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Book Summary: Drop Acid – The Surprising New Science of Uric Acid

Drop Acid (2022) is an in-depth exploration of uric acid, a substance increasingly linked to many modern health issues, from obesity and diabetes to hypertension and stroke. Uric acid has long been seen as a precursor to gout and kidney stones, but new research suggests that high levels of uric acid can contribute to many other health issues over the long term. With reference to scientific studies and a three-week “LUV” (Lower Uric Values) diet plan complete with recipes, this summary will prepare you to optimize your health by reducing foods and behaviors that play a part in raising uric-acid levels.

Book Summary: Drop Acid - The Surprising New Science of Uric Acid

Content Summary

Genres
Introduction: Learn about the dangers of uric acid and how to optimize your levels through diet and lifestyle changes.
Part One: The Suspect
Part One: The Suspect (continued)
Part Two: The Accomplices
Part Three: The Solution
Summary
About the author
Video and Podcast

Genres

Health, Nutrition, Diets, Weight Loss, Science, Food and Drink, Cooking, Nervous System Diseases, Immune Systems

Introduction: Learn about the dangers of uric acid and how to optimize your levels through diet and lifestyle changes.

If you selected this summary hoping to find a treatise on the benefits (or drawbacks) of psychedelics, you might be disappointed. The acid you’re going to learn about here isn’t LSD, and it’s not going to open your mind to the wonders of the universe.

The acid in question also isn’t illegal. And yet, research is increasingly connecting it to many modern health problems, such as metabolic syndrome and obesity, diabetes, dementia, and cardiovascular disease.

So it’s time to introduce you to our special guest: uric acid.

As you’ll soon learn, uric acid isn’t something we consume; it’s made in our bodies. But certain foods, drinks, and even lifestyle habits influence how much of it our system produces.

In Part One of this summary, you’ll learn about the main suspect: where uric acid comes from, what it does, and why many of us seem to be getting way too much of it these days. In Part Two, you’ll learn about the nutritional accomplices – those foods and drinks that can really push your UA levels over the top. And in Part Three, you’ll get the solution: how to prepare a three-week meal plan following the author’s LUV diet – that’s L-U-V for Lower Uric Values – to help you minimize uric acid-causing foods and maximize acid-dropping foods. Finally, as a treat at the end, you’ll get a day’s worth of the many recipes listed in the book to try at home. Let’s go drop acid!

Part One: The Suspect

Key takeaway: High uric acid levels are linked to many of today’s leading causes of premature death.

What do Leonardo da Vinci, Queen Anne of Britain, and Henry VIII all have in common? Many things, probably. But for now there’s only one commonality that concerns us – gout. That’s right, they all had gout, a form of arthritis that induces throbbing joints and excruciating inflammation, and is otherwise known as “that thing that causes your big toe to swell up and become super painful.”

Gout is often regarded as a malady of the past, like rickets or consumption. And that’s not totally inaccurate: it used to be more common. But that doesn’t mean gout isn’t still with us.

Over the last century, cases of gout have continued to rise. Between the 1960s and 1990s in the United States, the number of patients with gout doubled. Today, almost 10 million people in the US have gout.

Just like kidney stones, the main marker of those with gout is chronically elevated uric-acid levels. Here’s the rub: until very recently, these two ailments were the only reason most doctors paid attention to their patients’ UA levels. The reference range – often under 7 milligrams per deciliter – is mostly derived from UA’s connection to gout. But anything higher than 5.5 is what the author calls a “high normal,” and comes with a host of other dangers. According to a study over an eight-year period by the American College of Rheumatology, high uric-acid levels are to blame for 16 percent of all-cause mortality – that just means death from any cause. And for cardiovascular diseases such as stroke or coronary heart disease? That jumps to 39 percent.

There may be no immediate symptoms. But chronically elevated levels of uric acid can cause major problems. These often play out over a longer period, culminating in all sorts of diseases based on inflammation, from Alzheimer’s to nonalcoholic fatty liver disease and other disorders linked to obesity and metabolic syndrome, as well as sexual dysfunction in men.

So what is it exactly that’s causing our uric-acid levels to rise? Remember: uric acid is made in our body. And there are two main sources that cause this process to happen.

The first is fructose. Along with its turbo-charged sibling, high-fructose corn syrup, fructose has become the cheapest ingredient in recent decades. In concentrated form, it’s added to nearly everything, from (as you’d expect) sodas and desserts to (as you might not expect) breads, sauces, and yogurts.

