What’s Wrong With the “Healthy” Diet Advice

Is it too late for me to prevent dementia? That is what a 60-year-old woman asked me last week after she had struggled with being a vegan, taken all of the plants out of her diet, returned to a really nice diet called a ketogenic diet, and lost 60 pounds. She was doing all the things right that I would say to do, but the fear of what happened to her mother was still haunting her. And then a lab test came back that said, uh-oh, this might be bigger trouble than I thought it would be. Stick around tonight. We have an excellent show for you. I am very excited to teach this lesson. If you're new to the channel, I will tell you this is an advanced lesson, so please don't be intimidated. We'll get back to some basics over the next couple of weeks. But it was after teaching the 21 Day that I heard several people, including some folks at the Pin Chasers, a little support group that I have here, local to Tampa folks, come for free Tuesday mornings, 8 o'clock in the morning on Tuesdays. And they get to hear me talk about some pretty complex conversations. And today's was no exception. As we talked about it, I realized it's been a long time since I've taught this lesson on YouTube. So welcome to the back side. We are looking at all the folks of where they are coming to me from. So thanks from the Netherlands. We've got Detroit. We've got some folks from California, New Jersey. Thank you for telling me where you're from. I did check my numbers right before we went live. My glucose of 88, ketones of 2.9. And this is, again, a theme that we do. It's a ritual we do every week. So if you're trying to find a support system and you're looking for some regular methodical check-in, it is Tuesdays at 4 o'clock Eastern time that I go live. I do it because I know there are folks out there that are like my mom, in the middle of nowhere, without a big support system, trying to return their body to health. And you're going to hear about a woman who did such an excellent job of doing that. She did it. And then she checked her labs to find something that was shocking. And again, is a risk factor for that brain not doing well. We're going to learn about that tonight. Learn about what you should do before checking it. And then what caused it to go high. What I think she should be worried about. And how to help her. Let's not forget how to help her. All right. A couple of, again, thank you, thank you. Just looking at all the folks and where they're from. I mean, every time I do this. Teaching a lesson on YouTube is, well, it's lonely. I don't get to see what is confusing or which parts are connecting with the audience. But boy, do I get a rapid fix for that hunger of finding a live audience. When I do that class that I just got done with the 21 day. If you are looking for a class that's not quite so intense. And this is the last few days that the cart will be open for the six week course. Which is exactly the same curriculum. It's just not so intense over three weeks. We spread it out over six weeks. We cut the price by more than half. We also do the same strict rules within our company. Which is reach for excellence. I was looking at the exit interview from the folks that filled out a Google form at the end of the 21 day. And I really like setting the curve when I was in school. I am really happy to say that of the one question that I grade myself on at the end of that class. How satisfied were you with the 21 day? And is it very satisfied? I'm highly likely to recommend this class to someone else. Is it moderately satisfied? I'll probably recommend this to somebody else. Satisfied or dissatisfied? And I like getting 100%. So of the people who have filled it out. Which is almost like 80% of the class. We only have one person who said they were moderately satisfied. But we have the rest who said we are very satisfied with what we learned in this class. And I'm going to use one of those cases to teach you tonight. A lesson that I think is very difficult. It is very complex. We are going to start with. What was that lab test that the patient got? This vegan who had been vegan forever. She had looked at the plant paradox. Which really looks at those lectins. And whether or not those are the cause of all the problems she was having. And her sister is the one who told her. Hey you should go eat some sardines. And she's like never. Never. But then she did. And what happened next is an incredible story. Of not just weight loss. But restoration of a metabolism. That this 60 year old woman had not enjoyed for years. But had been very disciplined in trying to get there. However right before class she checked a uric acid. And we love that. I like mine to be less than five. My husband's had gout for many years. And I like his to be even lower than mine. Because he's got. Well you're going to learn tonight. He's got some storage of uric acid built up in his body. But this woman's came back at 7.7. Again a clear indicator that this is way too high. And it is a predictor of problems. A predictor of cardiovascular disease. Diabetes. And also the Lewy body dementia. The kind of dementia that seems to creep into people with metabolic disease. And after learning what she had learned in this class. She's like I'm certain that's what happened to my mom. For all those years. As we continued to give her a diet that wasn't helping. And probably was hurting. Let's get right into it. It's going to take me a hot minute to get through these. And again we are watching your questions as this comes in. So if you have questions that pertain to this information. I've got a team in the background saying. Yep we're watching. We will see what fits. And they will help me find those at the end of this. Hopefully I get to not just answer some of the questions. But that the lecture gets you a level of understanding. That we hope is very easy. So yes uric acid is what we're talking about tonight. A really powerful paradigm shift is. Is it the symptom or the cause? Meaning do you have high blood pressure. And then you get uric acid elevated in the blood. Or do you have obesity. And then you get uric acid in the blood. Or is it uric acid is building up