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Episode 495
The Doctor's Farmacy

The Untold Story Of Uric Acid: Solving The Puzzle Of Obesity, Diabetes, And Chronic Disease

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

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

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

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Uric acid is a central player in metabolic mayhem. Despite its long association with gout and kidney stones, it’s involved in so much more—especially our metabolic disease epidemic.

There are three things that raise our levels of uric acid: purines, alcohol, and fructose. The latter is the biggest challenge, due to its overwhelming presence in our Standard American Diet. That doesn’t mean all fruit is bad or even that all alcohol and purine-rich foods have the same effect. Like all parts of health and nutrition, there are nuances we need to consider to create optimal health.

That’s why I’m so excited to take a deep dive into the topic of uric acid on this episode of The Doctor’s Farmacy, with my friend and colleague Dr. David Perlmutter.

Dr. Perlmutter and I jump into this episode with some eye-opening facts on how fructose and uric acid impact our physiology, including why our bodies evolved to act this way. Gout is most definitely one issue, but insulin resistance, obesity, blood pressure, and brain health are all part of the picture as well.

If you’re confused about the difference between fructose and other sugars, like glucose, we’ve got you covered. Dr. Perlmutter and I talk about why fructose is so unique in how it impacts our metabolic pathways and I think you’ll be relieved to hear that a certain amount of fruit, in its whole form, can still be part of a healthy diet. It’s the high-fructose corn syrup hiding in boxes, bags, and bottles that is the real villain.

We also explain what purine-rich foods are, how to eat them mindfully, and what type of diet is the most uric-acid-friendly. Eating lots of plant foods rich in nutrients like vitamin C and phytochemicals like quercetin is one way to balance uric acid (and support the rest of the body while you’re at it).

If you want to take a more proactive approach to your health, we discuss how to talk to your doctor about uric acid, ways to test it, and what levels to use as a functional reference range. We also touch on what supplements and lifestyle changes could be helpful in addition to dietary changes.

This is such an exciting evolution in how we view, prevent, and manage metabolic diseases.

This episode is brought to you by Rupa Health, Thrive Market, and Cozy Earth.

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

Here are more of the details from our interview (audio):

  1. What is uric acid and how does it affect our health?
    (5:35)
  2. The impact of fructose consumption on our physiology
    (11:50)
  3. The differences between fructose vs glucose
    (19:24)
  4. Why high fructose corn syrup is used in so much food
    (21:19 )
  5. The three sources of uric acid
    (23:02)
  6. Fructose consumption, uric acid, and gut health
    (28:39)
  7. How to eat to reduce uric acid
    (33:59)
  8. Medications that increase uric acid
    (47:12 )
  9. Uric acid and Alzheimer’s
    (50:33)
  10. Heavy metals, supplements, sleep, exercise and uric acid
    (54:16)

Guest

 
Mark Hyman, MD

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

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

 
Dr. David Perlmutter

Dr. David Perlmutter is a Board-Certified Neurologist and five-time New York Times bestselling author. He serves on the Board of Directors and is a Fellow of the American College of Nutrition. He is the author of Grain Brain among others, and his new book, Drop Acid was just released.

Dr. Perlmutter received his M.D. degree from the University of Miami School of Medicine where he was awarded the Leonard G. Rowntree Research Award. He serves as a member of the Editorial Board for the Journal of Alzheimer’s Disease and has published extensively in peer-reviewed scientific journals including Archives of Neurology, Neurosurgery, and The Journal of Applied Nutrition.

Show Notes

  1. Get Dr. Perlmutter’s new book, Drop Acid: The Surprising New Science of Uric Acid - The Key to Losing Weight, Controlling Blood Sugar and Achieving Extraordinary Health

Transcript

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

Dr. David Perlmutter:
It’s so far beyond gout and kidney stones. It is as central as the article title stated, a central player orchestrating much of our metabolic mayhem as I call it in the book.

Dr. Mark Hyman:
Welcome to the The Doctor’s Farmacy. I’m Dr. Mark Hyman and that’s farmacy with an F, a place for conversations that matter. If you struggle with metabolic issue, with your weight, with diabetes, with chronic illness, you better listen up, because we’re with my favorite human doctor, Dr. David Perlmutter, who has been a mentor to me, a good friend, who’s been the fellow travel on this functional medicine journey for gosh, nearly, almost 30 years now, had to say that.

Dr. David Perlmutter:
Oh, God.

Dr. Mark Hyman:
We’re still at it. David is just an extraordinary scientist doctor, humanitarian, human being really, salt to the earth, real dude. Not only is he my friend and a brilliant doctor, but he’s a board certified neurologist, five times New York Times best selling author. You’ve heard of his book, obviously Grain Brain, which was a huge breakthrough around gluten and so forth. He’s on the board of directors. He is a fellow if the American College of Nutrition.

Dr. Mark Hyman:
His new book called Drop Acid is out February 15th, 2022. It’s not what you think. It’s not about LSD, which actually it could be. Maybe that’s why you call it that because it’s a hip topic now. David received his MD from University of Miami, School of Medicine and he received many awards. He’s on the editorial board of the Alzheimer’s Disease Journal. He’s published extensively in peer view journals and archives of neurology, neurosurgery, and many, many others. He lectures all over the world and he’s a great human and he’s always thinking about what’s new and different. I’m always learning from David over the last 30 years. So welcome David.

Dr. David Perlmutter:
Well, delighted to be here, Mark. It’s great to see you. It’s really terrific.

Dr. Mark Hyman:
So listen, you wrote this new book called Drop Acid and people are wondering, is it about LSD? It’s not. It’s about something called uric acid, which is a molecule that doctors often measure in the blood. We think it’s associated with gout, but we don’t pay much attention to it other than that. Yet it turns out it’s a really important marker for many longstanding metabolic issues that our population suffering from. In fact it’s the biggest threat to our planet in I think 2020, 88% of Americans are metabolic not healthy. That means they have some form of pre-diabetes, high blood sugar, high cholesterol, high blood pressure. It’s driving these host of chronic illnesses that are including obesity, diabetes, heart disease, Alzheimer’s.

Dr. Mark Hyman:
So what’s the deal with uric acid? I often measure it. I’ve seen high with people with insulin resistance in diabetes, and I thought it was a marker of some inflammation and some other issues, but didn’t really treat it directly. I was always treating the underlying issue, which was the blood sugar and so forth. Unless someone had gout, then I’d give him a drug or cherry extract or something. Well, tell us, why did you hit on uric acid and what are the reasons that’s so important?

Dr. David Perlmutter:
Boy, there’s a lot of places to go. Aren’t there? How did I come upon this? I would say that as like you, over the years, I’ve been really fixated on metabolic disorders. I’m a neurologist and why would I be interested in diabetes and hypertension and obesity and dyslipidemia because they paved the way for certain neurologic problems that then land in my lap, for which at that point, there is very little recourse. What are we going to do?

Dr. David Perlmutter:
I mean, we all saw what happened in 2021 with respect to a new so called Alzheimer’s drug. We don’t have anything. So if we can get to the root cause of some of these issues from in neurology, you mentioned other things like diabetes and cancer and cardiovascular disease, we can understand the fire and not just focus on the smoke or the end product. Then we have a leg up. We can keep people healthy as opposed to simply focusing on treating them. So that sets the stage for me being open to understanding new developments in terms of what are the causes of these metabolic problems.

