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    #14 - Robert Lustig, M.D., M.S.L.: fructose, processed food, NAFLD, and changing the food system

    enSeptember 10, 2018

    Podcast Summary

    • Experts Discuss Nuanced Aspects of Sugar, Fiber, and Balanced DietsAvoiding sugar alone is not sufficient for a healthy diet; consuming both soluble and insoluble fiber from real foods like vegetables is equally important.

      Discussions between experts like Peter Attia and Dr. Rob Lustig are crucial for understanding complex topics beyond the headlines. They delve into the nuanced aspects of issues like the effects of sugar on addiction and depression, as well as the importance of fiber in a balanced diet. Dr. Lustig emphasizes that avoiding sugar alone is not enough and highlights the significance of consuming both soluble and insoluble fiber, mainly found in real foods like vegetables. Practical advice on parenting and maintaining a healthy balance for children is also provided. This episode offers insights into topics such as fructose, liver function testing, uric acid, metabolic syndrome, and heart rate variability, providing a comprehensive understanding of these subjects.

    • The Differences Between Glucose and FructoseGlucose is essential for bodily functioning and energy, while fructose is primarily a storage form of energy in plants and is metabolized differently by gut bacteria.

      There are significant differences between glucose and fructose, two types of carbohydrates. Glucose is essential for proper bodily functioning and is the main source of energy for all cells. Even if you don't consume glucose directly, your body can produce it through a process called gluconeogenesis. On the other hand, fructose is not a crucial nutrient for animal life and is primarily a storage form of energy in plants. When consumed, fructose is metabolized more efficiently by gut bacteria than by our own bodies. Furthermore, glucose and fructose have different biochemical properties, with fructose being more prone to causing the Amadori rearrangement, a process associated with aging. Understanding these distinctions is important when considering the effects of sugar and processed foods on our health.

    • The Differences Between Fructose and GlucoseFructose has negative effects on the body, including decreased protein functionality, potential inflammation, and overeating, while glucose suppresses hunger and is metabolized differently in the brain. The claim that all sugars and calories are the same is inaccurate. Researchers are working on biomarkers for measuring fructose's effects.

      Fructose and glucose have significant differences in their effects on the body. Fructose causes a browning reaction in the body's proteins at a much faster rate than glucose, leading to decreased functionality and potential inflammation. Additionally, fructose does not suppress the hunger hormone ghrelin like glucose does, which can result in overeating. In terms of brain metabolism, glucose is primarily metabolized in areas related to sensory-motor function, while fructose specifically activates the brain's reward center, similar to addictive substances like cocaine. The food industry's claim that all sugars and calories are the same is inaccurate and misleading. While measuring fructose consumption is challenging, researchers are working on finding long-term biomarkers for its effects.

    • Effects of Excessive Sugar Consumption on HealthLowering sugar intake can improve blood pressure and liver health by reducing serum uric acid and ALT levels. It is important to be mindful of sugar consumption for overall well-being.

      Excessive sugar consumption leads to an increase in serum uric acid and ALT levels, which can have detrimental effects on our health. Consuming high amounts of fructose, found in sugary beverages and processed foods, puts us at higher risk for conditions like gout and elevated blood pressure. Uric acid inhibits an enzyme responsible for relaxing blood vessels, leading to increased blood pressure and an elevated risk of stroke. Lowering sugar intake can help decrease serum uric acid levels and subsequently improve blood pressure. Additionally, ALT levels indicate the amount of liver fat, and its increase suggests fatty liver disease. By reducing sugar consumption, ALT levels can decrease, promoting better liver health. It is crucial to be mindful of sugar intake and maintain levels within healthy limits.

    • Managing Uric Acid and Homocysteine Levels for Cardiovascular HealthHigh levels of uric acid and homocysteine can harm cardiovascular health by inhibiting nitric oxide synthesis. It is important to manage these levels to maintain optimal cardiovascular function.

      High levels of uric acid and homocysteine in the body can have detrimental effects on cardiovascular health. These substances can inhibit nitric oxide synthesis, leading to vasoconstriction in coronary arteries and increased risk of metabolic syndrome. The empirical and interventional data now available confirm the plausibility argument and highlight the importance of managing uric acid and homocysteine levels. Additionally, the discussion suggests that fructose consumption in its natural state (as in fruits) may have an advantage over glucose in quickly replenishing liver glycogen stores. However, this advantage is largely insignificant, as real food can effectively restore glycogen levels within a day. Overall, understanding the impact of these substances and their role in metabolic health is crucial for maintaining optimal cardiovascular function.

