Feel Better, Live More with Dr Rangan Chatterjee - The Key Driver of Chronic Disease That Nobody’s Talking About with David Perlmutter #368

Episode Date: June 6, 2023

What do obesity, insulin resistance, diabetes, fatty liver disease, hypertension, cardiovascular disease, stroke and dementia have in common? They are all chronic diseases that together are the leading cause of death in the world today. And they’re largely caused not by genes, but by our environment, lifestyle and food choices. This much many of us already know. But today’s guest brings some valuable new information to the table: the role of uric acid. Dr David Perlmutter is a board-certified neurologist and six-time New York Times bestselling author. He is on the Board of Directors of the American College of Nutrition and an Associate Professor at the University of Miami Miller School of Medicine. His latest book, Drop Acid: The Surprising New Science of Uric Acid, focuses on the pivotal role of uric acid in chronic metabolic diseases, claiming that lowering its level in the body holds the key to losing weight, controlling blood sugar, and transforming health. Many of us only think about uric acid in relation to a painful condition called gout. But, as David explains even slightly raised uric acid levels, can have damaging and widespread implications for our health. David and I discuss what he calls the ‘evolutionary environmental mismatch’ - how modern lives are at odds with what serves our biology best. And one of the key elements that is driving this mismatch is the modern food environment. Many of us simply think about food as energy or calories but David and I discuss why we need to start thinking about food as information. Every bite that we eat is giving our body cues and signals. If we give our bodies the right cues they will thrive. If we give them the wrong cues they will start to malfunction. We also talk about the relationship between our fructose intake and uric acid levels, the evolutionary benefit for slightly higher uric acid levels, how increased uric acid can drive fat storage, high blood sugar levels, high blood pressure and insulin resistance. We also discuss what changes we can make with our food choices to reduce uric acid levels in our body. David explains how certain food choices can make us more impulsive, less compassionate and less empathetic and how the right food choices can help us make better decisions and increase our happiness. David is a gifted communicator and someone who is committed to helping as many people as possible, live healthier and happier lives. I hope you enjoy listening. Support the podcast and enjoy Ad-Free episodes. Try FREE for 7 days on Apple Podcasts https://apple.co/feelbetterlivemore. For other podcast platforms go to https://fblm.supercast.com. Thanks to our sponsors: https://www.seed.com/livemore https://www.calm.com/livemore https://www.drinkag1.com/livemore Show notes https://drchatterjee.com/368 DISCLAIMER: The content in the podcast and on this webpage is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your doctor or qualified healthcare provider. Never disregard professional medical advice or delay in seeking it because of something you have heard on the podcast or on my website.

The prefrontal cortex is the adult in the room. It exercises what we call top-down control over the amygdala of the five-year-old that would have things that it wants right now, damn it, I don't care about anybody else. Inflammation severs the control. Inflammation severs the ability that we have to make good decisions.

Inflammation is brought out by or amplified by our modern diet. So globally, we are becoming more impulsive, less compassionate, less empathetic individuals. Hey guys, how you doing? Hope you're having a good week so far. My name is Dr. Rangan Chatterjee and this is my podcast, Feel Better, Live More. What do obesity, type 2 diabetes, fatty liver disease, high blood pressure, cardiovascular disease, strokes and dementia all have in common? Well, they're all chronic diseases which are usually underpinned by something called metabolic dysfunction. And together, they make up the leading causes of death worldwide. And they're largely caused not by our genes, but by our environment, lifestyle, and food choices. This much I think many of us already know. But today's guest brings

some valuable new information to the table, the role of something called uric acid. Dr. David Perlmutter is a board certified neurologist and six time New York Times bestselling author, whose work has won him many high profile awards. He serves on the board of directors and is a fellow of the American College of Nutrition. And he's an associate professor at the University of Miami Miller School of Medicine. His latest book, Drop Acid, focuses on the pivotal role of uric acid in the development of many of the chronic diseases I've just mentioned. Now, many of us, including healthcare professionals, only think about uric acid in relation to a painful condition called gout. But as David explains in our conversation,

even slightly raised uric acid levels can have damaging and widespread implications for our health. David and I begin by discussing what he calls the evolutionary environmental mismatch, how our modern lives are in many ways at odds with what serves our biology best. And of course one of the key elements that's driving this mismatch is the modern food environment. Many of us simply think about food as energy or calories or fuel. But during our conversation, David and I discussed why we need to start thinking about food as information. Every bite that we eat is giving our body cues and signals. Give our bodies the right cues and they will thrive. Give them the wrong cues and they will start to malfunction. Now,

one of the foods that is giving problematic cues to our bodies these days is fructose. In our conversation, David and I discuss what exactly fructose is, where it lives in the modern food environment, and why he is so keen for all of us to reduce the amount that we're consuming. We also talk about the relationship between our fructose intake and uric acid levels, the evolutionary benefits for slightly higher uric acid levels, the evolutionary benefits for slightly higher uric acid levels, how increased uric acid can drive fat storage, high blood sugar levels, high blood pressure, and insulin resistance, and of course, what changes we can make with our food choices to reduce uric acid levels in our body. We also talk about a topic that I'm sure you will find really, really fascinating,

how certain food choices can make us more impulsive, less compassionate, and less empathetic, and how the right food choices can help us make better decisions and increase our happiness. This conversation actually took place a little while ago now, when David was in London to speak at a conference. We only had one hour allocated together and ended up in quite a noisy room in the corner of the conference building. So the audio quality is not as sharp and as clear as I would have liked, but my sound engineer has worked really, really hard to make sure the audio is as clear and as punchy as possible. David really is a gifted communicator and someone who is committed to helping as many people as possible live healthier and happier lives. I enjoy talking

to him. I hope you enjoy listening. And now, my conversation with Dr. David Perlmutter. You're widely known all over the world now for advising people on diet and lifestyle, how they can better live their lives. Yet I still think there's a lot of people out there who don't see the link between the health of their brains and their lifestyle. So perhaps we could start there. Great place to start. And yeah, we still labor through this dichotomy between the health of the brain and the health of the body as if there's some division. And this gets back to Descartes and the whole notion of systems and looking at the body as a machine, the brain being the computer, the heart is the pump, the lungs are

