Controlling Uric Acid is

KEY TO METABOLIC HEALTH

If you’ve tried everything to gain control of your health and manage your weight but still feel like you can’t reach your goals, I think you’ll appreciate today’s NEW podcast episode about Uric Acid (UA) with six-time New York Times bestselling author, Dr. David Perlmutter.  

The scientific literature is bursting with evidence that chronic elevated UA lies at the root of many pervasive health conditions, such as obesity, diabetes, cardiovascular disease. But it’s not something that’s being discussed in  mainstream medicine and media…. Until now.  

David’s groundbreaking book, Grain Brain, showed that the fate of your brain is not in your genes. It’s in the food you eat. By the way, that book made it to the top… #1 on the New York Times bestseller list. 

David’s new book, Drop Acid, alerts us to the dangers of elevated uric acid, and how it’s a key to losing weight, controlling blood sugar, and achieving extraordinary health. 

“The root of metabolic health? Your uric acid levels.” 

Specific topics in today’s episode include… 

• The role that heightened uric acid levels play in your health… beyond gout and kidney stones
• Specific foods that pave the way to elevated uric acid levels, and how to minimize your risk 
• Why tart cherries rank at the top of Dr. Perlmutter’s most-effective list, and how much to have each day. 
• How to listen to your body screaming the alarm that your uric acid levels are at a dangerous level 

Kathy Smith: So, I, first of all, when Kristin Loberg told me that she’d been working with you for over a decade now, and Christa – as you probably know – is a friend of mine. Also, she was a writer on one of my books. So, I have a love. I think she’s fabulous, and she speaks so highly 0:02:00 of you for obvious reasons. 

But let’s jump into this topic because I have to say, honestly, I read everything, I’ve been around the block more than a few times, and yet, uric acid. The only way that I heard about uric acid were people who had gout, or people who were eating excessive amounts of meat, and that sort of thing. 

So, explain why you wrote this book now, why it’s something we haven’t heard about. Give us a little background on, you know, kind of the impetuous to getting this book out there. 

Dr. Perlmutter: Well, let’s first approach the question of why I wrote the book now. The reason I did is because Americans – and, really, all across the western world – we are suffering (actually, globally) from profound insults to our metabolic health with higher rates of obesity than we’ve ever seen, higher rates of hypertension, type 2 diabetes. These metabolic issues are threatening in it of themselves, but it’s the diseases that they pave the way for that are the real threats to our survive. 

What the World Health Organization calls the number one cause of death on planet earth, not coronavirus, it’s the chronic degenerative conditions. We set the stage for them when our metabolic issues arise: things like overweight and obesity, hypertension, and problems with regulating our blood sugar. So, that’s why it’s very interesting, to me, to discover this linkage to elevation of uric acid as it relates to disturbing our metabolism. 

You know, you brought up a very interesting point in the introduction, and that is most people heard of this. Yes, we’ve heard of uric acid in the context of kidney stones and gout, but when we start talking about elevated uric acid as paving the way for high blood pressure, weight gain, storage, and manufacturing 0:04:00 body fat, elevating our blood sugar. There’s not a lot of people who yet get their arms around that. Despite the fact that a book was written on this topic way back in 1898 looking at the role of elevation of uric acid in a variety of things well beyond gout. Like headaches, like depression, like cognitive decline, like skin disorders, and inflammation in general. 

I think a very powerful characterization of where we are with uric acid was published in 2016, in a collaborative effort from both Japanese and Turkish researchers, in a study that’s entitled “Uric Acid in Metabolic Syndrome: From innocent bystander to a central player.” What that characterizes is the notion that, yeah, we’ve seen the elevation of uric acid in tandem – or along with – obesity and high blood pressure and diabetes, for an awful long time. 

We thought, “Well, isn’t that interesting? The uric acid happens to be elevating.” Now we know that it’s actually playing what we call a mechanistic role. It’s actually involved in causing these problems. 

Now that we’ve identified that, man, oh, man. That gives us a powerful new tool in our toolbox, which absolutely – as you said in the introduction – may be the edge, the final straw, that people need if they’re finally going to break their weight gain conundrum, and their hypertension conundrum, and their issues with insulin resistance and high blood sugar. 

So, what I’m so excited about is that it’s another tool in the toolbox. It turns out to be very, very powerful. 

Kathy Smith: Well, before we jump into the obvious question of like, “What is uric acid?” I just wanted to bounce off something you said. 

