ATHE_Transcript_Ep 587_Dr. David Perlmutter
JJ Virgin: [00:00:00] I'm JJ Virgin, PhD dropout, sorry mom, turned four time New York Times best selling author. Yes, I'm a certified nutrition specialist, fitness hall of famer, and I speak at health conferences and trainings around the globe, but I'm driven by my insatiable curiosity and love of science to keep asking questions, digging for answers, and sharing the information I uncover with as many people as I can, and that's why I created the Well Beyond 40 Podcast.
To synthesize and simplify the science of health into actionable strategies to help you thrive. In each episode, we'll talk about what's working in the world of wellness, from personalized nutrition and healing your metabolism, to healthy aging and prescriptive fitness. Join me on the journey to better health so you can love how you look and feel right now and have the energy to play full out.
I have such a crowd [00:01:00] pleaser with me today. I've got my buddy, Dr. David Perlmutter. When I think about being well beyond 40 and for me, it's really, what do I want to be doing in my 70's, 80's, 100's? And one of the things I'm going to be doing is hanging out with Dr. David Perlmutter and his wife Lise, who we've gotten to know really well, and they're just phenomenal people. And what we're going to be talking about today really ties right into that, because The big idea of, of you've got to be metabolically healthy too, dot. Whether it is lose weight, have great brain function, be able to exercise, it all comes down to metabolic health.
And what we're going to be talking about today with uric acid really is like the, one of the first things that you can start to see issues with, that you can make a change with to impact your metabolic health so that all the other issues you hear won't be a problem. Let me tell you a little bit about Dr.
David Perlmutter. He's a board certified neurologist and a five times New York bestselling author. Number one on the New York Times with Grain [00:02:00] Brain. I think over a million copies of that now have been sold. He serves on the board of directors. And as a fellow of the American College of Nutrition, and again, is his book, Drop Acid.
We're going to be talking, we did a podcast on that. I'm going to link the podcast. I'm also going to link our other podcasts and the free ebook he has for you that I'm going to put at jjvirgin.com/uricacid, and also how to test your uric acid, how to get one of those little gadgets that are really inexpensive.
So you can do this. You know how much I love measuring and monitoring things so you can make a big shift. So you'll be able to get that as well. He wrote the book on this literally called Drop Acid. And what you're going to hear here, and if I was redoing my Overcoming Weight Loss Resistance seminar now, Uric acid would be right at the key here of things that you need to look at that can create weight loss resistance.
So I live in Florida near Dr. David Perlmutter and his [00:03:00] wife. He received his MD degree from the University of Miami. And he now lives over in Naples a lot of the year and then some of the year he's out on his boat and fishing. He has written tons. Besides all those books that he's got New York Times for, he's also written a bunch of research papers.
He's been published extensively in peer reviewed scientific journals, including the Archives of Neurology, Neurosurgery, and the Journal of Applied Nutrition. He lectures all over the place as well. Columbia. And Harvard and Scripps Institute, and most recently at one of the events that I helped host, which is the Transformation Leadership Council.
We had a ton of fun out in Mexico together, even did a sweat lodge. So cool. So I am super excited about bringing Dr. David Perlmutter back on the show. He also has an amazing podcast called the Empowering Neurologist Podcast. You'll definitely want to check that out. We'll put all of that again in the show notes at [00:04:00] jjvirgin.com/uricacid. All right. I will be right back with dr. David Perlmutter, stay with me.
Dr. David Perlmutter, welcome back. I'm so happy you're here.
Dr. David Perlmutter: I'm delighted, JJ. Spend time with you is always an honor. We've had a lot of good times lately in real life. I love just moving on.
JJ Virgin: That brings up the topic because here it really is.
You look at this and go, okay, I'm about to turn 60 here. The counting days down. And I think this thing flips where you go, okay, what do I need to do now so that I can continue having the fun that I'm having now at 70, 80, 90, a hundred? And who do I want to have that fun with? That's really where I'm taking this podcast with the new title, Well Beyond 40 is what are the things that we need to do now to ensure that we can be living our best life into our seventies, eighties, nineties, a hundred, like my mom golfing at 93.
Like you've done so much great groundbreaking work over the years, but I especially [00:05:00] love all of this information now digging into uric acid because I feel like this has just been this little marker on a lab test that's basically been ignored.
Dr. David Perlmutter: It's true. And people are asking me, how did you get to be the guru of uric acid?
And I was thinking about that. I'm not the guru of uric acid. A guy named Richard Johnson, I think is.
JJ Virgin: I love Rick Johnson.
Dr. David Perlmutter: He is, he gets the credit. In fact, I've dedicated my book to him. And he wrote a book about it and I wrote the foreword. So he gets the credit and briefly how that happened was I was running one day and I was listening to a podcast and he was on it and I was saying, well, this is amazing information about uric acid.
So I did twice my run because I didn't want it to stop. Anything dealing with metabolic health is going to be really interesting for me. Yes, as a neurologist, that may be is a stretch and we'll work through that in just a minute. But in general, when we look at why people are not well after 40, what is it that's bringing people down?[00:06:00]
It's basically, mostly, the metabolic, chronic, degenerative conditions. So we have to focus on metabolism. And we know that, well, blood sugar's important, insulin sensitivity, that's important, blood pressure control, our body weight, and even our blood lipids. These are all, you know, contributors to metabolic health.
There's a new sheriff in town. And it turns out it's uric acid, and maybe that's raising some eyebrows amongst your viewers, and it raised my eyebrows as well. Because we only learned about uric acid in the context of two things. That would be gout and kidney stones. And that was it. End of story, lecture over, here's the drugs, move on.
And brand new information lets us understand. That we have a new tool as it relates to metabolic health and that is controlling the uric acid. When I say brand new information, this only was published in 1898 by a Dr. Alexander Haig writing a book that said, yeah, uric acid is [00:07:00] elevated in people with gout, but there's a lot more to the story.
