Dhru Purohit Show - The Surprising Truth of Uric Acid and How It Impacts Metabolic Health with Dr. David Perlmutter

Starting point is 00:00:00 Hi everyone, Drew Brody here with another mini episode breakdown where we take some of our top episodes from the past and share the top and most exciting sections from that episode. Today we have Dr. David Perlmutter talking all about uric acid from his new book, Drop Acid. Now, uric acid is such a fascinating biomarker. It plays a major role in fat storage, insulin resistance, and other metabolizers. and chronic degenerative diseases that are driving illness, death, and disease in our country. And in today's episode, Dr. David Perlmutter gives us a big picture overview.

Starting point is 00:00:41 He also talks about the foods that drive uric acid levels, how elevated uric acid levels directly lead to increased fat storage, the consequences of elevated uric acid on our overall health, the main culprits that lead to elevated uric acid levels, and lastly, how you can test your uric acid levels from home and what the optimal ranges are. You know, we've done so many episodes on metabolic health and uric acid is one of those topics that is getting more attention, especially with the work of Dr. Richard Johnson, who's also been on this podcast, as one of the early canaries in the coal mine that are an indicator that major challenges are coming up.

Starting point is 00:01:28 You know, we primarily know uric acid as being something associated with gout. And when we have high levels of uric acid from drinking things like beer and having a lot of rich foods, you know, gout was called the rich man's disease. Then we're more likely to get gout in our lives. I've had many family members that have suffered from gout in the past. But we're understanding that this isn't just about gout. This is about so much more, not just fat storage, but overall metabolic help. It's a fascinating episode. If you've missed it before, today's mini episode featuring the highlights with our interview with Dr. David Perlmutter is absolutely for you.

Starting point is 00:02:05 Stay tuned. I want to start off with some immediate value that we can give to our audience that's there. Tell us about a few surprising foods that came across your plate, foods that like even maybe one or two, that you looked at through a completely different lens after doing the research and the deep dive that you did around this book and then we'll unpack the whole concept of uric acid, what it is, why it matters, and how you figured it out. Okay, here are the bullet points. Yeah.

Starting point is 00:02:37 Beer, sardines, anchovies, and of course, fructose, the sugar fructose uniquely. So all three of those categories as being foods, because I said surprising, I didn't say whether they were good or bad, quote unquote. And you would say that these are foods that all drive uric acid levels. And that's why if you're eating them or you're consuming any of these foods in a regular basis as part of your diet, you really want to be paying attention to this interview. That's right. And, you know, for years, there's been this attempt to make us believe that fructose was somehow

Starting point is 00:03:12 a safer, better sugar because it doesn't elicit an insulin response. And therefore, hey, it's a great sugar for everybody and diabetics especially. And the truth of the matter is nothing could be further from the truth. we know that fructose drives metabolic dysfunction and that metabolic dysfunction is at the core of our most dreaded common diseases of our time, the coronary artery disease, Alzheimer's, cancer, diabetes. So it is, you know, understanding this new biochemistry of the downstream metabolites of fructose and specifically uric acid that is a revelation and it is exceedingly. meaningly empowering for each and every one of us. This is a new tool in our toolbox like we've

Starting point is 00:04:00 never had before, and I just get pumped up to talk about it. So take us on the uric acid journey. Most people aren't always familiar. They know that sometimes they see it on a test report back from their doctor. There's not much discussion around it. How does the traditional world of medicine look at uric acid? How do you look at it now through the lens of some of the surprising research that's been actually out there for a few years now that you came across, and what does it mean to us as we're thinking about how to optimize our health? I'd say that you probably wouldn't need to ask me another question for the rest of our time together today.

Starting point is 00:04:35 Really? Because that is, it's why we're here, because we all grew up in the medical field looking at uric acid through the lens of gout and perhaps kidney stones. End of story. And if you went to your doctor and had your blood values done, typically it would contain anywhere between 12 and 20 different parameters. In general, uric acid would be included through the lens or in the context of gout risk or having kidney stone risk.

