In this episode, we have Dr. David Perlmutter on to talk about his new book, Drop Acid. Dr. Perlmutter talks about how he chose this topic and the profound impact of restoring metabolic health and controlling uric acid with simple dietary and lifestyle tweaks.

Highlights include:

  • The physiology of uric acid and how it becomes a marker of metabolic flexibility
  • Examples of the downstream effects of uric acid
  • How glucose levels can act as a parallel for metabolic health
  • And so much more!

Drop Acid with James and Dr Perlmutter | Ep 267

James Maskell: Welcome to the Evolution of Medicine podcast, the place health professionals come to hear from innovators and agitators leading the charge. We cover the latest clinical breakthroughs in health technology, as well as practical tools to help you transform your practice and the health of your community. This podcast is brought to you by the Lifestyle Matrix Resource Center, who provide a range of options to help you deliver successful, effective, functional, and integrative medicine. To find out more and to get started, go to That’s

So a warm welcome back to the Evolution of Medicine platform and the Functional Forum, Dr. David Perlmutter, so glad to have you back. Welcome.

David Perlmutter: I am delighted to see you again and delighted to be back. This is great.

James Maskell: So you’ve been the go-to expert in the functional medicine brain world, obviously, for as long as I’ve known you and you had a number of books and you’ve written a book with your son and you sort of, I don’t know, maybe gone as far as you could into that area. There’s been a lot of great information, I think it’s helped a lot of people. The new book, which I have here is called Drop Acid, and it’s about uric acid. So can you just tell us about that journey, how do you get from one to the other and why did you feel like this was the most important thing to be talking about now?

David Perlmutter: I will, for me, my depth of exploration over the past couple of decades has really been looking at metabolic issues. And by that, I mean, things like blood sugar and body weight and inflammatory markers, and certainly my interests has been in the brain as you characterized because metabolic problems affect the brain quite dramatically. So anything that can give us an understanding and therefore a leg up in terms of reining in this pervasive, metabolic mayhem that is now global, I’m going to be interested in, because it affects the brain, but it affects the heart, affects the entire body. So the number one cause of death on the planet right now are these chronic degenerative conditions like heart disease and Alzheimer’s and cancer and diabetes, not some kind of viral infection, though that gets all the attention. So what’s killing people globally are metabolic issues.

And frankly, our metabolic issues are pretty much related to our lifestyle choices, the food we eat, the sleep we get or don’t get, level of stress, level of exercise, how much time are we in nature, et cetera. Primarily the big player is certainly what we eat and that has changed incredibly over the past century. And this is leading us down this wrong pathway of being metabolically compromised, and then as mentioned all of the downstream problems that then ensue like Alzheimer’s and cancer and diabetes and coronary artery disease. So we discovered that uric acid, which we previously learned about and talked about in the context of gout and maybe kidney stones is actually far more important in terms of metabolism than we could ever have realized in the past. Yeah, we learned about uric acid, we learned what a normal level of uric acid level is, but always in the context of gout.

When now that we recognize that uric acid is playing a pivotal role in causing metabolic issues, it really needs a spotlight. There was a 2009 article written by researchers in Japan called uric acid in metabolic…actually Japan and Turkey, uric acid in metabolic syndrome: From innocent bystander to central player. So it’s not just that uric acid happens to be elevated in people who have a high BMI or obese or people who are pre-diabetic or diabetic, or have insulin resistance or high blood pressure. It’s actually fundamentally involved in the causation of these problems. And that’s a good thing because for most of our time on this planet, it paid for us to survive that we would make more fat and we would raise our blood pressure and raise our blood sugar and be insulin resistant. We always say, “Oh, insulin resistance. That’s a terrible thing. My gosh, we have to do everything we can to battle it.”

The reality is that was a survival mechanism for our primate ancestors and certainly paleolithic humans as well. When they became insulin resistant, it allowed them to have a higher blood sugar. And when they had increased production of blood sugar, that was a good thing as well. And production of body fat allow them to survive when they couldn’t find food. It just comes to conflict with us today, when overwhelmingly we have an overabundance of food and very calorie-dense foods. So this mechanism that we have in place through uric acid that tells the body, “Hey, make a lot of fat because you’re going to need it.” That’s just in conflict with our current environment where we’re eating a lot of those inputs into uric acid and signaling our body to get ready for the winter, that never comes.