the bellows, and there should be no interaction. And the reality is here you and I are filming at an integrative type conference, right? Integrative meaning that, yes, it's good to integrate our various approaches to healthcare, but the bodyative meaning that, yes, it's good to integrate our various approaches to healthcare, but the body functions as an integrated whole as well. The notion that there is a, in America, they call it a heart smart diet, as if what's good for the heart might not be so good for the brain, for the rest of the body, might not be so good as it relates to cancer risk reduction. The reality is that we are still doing the very best we can to refine our messaging for the health of the entire body, including the brain. The brain is a fundamental part of the whole,

much as each and every one of us functions as part of the global community. And even the notion, taking it further, of the idea that bacteria live upon us and within us and are intimately related to our moment-to-moment health and ability to resist disease is difficult to embrace, even with all the new exciting research coming out about the microbiome. We want to believe that body systems are segregated. We have the development of cardiologists and neurologists and pediatric neurologists dealing with the young brain. And we see higher, higher levels of specialization. But the reality is it's very important to take a step back from the forest

and realize that even as it relates to our role on the planet, you know, man did not weave the web of life. He's merely a strand of it. That's a quote from Chief Seattle. So we're, you know, we've really that you've written many books about. What kind of foods help support our health? Which kind of foods potentially take away from our health? In your view, with all your experience, is it more important for us to focus on foods to take out of our diets or foods to introduce? Foods to take out of our diets or foods to introduce?

That's a tough question. A lot of my work these days is taking the fructose out of the human diet. I have put myself in a place in very recent years of focusing on the notion of evolutionary environmental mismatch. What does it mean? It means that our environment and what we expose ourselves to in the modern world in terms of food, in terms of other aspects of our day-to-day existence, is deeply in contrast to what our genome would best be served by. We evolved over hundreds of thousands of years under a fairly static set of circumstances.

Suddenly, in the blink of an eye, those circumstances have changed and our genome has not had a chance to adapt. So we are living with a paleolithic genome in a very, very industrialized type of environment. And there's a huge mismatch. And I say that's become sort of my watchword in terms of focus as of late. But I wrote a paper on this topic half a century ago, publishing it in the Miami Herald, our local newspaper when I was 16. And I called at the end of that missive the question, what about those of us living today with the outdated machinery? I mean, that we are more suited to a different environment. So we're not going to change part one, the evolutionary part. We're not going to anytime soon be able to influence the code of our genetic legacy. But we can certainly look

at the other side of the balance beam, the environmental part, and that speaks to your question about food. And I think that clearly the input of food in terms of that relationship is vast. As such, we look upon food not just in terms of the macronutrients of protein, fat, and carbohydrates or the micronutrients of minerals and vitamins, but we look upon food as an information cue. Food is a powerful indicator to our bodies as to what we should be expecting right now, and even more importantly, what is to come. Food tells our bodies to prepare for food scarcity, to prepare for winter. It tells our bodies that now it's time to stop storing fat and to activate various pathways that allow us to burn fat as fuel and stop making glucose. But that relationship,

that signaling pathway, is now facing an accelerator the likes of which we have never imagined. Basically, what I'm saying is we're day in and day out stimulating a signaling pathway, telling our bodies to prepare for food scarcity, for winter, basically, but that winter will never come. The eternal summer. That's right. That sounds actually pretty good though. You're right. An endless summer sounds good, right? For enjoyment, for sun, for heat, but actually there's a very detrimental consequence for our bodies, our brains, our whole physiology, if we live in a state of eternal summer. You mentioned a couple of things which

really grabbed my ear. Food is information, right? If I think about the general public, whether it's in the UK, in the US, many countries around the world, food is still not seen as information. People think of food, as you say, as calories or how much fat is it, how much protein, how many carbs. And I think that's such a reductionist way to look at food. So maybe you could expand on food being information. What exactly do you mean by that? You've also mentioned fructose. What is fructose? Where does it live? And why are you so keen to help people get it out of their diets? I don't think people are keenly aware basically about anything related to their foods when

you think about it. When you walk around London, as I did today, and people are walking and eating, there's no real connection with the foods that they're eating. That the next bite is being prepared while the current bite is being chewed. And there's really no connection. And we eat what we are told to eat and what becomes available to us. And marketing has captivated us, knowing full well that each and every person on this planet has a sweet tooth.

While you, Rangan, would like to deny it, and David Perlmutter would like to deny it, we have as part of our hardwiring a survival mechanism to trend towards sweet. Sweet tells us two important things. It tells us that the food is safe and that the food is good for us, because it tells us winter is coming and basically allows us to make and store fat. Why does it tell us it's safe? Because basically there is no food on the planet that is sweet and is toxic, at least in terms of nature. That's for sure. That's a very interesting paradox is that nowadays the toxic foods are, in fact, sweet. But it plays upon us because our hardwiring says, eat that food.

It is sweet. It is safe. And it's the right color. You know, in nature, by and large, red foods, for example, have traditionally been threatening. Nowadays, red diet things and, you know, the gummy bears are certainly perfectly fine, seemingly. And, you know, the gummy bears are certainly perfectly fine, seemingly. But we've totally lost our connection, which wasn't something actually humans ever thought about. Humans didn't think about eating particular foods because it would prepare their bodies for a type of stress like food scarcity.

It just happened as part of our evolution and was a powerful survival mechanism. And it takes us to a place of understanding how our evolution has cultivated those behaviors that we have that make us crave fat, salt, and sweet as survival mechanisms. as survival mechanisms. Those ideas of adding more salt and fat and sweet to manufactured foods, what a concept, manufactured foods, preys upon us. It preys upon our hardwiring and makes us gravitate to those foods, eat way more of them than we should, and explains, in my opinion, the global explosion in terms of rates of overweight and obesity and all of the metabolic downstream issues that we are now seeing. Yeah. So fructose, your latest book, Drop Acid, is a really quite wonderful read, very eye-opening read, lots of things in there relating to uric acid that I certainly not come across. So I definitely want to talk about that. But what exactly

