High Uric Acid (Hyperuricemia): Everything You Need to Know

High uric acid, or hyperuricemia, occurs when there is excess uric acid in the blood. Uric acid is produced when the body breaks down purines, substances found in certain foods. Normally, it is processed by the kidneys and eliminated through urine. However, high levels can lead to the formation of kidney stones and gout, a painful form of arthritis. While some people with high uric acid levels experience no symptoms, certain purine-rich foods can increase uric acid and contribute to health problems. 

High Uric Acid (Hyperuricemia) Symptoms

Many individuals with high uric acid levels may be asymptomatic. While high uric acid is not a disease, high uric acid in the body over time can lead to health related complications. The symptoms listed may not directly due to high uric acid levels but to conditions caused by elevated uric acid, like gout or kidney stones.

Gout

Gout is a form of arthritis that affects about 20% of people with high uric acid levels. Symptoms of a gout attack in a joint may include:: 

• Joint stiffness
• Pain in the joints
• Difficulty moving the joints
• Swelling and redness
• Misshapen joints

Kidney Stone

High uric acid levels can result in the formation of uric acid crystals in the kidneys, leading to kidney stones. Symptoms of kidney stones may include:

• Pain in the abdomen, lower back and groin
• Increased urge to pass urine
• Nausea
• Pain and difficulty while urinating
• Blood in the urine
• Cloudy and foul-smelling urine
• Fever in case of kidney infection

Low Uric Acid Symptoms

Low uric acid levels affect fewer people than high uric acid levels. Symptoms of low uric acid levels depend upon the cause and are rarely noticed. These symptoms are related to the underlying conditions causing the low uric acid levels.

Symptoms of low uric acid levels due to Fanconi syndrome are,

• weakness
• bone pain
• excess urination.

Symptoms of low uric acid due to Wilson's disease are,

• loss of appetite
• fatigue
• swollen limbs
• body ache
• trembling
• difficulty in moving, speaking and swallowing

High Uric Acid (Hyperuricemia) Causes

Uric acid forms when purines break down in the body. Purines are chemicals found in foods, such as seafood, red meat, organ meat and beans. Alcohol, especially beer, can increase uric acid levels. Certain health conditions, like hypothyroidism or psoriasis, can elevate uric acid levels.

High uric acid levels occur either when the body is not able to eliminate it or when the body makes excess uric acid.

Related Medical Conditions

Certain health conditions are closely related to high uric levels. These are,

Gout

Gout is a form of painful arthritis. Its symptoms usually affect the toes, knees, and ankle joints. In this condition, uric acid builds up in the tissues and joints. This build-up causes swelling, pain and redness in the joints. First sign of gout is often sudden, severe pain in the big toe.

Cancer Treatment

During cancer treatment, chemotherapy causes the cells to die. When cells die, they release a chemical substance known as purine. Purines release uric acid into the bloodstream which is then broken down by the body. Rapid cell turnover from chemotherapy can increase uric acid levels, potentially leading to tumor lysis syndrome, a potentially life-threatening condition.

Kidney Disease

Kidney disease damages the kidneys and affects their functioning. As a result, the kidneys find it difficult to filter the waste. This leads to a build-up of uric acid in the blood. Though not all kidney diseases cause elevated uric acid levels. Chronic kidney disease, in particular, can reduce the kidney's ability to excrete uric acid.

Uric Acid Levels in Males and Females and How They are Determined

Uric acid levels vary based on weight, height, gender, blood pressure, renal function, health history and alcohol consumption.

Uric acid is measured in milligrams per decilitre (mg/dL). Check out the table for low, normal and high uric acid levels in males and females.

How Uric Acid Can Build Up in The Body?

Uric acid builds up in the body if the body makes too much uric acid and if the kidneys are not functioning efficiently and are unable to remove it from the body.

Consuming certain medicines like diuretics, aspirin or niacin or consuming foods high in purine, also leads to a build-up of uric acid in the body. Other causes include rapid weight loss, excessive alcohol consumption, or certain rare genetic factors.

How are High Uric Acid and Gout Diagnosed?

To diagnose high uric acid levels, a simple blood test is conducted to collect a blood sample to check the uric acid level. If a kidney stone is retrieved, it can be analyzed to determine if it is composed of uric acid.