James Maskell: Yeah, that’s super interesting. I could see all of the themes of your work, metabolic, ancestral health, coming together. So that makes a lot of sense. Why don’t we dive into the physiology first, early on in the interview while everyone’s still paying the most attention, it goes into the physiology of uric acid, how it’s made and I guess how it becomes that marker of metabolic flexibility.

David Perlmutter: I like the way you characterized that last part, because we now put uric acid in the same category as blood sugar, blood pressure, BMI, because it’s so valuable. And it’s much easier to bring under control than the things I just mentioned, and actually paves the way to get those under control as well. So uric acid is really only made from three things and that makes understanding this metabolism very straightforward, only three things create uric acid in the human body. They are purines which are the breakdown products of cells that contain DNA and RNA. We’ll talk about that in a bit. Alcohol in its various forms, some forms of alcohol really have no effect on uric acid. Other forms are pretty dramatic and finally the real biggest issue these days and that is a sugar called fructose. That is the biggest demon of all.

There’s so much written about the metabolic consequences of eating fructose, but that was first described in 1970 in the journal The Lancet, that higher levels of fructose consumption were associated with metabolic issues, but we never understood the how and why. We never understood how that happened and now, as we see that fructose is metabolized into this messenger molecule called uric acid, this signaling molecule, telling us alarmingly to get ready for winter, that we really get our arms around why fructose is such an issue. The average uric acid in Americans in the 1920s was 3.5. Now it’s six, and that increase over the decades has perfectly paralleled our increased consumption of the sugar fructose. So fructose when it’s metabolized forms, uric acid, purines, which come from DNA and RNA breakdown, we might find higher levels of purines in foods like liver and kidney and anchovies, sardines, mussels, and scallops.

And then of course, alcohol, but it turns out that the type of alcohol really is important. Hard liquor raises uric acid, wine consumption is associated in men with a pretty neutral uric acid and actually associated with a slightly lower uric acid in women. But the big player is beer and far be it for me to castigate beer during NFL playoff season, but I will say that beer is a problem on two accounts. First, it has alcohol, and it’s also very, very high in purines because it’s made from brewer’s yeast, very dense, very, a lot of genetic material that’s broken down into these purines. So that said, we know that beer causes a lot of uric acid to be made, it signals the body to make fat. And hence, now we know where the beer belly is coming from, because we’re double-targeting uric acid.

And we see these powerful correlations of elevated uric acid with things like obesity. And I would say, beyond obesity even some very serious issues, like risk of death, for example, one study, a Japanese study looked at 90,000 people, 42,000 men, 48,000 women, followed them for eight years. And at the beginning the study, they measured their uric acid and then they followed them for eight years and they determined, well, what happened to them. And what they found was actually very interesting that the people who had the highest uric acid had a 16% increased risk of what is called all-cause mortality, meaning they died of something, whatever. They had a 39% increased risk of cardiovascular mortality and a 35% increased risk of death from stroke. So that said, that’s an association metric, but it really is pretty powerful that risk of death is so strongly related to your entry into the study entry a uric acid level.

James Maskell: Yeah. That’s so interesting. How long have you been, I guess, following this story, because you said there was some science there from 2009, has this been on the back burner of your mind for a while? I guess the question I have is, if someone comes into your office with gout, then you may look for uric acid as a number to check out to see what’s going on, but in my estimation, I don’t know, maybe you wouldn’t look at that number if it wasn’t gout. And so—

David Perlmutter: Good point.

James Maskell: How do you—

David Perlmutter: That’s missing something very, very valuable. This is not your grandfather’s gout anymore, or your grandfather’s uric acid. We all learned a lecture in medical school that, well, if you have gout likely your uric acid is elevated, you need to use allopurinol or febuxostat or a drug to bring it down. End of story. In functional medicine, our story doesn’t end like that, our story ends at A, why is it elevated? And B, how can we bring it down without first reverting to the drugs? And C, might a problem like this means something else as well? Those are the three important tenets of functional medicine. Well, as it relates to gout, it’s more than uric acid. There are a lot of inputs into gout, well beyond uric acid, but having a very high uric acid does tend to set the stage for gout.