happens in the body when we consume fructose? Well, fructose is so named because it came from fruit sugar. We find fructose in nature. We find it in fruits and vegetables. And typically, we would find higher levels of fructose in the foods that we would consume in the later summer, early fall as they would ripen. And the process of ripening is a process whereby carbohydrate is broken down into sugar, making food more sweet and therefore more delectable, more palatable, and certainly more sought after by us now and certainly by our ancestors as well. And what happens when we consume fructose in the amounts we would consume by eating an apple or two or some grapes is we get a small amount of fructose packaged with dietary fiber

to slow its release into the body, packaged with vitamin C to actually help our bodies excrete something called uric acid, packaged with bioflavonoids to reduce the formation of uric acid. So now I've mentioned the entree to uric acid and why that's so important. Uric acid is made from fructose. When we eat fructose, our bodies metabolize it into uric acid. Now that's generally once the liver has exceeded its ability and the small intestine has exceeded its ability to deal with that fructose. We rely upon the small intestine has exceeded its ability to deal with that fructose. We rely upon the small intestine to deal with that first five grams of fructose that we may consume by consuming the apple, not the 36 grams of sugar in a glass of orange juice or apple juice, not the 36 grams of sugar that are found in 12 ounces of soda, for example, soft drinks.

sugar that are found in 12 ounces of soda, for example, soft drinks. That overwhelms the small intestine's ability to deal with its maximum five or six grams of fructose. That fructose then makes it weight to the liver, and that begins a cascade that threatens our health. It was a survival mechanism in that that overrunning of fructose from the small intestine and getting into the liver told our bodies hey stress is coming you're going to be food deprived calorie deprived winter's coming you need to make fat and that was a challenge for our ancestors we can take our story back 15 million years to our primate ancestors who faced a very powerful threat to their existence during what is called the Middle Miocene period. And what happened during that period is the Earth slowly cooled over a million years. Something that we can't really grasp. We can't grasp timeframes like that when we consider that agriculture

began 14,000 years ago. Anyhow, so the earth became cooler. Our primate ancestors, some of them developed a superpower. And what was that superpower? They made a little bit more fat, a hedge against caloric restriction, allowing them to survive and propagate.

They passed on their genome that had within it a change. What was the change? There was a change in the genes that coded for an enzyme called uricase. Now, the loss of the uricase enzyme meant that their uric acid levels would be a little bit higher. And that was the whole ballgame right there. Because they had higher uric acid values, it clued their bodies in to make and store more fat. It told their bodies, make more blood sugar to power their brains through what we call gluconeogenesis in the liver.

to power their brains through what we call gluconeogenesis in the liver. It caused their bodies to raise the blood pressure just a little bit as a hedge against dehydration. These were the ancestors that survived and passed on that uricase mutation to you and to me and to everyone walking the planet. So we as homo sapiens have within us a predisposition for higher levels of this alarm system called uric acid. When our uric acid levels are elevated, it's telling our bodies, make that fat, store that fat, lock it away, turn on the production of glucose in the liver so that your blood sugar goes higher, become more insulin resistant. All of those things were wonderful during our ancestral time, survival mechanisms.

Now you and I and everybody involved in preventive medicine is doing everything we can to help our patients become less insulin resistant, less overweight, let's certainly avoid obesity, keeping blood pressure in check, reducing triglycerides, and all of the things that characterize the metabolic syndrome, the harbinger for these chronic degenerative conditions, which the World Health Organization tells us are the number one cause of death on our planet. Yeah, it's really quite profound. There's so much there, David. In what you said, the first thing that comes to mind is this idea that this was a very helpful adaptation.

This actually helped us survive. This helped us thrive when the environment around us was different. Until yesterday. Yeah. So helpful in the environment 15 million years ago, incredibly unhelpful when we have food abundance. I think the second point for me that's really interesting is that it was actually those who had that adaptation, they're the ones who actually survived. So we, all of us, are descendants of the people who survived. So presumably all of us,

most of us, certainly will have that adaptation. So I find that really interesting. The uric acid I find fascinating and where this fits into everything. In terms of foods, though, to be super practical for people, a lot of people, they hear terms like fructose, sucrose, sugar, carbs, and I think it gets confusing for people. So in real practical terms, if someone's trying to improve their health, improve their brain health, their metabolic health, their heart health, as if these things are all separate things, of course they're not, fundamentally improve their health, improve their brain health, their metabolic health, their heart health, as if these things are all separate things. Of course, they're not. Fundamentally improve their metabolic function in the body. What specific foods relating to this

should they be thinking about? It's a wonderful question. It does get back to your question earlier about which is more important, eating foods that are good for us or avoiding those foods that are bad for us. But this is the hidden killer. And the notion that we're going to find all the fructose in our foods is, to be kind, very, very challenging. Because in America, sugar goes by 60 or more different names, that food manufacturers are able to use alternative names for the fructose or sugar that they add to their products. It's still sugar nonetheless, though it's been disguised. And they get away with it. So you really, even as a conscious consumer...

It's very hot. Yeah. You can rely on your taste buds. And the only time you'll get fooled is when there are artificial sweeteners that will trick you into thinking that a food is sweet. So if it's sweet, it's likely to have sugar in it. It's likely to have fructose in it. You bet. And to be more specific, the types of sugar. So table sugar is sucrose. And that is a joining of two types of sugar, fructose, which we're talking about, and glucose.

People are familiar with glucose. And rapidly upon consumption of table sugar, an enzyme breaks those two apart. Glucose is dealt with in an entirely different way. Glucose is the energy sugar, and fructose is the storage form of sugar, if you will, because fructose immediately tells our bodies make fat. So fructose is kind of the long-term survival depot instigator of preparing us for long-term fat accumulation. But nonetheless, even table sugar becomes a threat with reference to the fact that it's 50% fructose. Now, if that weren't bad enough, we now have since developed in 1958, but really making its way onto our plates at a theater near you in the early 1970s, something called high fructose.

