Uric Acid Diet, Levels, Tests, High, What is Uric Acid? Symptoms, Foods

What is Uric Acid?

Uric acid is a heterocyclic compound of carbon, nitrogen, oxygen, and hydrogen with the formula C5H4N4O3. It forms ions and salts known as urates and acid urates such as ammonium acid urate. Uric acid is a product of the metabolic breakdown of purine nucleotides. High blood concentrations of uric acid can lead to gout. The chemical is associated with other medical conditions including diabetes and the formation of ammonium acid urate kidney stones.

"If you reduce uric acid, at least in some patients, you may be able to reduce blood pressure," said Dr. Daniel Feig, associate professor of pediatrics-renal at BCM and chief of the pediatric hypertension clinics at Texas Children's Hospital. "This could be one way people develop hypertension and may allow us to develop new therapies." MayoClinic.com also reports that high uric acid is often a precursor to high blood pressure.

Uric acid builds up when the body makes too much of it or fails to excrete it. It is a waste product resulting from the metabolism of food. The level of uric acid in your blood can become elevated if your body produces too much or if it doesn't efficiently dispose of it. It is very important to keep your diet in check to avoid food that increases the Uric Acid content in the body.

Definition of Uric Acid

Uric acid is an acid derived from the degradation of certain elements in the body. The accumulation of uric acid in the tissues can cause gout disease.

Uric acid is stored by the body for two main reasons:

  • When uric acid is overproduced by the body, due to a "poor diet"

  • When you do not drink enough and that the removal of uric acid in urine is not sufficient

Consequences of an Increase in Uric Acid

Food in itself does not contain purines but uric acid. Uric acid is actually a substance produced naturally by our body during the breakdown of purines.

Uric acid can not be recycled by the body and be excreted in the urine. Some foods are particularly rich in purines and entail an increase of uric acid in the blood.

An increase in uric acid is called hyperuricaemia.

What are the Symptoms of High Level Uric Acid?

One of the best known consequences of increased uric acid is gout disease.

Although a number of people may have a high uric acid levels for years and did not notice when symptoms occur, they are recognizable!

  • Inflammation

  • Swelling

  • Redness

  • Heat

  • Agony

Diet to Reduce Uric Acid

If you want to reduce uric acid levels, it can be done through a behavior in three phases.

  • Change your diet with a reduction in meat consumption

Meats, especially organ meats, are the main causes of the appearance of uric acid. It is therefore necessary to reduce meat consumption or even to stop using some of them.

  • Drink water helps to reduce uric acid

Drink more water will help you to remove uric acid by a better uric acid filtering in the blood by your kidneys. It is therefore advisable to drink 2 liters of water per day to optimize uric acid filtering.

  • Change feeding habits can reduce uric acid

Besides the meat consumption, it is necessary to change feeding habits to reduce uric acid levels.

List of Foods to Choose to Decrease Uric Acid:

  • Fresh fruit

  • Fruit jams

  • Cereals such as wheat, rice, oats, ...

  • The Starchy foods like potatoes, tapioca, ...

  • Vegetables: Green beans, leeks, carrots, zucchini, ...

  • Milk

  • Soft cheeses

List of Foods to Reduce to Decrease Uric Acid:

  • White meats like veal and chicken

  • Whitefish

  • Eggs

  • Beans, peas, cabbage, asparagus

List of Foods to be Banned to Avoid Uric Acid:

  • Pulses such as beans, lentils, chickpeas

  • The deli

  • The pig

  • Butter

  • Sauces

  • Game and offal such as brains, kidneys, liver

  • Smoked meats

  • Sardines, anchovies, herring, trout, carp, pike, salmon, eel, mackerel or tuna

  • All seafood without exception

  • Vegetables such as spinach and Swiss chard

  • Sharp cheeses

  • Cocoa and chocolate

  • Nuts such as peanuts, almonds, ...

  • Sugary drinks non-alcoholic (fruit and fruit juices high in fructose)

  • Salt, pepper and spices in general

  • Alcohol

  • Coffee and tea

Diet Tips for High Uric Acid Patients:

  • Lower fat intake as excess fat reduces normal excretion of uric acid.

  • Liberal fluid intake to keep the urine dilute.

  • Restriction or elimination of alcohol.