Second, the drugs target a specific enzyme called xanthine oxidase, that is very much towards the end of the metabolism of fructose, purines and alcohol in the formation of uric acid. So if you target that enzyme, you reduce the formation of uric acid, that’s how the drugs work. But as it relates to the functional medicine model, we know for example, that things like luteolin and quercetin dramatically target xanthine oxidase, to the extent that they’re almost comparable to using drugs. So even if you were a gout patient and wanted to lose uric acid, lower uric acid, my thought would be that above all, do no harm, add in some quercetin, 500 milligrams per day, or luteolin, a 100 milligrams per day, and follow the uric acid, see how you’re doing, follow the frequency of gout attacks and see how you’re doing.

Finally, the big story is that well beyond what we learned in medical school about gout and uric acid, now we look at uric acid through a whole new lens, the lens of metabolic diseases. And how empowering it is for us as practitioners to be able to have another tool to rein in, weight gain, and insulin and resistance and hypertension and hypertriglyceridemia and dyslipidemia by bringing uric acid under control. And something I thought about this morning is perhaps it may even be valuable in PCOS, a polycystic ovarian syndrome. Those women have dramatically elevated uric acid are at much higher risk for having uric acid. And we need to unpack that a little bit at some point, but anything that we can do to keep people metabolically more intact, you’re going to get a lot of traction out of that. You’re going to get a lot of juice from that squeeze, that’s for sure.

James Maskell: That’s clear. So can you describe with us, I guess the pathway by which elevated uric acid causes these downstream effects, maybe as an example, like Alzheimer’s seeing that’s something you’ve worked with a lot?

David Perlmutter: Well, let’s first just deconstruct what uric acid is doing once it’s produced. We’ve spoken for years about some of these fundamental mechanisms that underlie, for example, Alzheimer’s disease. Let me take a step back and look at a study that was published in the Japanese literature that looked at 1,600 people, adults follow them for 12 years and every two years, so six times they would have a neurocognitive test during the 12 year period. At the beginning of the study, they measure their, believe it or not uric acid level. Those individuals who had a uric acid of seven or above had about an 80% increased risk during the study of 12 years of becoming demented. They had a 55% increased risk of developing a disease for which there is no pharmaceutical treatment called Alzheimer’s disease. And they had 166% increased risk of what is called mixed dementia or vascular dementia.

So for me as a neurologist, wow, that’s pretty impressive. Again, through the lens of the idea that we don’t really have a treatment for Alzheimer’s. As a matter of fact, I wish we did, but we don’t. So why might uric acid relate mechanistically to the changes in the brain that we see in Alzheimer’s? What’s going on in the Alzheimer’s brain? Several important things. We know that there’s increased inflammation. We know that there is increased oxidative stress. We know that there is increased damage to the mitochondria, and we know that there are problems with what are called the bio energetics, how the brain cells are able to use basically fuel for metabolism because their mitochondria are not working appropriately. Uric acid does all of these things. It’s powerfully pro-inflammatory, it’s powerfully in the extracellular space, rather the intercellular space, powerfully pro-oxidative, leading to oxidative stress, damaging the mitochondria. And as such leads to compromised ability of brain cells to utilize fuel to make energy. Let me unpack, this is really interesting.

Such that in the brains of Alzheimer’s patients, though they can’t utilize glucose as readily, in many areas of the brain, the glucose level actually rises because it’s not being utilized. Well, what does that do? You’re going to love this. Recent study demonstrated that in addition to the elevation of glucose, there is elevation of fructose. Fructose in the brain is made from glucose. Glucose through what is called the polyol pathway can be metabolized through something called sorbitol into fructose, meaning that we’re not just involving the fructose that you may consume, or hopefully now decide you’re not going to consume, that we have within our bodies and in the brain pathways that will make fructose, if the body thinks it needs to make fat basically, or needs to change its metabolism and activate the uric acid. And what else does the uric acid do? Again, increases free radical mediated stress.