What does that mean? That's scary right off the bat. High fructose corn syrup. And this was developed in America. What can I say? University of Oklahoma, 1958. And became a way to create this very, very sweet substance. Fructose is by leaps and bounds far sweeter than glucose. So that in the manufacturing of food, I love saying that because it's so perverse, manufacturers are able to use this high fructose corn syrup and make food sweet at a lower

cost because they don't have to use very much. And at least in America, the growth of corn from which high fructose corn syrup is derived is subsidized by the government. So the very government that is issuing these health proclamations, trying to keep people healthy, is subsidizing the growth of corn to be turned into high fructose corn syrup, which is thematically our most dangerous health threat, well beyond tobacco. So this is a global issue. It becomes very real. We wrote an op-ed. You and I were talking earlier about Levels Health. So Dr. Casey Means and I wrote an op-ed to President Biden, published February 21st, 2021 in something called MedPage Today and really just called to attention the fact that our United States Department of Agriculture

that issues edicts as it relates to what we should be recommending for as healthcare practitioners and what is the government's position on food, they said, hey, 10% of your calories from sugar, that's cool. And there's no science that would support that. The science would indicate that anything over 5% of your calories coming from sugar begins

to threaten your health, increases uric acid, increases your risk for type 2 diabetes, obesity, hypertension, all the downstream things that we've talked about. And yet here is the government recommendation being so influenced by industry that wants to sell us high fructose corn syrup. So in many ways, we have to be the sentinels who stand up and do our very best if there's a listening ear to get the information out that, hey, not necessarily in your best

interest. Here's what really matters, and that is focus on whole, unprocessed, unpackaged foods. If you choose to eat meat, that's totally... Everything you eat is obviously going to be your decision. But there's a move these days toward what is called carnivorous diet or carnivore diet, meaning eating basically all meat and all animal products. And plenty of discussion about that would indicate that probably the biggest flaw in that is the avoidance of a specific type of carbohydrate called fiber. So we need those carbs from fiber to nurture our gut bacteria and, of course, the various vitamins and minerals that plants provide. I am not a full-on vegetarian or

vegan. I do eat animal products. But the importance of carbohydrates in the context of our discussion today of sugar, in that sugar is a carb, I think is really very important because people who want to be involved in eating less carbohydrates, by all means, don't avoid the fiber. You certainly want to avoid refined carbohydrates, especially if you're trying to get your body into what's called ketosis, as I'm sure you just talked to Dr. Walter Longo about what wonderful work that he is doing as well, the fasting mimicking diet. There's certainly benefits to that. But the key is that this fructose has invaded our diets globally.

We used to say the standard American diet, SAD, sad. And then that became kind of the Western diet. Make no mistake about it. It is the global diet. That this insinuation of sugar into the foods, and I use that term loosely, that people are consuming is tragic. It is the global diet. It's interesting.

I was just chatting to Walter Longo. And when he went to America, I think around the age of 18, he noticed that a lot of his southern Italian relatives, where he rarely saw heart disease, he rarely saw people getting sick, when some of them would move to America, he saw rapidly how their health would decline. America, he saw rapidly how their health would decline. I think this is partially some of the drive he had to kind of study aging, study what's going on. And so this is many years ago when he could see a stark difference between where he's from in Southern Italy and America. And interestingly enough now, because we were discussing this when he came on the show, he said he doesn't see much difference anymore. Yeah. Which kind of speaks to what he's saying. It's no longer the kind of American diet.

America, like many things, has exported it to the world. And what you just described, I think, again, recapitulates this evolutionary environmental mismatch. If it were purely an evolutionary thing, then that wouldn't have changed when those individuals adopted a new lifestyle. And the uric acid story, I think, is best exemplified in that context by individuals in Polynesia and Micronesia who, until the mid-1800s, were lean and muscular.

1800s were lean and muscular. And their cultures were such that there was even more pressure for higher levels of uric acid because they made these epic thousands of miles journeys in their dugouts, basically, and boats that had outriggers and sails and had to survive. And they were selected for those that survived had higher uric acids. Introduce the Western diet and now rates of diabetes and obesity are amongst these individuals, the highest on our planet. An incredible manifestation of this evolutionary environmental mismatch. Yeah. Before we go into the weeds of uric acid, because I'd really love to go there because I don't think it's widely known about at all, this link. There's a lot of new information for me in your latest book.

We've mentioned carbs and how important certain types of carbs are. Fiber, you know, for our gut microbiome and all kinds of other reasons. And we mentioned sugar, sucrose. And I just want to make sure that people understand. She said if something's sweet, it's likely to have fructose in it. So often people may think of whole foods like a sweet potato and think, well, you know, that's pretty sweet.

I enjoy having that with my evening meal. Is that a problem, Dr. Perlmutter? And so can we just maybe, with a bit of nuance there, go into this field of carbohydrates? Some helpful feed the gut microbiome, refined ones obviously can put our blood sugar up and cause all kinds of problems. Where does sucrose fit into this? There is sucrose in fruits, of course. There's sucrose in other natural foods. How can people sort of make sense of that when trying to make changes? Just taking a quick break to give a shout out to AG1, one of the sponsors of today's show.

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That's drinkag1.com forward slash live more. Wrong, and it's a very, very good lead-in because it really gets to an empowerment moment for all of your viewers to understand that they need to eat whole foods. Having a sweet potato, half a sweet potato potato or white potato is really pretty reasonable. Now, understanding that we've got a new tool in the toolbox, and that tool is understanding not just the effect of the foods we eat moment to moment on our blood sugars. I see that you're using a continuous glucose monitor. What powerful technology is that that allows you to know this? But a new tool in the toolbox is knowing how foods affect your uric acid. Now, that's not necessarily best observed moment to moment, but over a period of weeks will change based upon the foods that

you eat. And it turns out that it is uric acid that influences the blood sugar in the longer run. That has a huge effect on insulin resistance. I'd love to have some time we can break that down in the actual mechanism. Please do, yeah. Because it's fascinating. But I think the best recommendation is vegetables that you buy in the periphery of the grocery store are fair game. Fruit, fair game. Even the animal products that are, again, in the periphery that haven't been modified are fair game. Even the animal products that are, again, in the periphery that haven't been modified are fair game. Now, to strengthen the argument, of course, we can add current technology like having your uric acid checked. You can do that at home or at the doctor's office and following your blood sugars as well. But if the foods that you are consuming are triggering an alarm system

that tells you that winter is coming, you've got a problem and you've got to deal with it. Because your health care practitioner may or may not be my country, the States, and generally in Western countries are involved in dealing with you once you're sick. So they should more rightfully be called sickness care systems. They will look at your blood sugar and act once the blood sugar, once the uric acid, once whatever metric we are looking at, whether it's lipids, triglycerides, body weight, once these things are out of the so-called normal range. Our interventions need to take place prior to them even being considered interventions. The lifestyle changes need to be