What to Avoid:

  1. Shell fishes, red meat, mince meat, meat extracts, organ meats, fishes (sardine, roe, makeral).

  2. Whole pulses (masur, rajmah, chana, chole, etc.). Other dals are allowed.

  3. Vegetables and fruits - green peas, spinach, French beans, brinjal, cauliflower, mushroom, chickoo, custard apple.

Diet Rules:

  1. Use less salt while cooking. Avoid adding salt while cooking rice or in chapatti dough.

  2. Use adjuncts like tomato, vinegar, cocum, amchur, lime juice, curd, pepper powder to make the food cooked with less salt palatable.

  3. Remove the salt shaker from the table.

  4. Avoid salted nuts/ biscuits, papads, pickles, chutneys.

  5. Avoid excess consumption of processed and preserved foods; eg. Bakery products

  6. Caution - Do not overdo on salt substitutes as that might cause an electrolyte imbalance.

Recommended Foods: 

  1. Fresh cherries, strawberries, blueberries and other red-blue berries 

  2. Bananas 

  3. Celery 

  4. Tomatoes 

  5. Vegetables including cabbage and parsley 

  6. Foods high in bromelain (pineapple) 

  7. Foods high in vitamin C (red cabbage, red bell peppers, tangerines, mandarins, oranges, potatoes) 

  8. Low-fat dairy products 

  9. Complex carbohydrates (breads, cereals) 

  10. Chocolate, cocoa 

  11. Coffee, tea

The Relationship Between Uric Acid and Gout

Since purines are found in so many foods, it’s important to understand that not all purine-source foods affect the body in the same way. For instance, although purines are found in vegetable sources, these purines don't cause the same amount of uric acid buildup in the body that meat sources do. In fact, fresh fruits and vegetables reduce acid levels in the body and it is often advised to avoid red meats, organ meats and highly processed foods. Fresh fruits and vegetables are encouraged so the patient can increase alkalinity in the blood. Therefore, rather than attempting to find foods that are free of purines and uric acid, its important to know how to increase the body’s alkalinity, which naturally reduces the body’s acidity. Fresh, non-processed foods, such as fruits and vegetables, are the way to go.

Being overweight appears to be the most common determining factor for excess uric acid production. Therefore, it is very important to maintain a healthy weight. Consider the calorific value of the foods that do not contain purines and aim to eat a healthy well-balanced diet. Fatty foods such as butter and cream should be avoided. When you begin to lose weight, the kidneys are more able to eliminate uric acid and in some cases, the production of uric acid by the liver is also reduced.

In order to understand what foods caused the gout attack it’s important to understand the underlying mechanisms of gout. Gout is caused by excess uric acid levels in the body. Uric acid is a byproduct of purines after they are broken down. Purines are naturally occurring substances found in all of the body’s cells and in most foods. Purines are a common substance because they provide part of the chemical structure of the genes of humans, plants and animals.

It’s logical that if purines caused uric acid then lowering purines would cause a lowering of uric acid. This is correct to a certain degree, however, there’s something else to factor into the equation. We must understand that there are 2 sources of purines – external and internal or those that we eat and those that our body naturally produces respectively.

Out of the 2 sources external and internal purines, the ones we eat (external) make up the minority. Yet this is where the mainstream dietary approach to managing gout has been focused on. Recommendations of “low purine” diets will have you avoiding food items such as: beef, lamb, chicken, pork, tuna and fish. All with the notion that lowering your intake of purines will result in a lowering of your uric acid levels. This is totally wrong.

A low purine diet would have you eating like a vegetarian. Yet studies have estimated the rate of gout in vegetarians in India at around 7%, which is no lower than average (1). In theory if decreasing our intake of purines in our diet really did affect uric acid levels then the incidence of gout should be lower.

The recommendation of the low purine diet and associated gout foods to avoid has been around for decades – it’s nothing new. If this really was a solution to gout then we would see gout rates dropping, instead we see the exact opposite.

A recent medical press release reveals shocking statistics:

This has to make you realize that this approach to managing gout has it all wrong.

The Reality of a Uric Acid Diet

Remember I mentioned uric acid was influence by 2 sources of purines – external (which comes from the food we eat) and internal (which comes from inside our body). It’s the internal purines that make up the largest bulk of purines in our body and have the biggest influence on our uric acid levels and therefore the probability of having a gout attack.

Uric acid levels in the body are influenced by the total production of uric acid and the excretion of uric acid. Either an increased uric acid production and/or a decrease in uric acid excretion can increase total uric acid levels. Certain foods have been shown to influence the production and excretion of uric acid with the end result being more or less total uric acid in the body.