Until people like Richard Johnson, A, did the experimental work and B, began to review the literature that has been global over decades, we didn't really know that. And again, getting back to my original description. Anything for me and hopefully for your viewers that can impact positively our metabolic health is going to be interesting for me and valuable for everyone.
So that's how my interest began in this uric acid stuff that everybody's talking about now.
JJ Virgin: Let's start from the very beginning of it. Because again, I think for most people, it's you get your blood panel. It's not one of the things you look at. Unless it says high. And for most people, it's not going to say high.
So you'll see things in terms of these challenges with metabolic health. They might see their triglycerides high or their blood sugar high. Maybe they've got high blood pressure, but this one probably isn't one that they're going to have the indicator on the lab test, even though it [00:08:00] actually is indicating it.
The levels aren't right, I'm assuming, to show that there's an issue. First of all, what is it? And. Then, let's talk about what we really should be looking at here.
Dr. David Perlmutter: Sure. So, uric acid is what we call a metabolic product. It's the downstream product of how we metabolize certain chemicals in our bodies. The first chemical are called purines and these are derived from the breakdown of cells.
When we break down cells whether it's foods that we eat or our own tissue as we exercise for example, we liberate parts of the cells that contain DNA and RNA. DNA and RNA become purines and product is something called uric acid. There are two other inroads to the pathway. One is alcohol. When we consume alcohol, that is metabolized to uric acid.
And the last one is by far and away the most important and unfortunately most [00:09:00] neglected, and that is the fructose that is in our diet. Dietary fructose. It's a type of sugar. Yes, the name is derived from fruit sugar, fructose. But it doesn't mean that fruit itself is a threat, it's the fructose that's in more than 70% of the processed foods that we consume.
Either fructose, form of high fructose corn syrup, or a derivative. But also fructose in many of the beverages that we consume as well, even fruit juices. We had an interesting experience two days ago, my wife and I went out to breakfast. And a couple sat next to us, we were outside, beautiful day, nice and, it was windy and beautiful, and this couple sat down and, one thing led to another, we were talking about health.
And the woman said, we don't consume sugar at all.
JJ Virgin: And she's drinking juice. What would it just
Dr. David Perlmutter: 16 ounce glass of OJ, 36 grams of sugar, I might add. They each got for breakfast, French toast, maple syrup. And I think hers had Nutella and chocolates. I don't know, [00:10:00] but they don't eat sugar. No, there was confectioner's sugar on it as well, but they don't eat sugar.
We were talking, I said, do you ever have, you ever concerned about diabetes, it's so common. And they said, no, we have our blood sugar checked every year. The doctor hasn't said anything about it. You know, it's not like pregnancy, whether you is or you ain't right. It's a scale. It's an analog scale. But anyway, for another time, the underrepresented player in the uric acid story is.
Fructose. Fructose is metabolized to uric acid. It's a signal to your body to get ready for winter. Now, what do I mean by that? In our primate days and early ancestral days, we would consume fructose in the form of ripened fruit in the late summer and in the early fall. And that would cause our bodies to know That winter was coming and we had to make and store fat and it was a survival mechanism.
The way it works is uric [00:11:00] acid is the messenger molecule, turns down our mitochondria so we burn less energy and it stimulates fat production while it saves fat for fuel. Now, that was a survival mechanism in our primate ancestors and then early humans until quite recently allowed us to survive during times of food scarcity.
We generally don't expect to have food scarcity in our lives right now, and yet, day in and day out, by our consumption of fructose, we're triggering this mechanism that says, hey, become insulin resistant, raise your blood pressure, make fat, store fat. Don't burn fat, we'll ratchet down your energy utilization, because winter is coming.
What I mean by that, it's winter of when we don't have access to food. We have food. We don't need to be activating this mechanism. So, let's turn that signaling pathway off, or at least down, by getting our uric [00:12:00] acid level under control. And, job one, ask yourself how much fructose are you consuming? If you eat an apple a day, not a problem.
That's five grams of fructose. If you're drinking a 12 ounce glass of orange juice a day, that's 36 grams of sugar. That's like a Coke. Call it what it is. We love orange juice. I live in Florida, like you. You can't go out to breakfast where they're gonna sneak up behind you and pour you a glass of orange juice if you have your eyes open, but you tell them no.
Everybody says it's a natural food. No. Cartons of OJ don't grow on trees. They weren't there for our hunter gatherer forebears to gobble up and consume, whether it's Orange juice or apple juice or Mr. Pibb or whatever it is. We love it because it's sweet. We gravitate to sweet foods because it's our survival mechanism.
It makes us fatter, which is a survival mechanism, but not today. So it's a conflict between our genome and our body's physiology with our [00:13:00] current environment. It's an evolutionary, environmental. And that's, that's how it plays out. So we have to use our prefrontal cortex, our smarts and say, what is my uric acid level?
Number one, what did my doctor find? Or what do I know about my uric acid level? I tested it at home and now how do I fix it?
JJ Virgin: A couple of questions around this. You mentioned those people and you said the people dining next to you. Had other blood sugars looked fine. And as we chuckled, cause we know that story, your blood sugar looks fine until you hit that number that you can now be considered diabetic and get treated for it.
But there's the, you did not wake up one day diabetic. This was a process to get there. And there's signs all along the way that we don't look at, like fasting insulin, like doing an insulin glucose tolerance test, like looking at hemoglobin A1c, like wearing a CGM that would have showed you these things, or maybe a triglyceride HDL ratio.
Where does uric acid fall in looking at these things? Is [00:14:00] uric acid looking at the levels correctly, a good early predictor of challenges?
Dr. David Perlmutter: I don't know where you want to begin, but let's begin by looking at this over time. Let's look at a study that was carried out. In publishing the annals of rheumatic diseases where they took, I think it was 1200 individuals.