To diagnose gout, uric acid crystals are studied in the fluid taken from a swollen joint. Imaging tests like CT scans, ultrasounds or X-rays are also conducted to observe the bones and the joints.

High And Low Uric Acid Levels Treatment

Treatment for High Uric Acid

Treatment of high uric acid depends upon its cause. If there are no symptoms of high uric acid levels (asymptomatic hyperuricemia), the doctor will not prescribe treatment. If the high uric acid levels are because of a condition, the doctor will prescribe treatment for the condition, namely gout and kidney stones.

• Treatment for gout:

Non-steroidal anti-inflammatory drugs (NSAIDs) are prescribed to reduce pain and swelling. Doctors advise drinking plenty of fluids, but not alcohol or sugary soft drinks.

• Treatment for kidney stones:

Doctors advise drinking more fluids so that the stones pass out of the body through urine. Doctors may prescribe medications that relax the ureter and help the stone pass. If the stone is too large, doctors may recommend surgery to avoid an infection. Depending on the type and size of the stone, other treatments like extracorporeal shock wave lithotripsy (ESWL) can be used.

Treatment for Low Uric Acid:

Health conditions, such as Wilson's disease and cancer and medications and chemotherapy can cause low uric acid levels. Treatment for low uric acid depends upon the cause.

Doctors may prescribe zinc supplements to increase uric acid levels in patients with Wilson's disease.

Doctors may recommend a diet high in purines to increase uric acid levels. Besides this, doctors will also advise avoiding alcohol and including moderate exercise to support overall health. Lifestyle modifications, such as dietary changes and reduced alcohol consumption, can also play a vital role.

Can High Uric Acid Levels Be Managed and Prevented?

Doctors advise a long-term programme to control uric acid levels and address joint pain. They prescribe medications to dissolve the uric acid crystal deposits.

A urate-lowering therapy is also prescribed along with medications to dissolve the crystals in the body and prevent gout flare-ups.

Besides medical therapy, managing uric acid levels involves:

• Losing weight and maintaining it at healthy levels
• Limiting the consumption of fish, organ meat, liver and beverages containing alcohol.

It’s important to note that dietary modifications are not just about restriction. Encouraging the consumption of foods with lower purine levels and increasing fluid intake can also help in managing uric acid levels. Also regularly monitor uric acid levels in at-risk individuals or those with a history of gout or kidney stones.

High Uric Acid Complications

People with high uric acid levels are prone to gout. Complications of gout include,

• Recurring Gout: While some people may not experience symptoms of gout, others may experience these several times in a year. If left untreated, gout can lead to damage to a joint.
• Advanced Gout: Untreated gout may lead to deposits of urate crystals under the skin. These deposits form nodules called Tophi and appear in fingers, hands, elbows, feet or the back of the ankles. While Tophi are not painful, they can become swollen during a gout attack. Tophi can take a long time to develop and are typically a sign of chronic untreated gout.
• Kidney Stones: High uric acid levels cause urate crystals to collect in the urinary tract and cause kidney stones—one of many types of kidney stone.

High Uric Acid Risk Factors

High uric acid levels increase the risk of gout. While some of these conditions can be associated with high uric acid levels, they don't directly cause it. Yet, factors that increase uric acid levels in the body are:

• Diet: Red meat, shellfish, sweetened beverages containing fructose, sodas, processed foods, and alcohol, particularly beer, increase uric acid levels and also increase the risk of gout.
• Weight: Excess weight causes the body to produce more uric acid. The kidneys also have difficulty eliminating uric acid from the body.
• Medical Conditions: Untreated high blood pressure, chronic uncontrolled diabetes, obesity, heart disease and kidney disease increase the risk of high uric acid and gout.
• Medications: Medications prescribed for high blood pressure including beta blockers, thiazide diuretics, and ACE (angiotensin-converting enzyme) inhibitors increase the risk of high uric acid. Anti-rejection drugs prescribed for people who have undergone an organ transplant also increase uric acid levels.
• Family History: A family history of gout increases the risk of high uric acid and gout.
• Age and Gender: Men are more likely to have gout than women, as women have lower levels of uric acid. However, after menopause, women too have higher uric acid levels. Men are likely to have gout earlier, between 30 and 50 years. Women are more at risk of high uric acid after menopause.
• Surgery: A recent surgery can also trigger a gout attack.

