Uric Acid: The Most Important Blood Test, You’re Not Checking.

Uric acid, is a natural occurring compound in the body that has recently garnered increasing attention for its far-reaching implications on human health. Uric acid plays a critical role in metabolic and chronic diseases.   I frequently see clients who are very proactive with their health and aging process – Uric acid is one of the least appreciated but most important lab values that many are neglecting, which is really unnecessary given that it is easy and relatively low in cost to check. 

Here’s a brief introduction to uric acid and what you should know.

What Is Uric Acid?

Uric acid is a waste product formed during the breakdown of purines—natural substances found in certain foods, drinks, and bodily cells. Normally, uric acid dissolves in the blood and is excreted via urine. However, when production in the body exceeds excretion, uric acid levels rise, leading to a condition called hyperuricemia. Elevated uric acid is commonly associated with gout, a type of inflammatory arthritis, but recent research suggests that its effects extend well beyond joint health, influencing metabolic pathways and contributing to obesity, diabetes, and cardiovascular disease.  Bottom line: You want to keep Uric acid levels low!

Uric acid is a natural waste product formed during the breakdown of purines, which are found in certain foods and body cells. Elevated uric acid levels, a condition known as hyperuricemia, are linked to metabolic health issues such as gout, insulin resistance, obesity, hypertension, and cardiovascular diseases. Managing uric acid levels through diet, lifestyle changes, or medication can help improve metabolic health and reduce associated risks.

Sources of Uric Acid

Uric acid production stems from three primary sources:

1. Dietary Intake: Foods rich in purines, such as red meat, shellfish, and organ meats, significantly contribute to uric acid levels. Fructose, a sugar found in sweetened beverages and processed foods, is a particularly potent driver of uric acid production (Choi et al., 2020).

2. Endogenous Production: Cellular turnover—the natural breakdown and recycling of body cells—also generates purines.

3. Alcohol Consumption: Beer and spirits are known to raise uric acid levels due to their high purine content and effects on metabolism (Juraschek et al., 2016).

Why Is Uric Acid Harmful to Health?

While uric acid is believed to serve an evolutionary purpose, acting as an antioxidant and supporting survival in low-calorie environments, chronically high levels are maladaptive and damaging to the body.  Modern diet and lifestyle are common offenders.  Among the important health risks associated with elevated Uric acid are:

1. Metabolic Dysfunction: Hyperuricemia (elevated Uric acid in the blood) disrupts insulin signaling, promoting insulin resistance, which is a precursor to type 2 diabetes (DeBosch et al., 2021). Elevated uric acid also encourages fat storage and weight gain by stimulating fat production in the liver.

2. Cardiovascular Disease: High uric acid levels contribute to endothelial dysfunction (damage to the lining of blood vessels) and inflammation, increasing the risk of hypertension and atherosclerosis (Kanbay et al., 2020).

3. Cognitive Decline: evolving research suggests that elevated uric acid may contribute to neuroinflammation, a potential factor in cognitive decline (Alam et al., 2020). Though, it is yet to be proven that it promotes or causes Alzheimer’s – this is a controversial topic of debate within the medical field at present, especially since the opposite has been suggested by at least one study (i.e., that very low uric acid levels may contribute to Alzheimer’s dementia) (Kim et al., 2020).

4. Gout and Kidney Stones: It has been known to medicine for decades that uric acid crystals can accumulate in joints and the urinary tract, causing painful gout attacks and kidney stones.
   

Recommendations to Manage Uric Acid Levels

Here are some strategies can help keep uric acid levels at a healthy level:

1.     Monitor, Measure, and maintain a healthy uric acid level: Routinely monitor uric acid levels, aiming for a target below 5.5 mg/dL. Home uric acid tests are now widely available and user-friendly.

2. Adopt a Low-Fructose Diet: Minimizing fructose consumption! Peer-reviewed studies demonstrate that reducing fructose intake can lower uric acid levels and improve metabolic health (Choi et al., 2020).

3. Uric acid food to Avoid - Limit Purine-Rich Foods: Avoid excessive intake of red meat, especially organ meats, and shellfish, and incorporate plant-based protein sources.  To be clear, I am not advocating for permanently avoiding these foods, only suggesting that lowering or eliminating them can help specifically to lower Uric acid levels.

4. Hydrate Adequately: Drinking sufficient water supports kidney function and helps flush uric acid from the body. The family medicine clinician in me has to reflexively suggest that this can be supported by keeping your blood pressure in a healthy range.

5. Prioritize Polyphenols: This is a big one!  Foods rich in polyphenols, such as cherries, berries, and green tea, have anti-inflammatory properties and may reduce uric acid levels (Rubin-Garcia et al., 2022).  You might also supplement with quality polyphenol supplements – I’m a fan of Metagenics products because of their quality control standards (I have no financial interest to disclose).

6. Cut out the booze!: Sorry, but alcohol raises uric acid levels due to its high purine content and effects on metabolism (Juraschek et al., 2016). It is definitely worth cutting alcohol out or drastically lowering intake to lower Uric acid levels... at least until your levels are in the right place.