For example it’s been shown that eating more protein actually increases the excretion of uric acid therefore decreasing the level of uric acid in the blood (2). Concentrating on these types of factors are much more important than paying attention to eating low purine foods.

References:

1. duncan’s diseases of metabolism, p. 631

2. Hydrick cr and fox ih, nutrition and gout, in present knowledge in nutrition, fifth edition, the nutrition foundation, Washington dc, 1984, p. 743


Hyperuricemia (High Uric Acid)

What is hyperuricemia?

Hyperuricemia is an excess of uric acid in the blood. Uric acid passes through the liver, and enters your bloodstream. Most of it is excreted (removed from your body) in your urine, or passes through your intestines to regulate "normal" levels.

Normal Uric acid levels are 2.4-6.0 mg/dL (female) and 3.4-7.0 mg/dL (male). Normal values will vary from laboratory to laboratory.

Also important to blood uric acid levels are purines. Purines are nitrogen-containing compounds, which are made inside the cells of your body (endogenous), or come from outside of your body, from foods containing purine (exogenous). Purine breaks down into uric acid. Increased levels of uric acid from excess purines may accumulate in your tissues, and form crystals. This may cause high uric acid levels in the blood.

Uric acid formation may occur when the blood uric acid level rises above 7 mg/dL. Problems, such as kidney stones, and gout (collection of uric acid crystals in the joints, especially in your toes and fingers), may occur.

What causes hyperuricemia?

Causes of high uric acid levels (hyperuricemia) can be primary (increased uric acid levels due to purine), and secondary (high uric acid levels due to another disease or condition). Sometimes, the body produces more uric acid than it is able to excrete.

Causes of high uric acid levels include:

  • Primary hyperuricemia

    • Increased production of uric acid from purine

    • Your kidneys cannot get rid of the uric acid in your blood, resulting in high levels

  • Secondary hyperuricemia

    • Certain cancers, or chemotherapy agents may cause an increased turnover rate of cell death. This is usually due to chemotherapy, but high uric acid levels can occur before chemotherapy is administered.

    • After chemotherapy, there is often a rapid amount of cellular destruction, and tumor lysis syndrome may occur. You may be at risk for tumor lysis syndrome if you receive chemotherapy for certain types of leukemia, lymphoma, or multiple myeloma, if there is a large amount of disease present.

    • Kidney disease - this may cause you to not be able to clear the uric acid out of your system, thus causing hyperuricemia.

    • Medications - can cause increased levels of uric acid in the blood

    • Endocrine or metabolic conditions -certain forms of diabetes, or acidosis can cause hyperuricemia

What are some symptoms of hyperuricemia to look for?

Elevated uric acid levels may produce kidney problems, or none at all. People may live many years with elevated uric acid levels, and they do not develop gout or gouty arthritis (arthritis means "joint inflammation"). Only about 20% of people with elevated uric acid levels ever develop gout, and some people with gout do not have significantly elevated uric acid levels in their blood.

Symptoms:

  • You may not have any symptoms.

  • If your blood uric acid levels are significantly elevated, and you are undergoing chemotherapy for leukemia or lymphoma, you may have kidney problems, or gouty arthritis from high uric acid levels in your blood.

  • You may have fever, chills, fatigue if you have certain forms of cancer, and your uric acid levels are elevated (caused by tumor lysis syndrome)

  • You may notice an inflammation of a joint (called "gout"), if the uric acid crystals deposit in one of your joints. (*Note- gout may occur with normal uric acid levels, too).

  • You may have kidney problems (caused by formation of kidney stones), or problems with urination

Things you can do about hyperuricemia:

  • Make sure you tell your doctor, as well as all healthcare providers, about any other medications you are taking (including over-the-counter, vitamins, or herbal remedies).  

  • Remind your doctor or healthcare provider if you have a history of diabetes, liver, kidney, or heart disease.

  • Follow your healthcare provider's instructions regarding lowering your blood uric acid level and treating your hyperuricemia. If your blood levels are severely elevated, he or she may prescribe medications to lower the uric acid levels to a safe range.

If you have an elevated blood uric acid level, and your healthcare provider thinks that you may be at risk for gout, kidney stones, try to eat a low purine diet.