    • The Potential Link between Maternal Hyperglycemia and Offspring's Metabolic DysfunctionWhile not yet proven in humans, there is a possibility that maternal hyperglycemia during pregnancy can lead to epigenetic changes in offspring, impacting their metabolism. Promoting healthy eating habits for our children is beneficial regardless.

      There may be a link between maternal hyperglycemia during pregnancy and epigenetic changes in offspring that can lead to metabolic dysfunction later in life. While this has been observed in animal studies, it has not been conclusively proven in humans. However, if it is true, it could explain the increasing prevalence of metabolic syndrome and related conditions. As parents, we should consider the food environment our children are exposed to and make efforts to promote healthy eating habits. Even if the link between epigenetics and metabolism is eventually proven untrue, there is no downside to encouraging our children to eat well, aside from the effort it requires.

    • The Impact of Overstimulation on NeuronsChronic overstimulation of neurons can lead to cell death, addiction, and a decrease in the ability to experience joy. Understanding this impact is crucial for promoting overall well-being.

      Chronic overstimulation of neurons can lead to cell death and a decrease in the ability to experience joy. Neurons are designed to be excited but not constantly bludgeoned with neurotransmitters. When neurons are continuously overstimulated, they down regulate their receptors to protect themselves, reducing the risk of cell death. However, this down regulation also leads to tolerance, where larger and larger hits are needed to achieve the same rush. Eventually, chronic stimulation causes neuronal cell death, resulting in addiction and permanent damage. It's important to note that not all drugs are stimulatory; there are also inhibitory drugs like benzodiazepines and psychedelics. Understanding the impact of overstimulation on neurons is crucial in order to prevent addiction and promote overall well-being.

    • The Impact of Different Substances and Behaviors on Dopamine and AddictionAddiction can be caused by a variety of substances and behaviors that stimulate dopamine in the brain, and addressing addiction may require different approaches depending on the specific substance or behavior involved.

      Different substances, including drugs and certain behaviors, can stimulate dopamine in the brain and lead to addictive behaviors. Not all drugs have the same negative impact on neurons. For example, psychedelics do not cause receptor down-regulation or withdrawal symptoms. Ethanol, on the other hand, not only acts as a gaba agonist but also produces acetaldehyde through metabolism, leading to the creation of reactive oxygen species that can harm neurons. Similarities between ethanol and fructose exist in both the liver and the brain, as they both stimulate the reward center through different mechanisms. Additionally, addictive behaviors such as gambling or using social media can also trigger dopamine response and induce tolerance. It is important to recognize that addiction can encompass a wide range of substances and behaviors, and addressing them may require different approaches.

    • The Hidden Dangers of Processed FoodsAvoiding processed foods and focusing on a low sugar, high fiber diet of real, unprocessed foods is the key to maintaining a healthy lifestyle.

      Processed foods are the main problem when it comes to sugar consumption. The added sugars that we are aware of, such as those found in sodas and candies, only make up about half of the added sugars consumed by children. The other half comes from foods where sugar is hidden, like bread and pasta sauce. This is because sugar is added to these products to act as a preservative and keep the water content high. It's important to focus on consuming a low sugar, high fiber diet, which is known as real food. The goal is not to fixate on specific target numbers, but rather to prioritize whole, unprocessed foods in order to maintain a healthy lifestyle.

    • The importance of a real food diet and understanding the difference between processed and real food.Educating ourselves and our children about the impact of food on our bodies can help us make healthier choices and prevent health issues in the long run.

      A diet consisting of real food is essential for maintaining good health. Processed foods, such as grocery store bread, should be avoided as they lack nutrients and can have negative effects on our bodies. Parents need to understand the difference between real food and processed food, and teach their children to make healthy food choices. Although it may require more time and money, investing in real food is worth it for our well-being. Furthermore, certain ethnic groups, such as Latinos, may have a genetic predisposition to conditions like non-alcoholic fatty liver disease (NAFLD). Therefore, it is especially important for those at higher risk to eliminate excessive sugar consumption from their diet. By educating people about the impact of food on our biochemistry and behavior, we can make healthier choices and prevent health issues.

    • Understanding the Link Between NAFLD, Diabetes, and Fructose ConsumptionFructose consumption plays a significant role in the development of NAFLD and related health issues, highlighting the importance of addressing dietary factors in preventing and managing these conditions.

      Nonalcoholic fatty liver disease (NAFLD) and type 2 diabetes are both on the rise among children and adults, suggesting an environmental insult rather than solely genetics. The speaker, Robert Lustig, had initially misunderstood his patients' claims of not consuming alcohol, only to later discover that they had NAFLD. He explains that the production of liver fat can occur through dietary fat or de novo lipogenesis, the process of turning sugar into fat. Despite previous beliefs that de novo lipogenesis was a minor pathway, it is now known to be a major pathway, contributing significantly to liver fat. This reveals the importance of addressing fructose consumption as a driving factor behind NAFLD and its related health issues.