Dr. David Perlmutter:
The truth of the matter is this came to me one day while I was running. Typically when I run, I listened to either music or podcast. I was listening to a podcast of an interview of a nephrologist from the university of Colorado, by the name of Richard Johnson, who for the past two decades has focused on the role of fructose in metabolic issues and the primal mechanism of uric acid then in leading to the host of metabolic issues. That the role of uric acid plays in elevating our blood pressure, in leading to glucogenesis, the new production of blood sugar, in making us insulin resistant, in increasing our production of body fat, in locking up our body fats that we can’t tap into it as an energy source.

Dr. David Perlmutter:
We’ll talk about that, how we as humans have this predisposition by virtue of our elevated uric acid. So you’ve known, we’ve all known for a long time that fructose is a bad player. We see correlations between fructose consumption and the very things that we’re talking about, but we’ve never really understood, “Well, how in the heck does that happen? What’s the link?” What Dr. Johnson was doing 20 years ago is he was creating hypertension, elevated blood pressure in laboratory animals. By feeding them fructose, they would develop high blood pressure.

Dr. Mark Hyman:
Wow.

Dr. David Perlmutter:
He noted that as a matter of fact, that in doing a blood panel looking at all kinds of things, that their uric acid levels would go up when he gave them fructose. Well, you would expect that because unlike glucose fructose is metabolized directly into uric acid. That’s where it comes from, from fructose. There are two other sources we’ll talk about. So he noted that. He said, “Well, isn’t that interesting uric acid levels increased.” Then he did something really fascinating. He gave them a lot of fructose, but he blocked the uric acid production by giving them a gout pill called allopurinol.

Dr. David Perlmutter:
Low and behold, here they’re eating all this fructose and they’re not getting high blood pressure because uric acid was not elevated.

Dr. Mark Hyman:
Fascinating.

Dr. David Perlmutter:
That is huge.

Dr. Mark Hyman:
Fascinating.

Dr. David Perlmutter:
He determined then by repeating the study in men, the same thing happened. Give them a lot of fructose within a couple weeks, blood pressure goes up, weight goes up, insulin resistance increases, blood sugar goes up. But if you give them allopurinol and where you and I are going with this today is not to say, everyone should take this drug. We’ll talk about what you can do, but low and behold, the same thing happened in humans. So that was groundbreaking. At that point, he began his research.

Dr. David Perlmutter:
But it’s interesting to note that in 1894, Dr. Alexander Haig, a different Alexander Haig, wrote a book entitled Uric Acid a Factor in the Causation of Disease and looked at things like dementia and hypertension and depression, and certainly rheumatism or joint problems, and really discussed it way back then. But it remained buried until just about 20 years ago. Now researchers around the world are looking at this and describing what to do. So yes, it’s a marker. You were correct in saying you noticed that it’s elevated. But there was an interesting report that came out of Turkey and Japan in 2016 that looked at uric acid elevation in metabolic syndrome as no longer being an in the title, innocent bystander, but playing a central role.

Dr. David Perlmutter:
That it’s actually mechanistically involved in causing these problems. It doesn’t just happen to be elevated because people have a crappy diet or they’re not exercising, not sleeping well. It is the cause, a cause, an important cause.

Dr. Mark Hyman:
Wow. So David people are listening probably going, “Well, geez. I mean, I can’t have an apple or is it just high fructose corn syrup that you get in soda and processed food?” What’s the deal?

Dr. David Perlmutter:
It’s a great question. I can tell you it’s something I’m asked every day and here’s what the literature tells us. It’s really quite interesting, in that if you eat apple, if you eat five grams of fructose or two apples, 10, 15 grams of fructose, all well and good. An apple has uercetin, it has other bioflavonoids. It has [inaudible 00:08:38].

Dr. Mark Hyman:
Fiber.

Dr. David Perlmutter:
Fiber which slows fructose absorption. It has vitamin C, which aids in uric acid excretion. As opposed to drinking a 12 ounce glass, 42 grams of fructose, of orange juice or apple juice, or certainly a soda. Those are the potent sources of fructose that we need to stay away from immediately tells your body something very important. That fructose signals your body, that winter’s coming. It’s telling your body that caloric scarcity is coming. You might starve. You better make fat. You better turn on your production of glucose to power your brain. You better elevate your blood pressure because you’re not going to have water to drink.

Dr. David Perlmutter:
It’s setting the stage for survival. This is a fascinating story that dates back about 15 million years ago when the earth cooled. There was some very powerful, selective pressure on our primate ancestors for survival during times of food scarcity. It turns out that around that time there was a mutation, was actually a series of mutations in the genes that made an enzyme called uricase. Uricase breaks down uric acid and would lead to a lower uric acid level. But this mutation disrupted how uricase worked.

Dr. David Perlmutter:
So those who inherited this mutation had higher levels of uric acid. They made more fat, they survived. So we as humans and other great apes still have that mutation in uricase. So we have four to five times higher levels of uric acid than other non primate mammals. These days, what we’re experiencing is called an evolutionary environmental mismatch. So we’re stuck with these outdated physiology that allowed our paleolithic ancestors to survive, or hunter gather four bears to survive when there wasn’t any food.

Dr. David Perlmutter:
If they could stumble on some berries, a little bit of fructose, make a little bit more fat, didn’t take a lot. Not that it made them fat, but just enough fat to hold them over till they could find food. Whether it was on the ground dead or they dug it up or whatever.

Dr. Mark Hyman:
I know you spent a lot of time on your boat, up in Alaska, but the grizzly bears up there, they eat salmon in the early part of the summer and they don’t really gain much weight. Then they go up the mountains and they eat all the berries and they gain like 500 pounds from eating berries.

Dr. David Perlmutter:
That’s right.

Dr. Mark Hyman:
What you’re saying is really important because we have a lot of mechanisms that adapt to starvation. People don’t realize this, that we have hundreds of genes and mechanisms in our body that are really good at dealing with scarcity, but almost none that are dealing with abundance. Because we’ve never had to deal with this before. We never lived in a food carnival before. We never lived in a food Lollapalooza, where there’s everything all the time in abundance and the worst possible crap you could imagine. So our bodies don’t know how to cope with it. So this mechanism, which actually is designed to help us stay alive is actually killing us now.

Dr. David Perlmutter:
That’s right. Again, we call it an evolutionary environmental mismatch. I wrote my first article on this, in the Miami Herald in 1971 when I was 16.

Dr. Mark Hyman:
Oh, wow. A head of the game, David.

Dr. David Perlmutter:
It was crazy. I said, what about us, the people of today who are saddled with this outdated machinery. That was how I ended the article. Because evolution isn’t going to save us. We’re not going to be able to evolve quickly enough the mechanisms to deal with exactly what Mark you’ve been writing about for years. This is this horrendous assault upon by the physiology by the very foods that are now global. We used to talk about the American diet, the standard American diet, the Western diet. It’s global now, face it. We talked about in brainwash, how that threatens connections in the brain that make us less empathetic. But that’s for another conversation, you and I have already had with Austin.

