🎯 The Hidden Metabolic Switch: Uric Acid Beyond Gout | Dr. Priti Nanda |Dr. Anshika Gupta

Good evening everybody, and thank you for joining us today. Before even I introduce the doctor with me on the special podcast, I want to welcome all of you to The Highs and Lows of Uric Acid, where we talk about the sneaky little chemical in the blood which actually can make your big toe the most famous part of your body. And what you don't know is that this actually is also a warning sign that your heart is in danger. And I have with me a very, very special guest today, Dr. Anshika Gupta, who is going to unravel all these pearls about this little but very, very important chemical. It's trying to do its best, but maybe we are not listening to what this is trying to tell us. Welcome, Dr. Ritisha, on this channel, and thank you for your time. And most importantly, thank you for picking up this topic.

Thank you so much, Dr. Preeti. You've beautifully introduced this topic, and it's an honor to be doing this with you. We've all, you know, seen all the work that you do And so beautifully you've introduced how uric acid, you know, the highs and lows, perfectly explained. And I'm so excited to dive deep into this and talk about how this could actually be life-changing for some of our viewers over here.

Amazing. So I like life-changing lives, I like transforming lives, right? And, uh, with you it's even going to get better. So before we deep dive into these you know, protest which our joints make when the uric acid goes high, or when it tells us that the body is inflamed or not able to function accurately or properly when it comes to the immune system. I want to know from you, Dr. Anshika, what inspired or motivated you? Oh, um, your horizons. And from here, of allopathic view, make your view towards health like this.

So Dr. Preeti, it took a lot of time honestly, and for people who are seeing me for the first time, hi, I'm Dr. Anshika Gupta, and ever since I was in my, you know, 12, 13 years ago when I was in my MBBS, the only thing I wanted to do was find a subject with which I resonate very deeply that could be my passion, you know, like I'm really passionate about the subject. So went through years of MBBS Didn't find that subject, and I thought maybe if I change the country, I change the healthcare system, I'll enjoy something in medicine. I went to UK, worked there for 3 years, my internal medicine residency, switched between rotations—cardio, gastro, nephro, neuro—did it all. Still didn't like anything by the end of it. Still didn't feel that something was resonating with me on that level. And then one day I read about functional medicine. Within 24 hours, I signed up for the IFM's, like, first program, and that is what widened my horizons. That's what truly changed my life. And ever since then, I've just been dedicated towards functional medicine. And because I feel like that's the science, that's the art, that's the real thing behind healing that really just resonates with me. And I'm sure that's the story of, like, a lot of doctors, nutritionists, and coaches over here.

Very beautifully said, Dr. Anshika. But I can sum this then up in one word. Okay, you were born to be a doctor. You were meant to be a doctor. Because I think actually, doctor, that doctor wants to transform lives and not put people on medicines for life.

I mean, that's an honor coming from you, Dr. Preeti, because I know about— I've met you and I know about your story. And I know how you've gone, you know, against all odds and done what you've done. So that's— thank you so much. Thank you.

And I'm very, very blessed to be having you here. And I love youngsters like you who actually go out all out for their passion. The journey is not easy, but it is very, very, very, very, very satisfying, very humbling. And I'm sure in the next few years when you will look back, you will talk to yourself and say, wow, this was the best decision of my life, right? So now coming to the topic, uric acid. According to you, what is the small little chemical? For people— of course, I know a lot of our viewers are health coaches and doctors, but still, for patients who might watch it today or later, What is this uric acid?

Okay, so Dr. Preeti, uric acid is basically, um, in all our cells there's something called DNA and RNA, and uric acid is just a waste product that's created when all this is degraded. So the thing that is degraded, the garbage, it starts with something called purines. So purine degradation product, that is what uric acid is. Now most people think it's just a waste product. It's a little bit more than that. It's something that manages our cardiometabolic risk and our metabolism in a very unique way, which we'll talk about going further. But yeah, essentially it's a breakdown product of purines, is what I would say.

And why is it given the importance it is given?

So, Dr. Preeti, I think, uh, till now when we usually speak about uric acid, mostly what comes to mind is gout, what comes to mind is kidney stones. But today, you know, after all of our viewers, those who are coaches, doctors, they go back to their clinic Monday morning, I want them to look at a report and when they see high uric acid, I want them to think of fatty liver, I want them to think of coronary artery disease. I want them to think of cancers also. I want to think— them to think of hypertension, you know. So that is what we're going to try and achieve through this session today. And essentially, I want them to understand that all of this uric acid, it's coming from somewhere and is exiting from somewhere. And if we can manage both the factors, we'll be able to manage the uric acid levels.

So what you are saying, if you are in balance, you can walk the talk, but if you are not in balance, then you will fall.

Definitely, definitely right on point, Dr.

Preeti. So if I have to sum this, what Dr. Anshika has just said, uric acid has different roles. It's of course a waste product, but it's also a great antioxidant, and your uric acid levels give you an indication how much oxidative stress your body is in or how much antioxidant functioning you need to restore from outside, right, Dr. Anshika?

Absolutely, Dr. Preeti, very well put. Great. So yeah, and that's a mistake that some people often make. They feel that with uric acid, the lesser it is, the better it is. But when I describe it to my patients, I tell them it's something like the Goldilocks zone. You know, the bed is too soft, too hard, just right. The porridge is too hot, too cold, just right. So uric acid is one of those things. You don't want it too high, you don't want it too low, because yes, it does act as an antioxidant and has some roles to play in your immune function, in the activation of T helper cells. So essentially, that Goldilocks, that sweet spot, that good zone between 2.5 to 5.5 is what we want. Great.