    • Body's methods for clearing out excess fat and the role of dietary fats and lipogenesis in fatty liver and inflammation.Excess fat in the body can be cleared out through oxidation and export, but an increase in de novo lipogenesis and high triglyceride levels can lead to fatty liver and inflammation. Insulin resistance, chronic stress, and the release of cortisol and neuropeptide y also play a role.

      There are two ways for the body to clear out excess fat: oxidation and export. Oxidation refers to the process of breaking down fatty acids for energy, while export involves moving fat out of the liver through VLDL or phosphatidylcholine. The decrease in dietary fats is not the cause of fatty liver, but rather the increase in de novo lipogenesis, the creation of fat from non-fat sources. This leads to fatty liver and inflammation, making the mitochondria less functional and impairing fatty acid oxidation. The high triglyceride levels in patients who consume fructose indicate that more fat is coming in than being cleared out. Insulin resistance and NAFLD are interconnected, but the adipogenic hypothesis of metabolic syndrome, which links fat cells and liver dysfunction, is only one of the pathways. Another pathway involves the accumulation of visceral fat due to chronic stress and the release of cortisol and neuropeptide y.

    • The Impact of Chronic Stress and Sympathetic Overstimulation on Visceral Fat Accumulation.Chronic stress and overstimulation of the sympathetic nervous system can lead to the accumulation of harmful visceral fat, which is linked to various health issues. Excessive sugar consumption is a major contributor to these negative health outcomes.

      Chronic overstimulation of the sympathetic nervous system, combined with chronic stress, leads to the accumulation of visceral fat. This visceral fat is distinct from subcutaneous fat and is more problematic for health. Additionally, the conversation highlights the role of cortisol and neuropeptide y in promoting lipogenesis and fat accumulation. This insight is supported by the correlation observed between low heart rate variability (indicating higher sympathetic tone) and higher glucose levels. The conversation also emphasizes the detrimental effects of liver dysfunction caused by cytokines released from visceral fat or due to primary hepatic dysfunction. Ultimately, the main culprit in promoting these negative health outcomes is excessive sugar consumption.

    • The Impact of Hyperinsulinemia on Chronic Metabolic DiseasesLowering blood insulin levels is crucial in addressing diabetes and chronic metabolic diseases, as it can help reduce weight gain, decrease the risk of heart attacks, and potentially prevent the development of cancer. Physicians need to prioritize addressing hyperinsulinemia alongside diabetes.

      Hyperinsulinemia, or high levels of insulin in the body, is a significant factor in chronic metabolic diseases. Insulin's primary function is to store energy, but it also causes inflammation and cell division. This can lead to weight gain, increased risk of heart attacks, and even the development of cancer. Lowering blood glucose levels alone is not enough to address diabetes; lowering blood insulin levels is equally important. Currently, the food industry perpetuates the idea that all calories contribute equally to weight gain and insulin resistance, but this is not true. It is crucial for physicians to recognize the importance of hyperinsulinemia and address it as seriously as diabetes itself.

    • The Impact of Fiber on Calorie Absorption and Gut HealthNot all calories are fully absorbed by the body, and consuming fiber is crucial for maintaining a healthy gut and digestive health.

      Not all calories are the same, contrary to popular belief. The example of almonds shows that even though they may have 160 calories, only about 75% of those calories are actually absorbed by the body. The soluble and insoluble fiber in the almonds form a gel in the intestines, preventing early absorption. This means that the remaining calories pass into the colon where they can be metabolized by the gut bacteria. Consuming fiber is crucial because it provides food for the gut bacteria, preventing them from damaging the mucin layer in the intestine. Both soluble and insoluble fiber are necessary for forming this protective barrier. It is important to include sources of fiber in our diet to maintain a healthy gut and overall digestive health.

    • The importance of functional fiber in promoting health and the need to transform the food industry's business model.The food industry's current practice of adding soluble fiber to processed foods is ineffective. Real food with both soluble and insoluble fiber is crucial for health, but changing the industry requires collaboration and addressing challenges.

      The food industry's current approach of adding soluble fiber to processed foods is not effective in promoting health. The industry claims that these products are good because they contain extra fiber, but the truth is that they lack functional fiber. Real food, on the other hand, provides both soluble and insoluble fiber, which work together to improve health. However, the challenge lies in changing the food industry's business model, as they currently profit from selling sugary products. To bring about change, there are four potential approaches: educating the public to make better food choices, executive branch efforts (although currently limited), legislative changes (difficult due to industry influence), and lawsuits targeting the food industry. Overall, transforming the food system requires a collective effort from various stakeholders.