Dr. Mark Hyman:
Well, that’s a good podcast. You should all listen to that podcast. Just to summarize it quickly, if I get this wrong, tell me. But essentially our modern diet, which is super inflammatory disconnects our frontal lobe, which is the [inaudible 00:12:43] in the room. From the limbic brain, which is the reptile lizard, fight or flight, reproduction feeding behavior, which is very triggerable. So all of a sudden, the grownup in the room is not managing the intense emotions of this limbic part of our brain. So we act in ways that are destructive or violent or aggressive.

Dr. Mark Hyman:
We see that in our society now as being a massively defied society. Whether it’s your paleo or your vegan or Republican or Democrat or Jewish or Palestinian or Muslim or Christian, it just goes on and on. Your argument is that part of that divisiveness could be related to what we’re eating.

Dr. David Perlmutter:
That’s right. What a match made in heaven that you and I are talking to today [inaudible 00:13:26] for so long. For me, it’s more about, well, what are the implications of that as it relates to behavior and the brain? Now we know that this uric acid because of its elevation threatens some really important physiology. As an example, it compromises the action of a chemical called nitric oxide. We need nitric oxide to do two very important things. It allows our blood vessels to relax. So we have good blood flow to kidneys, our heart and certainly to our brains.

Dr. David Perlmutter:
In addition, nitric oxide and that effect of nitric oxide in blood vessels is what helps insulin do its job. Insulin requires nitric oxide to get out of the artery and also into the muscle cell to let it change glucose into glycogen and help keep our blood sugars under control. That is threatened by uric acid. One other really interesting mechanism, I think that you hinted about on when you were talking about the bears eating all the berries to get ready to hibernate is that, that’s a uric acid mediated event in them. They shift over between two very important pathways of metabolism.

Dr. David Perlmutter:
One is called AMP kinase and the other is called AMP deaminase. When we are stimulating AMP deaminase, we are favoring fat production. We are favoring locking up our fat. We are favoring the metabolic issues that we want to avoid. AMP kinase on the other hand, which is not something that uric acid favors is when we burn our fat, it keeps our blood sugars in check, your insulin sensitivity goes up. Basically that’s what we do. We want to stimulate AMP kinase, is why we exercise. It’s why diabetics take Metformin is to stimulate this AMP kinase. That’s exactly what’s not happening when bears are getting ready to hibernate.

Dr. David Perlmutter:
Once they’re hibernating and they’re burning their fat, then AMP kinase is activated. It looks like uric acid is involved in that switch one way or the other. Where did the AMP come from? Very interesting. The AMP comes from the metabolism of fructose. When fructose is metabolized, it’s an energy consuming event unlike glucose. ATP is converted into AMP. Then where does the AMP go? We just talked about that. So it’s totally a different kettle of fish, how fructose is metabolized. Fructose is the sugar of energy storage and glucose is the currency of energy utilization and as different is night and day.

Dr. Mark Hyman:
So most of the time when we’re eating fructose, it’s in the form of fruit, right? Which you said is okay. It’s in the form of high fructose corn syrup, which is different in structure than regular sugar. Both contain glucose and fructose, but they’re different. Can you explain how they’re different and is table sugar as bad as high fructose corn syrup?

Dr. David Perlmutter:
I would say that-

Dr. Mark Hyman:
How do we think about that?

Dr. David Perlmutter:
When you say most of the time we get our fructose from eating fruit, actually-

Dr. Mark Hyman:
Not now but we should be getting it

Dr. David Perlmutter:
[inaudible 00:16:45] very little of our fructose. When we recognize that more than 60% of the foods in the grocery store that carry a barcode are sweetened, and by and large, that sweetener is a either directly high fructose corn syrup or derivative thereof, it means that there’s an awful lot of fructose going into our diets to make us satisfy our desire for sweet and buy the product. I mean, I’m speaking to the choir here. This is what you’ve been talking about for years. Hacking into a primitive survival mechanism that says, “Seek out sweet foods and you will survive.”

Dr. David Perlmutter:
Well now, all the foods are sweet and they’re making us sick. So high fructose corn syrup is 55% fructose as opposed to table sugar or sucrose, which is a 50/50 mix between glucose, which is less sweet and fructose, which is much sweeter. The reason that we use high fructose corn syrup, that’s older technology was actually University of Oklahoma 1957 was when we first saw the development of the process to make high fructose corn syrup, is basically because it’s very sweet and it’s really cheap. “Hey, sign me up if I’m a food producer. I want something that sweet. I can use less of it and it’s cheap. So our bottom line goes way up.”

Dr. Mark Hyman:
That’s right. That’s why I asked the vice chair of Pepsi once, why you use high fructose corn syrup in your studies? Because the government makes it too cheap for us not to use it.

Dr. David Perlmutter:
Well, the government to this day sponsors corn production to the tune of 500 billion a year. I mean, and why does a lot of that corn go? It goes to high fructose corn syrup to make us eat more sweets. The argument has been that fructose is not glucose. Therefore, it’s a safer sugar because when you metabolize glucose-

Dr. Mark Hyman:
It doesn’t raise your blood sugar actually.

Dr. David Perlmutter:
That’s the part. It doesn’t raise your blood sugar and doesn’t require insulin for its metabolism. Therefore, it’s safe. Well, immediately when you consume fructose, you turn on gluconeogenesis, you turn on the process to power your brain as a survival mechanism with higher levels of glucose. You also compromise insulin functionality right off the bat. So you are setting the stage for becoming a diabetic. One study indicated, a really large study, 42,000 men, 49,000 women determined that about a quarter of all the diabetes in the Western world is directly related to elevation of uric acid.

Dr. David Perlmutter:
Where do we get uric acid? Only from three sources, from alcohol, same metabolism as fructose and from a class of chemicals that are called purines. Purines are the breakdown products of DNA and RNA from foods that are rich in purine things like organ meat, and organ meats game would be liver and kidney. How do you eat those? I don’t know, but-

Dr. Mark Hyman:
Are you kidding? I love chicken livers. My mom used to make chicken livers all the time for me. Chicken livers and onions of a rice, really young.

Dr. David Perlmutter:
I get that. I could never tolerate. I ran away from home [inaudible 00:19:59].

Dr. Mark Hyman:
Chop liver, come on.

Dr. David Perlmutter:
What do I look like? But that said by and large, that’s not the issue. I mean, it’s not necessarily the purine. Traditionally-

Dr. Mark Hyman:
Because that was the old thinking, right? Is don’t eat meat, don’t drink wine, that’s what’s causing gout, but nobody really talks about the sugar aspect and the fructose aspect, but that’s really the major driver.

Dr. David Perlmutter:
That is the issue. It’s the fructose. Two thirds of the purines in your metabolism come from your own breakdown of your own muscle that you do whenever you exercise. Alcohol is certainly contributing to the uric acid pool, but the big elephant in the room is uric acid derived directly from fructose metabolism. The real concern is that the metabolism of fructose into uric acid feeds back to cause more metabolism of fructose. It’s a feed forward cycle. So uric acid stimulates a production of an enzyme called fructokinase, which is the first enzyme to break down fructose. So it’s self perpetuating. What does that fructose do? It inhibits lectin sensitivity, so we eat more.

Dr. Mark Hyman:
Because lectin is a the hunger suppressing hormone.