Maybe there’s a time in the brain when that’s important to have. Well, free radical mediated stress to the mitochondria turns down their metabolism. And there are times when we are starving, that that might actually be a way of saving calories, who knows. But the interesting point is that not just in the brain, but throughout the body, these are devastating issues brought on by uric acid. In addition to leading to insulin resistance, turning on gluconeogenesis and inhibiting nitric oxide. And we could talk about each of those individually, but I think one of the main things just to mention is for your audience, who I think fancies these ideas, that our bodies need to know whether it’s time for feast or time for famine. If it’s time for feast, we’ve got plenty of food. We have plenty of water, so we don’t need to be packing fat way, right?

And that’s a time when the body is activating a pathway called the AMP kinase pathway, AMPK. We want to keep AMPK lit up as much as we can because when our AMPK pathway is doing its thing, we’re telling the body don’t make fat, don’t store fat, burn fat, don’t increase production of glucose. We don’t need extra glucose floating around. And it’s the reason we want to do everything we can to activate our AMP kinase pathway. On the other hand, AMP can be metabolized in a different pathway called AMPD. So instead of AMPK, we go to AMP deaminase, and when that pathway is activated, it’s telling our bodies prepare for winter, make fat, store fat, increase glucose production. Why? Because we don’t know when we’re going to get food again. As a matter of fact, when animals are in the fall, when bears are getting ready to hibernate, they shut off AMPK and they activate AMP deaminase, they’re making and storing fat.

They’re getting ready to be in a situation where they’re not going to be eating. So most of us want to keep AMPK lit up at all times. When AMPK is active, we’re not making more blood sugar than we need in the liver, gluconeogenesis. That’s how metformin works as a matter of fact, metformin works to stimulate AMPK and shuts down the liver from making more glucose. That’s why metformin is a diabetes drug, because it turns off excess glucose production. It’s why exercise for example, is such a good thing for blood sugar control because it lights up AMP kinase, like for again, quercetin, twice I’ve mentioned it. And berberine, these are some supplements that turn on AMP kinase, telling our body the hunting is good. You don’t need to be packing the fat away for winter. But interestingly, uric acid turns AMPK off and turns on AMP deaminase.

It’s doing its job, it’s trying to help you survive. Because when uric acid is elevated, it knows it’s a signal that winter is coming and James needs to store fat, if James is going to survive. We can go down either pathway. We can do everything we can to keep AMPK going and so we’ll stay lean, and have the body think that it’s got plenty of food, don’t need to store it for the winter. Or we can activate AMP deaminase, in which case, uric acid’s doing what its job is, sounding the alarm that we’re not going to have food in the future. It’s not just food, it’s water. So when the body has a sense that it’s becoming dehydrated, it turns on this pathway to make more fructose and hence more uric acid. Why would that be? And a visual would be a very unique animal that walks across the desert for weeks without drinking water.

How does it do it? It has a hump on its back. So I’m talking about the camel and it can go long distances without drinking water, because guess what’s inside the hump? Fat not water. So the camel’s hump is filled with fat, up to 80 pounds of fat, because when we and camels and animals burn fat, they form water, carbon dioxide and water. So that’s metabolic water. So forming a body fat is a powerful mechanism activated with this fructose being turned on by dehydration, make body fat, activate uric acid, and that’s a survival tool. And how does our body know when it’s becoming dehydrated? The sodium goes up. So that’s interesting. So our sodium going up is a signal, quick turn on the pathway, turn glucose into fructose, make uric acid so we can make body fat, because we are dehydrated and we’re probably not going to make it unless we can make enough fat.

And then we can burn the fat and have a resource for water. Well, how else does your serum sodium go up? It goes up when you eat a bag of chips, it goes up when you eat those pretzels that they sell on the street in New York, that who doesn’t love, right?

James Maskell: Yeah.

