In today’s newsletter, we’re talking about uric acid, the role it plays in turning on, or off, our body’s fat storage switch, and how getting it under control can significantly reduce our risk of chronic disease.
In particular, today’s newsletter is especially important for anyone who:
- Drinks fruit juice regularly
- Drinks beer regularly
- Is struggling with non-alcoholic fatty liver disease or high blood pressure
- Eats “healthy” but is still struggling to lose weight
Let’s jump in!
So, want to hear something that’s kind of hard to believe?
High fructose corn syrup (HFCS) was once intended to be an alternative sweetener for diabetics.
Not only was it cheaper than cane sugar, but in the early 1970s, researchers discovered that fructose didn’t spike blood sugar and insulin the same as glucose (1).
Win-win, right? Not quite…
Soon after this discovery, the FDA approved the use of HFCS for food manufacturers and it quickly replaced cane sugar in processed foods, soft drinks, and sugar-sweetened beverages.
A well-intentioned decision at the time—but we all know it was no silver bullet for preventing type 2 diabetes, a condition that an estimated 32 million Americans have, and that number continues to rise.
In fact, high fructose consumption actually induces insulin resistance, high blood pressure, and weight gain through a different mechanism, one that’s linked to high levels of uric acid.
In today’s newsletter, we’re talking about uric acid and how it relates to our bodies’ metabolic switch that’s designed to turn excess sugar into fat. We’re also going to be talking about one of the key drivers of high uric acid levels—fructose.
But don’t worry, I’m not here to villainize the fructose in fruit, quite the opposite! I want to take the fear away, because fruit, in its whole foods form, is an important part of a well-rounded diet.
In my protocol this week, I’m going to talk about all things uric acid, why it’s important to keep our levels low, how to actually do it, and what types of fructose are the most detrimental to our health.
Before we get into that, let’s get a better idea of where uric acid comes from in the body to understand why having high levels could be an indicator of poor metabolic health.
Uric Acid: What’s The Big Deal? Hint: It’s Not Just About Gout!
Uric acid is typically associated with gout, a painful condition that’s most famously known for affecting the big toe, but it can also affect the wrists, elbows, fingers, and knee joints.
Gout has been called a “rich man’s disease” because it’s most prevalent in men who eat a lot of red meat and shellfish, like shrimp and lobster, and drink a considerable amount of alcohol, all of which were once only affordable to the ultra-rich. These foods and alcohol contain high levels of purines, the nucleic acids that make up DNA and RNA.
Uric acid is a product of purine breakdown. When uric acid levels are high, it crystallizes in the blood and deposits in the joints, resulting in this painful inflammatory condition. Aside from gout, researchers like Dr. Richard Johnson (who was recently on my podcast) have discovered that high uric acid levels could be a biomarker for detecting early signs of metabolic dysfunction.
Quick note: I want to thank Dr. Richard Johnson and his book, Nature Wants Us to Be Fat, for being the inspiration behind today’s newsletter. Dr. Johnson’s work is groundbreaking and I promise you that you will be hearing a lot more about uric acid in the coming years.
The Link Between Uric Acid And Metabolic Dysfunction
In addition to a purine-rich diet, foods and drinks high in fructose can also increase uric acid levels (2). Fructose is naturally found in fruit and varies in concentration depending on the fruit, its size, and its ripeness.
Fruit is an excellent source of prebiotic fiber, vitamins, minerals, and polyphenols in its whole foods form. We start to run into problems when we consume high concentrations of fruit outside of its food matrix, specifically in the form of fruit juice or high fructose corn syrup that’s commonly found in processed food and sugar-sweetened beverages like soda.
Before we can understand how modern-day fructose consumption disrupts our metabolic health and where concentrated sources of fructose hide in our diet, let’s first look at the bigger picture of why fructose poses challenges for our metabolic health.
Nature Wants Us To Get Fat
We are biologically programmed to see fruit, eat it, and want to keep eating it because leptin, our fullness hormone, is resistant to fructose (3). This meant our hunter-gatherer ancestors could eat as much fruit as they wanted without feeling full. Why would this be beneficial?
Think about a grizzly bear that spends its winters hibernating. They eat as much as they can leading up to hibernation because they’re preparing to go all season long without food. In addition to salmon, insects, and small animals, berries are definitely on the menu and are incredibly beneficial for bears to consume during this time.
Like humans, bears are also leptin-resistant when it comes to fruit. They eat as much of it as they can, and whatever is leftover that’s not burned for energy, or stored as glycogen right away, is turned into fat (4).
When we have a lot of sugar in our system, our liver turns on our fat production (lipogenesis) and fat storage switch. The fat is stored in our muscle, liver, and adipose tissue to tap into later when food isn’t readily available, think hibernation or famine.