Dr. David Perlmutter:
That’s inhibited by our consumption of fructose, so we eat. This was a great mechanism to get ready for winter, so we would eat more. That’s why the bears are doing what doing, they’re preparing to hibernate. If any-

Dr. Mark Hyman:
We just eat all winter [inaudible 00:21:31].

Dr. David Perlmutter:
… if any of your viewers are getting ready to hibernate, then have at it. Then that’s for you. Eat a lot of fructose. But I think to get back to your original question that you and I talked about or learned about uric acid in the context of gout. If you had high uric acid, you might get gout, you might get kidney stones. But now we have a term it’s pathetic. It’s called asymptomatic hyperuricemia, which means you have elevated uric acid, but hey, you don’t have gout. Therefore, it’s not important.

Dr. David Perlmutter:
Asymptomatic hyperuricemia, it’s clearly associated with hypertension, with obesity, with chronic kidney disease and non-alcoholic fatty liver disease.

Dr. Mark Hyman:
Diabetes.

Dr. David Perlmutter:
One interesting study out of Japan, looked at individuals with so-called asymptomatic hyperuricemia, and found that they had significant increased risk for becoming overweight, for developing problems with their lipids and even hypertension. Important components of the metabolic syndrome. You started off with our discussion saying that 88% of American adults have at least one component of the metabolic syndrome. Means only 12% of American adults is metabolically healthy. These are the big issues of our day. You can talk about viruses all you want. Sure, that’s important, but that’s not what’s killing most people on our planet.

Dr. Mark Hyman:
For sure.

Dr. David Perlmutter:
What’s killing most people right now are the chronic degenerative conditions, coronary artery disease, Alzheimer’s, cancer, diabetes. These are metabolic issues.

Dr. Mark Hyman:
Almost 50 million deaths a year.

Dr. David Perlmutter:
Yeah, related to the [inaudible 00:23:11].

Dr. Mark Hyman:
50 million million deaths a year, mostly [web 00:23:13].

Dr. David Perlmutter:
With an M, that’s Right.

Dr. Mark Hyman:
David, I just want to loop back a little bit because I want people to understand what this fructose thing is. So basically we’re getting it from high fructose corn syrup, which you said is 55% fructose, but it’s actually in some studies I’ve seen up to 75% fructose.

Dr. David Perlmutter:
That’s right.

Dr. Mark Hyman:
Also, it’s important people understand that in traditional sugar, fructose and glucose are bound together with a chemical bond. So they take some metabolism and they’re not as quickly absorbed. Fructose in high fructose corn syrup is free fructose. The other thing you didn’t quite mention, I’d love to hear your opinion about this, is work from Bruce Aim is where fructose requires energy to be absorbed as opposed to sugar, which has a transport channel. Doesn’t require the use of energy. When you use that energy for fructose and you’re having mostly fructose as your sugar, it’s causing depletion of ATP in your gut, which then causes the tight junctions, which are the things that prevent you from having a leaky gut to keep your cells stuck together, like LEGOs.

Dr. Mark Hyman:
It causes us to separate, and then you get leaky gut, which then even exacerbates the problem of obesity and insulin resistance and diabetes through another mechanism, which is endotoxemia from the metabolic byproducts of bacteria and weird things in the gut. So it may be that fructose is causing problems with many, many reasons, partly obviously this metabolic effects, but also the gut effects, which exacerbate the metabolic effects.

Dr. David Perlmutter:
That’s right. Again, this is all amplified by then the metabolism, which is an energy dependent event, ATP to AMP, then to uric acid. That uric acid then enhances in the gut more pro-inflammatory bacteria. Also dramatically increases the gut permeability, therefore increases inflammation. How interesting it is that one disease that is associated with elevated uric acid, which is gout has actually been demonstrated to be significantly improved in people undergoing what’s called a fecal microbial transplant where healthy fecal material is taken from an individual and then put into the colon of a person with gout. Remarkable reduction in the number of gout attacks without any significant dietary change.

Dr. Mark Hyman:
That’s amazing.

Dr. David Perlmutter:
True. So we’re back to talking about the gut, a place where you and I default to over the years and rightfully so. So uric acid itself is having such a dramatic effect on the gut-

Dr. Mark Hyman:
[inaudible 00:25:40] on the microbiome itself, right?

Dr. David Perlmutter:
You bet, enhances inflammation. So if we recognize that inflammation is certainly a centerpiece of the damage done by uric acid, then all of the downstream issues related to inflammation might well be anticipated to be increased in people with high uric acid levels. In fact, that’s what we see. A 2018 study looking at 42,000, I think I mentioned earlier, 42,000 men and 49,000 women and followed these individuals over an eight year period of time. What did they find? They found that all cause mortality was dramatically increased in those individuals with high levels of uric acid. That those who had high uric acid had a significant increased risk of cardiovascular related mortality of close to 40% and about a 35% increased risk of stroke related mortality. This is a big study. I mean, we’re talking about a 100, 0000 people followed over eight years, having a 35 to 40% increased risk of death from either a heart attack or stroke.

Dr. David Perlmutter:
Here’s something else that the study found I think was really interesting. That is for every point elevation of uric acid above seven milligrams per deciliter, for every point there is an 8 to 13% increased risk of all cause mortality. So this is mortality. When we look at the cardiovascular, we look at the stroke, this is mortality related to issues that have inflammation as their cornerstone. So it’s very important that we consider this. That we consider that uric acid is not just happens to be elevated, that it’s playing a mechanistic causal role and that we should do what we can to check our uric acid levels.

Dr. David Perlmutter:
You can use a home monitor, I’m going to send you one or people get their annual blood work. Uric acid is almost always on the annual blood work. What is it? For your viewers, the place where it needs to be is at or below 5.5. The units are milligrams per deciliter here in America. Typically, the lab will call it out if it’s at seven or higher, because that’s the level that it starts to become an issue as it relates to gout and kidney stones. But as it relates to the metabolic issues that we’re talking about, the increased blood sugar, the hypertension, the risk for all the things that we’re talking about, we want it at 5.5 or lower. Again, you can go online, go to Amazon, buy a uric acid monitor and check your level. I recently checked mine again and it’s 4.6. So I’m feeling good about that.

Dr. Mark Hyman:
That’s good. So basically this uric acid phenomena is really not well understood by most physicians. It’s really driven by diet, but not only our processed diet, high fructose corn syrup. It drives all these secondary effects of cardiovascular disease, death, Alzheimer’s, cancer, diabetes. It’s something that you can actually easily measure. Your doctor can check it for you when you go to the office. It should be less than five and a half, as you said. What should we do in terms of our diet to reduce uric acid and what are the worst things that cause uric acid and what actually helps reduce uric acid?

Dr. David Perlmutter:
Sure. Let’s talk about the sources of uric acid. Where’s it coming from? Did we mention fructose?

Dr. Mark Hyman:
Yes, you did.

Dr. David Perlmutter:
Fructose is the gorilla in the room, right? So fructose, again, was our signal that scarcity was coming, that winter is coming eat the berries. Fructose is telling your body, make fat, raise blood sugar, raise blood pressure because you might not have water to drink. So fructose is by and large, the biggest player. Fruit juice, sodas, added to sauces, added to just about anything that’s in a package these days.

Dr. Mark Hyman:
Salad dressing,

Dr. David Perlmutter:
You bet. We love it because it’s-

Dr. Mark Hyman:
Tomato sauce, ketchup.

