One of my favorite podcasts is The Peter Attia Drive. Every episode they go deep into topics related to health and longevity. These are not always biological and medical, sometimes topics can go into psychology, personal development, etc.

They've had many deep dives on various issues of metabolism and metabolic syndrome, something that we are seeing is at the heart of many modern chronic diseases. I was connecting the dots among a few episodes, and had some questions, which I submitted.

On the latest Ask Me Anything episode, they addressed my question. I'm copying that part of the show notes here, under fair use. If you want to hear the AMA episode(s) or get access to show notes and other benefits, please become a subscriber.

---
From AMA 21:
     
Electrolyte supplementation during fasting and keto, and why uric acid may increase [59:30]

After listening to the Dom D’Agostino AMAs (Part 1 and Part 2) and the Rick Johnson episode, a subscriber has a question about electrolyte supplements as well as about salt and uric acid and ketogenesis:

If salt does this conversion to fructose in the body, how is that affecting keto?

  • “Good question. I don’t think I know the answer.” says Peter
  • As a general rule, the salt supplementation in keto is really not necessary for everyone, and personally for Peter, he doesn’t find it necessary during his brief periods of keto (and even when he’s short periods of fasting)
  • However, during the longer fasts, Peter does need sodium, but that’s because he’s not eating food and he’s trying to just get sodium back to normal levels
  • In keto, he does not supplement sodium at all, but he does supplement magnesium
  • Again, when he’s fasting, he needs more magnesium and sodium, but that’s just to bring him up to what he’s not getting with his nutrition

Potential change in uric acid
  • Peter says why uric acid may increase is an interesting question and he’s not sure he knows the answer
  • But he has some thoughts on it…
    • First, we clearly see uric acid spike during a fast
    • And, there’s probably also an increase during ketosis
      •  Is it transient in ketosis?
      •  If so, is it because uric acid and BHB are competing for the same transporters in the kidney? ⇒ That would obviously explain why you would see it in a fast
    • An alternative explanation, which doesn’t have to be mutually exclusive, is that uric acid is going up because of the turnover of DNA that would take place during a fast, vis-a-vis autophagy and things like that.

Originally posted at Hey World