In this presentation Dr. David Perlmutter explains how uric acid is produced in the body, emphasizing three primary contributors: dietary fructose, alcohol, and purine-rich foods. He outlines the biochemical pathway where fructose and alcohol metabolism deplete ATP, generate AMP, and ultimately increase uric acid, while purines from DNA/RNA breakdown and certain foods (e.g., sardines, organ meats) also raise levels. Perlmutter then reviews an NHANES analysis of roughly 15,000 adults that examined serum uric acid in relation to consumption of beer, wine, and liquor, adjusting for other dietary risk factors. The data show that beer markedly raises uric acid (due to both alcohol and brewer’s‑yeast purines), wine slightly lowers uric acid in women but modestly raises it in men, and liquor has a neutral effect. He connects elevated uric acid to increased fat storage, offering a mechanistic explanation for the “beer belly.” The talk also notes emerging purine‑free beers and concludes with a call to keep uric acid low, promoting his upcoming book “Drop Acid: The Secret Key to Losing Weight, Controlling Blood Sugar, and Achieving Extraordinary Health.”
Chapters
Well, hello everyone, Dr. David Perlmutter here. We're going to be talking a little bit more today about uric acid, and, you know, by and large, I think the biggest issue that relates to elevation of uric acid in our modern world is the amount of fructose that has come into our diets, but I'd like to indicate as well that alcohol metabolism actually increases uric acid as well, and And it's instructional to look at what types of beverage are we consuming and how that might be reflected in uric acid levels. So let's review for just a moment where uric acid comes from. Where do we— how do we make uric acid? What are its sources? And I think 2 very important inputs into the production of uric acid include both fructose and alcohol. These are metabolized consuming ATP, forming AMP, and ultimately that leads to uric acid. And there is another important input into the formation of uric acid, and it is the breakdown products, a couple of breakdown products from the body's metabolism of both DNA and RNA, and these are called purines. Purine-rich foods, contribute to increasing uric acid. These are foods like sardines and organ meats. So these too contribute to formation of uric acid, but for now we are going to just focus on the important role of alcohol, and I'd like to spend a moment in looking at the actual types of alcohol and see if there are any important differences that we can learn about. that relate to uric acid production. We can look at beer and liquor and wine consumption and how that relates to uric acid levels. This is a study from NHANES, the National Health and Nutrition Examination Survey, and it looked at close to 15,000 participants, roughly half men, half women, and these individuals were provided a food frequency questionnaire. In other words, what are you eating? And along with that, then, these researchers decided to look at uric acid levels and compare those levels in individuals with respect to also the consumption of wine, liquor, beer, and compare this to those individuals who had no intake of any of these alcoholic beverages. And then the results were adjusted to take into consideration other dietary risk factors. We've talked about those for hyperuricemia, meaning elevation of uric acid. Uric acid. And let's just jump right into what these researchers found. Women are displayed in the green, men are displayed in the blue. And let's just move over to the wine section. And you'll realize that in comparison to no consumption, women in the green who do consume wine actually were found to have a slightly lower uric acid level in comparison, again, to those who do not consume wine. And also, in comparison to men who actually had a very small uptick in their uric acid. Interestingly, on the far left of your screen, you see the fairly dramatic increased relationship with uric acid in beer consumption, and we want to unpack that just a little bit. Beer does significantly increase uric acid because beer not only contains alcohol, but it contains And both alcohol and purines, as you know, elevate uric acid. And uric acid is associated with the production and storage of body fat. So now we can really begin to understand some of the science that may underlie what we have not so affectionately called the beer belly, that body fat, the storage of body fat is happening with higher levels of uric acid. Uric acid telling the body that winter is coming, caloric scarcity is coming, you better make fat and store it. store it. So again, as we look at the contributions to uric acid, alcohol and purines both contribute to uric acid, and beer contains both. We actually see beer these days that is being marketed because it's purine-free. So that's kind of exciting that it joins the ranks of low alcohol or no alcohol beer. Now we see purine-free beer. The word about purines, I think, is getting out. And this is something to think about. The purines that would normally have been in beer— not this beer— are coming from the brewer's yeast that is used in the manufacture of beer. So what did we learn? We learned about a new pathway for uric acid that you might not have been aware of, and that is that alcohol itself leads to the production of uric acid, but it really is Fairly type-dependent and to some degree, as we learned, gender-dependent, whereby wine, for example, was actually shown to reduce uric acid to a very small degree in women while there was a very small uptick in men. And because it contains both alcohol and purines, by and large, beer may not be your best choice. So we are exploring all of these ideas and more So what you can do to keep your low uric acid in check in our new book, Drop Acid: The Secret Key to Losing Weight, Controlling Blood Sugar, and Achieving Extraordinary Health. That's going to be published February 15th, 2022. If you want to learn about that book ahead of time, or anytime you like, you can visit dropacidbook.com.