    • The role of food subsidies in distorting the market and the need for regulatory measures to promote healthier food choices.Eliminating food subsidies and implementing regulations on unhealthy food marketing to children are important steps towards promoting healthier food choices and addressing the issue of distorted market prices.

      Food subsidies play a significant role in distorting the market and making junk food cheaper than real food. Robert Lustig emphasizes that getting rid of these subsidies would allow the market to function properly. While the price of most foods wouldn't change, corn and sugar would become more expensive, as they are major sources of dietary sugar. Lustig suggests incorporating the issue of the metabolic cost of food into the Farm Bill, which governs agricultural policies, to strengthen the link between food, productivity, and healthcare costs. Additionally, he acknowledges the importance of awareness and regulation in curbing unhealthy food marketing to children, as voluntary measures by industry players have proven insufficient. Overall, addressing food subsidies and marketing practices are vital steps towards promoting healthier food choices.

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    • Nutrition myth: GLP-1 agonists are a replacement for a healthy lifestyle [57:45];
    • Nutrition myth: There is a single best diet for weight loss [1:03:00];
    • Nutrition oversimplification: All calories are created equal [1:05:45];
    • Daily step goals [1:06:45];
    • The benefits of standing versus sitting throughout the day [1:10:45];
    • How to identify the most impactful and easiest-to-implement ways to improve your health [1:12:30];
    • The critical importance of emotional health [1:14:30];
    • Why supplements should be considered as supportive aids rather than primary solutions in one’s strategy to improve longevity [1:18:00];
    • Strategies for reducing high blood pressure [1:20:45];
    • Peter’s biggest frustrations with "mainstream health advice" [1:28:00];
    • Peter’s chaotic, yet cherished, morning routine [1:31:00]; and
    • More.

    Connect With Peter on TwitterInstagramFacebook and YouTube

    The Peter Attia Drive
    enJune 17, 2024

    #305 ‒ Heart rate variability: how to measure, interpret, and utilize HRV for training and health optimization | Joel Jamieson

    #305 ‒ Heart rate variability: how to measure, interpret, and utilize HRV for training and health optimization | Joel Jamieson

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    Joel Jamieson is a conditioning expert who developed Morpheus to give people a smarter way to build their conditioning regimen and improve their recovery. In this episode, Joel dives deep into the world of heart rate variability (HRV), explaining its scientific foundation, how it measures the balance between the sympathetic and parasympathetic nervous systems, the various methods of measurement, and how it can guide healthier lifestyle choices and improved training performance. He explores the nuances of HRV calculation, the impact of aging on HRV, and the roles of genetics, exercise, and other lifestyle factors in this process. He also covers Morpheus, the innovative training tool that won Peter over after his initial skepticism, highlighting its practicality and effectiveness in guiding training and optimizing fitness outcomes.

    We discuss:

    • Heart rate variability (HRV): evolution, science, and practical applications of HRV in athletic training [4:00];
    • Methods of measuring HRV: EKG, wrist-based sensors, and more [11:30];
    • How HRV is calculated from the data [22:30];
    • The role of the autonomic nervous system (ANS) in regulating HRV [25:45];
    • The decline in HRV with age, and the mitigating effects of fitness and other lifestyle factors [33:30];
    • The role of genetics in HRV, the modifiability of HRV, and a comparison of VO2 max and HRV as predictors of mortality [37:00];
    • How aging affects HRV and sympathetic drive, and the importance of spontaneous movement and exercise in maintaining the body's adaptability [43:30];
    • How Morpheus measures HRV using RMSSD and normalizes it to a 100-point scale for easier interpretation [49:45];
    • The Morpheus system: development, integration with various metrics, and personalized daily training recommendations to optimize fitness and recovery [51:30];
    • The benefits of morning HRV readings for assessing daily readiness compared to overnight HRV measurements [1:03:00];
    • Why Morpheus recommends using a chest strap rather than an arm band [1:10:00];
    • The impact of consistent exercise, stress, alcohol, and other lifestyle factors on HRV [1:11:15];
    • Optimizing zone 2 training with Morpheus [1:18:15];
    • Using heart rate recovery (HRR) as an indicator of athletic conditioning and the balance between aerobic and anaerobic systems [1:22:45];
    • The importance of tracking HRV trends over time rather than focusing on data from a given day [1:29:00];
    • Effect of GLP-1 agonists on heart rate and HRV [1:34:45];
    • Where HRV belongs in the hierarchy of health metrics [1:42:00];
    • Parting thoughts [1:46:30]; and
    • More.