Dr. David Perlmutter:
Again, fruit is okay. An apple a day keeps the doctor away. Not apples and cherries and high fructose fruits all day long, but have some fruit by all means. The next thing to consider that’s certainly less important are something called purines. All fruits, vegetables, and, and meats, really anything we eat has in it some DNA and RNA. When our bodies break that down, then purines are formed and purines are directly metabolized into uric acid. Interestingly uric acid favors that and enhances the production of purines in our bodies. Again, a feed forward cycle. It’s trying to keep us alive during times of food scarcity. So again, we want to avoid those foods that are really rich purines. I mentioned them already, the organ meats, the shellfish, the smaller fish that we were favoring over time, the anchos and the sardines.

Dr. David Perlmutter:
Sure. You can have the anchos in your Caesar salad, but you don’t want to make big meals having six ounces or more of any of those.

Dr. Mark Hyman:
Oh, I love anchos.

Dr. David Perlmutter:
Me too. White anchos one of my favorites. The last thing to consider I think it’s needs a little bit of, we need to double click on this a bit, and that is alcohol. Because alcohol shares the exact same metabolic pathway as fructose. As Robert Lustig is called it, fructose is alcohol without the buzz. So it similarly consumes ATP down to AMP. But in this case it really matters what kind of alcohol a person is drinking. Wine consumption in men has about zero effect on uric acid. Wine consumption in new women actually is associated with lower uric acid. Hard liquor will raise uric acid, but the worst offender is beer.

Dr. David Perlmutter:
Why? Because beer not only contains alcohol, but it contains purines that we just talked about from the brewer’s yeast that is used to make beer. So now we understand the biochemistry that underlies the beer belly. It’s coming from this elevation of uric acid, packing the fat away, getting ready for winter. So if you’re going to choose a beverage coffee, a good choice actually associated with lower uric acid. So those are the big things that we should avoid.

Dr. David Perlmutter:
I will make one other comment as it relates to high purine foods. Many people will pull up a list of high purine foods and see many vegetables. Things like broccoli, the cruciferous vegetables in general, like kale. Many vegetables have high levels of purines. Their consumption though is associated with lower uric acid. Why? Because again, fiber, bioflavonoids, vitamin C, which increases uric acid excretion. So eat all the vegetables like that, that you want. Never say never, but it’s going to be hard for me to imagine there’ll be a time when I tell people not to eat broccoli or broccoli sprouts.

Dr. Mark Hyman:
Exactly.

Dr. David Perlmutter:
That’s going to be a tough one for me.

Dr. Mark Hyman:
So what are the foods that help bring it down? Because if it’s elevated, you can stop eating the purine foods and the sugar foods and the high fructose corn syrup foods. What are the things that actually bring it down?

Dr. David Perlmutter:
We know that foods that are rich in certain Bioflavonoids, for example, quercetin is a very powerful bioflavonoid. Yes, it’s an antioxidant. Yes, it has anti-inflammatory activity. But here is the exciting news about quercetin. A recent study out of Britain demonstrates that 500 milligrams of quercetin a day in just two weeks is associated with an 8% lowering of uric acid. That’s really significant. So taking quercetin as a supplement is an idea along with vitamin C. Luteolin also dramatically lowers uric acid on par with allopurinol which is a pharmaceutical. It’s one to one, just about equal to the drug used for gout patients to lower their uric acid.

Dr. David Perlmutter:
So luteolin and quercetin, very powerful. Vitamin C aids in excretion. I like to round out the program with DHA. It doesn’t have direct effects on the pathways that we’re talking about, but it does tend offset some of the damaging effects of fructose in the human body. So those in terms of supplements would be good choices. Now, the diet then that you hear me outlining would be one that is mostly plant based. This is the Grain Brain doctor who many people said was just the next Adkins telling us all to eat bacon bits. That’s not what we’re saying. It’s not what I’ve ever said, but more of a plant based high or fiber colorful. That’s where the bioflavonoids are. Colorful a type of plate, that’s what we’re looking for. It’s more sustainable. It’s better for you. It’s better for your gut bacteria and it will help bring down your uric acid levels.

Dr. Mark Hyman:
So one of the things I often use was cherries, cherry extract.

Dr. David Perlmutter:
That’s right.

Dr. Mark Hyman:
It seems a little [inaudible 00:34:50] because it’s a fruit, got fructose in it. But I’ve often treated my patients with high uric acid or gout with cherry extract and very effective.

Dr. David Perlmutter:
It is very effective. It’s more effective in women than in men in, but tart cherry is on the list. A cup of cherries, that’s what was used in several studies. As a matter of fact, if you look at the cover of the book and I just happen to have one right here, look at the O of the Drop Acid. That’s the cherry. So you’re exactly right. Dropping uric acid using cherry’s been used for gout therapy for many, many years and vitamin C too. Vitamin C, quercetin’s a little newer to the game, but for a long time gout patients were told to take vitamin C and, or consume vitamin C rich foods, but not fruit juice.

Dr. David Perlmutter:
There’s really nothing ancestral about consuming fruit juice. It’s not like our hunter gatherer for bears. Would’ve been stumbled upon trees with cans and bottles of fruit juice hanging from them and then consume them. That’s a powerful fruit to load that’s really unlike anything that our physiology is ready for.

Dr. Mark Hyman:
It’s staggering how many people have really been brainwashed to think that fruit juice is a healthy drink.

Dr. David Perlmutter:
It’s a lot of [inaudible 00:36:09].

Dr. Mark Hyman:
Kind of like eat the fruits, skip the juice.

Dr. David Perlmutter:
I live in Florida and orange juice [inaudible 00:36:13] nature.

Dr. Mark Hyman:
Orange juice, yeah. Anita Bryant.

Dr. David Perlmutter:
You’re not having orange juice, what’s wrong with you? You didn’t have your breakfast until 12 o’clock noon. Again, what’s wrong with you? I guess there are a lot of things wrong with me because I take a take plenty of criticism. But that said it’s the orange juice growers association or whomever is the lobby that wants us to do certain things. That the whole grain goodness of these processed cereals that we think is heart healthy. All of this messaging that we’ve been getting for years and years is hugely effective. It’s what people think is the right thing.

Dr. David Perlmutter:
Breakfast is the most important meal of the day. Maybe it is, but it doesn’t mean a powerful carbohydrate load at eight o’clock in the morning is going to set you on your way. So that’s our mission, you and me and so many people is to let people hear the other side of the story so they could be better architects of their health destiny.

Dr. Mark Hyman:
I mean, I think that’s a problem is, all the things we’re pointing to, we both talked about forever are all really arriving this final common path way of insulin resistance and inflammation. That’s undergoing all these chronic illnesses from heart disease to diabetes, to cancer, to Alzheimer’s suppression, lots of more. What you’re saying is that a lot of this may be mediated by this mechanism of uric acid, which is directly related to these load of fructose that’s in our diet since probably the 1970s when high fructose corn started to be used in almost all industrial food products.

Dr. Mark Hyman:
It’s now really the majority of the sugar that we’re consuming and it’s quite different than regular sugar. I mean, but even regular sugar can be a problem. Even if you just have regular sugar, it can cause this because regular sugar has high glucose and fructose.

