Uncover Uric Acid’s Hidden Impact

Summit Introduction and Guest Welcome 0:00

Hello, ladies. Welcome back to Mastering The Meno(Pause) Transition Summit 3.0. I am your host, Dr. Sharon Stills. As always, it's an honor, privilege, and excited to be here with you and let you listen in on yet another riveting conversation that is going to help you make this transition one of the most amazing moments of your life. We are raising the story that this is where we get old and put out to pasture. We know that this second sacred act can be where we feel better than ever before. By pausing and really taking stock of where we've been, where we are, and where we're going.

And as always, I tell you, I get the the best people to be guests and come speak to you all. And I have got Dr. David Perlmutter with me, who I'm sure most of you know, he's a man who needs no introduction. He's a six- time New York bestselling author. He is just so prominent in my field of educating about brain health. His newest book, Drop Acid, is all about uric acid and what you need to know about it for your cardiovascular health. So strap in. We're going to have a really good conversation.

You're going to learn a lot about your brain, about your heart, about all the things that we need to be focused on as we are aging gracefully. So thank you, Dr. Perlmutter, for being here. I am so delighted Dr. Stills. Thank you. I want to make one comment. interestingly, I observed that when you said to all the ladies I would I would hope that men would watch this as well. Well, it's our third year round and everyone hasn't happened yet. You know, no one's really told me. I don't get a lot of comments from men about the summit, but yeah, yeah.

You think I always make the invitation because, right, happy wife, happy life. You know that men need to get educated too. And we have in the past talked about erectile dysfunction. We've talked about some things that are more important for the men because that's. What I meant by that is, you know, if you want to know everything you can to be helpful for your wife and her health, you want to know this dimension, right? Not I'm not. It's not about me and my, you know, aging or whatever, but just to, you know, as an idea, I'd like to know how what my wife is going through and what I can, how I can encourage her or listen together so we can both pick up the pearls or whatever.

Anyhow, just an observation. Well, and truthfully, a lot of what we talk about relates to men anyway, right.

Why Uric Acid Matters Beyond Gout 2:51

So men also need to be focused on movement and things of that nature. So yeah. Good. Good point. And so that's an invitation ladies. Go grab your bring your male partner and tell them to join us. So well it's truly an honor to have you here and thank you. You have expertise in so many important topics. And I think I just want to start with, we were talking about before we came live what we're going to talk about, but I'm really curious to have you talk a little to the audience about why you wrote Drop Acid and why, you know, we have so many blood markers we run on patients and why you really, you know, singled out uric acid and what the importance is for them.

Sure. Well, you know, you and I and and doctors and health care providers in general have been trained to connect uric acid elevation with risk for gout. And that was pretty much it. And a story and, you know, put people on medications or a special diet and the uric acid comes down and luckily their gout doesn't flare up anymore. That was pretty much the one hour lecture that we all got, but we learned that uric acid is far more important in human physiology than simply being a risk for developing gout.

That uric acid is a playing a central role in regulating our metabolism, our blood sugar, the function of insulin, whether we make body fat or we use body fat for energy, how our our mitochondria working, what's our blood pressure turns out, who knew that uric acid is deeply involved in so many aspects of metabolism? To the extent that many health care providers now are including a uric acid in their metabolic panels. In other words, when they check blood sugar, they check fasting insulin, the hemoglobin A1 to see the blood pressure, etc.

uric acid has gained a real, position of prominence in terms of being so valuable for two reasons. First, it does influence all the things I just mentioned. And second, it's relatively easy to control. a lot of it has to do with simply changing the diet and avoiding certain sugar. That will help to bring the uric acid down quite dramatically. So it's in this context that uric acid does when elevated so many bad things, to our metabolism that it's really become so much in the spotlight these days.

And so when the, when women or men who are listening are having their doctor run a uric acid level, are you just talking about it being outside of the lab reference range, or do you? I do want them to look great. I'm so glad you brought that up. And, you know, we look at our lab values and we want to see, well, are we in the normal range or not? And, you know, I'd say for, anybody involved in watching this program that in the normal range is not good enough for any of your audience. We want to be in the optimal range.

