 Well, good morning, everyone. Welcome to another episode of Dr. Jill Live. I am here this morning with a colleague, esteemed colleague, dear friend, Dr. David Perlmutter, and I am just honored and delighted to have him with us today for a bit of time to talk about his new book and so many of the things that he's brought to light. We were just talking about his many New York Times best sellers and what it takes to make a great book, and he is really master of this, not because he's just writing content that's changing lives. And I think one of the things you just mentioned, Dr. Perlmutter, is this content that really people are looking for, and they're not finding elsewhere. And I thought uric acid was such a great example of that because no one's talking about uric acid. And yet as we dive in today, it's such a critical part of health. And I'm so glad that you wrote that book and so many others. So let me introduce you and then we'll dive in today with our discussion. So Dr. David Perlmutter is a board certified neurologist, a six times New York Times bestselling author. He serves in the board of directors and a fellow in the American College of Nutrition. Dr. Perlmutter received his MD degree from the University of Miami School of Medicine, where he was awarded the Leonard Roundtree Research Award. He serves as a member of the editorial board for the Journal of Alzheimer's disease, and has published extensively in peer reviewed scientific journals, including Archives of Neurology, Neuroscience, and the Journal of Applied Nutrition. In addition, he's a frequent lecturer at symposia sponsored by institutions such as World Bank and IMF, Columbia University, Scripps Institute, New York University and Harvard University, and serves as an associate professor at the University of Miami Miller School of Medicine. Dr. Perlmutter is a recipient of numerous awards, including the Linus Pauling Award, that is an amazing award with one of our dear IFM groups for his innovative approaches to neurological disorders, sorry disorders, and the National Nutritional Foods Association Clinician of the Year Award, and Humanitarian of the Year Award from the American College of Nutrition. And most recently, the 2019 Global Leadership Award from the Integrative Healthcare Symposium. And so well deserved, Dr. Perlmutter. Welcome, welcome today. Thanks for taking time to join us. Delighted to be with you, Dr. Jill. Thank you for having me. You're welcome. Now, I want to dive into uric acid, but before we do, I want to frame the stage so people will get to know if they, if they don't know you, I can't imagine them not knowing you, but tell us a little bit about how did you get into medicine and then how did you get into this really, what I consider the really life changing part of medicine, which is getting people to change behavior and do the root cause analysis. You know, you can be sure I've been asked that question before, but as you asked it today, I was just thinking I think the main thing that propelled me into medicine, aside from the fact that it was a bit of a legacy thing going on with my father, which is a good thing, I guess, was the curiosity. I mean, it's really an area where you can try to solve problems and come up with novel ideas. I mean, I guess you can do that as an engineer, you can do it as a lawyer, that's for sure. But it just seemed that in trying to solve problems in medicine, not only did you get the satisfaction of solving it, but somebody else would benefit from that as well. So it seemed like a good, a good plan. Neurology attracted me again, a bit of a legacy. My dad was a brain surgeon. And also I found that in medical school, it was the one thing people really didn't want to pursue, they just said it was too hard. And that made, I found that to be, they said, you know, we didn't like neuroscience, we didn't like neuroanatomy. And so that was very attractive to me. Then, you know, I came out and practiced mainstream neurology for about 10 years and became a bit frustrated, let's be fair, because I wasn't really helping people get through their problems. I was helping them just manage their problems. I wasn't helping them, you know, get some finality about getting fixing things, but just how to manage it, sort of treating symptoms while we were ignoring the underlying problem. And I began to develop a real interest in why in the heck are these people here in the first place? Why are they, why are their brains declining? What's going on? And that led me to an exploration as to the cause of things like Alzheimer's and Parkinson's and MS and, you know, a litany of metabolic issues that we look at in the brain. And you'll notice I just said metabolic issues and the discovery was that Alzheimer's is really a metabolic problem. It's a problem with how the brain is able to do metabolism, how it's able to use fuel and create energy. It's not that it is an accumulation of some toxic protein that we're all led to believe is the cause of Alzheimer's. The mainstream journals do not subscribe to that. You know, it was kind of us on the fringe for so many years who thought that maybe if there was something beyond beta amyloid, but now it's even the Journal of the American Medical Association saying that metabolism is front and center, what we need to be focused on in terms of Alzheimer's. Why that's really good and why that played into my hand is because metabolism is something we can control. So