Kind: captions
Language: en
high uric acid is predictive of
hypertension of insulin resistance
elevated blood sugar therefore diabetes
inflammation oxidative stress all of
those mechanisms that underlie the
things that you don't want to get
dr david pearl mudder welcome back to
the show tom bilyeu i'm delighted to be
back it's going to be a lot of fun shall
we drop acid
we already did right
we'll see where it takes us i love the
title of the new book not quite as much
as i actually love the book itself
though but the title sets us up it
really makes a subject uric acid that i
would have thought would be very sort of
dry and boring into this really sexy
topic uric acid has always been very dry
and boring uric acid was always whether
you had gout or didn't have gout
basically
and the exciting news is that it is so
important it's so
it's it has so much influence on our
house what put this back on your radar
on the radar actually um
i was running one day and i was
listening to a podcast from peter athea
and he interviewed a dr richard johnson
university of colorado
and
explored this topic that uric acid is a
central player in our metabolic health
it's far more than
you know the dead end metabolic product
of fructose that has a role to play
again in gout
and for me
everything's about metabolism
because
when we're deranged in our metabolic
lives it sets the stage for all the bad
things you don't want to get alzheimer's
heart disease diabetes obesity cancer so
this becomes a very powerful tool and i
couldn't really fast what makes you
think that all of those things are
metabolic
they're born of metabolic disturbances
well they are i mean their their
underpinning is inflammation and
inflammation
has its genesis in disturbed metabolism
so these are all inflammatory conditions
we've talked about that before that
alzheimer's is basically an inflammatory
condition
that you know people are now becoming
aware of inflammation in the world of
covid getting this thing called the the
cytokine storm whereby suddenly
inflammatory chemicals are produced in
excess throughout the body and people
have problems with their brains and
their lungs etc
but
in the same force in a lower level
acting over a longer period of time
could be let's say the cytokine drizzle
and is equally as devastating to the
body so and the cytokine drizzle is a
response to eating pro-inflammatory
foods
not just eating pro-inflammatory foods
but anything
the answer is yes but not just
anything that increases inflammation not
getting enough sleep
engaged in stressful activities a
disturbed gut bacteria set in the state
that's a powerful source of inflammation
in human physiology uh leakiness of the
gut lining for example
dramatically amplifies inflammation so a
lot of roads lead to the realm of
inflammation and set the stage for
things like alzheimer's and coronary
artery disease
and because of that
it's the reason that a monotherapy or a
one drug
approach to alzheimer's for example
is beyond myopic it's never going to
work when we have what dr dale bredesen
has described as 36 possible inroads
into why your brain isn't working with
respect to alzheimer's uric acid now
being one of those
uh that the idea of targeting one thing
this beta-amyloid protein
you know uh
will forgive them for they know not what
they do
so all right we hear about uric acid
what was like the key insight that made
you go whoa there's really something
here because you've moved super quickly
into getting a book out you said you
want to make sure that this wasn't one
of those things that languished for 20
years and you know took all that time to
work its way into the medical
establishment what was the key insight
that made you go whoa this is a real
linchpin in the understanding of
metabolic health the urgency on my part
once i figured out how important it is
or realized how important it is
the urgency is that our metabolic health
globally is in a terrible place
i mean a third of american adults has
hypertension a 10
of of kids age 12 to 18 has hypertension
that's crazy it is uh 50
of adult americans will be obese by the
year 2030 not just overweight
but obese
so we are
you know our life expectancy is
declining is it that it's actually
declining oh it's declining dramatically
before covet
it began so people say well because of
covet people are dying earlier uh and
you know the truth of the matter is that
this metabolic derangement
bodes for a much worse outcome as it
relates to covet they're tracking that
like yeah there's actually been
published yeah you measure uric acid at
admission and it predicts to some degree
who's going to end up in the icu who's
going to end up on a vet and who's going
to die now that we recognize uric acid
and its role in disturbing metabolism
and its role in inflammation and its
role in increasing what is called
oxidative stress the damaging effects of
free radicals it was looked at and lo
and behold look what they're finding
what is uric acid like what what is it
what triggers the
unhealthy elevation
so uric acid is a very simple chemical
and it is the end product of the
metabolism in the human body
and
the bodies of other animals of only
three things alcohol
something called purines which are the
breakdown products of dna and rna
and by far and away fructose
so to me uh
we've known that fructose is a demon for
a long long time and you in 1970 it was
published in the journal the lancet that
fruitos is a player it is a big player
and yet
we were told that because fructose
doesn't cause insulin
to be
secreted and doesn't need insulin
to be metabolized therefore it was a
safer sugar
and
you know we recognize how industry
uh was able to manipulate that messaging
and
