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

Summary

In this podcast, host Peter Attia interviews a guest discussing the utility of fanny packs and their fashion choices. They delve into the biochemistry of uric acid, its association with gout, and its role as a blood-based biomarker linked to diseases like hypertension. The conversation explores factors influencing uric acid levels, from genetics and age to diet and medication. They also touch on the impact of uric acid on cardiovascular health and the potential connection to kidney stones.

Takeaways

• 🎧 Peter discusses the utility and fashion choices related to fanny packs, highlighting a humorous interaction with the audience.
• 🧬 Uric acid is a blood-based biomarker associated with purines breakdown and fructose metabolism, and it's linked to gout, kidney stones, and high blood pressure.
• 🚫 High levels of uric acid can lead to gout, an inflammatory condition in the joints, and kidney stones, specifically urate-based ones.
• 🧪 Peter explains that Mendelian randomization studies have helped establish the causal relationship between uric acid levels and blood pressure.
• 🚹🚺 Sex differences play a significant role in uric acid levels, with men naturally having higher levels than women.
• 🧬 Genetics account for about 40% of uric acid levels, indicating a strong hereditary component.
• 🏋️‍♂️ Intense anerobic exercise can temporarily increase uric acid levels due to ATP degradation byproducts.
• 🍺 Diets high in purines, such as red meat and beer, can elevate uric acid levels.
• 💊 Certain medications, like diuretics and low-dose aspirin, can increase uric acid levels.
• 🔍 The discussion suggests a complex relationship between uric acid, diet, exercise, and health conditions like gout and hypertension.

Q & A

What is the primary focus of the podcast episode featuring Peter?

The primary focus of the podcast episode is to discuss uric acid as a blood-based biomarker, its association with various health conditions like gout, kidney stones, and high blood pressure, and its role in cardiovascular disease. Additionally, the conversation delves into the relationship between protein intake and appetite.

Why is uric acid a concern in the context of health?

Uric acid is a concern because elevated levels are associated with gout, kidney stones, and high blood pressure. It can also be a marker for other health issues such as fatty liver disease and type 2 diabetes. Furthermore, there is evidence suggesting that high uric acid levels may contribute to cardiovascular disease.

What is the connection between fructose consumption and uric acid levels?

Fructose is a metabolite that can lead to increased uric acid levels, both transiently and potentially chronically. High fructose consumption, especially in liquid form, might contribute to the rising average serum uric acid levels observed over the past century.

How does the host's use of a fanny pack relate to the discussion on uric acid and protein?

The host's use of a fanny pack is a humorous aside and not directly related to the scientific discussion on uric acid and protein. It serves as a light-hearted moment in the podcast and is used by the guest to introduce the topic of protein's role in health.

What is the role of genetics in determining uric acid levels?

Genetics play a significant role in uric acid levels, with heritability estimated to be about 40%. This genetic variability allows for the use of mendelian randomization to establish causality in studies examining the impact of uric acid on various health outcomes.

How does the host's experience with ketosis relate to the discussion on uric acid?

The host shares a personal anecdote of developing gout while in ketosis, which led to a discussion on how ketosis can increase uric acid levels. This is due to the competition between ketones and uric acid for excretion in the kidneys.

What is mendelian randomization and why is it valuable in studying uric acid?

Mendelian randomization is a statistical technique used to establish causality by leveraging genetic variation. It is valuable in studying uric acid because it allows researchers to determine whether high uric acid levels are causing certain health outcomes or if there is another underlying cause.

What are some modifiable factors that can influence uric acid levels?

Modifiable factors that can influence uric acid levels include diet, specifically the consumption of fructose and purine-rich foods, alcohol intake, certain medications like diuretics, and physical activity levels, particularly heavy bouts of anaerobic exercise.

How does the guest's discussion on protein and appetite relate to the broader topic of health and longevity?

The guest's discussion on protein and appetite is relevant to health and longevity as it explores how protein intake can uniquely affect satiety, energy expenditure, and body weight regulation. Understanding these effects can inform dietary choices that promote healthier aging.

What is the significance of the gender difference in uric acid levels discussed in the podcast?

The gender difference in uric acid levels is significant as it points to potential hormonal influences, such as estrogen, on uric acid regulation. This difference also means that men and women might have different susceptibilities to conditions related to high uric acid, such as gout.

