Initially high uric acid was seen in urban population especially non-vegetarians with high intakes of red meat , crustaceans and alcohol. But, lately hyperuricemia is affecting all groups of people including rural, young and vegetarians. This is a major concern lately because it is seen in most overweight individuals both , young and old. Recent research indicates that high uric acid levels is an antecedent to high blood pressure later in life which makes it even more important to closely monitor it from the beginning.
What leads to high uric acid?
Uric Acid is usually produced in everyone’s body and gets flushed out with urine as a waste product of metabolism. But in certain cases, when body makes excess uric acid than the kidney can handle or if the kidney function is compromised due to some disease, then uric acid concentrations in the blood increase termed as hyperuricemia . High uric acid levels lead to gout which is a disease associated with accumulation of uric acid in the joint causing pain and inflammation.
Two types of gout :
Primary- It is usually congenital wherein kidneys are not able to remove waste from the body effectively.
Secondary – Acquired disease associated with tumours (abnormal growth of cells), anemia or diabetes with impaired kidney function.
What causes increased uric acid?
Purines are naturally occurring chemical products of metabolism obtained from the body (e.g. DNA breakdown) as well as diet (Red meat, seafood, beer, sugary foods especially those containing high fructose corn syrup, etc) . These purines are broken down to uric acid.
Factors that may cause a high uric acid level in your blood include:
- Diuretic medications (water pills)
- Drinking too much alcohol
- Genetics (inherited tendencies)
- Immune-suppressing drugs
- Purine-rich diet — liver, meat, anchovies, sardines, dried beans and peas, mushrooms, and other foods
- Renal insufficiency — inability of the kidneys to filter waste
- Tumor lysis syndrome — a rapid release of cells into the blood caused by certain cancers or by chemotherapy for those cancers
As we can see that obesity, diabetes and excessive alcohol consumption can lead to hyperuricemia. Ironically even prolonged fasting/ starvation or a rapid weight loss sometimes results in high uric acid levels as body cells break down and release purines.
Uric acid crystals and gout pain
The increased uric acid starts forming crystals which tend to get collected in certain areas such as the big toe, ear lobes, kidneys, etc. These crystal clumps are seen as white deposits or just protrusion (see image). During acute gout attacks , there is a severe pain in the joints and swelling of the affected areas.
- Men – 3.5 to 7.0mg/dL
- Women – 2.5 to 5.7 mg/dL
Initial treatment approach should include modification of diet and lifestyle. It is important to dispel the wrong notion that dals, pulses and legumes can increase uric acid levels. These do not contain high levels of purine. Unfortunately, physicians are also advising them to do so along with restricting other protein rich foods. This treatment approach can be very misleading and, in fact, counter-productive to weight management which is more important in controlling high uric acid. Vegetarians are barely able to meet their daily protein requirements and if dals and legumes are restricted, then protein intake decreases further. Recommendation suggest that a gout patient must follow a healthy diet based on lots of fruits and vegetables including high-purine vegetables, such as asparagus, spinach, peas, cauliflower or mushrooms and can also consume beans or lentils, which are moderately high in purines but are also a good source of protein.
Tips to lower uric acid levels
- Maintain healthy body weight
- Drink plenty of fluids (unsweetened, 2-3L) as uric acid gets flushed out in urine
- Eat a variety of fresh fruits and vegetables as they are alkaline ash and can neutralize the acidity produced by uric acid in the kidneys
- Consume low fat dairy products
- Avoid offal (internal organs and entrails of a butchered animal), shellfish, crustaceans and tinned fish
- Avoid excessive consumption of of meat, sausages, fish and poultry on a daily basis (not more than 100g).
- Avoid too much alcohol as it interferes with elimination of uric acid
- Eat low-fat food. The consumption of high-fat foods encourages weight gain.
- Avoid high fructose corn syrup
Uric acid is a part of kidney function tests which is usually done only in older age group while getting a complete body profile. But, we suggest that with the drastically changing diet and lifestyle, everybody should get complete body profile beyond age 30. Also, if you are grossly overweight and have strong family history of blood pressure and diabetes , then a complete body profile is necessary.