The the normal range is a norm. actually it's an enormous it's a, an average basically an average health these days is not good. So if you want to be average, which as I said, is not good, then you're in the normal range and you're good to go. a normal blood sugar is up to 100, and a blood sugar of 100 is not good enough for your viewers. We want blood sugars to be lower. We want, the uric acid to get back to our discussion to be at 5.5 or less. The laboratory is going to tell you anything under seven is considered normal.

Why? Because above seven, uric acid begins to crystallize and precipitate out of the blood and form crystals which are involved in gout. But the cardio metabolic issues related to your acid begin at a lower level. That's why 5.5, I don't want to say, is the new normal. That's so cliche, but we should be targeting an optimal level for uric acid. That's getting it down to 5.5 or lower. Are there any issues you find with having your uric acid level too low? Now? There has been one correlative study that correlated, very low uric acid with end stage Alzheimer's.

And it makes sense because uric acid in your blood is made from, to some degree, the breakdown of our food, of course. but also when we break down our body tissues, when we're catabolic, we're breaking down muscle for fuel, for example, it liberates from the cells of the body tissues that we're breaking down chemicals called purines. And those purines are tablas to form uric acid. And when we run out of muscle to break down, in other words, when we're in stage Alzheimer's, we don't have any more muscle to break down.

Then the uric acid level is going to be really, really love. So there's really no downside to having a very low uric acid level. That's it. And then you mentioned diet avoiding fructose sugar. Could you be a little more specific. What that means. What do we actually need to avoid? I will you know, over the years when, when you and I were originally trained and all of the literature that came out said, you know, if you want to lower 70s uric acid, they have to be on a low purine diet. Purines are the breakdown products of DNA and RNA in foods and tissues.

so you have to avoid foods high impure things like organ meats, for example, shellfish, etc. turns out that was not the big player. What the big player has always been has been what you just mentioned. Fructose sugar a unique type of sugar. Fructose means fruit sugar. It's the sugar that's highest in various forms of fruit. We don't want to really bombard our bodies with fructose, because when we reach

Diet, Fructose, and Lowering Uric Acid 8:51

a certain threshold, which is about five grams at any given moment, then that excess fructose gets metabolized directly into uric acid raises the uric acid. So what does it mean? It means that a 12 ounce glass of orange juice has about 36g of sugar. A lot of that is fructose. When you down that glass of orange juice that you normally would drink pretty quickly, you overwhelm the small intestines ability to deal with that fructose goes to the liver and becomes uric acid, as opposed to eating an apple.

You know, if you eat an apple, number one, you're not going to gulp it down. number two, it's delivered with fiber that slows the fructose absorption. Number three, there's vitamin C that increases fructose and rather, uric acid excretion. And number four, actually importantly, an apple doesn't have a lot of fructose in it anyway. It only has about five grams as opposed to so much sugar in sodas and added to foods to sweeten them via high fructose corn sirup and certainly fruit juices as well. So a lot of its context.

So, you know, I think that as people notice that their uric acid levels are less than ideal, that there are some very straightforward and simple dietary things they could do to help reduce the uric acid, by targeting fructose fat. Just so you're not saying avoid all fruit, you're just. Saying not at all. Not at all. You guys, with the the source of it and how you're intaking it. so any other things that the listeners should know about lowering their uric acid? Well, I think job one will be to figure out what it is.

And, most people on a general metabolic panel or blood panel, rather, there's a generally uric acid level is, included in that. And so to find out your uric acid, it might be as simple as making a phone call to the doctor's office or going on your portal and looking at it and say, well, what was it? You know, when I had my blood drawn last, or go and have it checked now, what, you know, the good news is, is uric acid is so important now that you can easily go online and buy a fingerstick. just like you checked your blood sugar test and figure out what your uric acid level.

It's actually very simple. I have my device, oddly enough, right here. This is what it looks like in my last year. Gas. It was. I don't think you see that 4.7. You know, you put a drop of blood on a strip and bingo, you got your result. So that's the first that's job. One second is of course restrict your, fructose consumption. Never tolerate it. There's a couple, of nutritional supplements, one of which is called quercetin, which in a very handy way will lower uric acid nicely. about 500mg a day.

