Good morning! Catchy subject line, huh? Well trust me, it won’t be as exciting. But hopefully you enjoy this scientific trip all the same!

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Drop (uric) acid with me!

Has your big toe ever caused so much pain that you can’t put on shoes, walk, exercise, or even bear the weight of a bedsheet resting on your toe? 

Yeah, I don’t recommend gout. When I was in grad school, I experienced it for the first time. Negative 99/10, do NOT recommend.

Gout is when excess uric acid in your body accumulates in sharp crystal form and deposits into a joint space—most commonly in the base joint of the great toe.

Most of you may not even have heard of uric acid (UA).

But it may be one of the most important biomarkers you could measure for insights into your metabolic and perhaps even cognitive health.

To quote Google’s summary definition, “Uric acid is a waste product created when the body breaks down purines, which are found in some foods and drinks, and in the body's cells when they die. Most uric acid dissolves in the blood and passes through the kidneys into the urine.”

Excess uric acid can accumulate when we either consume too much-purine containing foods or if we have issues filtering and clearing it from our bodies.

Much can be said on this topic. Books have been written, including one I’d recommend, Drop Acid, by Dr. David Perlmutter. I’ll do my best to present what’s most important to you in this brief newsletter.

Why does uric acid matter?

UA (not UnderArmour) is a major indicator of your metabolic health at large. High levels (much more common than low levels) can result in gout and kidney problems. High UA is also associated with hypertension, but this is a bit of a chicken or the egg scenario. They may both feed into each other, but it does seem that higher UA can lead to higher blood pressure.

Also of note—and I’ll spare you excess scientific details—AMPK is a protein that helps regulate metabolism. When it’s present, it signals to our body that we’re healthy and can shed fat to be lean and athletic. Uric acid suppresses AMPK and stimulates its opposite, AMPD2, to turn AMPK’s pathways off and promote the storage and preservation of fat.

The blood test for UA levels is pretty easy to either ask a doctor for or do yourself. You can purchase an at-home test device, UAssure, with test strips to monitor it on your own.

For men, ranges are as follows:

• <5.5: healthy

• 5.5—7: at risk

• >7: pathological

For women, subtract 1 from each of the numbers above.

For reference, when I’ve had a gout flare-up, my UA was certainly over 7, if not around 9. 

What can cause elevated uric acid levels and resultant gout flare-ups?

The main culprits are as follows:

• Excess dietary fructose & sugar

• Excess alcohol consumption

• High red/organ mean consumption

• High levels of stress/inflammation

• Recent weight gain

Turns out, starting graduate school can coincide with most/all of those! What a recipe for a gout flare-up. Pretty much any of the gout flare-ups I’ve had came after recent weight gain, a period of high stress, and habitual unhealthy eating. 

It also just so happens that this holiday-dense time of year, filled with sugary sweets, festive alcoholic drinks, high stress, and a potential drop in exercise, is a recipe for a gout-saster! (sorry)

The good news is, UA levels can drop to healthy ranges within a couple weeks, or even a matter of days, when minimizing fructose and other triggering foods and adding in helpful foods/supplements. 

Here are common food groups and their associations with gout risk:

• Alcohol: 158% increase

• Fructose: 114% increase

• Seafood: 31% increase

• Red meat: 29% increase

• Veggies: 14% decrease

• Soy: 15% decrease

• Coffee: 24% decrease

• Dairy: 44% decrease

The following are my top eight foods to avoid or limit (based on both research and scientific experience) to minimize UA and gout risk:

1. Alcohol (especially beer since it’s also yeasty)

2. High fructose foods & sugary drinks

3. Other processed carbs, sugars, and starches

4. Polyunsaturated fatty acids (PUFAs) such as corn, canola, soybean, safflower, sunflower, and vegetable oils and margarine

5. Hyper-cellular foods such as yeast, liver, and other organ meats

6. Shellfish/scallops/crab/shrimp

7. Highly processed meats

8. High amounts of red meat

And here are my top dozen foods to consume both on a regular basis to keep UA levels in check as well as in a pinch when UA gets high or even if I can feel a gout flare-up coming on:

1. Cherries (ideally tart) — probably the most potent anti-gout food

2. Blueberries

3. Broccoli sprouts & broccoli

4. Walnuts

5. Omega-3 fats (EPA & DHA)

6. Probiotic foods (kefir, sauerkraut, kombucha, etc.)

7. Pomegranates

8. Red onions

9. Red apples 

10. Kiwi (especially golden)

11. High-fiber, colorful fruits & veggies w/ the skins

12. Healthy fats (yogurts, grass-fed butter, organic eggs, olive, avocado, & coconut oils)

There are dozens more than make this list in my notes based on years of research. Hit me up if you’d like my full list sent to you! There are also supplements to consider if you really need the assistance, including vitamin C, quercetin, luteolin, omega-3s, and probiotic supplements.

And of course, I’d be remiss if I didn’t mention exercise’s role in all this. Daily exercise also works to keep UA in check. Breaking up sedentary time with movement, getting in 20 min of moderate-intensity exercise per day, and spending time in nature can all help regulate UA levels. Of course, quality sleep, stress management, and recovery practices have their vital place as well.

So there you have it! Uric acid 101. It would do all of us good to regularly monitor our UA levels alongside glucose, lipids, etc. at least a couple times per year.

And may you never experience the pain that gout brings, but if you do, you now are knowledgeable about it and can take quick action to mediate its effects!

✅ Take Action

Every newsletter's Take Action section will invite you to take small steps to improve your health. Recognizing that we all have different capabilities, I'll offer three different levels of action you can choose to take.

Level 1: Even without looking into your uric acid, you can take steps to live a healthier life by increasing the foods from the latter list and limiting those that can elevate UA.

Level 2: Order your own UAssure device or request a UA lab test for your next checkup visit. Once you have knowledge of where you stand, you can take appropriate action!

Level 3: Once you know your UA, take steps to lower it into an optimal range (below 5.5 for men and 4.5 for women)!

This newsletter is brought to you by… me!

Interested in becoming a sponsor? Know someone else who might be? I’d love to get to know you and/or your business and see how we can partner together. Reply to this email!

✍️ Drew's Picks:

• DROP: All uric acid podcast recs this week! Podcast 1 with Dr. Attia.

• THAT: Podcast 2 with Dr. Hyman.

• ACID!: And podcast 3 on The Ultimate Health Podcast.

Until next week, friends! A couple ideas for the next couple weeks include a 2024 Holiday Gift Guide and How I’m Changing my Health Habits in my 30s, so stay tuned!

Keep moving,

Drew

The content in Move to Improve is meant to be informative in nature, but it should not be taken as medical advice. It is always a good idea to consult with a trusted health professional before making any major lifestyle changes that could have a significant impact on your health. This is not a medical resource, and any opinions and articles are not intended for use as diagnosis, prevention, and/or treatment of health problems. They are not substitutes for consulting a qualified medical professional. Please think critically and take what I say with a grain of salt (aka don’t sue me).