in the body. Causing hypertension and obesity and kidney disease. And fatty liver and type 2 diabetes and heart disease. And Lewy body dementia and memory problems. So here's our patient. I think this is her output. So she comes to us after having lost the 60 pounds. And her A1c was down to 4.2. A very low A1c. And we thought maybe that was. Because her red blood cells weren't living long enough. That's one of the reasons you can have a falsely low hemoglobin A1c. But the blood sugars are pretty high. Indeed that's not true. Check this out. As she steps into class. Her glucose is this red line right here. Started in the 90s in the first couple of days. Very good glucose. I like to point out here is the line for the one ketones. And she's way above one for her ketones. Already on the first day of class. Well then as you might have been told. The next challenge is a sardine challenge. The sardines. Well they definitely raised her ketones. Even though they already were high to begin with. And that glucose went down. And then returned back to not a huge spike. Over the next couple of days. She went back to her normal eating cycle. And again this woman has been practicing a ketogenic diet for over six months. She really took the class to get this question answered. Do I have to worry about dementia? It's what my mom died of. And is it too late for me to reverse this? So as I start to look at these numbers. And of course don't miss that the Dr. Ba's ratio down here. You know if you can get it less than 20. That's what I want my cancer patients to do. You're doing great. This woman's got a Dr. Ba's ratio in the single digits. When she did that sardine challenge. And then she did a water fast. And again the blood sugars did go down. The ketones went up. And I mean here let's just draw this. Here's the blood sugar of 50 for that. And a little crooked line there. But you can see what I'm talking about. Wow her blood sugars are not high at all. This is not metabolic disease. Like a normal or typical patient was showing us. But her ketones again don't crash right after she quits the water fast. They just kind of go back to this area where. I mean she clearly makes very good ketones. Oops let's put that in white. Maybe a little better than our blue. Again really good outcome. The patient is doing well. So when she comes to me and says. Well could I reverse all the problems that were happening. Before I started this ketogenic diet. Before I really cleaned up this metabolism. And that's what we're going to try to answer tonight. So let's start with what she had achieved. Yes her A1c was a 4.2. I think that's an average blood sugar in the 90s or low 90s. Maybe even 90 itself. Fasting insulin was 2.0. Again very good. And if you've ever checked an omega-3 index. I think the first time I checked mine it was 4%. When you have more and more fish. Which is what really was one of her things that helped her lose all that weight. Get the metabolism under control. She started adding sardines like her sister told her to do. And she had omega-3 index of 15. Which again might be dolphin level. What she didn't like was that her uric acid was 7.7. Again far higher than we want it to be. I like to have A1c and uric acid both be 5.0 or less. And it's because your uric acid is a waste product in our bodies. When you can smell the urine of any mammal. Whether that pugnant smell of urate. Our brains instantly know oh that's a waste product from another animal. You don't hardly have to be taught that as a child. In our bodies that urate if it's too high in the body. It will find deposits and put them in tissue. Parenchymal tissue that is a storage place. So we know that when we do biopsies of kidneys. Biopsy of arteries with soft plaques in them. Biopsies of the muscle of the heart. What do we find? We find that there are crystals. Uric acid crystals or urate deposits in these tissues. And of course the one that this woman's most worried about. Is the uric acid crystals that happen or the urate that happens in a brain. And how that connects. I love this lecture. This teaching from Rick Johnson. Many folks have done it. But I think he did a great job in his book. Why Nature Wants Us to be Fat. Well if you go back to look at the different primates on earth. That can eat fructose and get rid of that fructose. Without the danger of a stimulus that makes us fat. Which is uric acid. It's because their uricase mutation. An enzyme that takes fructose and makes it into uric acid. Did not show up until. Well we're walking with two legs. And then we added some very dangerous things to our livelihood. That was sugarcane. Then we added some alcohol. And God forbid the western diet. Again what's happening as that uricase mutation. Showed up in how these bodies changed. It was with that uricase mutation. That allowed us to store fat. And it sounds like it was a mistake. It's not a mistake. When there was famine. And we couldn't eat. That stored fat is what bridged us through a season. Where if they didn't have that uricase mutation. They couldn't put on enough fat to survive a famine. So yes we're here because we can get fat. Unfortunately we've taken that a little too far. So if we look at the places where uric acid comes from. We're going to talk about fructose. We're going to talk about alcohol. And we're going to talk about purines. I will tell you most people. Even chat GPT gets this wrong. They look at the uric acid and the purines. Or excuse me. They look at the alcohol and the purines. As the two that everybody knows. If you drink a malted beer. That's got a lot of you know. That can precipitate a gout attack. So can well so can little fish. Because there's a lot of purines in that. Let's unpack that just so you can see. When you look at a uric acid of seven. I need you. The first point I want to make is. This woman comes to me with this number. And her blood is how I did that right. You draw the blood and you check the test. But remember that blood uric acid test. Shows us what is in transit. Not what is being stored. Not what is the whole body uric acid level. It just shows us what's in transit. We're going to unpack that in a couple of steps. Because I think it's