Drop Acid

Introduction

In his book "Drop Acid," Dr. David Perlmutter introduces readers to an often-overlooked health concern: uric acid. This compound, produced naturally in our bodies, has been linked to a wide range of modern health problems, including obesity, diabetes, heart disease, and even dementia. While most people are familiar with uric acid's role in gout, Perlmutter argues that its impact on our health is far more extensive and insidious than previously thought.

The book is divided into three main parts:

1. The Suspect: An introduction to uric acid and its effects on the body
2. The Accomplices: Foods, drinks, and lifestyle factors that contribute to high uric acid levels
3. The Solution: A three-week plan to lower uric acid levels through diet and lifestyle changes

Perlmutter's goal is to educate readers about the dangers of high uric acid levels and provide practical strategies for reducing them. By doing so, he believes we can significantly improve our overall health and reduce the risk of many chronic diseases.

Part One: The Suspect

The Rise of Uric Acid-Related Health Problems

Gout, a painful form of arthritis caused by high uric acid levels, has been around for centuries. Famous historical figures like Leonardo da Vinci, Queen Anne of Britain, and Henry VIII all suffered from this condition. While gout was once considered a "disease of kings" due to its association with rich foods, it has become increasingly common in recent decades.

In fact, between the 1960s and 1990s, the number of gout cases in the United States doubled. Today, nearly 10 million Americans have gout. However, Perlmutter argues that gout is just the tip of the iceberg when it comes to uric acid-related health problems.

Until recently, doctors only paid attention to uric acid levels in relation to gout and kidney stones. The standard reference range for uric acid is typically under 7 milligrams per deciliter. However, Perlmutter suggests that levels above 5.5 mg/dL should be considered "high normal" and can lead to various health issues.

Research has shown that high uric acid levels are associated with:

• 16% of all-cause mortality (death from any cause)
• 39% of deaths from cardiovascular diseases like stroke and heart disease
• Increased risk of Alzheimer's disease
• Nonalcoholic fatty liver disease
• Obesity and metabolic syndrome
• Sexual dysfunction in men

The Sources of Uric Acid

Uric acid is produced in our bodies when we break down certain compounds. The two main sources of uric acid are:

1. Fructose: This sugar, found naturally in fruits, has become ubiquitous in our modern diet due to the widespread use of high-fructose corn syrup. It's added to many processed foods, including sodas, desserts, breads, sauces, and yogurts.

2. Purines: These chemicals are present in nearly all living cells, including those in our bodies. While purines are necessary for healthy physiology, elevated levels can be harmful. Purines are found in many foods, particularly seafood, meat, beer, and some vegetables.

When we consume foods high in fructose or purines, our bodies break them down in the liver, intestines, and blood vessel linings, producing uric acid as a byproduct. This uric acid can then trigger fat production, even in people who are not obese, leading to fat buildup in the liver.

The Evolutionary Mismatch

Perlmutter explains that our bodies have not yet adapted to the modern Western diet. He draws on the concept of evolutionary mismatch to illustrate why high uric acid levels have become such a problem in recent times.

For tens of thousands of years, our ancestors lived as hunter-gatherers, consuming a diet of nuts, fruits, and occasional meat. The development of agriculture around 12,000 years ago marked the beginning of a slow shift towards more fructose-rich diets. However, in evolutionary terms, this period is incredibly short – not nearly enough time for our bodies to adapt fully to these new dietary patterns.

The author references the thrifty-gene hypothesis, proposed by geneticist James Neel in 1962. This theory suggests that humans evolved to efficiently store fat during times of plenty as a survival mechanism for periods of food scarcity. The ability to produce uric acid and store fat was once advantageous for our survival.

However, in today's world of abundant, cheap calories – particularly those from fructose-rich processed foods – this once-beneficial trait has become a liability. Foods and beverages that cause the most uric acid production, such as refined grains, sugars, vegetable oils, and alcohol, now make up over 72% of the total energy consumed by people in the United States.

The introduction of high-fructose corn syrup in the 1950s, which gained popularity in the 1970s due to its low cost, has further exacerbated the problem. While fructose does occur naturally in fruits and honey, it's much easier to consume large amounts of fructose from sweetened drinks and processed foods than from whole fruits.

Part Two: The Accomplices

Identifying Uric Acid-Causing Foods

To illustrate the importance of understanding uric acid-causing foods, Perlmutter shares the story of Joanna, a woman in her late forties struggling with various health issues, including high blood pressure, diabetes, and sudden weight gain. During a visit to a medical spa, a doctor diagnosed her with metabolic syndrome and asked about her fructose consumption – a question that left her stumped.