When I was reading your book, 0:06:00 dove into your book, I was in Boulder, Colorado because that’s where one of my daughters lives. I got to a portion of the book there, and you mentioned – let me get his name right – Dr. Richard Johnson and the Fat Switch, which he’s a professor in Colorado. You kind of credit him a little bit for when you dove into that book. Perhaps, what was that? 10 or 20 years ago? When did his book come out?

Dr. Perlmutter: No, his book came out a week before my book. I do much more than a little credit to him. I dedicated my entire book to him. He’s been doing this research for 20 years in both animal work and then in human interventional trials to really prove that when you elevate uric acid, you mess up metabolism. I wrote the forward to his book and dedicated my book to him. He deserves, you know, the lion’s share of the credit for the research. My mission here was to bring it to light, to make people aware of it. But, by all means, he’s the player here. 

In fact, I’ll tell you an interesting story. I actually recount this in the book: how I learned about this. It’s often a question. There are two questions I’m always asked in interviews. One is how did I learn about this, and the second thing is, “What about fruit?” We’ll get to that later on. 

Kathy Smith: Yeah, I got that one. 

Dr. Perlmutter: Right? I’m sure you wrote that one down. 

The first question, the first instance, I was running a couple of years ago, and I heard a podcast where Dr. Richard Johnson was being interviewed. It was stunning. It was literally a game-changer for me, such that I doubled my run in order to hear the very end of it, and then listened to the beginning of it again. Then, I was so taken by what I had learned that I immediately reached out and phoned his office and set up a time to speak with him. 

0:08:00 We hit it off. I mean, we’re both guitar players, we’re both interested in metabolism. We just had a great time. 

We started this really beautiful collaboration and became colleagues in this endeavor to let, basically, the world know that this has been here a long time. This science has been there, and, wow, it’s just sitting there. It’s low-hanging fruit. All we have to do is start to understand what we can do to lower our uric acid if it’s elevated. Certainly, that’s something that you and I will talk about moving forward. 

Kathy Smith: Well, thanks, first of all, for clarifying that. I would love to have been a fly on the wall with the two of you. 

The other thing that I notice about you – and admire so much about you – is that you don’t mind shaking up the establishment. You don’t mind stepping out there and taking it a little further, let’s say. Grain Brain did that. People thought, like, “Oh, my gosh. What is this gluten thing? What is he talking about?” Then it became mainstream!

Dr. Perlmutter: Yeah, and what about sugar? We were talking about that back in 2013, and you’re right. There was a bit of pushback when I wrote Grain Brain with over 400 peer-reviewed scientific articles supporting exactly what we were saying. Now, you know, this is major universities’ Alzheimer’s prevention programs – keeping the blood sugar as close to normal as possible, for example. That was a certain theme in Grain Brain, and as you well mentioned, the gluten story – which ended up being published. You know, this notion of non-celiac gluten sensitivity being published in the Journal of the American Medical Association. So, you’re right. 

I’m not going to say that the mission is necessarily to shake it up, to be confrontational. But Ronald Reagan famously said that the term “status quo” is Latin for “the mess we are in.” Frankly, Kathy, we’re in a mess. 50% of Americans will be classified as 0:10:00 being obese – not just overweight – by the year 2030, that’s eight years from now. We’ve got about 88 million Americans who are pre-diabetic, and another 30 million who are already type 2 diabetic. That’s about 40% of the adult population. 

Let’s make no mistake about it. Being diabetic sets the stage for some really serious things, like Alzheimer’s, like cardiovascular disease. 

Kathy Smith: Like, with Covid, ending up in the hospital. I mean, one of the things they’ve mentioned in a few of the studies, if you’re diabetic you have more of a chance of getting into the intensive care unit. 

Dr. Perlmutter: That’s right! But, interestingly, published in the New England Journal of Medicine two weeks ago was a study indicating – this is certainly challenging, but it’s science and we talk about it – that risk of long-haul Covid might be, actually, less in type 2 diabetics. So, you know, it’s difficult to interpret that. I think we need to see what more of the research looks like. 

But having said that, again, it keeps us in a place where we have to value being open-minded. That’s sort of the position I’ve taken over the years. Be open-minded to new results, and be appreciative of the ability to change the messaging. 

You know, if you and I would have been doing an interview 25 years ago, I would have been telling you, “Look, we all need to be on a very, very low-fat diet because that gives you heart disease if you eat more fat.” We now know that’s obviously not true, but that’s what the science was telling us. So, I changed my messaging. 