And I tell my patients, too less weight is bad, too more is bad.

Balance is important. The right balance. Balance is the key. Absolutely.

Balance is very, very important. So Dr. Anshika, you just said, yes, that yes, lot of people think of uric acid and gout together, but it is also an indication that your cardiac health is at a risk. Do you, one, believe it— believe in this? And second, if yes, Can you explain it to the viewers and even to the doctors and coaches? Why is this so and what are the mechanisms involved in this? Sure, Dr.

Preeti. Can I pull out a slide? Yes, that's the one. So this beautiful slide is the answer to all the questions. It's the connecting link between how uric acid contributes to cardiometabolic dysfunction. Over here we are focusing on 3 things. The first and the most important takeaway over here is that when you have high levels of uric acid, there is a nutrient sensing pathway in all of us called the AMP kinase pathway. Now what this pathway does is it controls how much and how you burn energy. And if doctors over here and coaches over here might know, there's a very popular diabetes drug called metformin. What metformin does is it upregulates AMP kinase, makes diabetic patients lose weight, helps them control blood sugar levels. And uric acid is like anti-metformin, it's the exact opposite. So it turns off your AMP kinase. Now once your AMP kinase is turned off, you are not going to use glucose, you are not going to use fats, and you are going to store them a lot, and you're going to make them a lot, which is going to be directly contributing to the lipid load, to the cardiometabolic dysfunction. So that's the most important key. The second mechanism that we say is really important—

before you move forward, Dr. Anshika, I loved when you said this is anti-metformin, because I think metformin everybody knows. It's one of the 5 drugs being studied for anti-aging or longevity today. Definitely. Yeah, right. So now nobody will forget how important uric acid is. Definitely.

Thanks for putting that out. No worries. Thank you. So yes, definitely the metformin— I'm going to stop calling this the MP kinase pathway and start calling it the metformin pathway because I think that's what resonates with people. So yes, uric acid turns this off. It's opposite of metformin. The second important pathway is there is something called nitric oxide. In our blood vessels. This nitric oxide, what it does is, is it dilates the blood vessels. It ensures that the blood flows smoothly, right? It ensures your blood pressure is maintained. Uric acid is going to inhibit nitric oxide in two ways. Number one, it reduces the production, and number two, it also reduces the action of nitric oxide, which means you're going to have less dilation of your blood vessels. You're going to have a higher blood pressure, hypertension, and you're also going to get some endothelial— which means the inner lining of your blood vessels is going to have little bits of inflammation, which is all a recipe for cardiometabolic disease, hypertension, coronary artery disease.

So I was not wrong when I said that it's a precursor to heart problems, and your body is just trying to cry and tell you, kuch kardo yaar, I am not feeling comfortable, right?

Yes, definitely, Dr. Preeti. Your body gives you a shout before anything else. It's always crying out for help. So definitely, this is the second pathway that I want everyone to remember, the eNOS pathway or the nitric oxide pathway. And the third pathway that's really important is that uric acid, by its very nature, at a high level is a pro-oxidant. It causes oxidative stress, and that it achieves by activating something called NADPH oxidase, which means more oxidative stress, more mitochondrial damage, more mitochondrial dysfunction, more fat storage. And that's how it contributes to cardiometabolic issues, by creating a lot of oxidative stress and inflammation.

Thank you, very, very beautifully put. And, um, I thought I will also show the slide so that you can go through this slide, and then I have lots of questions for you.

So yes, that is the whole idea of the session. If you guys are going to take away one thing from this session, it has to be this: when you look at a high uric acid level, do not restrict your thought process to gout and kidney stones. This is a list of pathologies that should be coming to your mind. A whole list of, you know, metabolic, cardiovascular, and complex pathologies. I want you to go through all of them in your mind, see what your patient is at risk for, and then initiate them on a plan which can reduce the risk of all of these.

Perfect. Thank you, Dr. Anshika, for this. And now some very, very important questions. One, why do some people generally have higher uric acid levels than others?

Thank you for the question, Dr. Preeti. So a very important thing to understand is the inlet of uric acid and the exit of uric acid from the body. So when we talk about high uric acid levels, where are they coming from? I say there are 3 main sources that are bringing uric acid into the body. No other sources, just 3 that I want everyone to remember. The first one is a diet which is rich in purines. Purine-rich diet means a diet that's rich in alcohol, especially beer. It includes seafood, it includes organ meats, red meats. All these are very high in purine, so that is how it's coming into your body. Second way it's coming into your body is that you're intaking a lot of fructose, or the sugar that we get from fruits, especially in the form of— not in the form of fruits as such, because that has shown to be less harmful, but in the form of things like high fructose corn syrup, in soft drinks, and juices, because the way fructose is metabolized in the liver, it makes a lot of uric acid as a byproduct of its metabolism. So second way you get high uric acid is fructose. The third way you're going to get high uric acid is when your cell turnover is too high, which means that the cells are dying and being born in your body very quickly. Something that we commonly see with conditions like psoriasis, something that we commonly see in cancers as well. So those are the 3 conditions. One is your purines in the diet, one is increased cell turnover, and fructose. These are 3 sources that will increase your uric acid. Beautiful.

