THIS CAUSES DISEASE - The Worst Foods You Need To AVOID At All Costs! | Dr. David Perlmutter

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 Perlmutter, 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're 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 health. this back on your radar? Or on your radar, actually. Um I was running one day and I was listening to a podcast from Peter Attia and he interviewed a Dr. Richard Johnson at the 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, uh 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, they're They're 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, this And the cytokine drizzle is a response to eating pro-inflammatory foods? Not just eating pro-inflammatory foods, but anything uh the answer is yes, but not just. Uh anything that increases inflammation, not getting enough sleep, uh engaged in stressful activities, a disturbed gut bacteria setting 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 Rome of inflammation and set the stage for things like Alzheimer's and coronary artery disease. And because of that it's uh the reason that a monotherapy or a one drug approach to Alzheimer's, for example, uh 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 it you know, uh we'll we'll 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." cuz you've moved super quickly into getting a book out. You said you wanted 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 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 COVID. It began. So, people say, "Well, because of COVID, 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 COVID. They're tracking that? Yeah, that's that's 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 vent, 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, uh and the bodies of other animals, of only three things: alcohol, uh, 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 of The Lancet that fructose is a player. It is a big player, and yet we were told that because fructose doesn't cause insulin to be uh, secreted and doesn't need insulin uh, to be metabolized, therefore it was a safer sugar. Mhm. And, um, 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 better? 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? Uh, 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, the the story, you know, everyone everything's been compartmentalized, but now we know that it's a lot a lot bigger story. We know that glucose can become fructose. High glucose levels, especially when blood turn into can become fructose through the use through the body's use of a an enzyme called aldose reductase. That is enhanced when serum sodium is higher. So, higher levels of salt leads the body to know that it is in it's getting ready for famine. Or water restriction. Make more salt. It actually create we 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 it comes from. So, what is it about the natural appearance of fruit that warns cuz fruit's what, spring, right? Or summer? Fall. It's fruits fall? Late summer and That's what happens when you live in LA. Late summer and early fall. That's when it ripens. Traditionally for our ancestors, I mean now you have fruit 360, right? Yeah, like I literally have no idea what's natural. 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 passed 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 um higher blood sugar and insulin resistance and all those terrible metabolic things that we're doing our damndest 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 or restoratively and and therefore uric acid is increasing and worsening our metabolism and leading to this host of diseases that we talked about. Hope you enjoyed the episode brought to you by our sponsor Ombre Labs. For $30 off your at-home gut health test, go to tryombre.com/impact. Enjoy the episode. 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 a 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, you're 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 your uric acid like tart cherries. Hence, the O in the book cover. See the O? I do indeed. It's the falling cherry. Nicely done. So, okay. So, we're intaking 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 uh double-click on something I think is really interesting vis-à-vis 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. Uh 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. Uh one of them is Viagra as an as a matter of fact. There's a time and a place when you a person might need Not you. A person might need uh more blood supply for erectile dysfunction. Uh 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 uh, reduction in the formation of what's called tau 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% increased 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 because of the elevated presence of uric acid. And important I think a lot of people get the nitric oxide blood supply uh, relationship. But the 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 a 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. does it interface with insulin? Because we need nitric oxide for two things. How insulin is able to get through the blood vessel into 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 function to pull that off. uh, 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. Uh that's really interesting. It's really interesting. It's 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 uh to allow uh glucose to get into the brain to power the 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. 