finally, a leverage tool, a way of fixing metabolism there for doing good things for the brain. So years ago, 2013, I wrote a book called Green Brain that looked at the effect of sugar damaging metabolism, how that's threatening to the brain. And then as you brought up more recently, I have been really deeply involved in the science of something called uric acid. And uric acid is something that you and I learned about in the context only of gout and kidney stones. And turns out that there's a big story to tell as it relates to uric acid, a dramatic issue as it relates to disturbing metabolism, therefore having a huge role to play in things like diabetes, hypertension, dyslipidemia, Alzheimer's, heart disease, all the big players are absolutely impacted by elevation of uric acid. Not just you're going to get a gouty toe, but it's going to affect how insulin works in your body. It's going to raise your blood sugar if it's elevated. It's going to raise your blood pressure. And all those things that you and I are working day and night to try to control are highly influenced by uric acid. When I began to appreciate that literature, it was very profound for me because it became a new tool in the toolbox. It's not the only tool that's for sure. It's not the only game in town, that's for sure. But it's very, very important. And I think you would agree that many of our colleagues who are looking with a bit of a more open mind are looking at uric acid now and doing their best to bring it under control for the very reasons that I just mentioned. Yeah. So I want to dive into that. I want to mention something that you said that I think is so profound and important. I ask you why did you do what you did? And you mentioned curiosity. And in researching for my book, one of the things I found over and over again, curiosity is one of the marks of genius. Because that no, I want to honor you with that because I see that in many people like yourself who've really done life changing work. It's that in medical school, we're not really taught to ask the question why or to go deeper. And it's the maybe 10%, 5% that go on in different fields, whether it's functional medicine or other medicine, or even research that say, well, why, why is this happening? Those are the people who are making the change and you're one of them. And it really is a mark of genius because when we ask those questions that we get curious, that's how we, whether serendipitous or just diving into the literature, we find, oh, this links to this links to this. And this makes sense. Like you're a guest, like you said, we're taught about gout. Totally. It's that, you know, you need that little piece of the puzzle that has a little blue sky in the corner and fits in somewhere. And when you finally put those into the puzzle and the dots are connected, you know, you sleep a little bit easier because I'm the kind of guy who'll wake up at night and say, well, why would fructose consumption relate to hypertension? You know, and now, you know, in the day, we could speculate, but now we're able to connect those dots quite handily. Why does eating a lot of dietary salt make you fat? How could that be? It's true. It is associated with it. Is it causal? We suspect so. But now we know, now we have the mechanism, we've unpacked it. And it's, it makes life a little bit easier when those dots are connected. It doesn't. It makes it more fun. Like it doesn't just give you the joy back of what you do and whether it's writing, researching, teaching, or seeing patients. To me, it's like the joy of really practicing medicine is that actually discovery. So thank you for your work there. So you're a gasset. My history of you're a gasset, I do remember years ago realizing fructose was connected, right? And I would put people on a low fructose diet and they'd get better and their gut would get better. So let's give, for people who've never heard of this, I have a lay person audience. I have a lot of practitioners too. So you can get technical. Why is uric acid such, give us a framework. What is it? What does it do in the body? And then why does fructose drive it and other things? Well, let me just begin by saying that what you just said was very profound and a bit iconoclastic. What? You said that you would have patients with high uric acid and immediately you will put them on a low fructose diet. If you visit the mainstream big name clinics websites and look at the dietary recommendations even today to lower uric acid, you generally don't see fructose barely getting any mention. Why? Because they're more inclined to talk about things called purines, which you'd get in eating a lot of meat, for example, high purine foods. And to electric extent, they would talk about alcohol. But the real issue is fructose. Fructose is directly metabolized to uric acid. Why the mainstream big shot clinics don't mention sugar? I will have to leave to your audience to speculate about, but they don't. But that's the big issue. Yeah, purines are important. Organ meats, liver, for example, a big culprit, alcohol is significant as well. Big player today. And the reason that uric acid levels have doubled since the 1920s is because uric acid levels have been in lockstep with our increase in fructose consumption, which gradually increased until about the 1970s at which point it exploded. And that was because of the introduction of what's called high fructose corn syrup into the