People have said, “Oh, Dr. Perlmutter changed. He used to tell us low-fat, and now he’s telling us to eat fat. How could you believe him?”

Well, you know, we’ve got to be open to new ideas and for challenges to what was considered dogma. Is it iconoclastic? 0:12:00 Yes, it is, but those icons have to fall. 

You know, I’ve always said that, for me, people say, “What you’re doing is always so far outside the box.” For me, it’s not trying to be outside the box. It’s about making the box bigger, making that box more inclusive so that ideas like uric acid relationship to metabolic dysfunction are looked at. Ultimately, my hope is, it’s appreciated by more and more clinicians, practicing doctors. You know? 

It’s been said that people tend to be down on what they are not up on. There is a tendency in medical practitioners to sort of learn what you learn, and then you stick with that for your remaining decades of practice. But, you know, things change. Things are changing now at an incredible rate. We have to be open to new ideas. The truth of the matter is that the relationship of elevation of uric acid to our metabolic problems has been something that many other countries around the world have known about for a long time and have acted on. 

Let me just give you an example. A lot of the research is done in Japan. You indicated earlier the relationship between eating a lot of meat and having an elevated uric acid. That’s because eating a lot of meat gives your body something that makes uric acid called purines. Purines are the breakdown product of DNA and RNA and nucleic acids.

In Japan, they have recognized how important this is that two things have happened. Number one, they are now treating people who have high blood pressure by giving them drugs to lower their uric acid. Number two, beer is exquisitely high in purines. Would you know it, Japan is now marketing non-purine beer for people who are conscious of their uric acid elevation and want to reign it in. Well beyond gout. 

So, you know, we should, I think, 0:14:00 the right segue for us right now is to ask that question: where does uric acid come from? 

Kathy Smith: Well, okay. I’ll go there, but even broader than that. A little tutorial. Where does it come from? What are the pathways, maybe? What does it do to our system when we have too much of it? Then, just, you know, even continuing on, we talk about this, but how can we check it? How can we know? Do we buy strips, do we go to the doctor? So, let’s give a tutorial about uric acid. 

Dr. Perlmutter: Yeah. Let’s first talk about what elevated uric acid is doing in anyone’s body. 

It’s screaming an alarm. It’s telling your body to prepare for food scarcity and to prepare for possible dehydration. It’s an alarm system that was a powerful, powerful survival mechanism. So, when the uric acid level is elevated, it’s telling your body that winter is coming. That you’re not going to have food. You better make as much fat as you can. You better store that fat and lock it up. You better ratchet down your energy utilization – your metabolism – and you better raise your blood sugar to power your brain so that you can avoid two important things. 

[inaudible] uric acid is something that was lifesaving for us for almost the entire time we’ve been on this planet. Interestingly, it responds to our consumption of a unique sugar that goes by the name fructose. Fruit, sugar, fructose. It’s where the name comes from. Fructose was something our ancestors would stumble upon in the late summer, early fall when the blueberries or whatever natural fruits were around would ripen, create their fructose, and that was a powerful signal. Did it make them fat? No, of course not, but it gave them a little bit of extra fat that ensured 0:16:00 their likelihood of survivability during the winter. 

Now, we target that pathway 365 days a year for the winter that never comes. We’re not going to face, likely, a time of starvation where we won’t have calories. But, yet, we are activating that pathway – fructose consumption – elevating our uric acid, telling our physiology, screaming to our physiology, “Make fat! Raise the blood sugar. Raise the blood pressure in case we’re dehydrated.” Screaming at that pathway day in and day out for, again, the winter that never comes. 

So, it’s actually very straightforward. What I’m saying is having an elevated blood sugar is a good thing, having excess body fat is a good thing, elevated blood pressure a good thing in our hunter-gatherer days – not today. What we are experiencing, then, is a mismatch between our physiology, our genetics, if you will, and our environment – our diets, our lifestyles. So, it’s an evolutionary, environmental mismatch that is the cornerstone of our metabolic ills that are troublesome in it of themselves. But, as I mentioned earlier, lead to the things that we dread the most: Alzheimer’s and coronary artery disease, and even cancer of the colon, breast, and pancreas. These are the conditions that are globally putting people in their graves far more than any infectious disease, far more than wars and trauma. It’s the number one killer on our planet. 

You know, life expectancy in America has been declining over the past four years for the first time in history – and this predates Covid. Our life expectancy began to decline – which is really quite worrisome – before there was even a Covid, before anyone had even heard of it. 

