January 28, 2023

It is well known that too much uric acid causes gout, a painful inflammation in the joints, usually in the big toe.

Many foods can increase uric acid levels, including seafood, red meat, and beer, and gout sufferers are advised to avoid them.

But uric acid is also linked to weight gain, high blood pressure, insulin resistance (a precursor to type 2 diabetes) and chronic inflammation, according to a new book by an American neurologist and expert in nutritional approaches. of the illness.

The implication is that this understanding could provide new ways to tackle some of our biggest killers, like heart disease, stroke, and dementia.

In fact, far from being a minor player in our metabolic health, uric acid may be more of a driver, suggests the book’s author, Dr. David Perlmutter, an associate professor at the University of Miami Miller School of Medicine.

Too much uric acid is known to cause gout: a painful inflammation in the joints, usually in the big toe.

In the course of his research, Dr. Perlmutter says he “kept coming across studies showing that too much uric acid was not only bad for your brain, but could also harm your health in multiple ways.”

Many of the foods associated with uric acid production are high in purines. Another source of uric acid is when the sugar fructose is broken down in the body.

The fructose that comes naturally from fruits and vegetables in our diet is not a problem, says Dr. Perlmutter, because “that fructose comes combined with fiber, which is great for feeding gut bacteria, and a variety of beneficial vitamins and minerals.” .

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But fructose isn’t as beneficial when it comes in the form of table sugar: Standard sugar is made up of a 50:50 combination of fructose and glucose. “And the fructose portion triggers the rise in uric acid and the side effects,” explains Dr. Perlmutter.

There is also fructose in the form of high fructose corn syrup, which is added to manufactured foods such as cakes, cookies, and pizza, particularly in the US.

Many foods can increase uric acid levels, including seafood, red meat, and beer, and gout sufferers are advised to avoid them.

Many foods can increase uric acid levels, including seafood, red meat, and beer, and gout sufferers are advised to avoid them.

Dr. Perlmutter says that it’s not just people with gout who have elevated uric acid levels, but so do patients with other chronic disorders, such as obesity, heart disease, and type 2 diabetes.

For example, a study in the Journal of the American Medical Association in 2008 showed that 90 percent of obese adolescents with high blood pressure had high uric acid levels. However, when they were given the gout drug allopurinol to lower their uric acid levels, their cardiovascular risk factors, including blood pressure and blood fats, improved.

Then a 2011 review in the journal Seminars in Nephrology linked rising uric acid levels in the US population with increases in gout, obesity and high blood pressure. The authors suggested that likely causes included sugar and fructose in soft drinks.

Uric acid has also been linked to more specific conditions, including impotence, irregular heart rhythms, sleep apnea, osteoporosis and blood clots in the legs, says Dr. Robert Lustig, professor emeritus of pediatrics at the University of California, San Francisco. and Lead Researcher in Uric Acid.

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These studies don’t prove that uric acid is the cause, Dr. Perlmutter cautions, “but there are many ways that elevated uric acid can, for example, damage blood vessels.”

High uric acid levels can reduce the supply of nitric oxide which, among other things, keeps arteries flexible and increases blood flow during an erection.

In addition to contributing to heart disease by causing inflammation, “fructose slows down the action of three enzymes crucial to the function of mitochondria, the powerhouses of our cells,” adds Dr. Lustig.

But others are not convinced. “Fructose accounts for around 3.5 per cent of our energy intake in the UK and is of no concern,” says Douglas Twenefour, who is assistant director of care at the charity Diabetes UK.

“In most trials where fructose intake has been linked to insulin sensitivity or uric acid production, participants’ diets were supplemented with high doses of pure fructose and compared with high doses of fructose. glucose. This does not reflect what happens in real life.

And Dr. Lustig says more research is needed to confirm the links. Meanwhile, drug-free approaches could be beneficial. For example, getting enough sleep and exercising; a lack of either is known to increase uric acid.

More controversially, a low-carb diet could help, suggests Dr David Unwin, a GP from Stockport in Lancashire, who pioneered the use of this approach to treat type 2 diabetes.

“I have treated more than 1,000 diabetes patients on the low-carb diet over the past decade and none have developed gout,” he says.

“But patients with type 2 diabetes who don’t diet are very likely to suffer from it. So it seems very likely to me that elevated uric acid is a marker of a metabolic problem.

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Dr. Perlmutter’s recommendations include vitamin C, as it helps eliminate uric acid, and tart cherries; and the antioxidant quercetin. These target an enzyme that produces uric acid.

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