They followed them for 12 years. And at the beginning of the trial, actually 1600 people, they beginning of the trial, 12 years long, they measured their uric acid levels. And then every two years they would do a neurocognitive examination. In other words, how well is your brain working? And then they came back and after 12 years, some people probably moved away or whatever, but they still had a robust, they had 1600, they started with higher number and they wanted to compare their cognitive function with what was the original uric acid level at the time we began our study.
And what they found was really quite remarkable. In looking at [00:15:00] the highest group of uric acid compared to the lowest group, risk for dementia was increased about 80%, risk for Alzheimer's specifically was increased 55%, and risk for what is called mixed dementia or vascular dementia was increased. And in the highest uric acid group, 165%.
So my point is, this is predictive. This is looking forward as to what this uric acid level elevation in your body right now is going to set the stage for. There is similar data that looks at all aspects of the metabolic syndrome, whether it's hypertension or overweight or dyslipidemia and insulin resistance.
And there are just countless, what we call association. Studies, but we've seen elevated uric acid in association with diabetes and obesity and hypertension for an awful long time. In 2013, in a collaborative study between [00:16:00] researchers in Japan and Turkey, the title of their study was. Uric acid in metabolic syndrome from association to being a central player or from what they called an innocent bystander to a central player.
Meaning, yeah, we thought it was an innocent bystander. Just you happen to have high uric acid and you're hypertensive. But they began to tease apart the fact that no, it's causing the problem. And since that time, interventional trials have been carried out where. They take people who have metabolic syndrome, for example, and they put them on uric acid lowering drugs versus placebo.
And watch them improve. One study actually gave men metabolic syndrome by having them consume, who knew what, 200 grams of fructose a day. That sounds like an awful lot, but there are plenty of younger adults who are consuming that much. Yeah. What's that?
JJ Virgin: A couple of super big gulps or something? Yeah, I know.
Dr. David Perlmutter: And you're going to want more because [00:17:00] you left anyway. And what they found was in The non interventional group that didn't take the uric acid lowering drug, more than 50% had developed metabolic syndrome in two weeks. So the point is that, you know, we've seen the associations for an awful long time. Now we're seeing prospective studies and interventional trials that say, hey, This uric acid is far more than your grandfather's kidney stones or gout.
This is a central player, as the title of that study or paper called it, a central player in metabolic issues. It's mechanistically, it's causing issues. In my world, I've got to bring people's metabolism under control, not just because of The diabetes and the hypertension, but because it relates to risk for Alzheimer's, a disease for which we have no meaningful treatment whatsoever.
JJ Virgin: I just wonder now, like when you look at how they're [00:18:00] giving you the parameters for metabolic health with blood pressure, blood sugar, triglycerides, HDL, waist measurement, if they put uric acid in there. If we would be able to see this sooner. And so knowing that, because in the lab test, the range really is just, it's only indicating high, if you're really a kidney stones or gout risk, right?
Dr. David Perlmutter: That's right. That number is seven milligrams per deciliter. In other words. I went to my doctor and she told me that my uric acid is fine. Let's say that's the message you get. Let's dig a little deeper. Call back. What was the number? Again, the doctor said, fine. It's in the normal range. Yeah, it's in the range.
In range, right? Means you're average. Who wants to be average? If you want to be well beyond 40, average isn't going to cut it. Average health in America is not great. Let's face the music. We expect that by 2030, that's in the distant future, isn't it? 50% of American adults will be not just overweight, but obese.
[00:19:00] We have, right now, 86 million Americans either diabetic or pre diabetic. 90% of American adults is metabolically compromised, meaning only 10% of American adults is intact from a metabolic perspective. And we can do better. So we need to be not thinking of what's in the normal range, what's ideal. That number 7 in your uric acid test is the level above which, in most people, uric acid will precipitate into crystals.
These crystals are related to gout in your joints, but oddly enough, as fate would have it, new research shows that these crystals form in your coronary arteries and in your prostate gland. Crystals are not a good thing and beyond the metabolic signaling of uric acid. Even the crystal formation as they precipitate above a level of seven, that's a big deal.
High uric acid threatens kidney function, leads to hypertension through multitude of mechanisms. Maybe we'll have a chance to talk about that. The real question then [00:20:00] becomes, all right, we want to be well beyond 40. What's ideal? What's optimal? And the number is 5. 5 milligrams per deciliter. But here in America, just remember, 55 and stay alive or whatever you want it.
JJ Virgin: And is that the ideal or is that you don't want to be any higher than that?
Dr. David Perlmutter: You don't want to be higher than that. Lower than that is fine. There's no bottom. Anything over 5. 5, you're, you're starting to get on the upslope of risk for cardiometabolic diseases. And I just want to say, parenthetically, I'm beginning to object to the term cardiometabolic diseases because we throw that around.
Because it embraces things like hypertension and insulin resistance and all that stuff. What about the brain? Neurometabolic diseases. What about the liver? Hepatometabolic. It's metabolic diseases. It's not unique to the heart. I can assure you of that. So the number you want is 5. 5 and it's step one, get the fructose out of your life.
JJ Virgin: I think the challenging, the big challenge people have is they then go, [00:21:00] Oh, no fruit. And that is not at all what we're saying. We're saying don't unwrap the fruit, turn it into a soda. Right? And just leave the sugar there and get rid of the fiber. But I think two pieces of fruit a day is an important part of the diet.
Dr. David Perlmutter: And I would respond to that by saying you're exactly correct. Why? Because, think about it. You can't slug down an apple or an orange, but you can chug Coke or orange juice or apple juice. Same thing. And that overwhelms your small intestine. And any delivery to the small intestine above about five grams of fructose.
Then overrides the small intestine's ability to deal with that. It goes to the liver and then we start this cascade. It threatens the liver with respect to non alcoholic fatty liver disease, leads to uric acid production. We've talked about why that's an issue. You eat an apple. First of all, that may have five grams of fructose in it if it's a big apple.
