Peter Attia· MD
and in the case of this patient he actually had a positive calcium score so there was even more reason to be aggressive with respect to his blood pressure management just based on the lipids but again it's important to reiterate this is a guy that on paper looked really really good and if you looked at him in person he looks great he's very muscular and lean he runs and exercises six days a week he's doing all the right stuff eats all the right stuff but his uric acid was 6.1 and it was quite stubborn never went down no matter what we did dietarily tweaking protein levels reducing fructose didn't matter could not get his uric acid below six it was always between six and seven and again just to make a plug for the rick johnson podcast if people haven't heard it rick makes an exceptional case as to why you want that number lower and again internally we have been targeting five so we finally put him on uloric and i gotta be honest with you i don't remember if we put him on allopurinol first and he had a reaction to it or what the reason was but nevertheless we put him on ulrich and that fixed uric acid he was now in the mid-fours and he had to come off his blood pressure medication and his blood pressure normalized so we took the uric acid from six point call it one down to say 4.1 and he no longer needed the ace inhibitor and without any other change this is not a guy who gained weight lost weight made any other meaningful change even in his exercise but his blood pressure now is sort of 120 over 80.