    Connect With Peter on TwitterInstagramFacebook and YouTube

    The Peter Attia Drive
    enJune 10, 2024

    #304 – NEW: Introducing quarterly podcast summaries - Peter shares his biggest takeaways on muscle protein synthesis, VO2 max, toe strength, gut health, and more

    #304 – NEW: Introducing quarterly podcast summaries - Peter shares his biggest takeaways on muscle protein synthesis, VO2 max, toe strength, gut health, and more

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    In this quarterly podcast summary (QPS) episode, Peter introduces a new format aimed at summarizing his biggest takeaways from the last three months of guest interviews on the podcast. Peter shares key insights from each episode, covering diverse topics such as protein and muscle building with Luc van Loon, toe strength with Courtney Conley, VO2 max with Olav Aleksander Bu, liquid biopsies for cancer with Alex Aravanis, gut health and probiotics with Colleen Cutcliffe, and road safety with Mark Rosekind. Additionally, Peter shares any personal behavioral adjustments or modifications to his patient care practices that have arisen from these engaging discussions.

    If you’re not a subscriber and are listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your private RSS feed or our website at the episode #304 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here.

    We discuss:

    • How Peter keeps track of his takeaways from each podcast episode [5:15];
    • Luc van Loon episode: fat utilization, muscle protein synthesis, dietary protein, aging and inactivity, and more [8:45];
    • Behavioral changes that have come about from the conversation with Luc van Loon [23:45];
    • Courtney Conley episode: importance of toe strength and the impact of dedicated foot training [26:45];
    • Olav Aleksander Bu episode: the importance of VO2 max for lifespan, and the practicalities of measuring and improving VO2 max [36:45];
    • Behavioral changes that have come about from the conversation with Olav [56:00];
    • Alex Aravanis episode: liquid biopsies for cancer detection [1:01:30];
    • Colleen Cutcliffe episode: the importance of gut bacteria balance, and the potential therapeutic uses of probiotics, particularly Akkermansia [1:16:45];
    • Mark Rosekind: the significant issue of road fatalities and injuries, their causes, and practical safety measures to reduce risks [1:27:00]; and
    • More.

    Connect With Peter on TwitterInstagramFacebook and YouTube

    The Peter Attia Drive
    enJune 03, 2024

    #303 - A breakthrough in Alzheimer’s disease: the promising potential of klotho for brain health, cognitive decline, and as a therapeutic tool for Alzheimer's disease | Dena Dubal, M.D., Ph.D.

    #303 - A breakthrough in Alzheimer’s disease: the promising potential of klotho for brain health, cognitive decline, and as a therapeutic tool for Alzheimer's disease | Dena Dubal, M.D., Ph.D.

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    Dena Dubal is a physician-scientist and professor of neurology at UCSF whose work focuses on mechanisms of longevity and brain resilience. In this episode, Dena delves into the intricacies of the longevity factor klotho: its formation and distribution in the body, the factors such as stress and exercise that impact its levels, and its profound impact on cognitive function and overall brain health. Dena shares insights from exciting research in animal models showing the potential of klotho in treating neurodegenerative diseases as well as its broader implications for organ health and disease prevention. She concludes with an optimistic outlook for future research in humans and the potential of klotho for the prevention and treatment of Alzheimer’s disease.

    Disclosure: Peter is an investor in Jocasta Neuroscience, a company working to develop klotho as a therapy for people with Alzheimer’s disease.

    We discuss:

    • Dena’s fascination with aging and how she came to study klotho [3:30];
    • Biological properties of klotho: production, regulation, decline with age, and factors influencing its levels [11:45];
    • Potential benefits of klotho on brain health [22:00];
    • The relationship between soluble klotho protein, platelet factors, and cognitive enhancement [33:45];
    • The role of platelet factor 4 (PF4) and it’s interaction with GluN2B in mediating cognitive enhancement [46:45];
    • Benefits of klotho observed in a mouse model of Parkinson’s disease [55:45];
    • Benefits of klotho observed in a mouse model of Alzheimer’s disease [1:03:00];
    • Promising results of klotho in primate models, and the importance of finding an appropriate therapeutic dose before moving to human trials [1:08:00];
    • Speculating why a single klotho injection has such long-lasting effects [1:25:30];
    • Potential cognitive benefits of klotho in humans, the impact of the KL-VS genetic variant on klotho levels, and the need for human trials to confirm these effects [1:27:45];
    • The interaction between the KL-VS genetic variant and APOE4 and how it impacts risk of Alzheimer’s disease [1:34:45];
    • The significance of klotho levels: studies linking lower levels to increased mortality and the broader implications for organ health and disease prevention [1:47:15];
    • Measuring klotho levels and determining an individual’s KL-VS status [1:52:15];
    • The promising potential of klotho for Alzheimer’s disease treatment, and the importance of philanthropy for funding research [1:58:00]; and
    • More.