And, you're chewing it slowly, you're getting vitamin C, [00:22:00] which increases uric acid loss in the urine, and the fiber slows the delivery of that fructose to your small intestine. The point is, eat the apple a day, looking at tens of thousands of people who've completed a what's called food frequency questionnaire, meaning what do you eat over time, but the uric acid levels are a little bit lower in those who consume a little bit of fruit each day, a couple of pieces of fruit.
Have at it, what a treat, but vegetables as well. You want to think about that? There are some vegetables that are high in purines. And if you go on the websites of the very famous clinics here in America, this or that clinic, they'll say, avoid purine rich foods. They don't do the work because purines make uric acid, but okay, that's interesting.
But does eating broccoli raise my uric acid and it's high in purines? It does not, it actually lowers uric acid. So the big issue that you're not seeing on those websites is fructose. You might wonder why these [00:23:00] very famous clinics don't irrigate sugar the way that they should. And that might be the subject of another podcast.
JJ Virgin: Yeah, I was going to say, it sounds like there's money involved. I'm thinking of Rick Johnson when we were on the podcast chatting, cause he was saying just the difference in Mexico with cane sugar in the soda versus U. S. with high fructose corn syrup in the sodas made a difference. Like it is. Just these things that you don't realize.
And I, where I see the biggest challenge for people who are trying to eat healthy out there and like the people you described who think they're actually doing the right thing by having juice, right? They go to the health food store. And they get the things that look like they're great, that might say no sugar added, that have fruit juice concentrate, like apple juice concentrate, which is more fructose than high fructose corn syrup.
Or they're getting agave and it will say, right? And it says low glycemic index and you're like head slap.
Dr. David Perlmutter: And it's not just agave, but it's [00:24:00] agave nectar. How can you argue with something called nectar? It sounds close to godliness. Drink of the gods. And it's 70% fructose. It is probably. One of the most threatening foods on the planet.
And then you go to the health food store and get a tea. And there is the agave, no sugar, but we're going to give agave to put down. I'm like, gosh, and I've given up thinking that I would even ask the people there, why are you doing this? But you're right, it's about understanding what the heck is going on, why I wrote the book so people can realize that here in America, the pressures on us to consume sugar are vast.
And there are very aggressive forces out there that are keeping us from the truth, that are supportive of the corn growers. Such that there's an outlet for corn aside from just giving it to cattle and making the 10% ethanol for our fuel. No, high fructose corn syrup is a big player. And in [00:25:00] 2021, the five year USDA American recommendation, dietary recommendation came out.
And it comes out every five years and said that it's totally fine to have 10% of your daily calories come from sugar. And it's astounding because that's not what their scientists told them. And if you're consuming 3000 calories a day, that's on low side, I would say for most people, that's 300 calories from sugar.
That's pretty breathtaking. We're talking about 14 teaspoons of added sugar to your Cap'n Crunch each day. How could that be a good recommendation? This is the U. S. Department of Agriculture, agriculture.
JJ Virgin: And again, you said by the year 2030, 50% of the population would be obese. We're going to beat that clearly for 43%, right?
I mean, it's like, I remember hearing David that by the year 2030, a hundred percent of us would have diabetes. And I thought, well, that is the most outrageous [00:26:00] statement I've ever heard. A hundred percent of us. And now you're looking at that going, well, maybe it wasn't quite so far fetched as we thought.
But the person who is listening that says, okay, I'm not going to be the statistic. And what do I need to do? Like the, the two sides of this coin, what do I need to do to lower my uric acid? And then what beyond fructose, are there other things that I need to be very careful with in terms of impacting uric acid?
Dr. David Perlmutter: And then we'll talk about what you can actually take in the supplement world that can be helpful as well. So step one is know thy uric acid. And how do you do that? For most people, it's a phone call. You've probably already had it done and it's included in your annual metabolic panel and respectfully may have been glossed over because you don't have gout and may not have been flagged.
Generally, unless something is flagged, no one's going to call you or indicate that some attention needs to be directed towards this. It's not going to be flagged if it's below seven. Nonetheless, that's still too high. 6. [00:27:00] 5, which is the average uric acid level I might add in America was 3. 5 in the 1920s and nothing has changed in our genetics, but what's changed is the amount of fructose that we consume.
If not, you can buy one of these guys. This is a home uric acid test thing and a drop of blood. My most recent was 4. 7. So you can follow your uric acid. It's a biohack. It's like wearing a CGM. You need to know this. And frankly, not to point fingers, but not all doctors are going to be aware of it. This is what we call empowerment via knowledge.
So it'll be part of mainstream medicine in another decade or who knows when. But meanwhile, let's get ahead of this and recognize that when your uric acid is elevated, it is partially responsible for why you can't lose weight, why your blood pressure is ticking up and certainly, aggressively, why you are becoming insulin resistant.[00:28:00]
And you may not know that either because your blood sugar that you have once a year is still in the normal range. But how would you know? You can't, you cannot check your blood sugar once a year and think that snapshot is as good as a video that you might take of your blood sugar by wearing a CGM, or having it checked more often, or more importantly, getting your fasting insulin checked so you know if your insulin is high that it's working overtime, your pancreas.
To keep that blood sugar down, that can't continue forever. That's going to stop. And back to the couple that was sitting next to us. The once a year blood sugar. I mean, many people train for that for a few days ahead of time. So that's even worse. I know it is a fasting blood sugar. So you didn't eat the night before.
And I only imagine what a continuous glucose monitor would have shown these individuals after the French toast. It would have been scary, but it would have been enlightening. [00:29:00] And there was an interesting editorial written in the Journal of the American Medical Association about continuous glucose monitors and concluded that it's not ready for prime time for anyone who's not already diabetic.
JJ Virgin: And their conclusion was based on, on what? Nothing.
Dr. David Perlmutter: It's going to make people neurotic about their blood sugar.
JJ Virgin: Yeah. Good. I'm glad.