initiated to keep people healthy in the first place. What a notion. That's the best economics we could talk about. It's the right thing to do as a healthcare provider from a compassion perspective. And the fourth century yellow emperor once said that prevention is the ultimate principle of wisdom. To cure a disease after it has manifest is like digging a well when one feels thirsty or forging weapons when the war has already begun. Think of that last sentence, forging weapons when the war has already begun. What do doctors do? I gave a lecture several years ago in New Jersey to a group of mainstream doctors. I asked the audience, I said, well, what's your best, let's go around the room, what's your best treatment for diabetes? The hands went up, sulfonylurea drugs, perhaps metformin, and all of these things. And I said,

basically, no one has mentioned a treatment for diabetes as yet. And I can prove that to you by asking you one simple question. What happens when you stop that medication? Oh, well, doctor, the blood sugar will go up very rapidly indeed. So you never treated anything. You didn't treat the underlying problem. We don't have a pharmaceutical treatment for diabetes. We don't have a pharmaceutical treatment for hypertension for that matter. The point is that we can talk about reversing the underlying disease process by lifestyle interventions. We've seen how a ketogenic diet can help people stop from being type 2 diabetic and come off of antihypertensive medications as well. That's treating the problem. But even beforehand, we certainly want to be

giving people, to answer your question, those tools about the foods that they consume to get out of harm's way early on before there is any harm, before the clouds are brewing on the horizon. Yeah. Let me take you back to your, on the stage this morning, we popped in. And as you looked out at that audience, what did you see? What was the complexion of the audience? It says a male, female, predominantly female. I'd say at least 90%. It was breathtaking. And I think that gets back to the whole underlying mentality of do we fight disease or do we nurture health? Mainstream medicine is involved in fighting disease, in the war on cancer, stamping out

hypertension and Alzheimer's, if possible, as opposed to being at a conference like this where it's more about nurturing health. And as such, the audience was, in my opinion, 90% feminine. Venus, not Mars, not carrying a weapon, but nurturing. We spent the morning in the National Gallery and the paintings of nurturing the Christ child, the whole notion of nurturing and benevolence and not engaging in the fight was portrayed in countless paintings. And we need to get back to that. We need to get back to the femininity of what we are here to do. And it's compassionate and it's empathetic.

what we are here to do. And it's compassionate and it's empathetic. And it takes me to a place of an understanding of why we're here. And it relates right back to the diets that we are consuming. We're consuming a very pro-inflammatory diet now globally. And our decision-making ability really stems from two unique areas of the brain. On the one hand, we have amygdala-based activity that is impulsive, compulsive, and self-centered, non-empathetic. Not even empathetic to my future self, and certainly not empathetic to you, to the planet, to others around me. On the other hand, we have the ability to make decisions based upon tapping in

to our human gift, which is this prefrontal cortex. The prefrontal cortex is the adult in the room. It exercises what we call top-down control over the amygdala of the five-year-old that would have things that it wants right now. Damn it, I want that sweet cake. I want to stay up late. Whatever the child wants.

I don't care about anybody else. Fortunately, our prefrontal cortex is the adult in the room and helps us make more measured decisions. This top-down control that reigns in the child is connectivity. It's actually called the anticellular cortex. We need this top-down control. We need the connectivity to the adult in the room. Inflammation severs the control.

Inflammation severs the ability that we have to make good decisions. Inflammation is brought out by or amplified by our modern diet that's so high in refined carbohydrates. So globally, we are becoming more impulsive, less compassionate, less empathetic individuals, and it fosters a lot of what we see going on around us in the world today. But getting right back to the notion of being compassionate healthcare providers, less and less of that can happen when we want to simply act aggressively right now

and be in that mindset. It's fascinating that in the UK, there's a trend now that I think in many medical schools, there is more than 50% of the years now are female. So less than half of the medical students now, certainly the last time I checked, were men. This is a complete sea change probably from 30 years ago. And I guess speaking to what you just said about bringing more of the feminine into medicine, into healthcare, compassion, empathy, these kinds of qualities, I guess that

gives us hope that things are likely to change. But then David, you said something really interesting about decision-making. Everyone wants to be able to make better decisions for all aspects. A business leader wants to make better decisions for their work. A parent wants to make better decisions for their life and their children's life. We all individually want to make better decisions for our health. And you mentioned how inflammation, this chronic unresolved inflammation that many of us are facing these days, because hugely from our lifestyle, whether that be poor diets, insufficient movements, sleep deprivation, chronic stress, whatever it might be, you've just said that that chronic inflammation is affecting the way we make decisions. So in many ways, it's actually affecting the way we see and view the world. Exactly. But that's profound. It relates back to the foods that we eat.

Those pro-inflammatory foods change the way we see the world around us. So this goes beyond health. Of course, as medical doctors, we're passionate about helping people with their health. But this is for happiness. This is for harmonious relationships. This is for, I guess, a healthy and happy life. It's not just health.

This is everything. That's right. And I would hope that people watching our time together right now would maybe rewind to this past five minutes and really see what just happened. And that is the relationship then between our lifestyle choices, how we see the earth and therefore the future of our existence. Yeah. That's what's going on that's the real uh what's really behind the curtain here yeah uh and inflammation affects our decision making and how we see the world not just through this threat to the connection between our higher

self the prefrontal cortex and the amygdala. Inflammation acts, and this is a little bit more mechanistically, by threatening the production of serotonin within our bodies. When we have higher levels of inflammation, we're not as able to make that important neurotransmitter serotonin from its precursor amino acid, tryptophan, because that pathway that allows that to happen is shifted away to producing something else called kynurenic acid, which ultimately becomes something called quinolinic acid, which is a powerful pro-oxidant threat to the survival of our brain cells. So not that inflammation is always a bad thing. In the right context, we need inflammation.