manufacturing of food. I have difficulty even saying that those words, the manufacturing of food. Food, to me, shouldn't be manufactured. But nonetheless, the development in 1957, I think it was of the technology to make fructose out of corn at the University at Oklahoma State University was really kind of a breakthrough because it allowed the production of a sweetener, in this case, fructose that is cheaper than sugar, table sugar, and also far sweeter. So the more fructose you use, the less it costs. And that's why high fructose corn syrup has made its way into every product from A to Z these days. 70% of packaged foods in American grocery stores have added sweetener, much of which comes from this notion of high fructose corn syrup. When fructose is metabolized in the body, it becomes uric acid. And I want to spend a moment, if I may, because I think the story of how and why the teleological approach to this is really interesting. Fructose traditionally in our hunter-gatherer forebears, and even before that primates, is a signal that winter is coming. Fructose is when you are eating ripened fruit, the blueberries you might find when you're hunting and gathering, or whatever that fruit may be. And it's telling your body that winter is coming. It's telling your body that there is going to be a stress in terms of not having enough food. It signals the body to make fat. And how it signals the body to make fat is a beautiful process. But it does so by creating a very strange chemical called uric acid. Uric acid is the survival chemical that tells your body to ratchet down its energy use, to increase its sugar glucose production to power the brain, to increase its storage and manufacturing of fat, and to reduce its burning of fat. All the things that today we would not want to do. But this is a powerful survival mechanism that allowed our hunter-gatherer ancestors to make just not that they got fat, but to make a little bit more body fat in the late summer, early fall, in the fall when fruit would be ripe, and that allow them to survive in the winter. Those who had a better way of doing that, in other words, their uric acid levels were a little bit higher, would survive and ostensibly reproduce. So it was a selection process that actually selected out those who had the higher uric acid levels. It turns out that that selection process began about seven to eight million years ago in our primate ancestors, and we had prior to that an enzyme called uricase that would break down uric acid, keep uric acid levels low. But when the earth cooled during the middle myocene period, food for our primate ancestors was scarce. And the ones that survived had a change in their uricase genes, such that they lost the ability to break down uric acid. Their uric acid levels went up when they consumed whatever a little bit of fructose was around. They made a little bit more body fat. They made a little bit more blood sugar, raised their blood pressure a little bit as a hedge against dehydration, and they survived to give Dr. Jill and me and everyone watching this higher levels of uric acid. So in the context of our ancestors making them a little bit diabetic, a little bit hypertensive, and a little fatter, it was great when they had a little bit of fructose in their diet. Now we confront this pathway, this evolutionary advantage that you and I carry. We confront it with massive, massive amounts of fructose increasing five folds since the 1920s. And we're just raising uric acid levels, telling our bodies to prepare for winter, make fat, store fat, raise the blood pressure, raise the blood sugar, all the things relate to our metabolic status that we're desperately trying to avoid. And the mediator, the signal, the survival signal, if you will, is uric acid. That's why we've got to do everything to bring it out of control. It's doing its best to keep us alive, but it's locked in the on position and we've got to change that. So it makes so much sense. And I suspect that corn growers in the US were very happy. There's probably a little other political motivation behind what the switch was, but I think there was a lot. Again, I don't want to speculate, you probably know from your research all the details, but often these things aren't motivated by pure health reasons, right? Whether it's the food pyramid or all these stuff. So I don't want to get it deep into that, but I just want to say, because some people are like, well, why did that happen or whatever? It makes perfect sense. A little bit the politics behind using a cheaper subsidiary from corn, which was made. Was it mostly from US corn and product? Yes. Hey, I mean, if you're a corn grower, development of that technology to make sugar out of corn at a time when we had been getting sugar from Cuba, now we shut off our relationship with Cuba. We grow some sugarcane in Florida, but now the whole Midwest gets open to our sugar addiction and bingo, everybody's happy. And it continues to this day. In February of 2021, the USDA published its five-year dietary recommendation for Americans, and in that they said that 10% of your daily calories as an American adult coming from sugar totally fine, all good. Unbelievable. None of their scientists agreed to that, supported that. And yet that's what the United States Department of Agriculture, what is their mission? Their mission is to help farmers to come out with and said 10%. So we wrote a letter in MedPage today, it was