Starting point is 00:05:05 And now we recognize that uric acid is far from this inert metabolite that might be related to gout, that it is a central player. It's gone from, there's a title actually of a journal article. uric acid in metabolic syndrome from innocent bystander to central player. So we recognize that it is exceedingly active in playing a role for the host of metabolic issues that threaten our health, whether it's high blood pressure, fat deposition, keeping fat locked up, gluconeogenesis or the creation of blood sugar in your body, insulin resistance, oxidative stress, inflammation, nitric oxide inhibition, all of these mechanisms are now associated with uric acid,

Starting point is 00:05:54 and were all good things in the day, that becoming insulin resistant, which we now, every guest on your show who talks about metabolic health who say, we had to do everything we can to not become insulin resistant. I mean, Dr. Hyman's written books on this topic, Dr. Lustig as well, many people, myself included. And yeah, it's true that this. These days, we should do everything we can not to be insulin resistant, but for 99.99% of our time on this planet, being insulin resistant, having blood sugar higher than what we consider normal, was a very powerful survival tactic. And we wouldn't be here today if it weren't for the fact that we humans, by virtue of our

Starting point is 00:06:41 thrifty genome, have a real strong predisposition to raise our blood sugars, to make body fat, to increase our blood sugar, to make more blood sugar in our bodies to power the brain so that we can avoid the two things that threatened our ancestors, starvation and predation. You know, we've always been at risk of not having food, and we've always been at risk for being eaten by something else in the forest, right? Those aren't really risk that we encounter these days. We're not, you know, we're not at risk for having another animal come along and eat us anymore. So I think that where we'll take our discussion today is to an incredibly fascinating place that

Starting point is 00:07:24 through the years of our evolution, we had some unique changes in our genome that paved the way for us to be very thrifty as it relates to the calories that we've consumed, that we've always banked calories in the form of fat so that we would have a hedge against starvation. And that's where this elevation of uric acid comes into play. So what we've learned is that between 14 and 17 million years ago, there was a series of mutations in the genes that made an enzyme called uricase that breaks down uric acid. And these genetic mutations turned off the production of this enzyme. So our uric acid levels increased. And now we know what that means. It means that higher levels of uric acid told our bodies that winter was coming, told our bodies make fat, store fat, make more blood sugar,

Starting point is 00:08:22 raised the blood pressure because that's how we would survive when we didn't have food and we didn't have water. So those of our ancestors that had these mutations then would survive when food was scarce and they pass those genes onto you and to me and to every human walking the planet now a time when we don't necessarily have food scarcity. And the biggest trigger of all, to lead back to your original question, is the sugar fructose. Fructose becomes available to us in the late summer and in the early fall. Well, when I say us, I mean perhaps our hunter-gatherer forebears and our primate ancestors, we consume fructose.

Starting point is 00:09:04 It's metabolized into uric acid, and uric acid tells the body, hey, get ready, when coming. Make fat. Get ready. Get ready almost for hibernation. That's what animals that hibernate do. They have higher levels briefly of uric acid. They make more body fat. Then they hibernate and they have the calories to sustain themselves. So it's an incredibly interesting story because ultimately where we go with that is to where we are today, where we experience the consequences of this evolutionary, mismatch. So we have this genome, this physiology, this human body that wants to save every calorie, that wants to make fat to hedge against times of caloric scarcity. And yet we're triggering that mechanism to make more fat day in and day out, you know, to the extent that a third of American adults

Starting point is 00:10:04 is obese. And that number is going to be 50% by the year 2020. Now 2030. We think 2030, you know, that's in the distant future. I know this is probably evergreen, but I'm going to say, as we have this conversation, it's eight years from now. 50% of American adults will be classified as not just being overweight, but obese. You know, you mentioned consequences. Obesity is one of them, and uric acid plays a central role in that. We'll come back to that.

Starting point is 00:10:33 What are some of the other consequences, diseases that people might think of that are out there, that they know that people, maybe even loved ones, maybe even themselves that they're diagnosed with, that have a direct connection all the way back to the upstream elevated levels of uric acid that people are facing. This episode is brought to you by Inside Tracker. You know, I just turned 40 this year, and I can honestly say I've never felt better.

