A Sugar Substitute That’s Good For You? The Science Behind Allulose - with Dr. Bikman | EP 169

the degree to which alose can be used as a replacement for fructose containing sugar um is an a direct that direct swap will result in an immediate reduction in uric acid production and I've I've seen this as [Music] well hello everyone I'm Dr David peotter welcome back to the program there's been a lot of talk lately about a sugar called allulose indicating that in fact consuming this allulose sugar might actually be good for you might help you uh with things like your body weight with controlling your blood sugar other markers of metabolism and I've asked Dr Benjamin bman to come on the program today to walk us through the latest in the science as it relates to alos Dr bikman uh is really a leader out there right now in terms of bioenergetics in terms of uh insulin sensitivity insulin resistance and that whole Paradigm and let me tell you a little bit more about him Dr Benjamin bman earned his PhD in bioenergetics and was a post-doctoral fellow with the Duke National University of Singapore in metabolic disorders currently his professional Focus as a scientist and professor at Brigham Young University is to better understand the role of elevated insulin and nutrient metabolism in regulating obesity diabetes disas and dementia so we're going to jump right in and learn all we can about allulose a very very exciting a new development in the world of sweeteners here we go hello Dr bman Welcome to our program hey Dr pearlmutter nice to see you again nice to see you too we in fact uh just saw each other uh on a scientific Advisory board meeting for RX sugar a form of alul so I I wanted to mention that on our time together today and who knows it just happened but before we jump into allulose I know uh there's a lot of interest in that I I want to explore you a little bit and uh because your interest is deeply rooted in metabolism bioenergetics I would say pretty much one and the same so what is it mean that you study metabolism and why is that important right yeah I appreciate the question simply because there are so many ways to Define metabolism so much understanding of it yeah my I like that you mentioned my actual academic credentials which is bioenergetics bioenergetics is the study of energy in living organisms which is metabolism in some where you are familiar with the building up and the breaking down and the the energetic expense or the molecules that um have to get broken apart to pay for that work if you will so my focus in metabolism um which more and more I guess to Define that a little deeper is I study metabolic Health uh and I Define that based on the efficacy of the hormone insulin and someone may think that's a strange step to take how do we go from metabolic Health to the hormone insulin uh it's because insulin is the it is the the gatekeeper um to all uh reactions that I care about as a scientist who studies muscle and neurons and fat cells that the the primary tissues of interest for my lab insulin has a thematic effect throughout the body which is to it tells cells of the body what to do with the energy that it has um and in that role it has a powerful influence potentially influencing whole body metabolic rate for example getting back to bioenergetics and measuring metabolic rate so my focus as a metabolic scientist is really studying the effects of insulin and the consequences of having too much insulin to be really precise well you know in my world uh the role of insulin is as you described so fundamental in terms of brain health and beyond that you know the notion that insulin is a trophic hormone that it actually stimulates the growth of of neurons it stimulates the connection of neurons in terms of synaptogenesis and even nurtures these connections you know as another very minimally talked about uh sidelight in terms of the incredible role of insulin but you know what you're talking about is at the the central core of not just our metabolism but by default therefore our health resistance to disease our longevity and really the whole experience based upon metabolism with insulin being the central player so what do you do a dayto day in terms of looking at insulin what are you involved in in terms of your research right yeah my research U with the big theme being uh better understanding insulin and the pathogenicity of living a life where insulin levels are too high too often um an average day will be a mix in so far as I am yes both research scientist and Professor I will have a mix of teaching a class um in this semester it just happens to be my teaching assignment is a class called pathophysiology so any any uh you know pathopysiology is a course that Nur nursing students will take and a lot of Premed students take it um just if you'll me a brief aside um it's been a very gratifying class to teach because it has helped hone my and perfect my view of the relevance of insulin resistance in chronic diseases of virtually every tissue whether we're talking about heart problems or or liver problems or brain problems or reproductive problems it's been a fun exercise for me over the years as being a teaching Professor to just as a Act of of personal curiosity look to determine the influence of insulin resistance in those and more problems but then other than the classroom of course I have a considerable interest in what goes on in my laboratory here on campus where we have multiple projects um going on for example today we have a lab meeting um to discuss a uric acid project that we're doing with Dr Rick Johnson at Colorado um and just to shed a brief moment of light on that it's we're trying to determine the degree to which ketones are sufficient to offset the influence that is turned on in response to uric acid so what happens if uric acid levels are up but also Ketone levels are up within a body uh so that that's one of a handful of experimental um designs and projects that we have working on so that that's the average day in the life of a research Professor um and scientist well please give Dr Johnson my regards I'm we've not met personally but we've spent an awful lot of time together in conversations