One more thing I think I will want to add here is some people, they have overactive xanthine oxidase. Okay, right, the enzyme that converts purines into uric acid.

Wonderful. Yes, Dr. Preeti, definitely these are the little genetic variations that we look for.

Exactly. Also genetic variations in terms of ureate transporters in the kidney. So this also— and now because of these genes, you will see in some patients You know, they will generally have higher uric acid again and again and again and again, but these people will not have any symptoms. So now my question to you is, if they have no symptoms but slightly higher side uric acid in one report, in the second, in the third, every 6 months or a year, what will be your take on this?

So thank you, that's a really good question, Dr. Preeti, because we see all these guidelines, right? ACR guidelines and all these guidelines are related to gout and they're related to what you should do when these are forming uric acid crystals. But there are no guidelines on asymptomatic hyperuricemia, or as you said, uric acid is high but you don't have any joint symptoms. But Dr. Preeti, we have enough data saying that Without symptoms, a high uric acid is still fatal. It can— according to a very recent report by ACR, American College of Rheumatology, it increases the risk of all-cause mortality by about 16%. Also, it increases the risk of a cardiometabolic or cardiovascular event by 39%. And these are big numbers, and I say these are big enough reasons to intervene. So when someone comes to me, or I would say to any functional medicine doctor, with high uric acid levels, no symptoms, I would say you still go ahead and treat with lifestyle interventions.

Thank you for saying that, because yes, I would say that I would tell the patient don't panic, right? But yes, because there is— there are some genetic changes happening that you have it on the higher side. Make sure that your lifestyle is adapted in such a way that this does not increase further. But of course, in functional medicine, as we always say, we don't treat the report, we treat the individual ways. Yeah, so please make sure that you know the history, the family history, and ask subtle, subtle questions. And you will know this level. You already mentioned, Dr. Anshika, that purees— how much does diet really matter? And more importantly, generally when we go to an allopathic doctor like yourself, the guidelines tell you that no protein to be given to this patient. Now, yes, that even young people of 20 years, 18 years are coming to me with high uric acid. If I don't give them any protein, what am I doing, right? So as a doctor, how important is diet and why do you guys tell people to stop protein completely?

So very good question, Dr. Preeti, and this is probably one of those burning questions around uric acid. And it's a big misconception— this one is a big misconception— that a high protein diet gives you high uric acid levels. There's, first of all, no association between protein and uric acid, and the protein that we usually recommend to most of our patients is still in the same range between 1.2 to 2 grams per day, or like 1.5 per pound. That's the usual protein intake shake that we recommend even to patients with high uric acid. But coming to diet-wise, what can they do to bring out— bring down their uric acid? One of the most important things is to cut out alcohol, to cut out everything that's a source of purine. So red meats, organ meats, seafood, all of that has to be cut out. And then I also see that incidence of high uric acid in very young adults. I'm talking the ages of like, you know, 16, 17, the likes of that, coming in with high uric acid. And this is what I cut out from diet. Soft drinks, one of the biggest culprits. Soft drinks, sodas, fruit juices, that load of fructose that they take in. I think it's one of the biggest contributors, especially in young people. And then the first thing that I encourage them to take is a nutrient-dense diet. Good amount of protein, focus on good fats, focus on polyphenols, focus on getting that colorful mix of vegetables and fruits. And focus on good hydration.

Right. And Dr. Manik Kiranandani is saying— thank you, Dr. Manik, for joining us— make sure they are drinking enough water, at least 4 liters every day. And that was my next question, Dr. Manik, but thanks for giving the answer initially. But here I want to tell all the viewers, all the health coaches, doctors, I think the biggest myth in the diet side of things coming from doctors also is no protein for these patients. See, protein are our building blocks, aren't they? And if we don't give protein, we are not helping them with uric acid. We are messing up with them completely. So with your permission, I will share what I do. So uric acid has been one of these conditions which happened, came to me very, very initial years of my functional medicine practice, Dr. Anshika, and I had many patients but with different reasons. And two things really have stayed here. One, I always give protein to my uric acid patients in the morning and in afternoon. No protein after 3-4 PM. Simple logic is digestion and exercise both are more in the morning. Protein takes a longer time to digest. Undigested food will lead to leaky gut and will lead to, you know, not proper excretion, right? So whatever 1, 1.5 gram I want to give, I will give it there. 1. And this has worked for me for 10 years, guys. Try it and share with you, you know me, whether it works for you or not. Second, I had this patient, you know, I met in a meeting and I saw this patient and this patient was looking completely toxic. So people who know me know this, that, you know, I am very emotional being. So I went and said hello and I said, if you don't mind, can I know how are you feeling and are you healthy and all? And, uh, he said, oh, I have high uric acid of 14 or 15. I am on steroids, it is not coming down, and You know, doctor is really troubling me. And this guy was 27 years old in a business meeting. I came back and I started with my diet and everything, and I saw that the effect is okay, but the miracle I was wanting to see in him, I was not seeing. But because it was toxic, I knew it's something from the gut. 30 days I put him on elimination diet. I have published this paper in a journal. Right, 30 days his uric acid came down to 6.4. No steroids, no other medicines, and 6.4. So guys, yes, so look at this. If you have a 16-year-old coming and if he has normal triglycerides, make sure you do a trial of 3 weeks of elimination diet. And see, you never know how many would have gluten sensitivity, and that's the reason they are having leaky gut, and that's the reason all this is showing up. So, um, and I couldn't resist, I shared it.

