Vitality Unleashed: The Functional Medicine Podcast

Is Your Uric Acid > 7.0? The Silent Saboteur of Male Sexual Performance

• Dr. Kumar from LifeWellMD.com • Season 1 • Episode 224

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Think Uric Acid is just a problem for your big toe? Think again.

In this episode, we uncover a startling connection that most men—and even many doctors—overlook: High Uric Acid is a metabolic toxin that actively sabotages erectile function.

We dive into the new research showing that Uric Acid acts as a "vascular vandal," stealing the very fuel (Nitric Oxide) your body needs for performance.

We break down the "Triad of Destruction":

  • The Nitric Oxide Heist: How Uric Acid strips your blood vessels of the gas needed for an erection.
  • The 7.0 Red Line: Why a level above 7.0 mg/dL is the danger zone, even if you’ve never had a gout flare-up.
  • The "Canary in the Coal Mine": Why ED is often the first sign of widespread vascular inflammation and heart risk.

Stop treating the symptom and start fixing the system.

If you are relying on pills but ignoring your metabolic labs, you are missing the bigger picture. You need a Medical Detective who looks at the whole board—connecting your blood work to your biology.

Connect with Dr. Ramesh T. Kumar at LifeWell MD

Dr. Kumar is a Board Certified Radiation Oncologist and Functional Medicine expert who helps men optimize their metabolic health to restore function and vitality.

📞 Schedule Your Consultation Today:

Call: 561-210-9999

🌐 Visit: LifeWellMD.com

Available for In-Office Consultations (North Palm Beach) and Telemedicine.

Disclaimer:
The information provided in this podcast is for educational purposes only and is not intended as medical advice. Always consult with a qualified healthcare professional before making changes to your supplement regimen or health routine. Individual needs and reactions vary, so it’s important to make informed decisions with the guidance of your physician.

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Stay Informed, Stay Healthy:
Remember, informed choices lead to better health. Until next time, be well and take care of yourself.

SPEAKER_02:

Welcome back to the deep dive. Today we are opening up a file that honestly feels a bit like a medical detective story.

SPEAKER_00:

It really does.

SPEAKER_02:

Aaron Powell We're looking at a connection that most men, and I'd say a frightening number of doctors, might just completely overlook. We are connecting the dots between, of all things, a painful toe and a very, very specific problem in the bedroom.

SPEAKER_00:

Aaron Powell It's a hidden link. It really is. And it's one of those topics where once you see the data, you just can't unsee it.

SPEAKER_02:

Right.

SPEAKER_00:

It completely changes how you look at a standard blood panel forever.

SPEAKER_02:

Aaron Powell Exactly. So let's set the scene. When I say uric acid, what do people think of? The immediate association is gout.

SPEAKER_00:

Gout. The rich man's disease. Right. Port wine, steak, Henry VIII.

SPEAKER_02:

And a swollen, red, throbbing big dough, yeah.

SPEAKER_00:

Right. And it's classically seen as what, an orthopedic issue, a joint problem, you go see a rheumatologist.

SPEAKER_02:

Aaron Powell But we have this new scoping review here. It's from the Journal of Men's Health, and it suggests that the pain in the toe, that might actually be the final signal, not the first.

SPEAKER_00:

That is the hook.

SPEAKER_02:

This paper, and it covers nearly 300,000 men, suggests that high uric acid could be silently sabotaging erectile function long, long before a joint ever hurts.

SPEAKER_00:

Aaron Powell And we're not just talking about a vague correlation here. The paper lays out what it calls a triad of biological destruction. It's happening inside the blood vessel walls.

SPEAKER_02:

Aaron Powell It sounds dramatic, but you're saying the biology is there.

SPEAKER_00:

Oh, it absolutely supports it. What we're seeing really is the penis acting as a kind of barometer for the entire vascular system. And uric acid is the pressure system that's altering the weather.

SPEAKER_02:

Aaron Powell So our mission today is to unpack this. By the end of this deep dive, you're going to understand exactly how this triad works, why it destroys vascular health, and maybe most importantly, you're going to know the specific number, the line in the sand you need to look for on your next blood test.

