This once overlooked chemical may play a central role in maintaining a healthy metabolism.
If you’ve ever heard of uric acid, it was probably in relation to two unpleasant maladies — gout and kidney stones. For years, uric acid had been viewed as the culprit of both of those ailments. (And if you haven’t heard of uric acid, consider yourself lucky!) However, we have reason to believe you should get familiar with the metabolic waste product. In his new book, David Perlmutter, M.D., argues that uric acid is actually a “central player in bringing about severe metabolic issues,” like weight gain and diabetes, and has even been implicated in dementia and Alzheimer’s. For too long, it’s flown under the radar, he tells us.
Scientists have begun to piece together the crucial role uric acid plays in the body and how keeping it in check can be a powerful way to ward off a number of conditions. Dr. Perlmutter unpacks the latest research on the chemical in his book, Drop Acid.
He spoke to us about why we may want to start monitoring our uric acid levels, how to do just that at home, and what foods and supplements can help bring the uric acid in our bodies back down to a safe and healthy level.
KCM: What is uric acid and what role does it play in our bodies?
Dr. Perlmutter: Uric acid is a metabolic waste product that, when it’s elevated, has been associated with gout, where you develop crystals in your joints. It’s very painful. But what we’ve discovered over the past two decades is that uric acid is actually a central player in bringing about severe metabolic issues, like weight gain, elevated blood sugar, and elevated blood pressure.
We didn’t realize in the past when we checked it on a blood test, but we see now that this is a powerful mechanism that’s creating these metabolic problems. And as such, it’s a powerful target for us if we can bring it under control.
In your book, you discuss how high uric acid levels is a growing problem in the U.S. What causes uric acid level increases?
We know that uric acid levels in American adults in the 1920s were around 3.5 milligrams per deciliter. Now they’re averaging 6. The increase in uric acid has been in lockstep with our increase in consumption of sugar, specifically one type of sugar called fructose. We know that there are only three sources of uric acid. There’s alcohol and a chemical called purines that’s found in certain foods. But the big issue is by far the amount of fructose we’re consuming, which has increased incredibly compared to early in the 20th century.
So this consumption of fructose is triggering survival mechanisms in our bodies. It’s telling our bodies to get ready for food scarcity, prepare for winter, make fat, store fat, raise blood sugar, and raise blood pressure because we’re not going to have enough food. That’s how fructose has signaled our metabolism for hundreds of thousands, if not millions of years. Now, we’re signaling this pathway through our consumption of fructose 365 days a year — for a winter that never comes.
We’ve known for a long time that fructose is a powerful threat to metabolic health. But we never understood how. Now we know that it’s through the metabolism of fructose into uric acid that’s causing all of these conditions — from diabetes to high blood pressure.
How are high uric acid levels connected to conditions like Alzheimer’s?
A very powerful study was published in 2018, where researchers followed 1,600 people for 12 years. At the beginning of this trial, they measured their uric acid. They found that among those who had the highest uric-acid levels at the start, their risk of dementia was increased by 80 percent. Their risk of Alzheimer’s was increased by 55 percent and their risk for vascular dementia was increased by 166 percent. The point is, there’s this powerful relationship between the elevation of uric acid over time and the development of dementia, and specifically for the development of Alzheimer’s disease.
Is there a movement to monitor uric acid levels more closely in the U.S.?
Not as much in America as in other countries. For example, Japan has been dialed into the role of uric acid for a couple of decades. So much so that in Japan they’re marketing purine-free beer. (Foods that are high in purines and alcohol both increase uric acid.) A lot of the research has come from there. In America, there are some forward-thinking practitioners who are understanding this, but it has not yet gained widespread acceptance.
How can we measure our uric acid levels, and what’s a healthy range?
Determining your uric-acid levels might be as easy as phoning your doctor. Generally, it’s measured in your annual blood work. But traditionally health practitioners are only looking at your uric acid levels in the context of whether you’re at risk for gout. So, if you’re at 7 milligrams per deciliter or lower, your doctor would normally tell you you’re all well and good. But as it relates to your metabolic health, that level should be lower, around 5.5 or lower. So you can ask your doctor if your uric acid was measured in your last bloodwork. You can also go online and order a home uric acid monitor. You just need to prick your finger and you can do a simple blood test.
How can we lower our uric acid?
The three big inputs in creating uric acid are fructose, alcohol, and purines. So lowering our consumption of these, with a focus on really eating less fructose is key. Now, when it comes to alcohol, there are a few things to consider. It turns out that moderate wine consumption in men has very little effect on uric acid, and in women, it’s associated with a slight lowering of uric acid. Hard liquor, on the other hand, is associated with raising uric acid in both men and women. And beer is the worst player if you’re going to choose to have a drink because it also contains purines.
There are also drugs that have been around for decades that will lower uric acid by targeting a specific enzyme. But there are foods and supplements that also target this enzyme. Research shows that 500 milligrams a day of the supplement quercetin can aggressively lower uric acid. There’s another called luteolin, and my recommended dosage for that is 100 milligrams per day.
Foods rich in bioflavonoids are also recommended. One specifically is tart cherry, which has been used as a gout remedy for decades.
