Most of you have heard about Uric Acid, but very few people know why it is such an important player in our body’s homeostasis.
What IS Uric Acid?
Uric Acid is derived from metabolism of purine nucleotides. Examples of the nucleotides are Guanine and Adenine–some of the building blocks of the DNA and RNA. Normally, Uric Acid dissolves in the blood, passes through the kidneys, and is excreted in urine. However, when the body produces too much uric acid or fails to eliminate it effectively, levels can build up, leading to a condition known as Hyperuricemia. This excess Uric Acid can crystallize and deposit in joints and tissues, resulting in Gout, a form of inflammatory arthritis characterized by sudden, severe attacks of pain, redness, and swelling.
The Good and the Bad
Like all important things in life, Uric Acid has a complicated duality to it. On one hand, it is an important antioxidant and an immune regulator, and it may have a protective effect against neurodegenerative conditions like Multiple Sclerosis and Parkinson’s. On the other hand, the excess of Uric Acid in the body is connected to a spectrum of health issues, of which the most well-known to the public is Gout.
Among other common conditions associated with excessively high levels of Uric Acid are:
- Non-Alcoholic Fatty Liver Disease (NAFLD)
- Metabolic Syndrome and Type 2 Diabetes
- Hypertension
- Coronary Heart Disease
Around 21% of the general population has elevated Uric Acid levels also known as Hyperuricemia. However, only around 3.9% of people in the U.S. are estimated to have Gout. Thus, it is not just the Uric Acid itself that is the culprit but also the way it is balanced with other parts of the individual’s biochemical equilibrium.
Nutritional Companions to Uric Acid
For example, for Uric Acid to perform its beneficial anti-oxidant duties properly, it needs to be accompanied by the healthy levels of vitamin C in the body. It also needs thiols—sulfur-containing molecules—to help it fight free radicals in inflammation. Lastly, Uric Acid as a good guy—needs to exist in a hydrophilic environment. That is why I always sound like a broken record to my patients, reminding them to drink more water.
Foods to AVOID
For people whose Uric Acid levels are too low, they should make sure that they have enough protein in their diet and that they do not develop sarcopenia, which is an age-related skeletal muscle mass loss.
On the opposite side of the spectrum, people with more body fat and less water content in their plasma, are more likely to experience Uric Acid—the bad guy—and less likely to reap its potential antioxidant benefits. When Uric Acid exists in excess, it acts as a pro-oxidant molecule, promoting inflammation. We are talking about inflammation anywhere: in the joints, in the arteries, causing atherosclerosis, and raising the risk for autoimmunity. Chronic oxidative stress caused by elevated Uric Acid is also associated with telomere shortening, which is correlated with faster aging.
Uric Acid is present in high amounts in the following foods:
- Organ Meats (liver, kidney, and brain)
- Certain Fish and shellfish (anchovies, sardines, herring, mussels, and scallops).
- Alcohol, especially beer
- Grains, especially wheat
- Yeast (kimchi, sauerkraut)
This means that people with Hyperuricemia should be mindful of limiting these foods.
The Role of Fructose
Another common reason why people are so hyperuricemic nowadays is that they eat so much fructose—especially from the addictive high fructose corn syrup or processed foods—which leads to elevated ATP (adenosine triphosphate—the body’s energy currency) consumption, and, ultimately, to Uric Acid production.
Elevated fructose production can also take place via the polyol pathway, by converting excess glucose into fructose via sorbitol. The latter happens in Diabetes Mellitus type 2. Thus, being a diabetic is a risk factor for Hyperuricemia as well.
“Don’t fruits also have fructose?“, you might ask. The answer is that they do, but typically the small amount of fructose in fruits is accompanied by beneficial companions like vitamin C, Quercetin, and Fiber—all of which definitely balance out the Uric acid production effect. Another culprit that leads to elevated Uric Acid production is a diet high in salt (sodium).
Managing Uric Acid Levels: A Functional Medicine Perspective
So, here are some useful functional recommendations for people with Gout or even those with simply elevated Uric Acid levels:
1) Focus on decreasing consumption of:
- Sugar, High Fructose Corn Syrup, Fruit Juices
- Sodium (Salt)
- Alcohol
- Organ Meats
- Red Meats, Lamb, Pork
- Shellfish, lobster, mussels, anchovies, sardines.
2) Optimize your weight. Excess weight contributes to higher Uric Acid production and reduces the body’s ability to eliminate it.
3) Make sure you are getting ample amounts of vitamin C. This will help to optimize the antioxidant properties of the existing Uric Acid and may help in promoting proper excretion of Uric Acid.
4) Consider taking Quercetin—a flavonoid with antioxidant and anti-inflammatory properties—which can help inhibit xanthine oxidase—an enzyme required for Uric Acid production. Inhibiting this enzyme is actually exactly how Allopurinol works except that Allopurinol is a prescription medication and is much stronger.
5) Consider taking Tart Cherry, which is rich in phytochemicals. One study found a 38% reduction in Uric Acid levels with tart cherry (prunus cerasus) concentrate.
6) Consider discontinuing medications that may be increasing the levels of Uric Acid as their side effect. Example would be: Diuretics (especially hydrochlorothiazide), beta blockers, aspirin, and immunosuppressive medications, to mention a few. And vice versa, consider substitutions with the medications, which may be helpful in decreasing Uric Acid levels, such as fenofibrates, calcium channel blockers, and losartan.
7) Minimize environmental exposures to toxic substances, as there have been publications indicating that there may be some connection with elevated Uric Acid levels.
8) Hydrate with water.