David Perlmutter: But that salt in your diet will raise your body’s fructose consumption and lead to, it explains now we’ve never known this, but why is it that people who eat a lot of salt are fat? Gain a lot of weight, have a hug increased risk of diabetes. Well, we’ve known the blood pressure story for an awful long time, but why would there be such a relationship between eating a lot of salt and becoming overweight or becoming diabetic? What’s the mechanism? Now it’s very clear. So for your viewers, I would say that the simple answer, if you’ve got to eat that bag of pretzels or whatever it may be, drink a lot of water with it. If you drink water, you’ll dilute down that sodium. You’re not going to trigger this mechanism, and yes, drinking water in this instance is going to help you lose weight, who knew.

James Maskell: It’s interesting. I guess the one thing that we haven’t talked about here so far, which I think would be surprising for anyone, if we were talking about gout and we were talking about uric acid is meat, right. Because that’s always like, you’re talking about grandpa’s diabetes, right. Grandpa’s uric acid and grandpa’s gout, the meat was the thing that was the fingers were pointed at. So obviously, I’d love to get your take on that because I would think that there may be a situation where a vegan activist would be like, “Well, of course, Perlmutter’s next book is on uric acid because he’s been getting everyone to eat meat for the last 10 years. And I’m sure all of his patients now have gout.”

David Perlmutter: Well, it turns out that that’s not the biggest player by far. I eat meat, not much. My diet is mostly plant based. And I’ve been talking about that for an awful long time for anyone who’s been following me, but do I eat some meat on occasion? I do. Do I eat fish? Yes, I do. But it was the messaging for so long and you certainly should know this as would your father, that gosh, patients with gout should really avoid meat. Because gout is the king of diseases and the disease of Kings, because who could afford meat? It was the very wealthy, they eat a lot of meat, drink a lot of wine, and eat cheese, get gout, because they’re eating rich foods. But more recently, I think there’s been an attempt to keep the fructose connection away from us. Because as you well know in recent decades, everything has stacked up to keep us from pointing the finger at sugar.

James Maskell: Yeah.

David Perlmutter: It’s always been point the finger at fat, right? Dietary fat because of cholesterol and heart attacks. And then more recently is point the finger at meat. But the biggest issue by far is the fructose, that’s for sure. When you see 60 to 70% of the food on America’s grocery store shelves that is packaged have added sweetener and it’s by and large fructose or derivative, that it’s no wonder that our uric acid levels have climbed so aggressively 3.5 in the 1920s. Now the average is six milligrams per deciliter in lockstep with our fructose consumption, not in lockstep with increasing meat consumption or alcohol consumption. That has changed, but it hasn’t changed the thing that’s really…between 1970 and 1990, our fructose consumption increased a 1,000%.

James Maskell: Yeah.

David Perlmutter: So that’s the big player. I have never been an advocate even back in the Grain Brain days of 2013 of eating an awful lot of meat. And if a person’s going to eat six to eight ounces in a day, that’s more than enough in my opinion. So even in the Grain Brain days, while we were saying don’t need a lot of refined carbohydrates, hence the title and how sugar is the enemy of the brain. It was still eating as many vegetables as you can with as many collards on your plate as you’re able to achieve. And again, if people want to eat things like the high purine type types of meats, liver, kidney, mollusks and small fish like sardines and anchovies, you may very well get away with it. And you’re not going to know unless you check your uric acid. It’s a simple blood test.

The doctor probably already did it, it’s part of the annual blood work. You can go online to get a uric acid monitor, do a finger stick and know your uric acid level in 30 seconds or less. It’s available to anyone, I have my uric acid monitor right here, there it is. If I push the button, that’s my most recent level. What does it say? 4.7. That’s where you want to keep it. You want to keep it below 5.5, below seven is in the normal range. And I’m not about that. I’m not about in the normal range. We want to do better than normal, normal is average. We want to be optimal. So A and B that level is derived because that relates to gout, anything over seven, and that starts to be when there’s enough concentration of uric acid, that it can extracellularly in the blood, it can start to crystallize in one of the hallmarks of gout.