Dr. David Perlmutter: Because you doctor are not. And I need to know this because I don't want to get Alzheimer's, frankly, and that's the world that is important to me. But you could fill in, I don't want to get blank, cardiovascular disease, diabetes, some forms of cancer, you pick your poison.
And that's why I want to keep my blood sugar under control. After the USDA came out with that 10% calories from sugar BS, I along with Dr. Casey Means wrote an op ed in something called MedPage Today, was an open letter to President Biden saying, basically, 5% please, not 10%. There's no science beyond 10%. We need [00:30:00] to lower the amount of sugar that Americans are consuming because we're declining in terms of our lifespan pre COVID.
Not that COVID jumped that down a couple years and increased the incidence of Alzheimer's by 17%, but that said, Our declining lifespan began pre COVID, so don't blame it on COVID. Blame it on what you see when you look around, and that's scary business. What we are told is live your life how you want, and then watch television, and what you see is people who are out of shape, but they're taking this, they're taking that, and they're happy.
Even though they're still overweight because their A1c is below 7. And that is another example like the uric acid level below 7. That means absolutely nothing. Cardiovascular risk, Alzheimer's risk, certainly a diabetes risk, and even some forms of cancer risk. Increase around hemoglobin A1C at about 5. 8%.
So you want optimal or [00:31:00] you want to be in the normal range with people who are skewing that to a higher level.
JJ Virgin: I would assume that the things that help. Lower uric acid are the same things that improve insulin sensitivity and the same things that help with blood sugar control. I would assume they all are similar, like they might be different pathways, but the same things, lowering sugar.
Dr. David Perlmutter: The biggest issue, aside from just blatant fructose consumption, is these ultra processed foods.
Because you may as well be eating sugar, face it. These foods are so highly processed that the moment they enter the intestine, they are immediately metabolized into sugar.
JJ Virgin: Their main line, I call it the main line. You know, you want your body to make sugar slowly from that broccoli, slowly from the lentils.
You don't want to mainline it from the fat free cookies that you ate.
Dr. David Perlmutter: Yeah SETI came out this year, actually, that showed a significant correlation. [00:32:00] of the consumption of highly ultra processed foods and level of uric acid. And another one, they came out and showed significant relationship between consumption, even anything above 20% of your calories coming from ultra processed foods and risk for dementia.
That study actually began first paragraph by saying, in America, the percentage of calories for the average American coming from ultra processed foods is 58. Holy smokes. Like you say, they are mainlining and wow, but we don't eat sugar. I didn't take a picture of the meal, but I don't think I'm ever going to forget that one.
We don't eat sugar. Oh my gosh. So it's the, it's the processing of the flour that went into that French toast, pour the maple syrup upon it and gee whiz, what did your blood sugar do after that meal? So know your uric acid and get a home monitor and check it every couple of weeks until it comes down. You want to avoid the sources of fructose that are so common.
And then think about those sources of [00:33:00] fructose that are maybe not as evident, like in the sauces and the salad dressings and the places where they are hiding. And yes, something can be gluten free and still have fructose and not be good for you.
JJ Virgin: You want the gluten free where they don't actually have to say gluten free on the label.
Dr. David Perlmutter: Or even have a label, except if it's a little sticker that says USD organic. That's what you find on your meat and your eggs and apples and good foods, whole foods.
JJ Virgin: So becoming very aware of where sugar is sneaking in and kind of my rule for ultra processed foods, how do you know it is? Cause it's like, I always say all food we're getting at this point, you don't have a garden and you probably don't have a cow and some fish out in your yard, you do, you're the unusual humans,
Dr. David Perlmutter: but I'll take that either way.
And I don't mind.
JJ Virgin: I think at this point, unusual is good. Something had to happen to that wild salmon before it got into my house. But what I'm really looking at as a key sign is that food that you eat that should have been satiating when you [00:34:00] had that amount and nope, you eat it and what do you want? You want more.
And that's the ultimate benchmark of an ultra processed food is it is not satiating.
Dr. David Perlmutter: Right. That's for sure. And that's a survival mechanism because all of a sudden your body says, Oh, we just discovered something sweet. Keep eating. So leptin is a satiety hormone. It's blocked, so you're not benefiting to know when you should push away from the table because suddenly your brain says, we've just identified a source of calories that are going to make us fat.
Don't stop. That's why you have to keep eating. And if there are carbs in your meal, refined carbohydrates, good luck saying no to the dessert. You are lit up. Your brain is saying, wow, we've got the key to survival here. And so bring on the key lime pie or the tiramisu for that matter. But if there are very few processed carbohydrates in your meal and to enhance leptin functionality, you've added fat, [00:35:00] then dessert is like not a thing.
Everybody struggles with dessert. And it's very clear to me that you set the stage for dessert based upon what you eat. I did a podcast yesterday with the WildFit group and we talked about Did you get baked salmon or did you get salmon fettuccine? And your response when it's dessert time is going to be very different if you got the baked salmon with a side of broccoli and a lot of olive oil versus the salmon fettuccine.
It's night and day. Once you start priming the sugar pump during your meal, your brain lights up and says, we're going to survive because we're going to eat more sugar. Don't leave. The berry patch, don't leave the blueberries, what your brain thinks, keep gorging because winter's coming. That's the signal that you're sending.
JJ Virgin: Are there any foods in particular, and you mentioned supplements that can be helpful here?
Dr. David Perlmutter: Yeah. And so first recognize that the production of uric acid requires [00:36:00] a specific xanthine oxidase. That's not going to be on the quiz. Don't worry. Your body needs this enzyme in order to create uric acid. If you have gout, you will take a medication that will turn that enzyme off and your uric acid level goes down.
But guess what? You can do that with certain foods that are rich. in certain polyphenols like quercetin and luteolin that'll also shut down that enzyme to some degree and help you control uric acid. That's why broccoli, for example, even though it's high in purines, is associated with a lowering of the uric acid.