Starting point is 00:10:58 So many people have a fear around getting older because they think it has to come with chronic disease and deteriorating mental and physical health. If that were the case, I'd be worried, too, about getting older. but it doesn't have to be that way. It's possible to get older and stay young at the same time, but sometimes we need a little help to know exactly how to do it. That's why Inside Tracker developed Inner Age 2.0.

Starting point is 00:11:20 This proprietary AI-driven platform reveals how your body is aging and provides you a personalized science-backed action plan to help you get younger from the Inside Out. Inside Tracker's new inner age test allows you to see how your inner age compares with your chronological age and gives you a longevity-focused plan with science-back recommendations to help you make sure your best days are still ahead of you. Right now, InsideTracker is offering my podcast community 20% off. Just go to inside tracker.com slash drew. That's D-H-R-U to get your discount code and to try it out yourself.

Starting point is 00:11:57 that's inside, I-N-S-I-D-E-T-R-A-C-E-R-D-R dot com slash D-H-R-U for 20% off today. Did you know that the health of your entire body is rooted in the health of your gut? Hippocrates said this many, many years ago. Disease begins in the gut, and so does health. Over the last decade, research on the importance of the gut microbiome has exploded, which led myself and my business partner, Dr. Mark Hyman, to ask the same thing, simple question, is there a way that we can create a daily support system for the individuals in our community to help them transform their gut for the better? Turns out there is. With the

Starting point is 00:12:38 help of a few experts and years of research, we created the ultimate multivitamin for your gut microbiome. It's called gut food. Gut food uses the power of three critical gut supporting components, prebiotics, probiotics, and polyphenols, and features five ingredients at clinically validated dosages to support the reduction in overall inflammation, support the growth of beneficial gut bacteria, help support the reduction in bloating, and help support mood and energy. You know, we created this product because it's exactly what we wanted for ourselves and what we wanted to offer to our community because nurturing your gut health can literally transform your life.

Starting point is 00:13:20 I'm so excited about gut food and I want you to know that you're going to love it too. If you want to learn more about gut food and what we've been up to, go to gutfood.com. That's G-U-T-F-O-O-D.com to learn more. So the number one cause of death on planet Earth are the chronic degenerative conditions. And those include things like type 2 diabetes, coronary artery disease, Alzheimer's type cancer, various forms of cancer. So what's killing people across our planet are these chronic degenerative? inflammatory metabolic diseases. At their core, there is metabolic dysfunction that paves the way.

Starting point is 00:14:02 Metabolic dysfunction so that we gain weight. Our blood sugars go up. We become insulin-resistant. We have higher levels of inflammation in our bodies, a central mechanism for things like Alzheimer's and coronary artery disease. So those are the big threats. Even bad outcome as it relates to COVID infection is seen in people with higher levels of uric acid. So it is front and center leading to this metabolic dysfunction in the day of our caloric consequence, in the days when we didn't know we would have calories or not, we knew or we didn't. These issues would be life-saving. They paved the way for our survival in the context of possibly starving to death. That's not generally where we are today. So people should then understand that we're set up to gain weight.

Starting point is 00:14:56 We're set up to make more blood sugar by virtue of this innate mechanism that all humans possess. And that is how we trigger uric acid production that is the danger signal. It tells the body, get ready. And then we should then ask ourselves, well, what are those inroads to elevating uric acid. And its diet, its lifestyle diet, primarily these days, fructose. Our fructose consumption has dramatically increased over the past century, whereas in the 1920s, we would consume perhaps 15 grams of fructose a day. Now that number's up to 55 grams. That, you know, we're consuming 17 teaspoons of sugar a day, the average American. And that's table sugar, sucrose, which is 50% fructose. And fructose and glucose are totally different molecules,

Starting point is 00:15:52 though their chemical formula is the same. Their configuration is totally different. And their metabolism is like night and day. We metabolize glucose by using a hormone called insulin, drives glucose into the cells, creates glycogen, we store it. Fructose has nothing to do with that. Fructose is metabolized into something called uric acid, and the consequences of that are manifold. They are severe, and they represent a central player in our time of metabolic discontent, if you will. When you look around the planet, you know, to get back to your question, these metabolic issues are the number one causes of death, and they are avoidable. And, you know, as I was getting ready for our interviews today, I was thinking about some of the questions you might ask, and I realized that