a super important point to make. When looking at the amount of uric acid that you get. The amount of purines that you get. When you eat little fish. I give them a couple of points. It's not nothing. Those are purines. And that is one of the backbones for making this uric acid. The uric acid ending up in her mother's brain. Is what she's worried about. And how can she undo that? So again she's eating these little fish to get better. So am I making this worse by doing that? Stick around. We'll teach you that. And then the nucleoproteins that you lose. That you recycle. When your body's mass declines. So this woman in this profile is overweight. As she loses weight. She is sacrificing the recycling of her own DNA. Of those own nucleotides. And by golly it does increase the uric acid in transit. As she lost weight. So she's like wait a minute. The uric acid is high because I lost weight. The uric acid is high because I ate little fish. And I'm like okay. It's not nothing. That is not close to the answer. That we see when people are suffering with uric acid that's elevated. So let's go through a few lessons here. Some of this it might be new to you. Sucrose is the little table sugar you've got. That you sprinkle on whatever you sprinkle it on these days. It comes with two saccharides. Two molecules that become sucrose. Which is glucose and fructose. Glucose we've talked about a lot on this channel. When you get that glucose to your mitochondria. It is going to spin down that electron chain transport. It's going to give you some ATP. Otherwise known as an energy. Adenosine triphosphate. So that T stands for tri. That's how many phosphates are put onto that backbone. If however you are trying to metabolize fructose. Fructose does not give you the same level of energy as glucose. And we can see that when we watch it inside a mitochondria. What comes out the other end of fructose is ADP. Adenosine diphosphate. Two phosphates instead of three. That's what do you care? It's a decreased energy. That's what happens. That's why when you drink high fructose corn syrup. Or have lots of fructose in your diet. The energy doesn't last as long. And there's a dirty little trick happening. That what becomes monophosphate. And now the monophosphate has to be dealt with. And that becomes the backbone for the uric acid. As it continues to be metabolized. That uric acid is what we are trying to measure. Of course when I put that needle in your arm. To draw your blood test. I'm measuring uric acid in transit. It's in transit. So keep that in mind as we talk about this. All right so here's a little anatomy. I think this is just fun to show you the animation. Yes here's a finger. And the tip of your finger has a blood vessel on it. So the blood vessel is going to have some uric acid crystals. Floating in it at all times. You are getting rid of waste at all time. How much waste are you getting rid of? Well if you're losing weight. That might be a little more waste. If you are eating a bunch of fish. There might be a little more purine in your blood. Would your body notice? Well depends on what it was doing before. We gave it those extra tasks to manage that weight loss. Specifically where that uric acid is supposed to be heading. Is to the exit door. It is a waste product. Urine has got that nitrogen or urate in it. So here's the place where blood gets filtered at the final step in the kidney. And as those uric acid crystals come along. They are in that little capillary bed. And it will slip into the urine. So that you can pee them out. If you've ever had a kidney stone. It's somewhere in this exit strategy. That if the kidney stone is made of gout crystals or uric acid crystals. It's a bad day for you. But it is part of the natural process of how do you get these waste products out of you. And if you have too much in transit. Well your body does things with that. So here's a picture of Mr. Normal Insulin. That's happy. There's no veins on his head. He's got a nice little smile on him. Normal amounts of insulin are accompanied by normal amounts of blood sugar. And you can see our patient over the last few months. Has been a very normal blood sugar. But she comes from a season where the insulin had been elevated. There are several signals in her past. That we say yep she had excess insulin. So this is what insulin usually looks like on this channel. He's got a much angrier face. Got some veins in his forehead. And he is causing problems definitely. So this is elevated insulin. What happens with an elevated insulin state. Is you're going to find more uric acid crystals in transit. In the blood. And if you get enough of them. They are going to find their way to a couple classic places in the body. One of those is the big toe. If you've ever seen gout painted in a picture. It's usually the big toe. Usually a big fat guy with a big fat tummy. A life of abundance. Usually a king is. Got a red toe. He's usually got a big meat stick in his hand for the purines. And then he's got a glass of beer. IPA beer. So how do you get gout? You have a fat tummy. But maybe the fat tummy came from these little crystals. Having too much of the real estate in your body. All right so here we go with. There's a tiny little uric acid crystal. It's trying to get out. It's got a lot of things to get around of how it ends up. Exiting the circulation. And then going to a place where the crystals then migrate outside the circulation. So when you lower the blood sugar. When you lower the insulin. Now you finally have a time. That these uric acid crystals can leave that joint. Leave that storage. And get to the kidney. I hope you noticed this little fella moving up and down over here. As uric acid goes to seven. And then back to five. It is where is the uric acid in the body? Is it in the toe? And if it is simply in the toe. I can't measure it in your blood test. This woman got a blood test the week before class. And her uric acid was very high. Surprisingly high. I love this little experiment that I did with one of my favorite patients. And it was. This is when you could get uric acid point of care tests. So just like I pricked my finger for the glucose and ketones at the beginning of the