on the phone uh and I look forward to to meeting with them we we actually I think began our our friendship during Co so we we've been virtual since um but let's get back to this notion of insulin resistance which I think is as you mentioned so uh fundamental to all of our chronic degenerative conditions which the World Health Organization would characterize as being the number one cause of death on our planet that said if insulin functionality is playing such a pivotal role and these diseases are increasing aggressively why is it that more and more people are becoming less able to use their insulin effectively right yeah that's a great way of framing the question and just so that the audience appreciates why I would even devote my career to this insulin resistance affects up to 88% of all adults within the United States based on recent data this is the most common health problem and if it uh if that were all and it was a health problem that was benign then who would care but the fact that it is not only the most common health problem but also contributes to every non-communicable chronic disease it means it's ALS not only is it very prevalent but also very relevant so how does it start firstly let me just provide my own very brief definition of what insulin resistance is and I I will invoke this a metaphor of of a coin that imagine this coin that I'm holding is insulin resistance on one side of the coin is the phenomenon that you just described which is insulin isn't working as well as it used to um at some cells I will add that as a provision here so some of the cells of the body indeed big ones and dominant ones like muscle cells and fat cells aren't responding to insulin as well as they used to now however some cells are responding well to insulin and that becomes a problem when we flip the coin over because the other side of the coin that we call insulin resistance is an obligatory hyperinsulinemia or chronically elevated insulin and that a good place to start um because of the handful of causes of insulin resistance I firmly believe that chronically elevated insulin is the most relevant of the causes in other words if a person is living a lifestyle which is chronically keeping their insulin at an elevated State they become they become progressively more and more resistant to that insulin at least some of the cells of the body do and this then is the insulin resistance in that coin metaphor so uh chronically elevated insulin is a key cause now of course um as the body becomes more resistant to insulin it needs more insulin in order to get the same signal that once upon a time was realized with a more modest amount of insulin and thus we start to see this very vicious cycle where yes on one hand too much insulin is driving insulin resistance but a failure of the body to respond to the insulin is in turn promoting a greater need for insulin and so we end up with this scenario in which hyperinsulinemia is both cause and consequence of insulin resistance hey guys we're going to get right back to the podcast but I wanted to let you know that today's podcast is being brought to you by our friends at Chef's Foundry this is the type of cookware that we use at home nonstick ceramic cookware you know a lot of the non-stick cookware that's out there uh these days is coated with some pretty toxic chemicals including things like pfas and pfoas and this is ceramic cookware they have their P600 cookware line it's highly durable it resists discoloration it resists cracking it's incredibly easy to clean and again it's what we're using here at home and I want to let you know that Chef's Foundry is offering up to a 53% discount uh on buying their new P600 cookware line and they're going to give you a a set of six silicone utensils as well what you want to do is uh go to their website which is chefs foundry.com then put in Ford promot or Dr promot and you can uh take advantage of this discount really incredible cookware again it's what we're using here at home we're super happy with it let's get right back to our podcast well well let me go back just a little bit you said if people are living a life that's causing chronically their insulin levels to be higher what do people do that's causing their insulin levels to be chronically higher than they should be right uh it is it becomes obvious when we consider the insulin effect of the three macronutrients within the human diet so the macronutrients and your audience knows this carbohydrates proteins and fats if a person eats pure fat there is no insulin Spike at all the body the the beta cells of the pancreas don't respond to dietary fat when someone eats pure protein there can be a modest effect um but it sort of depends on the individual for example type two diabetics may have a higher response to protein than a non-diabetic in fact most certainly does but generally it's little to no effect when someone eats pure carbohydrate there is a substantial effect where even in an insulin sensitive person insulin will easily Spike 10 times over normal over fasting levels and take up to three hours before it comes back down to normal that's a normal good response insulin doing what supposed to do that is a response in an insulin sensitive person now if we were to look at that same response to Pure carbohydrate in an insulin resistant person it could go up twice as high as that so up to 20 times higher than normal and stay elevated for up to five hours now in an attempt to bring down the blood sugar that's right insulin is just having to work so much harder and stick around so much longer to in order to correct the blood sugar all the while creating Havoc throughout the body at the liver cells or the gonads par you know the ovaries and women or the the blood vessels creating metabolic havoc in the meantime now that phenomenon that response to carbohydrate is relevant in of itself but it becomes doubly relevant when we look at it through the lens of what the average person is doing so an uncommon person will eat only three meals a day and be insulin sensitive and so if they eat three meals a day with about four hours in between each meal there has probably been some some period of time