7. Maintain a Healthy Weight: Obesity is a significant risk factor for hyperuricemia. Losing weight—particularly visceral fat—can markedly reduce uric acid levels.

8. Consider Medication When Necessary: For individuals with persistently high levels, medications like allopurinol or febuxostat may be prescribed. However, this is rarely necessary - lifestyle changes should remain the foundation of management.

A Balanced Perspective

While you can certainly influence Uric acid levels with relatively simple dietary and lifestyle changes, elevated levels can sometimes result from a complex interplay between genetics, environment, and uric acid metabolism, where genetic predispositions can influence uric acid excretion, potentially necessitating personalized approaches to treatment (Dehghan et al., 2008).  In other words, for most people, you can probably bring Uric acid levels to a healthy range on your own, but when that doesn’t work, it would be worth it to seek medical help to look for other opportunities to lower Uric acid.

Uric acid in a nutshell

Uric acid, has been long associated with gout.  It is now recognized as a central player in metabolic health. There are simple, practical tools to help lower uric acid levels and improve overall health, and avoid chronic disease.

About the Author:  Dr. David George is a multiple-board certified clinician who founded Neuregen Integrative Psychiatry and Neurologic Health, in Scottsdale Arizona.   Neuregen sees clients with a range of conditions, including “mystery diagnoses” affecting mental health and brain function.  The clinic also provides cutting-edge therapies, including regenerative medical procedures, ketamine therapy, stellate ganglion block, and integrative psychiatry, focused on a brain-optimizing approach to health.

References

Alam, A., Wu, A., Power, M., West, N., & Alonso, Á. (2020). Associations of serum uric acid with incident dementia and cognitive decline in the ARIC-NCS cohort. Journal of the Neurological Sciences, 414. https://doi.org/10.1016/j.jns.2020.116866.

Choi, H. K., Ford, E. S., Gao, X., & Choi, J. W. (2020). Sugar-sweetened soft drinks, diet soft drinks, and serum uric acid level: The Third National Health and Nutrition Examination Survey. Arthritis & Rheumatism, 59(1), 109-116. https://doi.org/10.1002/art.23266

DeBosch, B., Kluth, O., & Schürmann, A. (2021). Uric acid signaling and metabolism in the pathogenesis of metabolic disorders. Cell Metabolism, 33(7), 1466-1479. https://doi.org/10.1016/j.cmet.2021.05.004

Dehghan, A., Köttgen, A., Yang, Q., Hwang, S. J., Kao, W. L., & Gaziano, J. M. (2008). Association of three genetic loci with uric acid levels and gout risk: A genome-wide association study. The Lancet, 372(9654), 1953-1961. https://doi.org/10.1016/S0140-6736(08)61343-4

Juraschek, S. P., Gelber, A. C., Choi, H. K., & Appel, L. J. (2016). Effects of dietary patterns on serum uric acid: Results from a randomized trial. Arthritis & Rheumatology, 68(4), 1145-1152. https://doi.org/10.1002/art.39515

Kanbay, M., Jensen, T., Solak, Y., Le, M., Roncal-Jimenez, C., & Nakagawa, T. (2020). Uric acid in metabolic syndrome: From an innocent bystander to a central player. European Journal of Internal Medicine, 29(1), 3-8. https://doi.org/10.1016/j.ejim.2016.11.023

Kim, J., Byun, M., Yi, D., Lee, J., Jeon, S., Ko, K., Jung, G., Lee, H., Lee, J., Sohn, C., Lee, Y., Shin, S., Kim, Y., & Lee, D. (2020). Serum Uric Acid, Alzheimer-Related Brain Changes, and Cognitive Impairment. Frontiers in Aging Neuroscience, 12. https://doi.org/10.3389/fnagi.2020.00160.

 Rubín-García, M., Vitelli-Storelli, F., Álvarez-álvarez, L., Martínez-González, M., Salas‐Salvadó, J., Corella, D., Hernáez, Á., Martínez, J., Alonso-Gómez, Á., Wärnberg, J., Vioque, J., Romaguera, D., López-Miranda, J., Estruch, R., Tinahones, F., Serra-Majem, L., Cano-Ibáñez, N., Tur, J., Marcos-Delgado, A., Tresserra-Rimbau, A., Pintó, X., Delgado-Rodríguez, M., Matía-Martín, P., Vidal, J., Vázquez, C., Daimiel, L., Ros, E., Vázquez-Ruiz, Z., Babio, N., Barragán, R., Castañer-Niño, O., Razquín, C., Tojal-Sierra, L., Gómez-Gracia, E., González-Palacios, S., Morey, M., Garcia-Rios, A., Castro-Barquero, S., Bernal-López, M., Santos-Lozano, J., Ruíz-Canela, M., Castro-Salomó, A., Pascual-Castelló, E., Moldon, V., Bullón-Vela, V., Sorto-Sanchez, C., Cenoz-Osinaga, J., Gutiérrez, L., Mengual, M., Lamuela-Raventós, R., & Martín-Sánchez, V. (2022). Association Among Polyphenol Intake, Uric Acid, and Hyperuricemia: A Cross‐Sectional Analysis in a Population at High Cardiovascular Risk. Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, 11. https://doi.org/10.1161/JAHA.122.026053.