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 were, you know, were were 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 uricase 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 molecule 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 cuz 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 you talked about it before. And I I 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 and eat enough limes 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 um this oxidative stress triggers fat production, which was a good thing. It's again fat production a good thing, being coming 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 a 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, um 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 um encouraging. You know, it was resoundly 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 4% 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 100% genetic. As is type 2 diabetes. I would say it's 100% genetic, and you're looking at me saying, "W- 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, uh 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 something 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 uh disease in that context of the mismatch. And we're living then with physiology and and a body, a machine uh that is uh 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 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 you know, it's the foundation of the paleo movement. Let's try to recapitulate the environment of our of our ancestors both uh 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 LUV 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 uh let's say that diet is one of the biggest players and I think perhaps the most important. Um so, LUV means lower uric values and it's the diet that we constructed that can be um 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 uh can be adapted to be more conducive to lowering your uric acid values. Uh 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% do. And by and large, that comes from high fructose, there's the villain, uh corn syrup that we subsidize to the tune of $500 a year. So, um it's time to call that out. Uh uh I wrote a an op-ed, it was an open letter to President Biden uh February 21st of this year with Dr. Casey Means uh saying that, you know, these um uh nutrition recommendations that last for 5 years for the United States that are put out uh by the USDA allow uh indicate that 10% of our daily calories coming from sugar is okay. There I wouldn't say there's no science that would support that, but 99% of the science uh that was provided to the review committee for that dogma or that doctrine said that's way too much. That 6% 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 5-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 start reading it. No, no, no. I'm talking about in terms of uh government influence, that the military and schools and federal uh food programs. They say 10%, they you know, then they're therefore these foods that are manufactured that have all this added sugar fair game. Oof. 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. Let's talk about Ombre Labs. Did you know that your gut is related to so many health issues? Trouble focusing, bloating, constipation, maintaining a healthy weight, and skin blemishes like acne and eczema. And when gut health is poor, it can directly contribute to these types of health concerns. My wife Lisa has struggled with gut problems, so I know exactly how troublesome this can be. Unfortunately, Lisa's not alone in this battle. One in five Americans are struggling with gut health issues. Thankfully, we can fix a lot of these issues with a better diet and the right probiotics. And Ombre Labs makes this process really simple by offering an at-home gut health test, so you can know the state of your gut health and what problems it may be causing. These aren't the one-size-fits-all probiotics you will find at the grocery store. These are personalized to you based on the results of the test. You go to tryombre.com/impact. That's tryombre.com/impact. Ombre Labs, again, tryombre.com. For $30 off your at-home gut health test. All right, guys. Take care and be legendary. Okay, so I'm guessing that that hasn't been adopted, that we're still at 10%. 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 going to find like if we know that DNA and RNA is in everything, then I I don't even understand, to be honest, how some things are higher or lower. It has to do with the cellularity and the concentration. The more cells it has as opposed to other Give me a dense cellular one and a Dense cellular one be a like a small fish like a sardine or an anchovy. Is more than an apple. Well, it's just say with it meat or animal products for one sec. We'll get to that in a second. Uh as opposed to chicken or Really? Just the space between the cells is different. 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 uh 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 What is gout? So, gout is the extracellular crystallization of uric acid where uric acid is so high that it finally precipitates out. It's like um making rock candy. Have you ever made rock candy I have in the day? All right. Well, how you make rock candy is uh 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 and 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. it like on people's elbows and stuff. It's crazy. And it crystallizes. Why it picks the great toe, who knows? through the skin? Can. They can open up and be hugely painful. 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 gout? They're just eating things that are too They're eating other lizards and they're just too high in 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, prototypical carnivores and as such were at higher risk for gout. Segues 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. Mhm. 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. Okay. That's what the research indicates uh 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 8 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. Uh stroke risk, death from stroke, 35% increased risk. And here's an interesting part of that study I thought um for people looking at their values. For every point of uric acid elevation over seven uh all-cause mortality increased 8 to 13%. Oh god. So at eight at nine, at 10, you know, you see people with a uric acid level of 11. Ooh. That's a big big study. The other thing the study showed, which I thought was really quite interesting, they concluded that 1/4 of all uh type 2 diabetes was a consequence of elevated uric acid. What? Okay, so hold on. Let's the the cause thing. I want to really put a fine point on that. So uh the cause of type 2 diabetes is the overconsumption of sugar, I would assume, which leads to elevation in uric acid, not that the elevation of uric acid is the cause of type two type two diabetes. Or are you saying, "No, no, no, that's exactly what's happening. If you overconsume 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, uh who I dedicated the book to, uh did research with laboratory um animals, rats. If you want to make them diabetic and hypertensive, you give them fructose. You put fructose in 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 metabolic go? Do they urinate it out? Uh it actually is metabolized into other things. You know, normally, if we have a functioning uricase enzyme, we will then metabolize uric acid into another product called allantoin. But in this case, they they it simply gets recycled and is used as a building block for other things, even 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 effect. 