Outlines

00:00

🎧 Podcast Introduction and Fanny Pack Discussion

The podcast begins with host Peter welcoming a guest back to the show. They engage in light-hearted banter, particularly about the guest's fashion choice involving a fanny pack. Peter humorously questions the utility of the fanny pack when the guest carries a phone in their pocket. The conversation then shifts to the main topics of the podcast: uric acid as a blood-based biomarker and its relation to various health conditions, and the impact of protein on appetite and energy expenditure. The guest suggests that the fanny pack debate could be a topic for another podcast, hinting at its contentious nature among listeners.

05:01

🧬 Understanding Uric Acid and Its Health Implications

The conversation delves into the science of uric acid, a metabolite resulting from the breakdown of purines found in DNA and RNA, and fructose metabolism. Uric acid's association with gout, kidney stones, and high blood pressure is discussed, with the guest explaining the role of genetics and sex differences in uric acid levels. The guest also touches on the potential evolutionary advantage of higher uric acid levels in humans, possibly linked to survival during cold periods. The segment concludes with an exploration of how uric acid levels can be influenced by factors such as diet, medications, and conditions like obesity and diabetes.

10:02

🚫 Modifiable and Non-Modifiable Factors Affecting Uric Acid

The discussion identifies factors that can influence uric acid levels, distinguishing between modifiable and non-modifiable elements. Non-modifiable factors include sex, with men naturally having higher uric acid levels, and genetics, which account for about 40% of uric acid variability. Age is also a non-modifiable factor, with uric acid levels increasing with age, especially in women post-menopause. On the modifiable side, diet plays a significant role, with high fructose consumption and high-purine foods contributing to higher uric acid levels. The guest also mentions the impact of certain medications, like diuretics and low-dose aspirin, and conditions such as ketosis and intense anaerobic exercise on uric acid levels.

15:05

🏋️‍♂️ The Impact of Exercise and Ketosis on Uric Acid

This segment focuses on how intense anaerobic exercise can temporarily increase uric acid levels due to the breakdown of muscle ATP and the subsequent conversion of IM to uric acid. The guest also shares a personal anecdote about experiencing gout while in nutritional ketosis, attributing it to the competition between beta hydroxybutyrate (a ketone body) and uric acid for excretion in the kidneys. The discussion suggests an adaptation to this increase over time and questions the pathological significance of this transient rise in uric acid.

20:06

💡 Wrapping Up and Inviting Listeners to Premium Content

The podcast concludes with a call to action for listeners to become premium members to access the full AMA episode and additional exclusive content. The host outlines the benefits of membership, including comprehensive show notes, monthly AMA episodes, a premium newsletter, access to a private podcast feed, and other member-only perks. The host also invites listeners to engage with him on social media and to leave reviews for the podcast. The podcast's disclaimer emphasizes that the content is for informational purposes only and should not replace professional medical advice.

Keywords

💡Uric Acid

Uric acid is a metabolite that results from the breakdown of purines, which are components of DNA and RNA. In the script, uric acid is discussed as a blood-based biomarker that is commonly associated with gout, a condition characterized by the crystallization of uric acid in joints, causing severe pain. The conversation also touches on how uric acid levels can be influenced by factors such as diet, particularly fructose consumption, and how high levels can contribute to hypertension and potentially cardiovascular disease.

💡Gout

Gout is a form of arthritis caused by deposits of uric acid crystals in joints, leading to inflammation and intense pain. The script mentions gout as a common condition related to high uric acid levels, with a focus on how it typically affects the big toe and the role of lifestyle and dietary factors in its development.

💡Fructose

Fructose is a simple sugar found in fruits and used as a sweetener in many processed foods and beverages. The script discusses fructose as a significant dietary factor that can lead to increased uric acid levels, potentially contributing to conditions like gout and metabolic syndrome. It is highlighted as a substance that, when metabolized, can directly increase uric acid production.

💡Mendelian Randomization

Mendelian randomization is a statistical method used to establish causality in observational studies by leveraging genetic variants as instrumental variables. In the script, this method is mentioned as a tool that has helped researchers understand the causal relationship between uric acid levels and various health outcomes, such as blood pressure and cardiovascular disease.