Onions, red onions in particular. Tart cherries are probably The best food on the planet in terms of choosing a food versus supplement to help you lower your uric acid. Now, that doesn't mean that cherry flavored Mr. Pibb is necessarily what you want to consume, but tart cherries as an extract, they have it in pill form as a matter of fact, or eating a few cherries, not reasonable.
JJ Virgin: [00:37:00] But not that tart cherry, because you always see them like, we have tart cherry juice for gout. I'm like, wait a minute.
Dr. David Perlmutter: If you find tart cherry juice and you drink it and you like it. That's not tart. Tart is the opposite of sweet. If it's tart, when you taste it, that's the bioflavonoids that are talking to you.
It's like why, for example, you like the pepper flavor of the olive oil, the back of your tongue, right? That tartness is telling you it's rich in these bioflavonoids that actually don't taste good for a reason. It's to keep the plant from being eaten by various animals that would otherwise like to eat it.
Eat raw kale. It doesn't taste great. I mean, you know, you want to saute it. Eating raw broccoli is not the most flavorful food because of what you're getting. You're getting these flavors of these bioflavonoids that keeps the plant from being consumed. We could dive deep into that. That's another story.
Really fascinating though. But that said, now that we know what those bioflavonoids are that are [00:38:00] most active, and many, many of them are, but two of the key players are something called luteolin. Luteolin. And that'd be 100 milligrams per day. And quercetin, and that'd be 500 milligrams per day. But quercetin directly targets that enzyme, xanthine oxidase, and luteolin does too, almost in equivalency to the drugs used for gout.
Quercetin does a lot of other cool things, by the way, that really make it one of my most go to nutritional supplements. I mean, quercetin activates a pathway called AMP kinase, help us with blood sugar control, help us with fat burning, leads us to develop healthier, more robust mitochondria. Who doesn't want that?
I opened that can of worms. I got to take it a little bit further because it's so interesting. A lot of people in this space talk about why we want to light up AMP kinase. It's one of the reasons we like to exercise. Exercise is one of the most powerful tonics through [00:39:00] activation of this pathway, AMP kinase.
Improves insulin sensitivity, improves mitochondrial function, helps us choose to burn fat for energy. All the good things that we want. AMP kinase is an enzyme system that's involved in how we break down AMP. Where does AMP come from? One place it comes from is the metabolism of fructose. Who knew? When we consume fructose, we go to ATP, the energy currency, down to ADP, adenosine diphosphate, down to AMP.
Now, we have AMP. That AMP can go one of two ways. It can use a m p kinase and light it up. We'd like that. But a m P kinase has an evil twin, and it's called a M P D A M P deaminase. If a m P goes through a m p deaminase to be metabolized, the opposite happens. A M P Deaminase says to your body, Winter's coming, and [00:40:00] if you're a bear and you're going to hibernate, anyway, it lights up the fat production pathway.
We want to do everything we can to keep away from AMP deaminase. It raises your blood sugar. It locks your fat away. It doesn't do anything for your mitochondria, except step down their function. So we want AMPK, we don't want its evil twin, AMP deaminase. Guess what? Who decides? How is that decision made?
It's a fundamental health decision. You can favor AMP kinase if you exercise, for one. If you take quercetin, for another. But the switch between one side of this or the other is determined by your uric acid level. Who knew? Your uric acid level is elevated, you shut off AMP kinase, you tell your body, no, save my body's fat.
Raise my blood sugar, raise my blood pressure, mess with my mitochondria. I don't, I really don't want anything messing with my mitochondria. Thank you very much. That's [00:41:00] what happens when uric acid is elevated. So You know, I know we got into the woods a little bit, but people who are paying attention to you are probably used to it and probably, like me, get kind of excited because to me it's not good enough to say having a high uric acid is bad and you should lower it.
Talk to you later. Why? First, what's the literature saying about high uric acid? We covered that. But B, okay, how does it work? It's good to know that high uric acid inhibits something called nitric oxide. Many people talk about nitric oxide. That's what allows insulin to work and it's what allows our blood vessels to open up and give blood supply to our brains, our liver, our kidneys, throughout our bodies.
We need nitric oxide. Uric acid inhibits that. That is not a good thing. People are hearing about nitric oxide and one of the most promising Alzheimer's drugs is called Viagra. I'm not making that up. This is a study of millions of people that demonstrated That [00:42:00] those who take Viagra have a more than 50% reduction in risk for developing Alzheimer's disease.
What's the connection? How does Viagra work? It's used for erectile dysfunction and erectile dysfunction is a blood supply problem. What Viagra does is it increases nitric oxide. It improves blood supply. But it doesn't just stop at the rectal dysfunction. It improves blood supply throughout the body, including the brain.
The risk of erectile dysfunction dramatically increased if your uric acid level is elevated. So it's offset by taking Viagra, but get your uric acid level down.
JJ Virgin: One of the things you just said for years, I would go around the country teaching this course to doctors called overcoming weight loss resistance.
Because what I saw early on working with hundreds of clients was that. Diet and exercise wasn't working for everybody. And at first, I will be honest, I thought they were cheating. But then I got time to spend. I was like, I took a group away [00:43:00] for seven days and they couldn't cheat. And I went, okay, not cheating.
What really is happening here? And so I've looked at all of these different factors. Of course, I knew nothing about uric acid. One of the factors obviously was insulin resistance. But this to me is the bigger picture to look at is uric acid. You described the ultimate issue for weight loss resistance.
And a person is thinking if we just use a supplement or something to lower uric acid, are we really fixing anything? Or did we just lower it? You know, how you'll do something and go, but did you fix the problem? Or did you band aid the problem? But if you lower uric acid and allow the pathways to work well again, Because that's the challenge.
Now it's stuck here.
Dr. David Perlmutter: I mean, we've all dealt with clients slash patients for years who couldn't lose weight. And I think, to be fair, you question, are they really following their dietary plan closely? Are they actually doing all the right things? Are they getting enough sleep? People don't value sleep as it relates to weight loss and should.