about an hour or so before the next meal when insulin has been able to come back down to fasting conditions so they have most of their day is spent with normal insulin or at least a decent part of it of their waking day a decent part of it now however when we consider two things it becomes problematic well three actually one um which is that most people don't eat three times a day most people eat six times a day or so they will have a big three big meals and then three snacks in between that we call it a snack but it might actually be as big as the meal itself was particularly into the evening when most people really start to indulge um and second most people are eating primarily carbohydrate globally about 70% of all calories consumed are carbohydrates so we're eating not only most of the greatest insulin spiking macronutrient but we're eating them every hour and a half or so um so insulin never has time to come down but the third aspect of this that's so relevant is that the average person is in fact insulin resistant and so there is not even a hint of moment every where where in every waking moment insulin levels are are elevated I'll say it that way so the average individual is living a life where every waking moment is spent with elevated insulin and frankly depending on their metabolic health and when they eat in the evening this may be even spilling into several hours of their non- waking moment and this is why I believe firm that we need to of all the various noxious stimuli that can contribute to insulin resistance and there are others and I believe they they they are relevant but the most relevant is just give your body a break from the hyperinsulinemia give it a chance to have insulin come down and now you can resensitize the body and your RIS of risk of all these chronic diseases goes away if not the disease itself disappearing and get a good night sleep absolutely and that's much easier to do David if they go to bed without having hyperglycemia as much as we always focus on blue light and I think that matters I'm not saying it doesn't what we Overlook what too many people Overlook is what did you eat before you went to bed and we know very well that if someone goes to bed with hypoglycemia they will have activated the sympathetic nervous system good luck trying to sleep if you are in your fight ORF flight response mode where your your your blood pressure is going to be higher your heart is beating harder and your body temperature is going to be elevated that is a perfect storm to ensure it takes you a long time to fall asleep and you're going to sleep poorly and most people will say I'm a bad sleeper because I just start to feel anxious anxiety has nothing to do with it you've simply activated that's the consequence if this is so Central to health and disease resistance and plays such an important role in all of The Chronic degenerative conditions that are globally so pervasive how does that since it's that important how do you Weare that with the fasting blood sugar test that most people get once a year at their doctor's office as an indicator of their glucose homeostasis right right I I very much rail against our glucose Centric Paradigm of metabolic Health um but you teed this up well and I it is important for people to appreciate the fact that our conventional clinical care really does Peg almost all markers of metabolic Health on glucose and and for a problem called insulin resistance there is one aspect that is conspicuously absent and just to really illustrate the problem with this insulin resistance which is you know before it's become type two diabetes and we Define type two diabetes based on the glucose level exactly unfortunately this means by having such a glucose Centric Paradigm we're missing what's happening over here if you will on the other side of this formula because insulin resist in this pre-diabetic state is a state where glucose levels are normal but in order to keep the glucose levels normal insulin has been steadily multiplying up over the years and so by the time glucose levels changed in in in an individual it's very very likely that their insulin has been elevated in a fasted state for up to 10 or 20 years of course nowadays this is happening in kids that are under 10 so we are condensing this timeline significantly but even still the individual as I'm kind of acting this out and those who can't hear um or aren't watching us but just listening insulin resistance is a state where insulin is elevated but glucose is normal thus the glucose Centric Paradigm fails to detect the problem um there's another Canary in the coal mine that's whistling and that's insulin right in other words if you're having a fasting blood sugar uh once a year which I think is is ridiculous a snapshot when you should be looking at a video why not at least ask your doctor to do a fasting insulin at that time as well a better test would be a glucose tolerance test with insulin measurements each time and then what is your feeling of the merits of a continuous glucose monitor yeah I am an enormous Advocate um I have seen I've looked with some Wonder at this debate where many people are are very animated in their opposition and I can't I can't understand that to me I know that I know what the argument is and I and it it's puzzling but the biggest argument as published in the debate which was uh an oped actually in the Journal of the American Medical Associate Association was giving people this data is going to make them neurotic oh my gosh therefore we shouldn't allow people to buy scales so they can't so to know how much they weigh yeah he forid a metric that you can use yeah heaven forbid don't let anyone have an atome blood pressure monitoring device you know the doctor knows best and we'll check the pressure yeah and what good is a speedometer on your car you don't need to know how fast they going yeah you know it's it's crazy I I think that there is I mean would I mean would to wouldn't it be wonderful if more people were a little neurotic about what they ate perhaps we wouldn't be in the problem we're in but I I think that's a silly premise I do firmly believe in the democratization of cgms um I