So, 0:18:00 we marvel at our wonderful medical advances, our ability to map the genome and create immune-based cancer therapies, etcetera, but we’re not living longer. We’re living a shorter period of time. And our health span – the time in our lives when we are healthy and able to do all the stuff we like to do – is becoming shortened as well. It is, at its central core, a consequence of what we are doing to mess up our metabolism. What is happening is we are sending environmental signals – primarily through the foods that we eat – to our physiology to make us metabolically dysfunctional.

Kathy Smith: Well, let’s talk. I mean, that’s a great segue into the food supply. You talk about it in the book. You talk about, first of all, the introduction of agriculture 10,000 years ago or whatever, but then there was the introduction of processed foods. Which then accelerated this idea that we can… You said we can have fructose 365 days a year, but we can also have it every hour on the hour. I think what we should be talking about a little bit here… Because even when I go out to people and talk about this topic, they always immediately go to fruit, not realizing that fructose is in so many other products. Do you want to talk about the pervasiveness of this? 

Dr. Perlmutter: Sure. Well, in America, more than 60% of foods in the grocery store that are in a package and carry a barcode, if you will, have added sweetener. Think about that. By and large, it’s fructose or high-fructose corn syrup or some derivative thereof. Why? Because we like sweet. There’s nobody who doesn’t like sweet. We are hard-wired to eat sweet, to seek it out, because, again, it allowed us to survive. Sweet [inaudible] our bodies into the notion that winter was coming, and, by and large, in nature, the foods 0:20:00 that are safe to eat are sweet, as opposed to foods that are bitter, which may threaten our health – or be poisonous, even worse. 

So, it’s hard to escape. That’s what this book is written about: the notion that we’re being bombarded by fructose day in and day out by any number of different names. There are two pages in the book dedicated to the various names that food manufacturing companies…

Just think about that for a moment: food manufacturing companies. If that’s not an oxymoron… How do you manufacture food? Anyway, we’ll leave that for another day. 

But just the various stealthy names they try to give sugar and get it into your food so that you might not know it, or you might not think it’s bad. Like, you know, all-natural date palm sugar or syrup or who knows what? Call it what it is. We need to know to be fair. 

Now, clearly, there is fructose in many foods – in fruit and in vegetables – naturally. That’s, as I mentioned, where the name comes from. But when we eat fructose, for example, in a soda – when we drink fructose – it overwhelms how our bodies are able to handle that, and immediately gets processed in the liver and sent off [inaudible]… fat production [inaudible]… compromises how our energy production works at the level of what are called the mitochondria, increases dramatically inflammation and causes our bodies to make higher levels of blood sugar. Essentially, getting us ready to hibernate, if you will. 

So, then the question is, well, if there’s fructose in fruit, should we eat fruit? My answer is yes, of course. Because when we eat fruit, several things are going on. Number one, we’re not drinking it and getting a sudden load to our intestines that we can’t deal with. You don’t, you know, drink an apple as quickly as you can. You’re going to have to 0:22:00 eat it more slowly. It has fiber, which slowly releases fructose into your system in a measured way so that your body can handle it. It has vitamin C that allows your body to excrete more uric acid. Finally, there are a series of what are called bioflavonoids that actually turn off the enzyme that is responsible for making uric acid. It’s exactly how the drug allopurinol – a drug used in gout therapy. How that worked: by targeting a specific enzyme. Quercetin, for example, does exactly the same thing. 

So, eat fruit, but it doesn’t mean you’re going to get away with eating a lot of fruit. I mean, when you look at a bear preparing for hibernation, they are massive amounts of berries day in and day out preparing to hibernate. So, you know, an apple a day will keep the doctor away, but five apples a day, and the doctor you will pay. Meaning, you can overdo it. 

But fruit juice is not what you want to be doing. You see it labeled “natural fruit juice.” There’s nothing natural about fruit juice. Our ancestors, I assure you, didn’t hunter-gather their way to cartons of orange juice or – the worst – apple juice. So, that’s a sudden, powerful bolus of fructose that your body is going to have trouble dealing with. It’s going to make its way to the liver and upset the apple cart, if you will. 

If you feel like you want to have a glass of fruit juice with your breakfast, fine. Dilute it at least four to one. Then, you’ll get the flavor. Add some ice; that will dilute it even more. But that, you know, is 32 grams of sugar – much of that fructose – in that glass of apple juice is immediately metabolized to something called uric acid. Telling your body, “Make and store fat.” 