Try it and see how more miracles will happen. That's a really valuable point, Dr. Preeti, that you've raised. That's a really valuable point because, uh, when we look at the elimination of uric acid about 70% goes out through the kidney that we all know about, but that remaining 30% is actually metabolized by your gut bacteria. And if you— someone's got dysbiosis, they're not going to metabolize it. It's going to be reabsorbed. So again, you know, once again reinforcing the importance of the gut as the center of your metabolic system. And definitely emphasis on gut health is so important, and your case just proves that.

Good. Okay, so Dr. Anshika, another question I have for you is, as an allopathic doctor— or right now I know that you do functional and allopathy, right? But your other colleagues, what will they do when uric acid is high? And yeah, what is your take on that? Should you do it? Should you not do it? And I'm looking at a very balanced opinion. I love allopathy, I love Ayurveda, I love homeopathy, and of course I love a little more functional medicine.

Yes, so Dr. Preeti, um, I think from years of working with my conventional colleagues, I think the idea behind this is to give a little bit of diet advice on purees and then ultimately unless it's an acute flare-up of gout, start them on something that will bring their uric acid down. Like allopurinol is very common, Febuxostat is very common. So these agents is what is the usual first line to bring down the uric acid. But again, the caveat with this therapy is that you continue it and you keep, you know, you have lower uric acid levels for a while. The moment you're off this therapy your uric acid levels are going to spike up again. So that's the treatment that's followed, and that's the caveat with the treatment. I think this treatment is a great idea if it can be integrated on the side with things that complement this therapy— the lifestyle changes, the exercise, the sleep. I think the day we find that sync and combination for acute cases Definitely this is helpful.

I also give some of my patients this where I understand that they cannot do too much of lifestyle and stuff which we want them to do. But then this is never more than 2 to 3 weeks. So Dr. Anshika, my next question is, are there any side effects if people take these medicines for a longer time?

So definitely, Dr. Preeti, none of the medicines come without these side effects, and they do have their own— they take a toll on your liver. Spurbuxostat is known to have a lot of cardiovascular risk attached to it as well. And, you know, so it's always— I mean, just as, you know, we do in all of our discussions with patients, it's always a risk-to-benefit ratio that we look at. So that's why even for someone with asymptomatic hyperuricemia, guidelines don't recommend these drugs, and that's because the risk is too much and the benefit Too little.

Too little. Yes, thank you. But are there any other common mistakes which you think conventional doctors do when they think of or treat uric acid?

I think there's one mistake that we all know of which is very common, which is giving these drugs in an acute flare-up. That's a very common mistake that some people might make, which is not usually advised because it can bring about ups and downs of uric acid again and worsen the joint disease. So that's one of the things that now clinicians are becoming really aware of. Apart from that, can't think of—

perfect, no worries.

Can exercise help these patients? Definitely. Exercise, muscle type of exercise.

And what is very, very important in this exercise So Dr.

Preeti, I encourage my patients. I tell them, do something, you know, move. If you can take your dog out to the park, move. If you can join a dance class, do that. Yoga, anything, really anything will work as long as you're moving your body and you're enjoying the process. Of course, muscle building is going to be another whole level of, you know, making sure that your cardiometabolic health is better. And of course, muscles are anti-inflammatory themselves because they release myokines. So definitely any kind of physical activity, but yes, weight training, muscle building is what I usually tell them is going to be better in the long run. Great.

So I tell these people, just relax and sweat a lot. Open your largest detox organ, which is your skin. Go in the sun, play a lot, laugh a lot, increase your metabolism. And if you can, do a far infrared sauna session. Beautiful effect, very calming, very nice, helps you detox better. So your second thing, now in the beginning, multiple times you have highlighted that one is kitna ban rahi hai, but second is kitna nikal rahi hai. The second valley part, we focus, is also equally important. True. And, uh, just using your skin for it really helps.

I mean, that's a great hack. That's a really good hack, just sweating it out. I mean, yeah, yeah.

And if you can do it with far infrared, nothing. Now I have a very innovative question for you, with your permission. Sure, Dr. Preeti, go ahead. If uric acid had a personality, how would you describe it? And I know all my questions are extempore, you have not prepared them, but that's all right because you know what comes extempore really at times comes beautifully.

That's true, Dr. Preeti, but your questions— this is actually one of the best questions that I've been asked about uric acid ever because it forces me to think, um, you know, in terms of a character or a personality. I mean, okay, um, you know how in India we say that, um, if a guest comes over and the guest comes over for a few days, you know, 2-3 days, you enjoy it. But when the guests overstay, it's 10-15 days, it starts irritating you. I think uric acid is like that. Low levels of uric acid in that, you know, antioxidant, immune We don't want them low. Yeah, we don't want them low, and moderate levels are okay, but higher levels are going to start irritating you. So somewhat like, you know, you want them to come, but only—

I must compliment you on your thinking abilities. Great. So there is a question for you.

Can sluggish thyroid also be a contributing factor to high uric So sluggish thyroid, definitely I see some correlation in clinical practice on that. I do see that patients with a sluggish thyroid, because their AMPK pathway, because their cardiometabolic factors are not completely in order, I do see some correlation. So I think definitely there's something brewing over there.