Humans don’t hibernate, but we did evolve to handle harsh winters with limited food. Converting sugar to fat was a survival mechanism that allowed our hunter-gatherer ancestors to have a source of backup energy to hunt and find food when in times of scarcity.
Metabolic Syndrome: A Survival Mechanism
Fructose not only increases uric acid and allows us to store fat, but it also induces hepatic (liver) insulin resistance when you eat a lot of it (1). Why would our liver want to become insulin resistant? One of the main reasons, according to Dr. Richard Johnson, is that blocking incoming fructose (and glucose) from entering the liver means more could be available and circulating in our bloodstream.
The neurons in our brain have the highest energy demand and require continuous glucose delivery from the blood. When our blood sugar runs low, our brains tell the pancreas to make glucagon, the hormone that releases the glycogen that’s stored in our liver. Additionally, our brains produce our “flight or fight” hormones that mobilize fat for energy so that any glucose that’s left in the blood can be delivered to the brain (5).
All this to say, sugar is our brain’s preferred energy source, and having more in our bloodstream, especially during food scarcity, gives our brain the energy it needs to find food.
Plus, we know fructose increases uric acid, but did you know uric acid increases blood pressure? Together, insulin resistance and high blood pressure meant faster blood flow and delivery of nutrients to our tissues to have the energy they needed to continue looking for food.
Mother Nature makes no mistakes. She created the metabolic switch in our liver to induce metabolic syndrome for a reason—to keep us alive. However, today, our modern-day industrialized diet is causing our liver’s metabolic switch to backfire.
Our Metabolic Switch Is Always Turned On
The typical Westerner rarely ever goes more than a few hours without food. And the refined carbohydrates and sugar that make up the bulk of Western diets make it so that our liver’s fat storage switch is almost always turned on.
On top of that, we’re getting more fructose in our diet than ever before, and not the good kind (from a diversity of fruits and vegetables). Due to our modern-day processed diets, most people get the majority of their fructose from concentrated liquid forms (more on this next).
Unfortunately, our metabolic switch doesn’t hold the same survival value as it did for our ancestors. Fructose consumption (in addition to other forms of refined carbohydrates and sugar) is much higher today than it was a hundred years ago.
This has caused many problems for our blood glucose control, insulin sensitivity, and arterial health, which explains why non-communicable chronic diseases like obesity, type 2 diabetes, non-alcoholic fatty liver disease, and heart disease are so common today.
Regular old sugar isn’t off the hook either, sucrose (i.e. table sugar) is a disaccharide, meaning it is made up of two sugar molecules (glucose + fructose) that, like fructose, are also converted into fat by the liver when it can’t be used up for energy or stored as glycogen.
High Fructose Corn Syrup: A SAD Addition To Our Diet
HFCS, a liquid syrup that’s extracted from corn, is ubiquitous in soft drinks, sugar-sweetened beverages, and processed foods, which make up 60% of Americans’ energy intake (6).
Before adding HFCS to the food supply, Americans consumed about 15 grams of fructose per day from whole fruits and vegetables. Now, the average American consumes 55 grams of fructose per day, and adolescents, on average, consume a whopping 73 grams of fructose per day.
Fructose accounts for about 10% of our daily energy intake (7), and most of it comes from refined sugars and HFCS used to make breakfast cereals, pastries, soda, fruit drinks, and other sweet foods and beverages (7)(8).
Hidden Sources of Fructose in Our Diets
In addition to HFCS, there are hidden sources of fructose in our diets disguised as healthy that might surprise you. For example, fruit juice, a popular breakfast staple for children and adults, rivals soda for the amount of sugar present in a liter. Minute Maid 100 percent apple juice contains nearly 66 grams of fructose per liter which is more than Coca-Cola (62.5 grams of fructose) and Dr. Pepper (61 grams of fructose) (9).
Drinking fruit juice is another example of how taking fruit out of its food matrix can cause health problems. Yes, there are vitamins, minerals, and antioxidants present in fruit juice, but that doesn’t mean it’s something we want to be consuming on a regular basis.
The same applies to high-fruit smoothies. It’s one thing to add a few frozen berries to your smoothie (see our favorite smoothie recipes), but it’s a whole other beast when your smoothie consists mostly of fruit. When you blend fruit, you decimate its fiber that’s there to slow sugar absorption. This increases fructose absorption and puts more pressure on the liver to process it.
This chart is super helpful for understanding the fructose impact of various fruits. In the case of smoothies and fruit juice, for every serving of fruit or veggies that’s in your drink, you would have to add up the fructose that’s present. You can see how the fructose levels can get pretty high!