But I understand that as it relates to that, and this is a bit off-topic, but along with getting gout crystals in your great toe, when you have elevated uric acid, it’ll crystallize or can crystallize in your coronary arteries, other parts of the body, including even the prostate gland for crying out loud, where it induces inflammation. Even in people who’ve never had a gout flare up, we’ve got rein in uric acid, now that we know certainly the metabolic consequences of having a high uric acid and beyond that, the fact that these crystal deforming in various parts of the body, that’s important as well because that’s powerfully inflammatory.

James Maskell: Yeah. Well, so many interesting parallels between continuous glucose monitor, over use of glucose, glucose and weight gain, which was one connection. Then you’ve got the uric acid monitor, overuse of fructose and uric acid, and like you said, there’re the industry influence to point the finger away from glucose and fructose, makes a lot of sense after what we’ve seen in these—

David Perlmutter: Yeah. And I wish it were over, but it’s not over yet. In February of ’21, I along with the Dr. Casey Means, we wrote an open letter in Medpage Today to President Biden saying, “Look, we know that the USDA has again, said that we can get 10% of our total calories from sugar. That’s not in line with the science. The science indicates that no more than 6%.” And we quoted the studies and we said, please, even though this is a USDA doctrine that comes out every five years, and the truth is it came out before President Biden took office. We were hoping perhaps there would be something that could be done to rewrite this or to reevaluate at the very least that hasn’t happened yet. We subsidize corn to the tune of $500 billion a year, much of that goes to the production of high fructose corn syrup, which is fueling epidemics of obesity and hypertension and diabetes. So we’re paying for it both ways, it does not make sense.

James Maskell: Yeah. Well, look, as you’ve mentioned a couple times already, and because I prompted you before we started the interview, this is something that’s particularly interesting and important to me because I have had gout flares in my life already. I had the first one when I was 25, interestingly, when I went into a new health regime, I left living in London and moved to America and actually started working in a functional medicine office and started taking my health seriously and doing it and I had the first moment then. And I would say over the last five years started to have regular ones, once I was in England with Dr. Chatterjee and Mike Ash and I told Mike Ash, didn’t really know what it was. I was just like, “Man, my foot hurts.” And he had bicarbonate of soda and vitamin C and I drank a lot of it, high dose and it went away straight away and that was good for a bit. And then I started getting it a bit more and I was like, “Okay, well, cherry juice seemed to work really well.” And then—

David Perlmutter: Funny you mention that. Look at the O on Drop Acid that’s—

James Maskell: —the cherries.

David Perlmutter: You’re exactly right.

James Maskell: And the cherries worked for a little bit and well for a long time then it didn’t and then it was like, “Am I really going to take colchicine?” Because I didn’t want to do it. I didn’t really want to take any of the drugs, and I’ve certainly come down to it, I guess. One thing I just want to ask you is last year 2021, I had the worst gout that I’d ever had, the worst hit, but by all dietary or lifestyle size, I would say that I was exercising super regularly, more regularly than I had at any time in the last 15 years. Was going to CrossFit three times a week, two, I had pretty much stopped drinking alcohol, and yet here was almost a constant gout flare. And it’s interesting what I think I took from the first part of the interview is there’s a lot of complex mechanisms that are driving it. And as you were speaking earlier, it looked like I was paying direct attention to you, but I was actually just thinking, “Oh yeah, that makes a lot of sense that these other—

David Perlmutter: Let me just stop you for a moment. When you said you stopped drinking alcohol, what alcohol do you drink? What is your drink of choice?

James Maskell: Well, I’ve moved more to drink tequila recently, but I would say, I always used to drink beer, but I just haven’t really drank—

David Perlmutter: Now why would beer be absolutely the worst drink for you?

James Maskell: Yeah.

David Perlmutter: Why? Two reasons, alcohol and beer is exquisitely high in purines. Why? Because it’s made from brewer’s yeast, it is a devastating beverage for somebody with gout to be drinking. That’s why we talk about it in the book, as well as for people with elevated uric acid, don’t drink beer. Tequila, if you must drink alcohol would be not a great choice, I would choose wine, if I were you, causes the…but by far and away a beer consumption is hugely related to dramatic increase of the uric acid. And as you mentioned, colchicine, certainly something during a gout flare up, no question, but you want to keep that from happening. So you want to keep your uric acid level low and how the preventive drugs work is by targeting a specific enzyme called xanthine oxidase.