Starting point is 00:16:45 we say in general that Alzheimer's is not really a genetic disease. You know, about four to five percent of Alzheimer's patients have a real strong genetic issue, puts them at great risk. We don't say, for example, coronary artery disease or type two diabetes are really genetic issues. But through the lens of this genetic change that happened to our ancestors and the mismatch then between what our ancestors and even our hunter-gatherer forebears experienced and the world of today, we still have those genes. So in a very real sense, Alzheimer's and type 2 diabetes and coronary artery disease because they are metabolic are 100% genetic. They are the downstream manifestation of this mismatch between our physiology, dictated by our genome, and how we speak to

Starting point is 00:17:44 our physiology based upon our lifestyle choices, primarily the food we eat, but also the sleep that we get or don't get, the exercise, the stress, the other lifestyle factors that are truly influential in relating to what our genome expects. Yeah, it's so profound when you zoom out and you think about it. It's like this mutation, as you've been talking about, this genetic mutation that we had. And the people that didn't have it, they didn't make it. So we're all ancestors from those people. And from my understanding, because 15 million years ago was about it was apes.

Starting point is 00:18:19 It was before homo sapiens, right? Long before, yes. Long before homo sapiens. And so these ape ancestors, there was a group of ape ancestors that didn't have this mutation. They couldn't survive winter. There wasn't enough fruit trees that they had access to. to, they couldn't store fat, they couldn't do our evolved ape ancestor version of making it through the winter instead of like a full-bone hibernation, right? Because at that point in time, there wasn't

Starting point is 00:18:47 really a full-blown hibernation period that our ape ancestors were going through. And now, because our modern lifestyle has changed so much around us and there's so much fructose in our environment, we'll talk about the top sources that are out there. Surprisingly, some foods that Many people think are healthy that they're eating on a regular basis that could be driving these high Uyric acid levels. But because we're so much surrounded by it, we've changed and our environment has changed, but our genes have not changed. And that's why we're in this mess that we're in today when it comes to chronic disease.

Starting point is 00:19:18 That's right. And, you know, so it's an environmental pressure. Evolution is the response to environmental pressures of one sort or another. and our genome basically is selected for those mutations that will then confer certain superpowers, if you will. And this specific Euricase set of mutations took place over a couple of million years, so it didn't happen very quickly. And in fact, the changes during the middle Miocene period were actually very slow with the earth cooling

Starting point is 00:19:53 and the progressive loss of food availability. Now, we've turned the tables on these genetic mutations in a century or two, and we cannot adapt. And I actually wrote my first article on this topic half a century ago when I was 16. I published an article in the Miami Herald talking about, you know, what's happening to us who are, in my words, stuck with this outdated machinery. So we can't evolve quickly enough to be able to be in common. with our current environment. We can't change our genome. We don't have that technology just yet. Maybe we will, but we can sure change our environment. You know, this is sort of the underpinning of the so-called paleo movement to try to emulate the environment of our ancestors that

Starting point is 00:20:44 coexisted quite well when you looked at the relationship between genome and environment. Now there's a great disparity between those two. We want to try to do what we can to give back to our genome those signals so that it can keep us alive, those salubrious signals that we give via our foods, the environmental choices that we make. And that's what this is all about. And focusing in on uric acid as being that sentinel, that alarm signal, and we want to do everything we can not to trigger it. You know, there's a really powerful study from 2016 that looked at 42,000 men and 48,000 women, a big study. And they showed that those in the group, they followed these people over eight years, those in the group who had the highest level of uric acid had about a 16% increased risk of

Starting point is 00:21:40 what is called all-cause mortality. What does that mean? Dying from absolutely anything, from being hit by a bus to coronary artery disease, having a stroke, you name it. But more specifically, their risk for cardiovascular death in the group with the highest uric acid was increased by 39 percent, almost 40 percent. Risk of dying of a stroke increased by 35 percent. And for every point of elevation of the uric acid above seven, the units we use here are milligrams per decilator, for every point. So at eight and then at nine, there's an additional eight to 13 percent, increased risk of death from any cause whatsoever. And the final conclusion of that study was that in this group of 90,000 adults,