show. You could prick your finger and look for uric acid in your own blood. So he checked this several times throughout the day. I want you to notice. Here is where he ate. Okay. And so this was 16 hours fasted. And this is what the uric acid was at one hour. Two hours. Three hours along. Okay. So you can see what happens is it changes. Right. So it's going from 5 to 7.5 all along that. And then we said. All right. Here's a bunch more uric acid strips. I just want you to engineer. Do that engineer thing where you check and check and check. And let's see if we can make sense of what's happening in these patients in a ketogenic state. So where they check. The time they check since eating is a powerful predictor of how much uric acid are you using. I am very careful on the words. I choose for that because it doesn't mean. Oh, you ate two hours ago. So it's going to be X. It's you ate two hours ago. And in the past six months of what your insulin production has been. It is influencing whether you're storing uric acid or whether you're draining it out of the places it's been stored. So there's a whole formula there that I think is very difficult to really understand until you. Oh, exhaustively studying uric acid. So here are several days from the same exact patient. It's over the course of a time where he's being super disciplined, super strict. This was day one. Here's what happened at the zero time. It was in the like six and a half by two hours in. He is at here. I think he checked it at the half an hour there. But you can see by the time he gets to eight hours out, he's like at seven and a half. That's where our patient is. Right. So let's do the second day. A second day comes along. And again, up and down and up and down. I think he checked it like six times on day two. On day three, it was even worse. Like, oh my goodness, it doesn't make any sense. There is so much happening that if you're judging the uric acid by the blood level and you're trying to assess what's the whole body uric acid, you've got a flawed formula. And we've had a flawed formula for uric acid for a long time because of this. So here's four days from a very dedicated student who helped me say, I give up. I give up trying to predict what uric acid has to do with the patient in front of me. However, the study is looking at that dementia, that brain that doesn't work right. And why are those uric acid crystals on the other side of that brain? Oh my goodness, I just crashed. Let's try that again. I'll come back over here while I fix this. Yeah, if you had joined me last week, you know that I had a big learning curve last week. And it is not a mistake I'll make again. I am definitely thankful for my team who said, here, here's how you fix this. All right, here we go back to our patient. Okay, so here's our patient. This is just a recap of what happened. Reminding you that this is what happened with her sardines. This is what happened with her water fast. Notice that Dr. Bha's ratio is really good. Again, what am I really looking for when I look at that Dr. Bha's ratio? From the moment she came into class, her Dr. Bha's ratios were, I mean, crazy low, way better than mine would be. Which means she is not using her insulin resistance, although it may have been a major problem in her health in the past years. The season she's in right now has a very low insulin production. So says her Dr. Bha's ratio. And again, we get to compare numbers when you're in class together. Definitely a few folks that were a little bit jealous of how good these numbers were. So here's one thing that became a very important teaching lesson. She comes in front of the team. She was in the middle of the water fast during this case. And we had the numbers from the sardine challenge where those ketones went really high. And I said, had you checked your uric acid during that sardine challenge, your uric acid would have been worse. Okay, why? All right. So in a season where she had super high ketones, getting ketones to disperse, dispense throughout the body, getting them used by the cells that are ready to use them. But then if nobody is ready to use them, there is an exit for those ketones. You pee them out. It is an overflow in the kidney. And when you have a bunch of ketones that are in excess, it competes with getting rid of uric acid. So during a season where the ketones were really high, or in that three or four days where she's taking in those little fish, so that's going to increase her purine production. And then she's fasting, a water fast on top of it the week after. Both times, her ketones are usually not this high, but she was being extra good during class. And of course, the blood uric acid, it's 7.7 there, is what is getting everybody's attention. So I want to just say that one more time, making sure everybody heard that. When you look at uric acid and what happens in the transient part during a sardine challenge or during a water fast, when your ketones go up, the exit door for your uric acid crystals is blocked. Or it's competing with uric acid and the ketones to get them into the urine. The ketones win. Ketones super high give you an acidosis. The body's going to pick the ketones to get rid of first before the waste product of uric acid. So when you're in an extreme challenge or extreme metabolic stress, you will see those go up quite significantly. All right. So the other part that we talk about in our class is something called the polyol pathway. So let me just recap what I've said. Why did this woman's uric acid elevated? Yes, she's eating little fish. Yes, she has got weight loss that's happened for 60 pounds worth. There's elevated ketones in recent days. That's not nothing. Her insulin is not elevated. So that's on the list, but that's not for her. She doesn't eat fructose. She doesn't eat a lot of fruit. So that's not it. But there's this, the polyol pathway. So this is something I've talked about in other lectures. So I'll keep it brief, but I love the hidden what happens. The polyol pathway is something I thought only happened in advanced diabetics. And as an internist, I just like, I don't know. I'm sure somebody taught me this in medical school, but it's something