Dr. David Perlmutter:
It is immediately. We talk about it’s fructose in this case bound to glucose, but that separation takes place immediately in the small intestine that then liberate fructose. Interestingly, here’s another bit of trivia, but I think it’s relevant because of the amount of sodium added to our foods, the amount of sodium that people are consuming. That this salt in our bloodstream activates enzymes that actually create fructose from glucose. The enzyme is something something called aldose reductase. But so we’re actually making fructose in our bodies from glucose to again [crosstalk 00:38:35].

Dr. David Perlmutter:
But again, and it’s the sugar in our diets. As you know, every five years our government puts out these guidelines and we wrote, Dr. Casey means is an individual involved in getting out information about blood sugar. I’m sure you know her.

Dr. Mark Hyman:
She’s been on our podcast for sure.

Dr. David Perlmutter:
We wrote an OpEd in MedPage today that was published February 21st of ’21. It was a letter to president Biden saying, “Look, basically all the scientists who were involved in giving the information for the USDA to make this policy indicated that we need to consume less sugar. Yet the number of calories derived from sugar is still 10%, but the government recommends. That was not during the Biden administration, but we were hoping that there could be some intervention to get it down to about 6% of total calories derived from sugar. Because it’s the big villain. I mean, so many people that you’ve interviewed have talked about it. It is the big villain.

Dr. Mark Hyman:
So David, what about flour? Because in my world, there’s not that much difference between flour and sugar. Is that also an issue?

Dr. David Perlmutter:
Of course, it is. We create these feedback loops whereby we enhance these processes that are designed to be enhanced, to keep us alive. As it relates to flour, that will directly elevate our blood sugar. What does that do? That increases insulin resistance. What happens to insulin when it’s not working very well? It goes up. Now here’s where the feed forward plays in. It’s really quite fascinating. Higher levels of insulin, that can be a consequence of eating refined carbs, like flour. Higher levels of insulin increase uric acid by inhibiting the excretion of uric acid in the kidney.

Dr. David Perlmutter:
So now we’ve tapped into the whole process of uric acid elevation, everything you and I have been talking about by virtue of the fact that we’re eating these refined carbohydrates. So again, that just activates this mechanism saying, “Oh my gosh, you’re not going to have food very soon. You had better start making fat. You better start retaining salt because you may not have water. You better start increasing your sugar production through the liver. A process called gluconeogenesis to power your brain so you can find food.

Dr. David Perlmutter:
That’s our ace in the hole. We’re not the strongest. We’re not the fastest, but we have this brain that can help us find food. Our biggest issues throughout our history were starvation and predation. In other words, either we found food or we were food for somebody else that would eat us. Again, what has saved humans has been the fact that we got this big brain. I don’t know if it’s saving us anymore. Another discussion perhaps, but the fact that we can survive by our wits. That’s what it’s been. That we can find food. We can realize we don’t want to go to a certain place because there might be an animal there that can eat us. This is how we survived.

Dr. Mark Hyman:
It’s pretty striking. So David, let’s go into some more granular details about uric acid. We talked about the foods that raise it. We talked about foods that can help lower it, essentially plant rich foods, cherry extract, and so forth. There’s also interaction with medication. There’s a lot of medications that can increase uric acid. Can you talk about those?

Dr. David Perlmutter:
That’s right. I think some of the biggest players as relates to medication include aspirin. Over the years everybody was told take aspirin, it’ll keep you from having a stroke or having your children more naked or whatever. So everybody should be taking aspirin. Aspirin will raise uric acid. I think the other big players are water pills or diuretics. These directly are associated with increased uric acid, but there are a number of them. The proton pump inhibitors, that’s a drug-

Dr. Mark Hyman:
Acid blockers.

Dr. David Perlmutter:
Acid blocking drugs taken by 15 million Americans over the counter for crying out loud are in stuff that we’ve been talking about for the past few years, significantly associated with risk for Alzheimer’s and stroke. Now we know that a powerful mechanism we can get back to it is maybe through the elevation of uric acid, beta blockers, xylitol. We don’t consider it a drug, but I included there so I don’t forget, as a sugar alcohol that’s very commonly added to food. Significantly increases uric acid.

Dr. Mark Hyman:
A lot of health foods have it, and as a way of getting rid to of sugar.

Dr. David Perlmutter:
That’s right.

Dr. Mark Hyman:
So you might be thinking you’re helping yourself on one hand, but on the other hand, you’re putting in these sugar alcohols, which can be harmful. Not just to uric acid, but also your microbiome and other issues.

Dr. David Perlmutter:
That’s right. For sure. Even drugs that enhance nitric oxide for erectile dysfunction will raise uric acid. Let me unpack that just a little, because I think it’s really important.

Dr. Mark Hyman:
Oh wow.

Dr. Mark Hyman:
Although sex makes you live longer. So maybe it even out. I don’t know.

Dr. David Perlmutter:
Maybe so. Erectile function requires blood flow and the real mechanistic issue that seems to have been defined for erectile dysfunction is lack of blood flow because of poor function of nitric oxide that would have allowed blood flow to allow an erection to take place. Turns out that men with elevated uric acid have about a 36 to 38% increased risk of being diagnosed with erectile dysfunction. Because as I mentioned earlier, uric acid compromises the personality of nitric oxide. Here’s a drug that’s then used for the erectile dysfunction, but that can further increase uric acid.

Dr. David Perlmutter:
So wow. I think it’s so important that people understand that. I mean, it’s some interesting biochemistry. Other things that are associated with elevated uric acid include niacin, vitamin B3 and certain Parkinson’s drugs like levodopa and then a drug that’s used for people with certain types of respiratory problems called theophylline. That kind of rounds out the list of the big players as it relates to drugs. But aspirin gets a lot of press. I would ask your viewers to Google two things, uric, U-R-I-C, and the word metabolic, all the literature will come up and there’s a lot of it and included in that will certainly be lists of drugs that are associated with increasing uric acid. It’s so far beyond gout and kidney stone. It as a central as the article title stated, a central player orchestrating much of our metabolic mayhem, as I call it in the book.

Dr. Mark Hyman:
Talk about Alzheimer’s because that’s your specialty is neurology. It seems that this is also connected to Alzheimer’s. Uric acid maybe linked to the risk of Alzheimer’s.

Dr. David Perlmutter:
Well, you would expect that to be the case and it really is. There was a big study published in 2018 that looked at individuals, 1600 people, followed them for 12 years. These people had at the beginning of the study, a measurement of their uric acid level and an MRI scan of the brain and neurocognitive testing. In other words, how well is their brain working? Those neurocognitive tests were repeated six times during the 12 years. So let’s say every two years. What they found 1600 people is that those individuals who had the highest level of uric acid had an 80% increased risk of being diagnosed with dementia, a 55% increased risk of having actual Alzheimer’s disease and 165% increased risk of what’s called vascular or mixed form dementia. So it’s powerfully threatening to the brain as you might expect.

Dr. David Perlmutter:
Why? The brain requires fuel. Sure. But if we in induce insulin resistance by having high levels of uric acid, like we’ve talked about the brain requires insulin to use its glucose. That’s for sure. But insulin in the also acts as what we call a trophic hormone. It nurtures the brain cells. When we compromise insulin’s ability to nurture the brain cells, we take away the support. We take away the nurturing, the loving, what gives the brain cells what they need to function. So when we also consider how uric acid threatens nitric oxide and that threatens blood supply, that explains why we see such an increase number of small strokes in the brain.

