David Perlmutter: I want to just let everybody know, uh, Claudia and Sergey, who you are. Claudia, I'm gonna read a little bit, believe it or not: "Passionate about biohacking, healthspan and longevity, uh, and the founder of the Longevity & Lifestyle Podcast". I was so excited to be on your podcast recently.

Claudia von Boeselager: Thank you for coming on. 

David Perlmutter: "On a mission to uncover the strategies, tools and hacks to help us live, uh, better and thrive in all aspects of life". Sergey, Sergey Young: "My goal is to live to be 200". Mine, too. "And find an affordable way for everyone else to do the same". Uh, Sergey, uh, many of you know, funded the Longevity Vision Fund, and we have interviewed him in the past with reference to his book Growing Young.

And so here we are today. Looks like we got a bunch of people who may have some very interesting questions for us, but, uh, I'm all in, here we go. 

Sergey Young: Okay. Beautiful. Thanks David. Well, first of all, congratulations with the book. 

Claudia von Boeselager: Yep. 

David Perlmutter: Thank you. 

Sergey Young: I'm very excited. 

Claudia von Boeselager: We've got, we've got both of you guys, right? So we have the Drop Acid - 

David Perlmutter: Yeah, you know what I've found - 

Claudia von Boeselager: We've got Sergey's Growing Young - 

David Perlmutter: I have found that - 

Claudia von Boeselager: Essential reading.

David Perlmutter: The only reason that it's backwards is because of, if you flip the camera around, believe it or not, then it'll be the, the correct way. 

Sergey Young: Alrighty. 

Claudia von Boeselager: Quite the pro. 

David Perlmutter: I've just learned that. I, I, I thought about that the other day on a podcast and, uh, watch this. I can prove it to you. See? 

Claudia von Boeselager: There we go. 

Sergey Young: Uh-huh. Beautiful. 

David Perlmutter: When you're on, when you're facing your own camera, then it's backwards.

Claudia von Boeselager: It's a mirror image. Yeah. 

Sergey Young: Okay. We have so many questions for you today. 

David Perlmutter: Alright. I just checked my uric acid. And by the way it is, uh, 4.7. So there you go. 

Claudia von Boeselager: Oh, great. Mine's at 4.8. So - 

David Perlmutter: Good for you. 

Claudia von Boeselager: I'm also, I'm below the 5.5. 

Sergey Young: Yeah. And this is mine for the last five years. 

Claudia von Boeselager: We can tell you're a McKinsey consultant. 

David Perlmutter: Claudia, why are we not surprised, right? 

Claudia von Boeselager: I see the McKinsey coming through on this one, Sergey. 

Sergey Young: Yes. 

Claudia von Boeselager: Amazing. Sergey, do you wanna kick off? 

Sergey Young: Uh, no, I think, um, well, first of all, it's a very basic question, David. What exactly is uric acid and why - it was essential for us in the past - 

David Perlmutter: You know - 

Sergey Young: Why today it can be detrimental?

David Perlmutter: That's a question I think that so many people are gonna be asking more and more moving forward, because they've never heard of it. Or if they have heard of it, they've heard about it in reference to gout. Or maybe kidney stones. Uh, and the reality is we now recognize that uric acid, this thing that we, kind of, knew about and a doctor would check and we'd forget about, is really playing a fundamental role in regulating our metabolism. Our blood sugar. Our body weight. Our blood pressure. Our lipids. Our triglycerides. We never knew that before.

And, you know, that might sound like really compelling science, but, on the other hand, it's really empowering because when we lower this uric acid, we really have, we gain a huge advantage. And, you know, for both of you and all the other people who are interested in staying healthy and in, uh, enhancing longevity and healthspan, uh, this has become such a powerful tool.

And, you know, my mission here is just to get the word out. And people can measure it on their own at home, or go to the doctor's office, and learn powerful strategies to bring it down very easily and very quickly. 

Claudia von Boeselager: Really exciting. Sergey, do you want to continue? And then I'll take over? 

Sergey Young: Uh, yes, please. 

David Perlmutter: You guys are so good, this is like being on network television. 

Claudia von Boeselager: You've got pros here with you. As you are, David. 

Sergey Young: Yeah. So I, I was really surprised to look at the list of various diseases, David, which are, have something in common and related to uric acid. It's like diabetes, hypertension, neurological disorders, and the list just goes on and on.
How is that possible? And what's the connection there? What do they have in common here? 

David Perlmutter: Well, I, I think that we, if we take a step back, we recognize that our ancestors, both our paleolithic ancestors, and even before that our primate ancestors, their elevation of uric acid created some wonderful things for them.

Uh, things like being, uh, near diabetic, uh, gaining body fat, raising their blood pressure. And it may surprise many of the people watching right now that I'm saying those are good things. Because we all do everything we can not to become insulin resistant and gain body fat and all that stuff. 

But back in the day, those were survival mechanisms. So through the lens of our ancestors, those were really good things. 

Uric acid is this powerful alarm signal telling us that we don't have food. We're not going to have food. We may not even have water. And I, I think it's a really interesting story because I think people get the fact that, when you store body fat, that then you have calories for the times when you don't have food. You know, we understand that could be a survival mechanism. 