Starting point is 00:22:32 that a quarter of the diabetes, type 2 diabetes, had its origin in elevated uric acid. So we have to take this really seriously, but it's good news. You know, we've talked so much about blood sugar, and of course, uric acid is directly connected to, you know, the blood sugar, metabolic health, as you've talked about it a little bit earlier. And the interesting thing that, you know, as I started to go down the rabbit hole of uric acid, which is always included in my blood work, but like a lot of laboratory markers that are out there, they're based on the sort of normal reference ranges for the population. and normal is most of the population is not healthy, is not an optimal health.

Starting point is 00:23:18 So what your doctor tells you is normal is not always what is optimal from, you know, your stance and viewpoint and in functional medicine and the latest research. So talk to us about uric acid levels because it's very interesting. There are a few ways that, you know, people can test it, you know, some things that you've talked about online. And then they can also ask about it from their doctor, but how to interpret it is, not always there. So the data is accessible and it's nice that it's usually a pretty cheap test, but people don't often know what it means and their doctors aren't often trained in the subject.

Starting point is 00:23:53 True. That is an incredibly important point because most doctors are going to tell you that, again, your uric acid level is part of your annual blood test as a risk factor for gout. And as such, the norms that have been developed are way too high. because they deal with levels above which then you have a risk for having gout or having perhaps kidney stones. And the level of seven or above being considered abnormal relates to, again, risk for gout. And also above seven, that's when uric acid has a much higher tendency to crystallize and to form these gout crystals that can be painful in your toe, et cetera. So if you have an elevated level of uric acid above seven and you don't have gout and you don't have kidney stones,

Starting point is 00:24:49 you have what is called asymptomatic, meaning no symptoms, hyper, meaning elevated uricemia. So asymptomatic hyperurisemia, elevated blood uric acid without having symptoms, is looked upon as being nothing much to worry about. But again, that is only through the context or through the lens, rather, of gouty kidney stones. So asymptomatic hyperurisemia is a powerful risk factor for elevated blood sugar, for elevated blood pressure, for weight gain. There are a variety of studies that demonstrate that. So it's anything but benign. It's anything but asymptomatic because you just haven't looked at it.

Starting point is 00:25:29 You haven't looked at, you know, how it relates to these other issues. So cardiovascular risk, for example, begins at a level of 5.5 and above. So we really need to revise these norms. In fact, there are several studies that have had that in their title, that we need to revise what are considered the normative values for uric acid. And I think you make a very good point as it relates to functional medicine, and that is that oftentimes we're not so entrenched in the notion. of the so-called normal value that we're really trying to articulate what is the optimal value.

Starting point is 00:26:09 The people, you know, normal is what's common. And what's common today is pretty crappy health. And therefore, people who want to be healthy shouldn't look to being normal. I mean, as I mentioned earlier, in eight years, the normal American will be obese if you consider what's common. And that's not what we want. That's not ideal for anyone's health. So what we're trying to voice is what is optimal in keeping your uric acid level at 5.5 or even substantially lower.

Starting point is 00:26:43 And as you mentioned, you know, that's a test most people have had at their doctor's office. And the goodness is you can go online and buy your own uric acid monitor. I did and check your uric acid level with a finger stick just as you might check your blood sugar level. And I will tell you sneak preview here that we may very well see. continuous uric acid level monitoring in the future, much as we see CGM continuous glucose monitoring now becoming exceedingly popular for exactly the same reason so we can get a dynamic

Starting point is 00:27:15 understanding, a motion picture as opposed to looking at a still photo, of what our uric acid level is doing day to day, hour to hour based upon the foods we eat, the sleep we get or don't get the level of exercise that we engage. Are we in ketosis? How did that affect my uric acid level? And to understand how all of these inputs have an output that you are measuring on the uric acid meter, I think, is really quite profound in your effort to keep your uric acid level under control. So we note through these examples, and if anybody has had a family member that's had a kidney stone or has been diagnosed with gout, that crystallization, right, is often people have a picture of it or your doctor talks to you about it, that this crystallization is causing a