have seen so many people's lives changed and the power of it is that they change themselves once they see what's happening in their body they don't need someone to be telling them what to do it ends up becoming a self-correcting behavior because they look at what happens when they eat these foods that they they they are told they should and they see their glucose levels go up to 300 milligrams per deciliter and it takes four hours to come back down or they eat something simple like scrambled eggs and then they see that there's no response whatsoever uh to the to the glucose and that to me is the power we could talk about those venues whereby people are told what they should eat to keep their blood sugars under control and you know as we see the fruit juices Etc and you know high fructose corn syrup being used in recipes but that said uh I think we'll have to do that another time it's a bit cynical too and I don't know necessarily want to go there we are going to talk today about um a a a new player in the world of sugar and that is allulose and I think both you and I and Dr Johnson and many of us are really uh rewriting our books a little bit about embracing the notion that there's a sweetener out there that looks and feels like sugar that may actually have some positive aspects on metabolism so how did the allulose door get open for you let's start there right yeah so let me I'll preface this just by briefly saying I do think there is value in having sweet alternatives to Sugar I know some people will just say don't e anything sweet I personally don't love that idea because I simply enjoy having sweet tasting things so I every human walking the planet it's a survival mechanism so get over it we all have a sweet tooth question that's right you know how aggressive can you be with yourself and and at times miserable by not participating when others do yeah that's yeah well said right so for me alos got on my radar um intellectually when I saw data that suggests uh that that shows that alose as a rare sugar um increases glp1 now glp1 will sound a little familiar um to the audience because that is the drug mechanism of the most famous weight loss drugs on the planet right now um in the form of semaglutide and then in the form of um wovi is the weight loss version or OIC which was the earlier lower do diabetes yeah the anti-diabetic version um frankly when it was at the lower levels when in my PhD work in bioenergetics it was actually at a lab that was among the first Labs ever funded by Johnson and Johnson to study the effects of the incron so I have kept my finger on the pulse of this work for almost 20 years um at the very very beginning so that has left me with a pretty strong appreciation for the drug and increasingly a weariness to be frank where at at its original lower dose um and I will mention some of those effects because I think it becomes a little relevant with alios I I could look at it and give it a a passing grade as as much as I um am very reluctant to embrace drugs as a therapy for metabolic Health indeed I am but even still I could look at it and say all right the the benefits may be worth the negative consequences because every drug we take is a matter of balancing consequences are those the one are the ones we want worth the ones we don't want so again to answer the question succinctly I was interested in alos when I saw that it had a substantial effect at increasing glp1 now so what well there are benefits to increasing glp1 one of which is um to delay gastric emptying so it helps you feel a little more full um so if someone were to take allulose before their biggest meal of the day for example it's very very likely that they will control their appetite a little better during that meal or in the evening when they're at their weakest and they typically indulge more perhaps a little allulose is going to be sufficient to take the edge off those cravings and help them just feel full a little better so it delays gastric emptying it slows the rate at which the food is moving and helps you feel full longer another benefit of glp1 activation that we can see with alose is that it inhibits the hormone glucagon and as much as we've been talking about insulin um glucagon is insulin's opposite um with a few different metabolic pathways or metabolic processes most especially being blood glucose levels whereas insulin wants to lower blood glucose levels glucagon wants to increase blood glucose levels and so if gp1 is increased and it's inhibiting glucagon we can see that that's another mechanism whereby alul allulose may be helping correct blood glucose and this I suspect is one of the main reasons why um the evidence that we see a lot of it's anecdotal at the moment of people with type one diabetes who take an alose product like RX sugar they will have a significantly EAS easier time controlling their blood glucose levels even after they eat something that is starchy or sugary and it's probably due to the inhibition of glucagon which is chronically elevated in states of of diabetes type one or type two um so these two phenomenon the the delayed gastric emptying and the reduced glucagon I believe are mechanisms that help control blood sugar because it's controlling the amount of of glucose coming into the blood which is helping insulin be a little lower but also there's substantial evidence to suggest that alose helps On The Backs side as well which is the glucose clearance or removing the glucose from the blood so not only controlling the amount coming in but also the amount going out namely increasing it by activating an enzyme called amk and Everyone by now has heard of mtor and that's a topic for another time um but mtor is this now famous protein that wants to build things up umk wants to break things down including including accelerating the rate at which we're burning through glucose um just to start increasing the catabolic side of the metabolic equation breaking things down for the production of energy so collectively this really does become a pretty metabolically favorable milu where the glp1 increase um is delaying gastric emptying and it is affecting glucagon levels helping reduce the amount of