The article I am presenting to you is not well cited, but instead, a review of the book by David Perlmutter, Drop Acid. Perlmutter, a neurologist by trade, is one of the best authors on all that deals with nutrition. The book is extremely well-referenced; if you want to know more about the subject, I would strongly recommend the book.

From the beginning, I want you to understand that uric acid levels are extremely important to know. The literature in the recent past has come to consider its values as a bellwether to our overall health. I also want you to understand that you do not have to be a victim, but with some work, you can alter its metabolic effects.

From the beginning, a Scottish physician, Alexander Haig, first sounded the alarm about elevated uric levels and diverse conditions in his book written in 1892. The American Medical Association even reviewed the book's fourth edition. So much of what he was saying has been proven to be true. Alexander was too forward-thinking for his era.

Conventional medical wisdom became only worried about uric acid levels if the patient has clinical symptoms. The two primary symptoms are gout or kidney stones. If a patient has neither conditions, elevation was considered to be innocuous. The trend started to change around 2005.

Elevated uric acid values are very prevalent. It is hardwired into our genome. Our uric acid levels far exceed those in other mammals. During our genome development, a strategy was chosen to delete an enzyme to lower uric acid. You might ask, what about the environmental pressures that led us down this path? This choice dramatically increases our ability to become insulin resistant and, therefore, to put on life-sustaining fat. That tweak to our hard drive is excellent when starving but very detrimental in the land of plenty.

In 2017, a metadata review found elevated serum uric acid is one of the best independent predictors of insulin resistance and type 2 diabetes. One-quarter of type 2 diabetes cases can be attributed to high serum uric acid levels.

A giant seminal study of forty thousand men and fifty thousand women was followed over eight years—a 16% increase in the risk of death from any cause among people with elevated uric acid was found. A whopping 40 % increase in risk of death from cardiovascular disease and 35% increased risk from ischemic stroke. Researchers discovered an 8-13% death increase with every milligram per dL of uric acid in the blood above 7 mg/dL.

What is remarkable is that the risk of death from coronary heart disease is higher with an elevated uric acid group than those with a history of coronary heart disease.

High uric acid sets off a cascade of biochemical reactions collectively called oxidative stress, which constricts blood vessels—giving an increased risk for cardiovascular disease, hypertension, cognitive decline, erectile dysfunction, and abnormal blood fats.

The higher the blood sugar and uric acid, the faster the cognitive decline. Scientists have already documented a direct correlation between elevated uric acid and brain shrinkage and cognitive performance decline.

Uric acid levels increase during sleep, reaching their highest point at 5:00 a.m. for first-shift workers. Interestingly, it is also the peak hour for heart attacks.

Fructose is public enemy number one because it fuels ever-increasing uric acid levels and aggravates metabolic syndrome. In a meta-analysis covering fifteen studies worldwide, a team of Iranian researchers showed that consuming fructose in industrial foods, such as sweetened beverages, is the chief cause of metabolic syndrome. Consuming fructose, especially in a processed form, triggers lipogenesis and fat formation, chiefly in the form of triglycerides. The liver becomes overwhelmed with the onslaught of energy being thrown at it. The liver converts the extra energy into fatty acids, and is stored back into the liver as fat. Fat being stored in the liver is the beginning of metabolic syndrome.

I could go on and on about the catastrophic effects on our metabolism from fructose. Understand it is not a poison; it won't kill you in a single dose. It is a toxin and will kill you in a thousand doses. It is hidden all through our processed food, creating a dopamine dump and making us addicted. Also, understand fructose consumption is enemy number one for elevated uric acid levels.

Another culprit that elevates uric acid levels is a class of chemicals called purines. The body naturally breaks down purines, and uric acid is formed. This conversion occurs primarily in the liver and the inner cellular lining of vascular endothelium, blood vessels, and intestines. Low-purine diets have been prescribed for people prone to gout and kidney stones for fifty years.

Even though many vegetables, such as spinach, peas, asparagus, cauliflower, mushrooms, and broccoli, contain high levels of purines. They don't raise uric acid and can be eaten safely. The goal is to limit the serving sizes of purines. Fish that are highest in purines are anchovies, sardines, mussels, scallops, trout, and tuna. Organ meats are also a very rich source of purines.

Alcohol can also be a culprit for the elevation of blood uric acid levels. The worst offender is beer, especially for men. Moderate drinking is considered less of an issue. Moderate drinking is defined as two drinks a day for men and one drink a day for women.