Foods that are high in purine include:

  • All organ meats (such as liver), meat extracts and gravy

  • Yeasts, and yeast extracts (such as beer, and alcoholic beverages)

  • Asparagus, spinach, beans, peas, lentils, oatmeal, cauliflower and mushrooms

Foods that are low in purine include:

  • Refined cereals - breads, pasta, flour, tapioca, cakes

  • Milk and milk products, eggs

  • Lettuce, tomatoes, green vegetables

  • Cream soups without meat stock

  • Water, fruit juice, carbonated drinks

  • Peanut butter, fruits and nuts

  • Keep well hydrated, drinking 2 to 3 liters of water per day, unless you were told otherwise.

  • Take all of your medications for hyperuricemia as directed

  • Avoid caffeine and alcohol, as these can contribute to problems with uric acid and hyperuricemia.

  • Avoid medications, such as thiazide diuretics (hydrochlortiazide), and loop diuretics (such as furosemide or Lasix®). Also, drugs such as niacin, and low doses of aspirin (less than 3 grams per day) can aggravate uric acid levels. Do not take these medications, or aspirin unless a healthcare provider who knows your condition told you.

  • If you experience symptoms or side effects, especially if severe, be sure to discuss them with your health care team. They can prescribe medications and/or offer other suggestions that are effective in managing such problems.

Drugs or treatments that may be prescribed by your doctor to treat hyperuricemia:

Your doctor or healthcare provider may prescribe medications if you have a high blood uric acid levels. These may include:

  • Non-steroidal anti-inflammatory (NSAID) agents and Tylenol®- such as naproxen sodium and ibuprofen may provide relief of gout-related pain. Gout may be a result of a high uric acid level.

  • If you are to avoid NSAID drugs, because of your type of cancer or chemotherapy you are receiving, acetaminophen (Tylenol) up to 4000 mg per day (two extra-strength tablets every 6 hours) may help.

  • It is important not to exceed the recommended daily dose of Tylenol, as it may cause liver damage. Discuss this with your healthcare provider.

  • Uricosuric Drugs: These drugs work by blocking the reabsorption of urate, which can prevent uric acid crystals from being deposited into your tissues. Examples of uricosuric drugs include probenecid, and sulfinpyrazone.

  • Xanthine oxidase inhibitors - Such as allopurinol, will prevent gout. However, it may cause your symptoms of gout to be worse if it is taken during an episode of painful joint inflammation.

  • Allopurinol may also be given to you, if you have a certain form of leukemia or lymphoma, to prevent complications from chemotherapy and tumor lysis syndrome - and not necessarily to prevent gout. With high levels of uric acid in your blood, as a result of your disease, the uric acid will collect and form crystals in your kidneys. This may occur during chemotherapy, and may cause your kidneys to fail.

When to call your doctor or health care provider:

  • Localized joint pain (especially in a toe or finger joint), that is red and inflamed.

  • Shortness of breath, chest pain or discomfort; should be evaluated immediately.

  • Feeling your heart beat rapidly (palpitations).

  • Bleeding that does not stop after a few minutes.

  • Any new rashes on your skin - especially if you have started any new medications.

General guidelines are -

  • Restrict meat/fish/poultry intake

  • Avoid alcohol and processed foods

  • Lose weight if overweight

  • Exercise regularly

  • Drink 8-10 glasses of water a day

  • Eat plenty of fruits & vegetables

Restrict foods high in purines -

  • Organ meats such as liver, kidney, heart

  • Selected fish and shellfish

  • Meat & yeast extracts brewers and bakers yeast

  • Meat soups & stock cubes

Recommended foods to eat -

  • Fresh cherries, strawberries, blueberries and other red-blue berries

  • Bananas

  • Celery

  • Tomatoes

  • Vegetables including cabbage and parsley

  • Foods high in bromelain (pineapple)

  • Foods high in vitamin C (red cabbage, red bell peppers, tangerines, mandarins, oranges, potatoes)

  • Low-fat dairy products

  • Complex carbohydrates (breads, cereals)

  • Chocolate, cocoa

  • Coffee, tea

Although Purines (organic compounds, which create uric acid breakdown in the body) are found in vegetable sources, they don't cause the same amount of uric acid buildup in the body that meat sources do. In fact, fresh fruits and vegetables reduce acid levels in the body and it is often advised to avoid red meats, organ meats and highly processed foods. Fresh fruits and vegetables are encouraged so the patient can increase alkalinity in the blood.

Therefore, rather than attempting to find foods that are free of purines and uric acid, it’s important to know how to increase the body’s alkalinity, which naturally reduces the body’s acidity. Fresh, non-processed foods, such as fruits and vegetables, are the way to go.