But it could be these people have elevated uric acid. That's telling their bodies stay fat, [00:44:00] right? We need this to survive. It's a survival mechanism. And frankly, you know, I am hopeful that some of the big weight loss clinics, programs, you know, are now beginning to embrace this and it's going to turn out to be really, really helpful.
It's not the end all, but it is in the metabolic toolbox along with measuring your blood pressure, your waist to hip ratio. Your lipids, your insulin, sensitivity markers.
JJ Virgin: You can't measure your lipids at home. Here's a simple one. Like I love these things that we can do at home and then we can make the shifts and go, okay, I'm actually making a dent in this.
How much does one of these little home unit testers cost?
Dr. David Perlmutter: I think they're 89. The truth be known, they sent me one. I think that's how much they are.
JJ Virgin: Like a fantastic, probably can get them on Amazon. So a simple little thing. They're on Amazon. Yeah, you can test at home. And so if you get your labs and look in your above 5.
5, this is your thing that you do to monitor and what you monitor and measure, you can [00:45:00] improve. I mean, it's fantastic. And then you improve that a whole lot of other stuff improves.
Dr. David Perlmutter: Where it falls, I think is far more upstream than things we're used to. When you're looking at your blood sugar or let's say fasting insulin level and it's elevated, you're already in a bit of a pickle.
So the uric acid predicts those things well in advance. So it's further upstream in terms of getting us out of the river. Desmond Tutu said, did I give you that quote? Desmond Tutu said that it's important to pull people out of the river, but much more important to find out why they're falling in. And so it's more upstream.
It can predict insulin resistance, elevated blood sugar, elevated blood pressure and difficulty with weight loss. So it predicts these metrics that we're used to looking at. And I love that. I mean, I love being ahead of that. And for me, you know, in the world of Alzheimer's. Anything that we can do that can keep people intact metabolically is [00:46:00] very much upstream long before they start to have signs of cognitive impairment.
We don't have any drug for that. And I know people are thinking, well, gosh, I heard there's a new drug out. Let's be clear. Those results showed minimal effectiveness and a pretty dramatic increased risk of small hemorrhages in the brain and areas of brain swelling or edema.
JJ Virgin: Not a good thing. It's like, to me, when we look at metabolic health, I'd probably put this with a waist circumference, you know, do this early on and you just listed two supplements that are inexpensive to get and easily accessible.
When I wrote Sugar Impact Diet, the whole point of it was to get people hyper aware. I told Rick Johnson, I had like, your book was like my Bible to go after when I was reading, I went back and looked at all the old sugar. Books and sugar research because so much of what we have now is so pro sugar. I was like, I'm not looking at it.
That's so true.
Dr. David Perlmutter: You know, our discussion earlier about foods that might be organic or might be gluten free and yet loaded with sugar.
JJ Virgin: Loaded and even more so [00:47:00] usually. I had this one gal. Who I pulled off gluten and she came marching back into my office, completely thrilled that she'd found gluten free cupcakes, cookies.
I was like, holy smokes. Okay. I have to be a little more clear here, but it's like you, you go into a lot of these places like Whole Foods with the thinking that you've got this like halo effect of everything in there. And oh my gosh, you get yourself in a lot of trouble in those stores. Yeah. And
Dr. David Perlmutter: I think that as you look at the literature, there's a lot of studies that come out that talk about.
The fact that so called asymptomatic hyperuricemia is a thing, we see that it's associated with non alcoholic fatty liver disease, with hypertension, with diabetes, with obesity. Let's take a step back. What does it mean, asymptomatic hyperuricemia? It means this person has an elevated uric acid level, but they don't have symptoms, meaning they don't have gout.
So… They have these
JJ Virgin: other things going on, aren't those symptoms?
Dr. David Perlmutter: Yeah, but they just happen to have hypertension or obesity or [00:48:00] diabetes. So I think that we need to get to a place of recognizing that these are symptoms, doesn't just happen to be elevated. Give you another example. We've known for years that high salt consumption is something we see in diabetics, something we see in obesity.
And it was sort of like, well, that's interesting. And even high serum sodium levels, slightly higher, the body's very, very sensitive to that, are seen in correlation with these issues. Now we know it's not. In correlation, it's causative. High levels of sodium is a signal to your body that you're dehydrated.
It's exactly what's going on. If you're dehydrated, you're not drinking enough water. The signaling is that your sodium level becomes more concentrated and your brain registers that and tells your body to start conserving free water. So you send out a chemical called antidiuretic hormone and you conserve water.
It's interesting [00:49:00] because we don't know what else might be a mechanism here and what then is the association of those things I just mentioned. Why do we have high salt in obesity and in diabetes and hypertension? Turns out that when the body senses it is dehydrated, it activates a pathway that turns our blood sugar, glucose, into something called fructose.
Who knew?
JJ Virgin: I know. When I heard that, I was like, I cannot believe that this can happen.
Dr. David Perlmutter: We have the polyol pathway uses an enzyme, won't be on the quiz, called aldose reductase that's sensitive to elevation of sodium, such that when we are sensing that we're dehydrated, Our bodies make more fructose, make more uric acid and make more fat to save us from being dehydrated.
But how does that work? If I can't find water for months at a time, there are water resources are dwindling. Why wouldn't I have a signal that raises my [00:50:00] sodium and makes more fat? That'd be the last thing I would need. And again, when we have body fat and we're metabolizing that, we make two things. We make carbon dioxide and water, metabolic water.
So fat metabolism creates water in our bodies. That's why the camel has a hump and can go three weeks across the desert and not drink water. The hump isn't full of water. There's no thermos in there or whatever. It's fat. And the hummingbird, 40% of its body weight is fat when it's getting ready to fly a thousand miles or whatever the distance is.
And if you want a hummingbird in your backyard, what do you put in your backyard? A hummingbird feeder? Sugar water. We've all done it. They drink sugar in nature. They get nectar out of the flower, but they'll come to your backyard with sugar in a tube to make fat because your bodies use that fat to have a caloric source and a water source for their epic journeys.