Were it not for inflammation, we couldn't survive. But it's this overwhelming experience with inflammation that underlies all of our chronic diseases that we need to really get our arms around. People are familiar with the cytokine storm that is a characteristic of a bad outcome in SARS-CoV-2 infection. Equally, having for a protracted period of time, elevation of inflammation, let's call it the cytokine drizzle then, not a storm, but the drizzle, is threatening. threatening. This chronic mild upregulation of inflammation underlies coronary artery disease, diabetes, certainly Alzheimer's, for which we have no meaningful treatment. And make no mistake about it, one of the central mechanisms whereby elevated uric acid is so threatening is because it enhances inflammation in the human body.

That probably was a survival mechanism. That slight bump in inflammation that it connoted for our ancestors allow them to be less likely to be devastated by an infection, for example. There are so many facets getting back to uric acid, including upregulation of the formation of reactive oxygen species, free radicals, if you will, oxidative stress, perhaps, if you will, increasing insulin resistance, elevating blood sugar, increasing lipogenesis, the creation of fat, compromising mitochondrial function, reducing autophagy, taking us away from this pathway called AMP kinase that we so desperately want to activate, that pathway that tells us the hunting is good. Don't make more fat, don't raise your blood sugar.

We want to do all we can to activate that pathway, this AMP kinase pathway. That's why we exercise. It's what the drug metformin does. But uric acid says, no, no, no. We need to prepare you for hibernation. We need to increase inflammation. We need to threaten your brain. Yeah.

When people hear uric acid, when medical doctors say uric acid, we probably think about gout. I imagine much of the population or people watching may have heard about uric acid only so far in relation to gout. So what's going on there? Why is uric acid related to gout? And then what's the relation to everything else that you're talking about? Well, you're exactly right. And when you were in medical school, half of one lecture was high uric acid, gout, give the drug. Perfect. Problem solved, right? But how it often is in human physiology is things are multipurpose. And we learned that uric acid was for gout or maybe kidney stones. But we now know that uric acid throws a much wider net. And when it's elevated,

it sets the stage for disruption of our metabolism. That was only recently described in 1898, recently, right? 1898, Dr. Alexander Haig wrote a book in which he looked at the manifold issues related to elevated uric acid, in his case, headache, but he also looked at dementia and depression and skin issues. And that information was really quite under the radar until about two decades ago when Japanese researchers and Turkish researchers and ultimately American researchers and British researchers began to realize that while the elevation of uric acid was long known to be correlated with various metabolic problems like high blood pressure, high blood sugar, it began to be unraveled as not just being correlated, but causative. And in fact, one paper written in 2016, a collaborative paper by Turkish and Japanese researchers was called Uric Acid in the Metabolic Syndrome from Innocent bystander to central player. Meaning it's not just there, but it's actually involved in mechanistically causing these problems. Now we've seen one study was published three weeks ago that recapitulated what the findings were in the 2016 study. And there are multiple mechanisms involved whereby elevation of uric acid does

its dirty work in today's world. It wasn't dirty work for our ancestors. It was survival. But now we know pretty much fairly exactly how it does what it does. And now we know, for example, we see human research whereby blocking uric acid production using gout drugs, the very allopurinol that you learned about, using allopurinol lowers blood sugar, lowers blood pressure by lowering uric acid. Yeah. I mean, this is so fascinating, right? So a lot of things to do with health are on a continuum. And often in medicine, we get involved very late on that continuum. Blood sugar, metabolic dysregulation has been going on for years, and we say, normal, no problem, no problem, until, oh, boom, you've now got type 2 diabetes.

Without the recognition that this has been building up for five years, maybe 10 years in your body, all kinds of lifestyle inputs have been changing things, right? So we can evolve quite late. If we look at uric acid through that lens, and let's say gout, is gout, for example, in people who are prone to it, downstream on that continuum? Like if you're having gout where your doctor is measuring uric acid, you're quite far down that path now. Is it also fair to say that many of us may well be walking around with suboptimal uric acid levels that we don't even know about because we don't suffer from gout? That's right. So therefore, our doctor's never, ever going to recommend we get our uric acid done. And therefore, we could be looking at a key marker

in the same way that we know that maybe above a certain age, we should do our blood sugar once or twice a year, right? Are you at the point now where you think uric acid should be fitting into that same category? Yes. Let me take it back a little bit because you covered a lot there. The notion of having elevation of your uric acid, but no gout actually has been given a name. It's called asymptomatic hyperuricemia, meaning you've got elevated uric acid, but you don't have gout. So what's the problem? Well, you do have a problem. And it gets back to the normals versus the optimals. You hinted on that as well. In my country, the units are milligrams per deciliter for uric acid. And you're told that if your uric acid is seven or below, hey, you're fine. You don't have gout and everything's fine. But the cardiometabolic issues related to elevated

uric acid begin at 5.5. That's what the scientific research is telling people. And the medical community is slow to adopt, slow to realize that these manifestations are happening and they may not be necessarily issues that we will experience right now. When you have gout in your great toe, you sure as heck know that's going on. You don't need to have a doctor give you the wake-up call. But you don't necessarily have the appreciation of the fact that a uric acid level of 6.8 is related to the fact that your blood sugar is now elevated, that your blood pressure is slightly elevated, that you're having more and more difficulty losing weight. And that's why this is extremely valuable information. And for your viewers, how empowering it is that they know this

and can take this information to their doctors and ask for a uric acid level, though she or he may indicate no need, you don't have gout. Well, it's a new world out there as it relates to this new important tool as it relates to our metabolism. On an individual level for you, David, as someone who is a leader in the field who's been promoting a lot of these messages around the world for many years. You've written numerous bestsellers before this one. How incredible is it to you? How amazing is it to you to go, wow, I've written some, I think, incredible books that have helped so many people, and I didn't know about uric acid.

And I was helping people already. You know, does it make you think, what else is there? What else are we going to learn in science that we don't know yet? You know, aside from the compassion part of my mission, the alleviation of suffering, the curiosity part is huge in my life. I love it. I love listening to a podcast and saying, why, that's fantastic. And that's what happened with Uric acid. Listening to a podcast a couple of years ago, and it was an epiphany moment for me.