Joanna's case highlights the importance of being aware of the sources of fructose and other uric acid-promoting substances in our diets. Here are some key points to consider:

1. Fructose sources: Check labels for added sugars, including fructose, sucrose, and high-fructose corn syrup. These are often found in unexpected places, such as breads, sauces, and yogurts.

2. High-purine foods: Limit consumption of red meats (beef, lamb, pork), oily fish (sardines, anchovies), and organ meats (liver, kidney). These tend to have higher purine content.

3. Vegetables with high purine content: Some vegetables, like peas and spinach, are high in purines. However, it's generally difficult to consume excessive amounts of purines from vegetables alone.

4. Processed foods: Try to eliminate or reduce gluten, refined carbohydrates, added sugars, and MSG from your diet.

5. Artificial sweeteners: Many artificial sweeteners, including those in diet sodas, can raise uric acid levels even if they don't immediately impact blood sugar.

6. Salt: Excessive salt intake has been linked to cognitive decline, obesity, insulin resistance, and metabolic syndrome. The average American consumes about 10 grams of salt per day, while medical experts recommend less than half that amount.

Beneficial Foods and Drinks

While many foods can contribute to high uric acid levels, others can help lower them. Perlmutter recommends focusing on:

1. Plant-based meals with whole fruits and vegetables
2. Nuts and seeds
3. Extra virgin olive oil
4. Organic eggs
5. "Acid-dropping" foods and drinks such as tart cherries, broccoli, sprouts, and coffee

Alcohol and Uric Acid

Alcohol consumption can significantly impact uric acid levels:

• Beer causes the greatest increase in uric acid, even more than liquor
• Moderate wine consumption is associated with a decrease in uric acid levels in women, while in men it has a neutral effect

Medications and Supplements

Certain medications can raise uric acid levels, including:

• Aspirin
• Niacin
• Testosterone supplements
• Diuretics

Perlmutter suggests considering supplements to lower uric acid levels, such as quercetin, vitamin C, or luteolin. However, it's essential to consult with a physician before making any significant changes to your supplement regimen.

Sleep and Exercise

Sleep plays a crucial role in regulating uric acid levels. A 2019 study found a strong inverse correlation between sleep duration and uric acid levels. Getting enough sleep was associated with lower levels, suggesting that sleep helps regulate uric acid fluctuations.

Lack of sleep can also increase the risk of developing diabetes. A 2017 study found that prediabetic adults getting less than six hours of sleep had a 44% greater chance of developing diabetes, while those getting less than five hours had a 68% higher risk.

Regular exercise is also important for maintaining healthy uric acid levels and overall health.

Part Three: The Solution

The LUV Diet: Lower Uric Values

To help readers put his recommendations into practice, Perlmutter introduces the LUV (Lower Uric Values) diet. This three-week plan is designed to lower uric acid levels through diet and lifestyle changes. Here's an overview of the LUV diet approach:

1. Preparation:

   • Consult with your doctor before starting, especially if you have preexisting health conditions
   • Use home uric acid and blood glucose test kits to establish baseline levels and track progress
   • Begin with a 24-hour fast (water only, no solid food or caffeine) to start with a clean slate

2. Week One:

   • Follow a meal plan of acid-dropping dishes
   • Focus on consuming:
     • Healthful fats (extra virgin olive oil, sesame oil, coconut oil, avocado oil, ghee, organic butter)
     • Coconuts, olives, cheese, cottage cheese, nut butters, and nuts (especially walnuts)
     • Herbs and seasonings
     • Kimchi
     • Whole fruits and vegetables
     • Leafy greens
     • Legumes (black beans, lentils, chickpeas, kidney beans)
   • If needed, use allulose as an artificial sweetener

3. Weeks Two and Three:

   • Continue with the meal plan
   • Optimize your sleep schedule
   • Make time for regular movement and exercise
   • Reflect on challenges and set specific goals for overcoming them

Sample LUV Diet Meal Plan

To give readers a taste of what the LUV diet looks like in practice, Perlmutter provides a sample day of meals:

Breakfast: Coconut Pudding with Boiled Eggs

• Ingredients:
  • 16 oz fresh or thawed frozen young Thai coconut flesh
  • 1/4 cup water
  • 1 tbsp allulose
  • 1 tsp vanilla extract
  • Topping: cashews, nigella seeds, hemp hearts, berries (optional)
  • 1-2 soft or hard-boiled eggs
• Instructions:
  1. Blend coconut flesh, water, allulose, and vanilla until smooth
  2. Refrigerate for one hour
  3. Mix cashews, nigella seeds, and hemp hearts for topping
  4. Serve pudding topped with nut mixture and berries
  5. Enjoy with boiled eggs on the side