Yeah, [00:51:00] wild. It answers a lot of questions for us, doesn't it? I mean, we've seen these associations for years, but, you know, now that these dots are connected, it's such an epiphany. All these questions, these lingering questions are solved now, and there'll be many more generated from this line of investigation.
But you know, what a great thing it is to have this new tool in our toolbox. It isn't the end all. There's so many other things we have to pay attention to, but this is really simple and very straightforward. And I suspect that. We may in the future, along with measuring our glucose continuously, be able to have input into our smartphones of what our body's uric acid is at any given moment.
How cool will that be?
JJ Virgin: Yes, I can't wait. Hopefully that's fairly close by. But meanwhile, you can get one of those little machines on Amazon and prick your finger. And I also am going to put the link up at jjvirgin.com/uricacid so that everyone can get your ebook on this. You also have the book.
Drop acid. We'll put a link to all the books and all the [00:52:00] time on the podcast here. Make sure you grab that ebook at jjvirgin.com/uricacid. And we'll get to getting the, the little uric acid tester too. And I'm going to go test Tim's uric acid later too. Now that you've said it, I was like, wonder what his is.
I would imagine it's pretty so patient.
That's the thing. He'll let me do whatever to like, I'm like running all these labs and things on them. Of course. I don't know if you knew the story. Did it happen after the fact? Yeah. After we were with you, we went on a trip with Mary and Joe, Mary Morrissey and Joe Dickey.
We're on a cruise and I get back his stool test that finds out that he's got a sky high anti glad and IGA. And I'm like, honey, I'm like taking the sourdough bread out of his hand. He's like, I'm on a cruise. So he is very patient and allows me to do all of these things. We're about to go get another DEXA.
I want him to play full out at a hundred with all of us.
Dr. David Perlmutter: We should reserve that place already. I'll be there eight years before you, [00:53:00] but there you go.
JJ Virgin: But I'll be there to celebrate with you. So there you go.
Dr. David Perlmutter: You said a hundred percent of people, one prediction would be diabetic and maybe it's 99. 99% because it's not going to include you, me, Lise or Tim and a few other people that help you know.
JJ Virgin: Roxanne and David too. Yes. Yeah, that's for sure. We're creating the tribe of it and everyone listening. You should be in the group too, because now you've got this information. So thank you again so much. It's always so amazing to be with you. You
Dr. David Perlmutter: know, I love you to the depths of my heart. I will say that you just brought something up that is interesting.
Maybe, maybe we think about a group and we just keep this group going for decades. And who knows, maybe, and maybe there's something there. I don't know. It might be nice to create, have everybody along for the ride. We check in once a year or.
JJ Virgin: And we share the latest thing. Like, you know, all my, all my stuff now on DEXAs and lifting heavyweights and creatine, and, you know, we all have our hammer that we're focusing on and when you put [00:54:00] all of those together, I like to take all the research out there, synthesize it and put it into simple programs.
That's my favorite thing. And I see the researchers siloed and I'm like, no, we got to get all this information together. Then you kind of realize, Hey, when you're looking at uric acid, those things are actually symptoms, right? That's how we get those things put together.
Dr. David Perlmutter: And let me just say one other thing, a thought that occurs to me in closing, and that is that your viewers and certainly my viewers over time.
May say, gee, a couple of things. Why didn't you tell me this before? Or this is a little bit at odds with what you told me 10 years ago. And gee, what gives? I think to be clear, people should celebrate that, that we. Our messaging changes over time. That's a good thing, because in this world that you and I live in, nothing's in stone.
Things change, science changes, and our commitment is to stay on top of that science and bring everyone who will listen this latest, greatest, best information. So the messaging will change with time and be ready for it. So there you go.
JJ Virgin: And by the way, if someone isn't doing [00:55:00] that, that's when I get concerned.
You've got to continuously be evaluating everything. I, as someone told me once, critical open mindedness. I'm like,
Dr. David Perlmutter: okay. I'm there.
JJ Virgin: I'm going to remember that. Critically open minded and really look at all these things because it's easy to fall in that trap and go. This is what I believe, so I'm going to find everything that fits that paradigm, and that's not the approach to take.
Dr. David Perlmutter: That's right. I mean, you know, the best example for me was in medical school, we were told that brain cells were terminally differentiated. Fancy term means basically you get the maximum number of brain cells that you're ever going to have at age 18 to 20 years of age. That's it. And for all of us, we're on the skids thereafter.
And then, you know, they are, well, every beer you drink is 20, 000 brain cells, all that stuff.
JJ Virgin: Man, I got nothing left.
Dr. David Perlmutter: But the point is that the notion that we had the ability and that our brains were always repopulating with new neurons would have been considered blasphemy in those days. You wouldn't even talk about it, you would have been ostracized.
[00:56:00] Now it's common to talk about neurogenesis, how can you stimulate it, why it's important, etc. That's a 180 degree diametric opposition to the notion that we don't grow new brain cells. As a matter of fact, we do. Get over it. There's a lot of pushback when this doctor came out with his publication, the journal Nature, and it took him, I think, Six or eight journals to get it published because they rejected it.
They just said, yeah, we know it occurs in, in rodents. We know it occurs even in primates, but not in humans. That's just not in the cards. Matter of fact, it does. So get over it. There's new things. We don't know everything.
JJ Virgin: Cause we're just going to keep getting smarter too.
Dr. David Perlmutter: That's for sure.
JJ Virgin: There you go. All right.
Thank you jjvirgin.com/uricacid. All right. Thank you. Bye. Be sure to join me next time for more tools, tips, and techniques you can incorporate into everyday life to ensure you look and feel great. And more importantly, that you're [00:57:00] built to last and check me out on Instagram, Facebook, YouTube, and my website, jjvirgin. com and make sure to follow my podcast. So you don't miss a single episode at subscribetojj.com. See you next time.

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