The second is something called purines. They’re a class of chemicals present in nearly all living cells – including the human body. Purines are necessary for healthy physiology, but elevated levels can be harmful. You can find them in many foods, from seafood and meat to beer and some vegetables.

When you ingest purines or fructose, the body naturally breaks them down in the liver, the intestines, and the inner cellular lining of blood vessels. As a result, voilà. Uric acid is born.

It can then trigger fat production. Even for those who are not obese, excessive uric acid can cause fat to build up within the liver.

OK! You’ve made it through the main science part. Time for a celebratory deep breath.

Part One: The Suspect (continued)

Key takeaway: Human bodies have not yet adapted to the modern Western diet.

Think back tens of thousands of years ago to the time when your distant ancestors were still hunters and gatherers. There were no pizzas or burgers; no sodas or Twinkies. And no agriculture. They ate what they could find. Nuts, fruits, meat when they could get their hands on it. When agriculture first started developing around 12,000 years ago, things took a very, very slow turn toward fructose. But in evolutionary terms, the period from then till now is just the summary of an eye. For the collective human genome to make any real changes through evolution, between 40,000 and 70,000 years have to elapse. In other words, though we haven’t changed much since then, our environment has.

In pre-agricultural times, humans who were predisposed to save fat had an advantage. According to the thrifty-gene hypothesis, which was first put forward in 1962 by James Neel, a geneticist at the University of Michigan, it paid off to be able to put on more fat during times when food was plentiful. It was a way to prepare for times when food was scarce. It’s plausible, then, that we evolved the ability to create uric acid and add fat for similar reasons. It was advantageous.

These days, while food security is still an issue in some parts of the world, calories are becoming ever more abundant and cheap, partially thanks to the ever-rising amount of fructose in our foods. And foods and beverages that cause the most uric-acid production – such as highly processed cereal grains, all forms of refined sugars and vegetable oils, and alcohol – make up over 72 percent of the total energy consumed by people in the United States today. In this environment, the ability to create uric acid and add fat is definitely disadvantageous.

High-fructose corn syrup, which is a combination of 55 percent fructose and 42 percent glucose, came on the scene in the 1950s and gained popularity in the 1970s when cane and beet sugar was more expensive and corn was cheap. Even though fructose does naturally occur in fruit and honey, it takes real dedication to consume the same amount of fructose from some fresh blueberries as you can from the concentrated added sugar in sweetened drinks, sauces, and breads, among other places.

Next up, you’ll learn how to spot uric acid-causing foods, which is the first step toward avoiding them all together.

Part Two: The Accomplices

Key takeaway: To cut down on uric acid-causing foods, first learn where to spot them.

Joanna was in her late forties and had struggled with various health issues over the years. High blood pressure, diabetes, gaining 60 pounds seemingly overnight: she just couldn’t catch a break. All that her doctors would tell her was the vague “eat well and exercise.” For her fiftieth birthday, she decided to treat herself to a comprehensive medical spa, where on-site physicians would help her create a tailor-made plan to optimize her health. Her goal was to do this without the help of pharmaceuticals.

During her stay at the medical spa, one doctor looked over Joanna’s profile and diagnosed her with metabolic syndrome on the spot. She had all five main characteristics associated with the disorder: in addition to her high blood pressure and blood sugar, she also had excess body fat around the waist, high triglyceride levels in her blood, and abnormal cholesterol levels. The doctor’s next question left her stumped: “How much fructose do you consume?” he had asked. She had absolutely no idea what it was or how much she normally took in. Nor how it was related to uric acid, or how the latter was helping along fructose’s damaging effects.

It soon became clear: while she generally ate healthy food, she had a weakness for sugary drinks. In recent decades, there have been heated debates – and expensive lawsuits – about whether fructose is healthier than sucrose, or table sugar. Big Corn and Big Sugar both went to bat, trying to prove in court that they were, in fact, the healthier sweetener. The science, however, has shown both to have a similar effect on blood-sugar levels. And, predictably, it’s not a good one. Over time, Joanna was able to find the culprits, cut out sodas and other sources of fructose, and get her weight under control, all while improving her other health conditions.

Unprocessed food only contains small amounts of fructose. And in fruits and vegetables such as broccoli, artichokes, and asparagus, the fructose is offset by fiber and other nutrients, which slow the absorption of the sugar into the bloodstream. Drinking fruit juice or soft drinks, on the other hand, is essentially an express train to fructose town. Once in your system, fructose is quick to disable the parts of your metabolism that say when you’re feeling full, and can lead to mindless eating. Under the persistent influence of fructose, the body believes that it’s starving, so it goes into fat storage mode, thanks to elevated uric-acid values. Since insulin cannot work properly, the body is set on a course of long-term inflammation.