Because like yourself, like you've written about over the years, we've been telling people, hey, sugars don't need to be in your diet. The human requirement for dietary sugars is zero grams per day. We should exercise, pay attention to your sleep, stress your body a little bit, get out in nature, form better relationships with others. All the things that we've been talking about to have this totally new tool blindside me, and it was there, I just hadn't been aware of it, it was exciting and remains really exciting. Because now people like yourself are getting this message and saying, whoa, there's a new tool,

there's a new sheriff in town, And it's really very, very exciting. Can we say with certainty that if someone has type 2 diabetes, we know by definition they are insulin resistant, they have a lot of... We can say that with certainty. We can say that with certainty, sure. Yeah, that part, yeah. Can we say that it's almost certain that their uric acid will also be elevated,

or are we not quite there yet? Not. Before we get back to this week's episode, I just wanted to let you know that I am doing my very first national UK theatre tour. I am planning a really special evening where I share how you can break free from the habits that are holding you back and make meaningful changes in your life that truly last. It is called the Thrive Tour. Be the architect of your health and happiness. So many people tell me that health feels really complicated, but it really doesn't need to be.

In my live event, I'm going to simplify health, and together we're going to learn the skill of happiness, the secrets to optimal health, how to break free from the habits that are holding you back in your life, and I'm going to teach you how to make changes that actually last. Sound good? All you have to do is go to drchatterjee.com forward slash tour, and I can't wait to see you there. This episode is also brought to you by the Three Question Journal, the journal that I designed and created in partnership with Intelligent Change. Now, journaling is something that I've been recommending to my patients for years. It can help improve sleep, lead to better decision making and reduce symptoms of anxiety and depression. It's also been shown to decrease emotional stress, make it easier to turn new behaviours into long term habits and improve our relationships.

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We can say that their uric acid levels will most likely be elevated, though I've seen some type 2 diabetics without elevation of uric acid. But here's the reason, and there are multiple reasons, that type 2 diabetics have high uric acid. First of all, they are stimulating the pathway to make more blood sugar, the very pathway that metformin diabetes drug targets. So they're telling their bodies for survival, we need to make more blood sugar because we're not going to have any food around. I need to power my brain so I can avoid two things, starvation and predation,

meaning getting eaten by another animal. I've got to keep my brain going, therefore I need higher levels of blood sugar. But further, uric acid elevation actually inhibits a chemical called nitric oxide. We need nitric oxide to allow insulin to do its job. So not only does it directly foster the promotion of new blood sugar, it directly antagonizes the ability of insulin to lower the blood sugar. So that relationship to type 2 diabetes is profound. And it reminds me of where you and I were about seven minutes ago.

And that was the situation where people don't know this until the doctor finally says, OK, now you're diabetic. It's time to do something. There are very few binary things truly in medicine. Pregnancy is one of them. You either are or you're not. But not so with being diabetic. We have our cutoffs of a blood sugar of 126, whatever, or your hemoglobin A1C. But the reality is that the threats to your physiology, to your health, happen at blood sugar levels far lower than it would take to get your doctor excited.

In America, I don't know if you have direct-to-consumer advertising for drugs here. No, and I've got to tell you, having been to a lot of medical conferences in the US over the last eight, nine years, nothing shocks me more because I'm not used to it. Then when I get there, I check into the hotel and you just suddenly see this bombardment of pharmaceutical adverts on television.

When you're not used to it, you think, what is this? This is so bizarre. And what it is, is hugely effective. Of course it is. And again, it's a gross dramatization. We don't really have it in the same way here, that's for sure. I mean, it's a gross dramatization of the influence, the insinuation of pharmaceutical into what makes the wheels go round. Back to what we talked about earlier. round. Back to what we talked about earlier. But having said that, we have commercials on television that diabetics are happy because their A1C is now below seven. Their average blood sugar

is now below a number, seven. And they're looking into the camera saying, I got my A1C below seven because I take XYZ drug. Well, there's nothing magical about getting your A1C below seven. The health threats below begin at an A1C of 5.3 and 5.4. Blood sugar measurements, diabetes in our country measured at about 126. That's when you begin to worry because now you're diabetic.

The threats to your brain health begin at a blood sugar of 105. And that's not new information. That was published in 2013 in the New England Journal of Medicine. It's one of the main reasons. That publication alone really prompted me to write a book about blood sugar as it relates to the brain. That was Green Brain. Because people are under this misguided sense that they can live their lives come what may until they become diabetic, at which point it's up to you, my doctor, to fix it. Certainly not me. But this is such a key point, David, that I think we should really just pause on and hammer home because a lot of people in the UK or US,

certainly in the UK, your A1C, I guess, people are familiar with a variety of different units, right? But let's say the A1C here, we don't call it preddiabetes until it's six. Whereas I think in the US, it's 5.7. Right. And then type 2 diabetes, 6.5 or above. So that means in the UK, you could have an A1C,

which is an average of your blood sugar for two to three months, a 5.9, and it will routinely be reported as normal. Right. So you're going to get your blood test done by the doctor, and you often get told, if you don't hear from us, everything's okay. And if you do ask, you'll be told that that measurement, whether it's uric acid, blood sugar, or A1c, is in the normal range. Exactly.

I would say most doctors here in the UK are reporting or A1C, is in the normal range. Exactly. I would say most doctors here in the UK are reporting an A1C of 5.9 as normal. And I know there's reasons for that. I know the system, you just see which category is it in. But I think we're underserving patients. You're saying that there's research showing that above 5.3, your startings have damage in the body. So I think that's very empowering for people to say, look, look at your blood results. Look at what it was. Maybe it was reported as normal, but

what is your current A1c, your average blood sugar level? And what is it trending? And what is it trending? Right. And I would say that people should strive not to be in the normal range, but should strive to be in the optimal range. And what would you call that then with an A1c? With an A1c, I think 5.2, 5.3 or below is where you want to be. As it relates to uric acid, mentioned earlier, 5.5 or below.

Are there home tests now for uric acid? There are in America. And I test mine. I run around 4.6, 4.7. And some people have genetic predisposition to have a higher uric acid. There are a couple of gene variations, we call them polymorphisms, that predispose people as they would with blood sugar to have a higher level of uric acid, and they need to be a little bit more judicious. Now, when you find that your uric acid is elevated,

what do you do? You go online, you Google one of the big clinics, and they say, here's what you need to do to lower your uric acid. All of that information is derived from the gout mentality. And the gout mentality would have us believe that our uric acid elevation, because now we have gout, was caused by what was called a high purine diet, a diet that's high in certain chemicals that are derived from the breakdown of DNA and RNA. Certain foods like certain meats, organ meats, kidney, liver, sardines, anchovies, scallops, certain foods have a lot of purines in them and were traditionally related to having a gout. But the big issue is something called, who knew, fructose.