actually an open letter to President Biden saying that let's follow the science, no more than 5% of calories should come from sugar. Let's change this messaging and nothing happened, but at least we stood up and wrote. Good for you. And I have a very interesting background because I grew up on a farm in Central Illinois where my father and my brother still to this day grow corn and soybeans. Now because of my own life and and trajectory and passion, they've done a lot of things right. They've changed over to all a non-GMO and mostly organic and they're certainly not producing corn syrup out of their corn. But it is fascinating to come from that side of it and see the agricultural like I obviously know my dad talked about subsidiaries growing up. And so I know how this stuff works to help my dad and my family survive. But on the other hand, even the farming, we have to shift the practices. And I love that we're talking about this because I often have lately, Jeff Bland and I love to talk about how not auto immunity begins in the gut, but it begins in the soil, right? It kind of starts this like agriculture actually matters because the production of what we're producing, manufacturing, like you said, with our foods is really creating a more metabolically dysfunctional society. So thanks for going there with me because it's important. Yeah. Hey, everybody, I just stopped by to let you know that my new book, Unexpected, Finding Resilience through Functional Medicine, Science and Faith is now available for order wherever you purchase books. In this book, I share my own journey of overcoming life-threatening illness and the tools and tips and tricks and hope and resilience I found along the way. This book includes practical advice for things like cancer and Crohn's disease and other autoimmune conditions, infections like Lyme or Epstein Bar and mold and biotoxin-related illness. What I really hope is that as you read this book, you find transformational wisdom for health and healing. If you want to get your own copy, stop by readunexpected.com. There you can also collect your free bonuses. So grab your copy today and begin your own transformational journey through Functional Medicine in Finding Resilience because it's important. Yeah. And you're exactly right. I mean, we talk about lifespan declining for the first time since records have been kept over the past five years quite significantly. And let's be clear, this began pre-COVID. I mean, COVID really accelerated that situation but began pre-COVID that for the first time younger generations were expected to live not as long as their parents. Wow. We didn't change genetically. We changed environmentally. And there's such a profound relation between our environment. It means what everything around us including our foods, our sleep, all the things that we can choose and our genetics, how they interplace so important. We have turned the tables on our gift, on our genome in a very, very threatening way. And we're seeing the health consequences that are derived from that. So you are correct. And as it relates to uric acid, what a powerful when it's elevated threat to metabolic health. I mean, one study that came out in 2009 in the journal Arthritis and Rheumatism followed 90,000 people, I think 42,000 men, 48,000 women for eight years. And it noted that in the individuals whose uric acid levels were above seven was incredibly common that those individuals had a 15% increased risk of what it's called all cause mortality. That basically means dying from any cause they had a 39% increased risk of what we call cardiovascular mortality, dying of heart disease. 40% increased risk of dying of heart disease. We had a 35% increased risk of death from ischemic stroke. And interestingly, for every point of uric acid elevation over seven, which again is very, very common for every single point, there was an eight to 13% increased risk of death from any cause whatsoever. So when you go to the doctor and have your uric acid level done, she or he will tell you, well, it's 6.8. And so you're fine because you're now in the normal range. Well, it turns out that cardiovascular risk begins at 5.5 that the 7.0 milligrams per deciliter level above which you're at risk and below which everything's fine is really only derived in the context of gout. Now that we have so much more understanding about uric acid, we realize that the safer level is having the uric acid level at 5.5 or below. And the thing is people have their uric acid levels done probably of year as part of their metabolic panel. So for anybody watching this, what you need to do simply might be to call your doctor's office a BTW. When I had my blood work done last whatever, what was my uric acid level? And if it was above 5.5, then you need to begin thinking about what you can do to lower it because elevation of uric acid is strongly related to things like diabetes, high blood pressure, and weight gain among many others. But when I said those three, I think we checked a lot of boxes. Yeah, so good. So if you haven't asked your doctor to check your uric acid or if you have your uric acid, you want it below 5.5. Let's shift. We talked a little bit about high fructose corn syrup. What are some of the common sources? I mean, you and I know this is in a lot of processed foods. But for those who maybe don't know or aren't reading labels, where would people be like getting hidden sources of fructose? Good question. And