But how does this uric acid create a situation where we're not going to become dehydrated? And it does so by the exact same mechanism, making body fat. And the, the example I'd like to use is, there is an animal that can walk across the desert for three weeks and not drink any water. And it has a very unique characteristic, when you look at this animal, it has a big hump on its back. This is the camel - 

Claudia von Boeselager: Camels. Yeah. 

David Perlmutter: And they're able to walk across the desert for weeks and weeks without drinking water, because inside that hump is what? Not water. Fat. And when it burns that resource, that fat resource, when any of us burn fat we form two things, carbon dioxide, which we exhale, and water.

So storing fat, for all animals, including humans, uh, is a resource against dehydration, the, it's, whales do it. And why do you think whales are so fat? Even hummingbirds. You know, hummingbirds, before they begin this epic journey, they store body fat. As much as 40% of the body weight of hummingbird prior to its thousand mile or more, uh, epic journey, is fat.

And, you know, if you want a hummingbird in your backyard, what do you put out there? You put sugar water, right. Sugar water. And the next thing you know, they make body fat and they can survive these epic journeys. 

So this, this sugar signaling, this fructose signaling, to make body fat is through the uric acid. That's how it works. Hummingbirds, birds in general, reptiles, make a lot of uric acid. So do primates, Sergey, Claudia, so do you and I, and everybody else. We all make uric acid as a survival mechanism for the times when we're not gonna have food or water. And yet that's not the condition that most of us are in these days.

So we're packing on the weight, the body fat, uh, as a protection for winter that will never come. 

Claudia von Boeselager: Why does mainstream medicine remain so unaware, David, of the connection between uric acid levels and overall health? I appreciate that there has been studies back as, I think, 2009, you mentioned one out of Japan, but why is this not so completely mainstream -

David Perlmutter: Well, there are so many studies, Claudia. And I think it's like many of the things that the three of us and all of our, uh, biohacking compatriots, uh, are involved in day in and day out. And that is, you know, things that really haven't yet gained traction, but, you know, as we keep doing this year after year, we see that the things that we talk about, you know, ultimately become mainstream.

I mean, for example, the notion of continuous glucose monitoring. I mean, who in the world, who in their right mind would wanna know day in and day out what their blood sugar is and yet - 

Claudia von Boeselager: Me! 

David Perlmutter: We're seeing - yes, me, and me too. In fact, I have my, the monitor right here, my next one I'm gonna put on. 

But the point is that, um, people tend to be down on what they're not up on and I think that, you know, mainstream medicine looks at uric acid only in the context of gout and we have a medicine, we can fix it right now. End of story. 

You know, when you go online and read about how to lower uric acid, what you're gonna find is a lower purine diet. And maybe be careful of alcohol. But really no mention of the biggest player of all, and that is fructose. Because, you know, at least here in America, there's this real need, I think, for people not to recognize that sugar is really damaging to our health. 

Claudia von Boeselager: Well, it's everywhere, right? It's in so many things. 

David Perlmutter: That's been going on for an awful long time. 

Claudia von Boeselager: Yeah. 

David Perlmutter: Uh, but the reality is that the mainstream is coming along. Uh, certainly in other countries, like in Japan, for example, they've been dialed into the uric acid, uh, relationship to metabolic diseases, you know, for at least 20 years. And the research is happening all over the world. 

Uh, now if you read, all you have to do is Google two words, uric and metabolic, uh, and you'll see that there's research globally talking about how this simple thing, uric acid, is so profoundly related to what is causing our blood sugar to go up. What is telling our body to make fat. And even blood pressure related to elevated uric acid. So it will come. And we will think back of this time when the three of us got together on Instagram live and had this discussion, we said, gosh, why isn't it happening? Because pretty soon, uh, you will see doctors will be more and more involved.

You know, integrated doctors are definite, and functional medicine doctors, definitely have already gotten the memo and are using this technology and knowledge in treating their patients. So it'll spread, that's for sure.

Sergey Young: Beautiful. Uh, David, how often shall we test our uric acid level? 

David Perlmutter: Uh, I think, you know, unlike, uh, our blood sugar that we want to test very frequently, if not constantly, I think uric acid doesn't vary that much. So every two to four weeks is certainly a, uh, reasonable. So, um, you know, uh, knowing you Sergey, every two to four hours, probably. But, uh, no, it's something that you don't really need to check that, uh, that often. Which is helpful because, you know, whereas we can measure our blood sugars with a Continuous Glucose Monitor that doesn't require a blood draw anymore, the, the uric acid does require a little finger stick, uh, so it's a little bit more, dare I say, invasive but, my gosh, the, the knowledge that you get, uh, that informs your metabolism, uh, is so worth it. 

Claudia von Boeselager: David, what's the best way for people to test at home? Are there any particular testing companies that you recommend, um, that the results are accurate? 

David Perlmutter: Well, the device I use is called UASure and, um, and it's actually, uh, very simple. So here it is, probably backwards. 

Claudia von Boeselager: Good name. 

