular eel sauce is mostly made up of sugar.

Most annoying  is the current trend for restaurants to put a “balsamic glaze” loaded with sugar on perfectly good vegetables like brussel sprouts, ruining them for me.

Fructose and Processed Foods

A review article in the Mayo Clinic Proceedings (1) this month presents the case for fructose (from glucose and high-fructose corn syrup) being the major cause of our obesity and diabetes epidemics and thus, the major contributor to cardiovascular disease in the US.

Fructose is a monosaccharide that combines with the monosaccharide glucose to form sucrose, which is what most people recognize as sugar.

Processed foods commonly contain a lot of added fructose-containing sugar but also, increasingly they contain high fructose corn syrup (HFCS) which contains up to 65% fructose.

Large intake of fructose goes hand in hand with consumption of processed foods. Approximately 75% of all foods and beverages in the US contain added sugars. Consumption of added sugar by Americans increased from 4 lbs per person per year to 120 lbs per person per year between 1776 and 1994.

Thanks to a dramatic increase in sugar-sweetened beverages, American teenagers consume about 72 grams of fructose daily.

There are a substantial amount of observational, short-term basic science, and clinical trial data suggesting that all this added sugar, especially fructose, are posing a serious public health problem.

The article presents these data in detail and I’ll summarize the major points as follows:

  1. Fructose is the likely component of sucrose and HFCS that promotes insulin resistance.
  2. In animals and humans, replacement of starch (chains of glucose) with sucrose or fructose causes increase glucose and insulin levels and reduced insulin sensitivity.
  3. Fructose stimulates epigenetic changes and metabolic alterations that shunt calories into storage depots in abdominal fat cells.

In simpler language, fructose promotes abdominal fat build-up and makes you more likely to develop type 2 diabetes.

Fruits and Fructose

I’m sure many of you are thinking, “but fructose is the major sugar in fruit, should I stop eating fruit?”

The answer is NO! The fructose in fruit is not highly concentrated. Fructose makes up 1% of the weight of a pear for example. It is combined with all of the good things, including fiber and phytonutrients and vitamins, that make fruit good for you.

Eliminating added fructose (sugar and HFCS) is by far the simplest thing you can do diet wise to improve your health. If you avoid added fructose, you will be cutting out a lot of the processed foods and sugar-sweetened beverages which have no nutritional value but contribute to obesity and diabetes.

Fructose as Toxin

preserves
Real fruit (right) and “Just Fruit Spread” (left). Note the attempts to make the spread appear healthy by announcing that it is “non-GMO”, glutan-free, “organic” and “perfectly sweetened with fair trade cane sugar”. Cane juice is added sugar .

Robert Lustig, a pediatric endocrinologist has talked and written extensively about fructose as a “toxin.” You can watch him here. He’s also published a lot of books on the topic including one which identifies the 56 names under which sugar masquerades.

It’s probably not worth buying that book, but keep in mind that agave and evaporated cane juice are just different forms of sugar. Makers of organic and “natural” foods are   as guilty as food industry giants at adding sugar, but they try to pretend that “natural” sources of sugar are somehow better for you.

I don’t think the science on fructose is totally settled, however, and another recent review (from scientists not funded by the food industry) concluded:

“current evidence on the metabolic effects of fructose, as consumed by the majority of populations, is insufficient to demonstrate such a role in metabolic diseases and the global obesity epidemic”

Skeptically Yours,

Anthony C. Pearson, MD, FACC

1. Added Fructose: A Principal Driver of Type 2 Diabetes Mellitus and Its Consequences. Mayo Clin Proc. 2015:90(3);372-381. DiNicolantonio, JJ, O’Keefe, JH and Lucan SC