SPEAKER_00:

That number is so critical. And I just want to set the tone right now. This is not about shame, erectile dysfunction, ED. It's so often wrapped up in all this psychological baggage.

SPEAKER_02:

Of course.

SPEAKER_00:

But papers like this are a good reminder that ED is a vascular event. It's just data. It's a check engine light.

SPEAKER_02:

Okay, let's get into that data. The paper's title is The Relationship Between Hyperuricemia and Erectile Dysfunction, a scoping review. Let's start there. Define the villain for us. Hyperuricemia.

SPEAKER_00:

In plain English, hyperuricemia or HUA is just icaron. It's having too much uric acid in your blood.

SPEAKER_02:

Simple as that.

SPEAKER_00:

Uric acid is a waste product. It's what's left over when your body breaks down something called purins. You find those in red meat, shellfish, alcohol, but also just in your own cells as they, you know, die and regenerate.

SPEAKER_02:

And usually your kidneys just filter this stuff out.

SPEAKER_00:

Correct. You pee it away. But if you produce too much or your kidneys can't clear it fast enough, it builds up. The paper gives us a very rigid definition for what counts as too high.

SPEAKER_02:

This is key because lab ranges can be all over the place.

SPEAKER_00:

They can. But the study defines it as a fasting serum uric acid level exceeding 420 micromoles per liter. Which for us in the US that translates to 7.6 milligrams per deciliter. That is the threshold. If you are above 7.0 on two separate days, you are by definition hyper urethemic.

SPEAKER_02:

And it doesn't matter if you feel fine.

SPEAKER_00:

Doesn't matter if you've never had a gout flare in your life. Chemically, you are in the red zone.

SPEAKER_02:

And the other side of that equation is erectile dysfunction. But you've always said we shouldn't think of ED as a quote logal problem.

SPEAKER_00:

Never. It is a systemic issue. I mean, think about it. The arteries in the penis are tiny, maybe one to two millimeters. Compared to the heart. The coronary arteries in the heart are three to four millimeters. So if you have sludge in the pipes or if the lining of your vessels is inflamed, where do you think symptoms show up first?

SPEAKER_02:

In the smaller vessels.

SPEAKER_00:

It's the canary in the coal mine for heart disease.

SPEAKER_02:

Right. If the canary stops singing, or in this case performing, you don't just blame the bird.

SPEAKER_00:

You check the air in the mine. And this paper is telling us that uric acid is polluting the air.

SPEAKER_02:

So let's talk about the scope here. This is a scoping review. It covers studies published between 2014 and 2025. Why is this coming up now?

SPEAKER_00:

Well, traditionally the ED workup is pretty shallow. A man comes into the clinic, we check his testosterone, ask about stress, maybe look for diabetes.

SPEAKER_02:

And if those are normal.

SPEAKER_00:

He gets a prescription for a little blue pill and is sent on his way. It's the plumbing approach, you know.

SPEAKER_01:

Right.

SPEAKER_00:

But this paper is asking a much more interesting, maybe uncomfortable question. Is this metabolic waste product, uric acid, is it an independent bad actor? Or is it just a sidekick to the usual suspects like obesity and hypertension?

SPEAKER_02:

Is it the getaway driver or is it the guy actually holding the gun?

SPEAKER_00:

That is the perfect way to put it. And to figure that out, you need scale. You can't just look at 10 guys in a room. This review covers 16 clinical studies, 295,705 participants.

SPEAKER_02:

That's a huge number.

SPEAKER_00:

That's the kind of scale that lets you see patterns that smaller studies would just completely miss.

SPEAKER_02:

I do want to touch on the quality of that evidence, though, because 295,000 people sounds impressive, but big numbers can hide, well, bad data.

SPEAKER_00:

And the authors were very careful about this. They use something called the Newcastle-Ottawa scale to rate the quality of the studies they included. Now, 13 of the studies were cross-sectional, which is basically a snapshot in time. You know, here's a group of men, let's see who has gout and who has ED right now.

SPEAKER_02:

So they're good for spotting correlations, but they can't prove that one thing causes the other.

