Uric Acid concerns

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GemmaJ
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Uric Acid concerns

Postby GemmaJ » Wed Jul 21, 2021 8:31 am

Hello Everybody,

I haven't posted on here for a long time but as a 4/4 I have regularly checked in since finding out my status in 2017. I'm posting today because over the past few weeks something is really concerning me and I'm wondering if others had any thoughts on it or the same worried as me.

About a month ago I listened to Dhru Purohit's podcast with Dr Perlmutter which was on APOE 4/4 Facebook page https://www.youtube.com/watch?v=ImfCoaqr_SE and then read his blog on the topic of uric acid which he addresses in the interview https://www.drperlmutter.com/uric-acid- ... -diseases/ (I hope these links work - been a while since I posted and may be doing it wrong!).

I follow Dr Bredesen's protocol - 16 hour daily fast, no dairy, sugar, fruit (apart from few berries every day and odd organic apple when they're in season), grains, alcohol and I also cut out most lectin rich vegetables. I eat some grass fed meat now and again and lots of salmon and a couple of cans of tinned fish (mackerel and sardine) a week. My diet is low carb and high fat as many of us on this site. My ketone levels are routinely somewhere between 2 and 4 and my fasting glucose usually between 75-85. I struggle with my weight, as many of us do and try to keep it around 47-48kg (I'm 168 cm), however at mo it's dropped off a bit at 46kg.

I assumed my uric acid levels would be low and looked back over blood test results I've had over past 5 years, last one September 2020 - all around 2. something so no worries. However, the podcast had made a strong impression on me and following Dr Perlmutter's advice I bought a home testing uric acid kit - pin prick blood one like glucose and ketones. That was about 10 days ago and I have been shocked and worried by the results I've had - lowest was 7.8mg/dL and Dr Perlmutter's recommendation is that it should be under 5.5! I've tried different times of day and have higher reading than that but no lower. I left it for a week, drank diluted Apple Cider Vinegar everyday, cut out the mackerel and sardines and ate more eggs and tried again - still 7.something. Investigating today I found this about hyperuricemia: https://en.wikipedia.org/wiki/Hyperuricemia Here is says "A ketogenic diet impairs the ability of the kidney to excrete uric acid, due to competition for transport between uric acid and ketones." and "Starvation causes the body to metabolize its own (purine-rich) tissues for energy. Thus, like a high purine diet, starvation increases the amount of purine converted to uric acid. A very low calorie diet lacking in carbohydrates can induce extreme hyperuricemia; including some carbohydrate (and reducing the protein) reduces the level of hyperuricemia. Starvation also impairs the ability of the kidney to excrete uric acid, due to competition for transport between uric acid and ketones"

I'm worried. I have no symptoms of gout and all my other markers are good. Should I be eating more carbs? Is it my home test kit that's inaccurate (I have paid for a full blood test next week so we'll see...)? Should we 4/4s really be as concerned about this as Dr Perlmutter suggests? Can I ever eat mackerel again?

If anyone has any thoughts on this I'd be really interested.

Thank you so much everyone.

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Julie G
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Re: Uric Acid concerns

Postby Julie G » Wed Jul 21, 2021 1:58 pm

If anyone has any thoughts on this I'd be really interested.

Hi GemmaJ! In fell disclosure, I haven't seen the interview that you linked but previous research (linked below) has indicated that high levels of UA may actually be neuroprotective. Has Dr. Perlmutter concluded differently? FWIW, a ketone level between 2-4mM is pretty high for prevention. Perhaps you could relax things a bit if you think that's driving higher UA.

https://pubmed.ncbi.nlm.nih.gov/26084440/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7291838/

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SusanJ
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Re: Uric Acid concerns

Postby SusanJ » Wed Jul 21, 2021 3:09 pm

Seems like it would be telling to add back some healthy carbs to see if the UA drops at all. If you do try it, let us know how it goes.

A few extra healthy carbs might also help you gain back a bit of weight without sacrificing a low level of ketosis.

GemmaJ
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Re: Uric Acid concerns

Postby GemmaJ » Thu Jul 22, 2021 1:37 am

Julie G wrote:
If anyone has any thoughts on this I'd be really interested.

Hi GemmaJ! In fell disclosure, I haven't seen the interview that you linked but previous research (linked below) has indicated that high levels of UA may actually be neuroprotective. Has Dr. Perlmutter concluded differently? FWIW, a ketone level between 2-4mM is pretty high for prevention. Perhaps you could relax things a bit if you think that's driving higher UA.

https://pubmed.ncbi.nlm.nih.gov/26084440/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7291838/


Thanks so much for replying Julie G. It's really got me thinking. I had searched uric acid on this site and found previous ideas about it being neuroprotective. However, Dr Perlmutter has written a whole book about it "Acid Drop". The blog post goes into quite a lot of detail and concludes (after talking about the mechanics of AMPD):

"The product of AMPD is uric acid, and it is uric acid that then goes on to further activate this whole biochemical pathway favoring AMPD while shutting down AMPK, and this encourages the body to make fat, produce glucose, and enhances insulin resistance. So, we now see how uric acid plays such a central role in these important events that threaten human health when we consider all of the things associated with obesity and insulin resistance, as well as elevated blood glucose, like coronary heart disease, renal disease, cancer, and even Alzheimer’s disease."

He appears to take the opposite view. It's intriguing.

Thanks for the advice - I think I may add in some more carbs. Gx

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Re: Uric Acid concerns

Postby GemmaJ » Thu Jul 22, 2021 1:38 am

SusanJ wrote:Seems like it would be telling to add back some healthy carbs to see if the UA drops at all. If you do try it, let us know how it goes.

A few extra healthy carbs might also help you gain back a bit of weight without sacrificing a low level of ketosis.


Thanks for replying SusanJ. Yes, I'm thinking the same. I think some more healthy carbs may help. I'll experiment and let you know.

Gx

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Brian4
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Re: Uric Acid concerns

Postby Brian4 » Sun Sep 12, 2021 2:39 pm

There is enormous interested in trialing inosine, which raises uric acid levels, as a treatment in several neurological diseases. Inosine does other things, but its effect on uric acid, the most important plasma antioxidant, is thought to be what might drive any benefit. I started looking into inosine as a treatment for ME/CFS/SEID, which tends to correlate with low uric acid levels (probably because of defective purine metabolism), esp. in men. Myself, I'd much rather have high-normal than low-normal uric acid, based on everything I've read.

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Re: Uric Acid concerns

Postby Tincup » Sun Sep 12, 2021 4:38 pm

Per Rick Johnson MD in this Peter Attia podcast, fructose will increase uric acid. I have a long history of uric acid in the 4's.
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Re: Uric Acid concerns

Postby khooks03 » Sun Sep 12, 2021 7:13 pm

I've been on a keto diet for over a year but within the past six months, I have been having gout flare-ups. I'd love to add carbs but just read that a new study says carbs are our worst enemy. Well, it seems "everything in moderation" is a good rule of thumb. I plan to add a few carbs even if it bumps me out of ketosis a couple of times a week. Any observations or comments?

Incidentally, my mom. who died from Alzheimer's, also suffered from gout even though she was never on a keto diet. Could it be that gout is linked to APOE4/4 somehow?


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