glucose coming into the blood and then the alosis directly increasing ampk at tissues like the muscle which is accelerating the weight at which the rate at which we're pulling the glucose out and burning it for energy well these are really fundamental biochemical uh areas of uh interest for so many of us that are involved in looking at metabolism you know this notion of amp kinas I think we've we've talked with our audience quite a bit about it we want to activate amp kinas as you mentioned uh one of the best ways is physical exercise we know that a drug uh activates ainus called metformin and as such one of the things that's able to do when ainus is activated is reduce the formation of blood sugar from denovo creation of blood sugar in the liver we call that glucono Genesis so this is a pretty handy thing to have on board and using this uh in our our coffee or whatever or cooking that this is yet another way along with something else I think I'm I'm very fond of that is quatin as a nutritional supplement so this is these are some of the mechanisms of allulose and so we're really getting benefits it's not just that it's uh carbon neutral uh it's actually looks like there's some positive aspects to using this um in our Foods using it as a sweetener yeah yeah I I can tell you now we're firmly in the realm of anecdote now um but if if the the audience may find this amusing one of my great uh struggles with regards to my health is my Cravings in the evening um I I've made no um secret about this but I I know that I've heard you on a podcast and I it's an embarrassing it's an embarrassing conf confession where I think it's a consequence of my college days where you know as a college student uh in the late 90s early 2000s I I would I ate a lot of cereal of of Cold Cereal a lot like all of my roommates did it was just sort of the college male diet you know it was handy very very handy and always delicious and you you've because it's it's supplemented and has all these vitamins and minerals you've convinced yourself somehow that it might be healthy for you but nevertheless to this day when I have cleaned the house got the kids in bed and I'm sitting down to enjoy some quiet time with my wife if we have cereal in the house um and we don't I make breakfast from scratch for my kids every morning in part because I don't want it in the house if there is any cereal in the house it is just Whispering my name in these seductive tones all evening and like a true addict I will tell myself I'm just going to have one little bowl and I start to justify this knowing a little part of me knowing I can never stop at just one bowl so I heard you on somebody's podcast talking about this well but now I resolve it with allulose um truly I I have I have actually developed this little strategy where I will take a sachche of RX sugar and I get that delicious sweet hit and then I make my own cafeine I say it sort of the Russian way because of my time living in Russia but it's just this fermented milk that I ferment on my own I have a little corner of the kitchen counter that's devoted to my little milk my little Dairy Brewery but then I will drink a pint or so of this cafir and and to have the sweet followed with this little bit of tart from the fermented milk it this cafir it absolutely takes the edge off my appetite and so I unabashedly credit alos and AR f for really becoming part of my strategy for improving my Cravings well uh in the interest of transparency I will say that um as I started using allulose uh I I didn't then ask myself well how am I feeling but after a week or so I noticed that my appetite was reduced and I I mentioned it to my wife and I didn't put it together at first because I just started using allulose and then I realized that in fact my appetite is has declined a little bit and I have a voraus appetite I exercise a lot and I I have too good of an appetite can get me into trouble uh and even if it's too late in the day but that said um you know I I hear you loud and clear let me move on to um something that's been talked about quite a bit lately and that is the notion that allulose helps to bring down uric acid so why might that be important well hi everyone Dr David PR here we hope you're enjoying this content and if you would do so go ahead and hit the like button and if you're not already a subscriber to our Channel please consider doing so uh we're really grateful to have you as part of our community so let's get right back to the presentation right yes in fact you you're one of the authorities on this and it's very appropriate that we've discussed Rick Johnson who I credit him with really helping me be aware of uric acid and then I give you credit as well for the excellent book that you produced on the topic um so most people don't appreciate the origins of uric acid where we have this very not your audience but average individual if they know anything about uric acid and gout they're going to repeat the same old line which is avoid meat um and and and beer maybe maybe if they're thinking a little further they may invoke you know beer as well um and they those May especially beer um I would say much much less meat while that may be a source of uric acid by far the greater source is fructose metabolism and again a topic you're more familiar with than me my answer to the question then is simply the degree to which alose can be used as a replacement for fructose containing sugar um is an a direct that direct swap will result in an immediate reduction in uric acid production and I've I've seen this as well and time will test this out um with with more reviewed randomized trials but um I strongly suspect as those trials begin to come out we will see as alos is used to swap out sugar and other fructose containing sweets um we will produce less uric acid and gout symptoms will improve um that's it seems inevitable yeah and Beyond gout of course you know what what we had written about uh was the notion that uric acid is playing a really important role in metabolism that as a survival mechanism it would increase blood sugar increase sequestration of fat reduce energy burn so we stored fat for as a hedge against starvation uh