💡Fanny Pack

A fanny pack, also known as a waist pouch, is a small bag worn around the waist or over the shoulder. In the script, the fanny pack is humorously discussed as a fashion choice that became a topic of social media attention. It's also playfully linked to the discussion on protein intake, suggesting its utility for carrying protein-rich snacks.

💡Protein

Protein is one of the essential macronutrients required for various bodily functions, including muscle building and repair. The script delves into the relationship between protein intake and appetite, suggesting that protein has unique effects on satiety and energy expenditure compared to other macronutrients. It sets the stage for a deeper discussion on how different types of proteins might impact weight control and health.

💡Appetite

Appetite refers to the psychological desire to eat, which can be influenced by various factors including macronutrient intake. The script mentions appetite in the context of how protein consumption might uniquely affect it, potentially aiding in weight control and overall dietary management.

💡Kidney Stones

Kidney stones are solid masses that form in the kidneys from substances that usually dissolve in urine. The script briefly mentions uric acid as a less common but significant contributor to the formation of kidney stones, particularly when uric acid levels are high.

💡Cardiovascular Disease

Cardiovascular disease refers to conditions affecting the heart and blood vessels, such as atherosclerosis and heart attacks. The script discusses the potential link between high uric acid levels and an increased risk of cardiovascular disease, suggesting that uric acid may be a modifiable risk factor.

💡Aspirin

Aspirin is a common medication used to reduce pain, fever, and inflammation, and to prevent blood clots. The script notes that low-dose aspirin can contribute to higher uric acid levels, which might be a consideration for individuals at risk of gout or kidney stones.

💡Anorexigenic

Anorexigenic substances or conditions are those that suppress appetite. The script touches on the idea that certain types of exercise, like high-intensity anaerobic workouts, might have anorexigenic effects by transiently increasing uric acid levels, which could potentially influence appetite and energy expenditure.

Highlights

Discussion on the utility and fashion choice of fanny packs.

Introduction to the topics of uric acid and its significance in health.

Explanation of uric acid as a metabolite derived from purines and its association with gout.

The role of fructose in the production of uric acid and its potential health implications.

Mendelian randomization as a tool for establishing causality in biomarker studies.

Correlation between high uric acid levels and increased blood pressure.

Non-modifiable factors influencing uric acid levels, such as sex and genetics.

Dietary factors that can increase uric acid levels, including high purine foods.

The impact of medications like diuretics and aspirin on uric acid levels.

How ketosis can lead to increased uric acid levels due to competition for renal excretion.

Anorexic exercise and its transient effect on raising uric acid levels.

The potential link between uric acid and cardiovascular disease risk.

The relationship between protein intake and appetite regulation.

How protein compares to other macronutrients in influencing appetite and satiety.

Discussion on the unique effects of protein on energy expenditure and weight control.

Comparative analysis of different types of proteins and their impact on health.

Invitation to become a premium member for exclusive content and detailed discussions.

Details on the benefits of premium membership, including comprehensive show notes and exclusive AMA episodes.

Information on how to subscribe and access member-only content.

Disclosure of conflicts of interest and investment details by the host.

Transcripts

hey everyone welcome to the drive

podcast I'm your host Peter

[Music]