that you only have to think about when you're dealing with extreme diabetics. Well, I got schooled pretty nicely by the master of the polyol pathway, Rick Johnson, who studies kidneys, has looked at those kidney biopsies, seen uric acid crystals in his kidney biopsies, and then looking at why is there so much uric acid in these advanced metabolic patients? And part of it is this, that you turn glucose into fructose inside our bodies. That this is an escape clause that your body gets that glucose decreased. Now, remember, when I check this, when I check my sugars every week, and when you check them with your Keto Mojo, you're checking glucose. If fructose is in circulation, you do not measure it. This was a mistake that was kind of looked past in the 1970s when we said, high fructose corn syrup must be healthy because it doesn't raise their blood sugar. But holy Hannah, did it raise their insulin? And did it raise their uric acid? Did it raise the need for high fructose corn syrup? Makes you thirsty, makes you put on weight, increases that blood pressure. It does several metabolic diseases as if the blood sugar was high. But fructose is not measured by point of care. And it also is something that if you lower the glucose and turn it into fructose, it's kind of an escape clause for people who had super high blood sugars. Except when I was looking at, so here's, yeah, here's an example of that. So if you look at the blood sugar in the 85 range, most of those glucoses are going to stay the same. And you're going to have very few of them turning into fructose. If you do have a few fructose, where does that end up? Oh, that's uric acid crystals. But your kidney will pee it out, no problem. You're going to be fine. Notice how that little pink ball went up and down as I was talking about that. As you look at higher blood sugars, and I'm looking at closer to that, you know, 120, I thought maybe 180. This is what's happening. You're taking those glucose, you're making them into fructose. And then your body's got to deal with it in a different way. But at least the glucose was lowered. When I look at that 85 and then increasing the blood sugars like that, now we have that 120 blood sugar. And of course, what that means is many more of those blood glucoses are turning into fructose. And now you've got a bunch more crystals. Notice that that uric acid went up. There's a high amount of uric acid in transit in the blood. And your body deals with it by trying to pee it out. But if it's got a space in your big toe, it'll park a few of those crystals there. So when I look at the polyol pathway, I had I don't know, deception that only people who had to worry about this were diabetics. But when I got the master himself on the podcast, if you go back and watch our conversation, he's very tricky. He does not answer this question live because Michael, what's the number? What is the blood sugar? You should keep your patience below if you're trying to not make these chronic disease processes, especially the one in the brain. And he wouldn't answer it. So then we get off of it. I'm like, all right, Rick, what number do you want your blood sugar to be? In hopes to not trigger the polyol pathway, I should let you guys guess. The pin chasers guess this morning, too. And I was like, yeah, I know. But the answer is 105. I mean, when I was wearing a CGM and I learned this, I'm like, oh, my goodness, I can eat an apple and my blood sugars go higher than 105. I'm insulin resistant, had been for years. And even though I'd done a lot of things right, it did not take a lot of stimulus for me to send that blood sugar a little higher than it should. So something as healthy as an apple was triggering. And every time the blood sugars tip over this 105, the chances you're making more fructose is really is true. So here we are. Let's go back to our patient. Yes, she's eating those little fish. I give her a couple of little points for making uric acid crystals there. Yes, she lost 60 pounds over the last half of a year. And as she did that, she is removing those nucleotides from her body. She's decreasing the mass. That's the point of weight loss. So that's normal. But then she's got fructose consumption. She does not consume fructose, but she did have those blood sugars that were elevated in the past. Now, she shows up to class and they are not elevated. So that's where we're going with this. But I'm as you guys watch this and you say, hey, my blood sugars are 105 in the morning is a really important predictor that we say you've got to fix that. You've got to fix that. We have several things that we talk about. What does it mean to fix that? All right. Uric acid is 7.7. Again, transient uric acid is produced by the purines that come from those little fish, weight loss, fructose, excessive amounts of insulin, and even high ketones can push that uric acid blood levels up because it's competing for the exit. And of course, then we have the polyol pathway. All right. So go back to our picture here. This is the one we're trying to say, doctor, is it too late for me to prevent dementia? In my case, my mom got dementia in her 60s. I don't want to turn out like that. So the part that is difficult to talk about is, well, OK, so you've got high blood sugar. Now she doesn't have very high blood sugar, but in the past she did. So how did the fructose get into her brain? Well, the brain makes fructose on its own. Yeah, that's that polyol pathway that's happening on the other side of the blood brain barrier. So if you tuned in last week, these were some of the slides I was trying to show you. Here's the cute little brain. Yes, it's pink and happy and healthy. And if you look at this blood brain barrier, right there is this very protective part of our body. It's a very sealed and protective layer that keeps stuff happening on one side of the circulation. Stuff happening on the other side is past the blood brain barrier. And when you look at glucose, it needs a GLUT1 transporter to get from the circulation into the brain. So these little transporters come in, the glucose goes to the other side, and you say that's how glucose gets on the other side. But if you want fructose to get