SPEAKER_00:

Aaron Ross Powell Exactly. But, and this is important, they also included three cohort studies.

SPEAKER_02:

And those are better.

SPEAKER_00:

Those are the gold standard in this kind of research, because they track men over time. They start with men who don't have ED and then watch to see who develops it. And all three of those cohort studies scored a nine out of nine on the quality scale.

SPEAKER_02:

A perfect score.

SPEAKER_00:

It is. So when we look at the results from those specific studies, we can feel pretty confident in them. Aaron Powell, Jr.

SPEAKER_02:

We should mention one demographic thing, though. There was a bit of a skew.

SPEAKER_00:

Yes, a big one. About 62.5% of the studies were focused on Asian populations. So a lot of data from Taiwan, China, Korea.

SPEAKER_02:

Aaron Powell So what does that mean for a listener in, say, North America?

SPEAKER_00:

Aaron Powell It means we have to be careful about applying the exact risk percentages to everyone. Genetics, diet, they matter. But the biology, the underlying mechanism we're about to talk about, that's universal.

SPEAKER_02:

Okay, let's get to the numbers then, the headline stat.

SPEAKER_00:

Aaron Powell The consensus here is just it's overwhelming. Out of the 16 studies they looked at, 15 of them showed a positive correlation between high uric acid and erectile dysfunction.

SPEAKER_02:

Fifteen out of 16, that's what, 93, 94% agreement?

SPEAKER_00:

In the world of metabolic research, that is incredibly rare. You usually have so much more noise in the data. Here the signal is just loud and clear.

SPEAKER_02:

And when they pulled the data from those high-quality cohort studies, what did they find for a risk factor?

SPEAKER_00:

For men diagnosed with gout, the pooled analysis showed a 16% increased risk of developing ED down the line. That's your baseline. But then it gets much scarier when you start slicing the data by other health conditions.

SPEAKER_02:

You're talking about that hypertension study, the Tikua Lu study.

SPEAKER_00:

That's the one. That was the statistic that really made me sit up and pay attention. They looked at men who already had high blood pressure. Okay. In that group, having high uric acid increased their risk of ED by almost fourfold. Four. An odds ratio of 3.89. That's a massive multiplier. It suggests that if your vessels are already under pressure from hypertension, you know, literally stretched and stressed, uric acid just pours gasoline on the fire.

SPEAKER_02:

It pushes a system that's already struggling right over the edge.

SPEAKER_00:

Exactly. Into failure.

SPEAKER_02:

Wow. Okay, but I have to ask about the outlier. You said 15 out of 16 agreed. What about that one study that didn't? Aaron Powell Right.

SPEAKER_00:

The Gal it al study. It was a study in the general Chinese population that actually suggested uric acid was protective.

SPEAKER_02:

Aaron Ross Powell Protective. So high uric acid helped erections?

SPEAKER_00:

In that one data set, it looked that way, yes. Yeah. But this is where it gets really interesting. The paper explains this really well. Okay. Uic acid isn't purely evil. At normal levels, it actually acts as an antioxidant. It helps scavenge free radicals. It's good for your cells.

SPEAKER_02:

So you need some of it.

SPEAKER_00:

You do. Evolution kept it around for a reason. But it follows what we call a U-shaped curve. Once it gets too high, once it crosses that pathological threshold of 7.0, it flips. It becomes a prooxidant. It starts creating inflammation instead of fighting it.

SPEAKER_02:

So that outlier study might have just caught a population that was on the good side of that curve.

SPEAKER_00:

That's the theory. Or maybe other genetic factors were at play. But the overwhelming weight of the evidence from most modern men living with some metabolic excess is that we are firmly on the toxic side of that U-shaped curve.

SPEAKER_02:

It's like the difference between a glass of red wine and a bottle of vodka.

SPEAKER_00:

That is the perfect analogy. One might be an antioxidant, the other is just a poison.

SPEAKER_02:

Okay, so let's unpack that mechanism because correlations are one thing, but I want to know how. How does a waste product in my blood stop an erection? The paper calls it the oxidative stress inflammation metabolism triad.

