Drop Acid

In his forthcoming book, Dr. David Perlmutter, a board-certified neurologist and five-time New York Times bestselling author, exposes the deadly truth about uric acid and offers strategies on managing its levels in the body. Here, an exclusive first look.
Coffee is an acid-consuming gem that can bring uric acid into balance. Photography: Nathan Dumlao

Without a doubt, the overwhelming contributor to elevation of uric acid in our modern world is the cheapest, most abundant ingredient around. It’s the kind of sugar we’ve been told is relatively “safe” because it doesn’t directly raise blood sugar: fructose. And I’m not vilifying fructose from fresh, whole fruits. I’m talking about the refined, highly processed fructose that finds its way into many of our daily provisions, including our beloved salad dressings, sauces, condiments, baked goods, snack and energy bars, packaged foods, beverages, and foods you wouldn’t even think contain sugar. You probably have a general sense that high-fructose corn syrup isn’t good for you, but you don’t realize how pervasive this ingredient has become and that you can consume too much fructose by eating other forms of sugar. The science showing fructose’s true colors has only been elucidated in the medical journals over the past decade or so—and it doesn’t concern what your grandmother knew as fructose. Although the prestigious medical journal The Lancet reported on fructose-induced hyperuricemia in 1970, in the years since then we’ve come to understand the full range of fructose’s adverse effects.

It’s not news that sugar-rich diets are linked to all kinds of health problems. But we haven’t been told the why and how of sugar’s devastating blow to our bodies, especially as it relates to fructose from nonnatural sources. We now understand fructose’s biological mechanisms and its veiled relationship with uric acid, both of which help explain the root causes of these intractable conditions—and this is not merely a flimsy association. In fact, evidence from human and animal studies indicates that the connection between dietary sugars and obesity is probably driven primarily by the metabolic effects of fructose. The way the body handles fructose involves uric acid and directly favors the development of obesity.

The other main culprit that leads to elevated uric acid levels is a class of chemicals called purines, which are found in all living cells and contribute to healthy physiology but, like body fat, are problematic in excess. Purines are organic compounds that cells use to make the building blocks of DNA and RNA, and when purines are naturally broken down by the body, uric acid is formed. Because purines—two of which, adenine and guanine—provide the backbones, or nucleotides, for DNA and RNA formation, anything that has to do with tissue (cellular) breakdown will raise uric acid levels. As damaged, dying and dead cells are degraded, purines are released and turned into uric acid during the process. Purines are also constituents of other important biomolecules, such as the energy giant ATP (adenosine triphosphate) and the coenzymes we need for the biochemical reactions that sustain life.

Purines are more common than people realize. In addition to being naturally produced by the body during cellular turnover, they are abundant in a wide array of foods, including certain seafoods, meats, multigrain breads, beer, and even some legumes and vegetables. As these external sources of purines are processed by the body, uric acid is synthesized mainly in the liver, intestines and inner cellular lining of blood vessels (what’s called the vascular endothelium). Their prevalence in what we view as rich, lavish fare fit for the wealthy is why gout has long been known as the “king of diseases and the disease of kings.” But purines also lurk in many foods touted as healthful in popular diets. During the past decade, large epidemiological surveys have revealed an association between the intake of purine-rich food and the blood concentration of uric acid. Let’s not blame vegetables, however, because as we shall see, despite the fact that certain vegetables (e.g., cauliflower, spinach and mushrooms) might be rich in purines, they may not trigger an increase in uric acid.

For half a century, low-purine diets have been prescribed for people prone to gout and kidney stones. But this dietary protocol is increasingly recommended for anyone looking to control uric acid and rein in the body’s metabolism. Just because you don’t develop gout or kidney stones, conditions that can have genetic origins as well, doesn’t mean you won’t suffer from the consequences of chronic high uric acid. Our understanding of this compound we all have coursing through us provides vital clues to unlocking the mystery of optimum human health.

For people who have gone on every “doctor-approved” diet to little or no avail, targeting uric acid fills in a giant blank in the equation. If you don’t factor in the uric acid component, going low-carb, vegan, keto, Paleo, pescatarian, lectin-free or even Mediterranean might not be enough to help you permanently drop excess weight or easily manage both blood sugar and blood pressure. Moreover, this new science calls for a revision of the way we reference the glycemic index and consume certain so‑called healthful foods. Uric acid levels can generally be brought into balance by (1) implementing simple dietary tweaks, (2) getting quality sleep and adequate exercise, (3) minimizing the intake of uric acid–increasing drugs, and (4) consuming acid-reducing gems such as tart cherries, coffee, vitamin C and quercetin (the last two are found in many foods and can be taken in supplement form). Nurturing the microbiome is also vital to controlling uric acid; studies reveal correlations between elevation in uric acid and significant increases in the types of bad bacteria in the gut that are associated with inflammation. I call the protocol outlined in this book the LUV Diet—using an acronym for “lower uric values.” In this book, you will learn how to both lower uric acid levels and maintain ideal levels once you’ve achieved them.

My research taught me things that my medical education decades ago—and my experience in all the years since, working as a neurologist treating patients—never did. One important reason I became a physician to begin with was my own curiosity. Curiosity plays a key role in why I do what I do. I like to live on the edge of wonder, continually asking: Why do patients develop the problems they do? And once we unravel these mysteries, how might we change what we do as physicians so we can better serve our patients? For me, it has never been enough to simply treat the symptoms of a problem—for example, using a drug to lower blood pressure or balance blood sugar. I want to understand the root of these problems and so many others, then address the causes, not just the manifestations. As I have been fond of saying for many years, I’m really interested in focusing on the fire, not just the smoke.

Adapted from Drop Acid by David Perlmutter, MD, with Kristin Loberg. Copyright © 2022 by David Perlmutter, MD. Used with permission of Little, Brown Spark. New York. All rights reserved

Click here to purchase Drop Acid, available February 15, 2022.