Signs & Symptoms of Excess Uric Acid in the System

When the body breaks down purines, a substance found in human tissue and in many foods, uric acid forms. Uric acid dissolves in the blood and passes through the kidneys and into urine for elimination. If the kidneys do not eliminate the uric acid properly or if there is an excessive intake of high-purine foods, uric acid begins to crystallize. This crystallized uric acid settles in the kidneys and forms kidney stones or settles into joints and causes a form of arthritis called gout. Symptoms vary between individuals, depending on the severity of the condition. Some people with high levels of uric acid may not experience any symptoms.

Joint Symptoms

When uric acid crystals settle into joints, gouty symptoms may occur. Common joint symptoms of gout include pain, inflammation, swelling, redness and tenderness when touched. The joint may also feel hot. These symptoms usually begin suddenly at night.

Commonly Affected Joints

The first gout attack typically occurs in the big toe, according to the National Institute of Arthritis and Musculoskeletal and Skin Diseases. Additional joints in the body commonly affected by gout include the ankles, knees, heels, fingers, elbows and wrists. With the first gout attack, it is common for a person to experience symptoms in one joint, while subsequent attacks may involve more joints.

Duration of Joint Symptoms

The intense pain in the joint usually peaks in severity within the first 12 to 24 hours following the start of the symptoms, according to the Mayo Clinic's website. Once the most severe pain eases, discomfort in the joint may linger for several days to a few weeks. Attacks that occur later may cause pain to continue longer than the first gout attack. Without proper treatment or with repeated attacks, the uric acid may cause permanent damage to the joint.

Skin Symptoms

After years of repeated gout attacks, uric acid crystals may begin to form lumps beneath the skin. These nonpainful lumps, called tophi, commonly occur on the fingers, toes, hands and elbows. During an attack, the tophi may become swollen and tender.

Kidney Symptoms

If the uric acid crystals settle in the urinary tract, they cause kidney stones. Uric acid kidney stones are more common in men than women. Kidney stones may cause symptoms such as pain in the back, abdomen or groin, fever, chills, nausea, vomiting and bloody urine.

Uric Acid Crystals

Abnormally high levels of uric acid can lead to some worrisome health problems when uric acid crystals lodge in joints and elsewhere in the body.

Gout

The most widely reported manifestation of high uric acid levels is gout, which develops when uric acid crystals accumulate in a joint, causing severe pain. Gout, also known as acute gouty arthritis, develops most often in the joints of the toes, afflicting the big toe more often than the others. However, it can appear in any of the joints of the hands, wrists, knees, ankles and feet, according to Mayo Clinic. An acute attack of gout can be treated with prescription anti-inflammatory medications, such as indomethacin; OTC painkillers, including naproxen and ibuprofen; colchicine; and steroids, such as prednisone. Preventative medications include allopurinol, which helps to reduce uric acid levels.

Kidney Stones

Kidney stones form when excess quantities of chemicals are present in the urine, making it difficult for them to be completely dissolved in the urine. Not all kidney stones are caused by excess uric acid, but it is responsible for a large number of them. An abnormally high level of uric acid in the urine is known as hyperuricosuria. As in the joints, excess uric acid can clump together in crystals, creating the basis for the formation of kidney stones, which can cause excruciating pain when they pass from the kidney into the ureter and become stuck. The ureter is the duct that connects the kidney to the bladder.

Kidney Failure

Kidney failure, although far less common than kidney stones, can also be caused by high levels of uric acid. A study, the results of which were published in a 2007 issue of the Clinical Journal of the American Society of Nephrology, established a link between hyperuricemia and acute renal failure. In their conclusion, the study's authors observe that although "uric acid . . . has some antioxidant effects that may be beneficial, we believe that the net effect of hyperuricemia, particularly if it is marked or persistent, will be to affect renal outcomes adversely."

Reducing Uric Acid Levels

High uric acid levels can be reduced by minimizing your consumption of high-purine foods. Such foods include anchovies, gravy, herring, mackerel, sardines, scallops, sweetbreads (organ meats) and wild game, such as venison. It is also wise to limit your consumption of asparagus, cauliflower, dried peas/beans, mushrooms, oatmeal, spinach and wheat bran. Drink plenty of water, which will help to flush excess uric acid from the body. For those whose bodies produce abnormally high levels of uric acid, doctors usually prescribe allopurinol or a similar medication.

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