SPEAKER_00:

The triad. This is the biological why. And it's not magic, it's just vascular biology.

SPEAKER_02:

So let's break it down. Component one, nitric oxide theft.

SPEAKER_00:

This is, I think, the most direct impact. To get an erection, your body needs nitric oxide. NA. It's a gas that tells the smooth muscle in your blood vessels to relax and open up.

SPEAKER_02:

No abduction.

SPEAKER_00:

No dilation, no erection. It's the fuel for the whole process.

SPEAKER_02:

And what does uric acid do to the fuel?

SPEAKER_00:

It attacks it in two ways. First, it inhibits the enzyme. It's called ENOS that makes the fuel. It literally shuts down the factory.

SPEAKER_02:

Okay, and second.

SPEAKER_00:

Second, it increases something called reactive oxygen species, or ROS. These are unstable molecules that basically go around and scavenge whatever nitric oxide is produced. So uric acid stops production and it destroys the existing supply.

SPEAKER_02:

You're clamping the fuel line, the mental arousal is there, you're stepping on the gas, but the engine is getting zero fuel.

SPEAKER_00:

That's it.

SPEAKER_02:

Which leads us to component two, inflammation. And this isn't just about a swollen toe anymore.

SPEAKER_00:

No, and this is a key distinction. You don't need to have a gout flare to have this inflammation. The paper talks about how uric acid crystals, even microscopic ones, activate this thing called the NFD signaling pathway.

SPEAKER_02:

That sounds like a heavy-duty alarm system.

SPEAKER_00:

It is. It's the master switch for inflammation in the body. And when uric acid flips that switch, your body just starts pumping out inflammatory cytokines. Things like TNF alpha and intraleuin 1 beta.

SPEAKER_02:

And what do those do to the blood vessels?

SPEAKER_00:

They burn them. They cause what we call endothelial dysfunction. The endothelium is that smooth, nonstick inner lining of the blood vessel. When it gets inflamed, it gets stiff, it gets sticky, it can't expand.

SPEAKER_02:

So now we have no fuel, and the fuel line itself is getting corroded and stiff.

SPEAKER_00:

Precisely. And then comes component three, insulin resistance, the metabolic connection.

SPEAKER_02:

So it's all tied together.

SPEAKER_00:

The paper highlights this vicious cycle. High uric acid is linked to insulin resistance. And then insulin resistance makes it harder for the kidneys to get rid of uric acid. They just feed each other.

SPEAKER_02:

That's a loop.

SPEAKER_00:

It's a feedback loop from hell. And the paper pointed to a Korean study that found insulin resistance was an independent predictor of ED in gout patients. The odds ratio was 1.62.

SPEAKER_02:

So you get this metabolic storm, the sugar isn't being processed right, the vessels are inflamed, and the nitric oxide is gone.

SPEAKER_00:

That is a triad. It's not one thing going wrong, it's the whole system starting to crash.

SPEAKER_02:

So what does this all mean then? If I'm a listener or if I'm a patient walking into a clinic, how does this change the game?

SPEAKER_00:

Well, from a functional medicine perspective, it changes the intake completely. If a man comes in with ED, I'm not just reaching for the prescription pad for Cialis. I need to see his labs. I need to see his uric acid level.

SPEAKER_02:

And if it's high.

SPEAKER_00:

Then we know the ED isn't just a plumbing problem, it's a metabolic problem. And the reverse is true too. If a patient comes in with gout, I am now proactively screening him for sexual health issues. The study says his risk is 16% higher.

SPEAKER_02:

So you're asking about erections.

SPEAKER_00:

I'm asking about his erections, not to be nosy, but because it tells me about the health of his entire vascular system.

SPEAKER_02:

Now the paper does bring up that little controversy. Is uric acid the cause or just a symptom? Because some of the studies, like the Finnish one and the big U.S. Nhanese study, they suggested that once you adjust for obesity and heart health, that uric acid link kind of disappears.

SPEAKER_00:

Right, the classic independence debate. Is uric acid the lone gunman or is it just part of the gang?

SPEAKER_01:

Yeah.

