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Protein’s impact on appetite, and uric acid's link to disease & how to manage (AMA 62 sneak peek)

View show notes here: https://bit.ly/3ykzdJb Become a member to receive exclusive content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ In this “Ask Me Anything” (AMA) episode, Peter dives into two important health topics: uric acid and protein, examining them from unique perspectives. For uric acid, he explores its metabolic role and connection to various diseases, focusing on the potential causal link with cardiovascular disease. He also discusses factors influencing uric acid levels, such as diet, genetics, and lifestyle, providing practical tips for effective management. Shifting to protein, Peter delves into its role in appetite and weight management, the consequences of insufficient protein, and the “protein leverage hypothesis” linking protein deficiency to obesity. He covers optimal protein intake and its impact on energy expenditure, and he compares the satiety effects of solid versus liquid protein. Finally, Peter shares his strategy for incorporating protein into a comprehensive weight management plan. We discuss: 00:12 - Overview of episode topics (and an important discussion on fanny packs) 03:03 - Understanding uric acid: its role in metabolic processes, its association with gout and kidney stones, its impact on blood pressure, and more 10:03 - Non-modifiable factors that influence uric acid levels 13:39 - Modifiable factors that influence uric acid levels 20:05 - Association between high uric acid levels and cardiovascular disease In the full episode, we also discuss: -Evidence suggesting a causal link between high uric acid levels and cardiovascular disease [24:00]; -Inconclusive evidence about the cardiovascular benefits of lowering uric acid pharmacologically [28:15]; -Exploring the potential risks of low uric acid levels in neurodegenerative diseases [37:00]; -Managing uric acid levels: dietary interventions and pharmacological approaches [42:00]; -The impact of protein on appetite and weight management [44:00]; -The consequences of insufficient protein on eating behaviors and satiety [52:15]; -The relationship between protein deficiency and obesity: exploring the “protein leverage hypothesis” [57:15]; -The impact of protein intake on energy expenditure [1:02:15]; -Determining optimal protein intake to avoid deficiency and support health [1:05:45]; -The role of different amino acids and protein sources in promoting satiety [1:08:15]; -Comparing the satiety effects of solid vs. liquid protein sources [1:10:30]; -Peter’s framework for incorporating protein intake into a strategy for controlling body weight [1:12:00] -More. -------- About: The Peter Attia Drive is a deep-dive podcast focusing on maximizing longevity, and all that goes into that from physical to cognitive to emotional health. With over 90 million episodes downloaded, it features topics including exercise, nutritional biochemistry, cardiovascular disease, Alzheimer’s disease, cancer, mental health, and much more. Peter Attia is the founder of Early Medical, a medical practice that applies the principles of Medicine 3.0 to patients with the goal of lengthening their lifespan and simultaneously improving their healthspan. Learn more: https://peterattiamd.com Connect with Peter on: Facebook: http://bit.ly/PeterAttiaMDFB Twitter: http://bit.ly/PeterAttiaMDTW Instagram: http://bit.ly/PeterAttiaMDIG Subscribe to The Drive: Apple Podcast: http://bit.ly/TheDriveApplePodcasts Overcast: http://bit.ly/TheDriveOvercast Spotify: http://bit.ly/TheDriveSpotify Google Podcasts: http://bit.ly/TheDriveGoogle Disclaimer: This podcast is for general informational purposes only and does not constitute the practice of medicine, nursing, or other professional healthcare services, including the giving of medical advice. No doctor-patient relationship is formed. The use of this information and the materials linked to this podcast is at the user's own risk. The content on this podcast is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Users should not disregard or delay in obtaining medical advice for any medical condition they have, and they should seek the assistance of their healthcare professionals for any such conditions. I take conflicts of interest very seriously. For all of my disclosures and the companies I invest in or advise, please visit my website where I keep an up-to-date and active list of such companies. For a full list of our registered and unregistered trademarks, trade names, and service marks, please review our Terms of Use: https://peterattiamd.com/terms-of-use/

Peter Attiahost

Aug 12, 202423mWatch on YouTube ↗

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WHAT IT’S REALLY ABOUT

Uric Acid Explained: Causes, Risks, and Modifiable Factors, Plus Fanny Packs

The episode opens with banter about Peter Attia's fanny pack, which he defends as handy for carrying protein, before moving on to the planned topics of uric acid and protein's effect on appetite.
Attia describes uric acid as a metabolite of purine breakdown and of fructose, and links high levels to gout, urate kidney stones, and high blood pressure, with Mendelian randomization supporting a causal role in blood pressure.
Non-modifiable influences include sex, heritability of about 40 percent, and age, with women's levels rising sharply around menopause, which points to estrogen's role.
Modifiable influences include fructose, adiposity, certain medications, purine-rich foods and beer, ketosis or fasting, and heavy anaerobic exercise, and Attia shares his own gout episode while in nutritional ketosis.
The clip cuts off just as the question about uric acid and cardiovascular disease is posed, and the rest is a pitch for premium membership.

IDEAS WORTH REMEMBERING

5 ideas

Uric acid comes from both purines and fructose

Attia says it is a byproduct of breaking down purines, the DNA and RNA building blocks, and also a metabolite of fructose.

High uric acid has several clinical consequences

Beyond gout, which is inflammatory crystallization in joints such as the big toe, high levels predispose to urate kidney stones and contribute to high blood pressure.

Mendelian randomization helps establish causality

Because uric acid has genetic variation, Attia says MR shows blood pressure rising and falling with uric acid, though confounding from fatty liver and type 2 diabetes complicates the picture.

Sex, genetics, and age shape uric acid levels

Men run 0.5 to 1 mg/dL higher in the literature, though Attia sees 1 to 2 in his patients; heritability is about 40 percent; and women's levels climb after menopause.

Whether fructose chronically raises uric acid is unresolved

Attia notes fructose clearly raises uric acid transiently, but it is unknown whether it does so chronically or acts indirectly by driving eating and obesity.

WORDS WORTH SAVING

5 quotes

That's one of the beauties of the fanny pack is you can transport protein.

— Peter Attia

So uric acid is a metabolite, right? It is, it is the product of the breakdown of purines.

— Peter Attia

The heritability of uric acid seems to be about forty percent. In other words, nearly half of the value of your uric acid is determined genetically.

— Peter Attia

Beta-hydroxybutyrate competes with uric acid, uh, in the kidney for the same transporter that is going to, uh, excrete either uric acid or BHB.

— Peter Attia

I was just, you know, really lean, really healthy, you know, smoking and joking in my ketosis, it took me, like, two weeks to figure out why my toe hurt so much that I couldn't do a flip turn in the pool and put any weight on that foot as I pushed off.

— Peter Attia

Uric acid as a purine and fructose metaboliteGout and urate kidney stonesUric acid and blood pressureMendelian randomization and causalitySex, genetics, and age effects on uric acidKetosis, fasting, and goutDietary and drug influences on uric acid

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