it doesn't have to be high fructose corn syrup. But let me just, there's one aside that I just feel compelled to talk about. I think the highest most source of fructose, the most threatening food of all, if you want to call it food, is this agave nectar. It is about the worst food ever created. I mean, I guess the stuff with artificial colors and sweeteners that kids are eating as well. But and it's at the health food store right when you buy a coffee or a tea. Oh, would you like, I don't want sugar. No, I want agave nectar. About the worst food you could imagine, could be 70% pure fructose. About the last thing in the world that you would ever want to consume. But you know, fructose, the name comes from fruit, sugar, fructose. And there is fructose in apples and in really basically any fruit and some vegetables for sure. But not a whole heck of a lot. Even a good sized apple, it's going to have about five grams of sugar, not all of which is fructose, I might add. And you can handle that. Not only is it not much sugar, but you're also getting it delivered over a longer period of time. You're not drinking it. And it's packaged along with fiber that helps to slow its absorption as well as vitamin C that helps to enhance the excretion of uric acid. So you know, have the apple a day, keep the doctor away, fine with me. But 36 grams of sugar in a 16 ounce Coke or a 16 ounce glass of orange juice or apple juice, that's overwhelms the small intestine and that then sends fructose to the liver. And that's when the problems begin. That's when the liver becomes more fat containing. That's when uric acid is turned on, thinking that this is our last chance to make us fat, raise blood sugar and blood pressure goes into overdrive. And actually, incredibly, unlike almost any mechanism you can think of in the human body, uric acid enhances its own production. Normally in the body, when something is produced, there's a feedback mechanism then to turn it off, homeostasis. But uric acid actually increases its own production as a survival mechanism. So the fruit drinks, for example, that we want to give to our children right off the bat, you know, they're drinking after formula or breast milk, they're having apple juice and orange juice, does a lot of bad things. First of all, it gets them really liking sweet, like a treat. And the next thing it's doing is it's stimulating uric acid production, simulating activation of their survival pathways and making them fatter and more inclined to be diabetic. So we've got to stop that. Yes. And you see the studies, even the skinny fat, right? You don't know, I mean, obesity is part of this, but the metabolic dysfunction that we're creating in our young people. And I love that you differentiated food, which has fiber added and often slows the absorption of fructose between fruit sweetened or high fructose corn sweetened or agave sweetened drinks. The drinks are a really big, much bigger player in this than food, than real food than real fruit. So interesting, what have you, did you come across in your research, any connection to the gut microbiome and fructose and uric acid? Is there anything connected there? It feels like that's always as you would expect, right? So higher levels of dietary fructose actually enhance things in the gut that actually also pave the way for higher levels of uric acid. And as a matter of fact, there are a couple of reports now in the literature, believe it or not, demonstrating improvement in gout, which is a situation generally of high uric acid, by doing what's called a fecal microbial transplant. In other words, giving people who have, giving them different gut bacteria that they've, that have been derived from a person without gout, a healthier individual. So we know that there is a very powerful relationship, that uric acid can change the gut bacteria, and that can actually increase inflammation. So as you would expect, a very profound relationship. That makes sense, because I'm thinking about maltose fructose and these sugars that are disaccharides. They are typically in the FODMAP category, which are things that feed the small bowel overgrowth, which can cause a whole another set of issues. I can't tell you off the top of my head if that's directly connected like SIBO and consumption of fructose, but it makes sense that it would alter the gut microbiome. And the gut microbiome has to do with everything as the research comes out. One thing you mentioned too that I think is important for those listening, fatty liver, is at an all time high. And clearly the dumpage of these sugars directly into the liver, which is our filter for the blood after it comes from the gut, is a piece of the puzzle. Did you find pretty high associations with fatty liver disease and fructose and uric acid? Yeah. I mean, the association between fructose consumption and this naftal, non-alcoholic fatty liver disease has been described for many, many years. Now we understand that uric acid is playing a really central role in how that all comes about. Similarly, the other big metabolic issue of the day is insulin resistance slash ultimately becoming diabetic. And we know that they're very well-defined mechanisms whereby fructose becoming uric acid can lead to insulin resistance, can compromise how insulin works in the body. And interestingly, it works because through a mechanism that involves something called nitric oxide. And nitric oxide is a gas, but acts