Uric Acid Diet

Certain dietary changes can reduce the uric acid levels. Consulting a doctor before changing a diet is important. They will advise on the right diet. Continuing with medications along with a uric acid diet is crucial.

Foods to avoid in a uric acid diet are:

• Red meat
• Liver
• Seafood such as mussels, scallops and sardines
• Fish, such as tuna, cod and herring
• Vegetables, such as spinach, mushrooms and peas
• Oatmeal
• Lentils and beans
• Wheat germ
• Wheat bran
• Sugary drinks that contain fructose
• Alcohol and beer

Points to remember:

• Stay well-hydrated
• Exercise regularly
• Maintain a healthy weight
• Control blood sugar levels
• Manage blood pressure

Here's a list of foods that are generally considered low in purines and some that might help decrease uric acid levels:

Low-purine foods:

• Fruits: Most fruits are low in purines. Cherries, in particular, have been suggested to help lower uric acid levels.
• Vegetables: While all veggies are not necessarily low in purines, many are safe to eat, including carrots, cucumbers, lettuce, and zucchini. Note that some vegetables like spinach, mushrooms, and peas have moderate purine content but can still be included in a balanced diet.
• Eggs: Eggs are a good source of protein and are low in purines.
• Nuts and Seeds: Most nuts and seeds, including walnuts, almonds, and flaxseeds, are low in purines.
• Whole Grains: Oats, brown rice, and whole grain breads and cereals.
• Dairy Products: Low-fat and non-fat dairy products, including milk, yogurt, and cheese, are typically low in purines.
• Herbs and Spices: Most herbs and spices are low in purines. They can be used to add flavor without increasing uric acid.
• Coffee and Tea: Both are low in purines. Some studies suggest that coffee consumption, particularly regular caffeinated coffee, might be associated with a reduced risk of gout.

Foods that might help decrease uric acid levels:

• Cherries: Some studies suggest that cherries can help reduce uric acid levels and reduce the risk of gout attacks.
• Vitamin C-Rich Foods: Oranges, strawberries, bell peppers, and tomatoes. Vitamin C may help lower uric acid levels.
• Dairy Products: There's evidence to suggest that low-fat dairy products can reduce the risk of gout.
• Water: Drinking plenty of water helps to dilute uric acid in urine and promote its elimination.
• High-Fiber Foods: Foods such as oats, whole grains, and most fruits and vegetables can potentially help reduce uric acid levels.

When To See a Doctor For High Uric Acid Levels

High uric acid levels occur in the presence of a condition such as gout or kidney stones.

If the patient observes symptoms of gout, such as pain in the joints, swelling or redness, or symptoms of kidney stones, such as pain in the abdomen, blood in the urine, frequent urination or cloudy or foul-smelling urine, they must consult a doctor.

Frequently Asked Questions

1. What Happens if Uric Acid is High?

High uric acid is associated with heart disease, kidney disease, permanent bone damage, joint and tissue damage, type 2 diabetes, high blood pressure and fatty liver disease but a direct cause-and-effect relationship for all these conditions is not established. For example, high uric acid is a risk factor for gout, but its role in causing type 2 diabetes or heart disease is more complex and multifactorial.

2. How Do You Know If You Have High Uric Acid?

If you have high uric acid, you will experience pain and swelling in the joints, like the knees, ankles and the big toe. The skin will appear red or purple and shiny. However, a definitive diagnosis requires a blood test.

3. What are The Three Symptoms of Uric Acid?

The three main symptoms of uric acid are:

• Pain in the joints
• Joint stiffness
• Difficulty in moving the joints

4. How Can I Reduce Uric Acid in My Body?

You can reduce uric acid in your body by

• Avoiding sugary foods and sugary drinks
• Avoiding alcohol
• Managing blood glucose levels
• Losing weight
• Eating fibre-rich foods
• Eating vitamin C-rich foods
• Drinking more water
• Certain medications (Under physician’s guidance)

5. What is The Main Cause of High Uric Acid?

The main cause of high uric acid is the body making excess uric acid or not getting rid of it. This can occur due to the following:

• Consuming drinks and foods high in alcohol and fructose corn syrup
• Consuming high-purine foods, like seafood, red meat and liver