AA Peter welcome to an AMA how you doing

I'm good thanks for having me back by

the way you never comment when I say

that like thanks for having me

back like it's such a stupid thing to

say I don't know why I say it it's just

natural probably for you but yes it's

it's one of those if you're not here

it's a lot different of an episode for

sure um well speaking of that before we

get into it there is something that I've

been waiting to talk to you about may or

may not have been due to your fashion or

lack of fashion choices does that help

ring another Bell fanny pack yes do you

want to let people know what you were

rocking and how big that thing was

unless we're planning to do a dedicated

AMA on the utility of the fanny pack I

don't know that we want to go down

Rabbit Hole are you worried that you

have to justify it with a full 90-minute

podcast to why you should be wearing

that in the first place well I mean

north of 25,000 people

voted uh in dis favor of the fanny pack

which you know look there's I would bet

that the same number of people who think

that the fanny pack is a faux paw um are

probably equal in proportion not

necessarily the same people but equal in

proportion to the number of people who

think HRT causes breast cancer or you

know trt causes prostate cancer and so

you know it it requires um you know deep

thorough nuanced discussion to explain

the merits of certain approaches and I

think the fanny pack is no

exception that was quite a leap that you

made there which I didn't see coming the

biggest argument against the fanny pack

that I saw was a photo where you had the

big old fanny pack on and your phone in

your pocket so what's the point of the

fanny pack if the phone's not even going

in there that was one photo for the most

part the phone is in the fanny pack I

think in that moment the the phone out

of habit was just placed back in my

pocket it was just a weak weak moment on

your part I mean there is a slight

friction to the fanny pack because you

have to undo the zipper to put it in and

then put it back in and if you think I'm

going to use this phone again in 5

seconds sometimes it's just easier to

put it in your pocket

mhmh but I I was very amazed at how many

times the fanny pack showed up on social

media that I'm not even paying attention

to but somehow you are and you keep

sending me these pictures of me with a

fanny pack all over the place I mean it

was shocking how much it made the rounds

and a little alarming as well but that's

all right we'll we'll save it for

another podcast but for this AMA we're

going to touch on two different topics

the first is one we've spoken about

before but it's been a really long time

and actually since then a lot of new

information has come out and that's on

uric acid which is a blood-based

biomarker a lot of times when people

think about uric acid they naturally go

to gout however we'll cover it as it

relates to diseases metrics that you

look at for yourself and your patients

and then from there we'll go into

protein obviously a topic we've covered

in great detail but for this

conversation um we're going to cover a

piece that we haven't before and it's

something we get asked about a lot which

is the relationship between protein and

appetite and so I think we'll cover some

pretty interesting effects of protein

and how they're unique to protein

compared to other macronutrients on

appetite energy spanature and what that

means for protein intake weight control

and how different types of proteins

compare within that so I think it should

be a pretty interesting ation but with

that said anything else you want to add

before we get started no I think um I

think this is a really interesting um

couple of topics that are also somewhat

adjacent in terms of the relationship

between protein and uric acid which

obviously we'll

discuss yeah and also I assume you had a

lot of protein in your fanny pack in

those photos is that correct I I did

that's one of the beauties of the fanny

pack is you can transport

protein there you go you should have led

with that that and I think people would

have been a little more

understanding um all right well I think

it'd be helpful to start off on the uric

acid just reminding people briefly what

is uric acid why should people even care

about this metric yeah so so great great

question look I think uric acid is

probably something that many people have

seen on a blood test uh it's not

something that is commonly ordered um

but but it wouldn't surprise me if

people have at least seen it once or

twice on on a on a blood test um and I

think the other thing that that make um

Rouse some familiarity is that people

will associate uric acid correctly with

with gout um but let's just take a step

back and talk about what it is so so

uric acid is a metabolite right it is it

is the product of the breakdown of

purines so purines are um certain types

of DNA and RNA building

blocks um and as DNA and RNA are broken

down and in particular these types of

building blocks of DNA and RNA referred

to as purines are broken down one of the

downstream byproducts of this is uric

acid uric acid is also a metabolite of

fructose so again people who have heard

us talk about fructose on the podcast

before uh very specifically with Rick

Johnson who I think has been on twice if

not at least once um we talk at length

and in great detail about the

biochemical pathway that leads from the

metabolism of fructose to uric acid some

people might even remember um I I do

write about it in outlive where I talk

about um a particular uh mutation in a

gene for an enzyme that is quite unique

to our species and some very adjacent

species that actually uh allows us to

have higher levels of uric acid than

many of our uh related species ancestors

um and I won't go into all the reasons

why but it it might have to do with a

survival advantage that was afforded to

us specifically during a period of

extreme cold um in in what is now Europe

so all of that to say uric acid pretty