David Perlmutter: So that's the, these are the, uh, little, um, I think I have one that's open. They're very, they're very, it's just like we used to do with our blood sugar. You know, you put a test strip in the machine and, um, very straightforward. You put it in the machine and then you test, just tested mine. But here's what the test kit comes in. You open it up, uh, and then you do a little finger stick and you take, and you put it right into this, um, slot. And the next thing you know, you get a reading. I mean, and then the, the monitor, uh, will give you a history of what your readings have been. 

And I will tell you that there's a brand new monitor that I have here somewhere that's actually even smaller and, uh, certainly a lot more convenient but, um, you know, it's, it's very simple. Anyone who's ever checked their blood sugar, uh, will have no difficulty in using this monitor. I mean, it's, it's as straightforward as can be. And very inexpensive, so -

Claudia von Boeselager: And you said every few weeks, David, but is there a particular time of day to test it?

David Perlmutter: Good question, Claudia. And that would be first thing in the morning, uh, before eating I would say. I wouldn't be really involved in testing your uric acid level if you are just coming off a real aggressive exercise program, more than you might normally do. Because when you break down muscle, like you might do with a new exercise, uh, uh, program, uh, you'll liberate what are called purines that will raise your uric acid a little bit. Or if you're deeply involved in fasting, uh, then, uh, you will, um, also have a uric acid level that is, uh, elevated as well. So something you wanna think about. 

Somebody has asked for the box, for me to show the box. So I will, I'm gonna flip my camera around and, uh, we've got very high levels of technology here. I'm impressing myself. Here we go. 

Claudia von Boeselager: Well done. 

David Perlmutter: Let me, let me bring this up. So UASure is the brand that I've been using and, uh, there you go. So let me flip this puppy right back around. 

So important to, uh, realize that, I mean, the biggest player of all is fructo and, you know, a common question people are asking is, well then, uh, is, uh, eating fruit, fruit sugar, uh, going to be an issue. And fruit really isn't. You know, have an apple a day, keeps the doctor away. But five apples a day, the doctor you will pay. Meaning that, yes, have some fruit, but you don't wanna go overboard. 

And you don't wanna be having sudden high concentrations of fructose. Like you might get from fruit juice or certainly from soda. And from, you know, the incredible multitude of, uh, foods that are now with added sugars that are so popular, uh, at the grocery store.

Why are they popular? Because we like, we like fruit and we, uh, we like sugar, more particularly. We love sweet. We are all destined to be saddled with our, you know, love of sweet because it's a survival mechanism. Again, eating sweet foods gave our ancestors a leg up so they could survive and, um, not, not helping us, uh, to any degree today.

And it's through this mechanism of raising our uric acid. And that's what Drop Acid is all about. 

We can easily lower our uric acid. For example, there's a very common, um, supplement called quercetin, uh, that I really love for multiple reasons, maybe we'll talk about that at some point, but, quercetin really dramatically lowers uric acid.

So if you're following your uric acid, taking 500 milligrams of quercetin a day, uh, your uric acid within two weeks is gonna drop pretty dramatically. And that's the goal that we're looking at. That's what we're really trying to achieve here. In order to attain better, uh, metabolic health.

And, you know, uh, Sergey as it relates to all the things that, uh, well, actually Claudia as well, that you guys have been talking about for so long, that targets those varied mechanisms, uh, that are involved in aging of our bodies. 

Claudia von Boeselager: Yeah. 

David Perlmutter: Inflammation. Uh, oxidative stress. Damaging our mitochondria. These things are fundamental that, as it relates to, you know, what's going on that's aging our bodies. Or that we can target so that we can, uh, live a longer and certainly a healthier life.

Uh, Sergey, whether we make it to 200 or not, uh, who knows, but I know that's your goal. 

Claudia von Boeselager: I will meet you there. 

David Perlmutter: Yeah. I, I hope I'm around to see you reach that goal. So, uh, in which case I'll probably be 220 because I'm that much older than you. 

Sergey Young: Love it. Um, the next question, David, is, like, what else negatively impacts our, uh, uric acid level. Like, things like alcohol? 

David Perlmutter: Alcohol is a player, there's no question about it. And, um, but it really, uh, this is a bit of a context because, uh, not all alcohol is necessarily going to be a bad choice. Uh, in men wine really doesn't have much of an effect, but in women, uh, drinking wine is actually associated with slightly lowering of uric acid, or lower uric acid.

Claudia von Boeselager: Is that red or white? 

David Perlmutter: Uh, we would want red. You know, red means skins were involved in making it, that's where the bioflavonoids are, are found. And, uh, finally, when we look at the worst choice for uric acid, it would be beer. Why beer? Because, uh, beer contains, uh, not only alcohol, but also contains, uh, what are called purines. And purines are made, uh, they are derived rather, from the yeast that is found in, uh, brewer's yeast used to make beer. So, you know, that's raising uric acid, increasing body fat. So we have a very good explanation now, uh, for the, uh, beer belly that is, you know, it is a real thing. People that drink a lot of beer, get a big belly because their bodies are making fat to prepare for, uh, winter. 