Okay, so basically what happens is, you know, in hypothyroidism it can definitely raise uric acid. Why? Because thyroid hormones, they influence kidney function and the blood flow both. So excretion becomes compromised. Second is, of course, we all know metabolism slower, hypothyroidism, And that's the reason again, uric acid. So very interesting question, and that brings us also to the point, so we must make sure that we work on the thyroid function also. And you all know my thing is, if you want to work on the thyroid function, first 6 weeks work on the adrenals. And stress and sleep. So now I come to next question, Dr. Anshika. How do you think stress and sleep affect uric acid?

So definitely, Dr. Preeti, I think when we talk about functional medicine, the body is a web, you know, everything connects to everything. And when it comes to these lifestyle factors, both stress, both sleep, they have a very close association with uric acid You know, it's not a coincidence that when someone gets that inflamed podagra and the big toe, the joint, it's usually at night, you know. It's— and there's a very close association between sleep and uric acid. So people who have interrupted sleep, it may be because of any reason. It may be because of obstructive sleep apnea, which is again putting us in that loop of obstructive sleep apnea, metabolic syndrome, high uric acid. So it relates that way. And also stress, you know, the cortisol levels and then the thyroid levels. It does relate to uric acid in a big way.

Okay, so quickly, we have a lot of questions here. Before I ask my question, I will ask theirs. So S Yoga Kevin wants to know, how does fructose allergy affect uric acid and can it drive gout?

So fructose allergy, so what we say when it comes to fructose is that fructose metabolism itself does not make uric acid, but the byproduct of fructose metabolism is going to increase the uric acid. So fructose allergy, once again, I want to know if it's an IgE allergy that we're talking about, IgG allergy. If there's some way that they're not taking fructose, it's probably not going to impact the uric acid levels.

It depends on if we think it can cause leaky gut and that can lead to So, um, everything is connected, right? But if we know the mechanism, we will be able to help the patients better. So here, just make sure that the patient does not have leaky gut, and if it has, then you are supplementing with something which helps. What supplements— Shweta Jain wants to know what supplements would you give for uric acid before jumping into allopurinol?

So that's a very good question, very valuable question. There are some supplements that have shown a lot of promise when it comes to managing uric acid levels long term. First of all, coming to the basic ones, the anti-inflammatory supplements that we give— omega-3s, EPA, DHA, curcumin— has shown a lot of benefit because of the anti-inflammatory, antioxidant, uh, properties. Specifically, vitamin C has shown a lot of promise because vitamin C inhibits the formation, so production is less, and it also makes sure you secrete or excrete more uric acid through your urine. So vitamin C is great. Another one that's shown a lot of promise is quercetin. Quercetin is something that we commonly use for the gut also. We use it for allergies as well. Now quercetin is also a very potent xanthine oxidase inhibitor. So quercetin also is a really good supplement to add. Another one is the cherry extract. In fact, just eating, you know, cherries, it has shown to increase how well you excrete uric acid. So all of these supplements have shown a lot of promise, and the one that we should not forget about is probiotics. Different strains of probiotics, anything that improves gut health is going to be great for managing uric acid levels as well. Dr.

Anshika, will you be kind enough to share the doses of these supplements One, so that people know what they should use. Second is, generally vitamin C, you know, people say in kidney cases you should not give, especially kidney stones or something. Do you think in gout cases vitamin C should be given with caution? Any other thing in history which should be ruled out before you give it? And then what dosing you will want to give it?

Okay, Dr. Preeti, so usually starting with the first supplements I mentioned EPA, DHA, anywhere between 1 to 2 grams is a good dose. Um, talking about curcumin, 500 milligrams twice a day is a good dose. Talking about vitamin C, 500 milligrams once a day is a good dose. Um, in someone with acute gout, I would give it with some caution. Um, it is a potent antioxidant, so yes, I would just monitor for symptoms. If I'm giving it. And then we spoke about quercetin as well. Quercetin also, the same dose, 500 milligrams once a day, is the one that's shown promise. Then tart cherry extract has shown promise. So these are the usual doses that we go for.

Thank you, Dr. Anshika. Oh, questions are pouring in. Dr. Gold, Dr. Thang, is saying, although high uric acid is nowadays considered a metabolic marker, we can't find constant correlation between high uric acid and metabolic dysfunction. Many a times we find low uric acid levels. Why? Beautiful question, Dr.

T. Thank you. Yes, Dr. Aanchika, that's a really good question. Now there's one more interesting research that's been coming up. We've spoken about high uric acid, and there's also a lot of evidence. It's very raw, I would say. Right now we have, you know, association of low uric acid with a lot of conditions like Parkinson's, Alzheimer's, even multiple sclerosis and low uric acid. But this is an association. Till now we're not sure if it's a causation, right? So yes, this low uric acid, it does seem to be something that could be associated with certain conditions. That's one. Now the reason we see low uric acid, it could be because of being on certain drugs. There are certain drugs that bring down uric acid in the body, and most of these are cardiometabolic drugs. For example, things like angiotensin receptor blockers, ARBs, like losartan. Calcium channel blockers, they all increase the exit of uric acid from the body. So they will actually give you a falsely lower uric acid level, and you might think that there's no cardiometabolic risk while there is. So that could be one of the reasons.