Lunch: Chicken Salad with Broccoli-Sprout Pesto

• Ingredients for pesto:
  • 2 cups broccoli sprouts
  • 2 cups baby spinach leaves
  • 1/2 cup chopped raw unsalted walnuts
  • 1 tbsp miso paste
  • 1/2 tsp salt
  • 1/4 tsp red pepper flakes
  • 3/4 cup extra virgin olive oil
• Ingredients for salad:
  • 10 oz boneless skinless chicken breast, cooked and cubed
  • 1/4 cup finely diced green bell pepper
  • 1/4 cup finely diced red onion
  • Spinach leaves
  • Avocado
  • Olive oil
  • Lemon juice
  • Salt
• Instructions:
  1. Blend pesto ingredients until smooth
  2. Combine chicken, bell pepper, and onion
  3. Mix chicken with 4+ tbsp of pesto
  4. Toss spinach and avocado with olive oil, lemon juice, and salt
  5. Top salad with chicken mixture and serve

Dinner: Za'atar-Crusted Rack of Lamb with Arugula and Tart-Cherry Vinaigrette

• Ingredients for lamb:
  • 1 lb rack of baby lamb
  • Sea salt
  • Extra virgin olive oil
  • 3 tbsp za'atar
  • Lemon slices
• Ingredients for vinaigrette:
  • 1/4 cup fresh or thawed frozen tart cherries (pitted)
  • 2 cardamom pods
  • 1.5 tbsp apple cider vinegar
  • 1.5 tbsp dijon mustard
  • 1/4 cup olive oil
  • Salt and freshly ground black pepper
• Ingredients for salad:
  • 4 cups arugula or other leafy greens
  • Pomegranate seeds
  • Thinly sliced red onion
• Instructions:
  1. Season lamb with salt and olive oil, rub with za'atar, cover with lemon slices
  2. Bake at 450°F for 15 minutes, rest for 20 minutes before slicing
  3. Blend vinaigrette ingredients
  4. Toss greens with vinaigrette
  5. Serve salad topped with lamb chops, garnish with pomegranate seeds and red onion

Maintaining the LUV Diet Lifestyle

As readers progress through the three-week LUV diet plan, Perlmutter encourages them to reflect on their experiences and challenges. He suggests identifying the most difficult aspects of the diet and lifestyle changes, whether it's resisting favorite unhealthy foods or finding time for regular exercise.

To ensure long-term success, he recommends:

1. Setting specific, nonnegotiable goals (e.g., completely avoiding sweetened drinks or creating a sleep-friendly bedroom environment)
2. Taking time each week for self-assessment and planning
3. Organizing meals, sleep, and movement in advance to free up time for other important goals

By adopting these habits and maintaining awareness of uric acid levels, readers can continue to reap the health benefits of the LUV diet beyond the initial three-week period.

Conclusion

In "Drop Acid," Dr. David Perlmutter presents a compelling case for the importance of managing uric acid levels in our bodies. He argues that the modern Western diet, with its abundance of processed foods, added sugars, and high-purine ingredients, has created a perfect storm for elevated uric acid levels and the health problems that come with them.

The book's key takeaways include:

1. Uric acid is a significant factor in many chronic health conditions, including obesity, diabetes, heart disease, and cognitive decline.

2. Our bodies have not yet adapted to the dramatic changes in our diet and lifestyle over the past few centuries, leading to an evolutionary mismatch that contributes to high uric acid levels.

3. Many common foods and drinks, particularly those high in fructose and purines, can significantly increase uric acid production in our bodies.

4. Lifestyle factors such as sleep, exercise, and stress management play crucial roles in regulating uric acid levels.

5. By adopting the LUV diet and making targeted lifestyle changes, it's possible to lower uric acid levels and improve overall health.

Perlmutter's approach emphasizes the importance of understanding the root causes of health issues rather than simply treating symptoms. By focusing on uric acid as a key player in many chronic diseases, he offers readers a new perspective on how to approach their health and well-being.

The LUV diet and lifestyle recommendations provided in the book offer a practical roadmap for readers looking to improve their health by lowering their uric acid levels. While the initial three-week plan may seem challenging, Perlmutter argues that the potential benefits – including weight loss, improved energy levels, better cognitive function, and reduced risk of chronic diseases – make it well worth the effort.

It's important to note that while the book presents a compelling argument, readers should always consult with their healthcare providers before making significant changes to their diet or lifestyle, especially if they have preexisting health conditions. The LUV diet may not be suitable for everyone, and individual needs may vary.

In conclusion, "Drop Acid" sheds light on an often-overlooked aspect of our health and offers a fresh perspective on how we can take control of our well-being. By understanding the role of uric acid in our bodies and taking steps to optimize our levels, we may be able to prevent or even reverse some of the most pressing health issues of our time. Whether you're dealing with specific health concerns or simply looking to improve your overall wellness, the insights and strategies presented in this book provide valuable food for thought and action.