And if you look at some of the big name clinics in America on their websites, when they're talking about a diet for gout, in other words, a diet to lower the uric acid, they're very reluctant to go to the fructose discussion. And I'm going to let your viewers speculate as to what might be supportive of these clinics such that they don't talk about the fact that the biggest issue related to elevating uric acid these days is our fructose consumption. In the 1920s in America, average uric acid levels were around 3.5. In the 1970s, the average adult uric acid level had risen to 6.0, above the 5.5 threshold for being related to cardiometabolic risk. And that rise in the uric acid was in lockstep with our sugar consumption. Wow. I mean, it's incredible. There's a key message coming through in this conversation,

but also in a lot of previous work that people may be familiar with of yours, which is keep an eye for its toes, keep it down, excess sugar, be very, very careful. You don't need it. Of course, we all crave it in differing amounts. We might as well be honest. I do have a sweet tooth. As you said, you've got a sweet tooth, but we need that prefrontal cortex online to help us not engage in that temptation as much as we might want to. And certainly for me, David, I know this is the same for many of my patients. like you have written books on this stuff i know the science but i know in the past when i've got stress when i've got too much on if i'm sleep deprived i'm craving sugar and i find it harder to resist in those moments

the difference now having said that is i'm very compassionate to myself now in those moments instead of beating myself up about oh i can't can't believe you did that. It's like, they're wrong in your stress at the moment. That's why maybe tomorrow think about an earlier bedtime or try to mitigate your stress in other ways. So I think that's really important not to go down the blame game and the guilt game. That's right. And I am absolutely not perfect in my dietary choices either. And I value what you just said about the blame game. But it's good to have the ability to metricize these important concepts, i.e. measure uric acid, know your moment-to-moment blood sugar levels. And I think that that's one of the benefits of living in the times that we live. But you mentioned how the morning

following a poor night's sleep. I remember being up all night in the operating room in my training. And then in the morning, we would go in the hospital, the pediatric floor, and get all the baby food, especially the banana baby food, and just slurp it down because it's

so high in sugar. A bad choice. But interestingly, what the research demonstrates is when you do what's called functional MRI scans of the brain in a person who's stayed up all night, their amygdala is 60% more active. Amygdala, again, the impulsivity decision maker, which means I would go and get the bad food. And we all make bad decisions that following morning. That's right. And it's your biology that's changed. That's, I think, really interesting for people to learn.

David, I wish we had another hour. Unfortunately, we don't. As we bring this conversation to a close, what I hope is the first of many conversations. I think there's a lot of things we haven't discussed yet. There's a load more science and practical interventions on uric acid in your latest book, Drop Acid, which is really an insightful read for me.

And I feel I'm pretty well educated on this stuff. And I'm like, there's a lot in there that I didn't know. So thank you for that. That makes me feel very, very good inside. Thank you you um you mentioned sardines and anchovies i want to briefly touch on that because a lot of people are told uh that these are health foods that they are omega-3 rich fish low in mercury so a lot of people are trying to eat more sardines and anchovies could you just maybe clarify that? Because you're saying that high purine, that they may raise your uric acid.

And I'm glad we get to call that out. I love sardines and anchovies. When I have a Caesar salad, double the anchovies. I carry sardines when I travel, for crying out loud. And that's perfectly fine. I know where my uric acid level is. And it is not the sardines and anchovies. It would be if you had cut out all the fructose from your diet and still having some issues,

you'd want to pay a little more attention to then the purine part of the equation and the alcohol part of the equation. Those are the three inputs, alcohol, purines, and the biggest one by far, fructose. So that might be the fine-tuning part of it. For some people, you may need it. But you're saying if you get your uric acid checks, if it's above where it should be, or if you've got gout, which is, of course, pretty common, actually, getting more and more common. You're saying focus on the sugar, the sucrose, then think about alcohol. And then yeah, if you're still having problems, maybe you can get a bit more

specific. It's all detailed in your book for sure. That's right. So I think that's an important message. And then right at the end of this conversation, David, this podcast is called Feel Better Live More. When we feel better in ourselves, we get more out of our lives. You have got a wealth of information about all kinds of things that people can consider doing to improve the quality of their lives, both for their health and their happiness. What I love to do at the end of every conversation is leave the listeners, the viewers who hopefully feel inspired by what they've heard. I really want you to think about what are some of your top tips, your final words of wisdom for people who may be struggling with their health at the moment.

They're struggling with life. They know they can feel better than they currently do. They're not quite sure where to start. What would you say to them? Well, from a thematic perspective, I would say embrace the notion of reconnection. And what I mean by that is, first and foremost, reconnect with yourself and all the things that you do day to day. That if you're eating your meal, eat your meal. The distancing of your moment-to-moment activity by being distracted, by being on your phone,

or what else you may be doing. Be in the moment. We all have a tendency to need to check something on our cell phones. I'm there doing it. But the more we can distance ourselves from the distractions and be present, the better will our decisions making be. The other part of reconnection is the notion of reconnecting to your physiologically, your prefrontal cortex, but bring the adult back in the room. And we do that by allowing the adult back in the room, by really taking a moment when it's time to make a decision and being present with that higher level of function that allows us to look at various opportunities. Importantly, think about what our moment-to-moment decisions are going to imply for ourselves, but for others as well. So it's reconnecting

with your higher self and therefore my ability to connect to you. And as we just have, and I just very much enjoyed that. Yeah, me too. David, you've done incredible work for a number of years. You're helping so many people. I want to acknowledge you for that. Thank you for your tireless work at improving the lives of people around the world. I have so enjoyed speaking to you, someone I wanted to speak to for a long period of time. Thanks for coming on the show.

And I hope we get to do it again soon. Thank you for having me. Really hope you enjoyed that conversation. As always, do think about one thing that you can take away and start applying into your own life. Now, before you go, just wanted to let you know about Friday Five. It's my free weekly email

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