interesting molecule uh most of our

understanding of it of course is

associated with pathology and most of

that pathology centers around gout so

when uric acid crystallizes it can do so

in joints and um because it is quite

inflammatory when it crystallized is

this inflammatory condition within the

joints uh is what is clinically known as

gout and if you've ever had this people

listening will know it is incredibly

painful uh for reasons that are not

entirely clear to me uh and maybe

they're clear to some uh the great toe

the big toe uh seems to be one of the

joints where this occurs

disproportionately um and when patients

get this uh you you know you you you can

ride it out but more commonly you

actually have to put them on pretty

potent anti-inflammatory drugs uh the

other place where this shows up is in

kidney ston so while it's not the most

common form of kidney stones um it's

it's it's probably number two or number

three and so high levels of uric acid

are also going to predispose uh to to

urate based um kidney stones finally I

would say um and we're going to go into

this in more detail hyper uremia I high

high levels of uric acid contribute to

high blood pressure and this has been

demonstrated experimentally and it has

been demonstrated through mandelian

randomization we're going to talk a lot

about mandelian randomization today and

the reason for it is Mr is a really

valuable tool for establishing

causality when you are studying a

biomarker or a phenotype for which there

is great genetic variation so mandelian

randomization has helped us make sense

uh although I don't think we needed to

make much more sense of the causality of

LDL in um atherosclerotic cardiovascular

disease right so all the clinical

literature on LDL makes it pretty clear

that lowering LDL lowers uh

cardiovascular disease but you could ask

the question well do we know that it's

the you know that lowering LDL is the

cause of the reduction in risk or is it

that giving medications that lower LDL

lowers something else like inflammation

and that's the driver but when you do

mendelian randomization and you look at

the genetic distribution of LDL

cholesterol um you see that in fact

there is causality and similarly when

you do that type of analysis with uric

acid you see that um as uric acid levels

go up so too does blood pressure as uric

acid levels go down so too does blood

pressure all of this of course is

confounded by the fact that things that

are bad for tend to raise uric acid and

that Association is a little difficult

to um tease out causality so for example

we know that patients with fatty liver

disease and patients with type 2

diabetes usually have very high uric

acid levels and it's

unclear exactly what the uh direction of

causality is there so probably a longer

answer than you wanted Nick but given uh

you know the the the nature of of what

we're talking about it's probably worth

giving a bit more of an expansive

response and if someone's looking at

their uric acid levels what are some

factors that can increase their level of

uric acid well I I sort of think of this

as what are the modifiable things and

what are the non-modifiable things so

let's just start with the

non-modifiable U so sex is the biggest

difference um on average men have a uric

acid level that is about .5 to 1 Mig per

deciliter higher than women at a given

age um now that's based on the

literature if you asked me personally

like based on my experience and said

Peter tell me what you think I would

have said it's easily one to two

milligrams per deciliter higher just

based on what I see in patience um so in

other words the the Gap seems even

larger to me than than what is reported

in the literature um but but

nevertheless there there's there's

clearly a sex difference there um and um

you know I I the most obvious hypothesis

is that it centers around estrogen uh

and some of the downstream effects of

estrogen uh it's also clear by the way

that not only do women tend to have

lower levels of uric acid they also seem

to be more susceptible to higher levels

or to a given level of uric acid in

other words they seem to be uh more

likely to run into the trouble of a high

uric acid uh than a man is at a given

level okay um the other thing I alluded

to this also above genetics uh the

heritability of uric acid seems to be

about 40% in other words nearly half of

the value of your uric acid is

determined genetically um and that means

independent of just sex but I'm you know

let's just say across men or across

women and again um that genetic

variability that heritability of uric

acid is actually what allows us to

determine the causality of uric acid in

so many any of these things that we care

about if there was no genetic variation

to um to uric acid it would be very

difficult to do melian

randomization then the next thing that's

not modifiable that plays a significant

role in uric acid is age and uh as we

increase in age we tend to increase in

uric acid although this effect is more

pronounced in women than men and it

starts around the age of menopause which

again fact into the hypothesis I alluded

to earlier which is that estrogen

probably plays a significant role in

uric acid uh regulation given that women

are lower and then tend to have a big

uptick uh when they get through

menopause so um actually there's a

pretty cool figure that might be worth

showing for for folks if they want to

see the relationship between uric acid

in men women and then what happens

around menopause so um Nick if you can

just pull that up um this is a figure

that really speaks for itself here um

obviously the Blue Line represents men

and the red line represents women and

you can see that the Blue Line kind of

you know is well first of all it's

always higher than the red line and the

rate of increase is modest and steady uh

conversely the red line stays largely

flat until the mid 40s and then really

increases at a rate that exceeds even

the rate at which the males increase