to the other side, it is not allowed in these. It cannot come here. In fact, fructose cannot cross that blood brain barrier. They don't get to the other side. However, ketones, this was the other slide I was trying to show last week. Ketones, yes, they use an MCT and forgot what the MC stood for. Sorry about that, guys. That is a transporter for only ketones to get across the blood brain barrier. So the fuels that get past that are glucose and ketones. So then how did the uric acid end up in or the urate end up in these brains, especially the brains that were struggling with years of memory problems, years of Lewy body dementia? Again, her question, is it too late for me to prevent dementia? And she shows up to class doing so good. I'm like, I don't know if I can teach you anything. Look at how good you're doing. And she's got the weight off and she's really been a great citizen in her little classroom. People learning from her how she did this. And of course, she's a recovering vegan. So I'm like, wow, that is so off brand. How did you get here? But again, she said, I can't believe how much better I feel and what my brain is doing. So the final step for her was, OK, let's talk about this. You have a number that's very high and we have drugs that can help you. Of course, what came first was she lost the weight she controlled for her insulin. She reduced the average blood sugar. She did eat the little fish, even though there's purines in it. That's a tiny contribution to the bigger picture. She has control for several of these things. So what could I offer her? And that is, well, we do have a couple of drugs. One of them is the drug that takes AMP and it stops it from becoming uric acid. If we block this, the old drug is called allopurinol. The more recent, the one that I really, really recommend is buxostat. Now, I'm not able to write this prescription for her, but this is a very important conversation between her and her doctor. That uric acid of 7.7, I don't think it's an accident. In my years and years of checking for uric acid in patients and trying to assess where are they at in their gout attack, it is numerous. And this is a test question on boards that just because their uric acid is normal, doesn't mean that swollen big toe isn't gout. The diagnosis for gout is to aspirate or pull the fluid out of the toe, put it under a microscope, put that polarizing shield on there to see the crystal. And by that time, we are so far up a creek in the wrong direction. You're like, okay, you don't need to wait for it to be that bad. Let's take my husband, for example. We get married in our young 20s and gout runs in his family. He was a really good truck salesman. And every time he sold a truck, he took the guy out for a steak dinner. So he's heading close to 300 pounds before we have our first baby. And in that weight gain, the uric acid crystals traveled to his big toe. And his wife says, well, I can give you a shot in your big toe. It's going to hurt terrible, but then you'll be better. And of course, the prescription medications to lower the uric acid were allopurinol, probenicid, some of the other things that would stop the pain. And I got to learn what over and over and over again, a gout attack looked like because it was under my own roof. And surely the number of times we checked his uric acid and it came back at 5.8, 6.1. Why do I want uric acid below five? Because it's really hard to screw it up to go from a three or four to a seven just by changing the transient. We want the whole body uric acid to be lower. And if you're just testing the transient, you're missing a big part of that equation. So I know for certain that my husband has high uric acid in his body. He comes to the ketogenic diet. And indeed, when he would eat sardines and send his number up, oh, he would get a gout attack because he was making ketones, because he was adding in some purines. And his whole body was doing things that, well, that happen when you have years of excess uric acid. So when I saw his body mass decrease, and I want him to have the lowest amount of uric acid in his body because of these brain studies, well, I started him on Fibuxostat, 80 milligrams, or his doctor did. I talked his doctor into saying 80 milligrams of Fibuxostat. And it is a fast, rapid, like multiple times, two to five times more powerful than allopurinol. So if we're trying to get uric acid out of the body, Fibuxostat is an excellent tool that is now generic. You take the medication and it stops this conversion of, it's the xanthine oxidase enzyme that it's doing. Very powerful. Not something I can give this lady, but I can tell her if it was me, I'd be going to my doctor and asking for Fibuxostat. I'd want that in the two to three range, not anywhere close to seven. The other part that actually helps right at this junction, where those uric acid crystals are being lifted from the blood into the urine, and that's actually called probenicin. A little harder to dose, but it's an old drug that does increase the removal rate of uric acid. So doing that in this patient were two places where I said, I would do that if I were you. If it was my husband, I would do that. In fact, it has been a couple of places where you say, well, doc, how do I know if the uric acid in my body is elevated? And you say, well, you can check a blood test. And if it comes back at like 3.5 or 4, that's a really low level. You could probably believe that. But if it comes back high, like the 7.7 did in our lady, the first thing I would tell her to do is stop. I would tell her to stop the fast. She was on a water fast when she had done this, or she was prepping for class and was kind of like trying to be too good for her blood test that she was going to get measured. So I tell her, stop the water fast, go back to eating normally. You're just making way too many ketones, and you're blocking how quickly we can get uric acid into the urine. So stop that, let it settle down. And then I would just find your regular rhythm in life. Go back to your eating window of four to six hours. And when you check your uric acid, do it first thing in the morning, about 14 hours after you last ate, especially for my