Has done very well in terms of being able to lower, the uric acid. Another one a little more exotic is something called ludi olan and lut Ali and ludi olam 100mg a day and plain old vitamin C. I mentioned it before 500mg a day aids in the excretion of uric acid, but, you know, we're seeing, individuals who lower their uric acid and lo and behold, their blood sugars come down and their, blood pressures can come down and they can lose weight. So this is a an important lever to pull that. To be fair, we were not aware of, you know, ten years ago, five years ago, even though, the first publications about uric acid beyond gout, came out in the late 1800s, believe it or not, probably Doctor Alexander Haig wrote about all kinds of other manifestations of elevated uric acid, including, in various neurological issues, including headaches, etc..

Interesting text. What made you decide to, like, really focus and write a whole book about it? Well, the truth of the matter is, I was, going for a run and I was listening to a podcast, and it was an interview of a doctor, Richard Johnson, who has done the pioneering work in uric acid. And it was so good, so compelling. So I as soon as I finished, I went for another run, the same day to hear it again. And then I reached out to him. I said, this is great stuff. and, you know, we became friends and shared literature.

And to me, anything that is important in terms of metabolism and inflammation is really something I want to know everything about because these are really important factors related to brain health and function. So, you know, if it's uric acid elevation is going to raise the blood pressure and compromised blood flow and all these things I need to know about it, and people need to know about it in terms of a brain healthy program. But we want to start putting that in there, because I think a lot of the listeners are educated to know how to run an insulin, to run a homocysteine, to run a fibrinogen in or a CRP.

And so we want to make sure we have uric acid in with those with those other big players that were run. That's right. it really has gained a position of prominence. And let me be a little more technical here now, because I think your viewers are, really hopefully dialed in. Now, why do we want uric acid to be brought under control? It turns out that when uric acid level is elevated, it compromises in the body the ability of the body to make something called nitric oxide. That's not laughing gas, that's nitrous oxide.

This is nitric oxide. And we want to have a lot of nitric oxide floating around the body because it does two very, very important things. Number one, it allows blood vessels to open up. So we get more blood flow, throughout the body including the brain. And number two, it allows it insulin to do its job. So when we compromised nitric oxide, insulin cannot work as effectively. That's huge. Because if we don't let insulin, do its job, we become insulin resistant. We don't give glucose to our cells, and the brain, especially, is not happy.

Now when, nitric oxide is not working. And again, the relationship is high.

Nitric Oxide, Menopause, and Brain Blood Flow 15:27

Uric acid knocks down nitric oxide. And that's a powerful threat to metabolism. very important especially when we're talking about menopause and hormones and estrogen and at all. And, let me let me bring that up. I'm not sure where you're going with that, but it turns out that, the way that nitric oxide works, in terms of allowing blood vessels to dilate, is dependent upon estradiol E2. So it is a very good explanation, then in terms of the sudden increased risk of cardiovascular disease that we see, after menopause, because now, you know, as estrogen declines, nitric oxide function decline and it threatens the ability of nitric oxide to allow blood flow to throughout the body.

Right. And so, you know, that also impacts your libido and your ability to have an orgasm. And so it's it's all, you know, it all ends up being tied together to health as well. Now that you mention it, in men, erectile dysfunction is a blood supply issue. It's a, that's what is involved in erectile dysfunction is blood supply when there's not enough blood, going in for, penile, to medicines or erection, then that's what erectile dysfunction is. So drugs have been developed, like sildenafil to increase blood flow, penile blood flow and allow men to get an erection.

Well, what is sildenafil? Well, first of all, more recently we've seen that men who've taken sildenafil regularly have a 69% reduced risk of developing Alzheimer's disease. So what is sildenafil? It's Viagra and what does it do. It improves nitric oxide availability to allow blood flow to the penis. But it doesn't just allow it there. It allows it throughout the body including the brain. Again, dramatic reduction of Alzheimer's risk, better blood flow to the brain. Men taking Viagra. Now I'm not saying that everyone, men and women should be popping Viagra all day long.

But you know, we could have a discussion in terms of you know, where nitric oxide comes from. But let's leave it for now to say that elevated uric acid is associated with erectile dysfunction compromises nitric oxide and as such, threatens blood flow to the brain. So let's so let's let's kind of curve into Alzheimer's now. And because that is such a big concern I see in in my clinical practice, women are they've watched their mother or their grandmother and their and go through it. They, they're starting to get some brain fog or they're forgetful.