as a very fundamental signaling molecule in the body that does two really important things among others. First, it allows blood vessels to open up and relax so that would reduce blood pressure. And second, nitric oxide is fundamentally important for the function of insulin. Who knew? When you compromise the function of nitric oxide, then insulin doesn't do its job, blood sugar goes up, you become insulin resistant and ultimately diabetic, increasing your risk for Alzheimer's by about four fold. So this then connects a lot of dots now, doesn't it, between simply consuming fructose and risk for developing a condition for which there is no treatment called Alzheimer's disease. All through, or at least including to a significant degree, this nitric oxide mechanism. Now, interestingly then, so people talk about nitric oxide, we need it to keep our blood vessels open, keep our blood pressure under control. The story about nitric oxide and insulin functionality is a relatively newer understanding, but it explains now why people who consume higher levels of fructose, which has no direct effect upon insulin, it's not metabolized using insulin, unlike glucose. But if you consume fructose, because it becomes uric acid, which turns off nitric oxide, then turns off the function of insulin. So that explains why, even though fructose doesn't immediately affect insulin, it is strongly associated with diabetes risk profoundly related. It's through this uric acid mechanism. So getting back to your original question, it's really about cutting back on fructose and reading labels. By all means, high fructose corn chip is something to avoid. You're going to get some sugar if you eat fruit, and that's going to be fine. And other foods contain things called purines. Purines are the breakdown products of DNA and RNA that, when you eat food that has made of cells, which is typically most foods, you're going to break down DNA and RNA in the cells and they form purines. They are contributing to the uric acid pool. So you want to be careful with certain things like very cellular foods like yeast, for example, and liver and other organ meats, for example. And finally, I will mention that alcohol consumption is related to elevation of uric acid, but it really depends on the type of alcohol one consumes. It turns out in looking at a large study of food frequency analysis that women who consume moderate amounts of wine actually have lower uric acids. Why? Because when we talk about alcohol, we have to talk about the context. Wine has wonderful bioflavonoids that are associated with the reduction of uric acid. So on balance, women more than men who consume wine actually have a lower uric acid. The worst player of all is beer. Beer not only contains the alcohol, but contains lots and lots of purines that come from the brewer's yeast. And that then allows us to understand where the beer belly comes from. Because you're turning on uric acid production, you're telling the body make fat because winter is coming. So in Japan now, they're very, very dialed into the whole uric acid understanding. They're now marketing purine free beer. Wow. Based on this understanding. Can you imagine? Amazing. Just like sulfate free wine and all these other things. My thought is interesting. Again, I like to, sometimes my brain will go on tangents, but biogenic amines are one of the sources of histamine. And the whole of the class of people who have histamine intolerance unrelated to uric acid. But in my mind, it's interesting because some of those same foods that contain amines would be for my population. Those mass selectivation and histamine issues are probably going to be similar because of things that produce. And you mentioned yeast. So is fermentation of a food or aging of a food? Does that create more of the amines that create purines as well? Or is there any connection to fermented or not necessarily? No. I mean, the notion of fermentation is really one in which basically sugar then is utilized. So during the fermentation process, we're creating other downstream products and basically taking sugar out of the equation. And the fact is what you're doing is you're allowing the bacteria to replicate. And that ultimately based upon typically how foods are fermenting, not just today, but I mean, I think traditionally, we didn't always have fresh food. We had to eat whatever we could hunt or gather. And the gathering part meant when we were starving, we were eating a lot of food that was rotting on the ground. And interestingly, in that process, alcohol is produced. And as such, as an evolutionary advantage, humans developed the ability to break down alcohol, develop the actually a couple of enzymes that allowed us humans to break down alcohol be much less threatened by the consumption of alcohol in those fermenting foods that we would then find. That was an evolutionary advantage. Interesting. Makes you think of a funny little side story. I just read on the news not too long ago, a lady was stuck in her car in a snowstorm for 72 hours and she had to pack it a ketchup and a bottle of wine. And she survived me was longer than that. But it was, I thought, how interesting to survive on ketchup and wine, but she did it. Well, yeah, she did it. And you think of what people generally are consuming these days. I mean, ketchup qualifies as a vegetable in the federal school lunch program. Unbelievable. And yeah. And corn syrup isn't typically. And