Beyond gout: what high uric acid can mean for your health

Gout has become common enough that most of us know what it is—or at least know someone who has dealt with it. But while gout gets most of the attention, the real issue behind it is uric acid. If you’ve had gout, you may have heard about purines or were told to avoid certain foods, but when uric acid levels stay elevated, the ripple effects can extend well beyond a painful big toe.

Uric acid is a natural waste product that forms when the body breaks down purines. Purines are vital building blocks for DNA, RNA, and many other essential molecules found in our cells. During the normal processes of apoptosis and autophagy—when old cells are dismantled and some parts are recycled into new cells—purines are released from these molecules. Most are then broken down and converted into uric acid. Purines are also found in many foods and drinks, which is where the nutrition conversation usually begins.

The kidneys filter uric acid from the blood, and most of it leaves the body through urine. About 30% is eliminated through the gastrointestinal tract.

Uric acid isn’t just about #gout. Here’s what to know and how nutrition can help. #saslife
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When Does Uric Acid Become a Problem?

Uric acid becomes a concern when it builds up in the blood. This can happen when the body is producing too much, not clearing enough, or a little bit of both. Either way, elevated uric acid can quietly create problems over time.

When uric acid stays too high for too long, crystals can form and settle in different parts of the body. Most commonly, they collect around joints—especially the base of the big toe, which is the classic gout presentation—but they can also affect the ankles, knees, wrists, and fingers. These crystals trigger an immune response, leading to inflammation, swelling, redness, and pain. They can also collect in the urinary tract, increasing the risk of kidney stones, or accumulate in tendons, bursae, and under the skin.

The Bigger Picture: Uric Acid and Whole-body Health

Here’s where uric acid gets especially important. Elevated levels are associated with oxidative stress, inflammation, and endothelial dysfunction—all key players in the development of cardiovascular disease. In other words, high levels of uric acid increase your risk of cardiovascular disease, including atrial fibrillation and hypertension. Elevated uric acid levels are also associated with chronic kidney disease, diabetes, metabolic syndrome, non-alcoholic fatty liver disease, and neurodegenerative diseases.

*Low blood uric acid levels can also be a problem, but this is much less common and is usually related to certain medications, rare kidney disorders, severe liver disease, or genetic conditions.

Why Uric Acid Levels Rise

Most often, elevated uric acid is related to diet and lifestyle, although certain medical conditions, medications, and genetics can also contribute. Body composition matters too. Obesity and higher levels of visceral fat are directly correlated with elevated uric acid levels because adipose tissue itself produces uric acid. And, elevated uric acid levels can inhibit the activity of the “fullness hormone” leptin, which can lead to overeating, creating a viscous cycle.

One of the biggest modern contributors may be the substantial increase in fructose consumption from processed foods and sweetened beverages. Fructose is catabolized into uric acid, directly contributing to elevated uric acid levels, gout, and many of the related health concerns.

Animal-based foods and alcoholic beverages that are high in purines can also contribute to elevated uric acid levels. Organ meats, game meats, certain types of seafood, yeast extracts, and beer are among the highest. Interestingly, plant-based sources of purines—such as beans, lentils, sea vegetables, spinach, and asparagus—do not appear to have the same impact on uric acid levels or gout risk.

Reduced excretion of uric acid is often related to dehydration or kidney dysfunction, which can result from conditions such as diabetes or insulin resistance. Interestingly, insulin resistance and elevated uric acid levels can perpetuate each other in a vicious cycle. Gastrointestinal issues may also contribute. Remember, about 30% of uric acid leaves the body through the GI tract, so constipation and dysbiosis, among other GI issues, may reduce uric acid excretion.

Look at Your Medications and Supplements

If you struggle with elevated uric acid levels, taking a closer look at medications and supplements may be one helpful step. Some diuretics, including thiazide and loop diuretics, as well as immunosuppressants and high-dose niacin (2 g or more daily), can have a significant impact on uric acid levels. Beta-blockers—specifically metoprolol—along with low-dose aspirin, insulin, and testosterone may also have a moderate effect. Of course, do not stop any prescription medication without first talking with your health care provider.