And so incredibly in, uh, Japan, where they're really way ahead of us on the uric acid story, they're now marketing what is called purine-free beer so that you can enjoy, uh, beer and not be concerned about the incredibly high level of purines that inform your body to make fat, and raise your blood sugar, and make you insulin resistant, and raise your blood pressure. All the metabolic mayhem that all, all of us have been talking about for such a long time. 

Because, you know, these are the things that are breaking down our bodies. That are just, you know, leading us to age more rapidly. And paving the way, not only for decline in our longevity, but our decline in our healthspan. That period of time where we are still healthy and able to enjoy, uh, the life that we have. 

So adding, uh, years to our life is important, but adding life to our years, I think is, is equally important, more and more. 

Claudia von Boeselager: So helpful, David. And are there any common pharmaceuticals that threaten to increase uric acid levels? 

David Perlmutter: Well, there are, as a matter of fact. Um, you know, some very commonly used pharmaceuticals are associated with significant increase of uric acid, like aspirin, for example. Uh, like, uh, Viagra, which apparently is used quite aggressively around the world.

Interestingly, a study came out, uh, that demonstrated that Viagra use might, uh, actually be preventive as it relates to Alzheimer's. But we know it raises uric acid and therefore can threaten metabolism. 

The acid blocking drugs, like omeprazole, that are so commonly used, 15 million Americans use them, and they are in fact over the counter, uh, definitely raise, uh, uric acid, and have been associated with a fairly dramatic increased risk of stroke and even Alzheimer's. 

Um, So there are a variety of drugs, testosterone, beta blockers, uh, that are commonly used. Uh, and I think probably one of the biggest threat are drugs that are called diuretics, or water pills, that people take for a variety of reasons. Mostly, uh, for the treatment of high blood pressure. Raising uric acid that can then lead to high blood pressure. So - 

You're in a nice circle there. 

It really is a bit of a vicious, uh, circle. And you wonder who knows about that, uh, that you would then need more and more of the very drug that may be raising your blood pressure by virtue of the fact that it's raising the uric acid. So, you know, we put that all in the book, the various drugs people should be thinking about. 

And, you know, I'm not saying people need right away to stop these drugs. That's a discussion that people should have, of course, with their doctors. But I think the biggest player of all is to find out where you're getting your fructose, your fruit sugar, and limit it.

And, you know, some very interesting reason search has come out in the past five years that has revealed that we make fructose in our bodies. Think about that. You may be on a fructose-free program, and yet you're doing things that turn on your body's production of fructose and, therefore, the production, the downstream production, of uric acid and threatening your metabolic health.

So the question becomes, well then, what do we do that turns on uric acid, uh, production through fructose formation. And the production of fructose from glucose happens, for example, when we are dehydrated. Why? Because fructose turns on uric acid, makes more body fat. Then we have this resource to make metabolic water.

Well, our bodies become dehydrated when we don't have water or we think we're dehydrated, or our kidneys think we're dehydrated, when our sodium level goes up. So our sodium level will go up when we can't drink water. Uh, or when we eat a lot of salt. So this is very interesting. In other words, when you park yourself in front of the TV and start eating the pretzels, your sodium level goes up and that turns on your body's fructose production to make more body fat. 

And, you know, for decades we've known that a higher salt diet is associated with, uh, obesity. It's associated with diabetes. And we certainly know that higher salt is associated with hypertension or high blood pressure. But we didn't understand why that happens. Uh, how does it happen? And now we've, uh, found that piece of the puzzle. And we dropped it into the puzzle into, into our jigsaw puzzle. We now understand that eating more salt raises your sodium, as you would understand, the body thinks to dehydrated, so it makes more fat, and it concerns water, but it makes more fat so that we can make more metabolic water. So, uh, it is, um, it's really quite, quite fascinating. 

So for people who are on a keto diet, uh, for example, uh, and have, then might have, uh, mild elevation of the uric acid. They can supplement with a little sodium. I mean, there, there's a, a product called LMNT, for example, L-E, it's spelled L-M-N-T, that has potassium, magnesium. And it has a little bit of sodium. 

But certainly not, um, the 11 to 15 grams a day that people are adding to their foods that are then, not only raising their serum, serum sodium, but letting the body think it's dehydrated and turning on fructose production. Yowser, we don't need that. Stimulates the production of uric acid.

Claudia von Boeselager: David, I wanna ask a quick question regarding the correlation between certain fruits and their glycemic index. So, I mean, a ripe banana versus, say, blueberries, are there certain foods, uh, fruits that people should be focusing on? 

David Perlmutter: Yeah, I think that, uh, berries, for example, uh, more tart kinds of fruits are, are more acceptable.

One of my favorite fruits over the years was mango. And the fructose level in mango, uh, will knock your socks off. And, uh, no wonder we loved it because it was so sweet. Uh, we have, outside here, we have, uh, two, I think, two mango trees and they're covered with blossoms right now, more than I've ever seen. And I read about that. And, uh, it said that if you have a lot of mango blossoms on your tree, that means you're gonna get a hurricane. I mean, who knows, right? 

Claudia von Boeselager: You're, you're in south Florida. You're gonna get a hurricane anyway, David. 

David Perlmutter: Oh gosh, I, I hope you're wrong. We've we've had our share. But, again, tart, uh, tart types of fruits.