help to raise the blood pressure so for these reasons well beyond gout getting the uric acid level down uh you know is what we were talking about what people continue to recommend and you know if allulose can can help us with that goal by helping us reduce fructose input that's that's a big positive let's CLE back around to insulin resistance because uh we opened with that you know it's certainly an area of your primary focus how does alul factor into that right well it's it's an easy answer in so far as we've mentioned ampk where we have found in virtually every experimental model if you can turn onk you will improve insulin sensitivity now there are other ways I could answer this but that becomes a pretty convenient answer because we've already discussed it so ampk will increase the rate at which a cell is using energy or using nutrients to to burn nutrients for the sake of producing energy for the cell to work exercise activates ampk fasting activates ampk um that if you and because one of ampk's effect is to use more glucose you want to make the cell more insulin sensitive for example a muscle cell or a fat cell is going to have a hard time using glucose if it's not insulin sensitive because it needs insulin in order to get the glucose um to be pulled in except for exercise in the case of Muscle but even then even in the case of exercise where when the muscle's exercising it doesn't need insulin for glucose uptake but it still needs ampk it just has a different way of activating it so one way or another we have to go through ampk in order to open up these insulin dependent glucose doors and pull in the glucose so in that sense umk once again becomes a primary solution to improving insulin sensitivity because it will directly activate that pathway yeah that it does feed back to our discussion moments ago about uric acid we know that amp has to be metabolized and generally we consider the fact that well that's what amp kinas is all about but it turns out that ampk has an evil twin which is deaminase uh and what amp damin says is really pretty much the opposite of its twin a kyes and that is it Fosters uh increasing blood sugar increasing gluconeogenesis the production of blood sugar uh the the lack of our ability to utilize fat and even to some degree increases mitochondrial dysfunction so that we don't burn as much energy and guess what the lever is pulled by high elevation of uric acid uric acid is one of the Arbiters of determining which way we go amp KY on the good hand uh and Damas on the bad side and another area that's really relevant to this discussion I think and we'll talk about how alos plays into that is this production of uh fatty fatty liver disease non-alcoholic fatty liver disease how do you see allulose positioned uh in terms even some of the research now as relates to this really pervasive issue this NF DL non-alcoholic fatty liver disease or LD rather yeah um so fatty liver disease has two Origins I mean the ultimate with the ultimate problem being it just has too much fat now that sounds more benign than it is because having a fatty liver is just one small step away from it starting to get inflamed um and then scarred and it really is the Gateway problem to further much more catastrophic liver problems so we want to catch it at the fatty liver State because we can still turn it around and we can turn it around quickly now where does the fat come from there are two sources for that fat one source is insulin resistant fat cells where the fat cells that are Upstream from the viscera as they start leaking their fats in a state of high insulin um then it it the liver will readily pull that in and store it so that's one source um and in that case if alose can improve by activating ampk the insulin sensitivity of the fat cell then that fat won't be leaking out of the fat cell in a state of high insulin it's okay for a fat cell to leak fat in a state of low insulin because then liver will just burn it but if the liver is seeing a lot of fat and insulin is elevated it cannot burn it fat burning will be stopped fat oxidation it will have to store it it turns it into triglycerides and now we have fatty liver disease but the other so right there alos is once again potentially relevant at the fat cell um but then second we come back to fructose because the other most common form of the liver accumulating fat or the most common mechanism is it is it making its own fat this process called lipo Genesis and fructose I'll never forget a manuscript I read probably 20 years ago that described fructose one of its many ways of describing it as the most lipogenic molecule in the body so the liver will so readily take that fructose and turn it into fat very very easily and so that becomes a direct contributor where if some where if someone's eating fructose heavy sweeteners or sugar um or any other form of it then that fructose is directly contributing to turning into fat within the liver but if that fructose Rich sugar has been replaced with a rare sugar like alose then you are no longer getting it and rather than um having the the building block for fat in contrast you're activating ampk in the liver which will promote fat oxidation or the burning of the fat so then you begin literally resolving the problem rather than contributing to it I think Rick Johnson said it very well he said glucose is the uh the sugar of energy utilization and uh and fructose is the sugar of energy storage so fits right in with what what you're saying um there is some evidence that allulose can be M protective as it relates to mitochondria that may be relevant in terms of cardiovascular disease so where do we what do we know about that yeah yeah so Pro it it could be through once again the activation of ampk but whether it is through that pathway or not alose increases the expression of a master mitochondrial regulator called pgc1 Alpha and there's lots of acronyms here that you and I are invoking here but suffice it to say um when pgc1 Alpha is turned on we now have pulled up the lever of the most significant activator of mitochondrial biogenesis so the synthesis of new mitochondria so in that sense um alos continues to contribute to