    Connect With Peter on TwitterInstagramFacebook and YouTube

    The Peter Attia Drive
    enMay 27, 2024

    #302 - Confronting a metabolic epidemic: understanding liver health and how to prevent, diagnose, and manage liver disease | Julia Wattacheril, M.D., M.P.H.

    #302 - Confronting a metabolic epidemic: understanding liver health and how to prevent, diagnose, and manage liver disease | Julia Wattacheril, M.D., M.P.H.

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    Julia Wattacheril is a physician scientist and director of the Metabolic Dysfunction Associated Steatotic Liver Disease (MASLD) program at Columbia University Irving Medical Center. In this episode, Julia delves deep into the complex world of liver health, beginning with a foundational overview of liver physiology. She provides an in-depth look at how alcohol impacts liver function, breaking down the metabolism of ethanol and its detrimental effects. Julia then shifts the focus to understanding liver function tests and optimal enzyme levels, providing a detailed explanation of AST and ALT and elucidating why fluctuations in these levels may or may not be concerning. She provides a primer on the four major stages of liver disease, discussing risk and emphasizing the importance of early diagnosis. Julia highlights the role of liver disease in increasing the risk of cancer and cardiovascular disease and covers in detail the various strategies for diagnosing, treating, and preventing the progression of liver disease.

    We discuss:

    • Julia’s training, the importance of liver health, and the challenges and innovations of hepatology [3:15];
    • The complex and crucial functionality of the liver, its four most essential functions, and more [8:45];
    • Liver injuries: historical and evolving understanding of causal factors, and the progression to liver diseases and cancer [13:15];
    • How the liver metabolizes nutrients and what happens in the presence of excess calories or alcohol [24:45];
    • Methods of diagnosing liver disease and how insights guide treatment and management strategies [33:30];
    • The poisonous nature of ethanol to the liver [40:30];
    • Varied responses to alcohol, damaging effects of alcohol beyond the liver, and the process of advising patients on their alcohol consumption [47:15];
    • Understanding liver enzymes AST and ALT—interpreting levels, lifestyle factors that affect them, and diagnostic approaches [58:30];
    • Interpreting liver function tests for fatty liver disease, and the challenges of diagnosing liver pathologies, particularly in children versus adults [1:13:15];
    • Comprehensive liver health assessments via imaging and various diagnostic tools to prevent overlooking potential liver pathologies [1:18:45];
    • Potential impact of recreational drugs, statins, and other medications on liver function test results [1:26:45];
    • Shifting nomenclature from NAFLD to MASLD to reflect accuracy in the underlying pathophysiology and understanding of liver diseases [1:30:30];
    • Pathophysiology of MASLD, the need for proactive screening, and the significance of liver fat percentage as an indicator of metabolic health [1:36:30];
    • The importance of screening for rare conditions alongside common metabolic diseases associated with fatty liver accumulation [1:42:45];
    • Practical strategies for managing MAFLD [1:45:30];
    • The impact of fructose consumption on liver health and the challenges of disentangling its effects from other factors like obesity and insulin resistance [1:52:45];
    • The potential of GLP-1 agonists for the treatment of MASLD [1:57:45];
    • How the four stages of liver disease have evolved [2:00:30];
    • Increased cancer and heart disease risk associated with early-stage MAFLD [2:05:15];
    • Emerging drugs and therapies for addressing fat accumulation and fibrosis related to MAFLD [2:12:15];
    • Peter’s major takeaways [2:18:45]; and
    • More.

    Connect With Peter on TwitterInstagramFacebook and YouTube

    The Peter Attia Drive
    enMay 20, 2024

    Related Episodes

    Ordinary Vegan Podcast #53- What Is Sugar & Which Sugars Are Healthy

    Ordinary Vegan Podcast #53- What Is Sugar & Which Sugars Are Healthy

    Fifty-years-ago, the sugar industry funded research that downplayed the risks of sugar and highlighted the hazards of fat. Forty-years-ago, high fructose corn syrup  (HFCS) started trickling into our food supply. Most people didn't know what HFCS was. So began the confusion about what is sugar and what sugars are healthy.

    When I decided to tackle the subject of sugar, one of the most surprising statistics I found out is that 99% of  toddlers ages 12 to 18 months are downing 5-7 teaspoons of added sugar a day.  Not only that, the average sugar consumption for adults is 25 teaspoons a day. Well over the recommended amounts. 

    Since the discovery of high fructose corn syrup, the American consumption of fructose jumped from 37 grams per day in the 1970s to a record high of 62 grams per day in 2000.