And most importantly, we know that some fruits are directly related to lowering of the uric acid. Like cherries. Tart cherries have been used, for example, in gout treatment, uh, for, for many, many years. If people look at the "O" on the Drop Acid what do you see? It's actually a cherry falling from the sky. We wanted to connote, uh, that cherries lower uric acid.

So, uh, the other thing I would recommend is, if you're eating apples, for example, uh, eat the skin. Because that's where you find this really rich, uh, array of the bioflavonoids. And it is not where the fructose is, it's tart. And that, you know, if you're going to eat the whole apple, great. 

I actually want to eat an apple, eat the whole thing, the core, I eat it all. And so, I'm not dying from cyanide poisoning from the apple seeds. Remember, people used to talk about that. Well, I'm here to tell you, uh, maybe that's a little hormesis, maybe that cyanide, if there is any, is stressing me a tiny bit and keeping me going. 

Claudia von Boeselager: Excellent. 

David Perlmutter: Oh, somebody is mentioning lemon and limes, uh, and kiwi, uh, and, God, we're getting a lot of comments from, uh, people that was actually, I think, from Australia, uh, apple skins. Yes. And I think organic, that's a good point. Thank you. K8flan007, uh, that, yeah, if you're gonna eat the skin of an apple, um, it should be organic. You know, my vote would be organic apples in general.

I mean, uh, I always thought that if aliens came down from space, and I think, and, and, uh, the, the first thing they would say is, uh, they would ask is, why are you spraying, poison on the very food that you are eating?

I mean, do we need aliens to come down from another planet to tell us that. There's something inherently wrong - 

Claudia von Boeselager: Yeah. 

David Perlmutter: With putting poison on our food. Uh, but maybe we'll leave that discussion for another time. 

Claudia von Boeselager: Yeah. 

Sergey Young: Beautiful. 

Claudia von Boeselager: And also, they say eat the rainbow, right? So if you mix up the colors of the apples that you, uh, eat, uh, each week, right?

To get your 30, 30 rainbow colors a week. 

David Perlmutter: That's right. And, um, the other thing to recognize is there are a suite of, sweet, huh, interesting, suite of, of, uh, meats to, to be considering that have a lot of purines. Purines are what happens when our bodies break down the DNA and the RNA in certain foods and these are like the organ meats, liver, and, um, uh, kidney and venison game meats, and also, um, processed meats as well. 

Uh, herring, sardines, molluscs like, uh, shellfish, uh, scallops, uh, as well. It doesn't mean that these are necessarily off the table, but know about what your, uh, uric acid level is. Uh, you know, I, I might be able to eat - actually I do. I eat some sardines. I eat anchovies. My uric acid levels are staying down. But I know that cuz I follow my uric acid levels, but, you know, if my uric acid level were higher, like 7, and I consider that to be significantly elevated, I would be, uh, more aggressive about not just the fructose part of my lifestyle choices, but also certainly the alcohol part, uh, and, um, looking at the purine rich foods as well, the meats in particular. 

We know that certain vegetables can be high in purines, uh, and, oddly enough, they are not associated, like the cruciferous vegetables, are not associated with elevation of the uric acid. Why? Because, like we mentioned with fruit before, these vegetables have lots of fiber, they have bioflavonoids, they have vitamin C, and they are, net, a good thing to, uh, to, to be consuming obviously, uh, as it relates to uric acid, and probably about everything else you can think of, that's, uh, designed to help you, uh, improve your metabolism. Eat lots of as, Claudia, you say, colors of the rainbow. Uh, as it relates, not just fruit, but vegetables as well.

Oh, good question. Somebody's asking, um, what score are you looking for? 

Claudia von Boeselager: Yeah. 

David Perlmutter: In, uh, American units, and many other, uh, countries, we use milligrams per deciliter. And if you go to your doctor and have your uric acid level checked, they will generally tell you, well, 7 is what your goal is. Below 7.

And, I'm not gonna say it's silly, although I just did, but, uh, um, it goes without saying, but I'll say it, that seven, you know, that is a number that is derived as it relates to gout. Because above that level, there's so much uric acid floating around that it can then form, it can precipitate out, form crystals in your joints, and that's what gout. And also, I might add crystals in your heart arteries, and even in your prostate gland. I would say specifically Sergey on that one. 

Uh, but the point is that those numbers are derived from gout. That what we are looking at, as it relates to cardiometabolic disease, uh, are levels at 5.5 milligrams per deciliter or lower. So that is, uh, that is the goal. 

Does it, is there a difference between men and women? No, that is from Robert, uh, Tappin USA, uh, we want both men and women, and children, to keep their uric acid levels at 5.5 or lower. 

You know, interestingly, looking at the average uric acid level here in America, in 1920 it was 3.5. 

Claudia von Boeselager: Wow. 

David Perlmutter: And now it's 6. And that increase in uric acid has absolutely paralleled our increase consumption of fructose. 

Does this change with age? The, uh, the uric acid will slowly increase with age. Uh, and, uh, interestingly, uric acid levels in women are a little bit lower than they are, uh, in men until menopause. After menopause then, in women uric acid levels go up substantially because it looks like estrogen is very helpful in terms of allowing women to excrete, uh, uric acid. 