an overall metabolic scenario within the body that is wanting to burn and and break down it wants to take this nutrient the energy that we have stored and burn it so once again turning on pgc1 Alpha means we're increasing the density or the production the amount of mitochondria and where we have more more mitochondria we have a cell that is certainly more inclined and definitely more capable of burning fat for fuel yeah and we have another Entre of mitochondri mitochondrial biogenesis through ampy activation as well that's right well and I realized Dave sorry you need to ask this in the of heart disease um where mitochondria matter tremendously in the heart um I I'm I'm unaware of direct evidence of alilo in heart mitochondria um so I want to just be careful speculating but certainly there's this very strong pathway where if you're improving insulin sensitivity you are removing the leading risk factor for heart disease um where we know that you know type two diabetes or just insulin resistance is the leading risk factor for heart disease so any intervention you're you're embracing that is improving those aspects of metabolic health is reducing um cardiovascular risk I I have to stop you right there because people would want to listen to what you just said that insulin resistance is really the leading contributor to heart disease and how many years have we been saying oh no your cholesterol level is elevated I know so in in fact David did you see the paper that was just published was it maybe New England Journal of Medicine where they looked at the five leading risk factors of heart disease contribution and LDL was the absolute lowest of all of them and having a history of type 2 diabetes was not only the highest but nothing else was even close right it was multiples higher than every other risk factor but we love our diabetes because our diabetes is an indication that people are eating more highly processed foods it's good for growing corn and wheat and it all and the pharmaceutical let's not go there I've already gone there but I'm I'm going to oh no there's no question I mean just to I'll put my own fine point on the topic there's no question that the current view of metabolic Health which is a glucocentric paradigm all with the understanding of eat a lot of carbs and eat them often it is a wonderful way to sell medications Y and it works for everybody everybody gets a hand in the yep uh in the fructose sweeten pie um how might allulose be uh relevant to cognitive function or cognitive decline obviously an area I'm interested in what are your thoughts on that MH yeah well I'll go back to some um answers that we've already discussed here two in particular one improving insulin sensitivity and two improving mitochondria so my lab I'll start with the latter one which is um my lab's published work uh which is building on the work of many other much more prominent um dementia Alzheimer's Focus scientists than I am I'm a mitochondria guy but it was in there that we made our contribution where we found that um one that the the brain with dementia has a perfectly preserved at the level of its genetic expression ability to use ketones for a fuel whereas almost every Gene involved in glucose metabolism was significantly compromised in brains in the hippocampus the memory and learning center of people with Alzheimer's disease so there's a direct ability of the Ketone to fuel the brain and in that regard alose could be therapeutic because ketones are not only made in mitochondria they're not only made when the mitochondria are burning fat which you turn on when you activate ampk but they also only made if insulin is low which can only happen in a body that has in that is insulin sensitive and and so if you're taking normal sugar with the glucose and the fructose you are spiking insulin and you are inhibiting the production of ketones so you then begin depriving the brain of a fuel that it may be crying out for because just to really make sure people get this in if the if the brain is insulin resistant even though blood glucose levels may be very high it's like it's like this metabolic version of the rhyme of the Ancient Mariner this this this Shipwrecked sailor who's starve who who's um dying from dehydration but he's surrounded by water and he's boning the irony of water water everywhere nor any drop to drink drink but that's the brain saying glucose glucose everywhere but none for me I can't access it at parts of the hippoc because insulin isn't working to open those glucose doors so the ability of improving insulin sensitivity allows the brain to not only use glucose better but also have some ketones from time to time but then the second part of this is the induction of new mitochondria if you can increase the mitochondrial density within neurons they simply have more powerhouses within the cell more of a a greater ability to burn nutrients for energy including even burning the ketones that may be coming in you need mitochondria to burn ketones well you know my world is about prevention and uh we know that as things stand as you and I have our conversation today there's really no meaningful effective monotherapy treatment for Alzheimer's disease though you see the the headlines about the the new Wonder drugs that are are now being uh EV evaluated and some that are actually being uh used and sanctioned even by things like Medicare but having said that that as it relates to prevention you know we can demonstrate these defects that you just referred to these bioenergetic defects of glucose utilization in the human brain uh using radioactive markers flu deoxy glucose pet scans two decades before the onset of clinical manifestations when people begin to have cognitive issues forgetting their grandchildren's names or whatever it may be so you know where things stand right now in the world of dementia is well we'll just wait till you're suddenly cognitively uh at issue and then think it that we're going to have some kind of wonderful medicine for you when the reality is the prevention of that cognitive decline Falls right into Dr bikman's lap that is a metabolic issue it's a bioenergetic issue it's a mitochondriopathy it's