    So where is all this added sugar coming from? Here is an example. A 20 oz soft drink contains about 16 teaspoons of high fructose corn syrup, and an energy drink can hold over 50 grams of high fructose corn syrup. Salad dressings, ketchup, fruit drinks and even bread can have a large amounts of sugar. And most people have no idea they are consuming this much-added sugar.

    In today’s podcast, we break down the truth about sugar, and how it impacts our health. We also examine natural sugars and their role in a healthy diet.

    We also discuss why sugar may not be vegan due to its questionable infiltration.

    Resources:

    A List of Bone Char Free Sugar Companies

    Thanks for listening. Please follow me on Instagram@ordinaryvegan and please join our health and wellness community on Facebook, over 310,000 strong.

    I am devoted to keeping you healthy, and as many of you know, I began creating my own line ofCBD oilmade from hemp to assist you.

    CBD Oil(cannabidiol) is a naturally occurring compound found in the flowers of the hemp plant. A plant with a rich history as medicine going back thousands of years.

    I choose to provide CBD oilto our community because I wanted to make sure you received the safest and most reliable CBD oil on the market. Because I believe that the phytochemicals in CBD can help optimize human health no matter what your particular ailment may be. Hope my CBD oil can help you.

    To learn more about the power of CBD oil, listen toPodcast #30 – Everything You Need To Know About CBD Oil. Or visit our FAQ page.

    Thanks to this week’s sponsor - Blinkist. Go to Blinkist for your free seven-day trial.

    Til next time

    Research Resources:

    https://ordinaryvegan.net/vegansugar/

    https://www.sciencedaily.com/releases/2017/10/171013103623.htm

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4783224/

    https://genome.duke.edu/news/mon-04302018-1349/cancer-cells-adapt-gorge-sugar-liver

    https://en.wikipedia.org/wiki/Sugar

    #141 - AMA #18: Deep dive: sugar and sugar substitutes

    #141 - AMA #18: Deep dive: sugar and sugar substitutes

    In this “Ask Me Anything” (AMA) episode, Peter and Bob talk all about sugar and sugar substitutes and provide a way to think about sugar consumption. The conversation begins by defining the various forms of sugar, delineating between added sugar and naturally occurring sugar, and describing the important variables that determine the potential for metabolic damage from consumption. They then take a dive deep into three main categories of sugar substitutes—non-nutritive sweeteners, alcohol sugars, and leaving allulose, in a class by itself—including the safety profile of each, impact on blood sugar and insulin, side-effects, taste preferences, and more. 

    If you’re not a subscriber and listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your private RSS feed or on our website at the AMA #18 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here

    We discuss:

    • Delineating the various forms of “sugar” (2:00);
    • Added sugar vs. naturally occurring sugar (12:30);
    • Important variables related to sugar consumption: Density, volume, and velocity (17:00);
    • Alternatives to sugar: Non-nutritive sweeteners (22:30);
    • Alternatives to sugar: Alcohol sugars (34:15);
    • Alternatives to sugar: Allulose (39:00);
    • Contextualizing risk when it comes to sugar substitutes (45:00);
    • Why some people report feeling better when eliminating non-nutritive sweeteners from their diet (46:30);
    • The impact of sweetness—Cephalic insulin response and the metabolic drive to eat more (49:45); and
    • More.

    Learn more: https://peterattiamd.com/

    Show notes page for this episode: https://peterattiamd.com/ama18/ 

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    Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/

    Connect with Peter on Facebook | Twitter | Instagram.