and this continues throughout life but

to note even at the age of 80 which is

where these data stop women are still uh

considerably lower than men and so you

kind of laid out those are the things

that people really don't have control

over what do we know about factors that

can cause uric acid arays that people

may have control over well a a lot of

discussion on this topic kind of points

towards nutrition

because epidemiologic data tell us that

um average serum uric acid levels have

been increasing pretty substantially

over the past Century so in addition to

all of the things that we've talked

about the sex differences the age

progression if you just look at the

population level of uric acid it is

going up um and therefore the obvious

question is is it going up um for the

same reasons that certain other things

are going up such as obesity and

metabolic syndrome and if so what is it

about those things that's increasing

uric acid well given that fructose is

one of the things that drives um uric

acid production at least

transiently the question is does chronic

consumption of high amounts of fructose

presumably in liquid form more than

solid form play a role in this does it

play a role directly or does it play a

role indirectly what does that mean well

directly would mean does fructose

consumption which is known to and

unequivocally increase uh uric acid

levels transiently does enough fructose

consumption lead to Chronic elevation of

uric acid that's that that I think is an

unknown question um an alternative

explanation is that high levels of

fructose consumption are driving more

eating right so we talked a lot about

that with Rick Johnson what is it about

fructose consumption and intracellular

energy levels that lead to more consump

of food and therefore uh obesity and is

that the driver uh through through

energy balance so um you know there

there there have been bidirectional uh

mandelian randomization studies that

have been done and they have suggested

that higher levels of adiposity can

cause

hyperosmia uh so in other words that

would explain that um that that um that

that obesity and energy imbalance is a

dver of elevated uric acid and not the

other way around by the way that's

that's done by looking at um genes that

are known to increase fat Mass such as

the fto gene uh MCR uh mc4r Gene and

other genes that are um clearly

associated causally with

obesity um there are certain medications

that can do this so diuretics which are

very common in the treatment of of high

blood pressure and even lowd dose

aspirin can do this uh again we talked

about obviously the the dietary effects

of fructose but we shouldn't uh negate

the dietary consumption uh of foods that

are very high in purines so foods that

are very high in DNA meat uh and believe

it or not beer is quite high in DNA why

because beer contains a lot of yeast and

um the yeast obviously has genetic

material in it so high amounts of

alcohol though again I think

disproportionately beer over other types

of alcohol uh high amounts of very dense

food so you know uh by Foods I mean

foods that are dense in DNA so sardines

uh and things of that nature and red

meat these are things that are going to

also uh increase the the production of

uric acid now I'll tell you about

another funny example Nick of something

that I learned many years ago when I was

in ketosis which is that uh being in

ketosis either nutritionally or through

starvation um will increase uric acid

levels and can do so quite dramatically

and the reason for that is the primary

Ketone that is produced during either of

those States nutritional ketosis or

starvation ketosis I.E fasting uh is

something called beta hydroxybutyrate

and beta hydroxy butyrate competes with

uric acid uh in the kidney for the same

transporter that is going to uh excrete

either uric acid or BHB so when BHB is

out competing uric acid uh Visa you know

impairing this tubular uh secretion in

the kidney uric acid is going to go up

and so the first time I learned that was

when I was deep in nutritional ketosis

and I actually got Gout and this was

probably 12 years ago um and because I

didn't fit the phenotype of gout right

at the time 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 I mean that's how bad it

was um of of course I would go on to

learn exactly what happened and then in

subsequent years as I would fast um I

would always make sure I was taking

alopurinol or something but I did

confirm that during some significant

fast my uric acid would rise from say

five to 9 or 10 as my Ketone levels

approached you know four and five uh

Millo so um those are those are some of

the things that that are you know

modifiable and and obviously uh play a

role one other thing that's by the way

kind of interesting uh is uh Anor robic

exercise uh like heavy heavy bouts of

anob exercise can also increase uric

acid transiently um it might be that

this goes away over time um but um we're

not entirely clear why the hypothesis is

that high doses or rather heavy bouts of

anerobic exercise cause depletion of

muscle ATP and that the energy needs of

the muscle obviously can't be met

exclusively by glycolysis so um you know

we basically uh experience the buildup

of ATP degradation byproducts in the

muscle uh and in particular one of those

is IM uh which is converted into uric

acid so um I I think what's interesting

is that there seems to be an adaptation

to that um and I'm also not convinced

that there's anything pathologic about

that so that that's just more of an

interesting aside not like oh don't do

don't do intense anerobic activity and

you mentioned kind of earlier a few

times the relationship between uric acid

and blood pressure and we know about

blood pressure's role in cardiovascular

disease what do we know about uric acid

as it potentially relates to the risk of

cardiovascular

disease thank you for listening to

today's sneak peek AMA episode of the

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