The Role of Uric Acid on Diabetes and Chronic Diseases (It’s Not Just about Gout)
I listened to a great podcast featuring Dr. David Perlmutter’s new book. He is a board-certified neurologist and five times New York Times bestseller including the well-known “Grain Brain”. The new book was released in Feb 2022 and called “Drop Acid” which is NOT about LSD but refers to the role that uric acid plays in the development of diabetes and other chronic conditions.
Here’s a summary of the podcast interview:
- Up to 88% of Americans are metabolically unhealthy, with at least one component of metabolic syndrome like high blood sugar, insulin resistance, hypertension, obesity, cardiac disease and even Alzheimer’s. It was very eye-opening to learn about how uric acid plays a critical function on the development of chronic conditions.
- Uric acid is measured in blood and typically associated with gout BUT it’s also an important marker for metabolic conditions.
- In an 8-year study, it was found that all-cause mortality was dramatically increased with high levels of uric acid. For example, heart disease and stroke related mortality was 35-40% due to high levels of uric acid.
- Uric acid levels are easy to check during an annual check-up. Ideal level should be 5.5 mg/deciliter or below. For every point above 7, there is an 8-13% increased risk of all-cause mortality in addition to gout.
- Uric acid is raised by 3 key factors: Alcohol, Purine and Fructose
- Wine has not been shown to raise uric acid much; Hard liquor raises some but BEER raises it a lot. Why? Beer contains purines from the brewer’s yeast so it’s a double whammy of alcohol AND purine to contribute to the beer belly
- Purines are from organ meat consumption but unless you’re eating a ton, it doesn’t raise the bar much
- Fructose is the elephant in the room!
- Unlike glucose, fructose is metabolized directly into uric acid. As fructose raises uric acid, weight, blood pressure and insulin all go up. An interesting study showed that if you give the gout drug (allopurinol) to participants eating a lot of fructose, their uric acid levels drop.
- Fructose means energy storage whereas glucose means energy utilization. That’s why bears eat a ton of fruit during the summer so they can store fat for hibernation in the winter.
- Fructose in the form of fruit is okay because it’s a whole food and not processed. It has fiber, vitamins and antioxidants. However, modern fruit has been hybridized for ultra sweetness so an apple a day is fine but that doesn’t mean a half dozen…
- 60% of the food in the store with a bar code has been sweetened with high fructose corn syrup (HFCS) or some derivative of it. Our bodies are designed to seek out sweet food for our survival. Were you aware that the US gov’t sponsors corn production to the tune of ~$500B/year and a lot of that goes into making HFCS which then makes us fat and sick?
- When you eat fructose like HFCS, you are turning on gluco-neogenesis (body makes glucose), compromising insulin functionality and setting the stage for diabetes. Fructose inhibits leptin sensitivity (hunger suppressing hormone) which makes us want to keep eating and contributes to weight gain. Fructose also requires energy for it to be absorbed and uses up all the ATP (energy cells) in the gut. The uric acid enhances inflammatory bacteria and increases gut permeability leading to leaky gut syndrome.
- There are also medications that increase uric acid: Aspirin, diuretics, proton pump inhibitors, acid blockers, beta blockers and even the sugar substitute xylitol.
What to do?
- First, get your uric acid levels checked. You can ask your physician or buy a test kit on Amazon: Here’s one to try.
How to Reduce Uric Acid
- Eat a mostly plant-based, high fiber, high color diet. It’s better for you and your bacteria.
- Limit fruit and do NOT drink fruit juice as it’s a concentrated form of fructose. I stopped buying green drinks at the grocery store because they contain fruit juices to make it palatable to most of us. If you drink juice, stick to vegetable juice only (which is hard to find).
- Shellfish, anchovies and organ meats are rich sources of purine – it’s hard to eat a pound of anchovies in one sitting so no worries as long as everything is enjoyed in moderation.
- Alcohol, especially BEER, should be avoided except for an occasional glass of wine (and I mean occasional, not every other day occasional!)
- Coffee is a great drink for lowering uric acid.
- Vegetables like broccoli have higher levels of purine BUT it is rich in fiber, bioflavonoids and vitamin C so enjoy to your heart’s content.
- Minimize consumption of refined grains like flour – flour elevates insulin and this increases uric acid by inhibiting its excretion in the kidneys.
- Supplements that Dr. Perlmutter suggests to lower uric acid include:
- Quercetin (500mg/day) is a powerful antioxidant, anti-inflammatory bioflavonoid and is present in foods like onions.
- Vitamin C (1000mg/day) aids in the excretion of uric acid.
- Luteolin (100 mg/day) also lowers uric acid and is on par with the gout drug allopurinol!
- DHA (1000mg/day) present in fish oil offsets the damage of uric acid.
- Tart cherry extract can also bring down uric acid.
It has been estimated that 25% of the western world has elevated uric acid so it’s important to get our levels checked so we’re not part of this statistic.