0:24:00 That’s the relationship between drinking fruit juices and drinking sodas. Same amount of sugar in a soda that there is in fruit juice. And weight gain. It’s actually very, very straightforward. It’s not just because of the calories. So, it’s about signaling this pathway. Alcohol can do the same thing; beer especially does the same thing because not only does it have alcohol which is metabolized to uric acid (face it), but it also has purines from the breweries that it’s made from. It has a lot of purines, and it tells the body immediately by raising uric acid: “Make that belly fat!” That’s where the beer belly is coming from. Now, we understand. 

So, the notion of light beer because it has less carbs, it’s not really the carbs that we’re worried about. It’s the alcohol and the purines. 

Kathy Smith: The same principle holds true, I’m assuming, for your protein shakes that people drink – and even their green drinks. 

I have to tell you, I went out to a yoga class the other day. Walked across, and there was a new place that opened up. A girlfriend of mine said, “Oh, my god. They have the best green drink in this place.” I looked at the counter and the ingredients, and here we go: apple (and this is the order), kale, pineapple, spinach, banana, maple syrup. 

I looked down and go, “I can see why it’s the best tasting.”

Those are the hidden ways that even people that are watching what they’re doing – they want to do something healthy, have a green drink or have a shake. We know the story about shakes, that shakes can have all of the sugar and fructose in them. So, I think the message or the moral is read the labels. 

Okay. So, those are kind of the obvious ones. What are maybe the not-so-obvious ones along the aisles in the food store? Are there things that just stand out that say, “Just 0:26:00 avoid this because it’s got so much”? 

Dr. Perlmutter: Let me get back to the juicing for just a moment. To take those ingredients that you mentioned, put them in a blender and drink them, I don’t think it’s going to be a big issue. When you juice, you watch what happens at the health food store when they make your juice. Out comes this wonderful green drink and carrots are in it – or whatever you put in it – and then they empty out the fiber, and they throw it in the garbage. So, you’re really missing out on so much when you’re doing that. If you must, put things in a blender and just drink them that way. It’s going to be a lot thicker. It’s going to be a lot more satisfying, and the sugar is released much more slowly. 

Now, as far as the maple syrup goes, a teaspoon of maple syrup is not that critical. It’s not going to be a game-changer – or even a little bit of honey, for that matter. But, you know, that’s not what you get when you drink a glass of juice. You’re getting a major slug of fructose. 

So, that’s what you’ve got to look out for. Many dried fruits, for example – you mentioned, “What do we do in the grocery store?” – have a lot of fructose in them as well. We characterize all of these foods in Drop Acid.

The other thing that I think is very important, and this is a striking revelation (people have told me) that we put in the book. That is that you can avoid fructose entirely. Not have a drop of fructose in your diet, and yet, you still suffer the ill effects. Why? Because you can trigger your own body to make fructose in your body. Who knew? This has been something… Well, we have known about it for an awful long time. It’s called the polyol pathway. It, basically, converts your blood sugar into fructose, again, as a survival mechanism. 

I need to unpack this a little bit more. Why would that be something that we would do, and what triggers it? 

One of the most powerful 0:28:00 triggers to turn on this pathway to make fructose in the pathway is if the body thinks it is dehydrating or you don’t have access to water. What happens when we don’t drink any water? Can’t find water. You know, we can’t find a spring or a lake. Then our serum sodium starts to climb. That activates this pathway to make fructose. 

Well, why would that at all be something we would want to do if we can’t find water? Let me explain. 

When we metabolize fructose, it becomes – everybody should know this by now – uric acid. What does uric acid do? It tells the body, “Make and store fat.” 

Well, how in the world does that relate to dehydration? It’s very simple. When you metabolize fat – when you’re burning fat for energy – you produce two things: carbon dioxide and water (metabolic water). 

So, you wonder, for example, “How can the camel walk across the desert for three weeks (or whatever it takes) and not drink any water?” The secret to the camel, his superpower is that he has a hump on his back, and she has a hump on her back. That hump is filled with fat. As the camel uses fat for energy, it’s making water in its body and doesn’t need to drink. 

So, the reason it’s important that we have this discussion is because we can trigger this pathway. Again, when we’re dehydrated, our sodium goes up. We can trigger this pathway by eating a bag of pretzels – salted pretzels. Suddenly, we are raising our serum sodium just enough to trigger that pathway. We make more fructose, we turn on the production of uric acid, and we sound the alarm that winter is coming. 