Great. But Dr. T, very, very good question. And what I want to say here is that low uric acid, I also see in a lot of patients where there's been long-term inflammation and oxidative stress And that is where you will see that this is low. So like in adrenal fatigue, I tell people you will have high cortisol, but over the years now I see a lot of people with low cortisol. And I tell people low cortisol means that you have already crossed when it was high and you did not notice. So now this is the way I will have to bring you back, so it's going to take longer. And I think the same thing applies for uric acid also. So long-term problem, you will see low uric acid with metabolic markers high. And, uh, that makes very good sense, Dr. Anshupa. Super Wealthy Coach Akmaurya, I really like your name. What about aspirin in cardiac and diabetic patients with increased levels of uric acid, even Febustat not responding?

So in fact, you know, Dr. Preeti, aspirin is one of those drugs which increases uric acid levels. So it could be secondary to aspirin. Aspirin, Ecosprin, they all increase uric acid levels. Um, thiazide diuretics, loop diuretics, they all increase uric acid levels. So if it's not responding to Febuxostat, that could be one of the reasons, because the patient's on aspirin. Uh, now aspirin, we know, is one of those indispensable drugs. We've got to use it. What we can try with such patients is give them a multimodal approach. So try and do the diet, lifestyle, and try and give them, you know, some of these supplements, work on their gut health. That could be a more integrated approach, could be an idea with especially these complicated patients. Next question, Ram Punjabi has very good question.

That was my next question too for you. What is the optimal range for uric acid for men and women? And I will add my question to it is why is it different?

Okay, so when it comes to— that's a really good question. And you know, that was a question in my homework.

Well, after speaking to you, Dr. Archika, I got a very intelligent doctor. Co-doctor is coming on the channel. I should do a little deeper work.

And this is why we have this influx of questions. Honestly, I'm happy. I'm happy to see people engaging and I'm happy to I'm so happy to see people so curious about this because it is important, and I love that everyone's got their own questions. But coming back to this question, even I had this in my mind— why for females it's lesser? Why is lesser acceptable for females? Now, the most important reason for that is because estrogen— estrogen itself is something that increases the excretion of uric acid through your kidneys. So that's why a woman in the reproductive age, automatically you presume that at least 0.5 or 1 milligram per deciliter is being done by the estrogen itself. That's why for women the values are always a little lower. Now coming to the ideal values, I think less than 2 is a bit of a red flag. Less than 2 is where it becomes too low, where you're not getting any good qualities of uric acid as well. So make sure it's not less than 2 for men or less than 1.5 for women. And when it comes to the upper range, somewhere between around 5.5 for men and 5 for women is a, you know, it's one of those optimal targets. But if you're looking at proper targets, then yes, less than 6 and less than 5.5.

Perfect. I keep it to 2.3 or 2.6 as the lower range, and of course 5, 5.4 as the top range. Of course, women ranges are a little lesser than men ranges, and Dr. Anchika has very beautifully told you why.

But doctors, caution with women who are transitioning in their perimenopausal time. You might see the uric acid surge after menopause. That's because the action of estrogen declines, and then that's where you might want to put them on a slightly, you know, uric acid lowering therapy or uric acid lowering lifestyle.

Great. So Dr. Risha Sharma wants to know if anyone is on protein supplements and working out, does that affect high uric acid and how to approach high levels in such cases?

So I would say when someone is on multiple supplements, it's always a good idea to check interactions and make sure these supplements are not interacting in any way. Usually most of the supplements that we use, they are not going to really interfere with the uric acid levels because again we spoke about the inlet and the outlet. As long as your inlet and outlet are safe and you're not touching, you know, fructose and all those factors we spoke about in the beginning, or you're not touching kidney and gut function, your uric acid levels are going to be stable. But if there's something interfering with these, medications can do that. I can't think of any supplements as such which do that, but But remember that diuretics— diuretics is a class of drugs which makes you excrete water. So any supplements, even herbal diuretics or herbal supplements that make you, you know, excrete a lot of water, that might sort of have some impact on the uric acid levels because of the dehydration. So you might want to watch out for that. Great.

So Dr. Risha, my take on this in addition to what Anshika has said is that I would tell this patient to slow down the exercise for a little while, right? Why? Because exercise, especially high-intensity exercise, it rapidly uses ATP, and ATP leads to breakdown of purines, which turns into uric acid. And therefore, for some time, uric acid can go higher, which when the doctor will check, doctor might put it on something— what? The patient is doing and the doctor has not prescribed. So let's be wary of that. Second is lactic acid competition. Intense exercise, it increases lactic acid in muscles, right? And this lactic acid, it competes with uric acid for kidney excretion, so that transient rise in serum uric acid can also happen. And last is sweating decreases blood volume And water intake then will have to be even higher than 4 liters, which Dr. Manik has said, which would not be possible. So my take would be, tell the patient, go slow, go low. Body banchayi gi. Right now, body is trying to create a balance. Do everything which helps the body create a balance. So rather than doing high-intensity training or doing a lot of muscle building that time, I generally recommend patients to do walking, laughing— that also burns a lot of calories, guys, so you can definitely laugh sometimes, right? And then do some yoga, do some meditative exercises, and do things which helps you detox. So breathing, breathing, and breathing. And that's perfectly all right, and I have not seen people lose muscle during that time. In fact, in my cases, I've somewhere seen that uric acid improves And the muscle mass also improves when I do the BCAA. So guys, there's no harm telling the patient to change their lifestyle a little when we know that we will get in panga with doctors like Dr. Anshika, because we won't take the blame, you know. We will pass on everything to what the patient is doing. Okay, question, Dr. Risha. And, uh, so Mukta is saying Renadryl is a great probiotic that specifically targets and reduces uric acid levels. Yes, definitely, Renadryl is a great probiotic, guys. Use it for your kidney patients, for your uric acid patients, and give your patient the benefit that they've come to you for. Swati is saying, I'm not able to tolerate omega-3. Before I give this question to Dr. Yamshika, I want to tell you, Swati, either you are extremely deficient on omega-3. Do an omega-3 test, or your gut dysbiosis is pretty significant. You know your history well, but rule out these two things because you do need to take omega-3 at some point in your life if you want to stay young, even when you are, you know, growing, at least in biological age. Over to you, Dr. Anshika. She cannot tolerate omega-3. What is your take on that?