how everybody fell for it but if insulin
really is like one of these high risk
factors and fructose doesn't require
insulin
why
isn't it that is the
well i'd say million dollar question
that's the 500
billion dollar question that's how much
we subsidize the growth of corn to make
high fructose corn syrup today
with that as a premise that look it
should be safe because it doesn't need
insulin to be metabolized
it
is a powerful threat as it relates to
type 2 diabetes because it stimulates a
couple of things number one is
gluconeogenesis
the creation of glucose in your body de
novo in the liver and uric acid enhances
that process and it causes what is
called insulin resistance meaning that
insulin doesn't work as well in your
body through a number of mechanisms so
that's the dirty secret of fructose that
the industry didn't want us to know
about
now it's been called out so fructose can
only be metabolized in the liver
why
as it turns out it can be metabolized in
various other tissues in the body even
including the brain we learned about the
liver but even the kidney can metabolize
a fructose so
uh the the story you know everyone
everything's been compartmentalized but
now we know that it's a lot a lot bigger
stories we know that glucose can become
fructose
high glucose levels especially when we
turn into can be
fructose through the use uh through the
body's use of a an enzyme called
aldosterone reductase that is enhanced
when serum sodium is higher
so
higher levels of salt
leads the body to know that it is in uh
it's getting ready for famine
or water restriction make more salt
it actually create
we retain more salt and we make fructose
out of glucose fructose is the signal
then that prepares us for
not having any food which is really
quite
intriguing so fructose found in nature i
would assume primarily in fruit right so
fructose fruit sugar that's where
what is it about the natural appearance
of fruit that warrants because fruits
what spring right or so
it's fruits fall late summer and that's
what happens when you live in l.a late
summer and early uh fall
right so it's like hey traditionally for
our ancestors i mean now you have fruit
360 right like i literally have no idea
yeah so but traditionally it is the late
summer and early fall when the wild
blueberries would ripen and our
proclivity to finding sweet things
a survival mechanism deep in your brain
and the brain of every human walking the
planet makes us gravitate towards sweet
we consume fructose and that triggers a
powerful mechanism in our bodies to make
fat
to store fat to lock it up
to make more blood sugar to power our
brains to raise our blood our blood
pressure
so these are powerful survival
mechanisms
that
happened you know probably 14 to 17
million years ago when
in the middle myosin period
when the world cooled and for our
primate ancestors that was a
survival pressure and those
who had
mutations in the genes that have to do
with uric acid
made more uric acid which alerted their
bodies to make more fat now those are
the only only primates that survived
they pass it on to you and me and to
every human
such that when we are exposed to
fructose it's telling our bodies get
ready for times of food scarcity
so the idea of
higher blood sugar and insulin
resistance and all those terrible
metabolic things that we're doing our
damnedest right now to target
those were wonderful adaptations for us
for more than 99 of our time on this
planet what's happened is now we still
have the old genome
but we've challenged it with a new
environment that is rich in fructose
that is more sedentary we're not doing
as much we're not sleeping as well
restoratively and
and therefore uric acid is increasing
and
worsening our metabolism and leading to
this host of diseases that we talked
about
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okay so what's your take on fruit itself
like is that to be avoided or
that's a million dollar question so
fruit is on the table because of the
fiber content
fiber bioflavonoids and importantly
vitamin c so vitamin c
uh dramatically helps with your
excretion of uric acid so your net
negative in terms of uric acid by eating
an apple a day by eating a couple of
apples a day a handful of grapes uh and
certain fruits are actually associated
with lowering uric acid like tart
cherries hence the o in the book cover
cdo i do indeed it's the falling cherry
nicely done
so okay so we're
in taking all of this excess fructose
used to be good for us now it's becoming
a problem uh the end of that metabolic
train is uric acid uric acid used to be
or it has a
role
but not in the elevated levels that
we're talking about now
um uric acid is in these elevated levels
is causing inflammation
is there anything else going on or is it
simply this cytokine drip oh no it's
there's a lot going on and let's double
click on something i think is really
interesting visa be some news that
happened today
one of the things that uric acid does it
inhibits
nitric oxide
now not to be too technical but we need
nitric oxide
for many reasons two of which are it
allows blood vessels to open up
improving blood supply
when there's not enough nitric oxide
there's not enough blood supply
it also facilitates how insulin works to
keep our blood sugar in check
and
not having function of nitric oxide
compromises blood supply and compromises
how insulin works so our blood sugar
will go up
the reason i say that is
there are drugs that increase nitric
oxide
one of them is viagra as in as a matter
of fact there's a time and a place when
you a person might need not you a person
might need
more blood supply for erectile
dysfunction
and a study was published this morning
showing