That’s where allopurinol and febuxostat work, but you can dramatically target that enzyme with quercetin, 500 milligrams a day, and a luteolin a 100 milligrams per day. You can shut that enzyme almost shut it off and realize very quickly a dramatic reduction in your uric acid. You got to look for hidden sources of fructose as well, but you can have fruit. And if that doesn’t do it, then you should think about those purine related foods that I just mentioned, but when I hear that your beverage of choice was beer, man, that makes total sense to me.

James Maskell: Yeah. No, absolutely. No. There was a lot of things that were popping off there. I was interested about the shellfish as well, because I know there’s been a history of, I think in the biohacking world of looking at nutrient density. And I think some of those things that you mentioned, like the liver and the kidneys, the shellfish, those things are extremely nutrient-dense, but I guess there’s a tradeoff there with the purine.

David Perlmutter: Yeah. Wonderful source of iron, liver and B12 as well, but it happens to raise uric acid that you can’t afford. So I would bet you, James, that you implement what we’re talking about here and you start charting on the calendar, your gout flare ups, I bet you’re going to see significant improvement or at the very least a dropping of your uric acid. What kind of levels are you running?

James Maskell: I’d have to get back to you on that. I do have my follow up with my functional medicine doctor to see where I am. I’ve just been in South Africa for two months, but…

David Perlmutter: Do you check your levels at home?

James Maskell: I’m going to start, I didn’t even know that that thing existed and now that you mentioned—

David Perlmutter: Can you imagine.

James Maskell: …to me, I’m going to get it.

David Perlmutter: Ever heard of Amazon? There you go.

James Maskell: Yeah.

David Perlmutter: It’s very straightforward.

James Maskell: Well, I guess this is the year of growth here at the Evolution of Medicine, and I guess part of the reason why I wanted to have you on is because it just feel like this is an area where the average functional medicine doctor is already quite well educated. And a lot of the things that you’re talking about from you and other people who have been talking about these things for a long time, obviously this is an area where if you look at gout, maybe there’s not that many people, but if you look at the downstream impact of metabolic disease, it’s massive and it’s never been bigger and it’s not going in the right direction. I guess, what is your hope from this book and bringing attention to uric acid and what would you be your vision and dream of what this book and this movement that you are looking to create around uric acid? What could be the impact on functional medicine but also on medicine in general?

David Perlmutter: In one word, I would say empowerment, meaning really giving us a brand new, exciting, and very simple to use tool that can help us deal with metabolic mayhem that is so incredibly pervasive in our world right now. As the world’s diet became the Western diet from the standard American diet, people globally are eating a diet that’s going to raise their uric acid levels and pave the way for metabolic distress and the downstream issues we’ve talked about, the Alzheimer’s, heart disease, diabetes, and certainly some forms of cancer. So the hope is that this is going to enter the toolbox and be looked upon as a powerful regulator or metric of metabolism, along with measuring people’s blood pressure, their blood sugar, their body mass index and their uric acid levels. Are there other things to keep an eye on? You bet, on fasting insulin levels, inflammatory markers, all the things, but this is something that we can gain control over with relative ease.

One study from Oxford gave a group of young men with mild elevation of uric acid, 500 milligrams of quercetin like we just talked about, each day and in two weeks, their uric acid levels fell by 8%, which is pretty dramatic. That’s a simple over the counter non-prescription intervention and pretty exciting in the context of what we now see is happening from elevated uric acid. So I think that many functional practitioners are dialing into this. And I’m very surprised in the various interviews that I’ve been doing as of late, how many have been checking it for years, who knew about this stuff. The research is two decades old, but I was talking to Dr. Dale Bredesen, who’s doing so much work in Alzheimer’s. He said, “We’ve been following uric acid in these patients for an awful long time.”