And it is a big concern. And we know that, you know, post-menopausal women who aren't replacing their estrogen, they're putting themselves at risk for a higher incidence of Alzheimer's. So you are the the expert. So, what would you say to the to the listeners as far as what they can be do to preventing Alzheimer's, any testing or supplements or. I'd love for you to talk time. Well, first, you mentioned, that they've seen Alzheimer's in their mother, their grandmother or their auntie, all women. And I think it's really good to emphasize the notion that this is a predominantly a female disease and a 2 to 1.

and I think that's really so important, in terms of the attention that we need to place on this situation. And, you know, truthfully, when this individual that you referred to, the hypothetical individuals now noticing some cognitive issues that's late in the game, the the metabolic changes in the brain, the precise age, these cognitive complaints, either subjective or, measurable cognitive changes by about 2 to 3 decades, meaning the metabolic changes occur in the brain 2 to 3 decades prior to forgetting the grandchildren's names.

Now, we live in a world where do whatever you want and go along your merry way. And now suddenly you're having memory issues. Well, let's see if we can develop a drug for that. No, the problem has begun 20 to 30 years ago. based upon your body's metabolism over which you have control, i.e. being pre-diabetic or type two diabetic, having hypertension, being obese, these factors are hugely relevant as it relates to your brain's destiny. Long before you have cognitive change. We each have a level of what we call cognitive reserve.

You know, a little back up plan, that allows us to get through, even though those metabolic changes are already happening in the brain, we still can consumption. We don't really notice it, because we're dealing now with the reserve. The reserve tank, if you will. but the point is, in terms of Alzheimer's prevention, we've got to target metabolism in people in their 30s or even in their 20s or even in their teens or even in their adolescence, because we're seeing children and adolescents now developing

Alzheimer's Prevention and Metabolic Health 21:00

metabolic issues, developing type two diabetes and hypertension and obesity, that's bad for the brain. And that's when we should be intervening, not when somebody suddenly can't remember people's names. You know, prevention, prevention, prevention always I know in the health of our children. So for those of you that are listening, you know, this is important information, not just for yourself, but for your children, your grandchildren, because we owe it to these future generations to really make changes so we can start getting healthier.

Rather, I mean, our children have more chronic illness these days than ever before. It's super sad. So diet wise, you wrote a book called The Green Brain. So I. Well, do you eat greens? What do you think about greens? Or is it just me? The main thesis of grain. Grain wasn't gluten, it was. It was carbs, basically. And you know, our our source of carbs in general is, is from grains, you know, wheat, barley, right. etc. all, you know, basically seeds of grass and the degree of processing of these seeds is so dramatic and creating now what we call these ultra processed foods that are powerful threats to human metabolism in a country where about 56% of all calories in adults is coming from ultra processed foods, one wonders why we're having such, an epidemic of metabolic issues.

No mystery. There's no mystery here whatsoever, because we're eating foods that are so dramatically processed and raising our blood sugar and increasing inflammation. and that's a threat to the brain like no other. So that was the central thesis of Green Brain written in, I guess, what 2013 was. We've got to we didn't call them ultra processed foods in those days. That term hadn't been invented. But it was really that, foods based upon, manipulated and, processed grains are a powerful, clear and present danger as relates to human health.

And in this book, particularly the brain and, you know, similarly, like the uric acid. But that grain brain raised a lot of eyebrows. but I think people would agree that, you know, now that's the center of discussion, even in the mainstream, that there's this relationship between a types of foods that we consume and how the brain functions today. And what risk does the brain have in terms of disease tomorrow, with a lot of emphasis on these ultra processed foods. So what is, what is a day in the diet of Doctor David Perlmutter look like?

they're they're hard nosed for you. You don't do seed oils. You like what is. Oh, no. Seed oil. So I take 1 or 2 meals a day just because, you know, I'm not trying to accomplish anything, I don't. That's not. I'm not being strict. I just don't, I just eat 1 or 2 meals a day. Just works out for me. And that's. I don't usually eat anything except coffee in the morning till, 1 or 2 in the afternoon. just because that's how I feel. I don't I don't feel hungry in the morning. I mean, I, I get the, you know, the reason to extend the fast from the evening meal.