that people who take men who take
viagra uh
it's associated with a 70 reduction in
risk for alzheimer's
can you imagine and this is not the
first study
more blood supply to the brain
also a reduction in the formation of
what's called tall protein in the brain
but think about it that might well
explain why elevation of uric acid is
associated with an 80 increased risk of
dementia
a 55 increased risk of alzheimer's
specifically and a 165
increase risk of
vascular dementia because it's actually
lowering our no
it is lowering the functionality of
nitric oxide okay so we have the nitric
oxide in the system but it's unable to
do its thing which is the elevated
presence of uric acid and important
i think a lot of people get the nitric
oxide blood supply
relationship
but the
the uh tying nitric oxide into how
insulin works is a relatively new idea
so uh you know that's been demonstrated
in animals and then in humans that uh
you know that's an important function
that's compromised by uric acid so yes
we talked about inflammation cytokine
storm cytokine dribble this nitric oxide
story is actually very important as well
how does it interface with insulin
because we need nitric oxide for two
things
how insulin is able to get through the
blood vessel into to then target the
insulin receptor and then how it's able
to bring blood sugar into the cell doing
its job to help lower blood sugar so the
fine vasodilation to pull down you need
that's how insulin makes its way through
the blood vessel to get to
the muscle and or liver cells to do its
job in terms of the sequestration of
blood sugar if you will for the
formation of of glycogen okay so that
would predict then if the elevated
levels of uric acid cause my
vasculature to be too constricted now i
basically am leaving the glucose in my
bloodstream i'm probably then going to
secrete more and more insulin trying
desperately to get it out
because the mechanisms don't realize
that this isn't a lack of insulin
problem this is a vasodilation problem
i'm too constricted i can't get out i
can't reach the muscle cell i can't
reach the fat cells
that's really interesting it's really
interesting it's a big problem because
that leads to
insulin resistance insulin doesn't do
its job
and you know insulin resistance is
devastating for the brain
why well the brain requires glucose so
we can understand from that perspective
but insulin is a powerful trophic
hormone for the brain it nurtures brain
cells
if you want to grow brain cells in a in
a petri dish let's say you nurture them
with insulin and that's how they grow
so you know insulin has far more uh
important roles
you know beyond just its role in
regulating blood sugar so
insulin permits
the glucose receptors at the blood-brain
barrier
to allow glucose to get into the brain
to power brain cells if you will so it's
a very big story so
why might this be why would your what
would be the upside of having uric acid
create insulin resistance and therefore
cause blood sugar to go up
why because when you're starving it'll
help power your brain
because you know we're not the fastest
we're not the strongest but we have a
big brain in relation to our bodies so
that's been our ace in the hole it's
been our high card that we can play
during times of
you know either starvation or predation
so we need our brains to keep us
able to get food and to keep us from
becoming food and that's not a real
concern these days right but in the day
we needed to make sure we didn't get
eaten
one of the chapters in the book is
called survival of the fattest i assume
this is what we're
talking about yeah and it's not like our
primary ancestors were got fat and we're
you know we're lying around being fat
they just had a little bit a little edge
that superpower a little extra body fat
so that you know for that
extended period of time when there
wasn't food they would be the ones to
survive
they were able to lay down that fat and
survive because they had a mutation in
this gene what the uric ace genes so
they couldn't break down uric acid their
uric acid levels would go up
trigger their fat production and they
would survive
help me understand that mechanism in
light of what we just walked through so
elevated uric acid constriction of the
blood vessels the glucose stays in the
system how is it getting me to lay down
the fat if the glucose molecule or the
insulin molecules having a hard time
getting the glucose molecule into the
cell
other mechanisms so we only covered two
so far the next would be oxidative
stress
so elevated uric acid profoundly
increases what is called oxidative
stress
when mitochondria in the cell
are exposed to higher levels of
oxidative stress they are less
functional and that triggers that's one
of those
stresses in the body that triggers fat
production
and that becomes a really interesting
story that we didn't cover specifically
in the book
but
i think it's fascinating nonetheless
because it's similar and that is
why do we as human beings
not make vitamin c
i mean you know that's a fact we've
talked about it before
and i i think we have to talk about that
because it's not just well it sucks to
be human we don't make vitamin c you got
to make sure you're not a limey uh you
eat enough life you don't get scurvy so
that your teeth don't fall out and your
kids aren't born naked or whatever
happens when you have scurvy right well
i think it's interesting because
this oxidative stress triggers fat
production which was a good thing
it's again
fat production a good thing becoming a
little fatter is a good thing yes
in the through the lens of our history
of being primates or even
hunter-gatherers and increasing
oxidative stress by not having vitamin c
would have been looked at looked upon as
