Board-certified neurologist David Perlmutter, M.D., has written five New York Times bestsellers, including Brain Wash, Grain Brain and Brain Maker. His latest book is Drop Acid: The Surprising New Science of Uric Acid—The Key to Losing Weight, Controlling Blood Sugar, and Achieving Extraordinary Health. A recipient of the Linus Pauling Award for his innovative approaches to neurological disorders and the National Nutritional Foods Association Clinician of the Year award, he has appeared on 20/20, CNN, Fox News, The Today Show, Oprah and CBS This Morning.

What is the most significant threat to our health and longevity today? 

Metabolic issues like high blood pressure, increased body fat and high blood sugar are at the root of our most pervasive health challenges. According to the World Health Organization, the number one cause of death on planet Earth are chronic degenerative conditions like Alzheimer’s, coronary artery disease, diabetes and cancer, all of which are fundamentally metabolic problems. Astoundingly, 88 percent of American adults have at least one component of what is called the metabolic syndrome, which means only 12 percent of Americans are metabolically healthy.

What is the basic premise of Drop Acid? 

The book shows how uric acid elevation, previously thought of only in terms of gout, is the centerpiece for metabolic dysfunction and how you can easily bring your uric acid under control and regain metabolic health. You can test uric acid levels at your doctor’s office or with a home monitor that you can buy online, so this is a powerful new tool to help you be healthier.

What is the role of uric acid in our body?

Having elevated uric acid was a survival mechanism for our hunter/gatherer, Paleolithic and primate ancestors because it allowed their bodies to make more fat to protect them during times of food scarcity. Today, high levels of uric acid are leading to elevated blood sugar, increased production and storage of fat, and high blood pressure. Everything we do that raises our uric acid puts us at risk for these profound metabolic threats to our health. 

What foods and beverages should we reduce to control uric acid levels?

Alcohol, purines (the breakdown product of DNA and RNA in certain foods) and most importantly, fructose. In the 1900s, we consumed 10 to 15 grams of fructose per day, as opposed to over 70 grams today. The average American consumes 55 pounds of sugar each year. It’s absurd. High-fructose items like sodas, sauces and desserts are absolutely off the table, as is fruit juice, a powerful initiator of high uric acid. Fruit isn’t an issue. There may be five grams of fructose in an apple, and fruit contains vitamin C, which dramatically lowers uric acid, and fiber, which slows fructose release.

High-purine foods are organ meats, shellfish and small fish like anchovies and sardines. There are modest amounts of purines in red meat and chicken. I’m not saying these foods should be avoided; we want people to limit their consumption of chicken, fish and red meat to six ounces a day.

With alcohol, the big issues are hard liquor and beer. Beer contains a very concentrated source of purines because it’s made with brewer’s yeast. Though wine contains alcohol, it has polyphenols that help to reduce uric acid, possibly by nurturing the gut bacteria. Research demonstrates that a glass or two of wine is associated with either no change or a minimal decrease in uric acid. Coffee seems to lower uric acid.

Will these lifestyle choices really make a difference? 

Patients are confronted with a mentality from marketing that you can do whatever the heck you want with your food and lifestyle, and then take a pill. I’ve been to dinner with diabetics who eat the creme brûlée then pop a pill. But pills don’t treat diabetes. They may lower blood sugar, but they won’t treat the underlying problem, which is that the body isn’t responding to insulin. The moment patients stop the drug, much to the joy of the drug maker, their blood sugars go right back up. You’ve only treated the smoke. You haven’t looked at the fire. This approach of lowering uric acid puts the fire out.

Are you hopeful that more people will make better lifestyle choices? 

I see a bit of a trend where people are looking for more empowerment. They have greater access to data with wearable devices like continuous glucose monitors or an Oura Ring to tell you how you sleep. By better understanding moment-to-moment how our choices affect certain measurable factors, we’re slowly getting into the driver’s seat and becoming empowered to keep ourselves healthy. 

Sandra Yeyati, J.D., is a professional writer and editor. Reach her at [email protected].