The Uric Acid Marker

Dr. Richard Johnson has spent the past twenty years researching why we get fat so easily, and how fructose and uric acid play an important role in contributing to most of the major health problems we see today including heart disease, obesity, high blood pressure, dementia, and Alzheimer’s disease.  In his third book titled Why Nature Wants Us to Be Fat, Johnson uses his unique background in Anthropology, as a kidney specialist, and research background to detail how human physiology and diet have influenced the epidemic of the most common health problems seen today.

If you were to play a word association game with any physician and said uric acid the response would probably be Gout in nearly 100% of the cases. Uric acid is a waste product from the breakdown of the nucleic acids DNA and RNA of the purines that are elevated in red meat, sardines, shrimp, and brewer’s yeast.  If those purines crystalize in a joint such as the big toe, this is Gout, and it can be very painful.

What Dr. Johnson has discovered is that uric acid is also a downstream byproduct of the metabolism of fructose, and this is the key to what Dr. Johnson talked about in his second book called The Fat Switch.  Anthropologically, our inability to remove excess uric acid started around 15-20 million years ago during the Miocene era when the first apes appeared. During this time frame, global cooling allowed apes to cross land bridges to Europe. Prior to that, primates had an enzyme called uricase which enabled them to eat fruit almost exclusively dietarily without any worries about accumulating high amounts of uric acid and fat. Fruit which is high in fructose would give those primates fuel for energy without any of the deleterious effects of uric acid. Once in Europe these apes developed a mutated gene that lost the uricase enzyme which allowed them to eat fruit, and store fat and water more readily when fruit wasn’t available.

According to Dr. Peter Andrews an anthropologist and paleontologist at the Natural History Museum in London these apes eventually died out but not before some migrated back to Africa. It is those apes’ that humans are descended from - without the uricase enzyme. What was once a mutation for survival advantage is now considered a portal for understanding why obesity, high blood pressure, and diabetes is so prevalent today with easy access to food year-round. It also explains why humans are driven to prefer sweet over savory foods. The higher one’s uric acid, the more likely that you will retain sodium and lower nitric oxide, combination that works against cardiovascular protection. This will increase the likelihood of higher blood pressure, risk for diabetes, obesity, fatty liver, kidney disease, and risk for dementia. The drug allopurinol blocks uric acid formation and has been shown in studies to lower high blood pressure in those with high uric acid by blocking an enzyme called xanthine oxidase proving the elevated uric acid and blood pressure connection.  Natural compounds found in wild yam, burdock root, green tea, and tart cherry juice also do the same.

While most lab tests consider uric acid to be normal at 6.0-7.0 mg/dl for women and men respectively. However, when we compare ourselves to the great apes, they have uric acid levels in the 3.0-4.0 mg/dl range, and monkeys in the 1.0-2.0 mg/dl range. In southern Venezuela there is a native tribe called the Yanomamo Indians who are not exposed to refined sugar and whose carbohydrate intake come from tubers and plantains.  Their uric acid levels are 3.0 mg/dl.  In the early 1900’s uric acid values amongst most people were around 3.0 mg/dl. These markers reveal an example between the difference between normal and ideal and the shifting of the acceptable range now that high consumption of sugary foods is more common. Women tend to have slightly lower uric acid levels but that changes as women age, indicating that estrogen may have a protective effect on uric acid accumulation. It could also indicate that men consume more protein.

A large Turkish study of 90,000 people over eight years showed even slightly elevated uric acid levels led to an increased 38% risk of cardiovascular mortality and a 35% risk from dying from a stroke. For every point above 7.0, there is an additional 8-13% increased chance of death due to all-cause mortality. 

Fructose

I think most of us are familiar with the term high fructose corn syrup (HFCS). Consuming soft drinks with this as a sweetener is the most serious insult you can give to yourself in terms of uric acid accumulation. This is especially true the faster you drink the soft drink. For a long time, fructose was looked at as a sugar that was less harmful because it doesn’t stimulate insulin like glucose does. It was promoted as diabetic friendly sugar for that reason. Cane sugar was healthier too being less refined and not bleached. We now know differently. Cane sugar and regular table sugar also known as sucrose is half glucose and half fructose and studies with animals given only fructose will become insulin resistant before their glucose levels rise to diabetic levels.

This schematic shows how fructose is converted into uric acid.

Aside from refined sugars, refined starches like pretzels, potatoes, and bread products can also raise uric acid levels. These products spike glucose levels and then we make fructose when the liver enzymes convert the glucose into fructose along the polyol pathway that can be seen here:

There are drugs in development that will attempt to block this conversion and thereby block the mechanism of obesity. The only natural nutrients that seem to do this are quercetin and vitamin C.

Final thoughts

With seventy percent of all packaged goods containing sugar, and the high consumption of carbohydrates in our diets it appears that Dr. Richard Johnson’s connection to the fructose and uric acid connection is on target for furthering our understanding about why our society has soaring cases of obesity, high blood pressure and diabetes. His precautions surround the idea of dose. Carbs and fruit aren’t evil, but the excess amount of them and the speed you consume them triggering the overproduction of fructose is. Insulin resistance the precursor of diabetes results from excess fructose causing mitochondrial oxidative stress – not glucose. However, if you get glucose spikes (like you would see on a continuous glucose monitor), you can assume that fructose spikes are occurring simultaneously. Another interesting association were studies showing that high salt diets would stimulate the production of fructose in our bodies. High salt intake is dehydrating, and the body will increase fructose production to make fat which has a higher water content, thereby helping with dehydration. Therefore, he emphasizes the importance of drinking water while eating salty foods.

You can buy a home monitoring uric acid tester. These electronic testers require a drop of blood and run between 60.00-75.00 dollars.

Dr. Johnson also challenged my long-held belief that cane sugar was a better alternative to sugar free saccharin and aspartame. Saccharin has been linked to bladder tumors and aspartame to formaldehyde formation. Dr. Johnson acknowledges these risks but feels that if used sparingly they are the lesser of two evils by avoiding the fructose to uric acid formation.

Despite the warnings about fructose Dr. Johnson is not anti-fruit, just anti-fruit juice, anti-HFCS and anti-beer. He suggests moderation and slow consumption. A small bowl of berries would be a best choice, and fruit in moderation: perhaps one per day to provide vitamins, minerals, and antioxidants to benefit our overall health. More cautionary advice from Dr. Johnson: Agave is pure fructose and should be avoided, and dried fruit is another food to be careful of. The same would be true of any food with “added sugars”.

Special thanks for Dr. David Perlmutter, and Dr. Peter Attia for their podcasts with Dr. Johnson and of course Dr. Richard Johnson. https://drrichardjohnson.com/