Dec 30, 2021
David Perlmutter MD reveals the exciting and challenging science behind a major health risk that almost no one is talking about. Find out how uric acid is contributing to some of the biggest health risks in modern life, how the standard American diet is the perfect formula for creating dangerous levels of uric acid in your body, and how you can make changes to your diet that will help you lose weight, control your blood sugar, and live a healthier life.
- [1:40] As of 2022, David will be 67 years young and he’s planning on traveling from Vancouver to Alaska with his wife. The world has a lot of variability and uncertainty right now so it’s hard to make detailed plans for the following year, but in some ways, that’s good because it forces you to focus on the present.
- [5:00] David’s new book is called Drop Acid. It specifically deals with uric acid and how we discovered it to be a central player in regulating metabolic health. It’s not only that uric acid just becomes elevated, it actually plays a causal role in conditions like diabetes, hypertension, and obesity.
- [7:45] Metabolic issues are the number one cause of mortality on the planet. Countries like Japan have been aggressive in intervening with people with high levels of uric acid because of its dramatic associations with death from all causes.
- [8:25] Risk of death due to cardiovascular disease rises by 38%, stroke by 35%, and for every point of elevation in uric acid above 7 all cause mortality increases by 8%-13%. Having a high uric acid level is associated with a 80% risk of dementia, and a 55% risk of Alzheimer’s.
- [10:00] Testing uric acid levels is fairly routine, but what it indicated wasn’t meaningfully understood until recently. David began looking at uric acid because of his interest in metabolic health and its association to Alzheimer’s. The original paper linking uric acid to metabolic issues was published in 1894, and was buried until a researcher named Dr. Richard Johnson started doing studies on it.
- [12:15] David was listening to a podcast episode with Dr. Peter Attia doing an interview with Dr. Johnson and he was overwhelmed by the information. Every minute was a new pearl of information. David started communicating with Dr. Johnson, which became the basis of a new friendship.
- [14:30] The genetic mutations that cause humans to have higher uric acid than other mammals happened around 14 to 17 million years ago as an evolutionary survival mechanism. In times of food and water scarcity, uric acid allowed us to increase our blood sugar and retain water which were powerful advantages.
- [15:45] To this day, we have a component of our genes that want to be thrifty and pack away fat for the next period of food scarcity. Historically, the biggest threats to our survival was in finding food sources and being eaten by predators, and uric acid helped with both of those.
- [16:55] Certain cultures have evolved this gene and are more at risk of negative effects from it in our modern world. Fructose is the key ingredient to uric acid production in the body and the world is awash with it. The highest rates of obesity are in those genetic populations.
- [18:50] 50% of American adults will be obese by 2030, including children. 10% of kids between 12 and 18 are hypertensive. This is a direct manifestation of the foods we are eating, primarily fructose. Fructose is metabolized into uric acid and uric acid is doing the dirty work.
- [20:10] In the context of 99.9% of human habitation on this planet, this adaptation was very advantageous. It wasn’t until recently, when our diets have changed so significantly, that it has become a liability.
- [21:15] Clearing uric acid is where the challenge is. We have lost the function to clear uric acid and with most foods we eat increasing uric acid levels, it can be difficult to keep levels low on the standard American diet. Fructose is the main culprit and average daily consumption increased by 1000% between 1970 and 1990.
- {24:30] Not all alcohol is associated with high levels of uric acid, but beer is one of the worst contributors. Targeting a specific enzyme called xanthine oxidase can help the body excrete uric acid.
- [27:20] In menopause, uric acid increases because estrogen plays a major role in the kidney’s ability to excrete uric acid. Women who are on estrogen replacement therapy seem to have some protection from their uric acid rising.
- [28:30] One of the most important discoveries has to do with a master pathway known as AMPK. This pathway is turned on by things like exercise, berberine, and metformin, and when activated, it prevents the body’s production of extra glucose and sugar.
- [31:45] The opposite of AMPK is triggered by two ways: fructose entering the body and uric acid in general. Uric acid is the key to the ability to hibernate, but if you don’t plan on spending the four to six months sleeping, you should try to keep uric acid low to maintain your metabolic health.
- [33:55] For people who are working hard to lose weight and get healthy, reducing uric acid may be the vital tool they need. Picking up a uric acid monitor will give you a good idea where you are right now. We want to have a uric acid level below 5.5 mg/deciliter, with the average level in America being around 6.0.
- [37:40] The average individual in America, aged 60 or older, has full blown metabolic syndrome. 88% of adults in America have at least one component of metabolic syndrome.
- [38:30] The LUV diet can be incorporated into your keto, paleo, or vegan plan. The main focus is in getting the fructose out of your life.
- [39:15] Fruit has fructose but when you eat fruit you’re getting that fructose in the context of fiber, bioflavonoids and Vitamin C. Fruit juice consumption is associated with an overall smaller brain and weaker memory.
- [41:00] Tart cherries were used in the past with women to help them control their gout, and now through the lens of modern research we know why.
- [41:30] We’ve known since 1970 that fructose is a threat to metabolic health, despite the $10 billion that was spent to keep us from that information. $500 million was spent to convince the public that corn related sugar was the “safer” sugar. Fortunately the truth is now coming out and we are waking up to the risks of uric acid.
- [42:40] David published an op-ed challenging the Biden administration on the USDA recommendation that 10% of our daily calorie consumption should come from sugar. This is a perfect example of science coming up against politics.
- [44:10] The nutritional requirement of sugar is zero. High fructose corn syrup is a toxin to fetal health. When it comes to certain organizations, it’s like steering an aircraft carrier, especially when you look at which groups may be funding those organizations.
- [46:20] The only time we would need fructose in our bodies is when facing starvation, and even then our bodies can create fructose from glucose.
- [48:25] The quick fix is to eat less salt and your body will be less aggressive in triggering the pathway that leads to high uric acid levels.
- [49:00] One study looked at two groups of school-aged children, and in one group they placed a water fountain outside their classroom and encouraged them to drink. That group had a 30% reduction in the development of obesity. Fat is a powerful resource for making fresh water in your body, and when we’re dehydrated (or our body thinks we’re dehydrated) it wants to store fat to survive.
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