SPEAKER_00:

You know, is it just that men with obesity tend to have both high uric acid and ED, and one doesn't cause the other? The paper shows the results on this are mixed. Some studies say it's independent, others say it's a bystander. But here's the takeaway for you, for the listener. It doesn't matter.

SPEAKER_01:

It doesn't matter.

SPEAKER_00:

Not for the patient, no. Whether uric acid is the direct cause or it's just a massive red flag waving over your metabolic health, the action plan is the same. You have to lower it. You have to fix the underlying metabolic syndrome.

SPEAKER_02:

Let's get actionable then. The paper is very clear on the threshold.

SPEAKER_00:

7.0 milligdL. That is your magic number. If you're looking at your lab results from last year, go find that line item. If it's above seven, you need to be having a conversation with your doctor.

SPEAKER_02:

And what's the fix? Is it as simple as taking a pill like allopurinol to lower it?

SPEAKER_00:

So the paper concludes that just taking the pill, central uric acid lowering therapy, isn't fully proven to fix ED all by itself. Not yet. The data is still a little bit murky there.

SPEAKER_02:

Because of the triad, you're not fixing the other two parts.

SPEAKER_00:

Exactly. You can't just lower the uric acid number with a drug and ignore the years of insulin resistance and inflammation that have been brewing. You have to manage what the paper calls the comprehensive cardiovascular risk.

SPEAKER_01:

So diet, weight, lifestyle, the whole picture.

SPEAKER_00:

The whole picture. Specifically things like fructose intake. Fructose is a massive driver of uric acid production. Alcohol is another big one. It's about a whole body approach to cool down that systemic inflammation.

SPEAKER_02:

We should probably touch on what we don't know. This paper was a scoping review, but it did have limitations.

SPEAKER_00:

Oh, significant ones. We mentioned the geography bias already, mostly Asian populations. So we need more diverse data to be 100% sure of those risk ratios for everyone.

SPEAKER_02:

And the definitions were a bit messy.

SPEAKER_00:

Definition chaos is a real problem in these kinds of reviews. Only about 6% of the studies use that strict international standard of greater than 7.0. Others use different cutoffs or just a diagnosis of gout. It makes it hard to compare apples to apples.

SPEAKER_02:

And the causality issue.

SPEAKER_00:

Right. Most of them were snapshots. We know they hang out together, high uric acid and ED, but we're still waiting for that massive multi-year trial that proves if I lower your uric acid, your erection will return.

SPEAKER_02:

The biology says it should.

SPEAKER_00:

The biology strongly suggests it should, but the definitive trial data isn't quite there yet.

SPEAKER_02:

But waiting for the perfect trial could mean waiting until your arteries are already hardened.

SPEAKER_00:

That's it, exactly. We have to act on the best evidence we have right now. And the mechanism here, the nitric oxide theft, the inflammation, it's just too strong to ignore.

SPEAKER_02:

Okay, so let's summarize this whole deep dive.

SPEAKER_00:

Hyuric acid is not just about a painful toe, it is a metabolic toxin. It steals your nitric oxide, it inflames your blood vessels, and it's a huge signal of a deeper problem with insulin.

SPEAKER_02:

And all of this creates a hostile environment for erections, which are really just hydraulic events. They depend on clean, flexible vessels. Correct. We have a final provocative thought for you, the listener. Something to mull over.

SPEAKER_00:

I think the most important takeaway is to stop looking at the body and parts. We have a urologist for the penis, a rheumatologist for the toe, a cardiologist for the heart. But this paper shows it is all one network. The network is the key. If you are focused only on the plumbing of ED, just trying to force blood into the organ with pills, you are missing the metabolic storm that's happening upstream. Uric acid is the canary in the coal mine. And if the canary dies, you don't just go out and buy a new bird. You check the air in the mine. You check the air. So check your labs, look for 7.0. It is a simple, simple step that tells you an awful lot about your future.

SPEAKER_02:

Aaron Powell Thank you for guiding us through this. It's complex, but the message really is crystal clear.

SPEAKER_00:

My pleasure.

SPEAKER_02:

And to you, the listener, thanks for diving deep with us. Check those labs and stay curious. We'll see you on the next one.