so I wanted you are an urologist, you've written so many books about the brain. In a moment, I want to talk about between grain brain and uric acid, drop acid, your new book, diet, like what's the big picture. But before we do, I want to highlight what you said about Alzheimer's and the connection because not everybody makes that connection between uric acid, high fructose corn syrup and these things and Alzheimer's. But as you mentioned, we often call it type three diabetes. There's this very metabolic connection to the brain. Do you want to briefly explain for the layperson, how is your prevent your like insulin resistance and your pre diabetes connected to the brain because it's so important? I will. I mean, we are being bombarded day in and day out by messaging telling us that Alzheimer's is caused by the accumulation of a particular protein called beta amyloid. And there's this effort to convince us that that is the cause. And therefore, if we can rid the brain of that protein, misfolded protein, all will be well. Well, there are drugs that reduce beta amyloid formation. There are drugs that actually help eliminate beta amyloid and they're not working. They're not demonstrating any clinical improvement in these patients whatsoever. So it's typical, though, that we are messaged to think about diseases having a single cause because that paves the way for a single drug remedy that will then be the blockbuster that the drug companies wanted it to be. More recently, we've been told about a new beta amyloid drug about the dirty little secret that we weren't told and it did not wasn't disclosed. That came out about three weeks ago was the idea. Actually, some Australian researchers looked through the data that the researchers who approved got the drug to be approved had actually collected shows that these drugs are associated with a significant shrinkage of the human brain. Not a good thing. Not anything that we would want. But the point is there's a lot more going on in the brain that's been talked about for a lot longer than simply this accumulation of beta amyloid. The beta amyloid accumulation is the downstream manifestation of what's going on upstream, which is a metabolic issue in the brain. Desmond Tutu once said that it's important to pull people out of the river but equally or if not more important to find out why they're falling in in the first place. And so, you know, while it's great to think we're going to ultimately develop a drug treatment for Alzheimer's, I think we have to ask ourselves why are people falling into that river in the first place? And let's be clear. It's because of their metabolic dysfunction. If you become a type two diabetic, you've increased your risk for this untreatable condition called Alzheimer's by as much as four fold. An editorial appearing in the Journal of the American Medical Association in 2020 really hit home by saying it's time that we focus on the metabolic issues related to Alzheimer's disease and back down on this whole notion that it's caused by the accumulation of beta amyloid. And, you know, still unfortunately, that is the central core of the messaging that people are hearing on the news. You know, there's another amyloid drug being developed and it's heart-wrenching because people are left with the idea that they have no control over their brain's destiny and nothing could be further from the truth. We have, I'm not going to say absolute control, but we have a heck of a lot of control in terms of, you know, the destiny of our brains. One study that came out out of England in January of this year followed for 10 years 79,000 individuals and looked at six lifestyle variables, including, I hope I get them all, exercise, cigarette smoking, diet, social connectedness, cognitive connectedness, and alcohol consumption. And what they found was the more of the right choices that people made in those regards, the better was their cognitive outcome over this 10-year period of time, even as it relates to people carrying the so-called Alzheimer's gene or what we call the APOE4 allele, which represents between 20 to 28% of Americans. Those who did the right things had a dramatic reduction in the risk of cognitive decline. The point being that, you know, our lifestyle choices are front and center, the most important tool that we have for preserving our brain function and staying out of the river, as it were, and not having to hope that there's going to be a cure, you know. It's been said by James Cameron, the movie director, James Cameron, said that hope is not a strategy. And, you know, what I'm offering up in Uric acid, certainly part of that equation, is a meaningful strategy, a proven strategy to improve your odds of keeping your brain in a good place, maybe until such time as the pharmaceutical industry can come up with something. I'm all in favor. I'm not derogating them at all. But, you know, for now, we know what can help, and that's what this is all about. Yeah, brilliant. These complex metabolic things never have. We were, again, taught in medical school, there's one solution, one drug, and it just isn't that way in the complex metabolic ecosystem that's internal. There's so many factors, and I love that you talk about the control. So let's kind of wrap this up with the diet. And, again, I want you to bring in, obviously, this Uric acid information, we just talked about fructose, but it's bigger than that as far as what is the