This is the relationship that we’ve known about for many, many years between people who eat a 0:30:00 lot of salt, and risk for diabetes, and risk for obesity, and, certainly, we all know, risk for high blood pressure. Because we are activating an alarm system that tells the body, “Make fat, increase our blood sugar, and raise the blood pressure.”

So, you know, this understanding has really connected a lot of dots for us that needed to be connected because they were sort of like hanging chads. We knew these things were happening, but we didn’t know why – or, perhaps, more importantly, how. We know why. Why is to keep us alive in our hunter-gatherer days and even in primates. How it happens, now we fully understand. 

Kathy Smith: Okay. So, you mentioned that so many of us might have elevated uric acid. How do we find out? What would we do to find out? 

Dr. Perlmutter: Terrific question. 

Kathy Smith: What would be some of the symptoms? I’m assuming some of the symptoms are what you just mentioned: excessive belly fat…

Dr. Perlmutter: I think being an adult in America, you are at risk for having high uric acid. The average uric acid level in the 1920s was around 3.5 milligrams per deciliter. The average now has almost doubled to 6 milligrams per deciliter. 

So, the simplest thing to determine your uric acid might be just getting a phone call to your doctor because many people have had their uric acid checked over the years as part of a broad-ranging metabolic panel. But doctors have looked at it only in the context of gout. So, hey, call the doctor. Say, “By the way, last time I was in a year ago, I had my bloodwork. Did you happen to check my uric acid? If so, what was it?” 

That brings up the next point: Where should it be? What is considered normal? 

Likely, the doctor will say anything under 7 is totally fine, but a very important reason that you and I are together today is to dispel that 0:32:00 datapoint. 7 is only in relationship to gout risk. Above 7 is when uric acid begins to precipitate in the blood, can form the crystals that go into the toe, and can be really painful. We want the uric acid level to be at 5.5 or less. 

So, if you haven’t had a uric acid level done, you don’t have to go to the doctor. Call her or his office and ask them to call the lab and go in and have a uric acid level checked. Fasting. Go in first thing in the morning before you’ve eaten. You can have water, of course. Then, see where you are. You ideally want the uric acid level to be anywhere below 5.5. That is the safe range. 

Again, the lab will tell you anything under 7. Not good enough for people who listen to your podcast. 

Now, the third choice is to buy a meter. This is what my uric acid meter looks like. It requires a simple finger stick. I don’t know if you can see that. That’s my last… There you go. Maybe you can see it. 

Kathy Smith: What’s it say? 

Dr. Perlmutter: It says 4.7. So, that’s my last level. These are available everywhere. Amazon. 

Kathy Smith: What brand do you have there, just in case the audience wants to know? Is there a brand on that? 

Dr. Perlmutter: I use something called UASure, U-A-S-U-R-E. I wrote about it on my blogsite (drperlmutter.com). So, that’s the brand that I use. It’s very, very simple. 

Kathy Smith: How many times a day are you checking or would you recommend somebody check? 

Dr. Perlmutter: I generally recommend about every two to four weeks. If you’re running low and everything’s good, and you haven’t made any significant changes, you don’t need to keep checking it. But if it’s elevated and you’re tracking your progress to bring it under control – to drop acid, if you will – then you’re going to want to follow it every couple of weeks until you get it brought down. 

When you’ve now eliminated the fructose as 0:34:00 best you can, realize which types of alcohol can spike uric acid. Sneak preview here: that would be beer and hard liquor, not wine. Thought about purines a little bit; we’ll talk about that in just a moment. And added in some specific dietary supplements that can target uric acid and help to bring it under control. 

Kathy Smith: Okay. Well, again, I’m going to mention it in the close after you leave, but I’m going to let the audience know some of the things you recommend in your book for bringing it down. Which are the tart cherries. It’s the vitamin C, quercetin, coffee you mentioned – which, I was surprised at that one. It’s kind of counterintuitive. 

Dr. Perlmutter: I am gratefully not surprised, believe me. 

Kathy Smith: How about matcha? Is matcha on that list? Anything to do with matcha or green tea or not? 

Dr. Perlmutter: Data on tea is slightly lower uric acid. I’m a big fan of green tea; that’s what I do in the afternoon. But you’re right. In Drop Acid, the O of the Drop is the tart cherry. That is powerfully effective – even the extract – in lowering uric acid. You mentioned Quercetin. That would be 500 milligrams per day. Luteolin is another bioflavonoid that’s associated with lowering the uric acid: 100 milligrams per day. And a good dose of vitamin C that is typically used in research is 500 milligrams per day. 