ketogenic patients. I just want a very standard 12 hours is a little soon, but 14 hours seems to be the right interval to check that. The next thing I would do is I would ask, so I would stop the fast, I would stay hydrated, get the ketones to come down a level and then recheck it, see if it really is 7.7. I wonder, and this is the real art of medicine, that those years of a vegan diet, those years of trying to find the solution, that once she figured it out, bam, 60 pounds are off of this woman. She looks amazing. She feels amazing. So in the season where she was making more uric acid than she could remove, when the sugars were higher than they should have been, how much is there in her brain? And if it was me, I would be taking something like the Boxostat. I would say, no, do it for the next few years until you get a uric acid that's in the three and a half range because she's done everything right. She has lost the weight. She's figured it out. She pricks her finger. She was such a good student to teach her classmates how she has cracked the code on her body. And yet, is it too late for her to prevent the dementia? Can we get those uric acid crystals out of her brain? Well, we aren't going to do a biopsy to prove they're there. That's going to happen postmortem if she lets the pathologist look. And I wouldn't want to take the risk. I would be removing uric acid until the number is very low. And then stop it or keep an eye that the uric acid doesn't go back up after that. OK, so that lesson is very complicated. If it was your first time here on the channel, please, please, please don't be intimidated. We have a great one next week that isn't quite so complex. I do have a couple of things that I think will be in the questions. So I'll get to those in just a second. I want to go over to our website and say a couple of things. So first of all, number one, front page of our website, we have something it will have a newer look coming your way soon. So stick with us. I do want to show you that under the Dr. Ba's products, there is the six week class. This is let's see if that's changed. This is Jillian. I put her picture up there so you can see. Oh, and then I just replaced it with mine. I teaching this class has been something that I am. I think if you've ever had a calling in life and you avoided it and then you leaned into it and you could just feel that there is a holy spirit that comes through what I do in this class and teaching students. And I've never had something so impactful be so easy. And the person I've walked with this on the front stage with is Jillian. She is the coach that I trust to have to walk through this with you. This is her picture there. And she is amazing. She's been with me since I started this. And she has quite the origin story for teaching people as well. The enrollment is open. We just have a few seats left before we're going to close that. And we will use them for the next. They'll be with Jillian and I for the next six weeks. So join. You'll get to hear cases like the one we just just went through. I want to show you also on Dr. Ba's favorites. There is something that I want to announce too. This Ketogenic Foundation is something that I wish I could have attended, but I couldn't this year. This is the Keto Mojo. It is their organization for teaching the ketogenic diet. When I look at what happens inside that class, if it wasn't for their generosity in helping me set up those classrooms, teach the students how to use peer pressure, meaning look at other people's numbers. Don't be the only number you look at. It's not that HIPAA. It's really just blood sugar and ketones. And you can't believe how much we learn and teach one another by sharing in community those numbers. If it weren't for this organization, that class wouldn't be nearly as impactful. There are several places on here where they teach a ketogenic diet. If you're a school and you want to teach a ketogenic diet, if you are a church and you're trying to look for a ketogenic diet, if you're a medical school and you're trying to teach a ketogenic diet, this foundation is truly trying to be best in class through education. If you are looking for a place to donate, they of course could use the help. But most importantly, if you need a resource to watch the videos and understand this, they invite me. I actually sponsored something for them, and I've never done that before just because I didn't have the resources to do it in the past. But if I was going to put money towards somewhere, it would be this organization. Okay, so we've got the hard things done. We've got the six-week announced. We also have my friend and colleague, and I just want to make sure, go over to his website and just click on a few things so he can see the traffic increases when we send people there. They do such amazing work, so checking out their resources. Okay, let's get to your questions. I hope this hits home with what we're teaching today. Okay, so is there a connection with uric acid and oxalates or oxalate dumping? Not really, except for that both of these crystals end up in urine, and oxalate crystals are also elevated when you have high insulin. So uric acid elevated with high insulin, oxalate elevated with high insulin, both end up as crystals inside a kidney, which could be a kidney stone. But the way they're made, very different origin sources for both of those. Again, the oxalate that I always am shocked by is rhubarb. One of my favorite things as a kid was to go, in South Dakota, there was a rhubarb place where my mom and I would go get the rhubarb, and it's really a weed, but we would go get that, and apparently that is not okay if you're an oxalate producer to have that. All right, so let's go. Hello from Washington State. Husband has gout and is afraid to eat sardines because of the uric acid. Is there a way for him to safely eat the purine foods? Oh my goodness. First of all, she's a quilter. That's so nice. So let me walk you through that. Let me tell you what I did with my husband. First of all, if he has gout, you have the definition that there is more uric acid in his body than he is supposed to have. The places he puts that is what ages him faster. So