Dr. Jodi Nishida
Hawai‘i Herald Columnist

Dr. David Perlmutter holds up his book “Drop Acid.” (Photo courtesy of Dr. David Perlmutter’s Instagram page)

I recently read a book titled “Drop Acid” by Dr. David Perlmutter, MD. As a doctor who specializes in food and nutrition in ways different from our standard dietary guidelines, it is of utmost importance that I understand food of the 21st century. What we put in our mouths at every meal, every day, not only affects physical health, but mental health, too. It truly is fascinating. Our day revolves around food yet so few of us truly understand what we’re eating. From farm to factory to table, lots (often bad) can happen. “Drop Acid” is a terrific, enlightening read on fruit, fructose and high fructose corn syrup in relation to uric acid levels. Most of us have been conditioned to think of gout or kidney stones when we hear the words “uric acid.” I’m going to attempt to explain why it’s so much more than that and encourage you to get your fasting uric acid levels checked by your doctor routinely. If they ask why, suggest they read this book.

Uric acid comes from three sources: fructose, alcohol and purines. Fructose is the naturally occurring sugar found in fruit. We are told that fruit is good for us. Our food pyramid encourages 5-7 servings of fruits and vegetables per day. This can be misleading because one could interpret it as: “Seven fruits a day are good for my health!” No! Fruit has been extensively genetically modified over the last century to be bigger, brighter and sweeter to appeal to the consumer. Fruit in their original forms are nowhere near as sweet or physically appealing as they are now. Google it! It’s really interesting! Fruit must be eaten in moderation (< 1 serving/day) and a focus must be placed on lower sugar fruits such as berries. Unfortunately, the tropical stuff that we have here (mangoes, lychee, papaya, pineapple) are all extremely high in sugar. Please think about this during mango season or the next time you’re in line at one of the smoothie chains. Fructose causes a 114% increased risk of gout. That gives you an idea of how much it raises uric acid levels.

High Fructose Corn Syrup is the bigger problem. In 1957, two biochemists at Oklahoma State University discovered a way to convert the glucose found in corn syrup to fructose. This became a much cheaper way to sweeten EVERYTHING. Between 1970-1990, consumption of HFCS, hidden in foods, increased by 1000% and by the year 2000, the average American was consuming 60 pounds per year. I’m afraid to know what that number is today. Some of the foods that contain HFCS are bottled dressings, bottled sauces, condiments, baked goods, cookies, cakes, crackers, muffins, snack bars, energy bars, protein bars, packaged foods, soda, juices, energy drinks, syrups used to sweeten boba, tea and coffee drinks, medications (to improve taste), jams and jellies, ice cream, frozen desserts, sweetened yogurt, canned and boxed soups, and fast food such as pizza. The list is extensive and I ask all of you … when reading this list, how many of these do you consume? Fructose silences the hormone leptin, which tells us to stop eating. Fructose impairs energy production in the mitochondria of each cell. Fructose triggers triglyceride production in the liver. Fructose causes cognitive impairment in the brain and signals our bodies to store fat. Looking at these metabolic consequences collectively, you start to see a picture of how consuming fruit + HFCS is at the root cause of so many illnesses. Diabetes, hypertension, cholesterol imbalances, insulin resistance, cardiovascular disease, non-alcoholic fatty liver, dementia and Alzheimer’s Disease, cancer, ADHD, and so many others are directly linked to excessive fructose consumption. If we are not looking at uric acid levels routinely in labs, we are missing a major precursor to poor health. It’s gone way beyond gout and kidney stones thanks to our food industry.

Alcohol is another common, direct cause of high uric acid production in the human body. It is associated with a 158% increased risk of gout. I’m going to focus on beer because it dishes out a double whammy. Beer is not only an alcohol but it is high in purines. Want to lower your uric acid levels? Eliminate beer from your life. There are other types of alcohol out there that can be consumed in moderation. A glass or two of red wine or bourbon once a week is a much better choice than beer. 

The final source of uric acid is purines. Food sources of purines are wild game (venison, veal, elk, etc.), organ meats, red meat, deli meat, bacon, processed meats like salami, and high-purine seafood such as sardines, anchovies, mackerel, mussels, scallops, herring, and haddock. Red meat is associated with a 29% increased risk of gout and seafood is at 31%. These numbers are much smaller than fructose and alcohol. I believe that high-quality meat and seafood offer a variety of health benefits so it’s okay to eat these in moderation. I confidently eat red meat twice a week and sardines once a week on average because when you look at the data, it’s fructose, HFCS and beer that increases uric acid to alarming levels. It’s not meat and seafood. I also check my uric acid levels routinely and they are on the very low end of the scale. 

If you’d like to be proactive until you can get your labs drawn, here are some things you can do to reduce your uric acid levels. The first one is obvious. Reduce your consumption of fruit and anything containing HFCS. Eat real food such as meats, vegetables and eggs. Limit anything convenient, fast or packaged. Second, get seven hours of sleep a night. Our sleep cycle is directly linked to our body’s ability to clear uric acid. Third, hydrate with water. If you are a soda, energy drink, juice, or sweetened coffee drinker, slowly cut back a little bit every day to prevent headaches and replace it with water. Sixty-four ounces of water per day is an achievable amount for most people. Lastly, exercise! Exercise activates numerous processes and pathways in the human body that help to reduce uric acid and inflammation. Start with 20 minutes once a week and slowly work your way up from there. We all have a starting point. The point is to get started. Aim for a fasting uric acid level < 5.5 mg/dL and request this test from your physician even if you don’t have a history of gout or kidney stones. This easy test, available at our local labs, says so much about how your diet is affecting you. Good luck!

Dr. Nishida is a Doctor of Pharmacy and accredited Metabolic Healthcare Practitioner who’s been in healthcare for over 25 years. After experiencing the ketogenic lifestyle’s effect on her own autoimmune condition, she decided to build a keto-based medical practice so others could benefit from it too. Over the last few years, she’s helped almost a thousand patients realize the benefits of clean, medically guided keto.

With certifications in ketogenic nutrition, cardiovascular disease management, pharmacogenomics, and medication management, she works closely with each and every patient to tailor keto to their medications, medical conditions, lifestyle and socioeconomic situation. Dr. Nishida is also in training for processed food addiction recovery. To learn more, or to contact Dr. Nishida, visit her website at theketoprescription.com.

The content of this column is not meant to be medical advice. Please consult your doctor before starting any diet or lifestyle change and understand that there is no blanket approach to keto. Keto should be tailored to each individual through the guidance of a trained professional.

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