All of these have been researched and demonstrated in peer-reviewed journals to dramatically lower uric acid. So, is there a time and a place for taking a drug? I guess so, and I’m not anti-drug. But I think that these tools to bring the uric acid under control and, therefore, have a very meaningful, positive impact on metabolic issues like we’ve talked about, are very, very effective.  

Kathy Smith: One of the things that I’d love my 0:36:00 audience to hear – because this is a thing that I have with family, friends, people that aren’t “believers,” let’s say. What would you say? What would be your elevator pitch of why somebody should, first of all, pick up your book? Especially one of our family members who might be overweight, might be suffering from diabetes? How would you say it in such a way that doesn’t shame, doesn’t cause confrontation, but brings them into the fold? 

Dr. Perlmutter: The word I use is “empower.” You know, I begin that conversation as I begin many of my books: that we’ve been kind of led to believe that we should live our lives however we want, and then there will be a fix for our problem that we’re going to develop, whether we think there is going to be something for Alzheimer’s or whatever the problem is. 

I think, you know, as I lead into this, I tell people of an interesting story – an event in my life. I was giving a presentation to a group of around 500 mainstream doctors in New Jersey, and I said, “Well, I’d like to know from my audience, what are your best-in-class go-to drugs to treat diabetes?” Somebody will say this drug, somebody will raise their hand and say that drug. You know, all the common drugs. Then I say, you know, none of these drugs that you all have just mentioned treats diabetes. Then I say, “What are your best go-to drugs to treat high blood pressure?” Hands go up. People say this commonly used drug and that drug. I say, “None of those actually treats high blood pressure.” 

So, right now, I’ve got a lot of fidgeting doctors in the audience; they’re shifting in their seats. They’re thinking, “What’s wrong with this guy? Of course, these drugs treat diabetes and high blood pressure.” They don’t. How do you know that? Because I then asked, “Well, what happens when you stop 0:38:00 that diabetes drug?” The answer is within a few days the blood sugar goes up, obviously. So, we didn’t treat the fire; we’re only treating the smoke. We’re treating the symptoms of diabetes, which is elevated blood sugar. We are not actually approaching the underlying metabolic problem. 

So, it’s powerfully effective to let people know that they can take agency over the notion of getting to the root of the problem, and possibly reducing (or even stopping) their drugs, realizing that these drugs that they are taking are only temporarily treating the symptoms. When you stop your high blood pressure drug, you know your blood pressure goes right back up. Yet, you’ve done nothing to approach the fire; you’re only treating the smoke. 

When I talk about it like that, people begin to realize that, you know, maybe there’s some sense that we’re portraying here. You know, I think, again, when you watch the advertisements on television, you know, these are people that are generally in pretty bad physical shape, and they’re so happy because they’re taking their diabetes pill, and they got their A1C under 7 and whatever the goal may be. But the reality is that lifestyle matters a whole heck of a lot, and controlling uric acid is targeting a very powerful pathway that’s been active in our bodies back to when we were primates 15 million years ago. That’s when we developed the genetic mutations that set the stage for our elevation of uric acid because it allowed us to survive and persevere in the environment of not having enough to eat. Well, nowadays, that same pathway is being targeted. 

I have been taken by this environmental evolutionary mismatch for a long time. I wrote my first article about that half a century 0:40:00 ago, publishing it in the Miami Harold when I was 16, and I concluded the article asking, “What are we to do, those of us living today with this outdated machinery?” Meaning that our bodies, our physiology – and being dictated by our genome – has evolved under different circumstances, targeting our bodies with information like fructose (food as information). It’s sending a signal for us to prepare for winter. 

When people get their arms around that, it’s heavy. I get it. It’s difficult. I just rather eat the cake and take my etoformin and that’s that – you know, for the diabetes. But, I think people are beginning to understand more and more that they’re in the driver seat, that the ball has been hit over the net to their side of the court, and it’s time for them to play it. There’s nothing shaming here involved at all. It’s about empowerment. It’s about giving people the tools to finally take agency over their health destiny. 

Kathy Smith: Love the way that you put that. I think that is, honestly, a great way to wrap up. I know that you have a busy schedule. I do want to say that there is so much more in the book, but you’ve talked about so many important facets today. What I love about your delivery is that you’re just so inspiring. I mean, you really tell the story. You make it very doable, in the sense that – especially in your book – you lay out a plan that anybody can stick to. It’s not necessarily… I’m assuming, also, it’s not necessarily an all or nothing. For instance, I did the Camino de Santiago about three years ago, which is a 500 mile walk across Spain, and after 18 miles of walking every day, the only thing that I wanted was a beer. Which, 0:42:00 [unknown], it was called. That was an extraordinary situation, obviously. But what I’m finding when I’m sitting in the book is there is some wiggle room, depending on what your baseline is. 