being a good thing through that lens
again
and would also cause us to then seek out
the fruit those who would seek out the
fruit would survive get enough vitamin c
to survive during times of food scarcity
okay so
now as we
take this into a modern context
we know that it served us for a while
but now we're getting we have so much
fructose coming into the diet our levels
are going up so high we're constricting
the blood vessels going back to what you
said about um viagra like that just that
if that ends up holding i mean that's
like a miracle drug a 70 decrease in the
likelihood of alzheimer's is crazy
i would take a 5 decrease in alzheimer's
risk and i i think it's fair to say that
you know getting your metabolic house in
order is a powerful way to decrease your
alzheimer's risk we know that to be true
we know if you're a type 2 diabetic
you've quadrupled your risk for that
disease alzheimer's for which there is
no medical treatment as you and i have
this conversation right now despite the
exciting news of several months ago of a
new miracle drug that gets you know that
that limits beta amyloid uh what
happened with that was really quite
encouraging you know it was resoundingly
rejected by the neurology world and
rightfully so because it doesn't work
we don't have a drug to prevent that
disease and yet we really understand
where it's coming from it's coming from
disturbed metabolism
it's been said that alzheimer's is not
generally a genetic disease and i would
until recently have agreed with that
saying that yeah about four percent of
alzheimer's have familial type
alzheimer's disease you know there are
populations around the world south
america for example where it runs quite
strongly in families
i would tell you now that it's
probably a 100 percent genetic
as is type 2 diabetes i would say it's
100 percent
genetic and you're looking at me saying
where are you going to go with this and
let me go let me let me play it out
because as i've mentioned earlier
what we're seeing now are these
metabolic derangements that underlie
these diseases that represent
a disconnect between evolution and
environment
so we have this genome
that's coding for our survival
in the context of a different
environment
now that we're challenging that genome
with a new set of circumstances a new
context looking at it through a
different lens if you will
it's expressing genes that are paving
the way for our metabolic decline and
setting the stage for the very things we
don't want to get
and i have to tell you that language is
some that came to me i think the night
before last as i was just lying in bed
thinking about this stuff
that it is absolutely a genetic disease
in that context of the mismatch
and
we're living then
with physiology and and a body a machine
that is
you know
mismatched with our current environment
it's outdated machinery and i i realized
before i wrote drop acid
that i had written about that topic a
half century ago
and i wrote a an op-ed in the miami
herald about what about us living today
with the outdated machinery that is more
suited to the environment of our
ancestors
and uh
i i saved it i was 16 years old when i
wrote that article i saved it i put it
in the book
and um
that's the issue is that it's the
foundation of the paleo movement let's
try to recapitulate the environment of
our of our ancestors both
just in terms of other activities sleep
and exercise physical activity stress
but mostly the foods that we eat if we
can
emulate what our our genome expects
we'll have better health
all right so it's a good transition to
the love diet which you describe in the
book so walk us through what does luv
stand for
how do we get
that match re-lined up
again
let's say that diet is
one of the biggest players and i think
perhaps the most important
so love means lower uric values and it's
the diet that we constructed
that can be
used as a lens through which you could
look at your dietary preferences or your
dietary dogma if you will whether it's
keto
vegan
paleo
all of those diets and others
can be adapted to be more conducive to
lowering your uric acid values
it means as things that we've talked
about
being very cognizant of purines of
alcohol specific types of alcohol
and certainly
when you recognize that 70 of the
manufactured foods in america today in
other words if it has a barcode and it's
in the grocery store it has added
sweetener 70 percent do and by and large
that comes from
high fructose there's the villain
corn syrup that we subsidize to the tune
of 500 billion dollars a year
so um
it's time to call that out
i wrote a an op-ed it was an open letter
to pr president biden
february 21st of this year with dr casey
means
uh saying that you know these um
nutrition recommendations that last for
five years for the united states that
are put out uh by the usda
allow
indicate that ten percent of our
daily calories coming from sugar is okay
i wouldn't say there's no science that
would support that but ninety-nine
percent of the science uh that was
provided to the review committee for
that
dogma or that doctrine
said that's way too much that six
percent should come or less from sugar
so our hope was that we could get some
new language that would rewrite you know
that uh
that five-year recommendation but how
many people do you think steer by the
recommendation
a lot really oh my gosh like people
actually pick up the box and they say
military no no i'm talking about in
terms of uh government influence at the
military in schools and federal uh food
programs they say 10 they you know then
they're therefore these foods that are
manufactured they have all this added
sugar
fair game
that's and what does that do it creates