And, you know, we could talk about a time restricted eating and its value, but it just what works for me. I do use, a product called value loss. allulose. and that, is turns out to be what we call a GLP one agonist. In other words, it's a sweetener that doesn't actually raise your blood sugar, believe it or not. but it's a GLP one agonist. Acts like that and therefore helps to curb appetite. I don't do it for that reason, but I do it for the blood sugar control. what did I have today? Today I had a, hamburger that was actually made from beans.

So we call that, black bean burger. I had coleslaw and steamed vegetables and, happy as a clam at high tide. Just love to eat like this because I love to feel. Well, I don't know what we're having for dinner tonight. That's, I'm good at cleaning up. My wife's. It is a great book. So I can clean up, and I do a good job, and I do it with gratitude in my heart that we have such good food. We've bought a lot of olive oil, so we have olive oil at every meal. I bring a bottle of olive oil to restaurants.

As strange as that may seem, over the years, substantially less alcohol with time. you know, I met, like many, parroting the notion that a glass of red wine a day is a good thing. I'm not so sure anymore, based on, current data, but, you know, I frequently wear a continuous glucose monitor. My blood sugars are under awesome control. I'm not bragging. I'm just saying that anyone can do it because I'm no different. and and I do take a fair number of supplements, most of which are based upon my genetic profile that I have access to.

but, you know, beyond that, I think maybe even before that, the most important, part of my daily program is the exercise without fail.

Diet, Coffee, Exercise, and Daily Brain Health Habits 26:30

So, my father died of Alzheimer's, and, you know, I know what goes into an Alzheimer's prevention program, and exercise is key. Sleeping well is key. Eating well is obviously key. And I think people will say, well, what do I should be on? Should I be paleo, keto, vegetarian, this, that or the other? Only eat foods that have an end in a vowel. I don't know. Whatever food thing you want to choose, I'd say all good provided it's controlling your blood sugar. So pick a diet, maybe change it next week however you want to do it.

But you've got to know what that diet is doing to your blood sugar. And the only way you'll know is by wearing a continuous glucose monitor, which are now available without a prescription, which is about one of the most wonderful things I've read all year. So, you know, it's to match your size, your, your diet, to see what it's doing to you, not just because it's popular or some influencer happens to be on a diet, that's all. You know, meat or whatever it may be. Let's mattress size. Let's see what the diet you've chosen is doing to your blood sugar.

That's the most important parameter. Yes, it should be a diet that provides adequate amounts of fiber to give nutrition to your microbiome. Yes, you should have lots of colorful different colors of vegetables, so you get lots of good polyphenols. We get that. but if you want to look at one metric alone, it's going to be blood sugar. Yeah, it makes such a huge difference. I used to think I was so super cool because I run hemoglobin anyone sees and have so much more information than just a glucose, but you just can't tell what's going on moment to moment, and you can't tell how someone's reacting to a sweet potato versus a white potato.

And sometimes you're even surprised. And so it's such a valuable tool for really. But it's very individualized. That's the point. I didn't know that my blood sugar spike when I eat cashews. I thought, nuts, you know, I'll eat them all day long or whatever, and meeting blood sugar goes up. So that's probably not the case with you or who knows. But, but I also noted that this, allulose that I've been using has really blunted my, my, glucose spikes that I was getting when with exercise, most people notice when you're wearing a CGM, a continuous glucose monitor that your blood sugar spikes when you exercise or is elevated in the morning for whatever reason.

And, you know, we could talk about why that is. We understand it. But I loss tends to blunt that. And that's super cool. So are you taking out your loss as a supplement or is this. No, I just mixed it into my coffee in the morning. And I want to ask about coffee because coffee has, you know, gotten every good rep, bad rep. So I'd like to know what your thoughts are on coffee and brain health. Is it advised to drink a cup a day? Absolutely. Or two. Or two. Okay. And the sweet spot seems to be two cups of coffee a day.