So let’s identify the sources of fructose and purines, in addition to the lifestyle habits that can contribute to high uric acid.

We’ve already mentioned the usual suspects with added sugar. Check the labels on anything you buy that isn’t a whole food – you’d be surprised where fructose, sucrose, or other sweeteners have snuck in.

But also be careful to limit consumption of red meats like beef, lamb, and pork, as well as oily fish such as sardines and anchovies. Avoid organ meats such as liver and kidney. All of these tend to have higher purine content. Certain vegetables also have high purine content, but, as with berries, it’s difficult to get an overdose on purines by just eating peas or spinach. Some whole foods high in purines can even protect your body from an increase in uric acid.

Try to eliminate gluten in all forms, refined carbohydrates, added sugars, and MSG. Most artificial sweeteners, such as those in diet sodas, can also raise uric-acid levels, even though they don’t tend to impact blood sugar in the short term. Too much salt has been linked to cognitive decline and an increase in obesity, insulin resistance, and metabolic syndrome. The average American eats ten grams of salt a day or more, while medical experts advise to eat less than half of that. In the place of these acid-raisers, eat mainly plant-based meals with whole fruits and vegetables, nuts and seeds, extra virgin olive oil, and organic eggs. Make sure to incorporate “acid-dropping” foods and drinks such as tart cherries, broccoli, sprouts, and coffee.

Alcohol in its various forms also raises UA levels. Unfortunately, beer causes the greatest increase, even more than liquor. Luckily, moderate wine consumption is associated with a decrease in uric acid levels in women. In men, it caused neither an increase nor a decrease.

Take a moment to check out your medicine cabinet as well. Are you taking aspirin, niacin, or testosterone supplements? What about diuretics? These can also raise uric-acid levels.

The author suggests taking some supplements to lower your uric acid levels, such as quercetin, vitamin C, or luteolin, but be sure to check with your physician before making any big changes.

And, finally, sleep and exercise. According to a 2019 study, there is a strong inverse correlation between how long you sleep and how high your uric-acid levels are. Getting enough sleep was associated with lower levels, suggesting that sleep plays a role in regulating the rises and falls in uric acid. It would make sense, since most gout attacks also occur during the night. A 2017 study suggested that prediabetic adults getting less than six hours of sleep had a 44 percent greater chance of developing diabetes; the risk for those getting less than five hours of shuteye was 68 percent. In your fight against uric acid, the Z’s are your friend.

Part Three: The Solution

Key takeaway: By committing to the LUV diet for three weeks, you can get a taste of the healthful benefits of dropping acid.

At this point, you’ve heard some of the science about the dangers of elevated uric acid. Perhaps you’ve even approached your doctor or gone through your past bloodwork to check where your levels stand. The good news is that, just like with blood glucose monitors, home uric-acid test kits are affordable and accessible. If you’re ready to embark on a three-week journey to lower your uric-acid levels through diet and lifestyle changes, read on.

The LUV diet – again, that’s Lower Uric Values – is designed to do just what it says: lower your uric-acid levels. Its goal is also to help you get in the habit and routine that promotes low uric acid, so that once you get it down, you can keep it down.

Check with your doctor before starting any of this, especially if there are any preexisting health issues you need to watch out for. If you have test kits for both uric acid and blood glucose, test yourself before the first day, too, to have a baseline and track your progress.

The author recommends doing a 24-hour fast before the first day to start the week with a clean slate. It’s very simple: for 24 hours, don’t eat any solid food or consume caffeine. Just drink lots of water.

In the first week, you’ll learn to follow a meal plan of acid-dropping dishes – though feel free to cook your own recipes as long as they don’t include any of the foods mentioned earlier that are verboten.

Of the following, you can eat as much as you want: healthful fats such as extra virgin olive oil, sesame oil, coconut or avocado oil, ghee and organic butter. Then there’s coconuts, olives, cheese, cottage cheese, nut butters, and nuts – especially walnuts. There are no limits on herbs and seasonings, as well as kimchi, whole fruits, and vegetables. Don’t forget leafy greens and legumes such as black beans, lentils, chickpeas, and kidney beans. If you really need an artificial sweetener other than a drizzle of natural honey, the author recommends allulose. According to some research, it does not have a negative effect on blood glucose levels.