the very illnesses that are bankrupting
our health care system
so that don't make no sense to me no it
does not
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all right guys take care and be
legendary
okay so uh i'm guessing that that hasn't
been adopted that we're still at 10
um so we've got sugar hiding everywhere
what are things that are high in purines
that we should be paying attention to
um
like one one thing i definitely want to
talk about is red meat um but where else
are we gonna find like if we know that
dna and rna is in everything then
i don't even understand to be honest how
some things are higher or lower but it
has to do with the cellularity and the
concentration the more cells it has as
opposed to other
things give me a dense cellular one
dense cellular one be a like a small
fish like a sardine or an anchovy is
more really dense lots of cells
well let's just stay with uh meat or
animal products for one side we'll get
to that in a second uh as opposed to
chicken or really yes the space between
the cells is the space between it's that
density it's the uh the real cellularity
of uh organ meat for example liver and
kidney very high in purines so they will
they're directly involved in their
metabolism breakdown of the dna and rna
then to make uh uric acid but it doesn't
necessarily mean
as we segue to fruits and vegetables
that all foods neces who that are high
in purines are going to raise uric acid
so that's a bit of a disconnect that we
finally have massaged into being
meaningful because
for years well for years it was
foods high in purines if you have gout
stay away from them because we know
purines make uric acid we know high in
uric acid
is the cause of gout what is gel so gout
is the
extracellular
crystallization of uric acid where uric
acid is so high that it finally
precipitates out it's like
making rock candy have you ever made
rock candy i haven't in the day all
right well how you make rock candy is
you
have a solution of sugar and you heat it
and it because it's hot you can dilute
more sugar and then as it cools if you
have a thread in there it'll crystallize
on the thread you pull it out and you've
got rock candy i mean you're eating
sugar there's nothing else there right
anyway so things precipitate out when
their concentration is really high i've
seen it like on people's elbows and
stuff it's toast crazy and it
crystallized why it picks the grapes
rake through the skin can
they can open up and be hugely painful
and in fact you know we humans are not
the only animals at risk for that other
animals that have high uric acid like
reptiles and birds uh
t-rex uh sue the t-rex
had uh gout in her fossilized skeleton
but wait in in such a natural
environment how are they ending up
getting out they're just eating things
that are too they're eating other
lizards and they're just too high in
who can say i mean i don't think
we know exactly what t-rex ate but you
know it looks based upon teeth and short
digestive tract that they ate meat you
know they were these you know prototypic
carnivores and as such were at higher
risk for gout segways back to us as
humans
so
it doesn't mean that people who eat a
lot of meat are necessarily going to get
gout and may not even have a high level
of uric acid but it takes us to a place
it really depends on the person so
therefore you want to check your uric
acid but here's how do you check your
uric acid it's a blood test and over the
counter
yes
that's the good news but most people
have already had their uric acid checked
it's part of your annual blood test and
you could call your doctor say what's my
uric acid and she or he would say well
it's either normal or not if it's above
seven it's abnormal it's out of the
normal range and below seven you're in
the clear but understand tom this is
only in the context of gout
not metabolic health
so for metabolic health we want it not
in the normal range in
the optimal health which is range 5.5 or
lower
that's what the research indicates
is the cutoff uh in terms of
cardiometabolic issues so
having higher uric acid levels
one interesting study published in 2009
looked at 42 000 men 48 000 women
followed them for eight years
those who had the highest level of uric
acid had a 16 increased risk of
all-cause mortality becoming a dead
person for any reason whatsoever that's
what the term means cardiovascular
mortality 38
why might that be we talked about nitric
oxide we talked about blood flow we
talked about inflammation of the
arteries for example
stroke risk death from stroke 35
increased risk and here's an interesting
part of that study i thought
for people looking at their values
for every point of uric acid elevation
over seven
uh all cause mortality increased eight
to thirteen percent oh god so at eight
at nine at 10 you know you see people
with a uric acid level of 11. oh
that's a big big study the other thing
this study showed which i thought was
really quite interesting
they concluded that one-fourth of all
uh type 2 diabetes was a consequence of
elevated uric acid
okay so hold on let's the the cause
thing i want to
really put a fine point on that so
the cause of type 2 diabetes is the over
consumption of sugar i would assume
which leads to elevation in
uric acid not that the elevation of uric
acid is the cause of type 2 type 2
diabetes or are you saying no no that's
exactly what's happening if you over
consume the sugar but it was handled
appropriately and i could artificially
depress your uric acid you actually
wouldn't end up with type 2 diabetes
that study has actually been done in
both rodents and in humans and here's
how the study worked
uh dr richard johnson university of
colorado who i dedicated the book to