    How Sugar & Processed Foods Impact Your Health

    How Sugar & Processed Foods Impact Your Health
    In this episode, we address the “calories in- calories out” (CICO) model of metabolism and weight regulation and how specific macronutrients (protein, fat, carbohydrates), fiber, and sugar can modify the CICO equation. My guest is Dr. Robert Lustig, M.D., neuroendocrinologist, professor of pediatrics at the University of California, San Francisco (UCSF), and a bestselling author on nutrition and metabolic health. We cover how different types of sugars, specifically fructose, sugars found in liquid form, taste intensity, and other factors impact insulin levels, liver, kidney, and metabolic health. We also explore how fructose in non-fruit sources can be addictive, acting similarly to drugs of abuse, and how sugar alters brain circuits related to food cravings and satisfaction. The discussion then shifts to the role of sugar in childhood and adult obesity, gut health and disease, and mental health. We delve into how the food industry uses refined sugars to create pseudo foods and the implications of these on the brain and body. This episode is replete with actionable information about sugar and metabolism, weight control, brain health, and body composition. It ought to be of interest to anyone seeking to understand how specific food choices impact the immediate and long-term health of the brain and body. For show notes, including referenced articles and additional resources, please visit hubermanlab.com. Thank you to our sponsors AG1: https://drinkag1.com/huberman Eight Sleep: https://eightsleep.com/huberman Levels: https://levels.link/huberman LMNT: https://drinklmnt.com/huberman AeroPress: https://aeropress.com/huberman Momentous: https://livemomentous.com/huberman Timestamps (00:00:00) Dr. Robert Lustig (00:02:02) Sponsors: Eight Sleep, Levels & Aero Press (00:06:41) Calories, Fiber (00:12:15) Calories, Protein & Fat, Trans Fats (00:18:23) Carbohydrate Calories, Glucose vs. Fructose, Fruit, Processed Foods (00:26:43) Fructose, Mitochondria & Metabolic Health (00:31:54) Trans Fats; Food Industry & Language (00:35:33) Sponsor: AG1 (00:37:04) Glucose, Insulin, Muscle (00:42:31) Insulin & Cell Growth vs. Burn; Oxygen & Cell Growth, Cancer (00:51:14) Glucose vs. Fructose, Uric Acid; “Leaky Gut” & Inflammation (01:00:51) Supporting the Gut Microbiome, Fasting (01:04:13) Highly Processed Foods, Sugars; “Price Elasticity” & Food Industry (01:10:28) Sponsor: LMNT (01:11:51) Processed Foods & Added Sugars (01:14:19) Sugars, High-Fructose Corn Syrup (01:18:16) Food Industry & Added Sugar, Personal Responsibility, Public Health (01:30:04) Obesity, Diabetes, “Hidden” Sugars (01:34:57) Diet, Insulin & Sugars (01:38:20) Tools: NOVA Food Classification; Perfact Recommendations (01:43:46) Meat & Metabolic Health, Eggs, Fish (01:46:44) Sources of Omega-3s; Vitamin C & Vitamin D (01:52:37) Tool: Reduce Inflammation; Sugars, Cortisol & Stress (01:59:12) Food Industry, Big Pharma & Government; Statins (02:06:55) Public Health Shifts, Rebellion, Sugar Tax, Hidden Sugars (02:12:58) Real Food Movement, Public School Lunches & Processed Foods (02:18:25) 3 Fat Types & Metabolic Health; Sugar, Alcohol & Stress (02:26:40) Artificial & Non-Caloric Sweeteners, Insulin & Weight Gain (02:34:32) Re-Engineering Ultra-Processed Food (02:38:45) Sugar & Addiction, Caffeine (02:45:18) GLP-1, Semaglutide (Ozempic, Wegovy, Tirzepatide), Risks; Big Pharma (02:57:390 Obesity & Sugar Addiction; Brain Re-Mapping, Insulin & Leptin Resistance (03:03:31) Fructose & Addiction, Personal Responsibility & Tobacco (03:07:27) Food Choices: Fruit, Rice, Tomato Sauce, Bread, Meats, Fermented Foods (03:12:54) Intermittent Fasting, Diet Soda, Food Combinations, Fiber, Food Labels (03:19:14) Improving Health, Advocacy, School Lunches, Hidden Sugars (03:26:55) Zero-Cost Support, Spotify & Apple Reviews, YouTube Feedback, Sponsors, Momentous, Social Media, Neural Network Newsletter Disclaimer

    Episode 14 - How Sweet It Is - Not!

    Episode 14 - How Sweet It Is - Not!
    This week I’m talking about the dangers of consuming sugar and artificial sweeteners. Research shows most Americans are not very well informed about this issue, so you’ll definitely want to listen! For more information and details on creating vibrant 3D health, visit http://www.threedimensionalvitality.com/Home.html to sign up for my FREE weekly No-Nonsense Nutrition Report and become a fan at http://www.facebook.com/ThreeDimensionalVitality Visit these posts at Dr. Mercola’s website and learn more about the dangers of sugar http://articles.mercola.com/sites/articles/archive/2010/04/20/sugar-dangers.aspx#_edn8 and aspartame http://articles.mercola.com/sites/articles/archive/2011/06/08/aspartame-toxic-sweetener.aspx If you would like a free pdf report from NaturalNews.com – "The Truth About Aspartame, MSG and Excitotoxins," please email me at ann@threedimensionalvitality.com and I am more than happy to send it as a gift just for listening!

    ARTICLE: 3 Ways to Use Meal Timing to Transform Your Body

    ARTICLE: 3 Ways to Use Meal Timing to Transform Your Body

    www.bannafit.com

    It's unfortunate that the main driver in diets these days is calorie counting. I like to think of eating calories and burning calories as only the engine behind your progress. The way you burn those calories and the timing of the types of calories you eat are what steer the ship. Meal timing is key for making sure that the ship gets steered in the right direction.