And, interestingly, it looks like there is at least an association between testosterone levels and elevation of uric acid. Uh, one study that I reviewed yesterday, looking at what is called polycystic ovarian syndrome, PCOS, finds a very high risk of elevated uric acid in women with PCOS, and it seems very much to correlate with their testosterone levels. 

And, interestingly, uh, oftentimes women, uh, who have PCOS are treated with a drug called Metformin that we know is used for diabetes. So that can tell us something about how Metformin works and how uric acid works. So that might be a little much for our discussion right now. 

Fermented vegetables and uric acid levels, again, I, I think, overall, fermented vegetables are a good choice because of the nurturing that they do for our gut bacteria. Uh, I think no real threat in terms of, um, our uric acid levels. 

Claudia von Boeselager: David, what lifestyle strategies are helpful to manage uric acid levels? Are there particular sleep rhythms or exercise or fasting that you would recommend?

David Perlmutter: Well, fasting. Good question, Claudia. Fasting, um, I'll take them in reverse order. Fasting in the short run will actually raise uric acid levels. But once you complete your fast, then your uric acid levels, will either return to where they were or will actually, uh, be a little bit better. 

So we're advocates of fasting, we're definitely advocating what is called time-restricted eating, which maybe is a form of fasting, I would think, because of the incredible metabolic benefits that, uh, Dr. Satchin Panda has described, uh, being associated with the notion of, uh, not eating except for, into, uh, a compressed window of number of hours of the day. 

What is it, 9:30? I will have, uh, my breakfast, I will break fast, probably somewhere around, uh, 1:00 or 2:00 p.m. Today. And then only try to consume food between two o'clock, maybe in the afternoon and then maybe 6:00 or 7:00 p.m. And as doctor, uh, Panda has indicated, um, and made very clear, this offers us up some really profound, uh, benefits, uh, as it relates to improving our metabolism.

Uh, exercise is associated, in, in intense form, with a transient increase in, uh, uric acid. Uh, but overall, generally engaging in your exercise program, uh, is something, uh, that will keep uric acid levels where they want to be. Well, where you want them to be. 

Claudia von Boeselager: Yeah. 

David Perlmutter: And I'm actually doing this from, uh, my gym right now. There is, there's the, uh, uh, Precor machine.

Claudia von Boeselager: Are you, are you pre- or post-workout, David? 

David Perlmutter: Oh, uh, it is, uh, pre. You guys. I know you're in Europe, uh, it's still, you know, early here. 

Claudia von Boeselager: Yeah. 

David Perlmutter: So, uh, uh, the other thing to consider is that sleep, not getting enough sleep, will, is associated with an increased uric acid. And, uh, interestingly, something to think about is when, uh, we talked about this polyol pathway before whereby something turns on your body's production of fructose, and then that makes more uric acid. Well, one thing I didn't mention is that hypoxia, or having low oxygenation of your blood, can turn on, uh, uh, fructose production. And, uh, people can experience hypoxia if they have something called sleep apnea, meaning during the night they don't, they stop breathing, they're not oxygenating their blood as well. And what does that do? It signals the body to make more fructose, make more body fat, and that threatens to even cause more sleep apnea, and makes that whole process move forward in a feed forward cycle. So I'd say that wearing an Oura Ring, and probably you're both gonna raise your hands, or at least - I knew that would happen 

Claudia von Boeselager: Of course! And an Apple Watch is also great for it as well. 
David Perlmutter: There you go - uh, is worthwhile - me too - uh, to keep, keep track of your sleep, both its duration and its quality. Because we know that, uh, interrupting sleep, possibly by high sleep apnea, leads to hypoxia, and can even raise your body's production of that very sugar, even though you're not drinking soda or the fruit juice anymore. So something to think about. Very good question. 

Sergey Young: Beautiful. 

Claudia von Boeselager: I think it's also so important, if I might just make a, a small comment with that, that only thanks to wearing a Continuous Glucose Monitor and my Oura Ring was it actually discovered that I was waking up and, um, during the night, um, unbeknownst to me.

So I was obviously a bit groggy, et cetera. I was trying to figure out what was going on. And I was doing intermittent fasting, and eating super healthy, but what was, I was having hypoglycemic, glycemia, basically, during the night, and my blood sugar was dropping so low that it was causing a cortisol response. And I was waking up several times a night. 

So I was able to, sort of, hack that if you will, by taking palm, uh, palm-oil-free, sugar-free almond butter before bed. And it just kept my blood sugar levels stable overnight. So it was a real game changer then uh, as well. So that's why tracking is - 
David Perlmutter: I have to say, Claudia, my, my blood sugars fall at 3:00 AM.
I'm down to mid-50s, and, uh, uh, I, I, you know, I, I didn't, how would I have ever known if I didn't have a, a CGM, a Continuous Glucose Monitor? 

Claudia von Boeselager: Yeah. 