did research with laboratory rice
animals rats if you want to make them
diabetic and hypertensive you give them
fructose you put fructose into their
drinking water
and if you leave them alone they develop
these problems and they gain weight
if you give them a drug which is a gout
drug called allopurinol they still drink
the fructose but now you've done what
you've blocked uric acid production they
don't get these metabolisms do they
urinate it out uh it actually it's
metabolized into other things you know
normally if we have a functioning
uricase enzyme we will then metabolize
uric acid into another product called
alantoin but in this case they uh it
simply gets recycled and is used as a
building block for other things even um
dna and rna so it can re it can go into
those those pools he did the study in
humans as well
he gave them high fructose diet and gave
them this medication called allopurinol
which blocks
uric acid production and lo and behold
had the same effects so my point is that
it's that's the the study that you
wanted to know because you're saying i'm
eating a lot of fructose if i don't make
uric acid
i'm good now i'm not suggesting
therefore eat a lot of fructose i'll
tell you something even more exciting
the first enzyme in the metabolism of
fructose is called fructokinase
you're and that takes it ultimately down
to uric acid uric acid feeds back and
you would think would then would shut
off fructokinase it actually enhances
fructokinase activity this becomes a
feed forward process which is what you'd
want if you're going to get ready to
starve
there are now uh drug there's one drug
company and that is working on a drug to
block
fructokinase so we don't metabolize
fructose where it goes is anyone's guess
but it's not going to go on to form uric
acid so that's going to be could be a
powerful tool
in terms of obesity
so
let me finish one of the thought and
that is
i'm certainly not suggesting that people
then take a gout drug
but i will say that there are several
bioflavonoids that act in a similar way
to inhibit the
final step enzyme for the production of
uric acid for example quercetin
quercetin works just like aloperinol
um
uh luteolin is another bioflavonoid that
works
as well as in one study aloperinol to
block uric acid production
so
to get back to an earlier question then
so you follow your uric acid at home
with a home monitor that you can buy on
amazon much as you might follow your own
blood sugar i did not expect that answer
about i honestly thought you misspoke in
terms of causation of time oh it is
causation because it was a survival
mechanism we wanted we needed to become
diabetic
what we had to become diabetic to raise
our blood sugar to power the brain
so insulin resistance was cool and hold
on why would that need to be true if we
can pull the energy out of our fat
stores
use it even as ketones the brain can
metabolize ketones i know it prefers
glucose but why would we have to
because it seems so transient we can't
store it in the bloodstream long enough
for that to be meaningful right i mean
isn't that the whole idea behind fat
storage is it's a much more it is you
know
you have to consider that these are not
animals that are getting fat
they're just getting a little bit fatter
than the neighbor who doesn't have that
genetic
issue to have the uric acid so it's not
like these primate uh you know our
primary ancestors were getting fat and
laying around with big rolls of fat they
just had a tiny bit more fat so their
ability to tap into that fat source and
and then create ketone bodies to power
their brains
was something they had but only as long
as they had the fat reserves ultimately
they would need the ability to also
provide glucose at least in the short
run
uh to their brains by virtue of being a
little bit insulin resistant so let me
let me see full on diabetic but at least
a little bit more insulin resistant to
raise that blood sugar to power that
brain okay so let me say it in a
different way
that
every year
in winter
we had a cycle get triggered where we
would become slightly
diabetic
meaning
that our body
made it harder uric acid made it harder
for the normal mechanisms to pull the
blood sugar out of the bloodstream and
store it away exactly which meant that
it was available in circulating supply
we ran hot if you will of just there was
slightly elevated levels of sugar in our
blood and it becomes sort of a
second storage location in fact
is it the only storage location for
sugar you can store some in your liver
right you can store some of your muscles
but it doesn't come back out into
circulating supply right and you could
store some in your kidney
interesting that one you mentioned
earlier but i'd never heard that before
yes so if we get all these sort of
little nooks and crannies where
we are now storing sugar
for that period of the year and then
presumably we would come back out of
that as we got out of the fruit season
we made it through the winter
and now things would theoretically
normalize
that's right but remember
that
we can with that blood sugar we can then
trigger the
manufacturing again of fructose
even though we haven't consumed fructose
we can manufacture it from fat or from
are we gonna have to break down wheat
from sugar from glucose itself i think
that what that fructose is doing is in
keeping this whole cascade alive where
it's not just making fat but locking it
up storing it
keeping it you know guarding it it's
precious because that's at the end of
the day that's our last fuel source you
know you're going to go through your
glycogen ultimately if you have no food
whatsoever the other thing interestingly
is
as we metabolize fat as any animal