Some emerging studies link high sodium consumption to elevated uric acid levels—another reason to avoid processed food.

In the short run, extreme exercise or soft tissue trauma can also increase uric acid levels.

What uric acid levels should patients strive for to stop all the metabolic havoc? This author finds the higher end of the normal range of uric acid is still too high. His recommendation is 5.5 mg/dL or lower. This value holds for men, women, and children.

A uric acid testing kit can be obtained from A test kit is $70. The test is the most accurate before eating and exercising first thing in the morning. The author also recommends getting fasting A1C and insulin levels checked. Hopefully, I have convinced you to affect your elevated uric acid levels, or if you want to lower your levels without medication, here are the methods.

First, the author recommends starting the process with a twenty-four-hour fast to reboot your system. It is also essential during this process to get adequate sleep, somewhere between six and nine hours a night.

Exercise should be introduced if the patient is not currently active. A whole article could be written on ways to reintroduce physical activity if a patient has been sedentary. For many, adding in walking is a great way to begin.

Intermittent fasting is a powerful tool that helps to bring your metabolism back. The final goal is to eat in an eight-hour window. This gives the body a total of sixteen hours to clean and de-glitch itself.

Certain foods can be powerful tools to offset uric acid levels. The best are pomegranates, blueberries, broccoli, red onions, walnuts, celery, green onions, whole Bing or sour cherries, and broccoli sprouts. They contain a powerful precursor molecule, sulforaphane. Broccoli sprouts are when the plant is picked at only an inch high; this immature broccoli has between fifty and one hundred times the sulforaphane as the mature plant. A half cup of cherries per day can reduce the risk of flare-ups by 35%. The best beverages to consume are coffee and green tea. Coffee is especially beneficial to men.

The Lower Uric Acid Volume Diet (LUV Diet)

  1. Be gluten and GMO-free.
  2. By volume, eat primarily dark green vegetables.
  3. No refined carbohydrates, added sugar, or artificial sweeteners.
  4. No organ meats
  5. Eat dairy products but in small amounts.
  6. Limit serving sizes of purines, heavy meat, and fish – especially sardines and anchovies. Don't worry about purine levels in vegetables.
  7. Do eat nuts and seeds.
  8. Do eat organic free-range eggs.
  9. Be generous with extra virgin olive oil.
  10. Corporate acid-lowering offsets include broccoli sprouts, Bing and sour cherries, and coffee.

The author likes the ketogenic diet for patients with elevated uric acid. The macronutrient ratio for this diet is 5% carbohydrates, 35% protein, 60% fat. These values are measured in calories.

Nutritional supplements that have been found to make a profound difference in uric acid levels:

  1. Omega 3 fatty acid, consuming at least 1000mg of DHA daily.
  2. Vitamin C – 500mg, creating a 44% reduction in gout risk.
  3. Quercetin – 500mg (a type of polyphenol)
  4. Luteolin – 100mg (a type of flavonoid)
  5. Chlorella Vulgaris – 1200mg decreases blood sugar, c-reactive protein, and triglycerides. Increase insulin sensitivity. They are known for reducing fatty liver.

In conclusion, let's get real; these recommendations seem insurmountable and restrictive for many of my patients. So first, let's set some goals:

  1. Get a baseline to know your starting uric acid, A1C, and insulin levels. All tests should be performed with fasting.
  2. Try to get to bed by 10 pm or, let's say, no later than 11 pm.
  3. Move your body five times a week.
  4. Evidence is becoming stronger and stronger for intermittent fasting. Try to eat in a ten-hour window three days a week. Eventually, turn that into eating in an eight-hour window.
  5. Avoid consuming processed food to lower your consumption of fructose and sodium. When purchasing at the grocery store, stay on the outer edge.
  6. You may want to add coffee if you're not a current consumer. The health benefits are not depleted if you consume decaffeinated coffee.
  7. Eat powerful foods, Bing and sour cherries and the superstar, broccoli sprouts.
  8. Try to reduce the amount of grain that you are consuming. This is a powerful tool to reduce inflammation while reducing carbohydrates.
  9. Add in omega 3's. This is one supplement that virtually everyone should consider—probably the strongest anti-inflammatory effect.
  10. Add in Vitamin C - relatively cheap for a huge payout.
  11. After six weeks, re-test. Our goal is 5.5 mg/dL or less.    
Brian Rafool

Brian Rafool


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