Dr. Perlmutter: You bet. I just think this is a question of just how do you respond to the number? Get your uric acid level done and see where you are. Many people know their blood sugar. Many people check their blood sugar at home. Many people are wearing a continuous glucose monitor and know their blood sugar at any moment just by looking at their smartphone. But we are now seeing that uric acid is earning its place on that top shelf of things like fasting blood sugar, uric acid, blood pressure, body mass index as being one of the most fundamental metrics that we need to pay attention to if we’re going to be healthy, live a long time, and live a long healthspan – not just lifespan.

Kathy Smith: So, what’s your prediction then? What’s your prediction when this is going to be as mainstream as we see checking your blood sugar level? I mean, do you have it in mind? Have you envisioned it? 

Dr. Perlmutter: I don’t know if it will ever be where blood sugar is. I mean, blood pressure has been so fundamental since the 1930s, my goodness. But I can tell you that I work with a lot of people. I sit on a lot of boards, and everyone is interested in uric acid in terms of developing ways of measuring it, developing ways of targeting it. 

So, it’s very hot right now. I think it’s only going to become more and more validated as the research continues. 

Kathy Smith: Well, thanks to you. Thanks to you. I mean, you’re doing a huge service for not only the country but the world. I know my audience is just going to love this information. I know it’s something that was new to me. As I was thumbing through the book, I’m like, “Oh, my gosh. How did I not know this?” 0:44:00 So, it was a real eye-opener. So, I thank you for that. We’ll give it all in the liner notes, plus in my close after you leave here. I’ll give all the information of where to buy the book, and I can only thank you for coming on and spending your valuable time with us.

Dr. Perlmutter: Well, thank you for giving me this opportunity. You’re very kind. Thank you, Cathy. 

Kathy Smith: Okay. Big hug. Thank you. 

It was such a pleasure having David on the show today. 

So, reducing high uric acid levels, which is a hidden risk you might not even know you have, is one of the secrets to unlocking extraordinary health. 

Some natural hacks to lower your uric acid levels include consuming more tart cherries, vitamin C, quercetin, and coffee. I’m not a big coffee drinker, but if you are, that can help lower it. Don’t forget your sleep and your exercise. 

Now, if this has piqued your interest, you’ve got to check out his book: Dr. Perlmutter, Drop Acid. It really is amazing, and it has valuable strategies of how to manage uric acid, the foods to eat that are high in uric acid to not eat, and the foods that are low in uric acid, as well as so much other content. 

Now, if you go to drperlmutter.com, you’re going to see all of his blogs. You’re going to see so much information that he gives away for free, so you have to go to his site. 

Now, backing up here, I want to give a shoutout to people on the Reshape Program. For those of you that don’t know about Reshape, it’s an all-in-one app: daily workouts, daily meal plans, and daily inspiration meditations – all (can I say that again?) in one app. 

Reshape will take you to a place that I just love. It has meals that are plant-based and regular-based. It has daily videos and audio workouts that allow you to adjust for your level. And it has these daily visualization and meditations that really help jumpstart your day and, at the end of the day, also help you sleep a little better. 0:46:00 We could all use that. 

Now, if that sounds interesting, check out kathysmith.com/reshape. 

Also, a quick reminder, these podcasts are great to listen to when you’re out there walking. You walk, I talk. Let’s get that straight; you’re walking, I’m talking. You can be burning calories and be learning something new at the same time. There are hundreds of episodes – hundreds, now. I’m so excited about this! We’ve had over a million downloads. It’s a very exciting time for this podcast. 

So, I would love if you go into the archives and find something you like about human health, about heart health. You can check out about gut health with Dr. Will. You can check out about menopause with Dr. Felice Gersh. You can even check out a walking audio that I put in there just to mix things up a little bit if you want to get out for a walk and listen to me coaching you. 

If you like the podcast, oh, please, please, please, please, please leave a review because reviews really help me get the word out to other people, but they’re also a way that I can stay connected with you. You can ask questions, you can say who you want next up on the show, and it really is invaluable. So, leave a review. For everybody that has, big shoutout to all you guys. 

Until next time, big hug and kiss. Here’s to your health.