metabolizes fat we make water
so this is a powerful hedge against
dehydration as well
we make one gram of water for every gram
of fat that we metabolize
you know it's a pretty interesting
concept that it's a it's a hedge against
dehydration as well
i mean you know whales don't drink water
they make their own water from the fat
that's why they're so one of the reasons
they're so fat you know in animals that
live in the desert when there is fruit
available they'll eat that fruit make
fat as a storage
depot from which their bodies will make
water
whoa
this is far more interesting than
i would have thought it's a it's a
really fascinating mechanism i've never
heard anybody talk about this before
um okay i want to talk about red meat so
i eat a lot of red meat i've never
tested my uric acid levels so i'll be
very curious to get one of these i'm
going to send you one that would be
amazing i will send you one
and i ask because
i feel amazing
and i
though don't know if i'm killing myself
slowly so
uh hey every time i go to like get off
of red meat and eat higher
vegetable diet because i do eat
vegetables
i don't feel as good and i could just be
doing it poorly i'm fully
open to that but i am super curious
is it all red
meat why do we have to worry about red
meat like what's the the knock-on effect
as it relates to well there are many
things to talk about as it relates to
eating red meat that you've had
other people talk about and i i want to
focus on in the context of uric acid i
eat red meat myself
and you want to be sure you're eating
quality meat and if you eat poultry and
certainly if you eat fish
but that said
it's not uh beyond the quality then it
would be a quantity issue now you may
through your metabolism uh be able to
tolerate more
red meat or other uh animal products
but you would want to know your uric
acid levels so it it's
as you would know how much you could
tolerate in terms of carbs by virtue of
using your continuous glucose monitor
this is yet another biofeedback
mechanism whereby you're going to
understand
how your diet is influencing your uric
acid level by virtue of how much meat
you consume so yes certain meats are
worse than others the organ meats
the smaller fish etc and
but it's beyond purines i mean there are
other things to consider that you've
already considered that said there are
vegetables certain vegetables that are
fairly high in purines
like cruciferous vegetables for example
but again they are buffered by the fiber
content by the bioflavonoids like i
mentioned quercetin red onions really
high in in question a great food onions
and a crew surface to help lower uric
acid and the vitamin c part of that
equation as well so
how do those lower uric acid well the
vitamin c does so because it enhances
uric acid excretion from the kidney the
quercetin
and other bioflavonoids act like the
uric acid lowering drug they act like
the aloe vera enzyme the final enzyme uh
the xanthine oxidates if you will that
is involved in creating the uric acid
and then again the fiber in vegetables
if because they will contain some
fructose slows the release of that
fructose into your body so you don't get
like you would get from drinking a glass
of fruit juice
bad idea so
one in the book you talk
more than just about food you talk about
getting out into nature and things like
that so
paint a picture for me of the
ideal life i know we're trying to match
back to our genetics and what that looks
like
why does going outside matter
what is the ideal diet
and i assume it's going to be different
for everybody and do we just steer by
glucose and uric acid or is there some i
mean there are a lot of things we look
at
in uh trying to cultivate what is that
perfect
diet for tom
and i think to embrace embrace that
notion is really very helpful
the you know one size fits all just is
is really inappropriate your heritage is
different
your preferences are different there are
some broad strokes we know that
manufactured foods
foods that contain added sugars etc are
things to be avoided
but you know the nuances that you could
look at in terms of
how is this playing out in my body i
think are really quite valuable hence
the value of continuous glucose
monitoring of knowing your uric acid
levels of you know looking at other
parameters that that might be influenced
by not just that but your other
lifestyle interventions by knowing how
well
how well and how long you are sleeping
these are all extremely valuable inputs
for every individual to know and and
clearly
you know what's going to be best for you
will be somewhat different than for me
so for people that come out and say you
know everybody's got to eat this
particular way or it's your blood type
or whatever it may be
i think to be fair
in this day and age we know that people
are different but
i will say that it's quite clear that
of humans alive today or who have ever
lived
have this genetic issue with the uric
ace enzyme cannot break down
uric acid and therefore the uric acid
levels of humans is four to five times
higher than other mammals except for
primates number one
and number two that uric acid levels are
climbing
in lockstep with fructose consumption in
the 1920s average uric acid level in
americans was about 3.5 it's now six
so we're seeing this happen
as expected once you understand you know
where the uric acid is coming there's
such thing as too low
it's a really good question
there is some suggestion that uric acid
because it might act as an antioxidant
to some degree
would be threatening if it was really
low but i think when we see a
correlation
for example in elderly people with
very very low uric acids and risk for
degenerative conditions
it's probably because