Starting point is 00:28:02 problem, this uric acid buildup that's over here, and now you have the end result, which is like a kidney stone. In the case of heart disease, what's the mechanism of uric acid being elevated and then contributing to heart disease being more likely in an individual? What's the pathway? What does it make happen more? What does it prevent from happening? It'd be good to tease that out a little bit. Sure. And we can tease it out for heart disease, but let me just say that what I'm about to describe to you are the same fundamental mechanisms that relate to Alzheimer's, that relate to virtually all of the chronic degenerative conditions that are underpinned by the mechanisms of inflammation, insulin resistance, elevated blood sugar, and all the things that feed into that,

Starting point is 00:28:52 like overweight and obesity and the inflammation that that causes. So we can have the discussion focused on, again, on heart disease and then simple narrowing of the coronary arteries. But again, those fundamental mechanisms brought on by uric acid are at play across the spectrum of these really pernicious and global issues that threaten our health. So what is uric acid doing? Well, fructose, as mentioned, is metabolized. into uric acid. And that is what we call a feed-forward process. The more uric acid is produced,

Starting point is 00:29:29 the more fructose is metabolized because it is a survival mechanism. We want more metabolism of fructose to take full advantage of to make body fat to raise our blood sugar. Fructose in the liver turns on this process of gluconeogenesis, the production of glucose de novo. Why is that important? It's important because it provides blood sugar to power the brain, which is kind of like our ace in the whole. We're not the strongest animal. We're not the fastest, but we have a big brain that should keep us out of trouble. We can certainly argue that point these days.

Starting point is 00:30:08 We don't know what's going on with our big brain. But it's been a survival mechanism for us to keep our brains online. The consequence, however, is that this raising of our blood sugar leads to the pancreas having to work overtime, insulin levels being higher and higher to the extent that ultimately we develop what's called insulin resistance and we compromise blood supply to our vital organs. Another important mechanism relating specifically uric acid to coronary artery disease but also to brain-related disease is that it inhibits a chemical called nitric oxide. We desperately need nitric oxide to perform two tasks in our body. Number one,

Starting point is 00:30:52 it allows blood vessels to relax so that improves blood supply to the heart, to the liver, to the kidneys, and to the brain. You know, when the blood supply is compromised, we have things like heart attacks and strokes and problems with kidney function, for example. So that's job number one. We need nitric oxide, uric acid inhibits it. Number two, lesser known is the role of nitric oxide in allowing insulin to do its job. So higher levels of uric acid increase the compromise of the ability of insulin to do its work. So this higher level of uric acid, less nitric oxide, we become even more insulin resistant. We starve our organs. And, you know, ultimately with these higher levels of insulin that have to be produced, that in addition augments inflammation.

Starting point is 00:31:50 Inflammation is another feed-forward cycle because that antagonizes insulin functionality as well. So these, and there's several more, free radical mediated stress is dramatically increased by uric acid. What I'm saying is the increased production of free radicals. We all think that the more antioxidants that we take, the better because we're limiting this oxidative stress, oxidative stress is dramatically increased by the presence of uric acid. The other thing that is going on is that because of uric acid's role in enhancing the activity of a specific enzyme called fructokinase, which is important for fructose metabolism. As mentioned, again, unlike glucose metabolism, fructose metabolism keeps getting more

Starting point is 00:32:44 and more with time because we know winter's coming. It's a built-in mechanism that makes all those downstream effects happen more aggressively. The production of fat, the storage, the locking away of fat, the production of higher levels of blood sugar. And one other thing I'll mention is in that process of metabolizing this sugar fructose from, in our ancestor at least fruit, we'll talk about how we get it today. Something very fundamental happens, and it is an energy-consuming process. ATP, adenosin-trophosphate, not to be too technical, but that's our energy currency. The three phosphates, when each of them is liberated or taken off of adenosine, it liberates energy. It's the currency of energy in our bodies. So to metabolize fructose, we,