The following recipes are just a sample day in the life of the LUV diet – the rest are listed in the book and on the author’s website, drperlmutter.com, and can be adapted for a ketogenic or vegetarian diet. On some days, consider skipping breakfast to add some time-restricted eating – also known as intermittent fasting – to your regimen.

But not today! Today’s breakfast is coconut pudding with one or two eggs, soft boiled or hard boiled. All you need is 16 ounces of either fresh or thawed frozen young Thai coconut flesh, a quarter cup of water, one tablespoon of allulose, and one teaspoon of vanilla extract. Blend these four ingredients together until smooth and creamy, then pop them in the refrigerator for one hour. In the meantime, for the topping, mix cashews, nigella seeds, and hemp hearts in a bowl. Scoop the coconut blend into a bowl, top with the nut mixture, and toss some berries on there if you have them. For boiling the eggs, you’re on your own.

Time flies, it’s already lunch time! Just the right weather for a chicken salad with broccoli-sprout pesto. Here’s how you make it. For the pesto, combine two cups of broccoli sprouts, two cups of baby spinach leaves, half a cup of chopped raw unsalted walnuts, one tablespoon of miso paste, half a teaspoon of salt, a quarter teaspoon of red pepper flakes, and three quarters of a cup of extra virgin olive oil in a food processor and blend until smooth. For the chicken, cook ten ounces of boneless skinless chicken breast and cut it into cubes. Combine it with a quarter cup of finely diced green bell pepper and a quarter cup of finely diced red onion. Add four tablespoons or more of the pesto to the chicken and stir well. For the salad, toss the spinach and avocado in a medium bowl with olive oil, lemon juice, and salt. Add the chicken on top and serve. Bon appétit!

Dinner tonight is za’atar-crusted rack of lamb with arugula and a tart-cherry vinaigrette. Season one rack of baby lamb – about a pound – with sea salt and cover evenly with extra virgin olive oil. Rub three tablespoons of za’atar into the meat and cover with lemon slices. Place on a baking sheet and cook at 450 degrees for 15 minutes. Let it rest for 20 minutes before slicing it into chops. While the lamb’s cooking, make the vinaigrette: mix a quarter cup of fresh or thawed frozen tart cherries without the pits, two cardamom pods, one and a half tablespoons of both apple cider vinegar and dijon mustard, a quarter cup of olive oil, and salt and freshly ground black pepper to taste. To make the salad, take four cups of arugula or another leafy green and toss with salad dressing. Serve the salad onto two plates, top with the lamb chops, and garnish with pomegranate seeds and thinly sliced red onion.

There you have it! A gourmet day in the life of a not-so-average LUV dieter. Enjoy!

In the second and third weeks, you’ll continue with the meal plan and focus on optimizing your sleep schedule, making time for regular movement – whether it’s intense exercise or just getting up from your desk every hour. Week three is about looking at your rhythm, your life, and your goals.

Looking back over the first two weeks, what did you find most challenging? Did you frequently struggle to resist your favorite less-than-healthy foods? Or perhaps it was especially difficult to dedicate regular time to exercise? Hone in on your biggest weaknesses, and write down what specific things you can do to overcome them. Come up with a few nonnegotiable goals that you’ll be able to stick to – such as completely avoiding sweetened drinks, or creating the right environment for yourself to get quality sleep by leaving smartphones and other devices outside of the bedroom.

Going forward, try to take some time each week to self-assess and plan. By being organized about meals, sleep, and movement, you’ll have that much more free time to devote to the other goals that are most important to you.

Summary

Uric acid is a big deal – and a big problem. The more processed foods we eat, with their added fructose and high purine content, the more we’re setting ourselves up for health issues down the road, from obesity and liver disease to ADHD and dementia. By adopting the LUV diet and changing what we eat, how we move, and how well we sleep, we can prevent some of these problems from emerging – or, in certain cases, reverse their course.

About the author

David Perlmutter, MD, is a board-certified neurologist and Fellow of the American College of Nutrition. He is a frequent lecturer at symposia sponsored by institutions including the World Bank, Columbia University, New York University, Yale, and Harvard, and serves as an Associate Professor at the University of Miami Miller School of Medicine.

He is the recipient of numerous awards, including: the Linus Pauling Award for his innovative approaches to neurological disorders; the National Nutritional Foods Association Clinician of the Year Award; and the Humanitarian of the Year award from the American College of Nutrition. He maintains an active blog at DrPerlmutter.com and is the author of Brain Wash, Grain Brain, Brain Maker, The Grain Brain Whole Life Plan, The Grain Brain Cookbook, and Raise a Smarter Child by Kindergarten.

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