Now, you know, as far as that goes, then, in terms of relationship to risk for column decline, etc.. Having said that, make sure that it's in the morning and you're not you know, the half life of caffeine is six hours. So if you have, you know, if you're having a double espresso at 6:00 with dinner, then you realize that six hours later, i.e., midnight, there's still one of those double express espressos on board. So, you want to go? So we we describe what's called a caffeine curfew. For me, it's 2 p.m., but I generally would not have caffeine, you know, after the morning anyway.

So, you know, is it a ritual for me? Of course it is. Do my wife and I like to have a cup of coffee? Zoom out in the back. We do it every day, wherever we are. So that's a good thing. But, you know, I, I don't think there's really, any significant downside that we should be concerned about. And when you say coffee, are you referring to only black coffee? Well, let me extrapolate that for just a moment. The coffee discussion always tends to go to caffeine. Right. And, there's there, you know, more than 60 bioactive chemicals in a cup of black, let's say black coffee.

you know, you can add whatever you want. it then then the question becomes, are you actually fasting because you've added some oat milk or almond milk to your coffee? call it what you will. but for me, I will add some oat milk or macadamia milk. Not really milk. Macadamia, because it froths really? Well, for those of you who have a father, and and then the second cup, a couple hours later is just a shot, but in that, I put a teaspoon of allulose. And so that's become part of my regimen. Well, I'm going to start doing that.

I was a late coffee bloomer. I didn't start drinking coffee till I was 53. But it doesn't have to be coffee. You know, there's a lot of benefits to green tea. you know, you know, a lot of these beverages are. But, yeah, I think coffee is probably the most popular beverage on the planet right now. Yeah. you know, there's there's a lot of discussion. These are the climate change that, having access to coffee beans, maybe threatened in the in the near or future that you might be surprised. and are you very particular?

I'm assuming you're not going to Starbucks. You're making sure your coffee is mycotoxins free. And. Yes, if I'll drop a name here, I use what's called Purity Coffee. It's organic. It's third party, certified for being micro toxin free. it checks all the boxes for me. So, that's the one I choose. Excellent. Yeah, I like that one, too. So, any last words of wisdom, tips, inspiration for the. Well, yeah. And I would say that I want to get back to something we had covered and that is that, you know, we kind of live in a world that would lead us to believe that we can live our lives however we choose, and that modern medical science is going to be there with a magic pill to help us through our ails.

Reality is as relates to your brain that doesn't exist. There is no drug that will treat

Final Advice and Where to Find Dr. Perlmutter 33:00

your declining brain function, even Alzheimer's itself, that the seeds are sown for cognitive decline 20 or 30 years ahead of time. And that, as John Kennedy said in his inaugural address, the time to fix a roof is when the sun is shining, meaning that we've got a rain in our metabolism today while we while the sun is shining, if you will, and, you know, really double down on the exercise program. Mattresses are sleep where, some kind of wearable, like an aura ring or an Apple Watch determine how well we are sleeping and if not, if we're not sleeping well, make changes to improve that situation.

diet we talked about extensively to diet, exercise and sleep. The three pillars, of brain health. yes. Which, as I said in the beginning, applies to men and women. And that is just the for for anyone in the human condition that is important for baselines. So where can, where can the listeners follow you, find you. my website is drperlmutter.com. and I think Instagram is @David Perlmutter. but I think the website's a good place to start. I do have a podcast called The Empowering Neurologist, which is something I really love doing.

And again, as you know, you know, you get to interview people from all around the world. I interviewed someone this morning from Tasmania. it was, 11 until 12:00 at night for him. so there's a lot of, I believe, very, very good information from these wonderful people who, consent to offer up their time. So that's a good thing to look for. The Empowering Neurologist. Wonderful. Well, go, go check him out and learn more. And, you know, sometimes health is very complicated and sometimes it's foundational, and sometimes it's a mix of the two.

But, you know, getting your brain healthy is a lot about getting your metabolism in check. And that is something that we have control over. And we control what we choose to eat and when we eat and all of those things. So I know you all got this. You can do this and make sure you're getting your uric acid level. You can do this. Yeah. You really can. Like like you said, you know, you, me we're not we're we're just normal people. We just do the work and do the things and we get the benefits. And we're not special. Anyone can do that.

And that's why we spend time educating you. So you can do it too. So thank you all for being here, for being a part of this Summit and for listening in on this very informative conversation. And we will be back with another one. So stay tuned.