ideal, there maybe isn't one size fits all, but what is the general recommendations around diet, including your previous research on grain brain and give us some outline of what a typical human should be eating? You know, again, this is all related to the relationship between our evolution and our environment. In other words, how are our day-to-day choices being interpreted by our physiology, which is coded for by our genes? And I think that once we understand how Uric acid signals the body to prepare for winter, then we can make the right dietary choices that will help reduce that signaling. And it means reducing alcohol consumption. And if you do consume alcohol, probably wine is your best bet. Being careful of the purines that you consume, the organ meats, the small fish that are very cellular like sardines and anchovies, though we love them, have them. I won't eat liver because I can't stand it, but I certainly want anchovies on my Caesar salad. I just love that, but be careful. But you know, the big player is obviously fructose. I think job one, though, is to figure out what in the heck your Uric acid level is. And as I mentioned, you know, that's a blood test. You can do, I have a home test kit right here, oddly enough. So you can do a strip and learn what your Uric acid level is. My last one was, what does that say? 4.7, I think. I don't know if you can see that kind of reflected. So my last level was 4.7. And so I'm doing where I need to be and a good to know. And it's a new tool in the toolbox. It's not the only tool. We've got to know our insulin levels. We've got to know our fasting blood sugars. We've got to know our lipid profiles, our homocysteine, so many more things. That's for sure. But this is, this is right up there with blood sugar and blood pressure and body weight. I mean, it's a percentage of body fat. This is a big deal. And I think, you know, many, many more people are going to be talking about it. So it's not just the foods, but even supplements can have a big role to play like quercetin, for example. Quercetin works to target the main enzyme that makes Uric acid, which is called xanthine oxidase. That won't be on the quiz. But that's how the drugs work to lower Uric acid and gout. Allopurinol works by targeting that enzyme. Quercetin, that you can buy at the health food store, same thing. So there are various foods that are rich in these bioflavonoids that we can be eating, like cherries, for example. Yeah. So tart cherries are obviously the big one out there, quercetin. Anything else as far as supplements? Is vitamin C up there as far as one of them? Vitamin C is important because it aids in our excretion. Another bioflavonoid is luteolin, 100 milligrams per day. Quercetin would be about 500 milligrams per day. Luteolin, L-U-T-E-O-L-I-N, found in red onions, but you can buy it as a supplement, 100 milligrams per day. Check with your healthcare provider, of course. I like chlorella as it relates to this fatty liver issue that's been shown clinically to be helpful in that regard. And then to round it out, I would, vitamin C, of course, I would add D-H-A. I don't think in this lifetime I'm going to give any supplement recommendations that are not going to include this Omega-3 called D-H-A. At least 500 milligrams per day, but probably closer to 1,000. Fantastic. All really good stuff. I always talk about desert island vitamins. If you had like just two or three things, what would you take to desert island? And it's hard to wean it down, but I agree the D-H-A part of the fish oil, typically EPA and D-H-A, is so powerful for the brain. Correct. Referred. Amazing. Any last takeaway that you want to leave the audience with as far as pulling it all together? Sure. I think the message from me to you today is that we are the architect of our brain's destiny. And our choices are incredibly important. The choices that we make today in a world where we don't have any other alternative, there is no pharmaceutical intervention that can help your brain. Again, what you're hearing from me is I would welcome it, believe me. I'd use it in patients. I would have given it to my own father who tragically died of Alzheimer's as well. That said, we can do things on the front end. John Kennedy said that the time to fix the roof is when the sun is shining. And hopefully, for all your viewers, the sun is shining right now. Time to get busy. Not dramatically difficult to make these lifestyle changes. Knowing you, they're probably followers of you. They're probably well on their way already. So just a little bit of fine-tuning and by all means, get the level checked and learn more about it in the book as well. Yeah. And where would you send them to get your book? Drop acid is the title of your book. Drop acid, no one's going to forget that title. It's available everywhere. Amazon, they can learn about me at DrProMutter.com, but the book is available in anything online and retail as well. And as always, you are one of the most fun people to interview. You're so great at connecting the dots. I know people have enjoyed this. So go out. If you haven't checked his latest book, he's also got four or five other New York Times bestsellers. Check them all out. They're all on my shelf back here. Yeah. DrProMutter, it has been an absolute joy. And thank you for your time. I know time is precious. And we appreciate you so much. Thanks again for your interview today. Thank you. Glad to be here. Thanks.