I know that dealing with the uric acid, it's this bitter conversation. And I can tell you, I've had pillow talk over this with my husband as well. And again, when the sheets would lay on his big toe during an attack, it was like worse than childbirth, apparently. It was like really bad pain. So I get that this is a delicate conversation. The fish lower the insulin. And of course, that's the most common thing that cause, I mean, that's the biggest area under the curve. They have high blood sugars. They have, you know, high blood. So when you eat purines, you put, you know, and they come in sardines. When you eat sardines, you have a meal. The purines go up for a little bit right after you eat the meal, and then your body uses them. But when you have chronically elevated blood sugar, it's there all the time. I think that's one of the hardest things for people to appreciate is that it wasn't just the little time after they ate food. Your blood sugar is elevated all the time. And when it is above 105, you are turning a portion of those glucoses into fructose, and then fructose becomes uric acid. So it is, you know, a neon sign day after day and night and month after month that the crystals just keep finding new places to park. And especially when that's in the brain, the consequences are devastating. So I get that your husband does not want to hear that fish could help him. So don't start there. Put him on a ketogenic diet. Get a pricker. Make sure you're not playing around with a ketogenic diet. You're actually in ketosis. And that will be the first place that says yes. When the ketones are just a little bit high, we're talking like 1.2, 1.4, that's not going to block the exit of uric acid. If you saw our patient, that was ketones of 5, 6, 7, 8 that blocked the exit for her kidneys. And indeed, she did not get a gout attack the whole time. This was just a blood test that I want her to see is transient. But if it was me, I'd be lowering my whole body uric acid just in case because aging with those crystals in the brain is this memory problem that's linked to it. All right. So the high purine foods are really the fish. I know that steak and other meats have purines in them. But what you're really looking at the ketogenic diet is high fat. So make sure he's having the chicken wings dipped in blue seas, blue cheese dressing. Make sure he's having brisket, which is a lot of fat or pork belly, which is a lot of fat. 80% fat is where this chemistry shift happens. Don't miss that. All right. Back to the questions here. A couple more. So is it uric acid causes the kidney damage? Yeah. Let me go back to the slide real quick. Let's go to here. I like this one. There we go. So yeah, if you look at this, this is kind of blown up. What I don't want you to miss is uric acid crystals that are, you know, hanging out in the circulation. That's one thing. It's when we biopsy a artery and we see them in the plaque. When we biopsy the muscle or at autopsy, we look at... This isn't in the circulation of that heart. It's in the muscle of the heart. And of course, where Rick Johnson was just overwhelmed is when you would do a biopsy of the kidney. That uric acid was in the kidney. And yes, it's very damaging. It's like little knives living in there. And there is an inflammatory response to their presence that they are used to help take care of, you know, free radicals. It's part of the purpose of the uric acid crystals. But it's in here inside that brain where you say, oh, no, that fructose was produced on the inside of that brain. And when that fructose went to uric acid, it now parks there until the circulation is low enough that you can start reversing that process. All right. Well, thank you, guys. I will tell you that in my life after the 21 day feels like I'm on vacation. So it's been a lovely day. I want to say a special thanks to those folks at the Pinchasers who show up every Tuesday. This YouTube show would not be anything as good if they didn't come and visit me. It is free. If you're in Tampa, swing by and meet the Pinchasers and I. When I try to teach something, something as complicated as this, if I didn't have them asking questions in real time, you would not have that good of a report. Oh, we got one more question that just came in. Let's take care of that. Dolores writes in and says, why is fasting bad when uric acid is high? OK, so that's that's not the whole thing. Let's just unpack that a little bit. Why is fasting bad when uric acid is high? So when that woman was fasting, her ketones went up. And as the ketones got higher, they are competing for the same exit door. Uric acid and ketones both need to go out through that little capillary bed in the kidney. And as it's exiting, there's so many ketones trying to get out when she was fasting that there was not space for the uric acid to empty as well. So if it doesn't empty, it stays in circulation, which then would raise her uric acid a little higher. And indeed, she has such good ketone production that I don't think it's from the excessive production. Her blood sugars were in the 80s or 90s. But when she has that high ketones, getting the ketones to the door is more important to the body than getting the uric acid out the door. So it's not that fasting was bad. It's that it raised her uric acid. And it's because her ketones are like four or five. So it doesn't that that fasting is just a complication of uric acid rising. I mean, it's not uncommon that I have patients say I went on the ketogenic diet and my bones started to hurt when my ketones were like three. I'm like, I think I'm allergic to ketones. You're not allergic to ketones. You just have uric acid that's trying to get to the door. And when you get that really high production of ketones, it's not going to be there forever. It bounces up and then it goes back down. So when it's up high like that, you can't get the uric acid towards the door. And that's where it will build up in the body whenever you change the rate of movement of a uric acid crystal. That's when they hurt. So that's what fasting does. All right, that's a wrap, guys. We will see you next week. Thanks for tuning in. I really appreciate the committed attendance.