Uric acid is produced when the body breaks down purines. Purines are found in DNA and RNA, some foods, and are part of the energy-storing system in the body. As cells die, they release purines, which then get broken down by the body into uric acid before being eliminated.
Normal Uric acid levels
It’s normal for everyone to have at least some uric acid in their bodies. And it is considered normal to have a uric acid level of up to 7.0 mg/dL. Above this level, uric acid can come out of solution and form crystals. When treating gout, we try to get the uric acid level to less than 6.0 mg/dL.
Most uric acid dissolves in the blood then passes through the kidneys and leaves the body in urine. Some uric acid is eliminated through the bowels.
High Uric Acid Levels
If there is more uric acid than the kidneys can get rid of, a condition called hyperuricemia—or high uric acid in the blood—develops. This can lead to the development of urate crystals in the joints and other tissues. When these crystals accumulate, they can cause a painful attack of gout or a flare. Not everyone with hyperuricemia will get gout—but once gout develops, it is likely to return, unless treated with medicine to lower uric acid levels.
Having a High Uric Acid Level
A person with a level above 7.0 mg/dL is considered to have hyperuricemia. Most experts agree that lowering a person’s uric acid level to less than 6.0 mg/dL can prevent the painful consequences of hyperuricemia—particularly gout.
Too much uric acid can put people at risk for gout.
More than one out of three people with gout have not had their uric acid levels checked within the past five years.
Uric Acid Blood Test
A blood sample is needed to accurately measure the amount of uric acid in your system. To obtain a blood sample, a trained professional will withdraw it from either a vein on the inside of your elbow or the back of your hand. This test evaluates how much uric acid is present in your blood.
Although it is not a routine blood test, a uric acid test may be performed if you have or are suspected to have health problems associated with high uric acid levels.
High levels of uric acid can cause someone to develop gout. If you experience symptoms of gout, testing for uric acid blood levels will give an indication as to whether this could be the issue.
You may also hear this test called a serum uric acid test, serum urate, or UA.
Too Much Uric Acid
A high concentration of uric acid in the blood is termed hyperuricemia and it’s more common than you may think. It is estimated that as much as 21% of the general population and 25% of hospitalized patients have asymptomatic hyperuricemia. The most common complication associated with hyperuricemia is gout, which occurs in roughly 3.9% of the U.S. population.
Hyperuricemia is an elevated uric acid level in the blood. The normal upper limit is 7.0 mg/dL, and anything above this value is considered saturated, and crystals can form.
High uric acid levels can contribute to the development of gout, a form of arthritis in which uric acid crystals form in the joints. This can cause painful swelling, severe pain, joint inflammation, and joint damage.
Uric Acid Crystals
Uric acid typically dissolves in the blood and then passes through the kidneys, where it is eventually eliminated through urine.
When you have an excess of uric acid in your blood, it can cause urate crystals to form. These microscopic crystals can surround your joints and make them red, swollen, and painful.
How to Lower Uric Acid Levels
Your serum uric acid level can be easily determined through a quick blood test. Just as you regularly check your cholesterol levels, it’s important to monitor your uric acid too. If you have gout, then you should get tested every six months to ensure that your uric acid is below 6.0 mg/dL (or even lower if the doctor says so).
Your healthcare professional will work with you to find ways to lower your serum uric acid levels. This may include exercise and weight loss.
Standard urate-lowering medicines are:
- Allopurinol – This is an oral prescription medication that helps lower serum uric acid levels. This medicine is also known by brand names Lopurin® and Zyloprim®. When started on this drug, your doctor will likely gradually increase the dosage to a level necessary to bring the uric acid level down to below 6.0 mg/dL.
- Febuxostat – This is another urate-lowering therapy that can be prescribed under the brand name Uloric®. This medication is taken orally and, like allopurinol, decreases the body’s production of uric acid. It can be taken by people with mild to moderate kidney or liver disease.
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Purine Rich Foods Can Lead to High Levels of Uric Acid
Some foods and beverages that have a high purine content include, but are not limited to, red meat, organ meats, some fish, and beer.
Other High Purine Rich Foods
While no foods will specifically reduce uric acid levels in the blood, you can avoid many purine-rich foods in order to not increase blood uric acid levels further.
Foods to Avoid on a Low Purine Diet
- Foods with added sugars
- Alcoholic beverages, especially beer
- Red meat and organ meats
- Sugar-sweetened beverages
- High fructose corn syrup is a common ingredient in processed foods and should be avoided. It is known to cause elevated uric acid levels, as well as other health issues.
Although a number of vegetables are also high in purines—such as asparagus, cauliflower, mushrooms, spinach, and green peas—these foods do not have a significant effect on uric acid levels in the body.
For a full list of foods that are high in purines check out the diet and lifestyle page.
Recommended Diets and Lifestyle Changes
Even though particular foods can cause gout flares, there isn’t any one “gout diet.” Instead, living with gout means making healthy choices in how much you eat and drink.
Other Health Conditions
Uric acid levels play a role in several other medical conditions like gout, heart disease, joint pain, kidney diseases, diabetes, and hypertension (high blood pressure).
Uric acid is a known risk factor for both hypertension and heart disease. Many epidemiological studies show a link between uric acid and coronary disease, including stroke and heart attack. With higher levels of uric acid in the body, it creates an environment for painful gout flares. And those who have gout are more likely to have heart health issues, including coronary artery disease and heart failure. Left untreated, gout can be very dangerous, with new research showing that having gout doubles a person’s risk for heart attack or stroke.
Chronic Kidney Disease
When your kidneys aren’t working optimally, uric acid can begin to build up in your bloodstream. This is called hyperuricemia (high uric acid in the blood). When there’s too much uric acid present, it can lead to gout and painful crystals forming around joints.
Because kidneys play a vital role in treatment, close monitoring by a rheumatologist or nephrologist is necessary when treating gout in kidney disease patients. Medications that help to eliminate uric acid through the kidneys, like probenecid, become less effective as kidney function declines. NSAID use is not recommended in patients who have pre-existing damage to the kidneys.
Kidney stones can form when uric acid crystals deposit in the kidneys. A kidney stone can be very painful and – if left untreated – can block the urinary tract and result in infection and kidney failure. Research has shown that one in five people with gout will develop kidney stones.
Diabetes is a disease where the sugar levels in your blood are higher than normal. This happens when there is not enough insulin in your blood or when your body does not respond well to insulin. Studies have shown that having gout may make it harder for your body to respond to insulin. This is called insulin resistance. People who are obese or have high blood pressure are more likely to get gout.
One feature that is common to patients with metabolic syndrome is high uric acid levels. Although often considered to be secondary to hyperinsulinemia, recent evidence supports the primary role of uric acid in mediating this syndrome.
Tumor Lysis Syndrome
When cancer cells break down too quickly, levels of uric acid, potassium, and phosphorus in the body increase at a rate faster than the kidneys can remove them. This causes tumor lysis syndrome where excess uric acid in the kidney tubules blocking the flow of urine.
Living With Elevated Uric Acid Levels
It’s important to speak with your doctor to get your uric acid level under control. If you know you have high uric acid levels, be sure to check in with your doctor regularly so you can keep it under control.