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 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 other thought, and that is I'm 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 allopurinol. Um Um luteolin is another bioflavonoid that works as well as in one study allopurinol to block uric acid production. So, um 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 type two 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 a good thing. 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 cuz 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 stable long-term energy uh you have to consider that these are not animals that are getting fat. Mhm. They're just getting a little bit fatter than the neighbor who doesn't have that genetic issue to have the uricase. So, it's not like these primate in know, primate 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 insulin resistant. So, let me let me say diabetic, Yeah. 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. Mhm. 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 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 in your muscles, but it doesn't come back out into circulating supply, right? And you can 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, uh, that uh, 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 going to have to break down muscle? We from sugar, from glucose itself. And I think that what that fructose is doing is in keeping this whole cascade alive where we're 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 1 g of water for every gram of fat that we metabolize. So, you know, it's a pretty interesting uh 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, and animals that live in the desert, when there is fruit available, they'll eat that fruit, make fat as a storage depot to from which their bodies will make water. Whoa. This is far more interesting than I would have thought. It's uh 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 tests. 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, I every time I go to like get off of red meat and eat higher vegetable diet cuz I do eat vegetables. Um I don't feel as good. And I could just be doing it poorly. I'm fully um 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 uric 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. Uh and you want to be sure you're eating quality meat. And if you eat poultry and certainly if you eat fish. Uh 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 uh red meat or other uh animal products. Uh but you would want to know your uric acid level. 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, uh 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. The cruciferous vegetable, for example. But again, they are buffered by the fiber content, by the bioflavonoids. Like I mentioned, quercetin. Red onions really high in in quercetin. A great food, onions and the a cruciferous to help lower uric acid and the vitamin C part of that equation as well, So, how Sorry, 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 allopurinol. The final enzyme. The final enzyme, the xanthine oxidase, 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 in 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 other No, I mean there are a lot of things we look at in trying to cultivate what is that perfect diet for Tom. And I think to embrace embrace that notion is really very helpful. Um 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 100% of humans alive today or who have ever lived have this genetic issue with the uricase 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 from. 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 lb, and they're 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 um truthfully, uh 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. Yep. Um and J- Japan uh 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. Um 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. Right. 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. on this. Yeah, they are. Well, you know, it we in America tend to think we're we 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, uh we see that other even Turkey, I mean other countries are really uh 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 um and 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 a strategic metabolic marker right there with blood sugar and blood pressure and and serum lipids. I think you're going to 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 uh 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. Will raise it as will being in deep ketosis. Why would it raise it? Because you're catabolic, you're breaking down your tissue. You're liberating purines. Theoretically, it's 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 the nucleus of the cell, therefore spill out the nucleic acids, the DNA and the RNA that will be broken down into purines. Thing to think about in terms of fasting is even if it's an intermittent fast, that you will transiently raise your uric acid level. When it's done, you're a net positive. In a better place. The uric acid is slightly better. days a year. In terms of time restricted eating. Yes. Okay. 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 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. Satchin 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. Um 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 drperlmutter.com and that's pretty much a clearinghouse, drperlmutter.com for all the content. So much every article that we talk about in the book is there in full PDF form. And all my blogs. And this is, uh, dropacidbook.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 that you should be checking, if you haven't already, be sure to subscribe. And until next time, my friends, be legendary. Take care. Peace.