it's a pathology with the mitochondria the utilization of energy which uh for which Nature has provided us this wonderful back door to allow the keto in to be utilized as fuel and what I've often said during lectures is because we can show as well using markers of Ketone utilization in the very same brains of people who show that they can't utilize glucose that we can bring those neurons back to function by providing them the fuel I've said that these are neurons that are functional but not functioning and so the notion of providing them Fuel and your point is well take taken as it relates back to alul that here is a Nifty way to continue a a very normal diet that you like and have various types of foods that you like uh but still allow yourself to be in a situation where you can be ketogenic if you want to be and I I think that's a good place to be certainly as it relates to the brain for the reasons we just talked about yeah yeah I wholeheartedly agree as much as uh throughout my career I have not wanted I've been careful in that I've not wanted to be viewed as an advocate of a ketogenic diet but I want to be viewed as a defender of it because there's so much wrong thinking the one time however where I am an advocate of ketones is when it comes to neurological Health the evidence just is growing so rapidly and and your point about looking at it through a preventative lens is one I agree with wholeheartedly where the evidence suggesting that ketones are um able to preserve um neuron Health um and even to a degree albeit perhaps temporarily reverse um failure and dementia in in these clinical these case studies that are getting published more and more it it leaves me so convinced indeed that the primary reason why I want to be personally in ketosis for at least some hours during the day is that I want to make sure my brain is getting fed um I my fear of Alzheimers outpaces a fear of any other chronic disease even cancers I am more afraid of Alzheimer's disease than I am of getting cancer or even suffering from cancer even though I have a family history of the latter um it's Alzheimer's disease that worries me um it's just terrifies me and so I want to make sure my reason again for being in ketosis at least for some hours of the day is um my respect for Alzheimer's disease and my respect for the robust evidence that continues to accumulate and to which my lab has contributed that suggests ketones are therapeutic for the neurons um it's uh it it is it is much easier of course when frankly if I can control my Cravings in the evening even My Philosophy as a middle-aged guy with a young family is I will eat dinner with my family whatever my family's eating I'll have dinner with my family now usually my wife tends to see things in health through the same lens that I do but even still I'll be very strict with my breakfast um I'll be very strict with my lunch which is very controlled carbs and I may be a little more liberal with carbs for dinner depending on what my family's eating but if if I can control my evening snacks even though I may get out of ketosis for a few hours in the evening because of what I ate for dinner depending on what we eat I will absolutely be back in ketosis come the morning and so then I will have but that's not the case if I indulge and I eat three bowls of cereal I won't be in ketosis for a full 24 hours I will have so loaded my body with glucose that that it is it is dealing with that almost for the next full day um and and so it delays the time I'm in ketosis which worries me because I want my brain to be sharp well for our viewers if if you're more uh if you're interested in the role of the ketogenic diet as a therapeutic related to alzheimer's the interview I did with Dr Matthew Phillips uh is one you'll you'll want to look at and we've certainly uh you know interviewed a lot of the the leaders in this in this field looking at the role of uh excessive carbohydrates versus being in ketosis for General Health and you know uh you're right that um this really does play out well in brain related issues I mean that's where it began in 1927 with treating children with seizures and now we're seeing Interventional trials even as it relates to Parkinson's knowing full well that these are energetic issues these are acquired micropath these and so yeah and even migraines things that are less less um chronic than um Alzheimer's disease and Parkinson's disease you mentioned 1927 I think the first trial that I've ever seen I call it a trial study published by a physici for migraines was 1929 finding that if patients if he could get his patients into this ketotic state their migraines would stop um so it just is really appears to be that of all the tissues of the body that begin to suffer with chronic disease the one that appears to respond the most robustly um to in response to dietary changes and in insulin sensitizing diet is the brain interestingly Dr Alexander hag in the 1890s uh demonstrated that uh going on a diet to lower his uric acid helped his migraines so you know even older than I thought there you go yeah there you go well uh what a pleasure and I'm glad we had some time the other day we we've talked tangentially in various meetings but it's really great to have some one-on-one time with you and I hope we can do it again soon yeah this has been wonderful always always a pleasure to chat with you thank you great we'll talk soon bye for now interesting isn't it after all these years that there's actually a sweetener that looks like it is probably pretty darn good for us to use uh as uh in cooking and in using in our coffee if that's your desire I use allulose I actually um always liked my coffee suite and now I'm able to do that again so I hope you find this uh conversation we had today interesting I know I sure learned a lot thanks for joining me I'm Dr David pritter this is the empowering neurologist and we'll be back soon bye for [Music] now

Channel: DavidPerlmutterMD

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Keywords: david perlmutter, dr. david perlmutter, grain brain, dr. perlmutter, brain maker

Id: Zf2XrIteKMw

Length: 52min 45sec (3165 seconds)

Published: Mon Dec 04 2023