it's a an effect not the cause meaning
they're already sick and cachectic
they've lost muscle mass because they
have no more muscle mass they're not
able to
keep their uric acid levels up because
they're not breaking down any more
muscle which would liberate the purines
so you know this is all about then
looking at those dietary tweaks as your
uric acid levels
are examined over time to keep your uric
acid level in check and the ultimate
goal
of the book is that missing link that so
many people with
borderline diabetes or frank diabetes
mild elevation of blood sugar or can't
lose that last 20 pounds and are doing
everything they possibly can darn it i'm
doing everything i can there's got to be
something else this may be that
something else maybe that missing link
and
truthfully
as we've described it it's not going to
be that hard to get your uric acid level
back where it needs to be and we're
going to do it just by changing our diet
we're going to stop eating fructose
and
japan
is leading the charge
they are intervening with patients who
have metabolic conditions to lower their
uric acid america isn't doing that yet
they're targeting uric acid only if you
have gout
the notion of what we call asymptomatic
hyperuricemia means you have a very high
uric acid but you don't have gout so you
don't have any symptoms
no
you're at great risk for death from
cardiometabolic conditions that's what
the research is telling us you have a
dramatic increased risk for alzheimer's
and dementia in general
so they're kind of leading the charge to
the extent that japan is now producing
no purine beer
beer that has zero purines
to help you with your uric acid way
ahead on this yeah they are well you
know
we in america tend to think we're you
know we're leading the charge and in so
many areas you know renewable energy so
many areas we see when you look at what
the rest of the world is doing we can
learn from from the rest of the world
and as it relates to uric acid which is
a global problem
we see that other even turkey other
countries are really
moving ahead and recognizing that when
you have this information
it is the harbinger for future metabolic
issues
and it's predictive high uric acid is
predictive of hypertension of insulin
resistance elevated blood sugar
therefore diabetes inflammation
oxidative stress all of those mechanisms
that underlie the things that you don't
want to get
so you know john kennedy said that
the time to fix the roof is when the sun
is shining and you know that's the hope
with
it's not the end all but it's it's going
to be
a powerful addition
to our toolbox yes
keeping blood sugar under control yes
getting adequate exercise watching what
you eat controlling your stress getting
enough sleep wearing a wearable device
to look at your sleep
all these things are really important
this um
is now going to be looked at as a
strategic metabolic marker right there
with blood sugar and blood pressure and
and serum lipids i think you're gonna
see uric acid uh very soon uh being on
par with those is uric acid volatile so
when i think about wearing a continuous
glucose monitor the fun is that it's
moving around right so if i have not as
volatile as moment-to-moment blood sugar
measurements but it'll change within a
day
and
you know it'll go up if you exercise in
a way that you're not used to and
therefore break down a lot of muscle
fiber that will transiently raise your
uric acid level as will fasting in the
short run fasting will raise it we'll
raise it as well being in deep ketosis
why why
because you're catabolic you're breaking
down your tissue so liberating
experience theoretically is supposed to
be muscle sparing you even mentioned
that in the book right so if
it's muscle sparing
is it the release of fat
well it is mostly in when you get to the
point that you start breaking down
muscle
so it's mostly the breaking down of
muscle but also to some degree other
cellular components that will liberate
the the nucleus of the cell therefore
spill out the nucleic acids the dna and
the rna that will be broken down into
periods
thing to think about in terms of fasting
is even if it's an intermittent fast
uh that you will transitionally raise
your uric acid level
when it's done
your net positive in a better place
365 days a year
in terms of time restricted eating yes
okay uh there's not a huge amount of
data the studies look at
more of the people who will fast for a
day or two or three or even longer but
that ultimately the time restricted
eating is
so beneficial for your metabolism that
we included a chapter in the book on
that notion i mean
we've known that for a couple of years
and dr sachin panda
even recently has indicated that this
time restricted eating is one of the
most powerful things we can do to
improve our metabolism so
we're all in on that we talk about
continuous glucose monitoring as well
it's all about gaining this information
and then when you have it
having somebody tell you okay what
should i do with this information
dude this book is amazing where can
people follow along with you where can
they get the book so i'm dr
perlmutter.com and that's
pretty much a clearinghouse
drpromoter.com for
all the content uh
so much every article that we talk about
in the book is there in full pdf form on
all my blogs and this is uh
dropassedbook.com
love it man it's really fantastic uh
guys you are not going to regret reading
the book i cannot believe how
interesting it made the whole subject
and how important it seems like it is
i'm now obsessed i'm going to be
checking my uric acid levels and
speaking of things you should be
checking if you haven't already be sure
to subscribe and until next time my
friends be legendary take care peace
you