That's a very valuable pearl that you already gave away, Dr. Preeti. So yes, definitely I would look in the gut, especially fat digestion is something that I would be thinking about. Gallbladder health, fat digestion. So I would ideally, definitely, yeah, definitely I would say get an omega-3 index and omega-3 levels checked and also just have a look at your gut and see if, you know, fat digestion is an area of deficit.

Definitely a lot of people, pancreatitis patients, will not be able to digest omega-3. His amylase lipase will be very high, sometimes not low. So rule that out. But this is not something that tells you don't take omega-3. This is something which tells you do a little more about your health.

It's like omega-3 is the postman, it's not the— sorry, omega-3 is the postman, not the sender. So you need to find out who's the sender.

Yeah, yeah, you can't do anything without omega-3, you will age very fast. Okay, um, now this is a very good question. Ramanuru DV: Doctor, how can you relate uric acid imbalance to cancers?

Oh, that is a really good question. And that is, um, you know, when I rotated in many, many specialties One of the specialties where I rotated was hematology oncology, and in that department everyone has high uric acid levels. Everyone. And we are constantly checking their uric acid levels 2 times, 3 times, 4 times a day even. And that is because they have conditions where the cell turnover is, number one, very high, and the moment they're given any chemotherapy the cells start dying at a very high rate, and all this DNA, RNA inside the cells, all the purines come out in the blood, are degraded to uric acid, and the uric acid levels can shoot up very, very quickly. And if any— we've got any hematology doctors, they might relate this to something called tumor lysis syndrome, is what we call it. So definitely conditions with high turnover like cancers, you will find high uric acid levels because the production is really high.

Also leukemia, lymphomas, it's even higher, right? And, uh, again, the point which I said before, I want to reiterate: uric acid at normal levels is an antioxidant, but at high levels is a pro-oxidant. So that increases inflammation, endothelial dysfunction, supporting cancer progression.

Definitely, it comes the self-fulfilling loop. Yeah.

Okay. So please. Yes, this is very, very important. Can it also be related to autism?

I think so. That's not really my area of expertise. That's why I've not really seen a lot of kids with autism. And definitely I do related to the angle of fructose because if you're giving kids a lot of fructose that we know is going to be a disruptor of the microbiome. That we know is going to be a problem and that is going to shoot up uric acid levels. So fructose metabolism is one way where I can hold uric acid responsible, gut dysbiosis being another.

I will add on that because I work on autism. Uh, not too much data available, but now the relationship is being shown. Some of these studies, small studies and all, they're talking about it. The basic premise is oxidative stress, inflammatory pathways, which we know more inflammation, more oxidative stress in autism. And uric acid also, it affects inflammatory pathways, and therefore low-level inflammation in brain is implicated in ASD patients. And uric acid also interacts with microglia. Immune cells in the brain, and hence it affects neuroinflammation, right? So pretty interesting. And, um, you know, when, um, Dr. Anshika shared 2-3 topics with me and I chose uric acid because I see a lot of miracles happening there. But today on this podcast, I'm realizing we chose a good topic.

We chose a really good one, and I'm so happy to see the questions because I feel like that makes me feel that together we've chosen a good topic. And I feel like everyone resonated with this, and I hope—

yeah, Poonam wants to know— the time is running short, we only have 6 minutes, we will, you know, increase the speed. In respect to food, what all functional foods can be given to help bring down uric acid?

That's a very good question. It's going to tie this whole thing together, uh, but mostly foods that are anti-inflammatory like cumin, like ginger that we know of that work. Those are really good foods to introduce. Foods that are colorful, especially some, you know, why do we say that tart cherries are good? We say they're good because they contain colorful compounds like your anthocyanins. Those are really good. So I would say when it comes to functional foods, go for the colorful plate. Go for— if you're trying to add protein, then avoid the seafood, avoid the organ meats and go for lean cuts. Go for, you know, chicken or even omega-3 rich fish. Those are good options to add. Nuts, seeds are good options to add. So mostly anything except for that list of high purine foods is good. Also, black tea, black coffee, water— they're all really good. Also, there is now a lot of data coming in that milk proteins, milk proteins in the form of you know, milk or even casein, they somehow increase the excretion of uric acid. So milk proteins are a really good thing to add.