Dr. David Perlmutter:
There was another study that it was not a prospective study. This is a study that looked at a group of individuals, 168 individuals and it’s a study done right now. They took a group of elderly people. They measured their uric acid. They did some neurocognitive testing to see how their brains are working. They did MRI scan to the brain. What did they find 228 people? They found that those individuals who had the highest level of uric acid were four times as likely to be demented. Four full increased risk of dementia, those who had the highest levels of uric acid.

Dr. David Perlmutter:
It all makes sense when we understand that were compromising blood supply, we’re increasing inflammation, a central pillar of Alzheimer’s and we are messing up how insulin works throughout the body, including the brain. Powerful mechanism that the brain doesn’t appreciate. I’ve had several very interesting conversations with a colleague of yours, Dr. Dale Bredesen and he is vigorously involved in looking at uric acid levels as it relates to Alzheimer’s. Then getting uric acid levels to come down as one of the important pillars he uses.

Dr. David Perlmutter:
He looks at a lot of different things, unlike modern medicine that only wants to find one intervention to fix that problem. But as you know, Dr. Bredeson is reversing Alzheimer’s by looking at multiple inputs and certainly moving forward, uric acid is a powerful player.

Dr. Mark Hyman:
Now, David, this is something you may not have come across, but I’ve come across it. It’s an anecdotal observation, but sometimes uric acid levels are very low. Usually they’re written off as irrelevant, but I’ve noticed that there’s often correlated with heavy metal toxicity. Have you found that? Is there any data on that, anything about that?

Dr. David Perlmutter:
Yeah, there is as a matter of fact. The whole notion of us defining the upper limit of good uric acid speaks to what we call this U shaped curve or Goldilock Zone. I don’t want to say sweet spot, for obvious reason. But that there’s an ideal place for anything, whether it’s your blood sugar, the amount of sleep that you get, you name it. It may be that this is the case with uric acid as well. While I’ve not seen specific correlation with heavy metals, there is some discussion that uric acid does represent some form of an antioxidant in the body and having really low levels of uric acid might be threatening. That data is really based upon the observation that cachectic or really, really thin elderly people with very low levels of uric acid and with dementia and have very low levels of uric acid.

Dr. David Perlmutter:
I think the explanation that’s been offered, because I’ve asked actually Dr. Richard Johnson about this. He says, these are people that have no body mass whatsoever and their food consumption is such that their uric acid level’s going to be really, really low. So he looks upon it more as an effect, as opposed to being a cause. Therefore, we don’t really have the ability to define what is too low a level of uric acid. I think defining the upper limit these days make sense. The average uric acid level in 1920 was 3.5. Now the average level is above the ideal level. The average level is 6.0 in America.

Dr. Mark Hyman:
So you don’t think it’s necessarily correlated with heavy metals.

Dr. David Perlmutter:
I would have to think about that. I won’t just offer an off the cuff evaluation, but how interesting it is that the consumption in 1900 of humans consuming fructose, we would consume about 15 grams a day, a couple of apples, pieces of fruit, whatever. Now the average daily consumption of fructose, I’m not saying sugar, of fructose is 55 grams a day. That increase in fructose consumption, those curves perfectly line up as you would expect with uric acid levels over time.

Dr. David Perlmutter:
So everything’s fitting together. When we look at obesity rates, a third of adults being obese right now, as you and I have this conversation, that number’s 50% in the distant future, which is 2030. Hey, that’s not the distant future. I know we’re trying to be evergreen, but that’s eight years from now. That’ll be 50% of adults in America are not just overweight are obese. That is a scary proposition.

Dr. Mark Hyman:
Very scary.

Dr. David Perlmutter:
I mean, how are we going to care for those individuals? We’ve seen that lifespan is decreasing in America, pre COVID. Certainly COVID has added to the decline, but it was declining pre COVID and that makes sense now. When we look at these numbers and I look at them through the lens of uric at acid, the reason being is I want uric acid to be a new important metabolic marker. I’d like people to go to the doctor and have their blood sugar measured, their fasting insulin measured, their waist lines, blood pressure, and uric acid as well. A very important and powerful biometric, not just because it’s a biometric and we click and say, “Ah, it’s elevated, but we can fix it.” Getting your uric acid level down really is mechanistically a way to regain metabolic health.

Dr. Mark Hyman:
I think this is staggering and I just want to want to recap everybody about really understanding this. First of all, take us to why uric acid briefly is such an important thing to measure at your doctors, what the numbers should be and what the main foods that cause to go up, the main foods that cause to go down? Then we’ll follow up with what are the supplements to take and how do we [inaudible 00:53:24].

Dr. David Perlmutter:
Sure. Let me preface that if I could, by a statement and I don’t mean anything rude by this, but it’s something again, that those of us in functional medicine have come up against over the years. That is simply the idea that your mainstream doctor may be unaware of the relationship of uric acid to metabolic issues. I would say simply the query would be doctor please, just Google uric or uric acid and the word metabolic. That’s all you got to do. If you want to do it on PubMed, all the better, right?

Dr. David Perlmutter:
But to be fair, most doctors, many of us, we were told that uric acid is only important as it relates to gout and kidney stones, end of story. If you don’t have gout or kidney stones, you have nothing to worry about. Even if your uric acid level is sky high, that just is not the case anymore. We see interventional trials using drugs where blood pressure is lowered using allopurinol, that lowers uric acid. These studies even in adolescences published in the journal of the American Medical Association, adolescents who now 10% of kids between the ages of 12 and 19 are hypertensive, 10%.

Dr. David Perlmutter:
So metabolic issues are something that affecting younger and younger people. We’ve got to pay attention to this. Uric acid is playing a very important mechanistic role. So preface my response by saying lovingly, kindly mention to your doctor, “Hey, as a matter of fact, I saw this podcast with Dr. Hyman and I learned that uric acid might be a little more important than just gout. Ask him or her to look into that. So first and foremost, fructose, as Dr. Lustig says, it’s the alcohol without the buzz. It is profoundly threatening to us. We’ve known that since the Lancet published it in 1970, but now we understand how and why.

Dr. David Perlmutter:
How and why has to do with how it’s metabolized into this central player, uric acid. No longer just re associated with gout and kidney stones. So by and large, in our foods, it is fructose.

Dr. Mark Hyman:
But if it’s also sugar, it’s also flour. It’s anything that’s refined starchy carbohydrate, which has sugar in it, which are carbohydrate converted to fructose when you eat them.

Dr. David Perlmutter:
That’s right.

Dr. Mark Hyman:
It’s mostly high fructose corn syrup, but you got to understand it’s more than just that.

Dr. David Perlmutter:
Anything above 11 grams per day, already triggers that enzyme to convert your blood sugar into fructose making even more. We’ve recently seen a lot of press recommending to us to lower our sodium [inaudible 00:56:14]. We’ve known that for years, but now we have another reason to do that because high levels of serum sodium will convert as we say, the blood sugar that we have into fructose, adding fuel to the fire. So by and large, it’s fructose. If your uric acid is elevated, you want to cut out the fructose in your diet, but you may eat fruit.

