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Peter Attia MDProtein’s impact on appetite, and uric acid's link to disease & how to manage (AMA 62 sneak peek)
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CHAPTERS
- 0:02 – 1:48
Welcome and the Fanny Pack Debate
Peter Attia and the host banter about the fanny pack that made the rounds on social media. Attia defends its utility, including as a way to carry protein.
- •Host raises the fanny pack photos that circulated online
- •Attia jokes that more than 25,000 people voted against the fanny pack
- •Host points to a photo where the phone was in his pocket instead
- •Attia says the fanny pack is good for transporting protein
- 1:48 – 4:33
Episode Preview: Uric Acid and Protein's Effect on Appetite
The host lays out the two topics of the AMA: an update on uric acid as a biomarker, and the relationship between protein and appetite. Attia notes the two topics are adjacent through the protein–uric acid link.
- •Uric acid revisited because of new information since the last discussion
- •Uric acid will be covered in terms of disease and metrics used for patients
- •Protein section will cover appetite, energy expenditure, and protein types
- •Attia says the two topics are adjacent
- 4:33 – 10:11
What Uric Acid Is and Why It Matters
Attia explains that uric acid is a metabolite of purine breakdown and of fructose. He covers its links to gout, kidney stones, and high blood pressure, and why Mendelian randomization is useful for establishing causality.
- •Uric acid is a product of purine (DNA/RNA building block) breakdown and a fructose metabolite
- •A mutation unique to humans and close relatives allows higher uric acid levels
- •Crystallization in joints causes gout, often in the big toe; urate kidney stones are another consequence
- •Mendelian randomization suggests uric acid raises blood pressure
- •Fatty liver and type 2 diabetes come with high uric acid, but causality direction is unclear
- 10:11 – 13:51
Non-Modifiable Factors: Sex, Genetics, and Age
Attia describes the factors affecting uric acid that cannot be changed. Men run higher than women, heritability is about 40 percent, and levels rise with age, especially in women after menopause.
- •Men average 0.5 to 1 mg/dL higher than women in the literature, and Attia sees a bigger gap in patients
- •Estrogen is the most obvious hypothesis for the sex difference
- •Heritability of uric acid is about 40 percent, which enables Mendelian randomization
- •Women's levels rise sharply from the mid-forties, though still below men's at age 80
- 13:51 – 20:05
Modifiable Factors: Diet, Medications, Ketosis, and Exercise
Attia discusses what can raise uric acid, including fructose, adiposity, certain medications, purine-rich foods, beer, and ketosis. He shares his own experience getting gout in nutritional ketosis and notes that heavy anaerobic exercise can transiently raise levels.
- •Population uric acid levels have risen over the past century alongside obesity and metabolic syndrome
- •Mendelian randomization suggests adiposity can cause hyperuricemia
- •Diuretics, low-dose aspirin, red meat, sardines, and beer can raise uric acid
- •Beta-hydroxybutyrate competes with uric acid for kidney excretion, and Attia's levels rose from about 5 to 9 or 10 during fasts
- •Heavy anaerobic exercise transiently raises uric acid, which Attia doesn't consider pathologic
- 20:05 – 23:30
Uric Acid and Cardiovascular Disease, and Premium Membership Wrap-Up
The host asks how uric acid relates to cardiovascular disease risk, which the sneak peek does not answer. The episode ends with Attia's description of premium membership benefits and disclaimers.
- •Host links uric acid, blood pressure, and cardiovascular risk
- •Full AMA is available to premium members
- •Membership benefits include show notes, monthly AMAs, a premium newsletter, a private feed, and the Qualies
- •Standard medical disclaimer and disclosure information