Fruit juice and smoothies are rapidly ingested concentrated forms of fructose that can cause oxidative stress, insulin resistance, non-alcoholic fatty liver, metabolic syndrome, and increased fatty acid accumulation in the liver and in the belly (10).
Uric Acid: The Next Cardiometabolic Biomarker
Uric acid is traditionally looked at as a biomarker for kidney function and gout, but now we’re seeing that it could tell us a lot about our cardiometabolic health, too.
High uric acid levels indicate increased levels of oxidative stress and mitochondrial damage. Knowing your uric acid levels could be helpful for early intervention to prevent chronic disease.
My protocol this week is designed to help you reduce and modulate the concentrated forms of fructose in your diet so you can keep your uric acid levels in the ideal range, even if you don’t know your current level.
I. Avoid drinking sugar and beer. If there is one clear takeaway that I’ve learned from the groundbreaking work of Dr. Richard Johnson, and the follow-up work of Dr. David Perlmutter, it’s this—avoid drinking sugar, specifically fruit juice, and stay away from beer.
- Limit Liquid Fructose: Soda (sweetened with HFCS) and fruit juice are the two biggest sources of liquid fructose in our diets, making them the top recommended items to limit when it comes to keeping our uric acid levels in the ideal range.
We’re not talking about the occasional apple juice or Coke that someone might have in a blue moon, we’re talking about the daily or even weekly consumption of these beverages. It’s not about being perfect, it’s about having a baseline that supports your long-term health and reduces the risk of chronic disease.
Lastly on the topic of liquid fructose, beware of hidden sources of fructose that often find their way into “healthy” products. Most commercial green juices, and even smoothies, are incredibly high in fructose.
- Limit Beer: Alcohol, in general, has its challenges, but beer specifically raises uric acid levels much higher than wine or spirits because of its high concentration of purines. If beer is your go-to choice for an alcoholic beverage, you might want to reconsider.
The term “beer belly” isn’t just a stereotype, it actually has science behind it. In my interview with Dr. Richard Johnson, I talked about a documentary I watched on the topic of Japanese Sumo wrestlers and how they force their bodies to gain weight very quickly. One of their top hacks was to drink multiple glasses of beer every night before bed!
II. Minimize the Impact of Fructose with These Hacks. The goal isn’t to avoid fructose, the goal is to protect our body from large amounts of concentrated fructose all at once.
Here are a couple of hacks that will still allow you to live your life, but minimize the risk of spiking your uric acid levels.
- Avoid eating fruit on an empty stomach. Having a piece of fruit on an empty stomach every once in a while won’t kill you, but if you’re eating a lot of fruit or high fructose fruits (such as grapes or dried fruit) in the morning and struggling with insulin resistance and having trouble losing weight, it’s best to stick to small portion sizes and have them after meals that contain healthy, high-quality fats and protein.
- Eat protein and fat before high fructose food and drinks. Drinking socially with friends, grabbing a juice or smoothie from your favorite cafe, or ordering dessert when you’re out to eat is a part of living in the moment and enjoying life.
If you choose to drink the occasional alcoholic beverage, smoothie, green juice, or soda, plan on having it after a meal or snack that has protein, fat, or fiber. Additionally, drinking plenty of water is always a great hack to dilute the impact of alcohol (if you drink).
III. Clean up the base of your diet. We all know this, but we can all use a reminder here and there. Simply reducing your processed food intake and switching to a more whole foods diet will dramatically reduce your uric acid levels and improve your overall metabolic health.
- Uric Acid Meter and Drop Acid book: In his new book, my friend Dr. David Perlmutter goes incredibly deep on the topic of uric acid, including how he uses a simple monitor at home to measure his levels. There are a few uric acid meters on Amazon, the one I purchased recently was this one (not an affiliate link). I’ll be sharing some of the findings of my experiments in a future newsletter.
Additionally, stay tuned because I have a new interview coming out with Dr. David Perlmutter where he expands on the topic of uric acid, including why the goal is to have our baseline levels under 5.5 mg/dl.
If you don’t feel like splurging on a meter, know that uric acid is a very simple test and you can ask your doctor to include it in your blood work the next time you go in for an appointment.
Eating and drinking concentrated forms of fructose raises our uric acid levels, which is linked to insulin resistance, high blood pressure, obesity, and straight-up poor metabolic health.
If you’re someone who eats healthfully, exercises often, doesn’t drink much alcohol but struggles with maintaining or losing weight, cutting down on those hidden sources of fructose I mentioned today, and integrating mindful hacks to minimize the impact of fructose, could be what you are missing for optimizing your metabolic health.
Remember, we have a metabolic switch for a reason, occasionally turning it on is what it’s there for. But eating these foods as the staples of our diet unfavorably keeps our metabolic switch turned on in the fat production and fat storage position.
In health and gratitude,