Dr. Mark Hyman:
You pretty much want to do it anyway. Nobody should be having high fructose corn syrup.

Dr. David Perlmutter:
That’s right.

Dr. Mark Hyman:
I mean, if you would say to me, what are the two things that we should never eat, is high fructose corn syrup and trans fats. Then immediately cuts out like 95% of processed food.

Dr. David Perlmutter:
Well, what am I going to eat? You mean I can’t eat something out of a box? No, you shop at the grocery store and you have foods that don’t have a barcode, that they might even have to weigh, my gosh.

Dr. Mark Hyman:
That’s right.

Dr. David Perlmutter:
The other contributors are alcohol and again, some wine. A glass or two is fine. The studies actually did not delineate between red and white. I would say red based on it bioflavonoid content would probably be a better choice, but beer is a big problem. You wonder why people have these have beer bellies, because it’s purine rich and contains alcohol and hard liquor as well. The other issue would be purine rich animal based foods. All animal meats have purines in them, but it really depends on what your uric acid level is. To that, I would say so six ounces of chicken, if you’re a meat eater or steak or whatever it may be is going to be acceptable. But higher purine foods or things like shellfish, scallops, and small fish, the ancho, sardines that we’ve all favored over the years for other reasons, lower in bio accumulation and certainly higher in good fats.

Dr. David Perlmutter:
But that said, you may get away with it, but you won’t know until you follow your uric acid level. What I’m saying is see your doctor on occasion, see where you are today with your uric acid level. To know your uric acid level might be as simple as picking up the phone. Why don’t people pick up the phone anymore I think or reaching in your pocket, I guess?

Dr. Mark Hyman:
Hey Siri, call blah, blah, blah.

Dr. David Perlmutter:
Siri, get my uric acid level.

Dr. Mark Hyman:
Listen, you lean up brilliantly why we should be caring about uric acid and why people should buy your book, Drop Acid. Because it really explains this in great detail and helps you understand what to test for, to look for, what you should eat, what you shouldn’t eat and also what are the other things you can do to protect yourself. You mentioned some medications that we should be wary of, diuretics, acid blockers, aspirin, and others, that people should be cautious if they’re taking these to pay attention and check their levels.

Dr. Mark Hyman:
Then lastly, there are a number of different natural products and supplements that can help bring it down. We mentioned cherry extract extract, but you also mentioned a few others. Could you just summarize those briefly?

Dr. David Perlmutter:
Sure. The big player would be quercetin and I’m certain you’ve had people on your program who’ve talked about quercetin from other perspectives. As a senolytic, perhaps being able to help us get rid of aged immune cells. As an antioxidant, it’s in inflammation. But now we recognize that quercetin actually works in the same way as the gout drug allopurinal. It targets an enzyme that is fundamental for producing uric acid called xanthine oxidase. So it is a xanthine oxidase inhibitor like the drugs used to treat gout.

Dr. David Perlmutter:
Even more potent might be another bioflavonoid that’s called luteolin. So I’ll give you dosages. I would consider I’m not your healthcare practitioner, but the typical doses that will work would be quercetin 500 milligrams a day. Luteolin would be about a 100 milligrams a day, vitamin C, which aids in excreting uric acid. Vitamin C has been the darling supplement for gout patients for decades. That would be again about 500 milligrams per day. Maybe a 1000 milligrams of DHA would be reasonable. Again, not that it’s having a direct effect on uric acid, although I think it does, but because it offers an offset to other things that are going on.

Dr. David Perlmutter:
It decreases inflammation. It stimulates the production of something called BDNF, which we need for brain cell health. Offsetting the damaging effects of this insulin resistance that people tend to develop. So I couldn’t help myself, but include DHA in the recommendations. To be sure there are other issues that we should consider in the time we have left and that would be, that sleep plays a role. That not getting enough restorative sleep is associated with increased uric acid.

Dr. David Perlmutter:
[inaudible 01:00:52] meaning setting on your rear end a lot and not getting out and moving will be associated with elevated uric acid. One other point, as it relates to exercise think is really in important that if you suddenly engage in a level of exercise that’s far more vigorous than you are used to, you will break down some of your body tissue, some of your muscles, for example. Like you go on a long run, you’ll break down muscle tissue and that will transiently increase what are called purines in your body. That will raise in the short term uric acid.

Dr. David Perlmutter:
Interestingly, we know that if you fast, you’re going to raise your uric acid levels transiently, but ultimately that fasting is going to do good things for your metabolism. So again, we’re thinking that fasting and time restricted eating are in fact, I put it in the book, all good ideas as it relates to metabolic health in the long run. But if you’re testing your uric acid during a fast when you’re deeply into ketosis, it will momentarily be a little bit elevated. The messaging here is take a chill pill, take a deep breath. It’s going to be fine. You’ll be better off when it’s all said and done.

Dr. Mark Hyman:
Amazing. So everybody needs to get this. We need to pay attention to uric acid. We need to test it. We need to change our diet to get rid of the high fructose corn syrup, add in a lot more plant foods and number of supplements and we can really mitigate this risk. It’s not just a bystander molecule that we check and see it’s elevated in the context of diabetes, but it actually is one of the mechanistic drivers of a lot of these problems. So it’s important.

Dr. David Perlmutter:
That’s right. It’s in the driver’s seat. It’s orchestrating. Again, the story about how we got here from 14 million years ago is really so interesting. Well, when researchers look at hunter gatherer populations that are still living on the planet in South America, for example, we find that a, their uric acid levels are really low and b, they have a variety. When you look at their blood and other markers, they have very low levels of fasting insulin. Their blood sugars are lower. Their insulin sensitivity is higher. Their bone density is higher. Their visual acuity is higher. Blood pressure is lower. The raising of blood pressure with age isn’t happening. Leptin sensitivity is maintained.

Dr. David Perlmutter:
So all the that we talk about that are related to better metabolic health are seen in those cultures that haven’t yet stumbled on the sugar and whose uric acid levels remain low.

Dr. Mark Hyman:
That’s amazing. So people of you listening to this, hope you learned that we’re in trouble because of all the high fructose corn syrup and the fructose and everything that we’re eating is as well as the sugar and starch. That uric acid is such a big deal that we pretty much ignored. I’ve obviously followed it in my lab test for years, but never really understood the depth of how it interacts with their biology to cause all hosts of chronic diseases and that there’s a way to fix it.

Dr. Mark Hyman:
So David, thank you so much for writing your book Drop Acid, the surprising you science of uric acid, the key to losing weight, controlling blood sugar and achieving extraordinary health. It’s available. You can go get it anywhere you get books. Go to doctorperlmutter.com/books/drop-acid. If you want to learn more, I encourage you to get the book. Share it with your friends and family. Share this podcast with your friends and family. I bet you they’re going to be very interested in what David has to say. He’s always coming up with the newest and most interesting things from Brain Grain to Brain Wash, to the book about the brain and gut connection, the Brain Maker.

Dr. Mark Hyman:
So David’s really been on leading edge for so many years and I love you, David. I love your work. Leave a comment, let us know how maybe you’ve struggled with uric acid and what you’ve done to fix it. Subscribe wherever you get your podcast and we’ll see you next week on the Doctor’s Farmacy.

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

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

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