David Perlmutter: And, uh, so it's, it's so great to have this information. There was an interesting, um, op-ed that was written in the journal of the American Medical Association many months of ago now, I think it was last year, talking about should people who are non-diabetic have the opportunity to use a Continuous Glucose Monitor? And they concluded that no, if you're not diabetic, why on earth would you - gosh, it's unbelievable - why on earth would you wanna know your glucose? 
Well, uh, you're darn right you'd wanna know your glucose 'cause you don't wanna become a diabetic. 

Sergey Young: Yeah.

David Perlmutter: How are you going to know what your blood sugars are unless you're able to at least monitor them from time to time with a glucose monitor? But better, to know what they are, uh, at any given time in response to your sleep, or problems with sleep, or the level of exercise, or the, certainly, uh, the foods that you eat.

So, uh, you know, their conclusion was that the CGMs should be only for diabetics. Uh, I, I really feel that - 

Claudia von Boeselager: I disagree. 

David Perlmutter: That conclusion made no sense whatsoever. 

So, I work, uh, I, I am a, an advisor to a company called Levels, uh, Levels Health that, um, that's the app. That takes that information from the, uh, Continuous Glucose Monitor and then allows you to know what it means, you know, not just what your blood sugar is, moment to moment that transmits to your smartphone, but what does it mean? What does it telling you about the various lifestyle choices that you're making? And, my gosh, that is such powerful information that will, I believe, pave the way for, you know, longevity and certainly improving your healthspan. 

You don't wanna be diabetic. Here in America that's 86 million people. 34 million are, uh, um, 86 million are pre-diabetic, 34 million are actually diabetic. So over 100 million are either diabetic or pre-diabetic. And that sets the stage for Alzheimer's, and coronary artery disease, and even some forms of cancer. So you've gotta do everything you can to not become even pre-diabetic. 

I mean, what is this term pre-diabetes, you know? Nowhere else in medicine, do we have a pre something where you think you're a little bit safer. I mean, uh, the only thing that is binary, I think, in medicine is pregnancy. You're either pregnant or you're not pregnant. But as it relates to your blood sugar, it's, it's analog.

I mean, you're not even prediabetic at 105, or maybe you're just beginning to be pre-diabetic, but even at 105, you're already at risk for problems. You've increased your risk for dementia, or Alzheimer's itself, uh, a disease for which we have no treatment from the pharmacy whatsoever. So I think people have to get away from these notions of being in the normal range. Let's shoot for being in the optimal range of blood sugar, of uric acid, of body mass index, of blood pressure, whatever you wanna measure. 

And also, let's abandon the notion that, well, I'm not diabetic yet. I am only pre-diabetic. So, you know, if your blood sugar is 124 and you're pre-diabetic oh, I'm so much better off than a blood sugar to 126 where now I'm diabetic. Oh, I've crossed a line. No, you haven't. You know, that's nomenclature. And, uh, you've gotta get your blood sugar under control right now. 

And I think we'd, all three, agree, great messaging for all the people watching right now is think about a Continuous Glucose Monitor, that's for sure.

Sergey Young: Yeah, I agree. David, uh, we're about to finish in a few minutes. Uh, last two questions. One from me. What is the one thing that all of us can do right now to manage our uric acid level? 

David Perlmutter: I think test it. And know where it is. I mean, that is step one. 'Cause it may not be an issue for so many people watching, but it really is. Those uric acid levels globally are creeping up as the American, which became the Western, which became the global diet, so rich in sweeteners, mostly derived from, uh, from fructose, has become so pervasive that global uric acid levels are rising. So I think that the message is know what your level is.

Either get a monitor or go to the doctor's office and say I'd like a uric acid level check. And when the doctor says, why you don't have gout? Say just flatter me doctor, because I, I read some, some book and I think it's something I'd like to know. Uh, so that would really be step one. 
Uh, and if I may then step one in getting under control is target fructose. That's for sure. 

Sergey Young: Thank you. 

Claudia von Boeselager: I'd like to ask both of you, what is the next big thing for each of you as we start in January a new year? 

David Perlmutter: Go ahead, Sergey. I, I'll get a chance to - 
Look, I'm, I have to admit I'm in, uh, in a crisis mode right now. Just published my book and I'm, like, looking for the next big thing and it's not coming.

Sergey Young: So this is my version of depression. Post peak human depression. 

Claudia von Boeselager: Well, maybe, but you learn from everything, right? So maybe - 

Sergey Young: Oh yeah. 

Claudia von Boeselager: There's a time to introspect and, and go deep, right? So a new challenge. And David, how about you? 

David Perlmutter: Um, I would say, um, that - when you look at your keyboard, uh, here's my keyboard, I dunno if you can see it, but when you look at your keyboard, you know, that you are able, that there are certain keys that you can press that have a response on your computer. And they can be programmed. You can change what they do. 

What my wife and I were talking about the other day, and I think it may be a book, is that we have buttons in our, in our brains that other people can push and elicit responses for, uh, uh, that they may be looking for. Or that certain experiences we have pushed buttons. Those buttons get programmed very early in our life.

For example, anger, or fear, uh, or feeling inadequate, et cetera. Those feelings that we get throughout the course of our day, that don't help us. Um, I interviewed, uh, Jim Kwik recently, and he wrote a very interesting, uh, uh, book, uh, called, uh - 

Claudia von Boeselager: Limitless. 