My mission is to really blow it up and ultimately empower people with the knowledge that here is something exceedingly valuable. It’s not the end all, it’s not as if you get uric acid under control, then you can hang up with the exercise or stay up all night. But as an important new tool in your toolbox for really getting things under control, we’ve got to do everything we can to rein in this incredible disturbance of metabolism that is globally pervasive. People aren’t dying around the world, the number one cause is not some virus, it’s the metabolic conditions, the chronic degenerative conditions that are the downstream effect of our metabolic issues, heart disease, Alzheimer’s cancer, diabetes. That’s according to the World Health Organization, the number one causes of death on our planet, not COVID. Even as it relates to COVID, I think a comment is worth making.

And that is that we know people who are metabolically compromised do poorly when they get COVID, especially if they’re hospitalized, their outcome is generally threatened. Right? We now see research that shows that if you enter a hospital and at the time of your admission, your uric acid level happens to be elevated. You may have increased your risk for going into the ICU, getting put on a ventilator or death by as much as threefold.

James Maskell: Wow.

David Perlmutter: So this uric acid is an important player. And again, in the context that you can measure it at home, your doctor may not be dialed in yet, and it’s relatively straightforward to make simple lifestyle changes and bringing under control. And as it relates to point number two, a lot of people are going to call their doctors and say, “Hey, I know this stuff about uric acid. What was it the last time I was in a year ago, whenever I had my blood work?” And typically they’ll get back information, “Well, it was normal. Don’t worry about it.” And gosh, I don’t want to know that it’s normal, I want to know the value A and B normal in terms of what, gout? That’s where that level comes from 7.0 or below is normal, that’s as it relates to gout, we want the level 5.5 milligrams per deciliter, or lower.

Because it’s above 5.5 that our risk for all kinds of things really starts to increase, the cardiometabolic issues, the stroke issues, the dementia issues, the diabetes issues, all go up very quickly above about 5.5. Does it vary person to person? Of course, it does. Are there a probably a suite of snips or gene variations that play a role? Of course, they do. But I think by and large, we’ve got to know that this is out there and be empowered to bring it under control. And again, it’s not that challenging.

James Maskell: Well, Doc, I guess I just want to say thank you for bringing this to light. It’s been very an illuminating for me and I’m sure for all the doctors that have been monitoring uric acid, they’ve been thinking about it or wondering what its role was, I highly recommend the book. If you’re a functional medicine doctor, a great one to have in your office to give to patients who have metabolic issues, or even have high levels of uric acid that you can send off. I’m super grateful for you illuminating this and I never really had my own functional medicine thing. A lot of people come to functional medicine because there’s this issue, and then they overcome it and do it. And I was like, “Well, when’s my one going to come up?” Well, here it is for me.

And I appreciate you doing it at the exact time that I needed it. And I’m just really grateful for your leadership in this way. And I hope that in this year of growth that we are talking about, yes, there’s the growth of functional medicine into this new clinical area, where we can be super relevant, but on the level of personal growth, I certainly think that it’s mine to hold this year and to empower myself with this information and take action.

David Perlmutter: Well, let me give you one last gift. And that is that Japan is now marketing purine-free beer with your name on it. So there you go.

James Maskell: I got to get myself to Japan. They got—

David Perlmutter: No, I think it’s probably here. I think you could probably find it online. I think it’s available in America now. Because Japan has been dialed into this uric acid thing and metabolism for an awful long time, they take it very seriously in Japan. That’s where a lot of the research comes from. But just for you, if you’ve got to have that beer, go purine-free.

James Maskell: Yeah. All right, Doc. Thanks so much for being part of the Evolution of Medicine Podcast. This has been Dr. David Perlmutter, his new book is called Drop Acid: The Surprising New Science of Uric Acid—The Key to Losing Weight, Controlling Blood Sugar, and Achieving Extraordinary Health. It’s been great to see you as ever. Thanks everyone for listening, and we’ll see you next time.

Thanks for listening to the evolution of medicine podcast. Please share this with colleagues who need to hear it. Thanks so much to our sponsors, the Lifestyle Matrix Resource Center. This podcast is really possible because of them. Please visit to find out more about their clinical tools like the group visit toolkit. That’s Thanks so much for listening and we’ll see you next time.


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