Dietary Strategies that Can Help Lower Uric Acid

The good news is there are several nutrition strategies that may help bring uric acid levels down.

Start by reducing highly processed foods, sugary beverages, and alcohol—especially beer and sweet drinks/cocktails.

Limit concentrated sources of fructose, including anything made with high fructose corn syrup, as well as agave syrup and honey.

Reduce intake of high-purine animal foods, including organ meats (liver, kidney, etc.), game meats (veal, venison, etc.), and certain seafoods such as anchovies, shellfish, sardines, and mackerel.

On the supportive side:

Dairy has been shown to lower uric acid levels, and even whey protein has been shown to have a uric acid-lowering effect.

Hydration matters too. Aim for about 2½ to 3 liters of water per day to help your kidneys flush out uric acid.

Don’t forget about GI function either. Take steps to avoid or improve constipation and optimize your microbiome. Some specific strains have been shown to lower uric acid levels. Currently there are no retail products that contain these specific strains, so focusing on improving overall GI health is a good place to start.

Supplements that May Be Worth Discussing

Quercetin: 250–500 mg daily may help inhibit xanthine oxidase, the enzyme required for the final step of uric acid production and promote excretion via the kidneys.

Luteolin: 100 mg daily may also work by inhibiting xanthine oxidase and promoting excretion via the kidneys.

Vitamin C: 500 mg daily has been shown to lower uric acid levels by increasing excretion through the kidneys.

Tart cherry powder: 200–400 mg daily may help reduce uric acid production and promote excretion. Be careful with tart cherry juice though, most of what you find on the shelves is a “juice cocktail” that is more apple juice than anything else which is high in fructose.

The Bottom Line

The big picture is simple: build meals around a colorful variety of non-starchy vegetables, lower-fat dairy products, fiber-rich fruits, beans, lentils, and tofu or tempeh.

At the same time, limit high-purine animal foods, alcohol, and foods or drinks high in sugar or fructose—including fruit juice, honey, and agave syrup. When choosing seafood, focus on options rich in omega-3 fatty acids, such as salmon.

Make sure you are moving your body regularly, prioritizing sleep, managing stress, and losing excess body weight if needed.

And, as always, please talk to your health care provider and get regular check-ups.

Korean Tempeh Bowl

Makes 4 servings
Recipe adapted from: Joanne Eats Well With Others
PRINT RECIPE

Ingredients
1 cup brown rice (optional)

For the tempeh
8 oz tempeh, cut into ¾-inch cubes
¼ cup tamari
3 Tbsp rice vinegar
2 Tbsp mirin
1½ Tbsp sesame oil
1 tsp sugar
4 cloves garlic, minced
1 Tbsp minced ginger
1-2 tsp red pepper flakes
1 Tbsp avocado oil

For the vegetables
1½ tsp avocado oil
2 large carrots, cut into matchsticks
2 small zucchini, cut into matchsticks
12 oz broccoli, cut into bite-sized florets
2 Tbsp toasted sesame seeds

Instructions

Cook the rice according to package directions. Set aside.

Place the tempeh cubes in a shallow glass bowl in a single layer, if possible. Whisk together the tamari, vinegar, mirin, sesame oil, sugar, garlic, ginger, and red pepper flakes in a separate small bowl. Pour over the tempeh and stir so that it gets evenly coated. Cover and let sit for 20-30 minutes.

Heat the avocado oil in a large wok or nonstick skillet over medium heat. Place the tempeh cubes in the pan, leaving as much marinade as possible in the bowl. Cook for 7-8 minutes, until browned on all sides. Transfer to a plate while you prepare the vegetables.

Heat the oil in the same skillet that you used to cook the tempeh. Add the carrots, zucchini, and broccoli to the pan. Cook, stirring frequently, for 3 minutes, or until the broccoli and carrots are starting to become tender. Reduce the heat to low and pour in the reserved marinade from the tempeh. Allow to cook for 3-5 minutes, or until the broccoli is crisp-tender.

Divide the rice evenly among four bowls. Top each with a quarter of the tempeh and vegetables and sprinkle with the sesame seeds.