Starting point is 00:33:41 break down ATP, ultimately into AMP, adenosine monophosphate. And without getting too much into the weeds here, that drop in energy is fundamental. Because it shifts metabolism away from burning energy to storing energy. And to be technical about it for some of the listeners who like that kind of stuff, it shifts us away from stimulating something called AMP kinase, we'll talk about why that's a good thing, to something called AMP deaminase or the metabolism of hibernation. It's basically saying make fat, store fat, become insulin resistant because this is what you need if you're going to hibernate or we're not going to have food around. Whereas we want to stimulate AMP kinase because AMP kinase says,

Starting point is 00:34:39 hey, let's burn our fat, let's be a fat burning machine. Let's not store fat anymore. Let's not make more blood sugar because we don't need anymore. So what I'm saying is we need to do everything we possibly can to keep this AMP kinase active. We do so, for example, one of the most powerful things we can do to keep that pathway going. It's a switch. Do you want to make fat store fat or do you want to burn fat and not make fat? The most powerful thing that we can do to keep that A.m. AMP kinase active are things like exercise and staying away from fructose. Those are keys. We have medicines that activate AMP kinase to turn down our liver's production of blood sugar,

Starting point is 00:35:24 gluconeogenesis, glucose, like metformin, for example. That's how that diabetes drug works by AMP kinase stimulation. You could do it, same thing by exercising. You could take berberine as a nutritional supplement. for example. But that is the side of that switch that we need to keep active. The other side of the switch is this A&P deaminase that sets you up for making so much fat that you're now ready to hibernate for six months. And I would simply ask anyone, is that your plan? Are you getting ready to hybridate for six months? Most people are going to say no. Maybe some are. You know,

Starting point is 00:36:04 you're going to hybridate in front of TV and be a couch potato for the next six months. If that's the case and you're not going to eat, then you need to make fat. But we're just beginning to unravel this science in the context of what it took for us to survive as long as we've been walking this planet and our primate ancestors too. This incredible survival mechanism that's been in place for 14 to 17 million years, would we finally look at all of these mechanisms contextually We realize that that's the problem that we have today. It gets back to this evolutionary environmental mismatch. And I want to give you one more because I think it's really fascinating.

Starting point is 00:36:51 Unlike most other animals and mammals included, we humans don't make vitamin C. I mean, you know that. We don't make vitamins since we have to eat fruit. We have to take vitamin C or we'll get scurvy. Our teeth will fall out and our children will be boned. naked, all the things that happen, right? So we need ascurvic acid or escorbic acid against scurvy. And, you know, you would say to yourself, okay, that's cool. It sucks to be human because we don't have vitamin C. Let's move on. But why? Why is it somehow an advantage? How do we get selected

Starting point is 00:37:27 for to have this last step in vitamin C manufacturing in our body be compromised? They're four steps. The very last step in making vitamin C from, oddly enough, glucose is compromised in humans. Well, we have to ask, why would that be a good thing? Because if it were not a good thing, that wouldn't be a genetic issue that we have, right? We would select it against it, but yet we selected for it. Well, what is vitamin C? It's a lot of things, but it's an antioxidant. And it turns out that like uric acid, how uric acid induces our mitochondria to pave the way for fat production is through oxidative stress. That's one of the hallmarks of elevated uric acid, induces oxidative stress in the mitochondria.

Starting point is 00:38:20 That is a signal to make fat. If you don't have enough antioxidant, same thing. So that begins to let us understand why it's a powerful positive selection that we don't have the ability to make vitamin C because this oxidative stress helps us make fat and survive. Not what we need today. In fact, there are certainly some animal studies and some preliminary human studies indicating that higher levels of vitamin C help us reduce our fat production. So I think where we're going today and what we're encompassing is, looking at all of these metabolic nuances of being a human being through the lens of the evolutionary advantage that they offered and now how disadvantageous they are in light of our current

Starting point is 00:39:13 environment, meaning our food choices, our other lifestyle choices.

Dhru Purohit Show - The Surprising Truth of Uric Acid and How It Impacts Metabolic Health with Dr. David Perlmutter

There aren't comments yet for this episode. Click on any sentence in the transcript to leave a comment.