Positive Health Online

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I am delighted to have the opportunity to bring to your attention this important and highly relevant book for supporting health throughout life and aiding the management of a broad range of chronic health problems commonly seen today that are showing little sign of abating.

Dr Perlmutter, a renowned medical doctor, lecturer and author has expertly presented the research evidence accumulating since the 1800’s of uric acids role in many chronic diseases, and at the same time made accessible the complex biochemistry that underpins how uric acid is used and discarded by the body, including factors that can reduce elimination via urine leading to a build-up in the bloodstream.

As well as bringing the science and research evidence to your attention, Dr Perlumutter provides practical diet, lifestyle interventions and 5 key nutritional supplements that should help keep uric acid levels in check. Reference to the potential benefits of time-restricted eating and a ketogenic diet is included. It is possible to benefit from this book without fully grasping all of the scientific complexities. Meal plans are included to help get started.

Keeping uric acid levels within normal laboratory reference limits is the key target. Uric acid at normal levels has an important role as an antioxidant and when elevated has the reverse effect and acts as an oxidant triggering multiple reactions that can contribute via several mechanisms to chronic disease. It is not the intention to ‘drop’ uric acid altogether but to keep this compound within safe levels.

The evidence appears overwhelming in support of a central role that elevated uric acid levels play in chronic health problems and needs much more attention than purely as a trigger for gout in susceptible individuals. Albeit the incidence of gout appears to be on the rise, and is a painful and unpleasant condition for those that suffer with this ailment. Uric acid's role in health and disease is much more than a waste product found in urine following the breakdown of purines.

So much research is conducted on individual conditions and potential mechanisms underlying disease relevant to the researchers field and application to healthcare practitioners in the same field. Bringing the evidence together from disparate sources and making the findings applicable across diseases is a separate challenge. Without the dedication of individuals like Dr Perlmutter and their commitment to promoting health and wellbeing by bringing such data together to further our understanding of how to reduce disease risk and promote wellness is uncommon. Biochemistry is complex as is the pathology underlying chronic diseases.

Whilst positive diet and lifestyle interventions throughout life seems simple and logical in comparison, getting started and sustaining positive change can be a real challenge for many people including healthcare professionals due to the complexities of our personal situations. Dr Perlmutter does touch on this issue within the guidance offered for dietary change as well as lifestyle factors that can impact uric acid levels such as quality sleep and exercise and the potential impact of poor sleep and sedentary lifestyles on uric acid levels. He recommends starting with simple manageable steps. Raising children on healthy diets is yet another challenge for parents and guardians. Working alongside a nutrition professional and health coach is merited when complex overlapping chronic health problems are present and when it is difficult to keep to plan on your own, or seek guidance for children.

Health practitioners supporting patients with chronic illnesses including, but not limited to, asthma and immune disorders, cancer, cardiovascular disease including high blood pressure, chronic kidney disease, dementia, depression, diabetes, insulin resistance, poor blood glucose control and metabolic syndrome, digestive complaints and suspected gut dysbiosis, epilepsy, headaches and migraines, immune disorders, non-alcoholic fatty liver disease, obesity and excess weight should find the information and guidance in this book of great to support in clinical practice.

As commented by David Sinclair PhD on the back cover of Drop Acid “Drop Acid is the most informative, life-changing book I’ve read in years. It is undoubtedly one of the most important books on human health this past decade and will be seen as a landmark in medicine. I’ve changed the way I live my life. A must-read.”

It is possible that many people are living with a raised uric acid level without knowing it. Uric acid is not routinely measured as part of general blood tests and raised levels are more likely tested for a patient presenting with arthritic gout, kidney stones, or undergoing chemotherapy or radiotherapy treatments. Dr Perlmutter indicates from the research evidence that uric acid levels can be raised from a young age and unless suffering with painful gout or kidney stones will generally not give rise to symptoms. Chronic health problems are increasingly seen in younger age groups. As the role of uric acid becomes more widely understood as a significant biomarker in chronic disease I trust it will be included as part of a general biochemistry panel.

Central to the argument throughout the book is the role that fructose (fruit sugar) plays in keeping uric acid levels elevated. Dr Perlmutter explains that eating fruit in its whole form should not be a problem unless eaten in excess and suggests specific fruits that are better options including the value of cherries. Too much fruit juice devoid of its natural fibre is potentially problematic. It is fructose found in high-fructose corn syrup added as a sweetener to food and drink that appears to be the main problem. High-fructose corn syrup is frequently found in sweets, soda drinks, juices, canned fruits, prepared desserts, ice-cream, sauces, preserves, syrups and some savoury foods as well as bread and crackers.

Back to purines. Purines are important compounds and form part of our DNA and RNA as well having a role in many body processes including cardiovascular function, the immune response, brain chemistry and managing inflammation. Most purines are produced in the body but around a third of purines come in through dietary intake of organ meats, some seafood, meats and alcohol. Dr Perlmutter gives good guidance on how to include low-purine alternatives in your daily diet and many healthy foods and drinks to focus on to keep uric acid levels within healthy limits. He also explains the interrelationship between salt intake and the body's handling of fructose presenting another mechanism for increasing uric acid levels.

Back to the late 1800s. Dr Perlmutter writes that Sir William Osler described gout in his book The Principles and Practice of Medicine, as a ‘nutritional disorder' and that he recommended restricting fruit intake to reduce arthritic gout attacks. Interestingly the incidence of gout is reported to have doubled in the USA between the 1960s to the 1990s levels continue to rise and I have noted this rise is more frequently reported on in the press. Historically gout was mostly considered an 18th century disease associated with over-indulgence and drinking port which is high in purines.

So why the sudden increase in gout? A central consideration in the book is the introduction in the 1970s of high-fructose corn syrup into the human diet. Alongside the increased incidence of gout we have seen a burgeoning of chronic health problems at unparalleled levels. Now, after reading this book I have a much better understanding of the role of uric acid in human health and disease and importantly how our inherited thrifty genes designed for food scarcity do not serve us well in the context of our ability to excrete uric acid from the body. Dr Perlmutter describes this as a “mismatch between our environment and evolution, which is also the central premise of the so-called Paleo movement”.

As a student nurse at a London Teaching Hospital in Whitechapel in the 1970s I clearly remember a nurse tutor saying to us that we should not expect the same level of care when we became the older generation as we were able to provide at that time. No specific explanation was given to us. I have thought about this comment frequently over the years alongside witnessing the increased incidence of chronic diseases, massive dietary and lifestyle changes as well as their impact on our environment. Although there may be several compounds that could tell a central story like uric acid I consider the information and guidance in this exemplary book if applied throughout life could considerably reduce the burden of chronic disease and overwhelm we see on health services today.

Take heed of the research findings and guidance and take heart there is so much we can do to support our patients, clients and ourselves to keep well.

Further Information

Available from Yellow Kite  Hatchette Books  Amazon.co.uk  and Amazon.com