Great. So my thing, what I tell my patients is eat a lot of cucumbers, watermelon, lettuce, because I want you to eat water, not drink water, right? Low purine foods like carrots and bell peppers and broccoli. I'm zucchini. They help even in detox, but more importantly, low purines. And then cherries or berries, if they can have that access, very, very good. Your vitamin C in form of oranges, lemons, limes. And then fiber. So these are the foods to be eaten. And of course, avoid— we have already discussed. Another quick question, Abira Ghosh wants to know, can uric acid act as a marker for the onset of HPV-associated cervical cancer?

Um, so I don't think there's a lot of— I don't think there's a lot of data around the infection and if uric acid could be a marker. But then I don't think there's a lot of data around that. I don't think it could be a marker for HPV-associated cervical cancer. Have you encountered that, Dr. Preeti, in your practice?

Any— no, should not. This, uh, because I don't do too much of cancer. I've started doing it, so maybe a year or so I will have more data with me. Um, this is an area I don't do, and, um, I somehow feel maybe this might not be too connected. Okay, definitely.

Yeah, because infection—

yeah, you're right, because infection is the major thing. So, but we will park it. Both of us don't know about this. Sorry, Abira. Um, anyways, to improve the GFR levels with a person who has one kidney functioning and uric acid of 6.26.

And the eGFR levels, is there any— I mean, for such patients, levels are low. Okay, so, um, for patients with a single kidney, what I've encountered in my practice so far is that you really have to take care of the cardiometabolic risk because there's something called, uh, you know, a hypertensive nephropathy. Nephropathy, or a nephropathy secondary to low heart function as well. So whenever they're going to slip into a cardiometabolic syndrome, because they have one functioning kidney, that is often the first thing to take a hit, and they may develop mild nephropathy or proteinuria just because they have got hypertension. And that's something that we commonly see. So with them, I always advise them that if I do have a patient, and you know, whether they are someone with a normal eGFR or slightly below normal, I tell them to work on their lifestyle. Lifestyle. That's probably the only way you control the hypertension, you control the inflammation, oxidative stress. That's probably the best way to at least halt the progression of CKD.

Last question we have is, please explain pancreatitis and omega-3 and uric acid. Okay, I have selected this question for you.

Yes. So now, pancreatitis, we say that basically it's an inflammation that happens in your pancreas, and this inflammation, we say it can be acute, can be chronic. Now, when it is acute, it happens overnight, you know, free few hours, and pancreas are completely inflamed. And when can that happen? That can happen only when the pancreatic ducts are blocked. What blocks them? Bile stones, gallstones block them, right? So that is the acute pancreatitis that you get. The second kind of pancreatitis that you get is chronic pancreatitis, where over a long period of time the pancreas are blocked, pancreas are inflamed, and then they can develop calcifications and all of that. Now what happens when pancreas are not working long term? Your fat digestion suffers, which basically means that the pancreatic enzymes that were digesting fats are not able to do so because somehow it is blocked or somehow the pancreatic function is not 100%. In that case, you can have trouble digesting any kind of fats, not just omega-3 fats. Any kind of fats will be a problem, and you can actually test this in your stool by checking something called elastase levels, and these will give you an idea of how good or bad the pancreatic function is. Also check for steatorrhea.

You will know how the digestion is happening, how the enzymes are there. And, um, last thing is I want to say, post-COVID, I am seeing many, many, many more cases of pancreatitis than I used to see before. Do not ignore this, check this. And I think Dr. Anshika has really explained very beautifully how the gallstones are one leading cause of this. And you know what, I was a director with AB Hospitals and we did only 4 most common surgeries, and cholecystectomy was one of them. Please know that 1 out of 3 or 4 people is having gallstones, and half of them don't know about it, and they will land up to you with pancreatitis, especially in the current state where we have so much toxins. Our environment is bad, our lifestyle needs so much correction. So I think this is something you should look at, and this will really— what Anshika said on Monday morning, you should look at uric acid or reports differently. I want to say this will take your practice to the next level, and let's heal more and more people together beautifully from the root cause and have fun and more satisfying careers. Thank you, Dr. Anshika, for being here. I'm known to end the talk right on time, and it's 2. I'm already 2 minutes late, but thank you everybody for so many questions, for so much love and care you share. And please, if you want us to come back to you with any other topic, share your topic with Renuka, and I'll be happy to have somebody like Dr. Anshika, or maybe Dr. Anshika, to talk about the topic and bring it, you know, make it so simple but so important. That you guys join us and then Monday morning you change your practice. Thank you very much. Poonam Diwan is saying, in my practice I've seen many people who are into bodybuilding taking high amounts of protein powders have uric acid. Here, should we correlate it with muscle breakdown or metabolic disorder? Poonam, I would say both. Mitochondrial dysfunction, perfect. Next time Let's come back to you with mitochondrial dysfunction. Thank you, Ashu. Thank you, everybody. Thank you, Dr.

Anshika. Thank you, Dr. Preeti. It was a pleasure doing this with you, and loads of love to you.

I love all you young doctors who are becoming a part of this very, very, very important journey where I feel chronic diseases— we need a little more than what we are doing in conventional medicine. Of course, conventional medicine is the heart and key of medicine, and if some things can be created around it, I think we can have a healthy country.

Definitely, Dr. Preeti, beautifully summed up.

Yeah, thank you very much. Bye-bye, enjoy your evening. Happy Diwali to all of you and wish you loads of light and success and health and happiness. Have fun. Bye-bye, take care.