David Perlmutter: Limitless. 

Claudia von Boeselager: Yeah, I read it. 

David Perlmutter: And it's a terrific book because it talks about how we engage in activities that limit ourselves and, as he makes so clear - he's an amazing guy. I've never, uh, actually I did meet him many years ago - but it's all about getting rid of those in my, uh, uh, understanding, and what I might write about is, reprogramming the buttons on our keyboard. So that when you push, uh, control, shift, 5, instead of making you feel inadequate or unable to live up to your parents' expectations, or whatever it may be that's destructive, you can program the keyboard in your mind of control, command, 5, to indicate to you that you're gonna make it through it. And you have certain skills. 

And it's really about the notion of reprogramming this keyboard that in many people, I can speak for myself, uh, that buttons get pushed from time to time that make me respond in ways that are not good for me. Uh, and I've gone to explore that deeply and that's, I think that'll be the mission for us in, in, uh, in 2022. 

Claudia von Boeselager: That's so exciting. And, and very funny because that's my overarching theme for this year is mindset and how we have a choice to decide how we react. So, as you were saying, the limiting beliefs from childhood. And two hacks, maybe to, to share - one, uh, what I had to learn as a perfectionist is to celebrate the little wins, right?

So I'd set myself a goal, get to the goal, and then it was onto the next one. So Sergey, it sounds like you're at this space right now. And it's actually, you know, celebrate the little wins as you go along. 

And, um, what you were saying. There's a really cute expression that neurons that fire together wire together. So the more you train your brain to focus on what's good and what's going right, you become that optimist as well, instead of the negativity around it. Um - 

David Perlmutter: That's right. That's Hebbian theory, Donald Hebb. And you know what, Claudia, now that that's what you're, uh, so engaged in for the year, let's stay in touch, let's do more of these IG Lives. 

Claudia von Boeselager: Love it. 

David Perlmutter: Uh, let's do some podcasting, but, uh, you know, if at first you don't succeed. You're right. If at first you don't succeed - you're in the same boat as all the rest of us. 

Claudia von Boeselager: Yeah. 

David Perlmutter: And that's what it's all about, you know? It's, uh - Thomas Edison said that when he finally invents something, it's not the invention of that, that, that he learned so much from, it's the 99 failures that took him to the - 

Sergey Young: Yeah.

David Perlmutter: To that 100th thing. That's what, that's where you learn. And, you know, we could be our, our own worst critics. And I - 

Claudia von Boeselager: Yeah. 

David Perlmutter: You know, we were on the boat, uh, on New Year's Eve, and my wife had us each take a small piece of paper, we had several people with us and, um, blow into that piece of paper, what you wanna get rid of for 2022, and then we lit it on fire and off it went. We, uh, and for me it was, uh, self-criticism. Um, and, um, I'm happy to be transparent about that because, you know, we are our own worst critics. 

Claudia von Boeselager: Yeah. 

David Perlmutter: And it gets in our way because we're doing okay, you know? 

Claudia von Boeselager: Yeah. 

David Perlmutter: And, uh, I think we can do much better, uh, uh, like Jim Kwik talks about in, uh, his book. Uh, if we just let that go. And we program our, our keyboard such that when we hit a certain key that brings up, you know, the parents or the teacher who was so critical, or whatever it was, and we reprogram that to be something positive.
I think there's a lot to gain from that. 

Claudia von Boeselager: Yeah. And just one word on that. What I really liked as well is when you realize that life happens for you, and not to you, it also really shifts, shifts the mindset. So look for the opportunity in the challenge. 
Um, so yeah, this is a, a very passionate topic of mine, David, so, and - 

David Perlmutter: Well, we're gonna stay with it.

Uh, Claudia, Sergey, I love you guys. So great to, to spend time with you today. We've had a lot, uh, today, we had so many people joining in. Uh, so many wonderful comments and questions from around the world, I, I wish we could have gotten to them. Um - 

Claudia von Boeselager: Yeah. 

David Perlmutter: But anyhow, I, I hope to see you guys soon and let's do this again.

Claudia von Boeselager: Would be a pleasure. Thank you both so much. 

Sergey Young: Again, congratulations. 

David Perlmutter: Bye. 

Claudia von Boeselager: Yeah. 

David Perlmutter: How did you get that to turn the right direction? 

Sergey Young: No, look, I, I, okay, so what we do, we go to Amazon, we print out the picture of that and we change it. 

David Perlmutter: Oh my God, you are too much.

Sergey Young: Yeah, okay. It, it took a little bit of effort. 

Claudia von Boeselager: Well done Sergey. 

David Perlmutter: Unbelievable. 

All right. Bye, you guys. 

Claudia von Boeselager: Thank you both so much.

Sergey Young: Thank you. Thanks David. 

Claudia von Boeselager: Such a pleasure. 

Sergey Young: Thanks Claudia.. 

Claudia von Boeselager: Thank you everyone for joining. 

Sergey Young: Thanks everyone. Cheers.

Claudia von Boeselager: Thanks for joining. 

David Perlmutter: Bye bye. 

Claudia von Boeselager: Bye.